Anxiety & OCD
What type of anxiety is beneficial to learning?
Mild
What is an appropriate response when a patient says I'm hearing voices?
What are these voices saying to you?
I don't hear voices, but I believe you when you say you hear them.
tell the voices to go away
provide auditory distractions: watching tv, music etc
Why might depression be overlooked in older adults?
Because sadness is expected with aging
What are protective factors for someone not to commit suicide?
-social supports
-religion
-pregnant or kids at home
NO
What defense mechanism appears as an unconscious burial of a specific unpleasant memory?
Repression
What is polydipsia?
Fatal water intoxication
can lead to hyponatremia, confusion, coma
Patients do this as a result of compulsiveness, dry mouth etc
What is electroconvulsive therapy (ECT) and what do we need to monitor with it?
- 6-15 inductions of seizures that treat symptoms of MDD or Bipolar
-Monitor Cardiac because of stress on the heart, do pre CBC count, urinalysis, chest x ray, electrolytes
What are impending signs?
-giving away prized possessions
-sudden cheerful demeanor
-getting affairs in order
-saying "everything will be alright soon"
What are signs and symptoms of serotonin syndrome with toxic levels of SSRI's?
abdominal pain, diarrhea, elevated BP, tachycardia, fever
What type of anxiety is characterized by pacing with a sense of impending doom?
severe
Why might a patient not adhere to their medication plan?
-denial
-lack of trust in doctor
-lack of insight
-failure to understand completion/taking full dose
-undesired side effects
-substance abuse
-homelessness
EDPS screening or health questionnaire
Who is most likely to commit suicide?
A white 20s male who's girlfriend just broke up with him who has a plan to hurt himself with a firearm and has access to one.
What method is the nurse using when she asks the patient "what does it mean if I have a chip on my shoulder, or I'm seeing red"
She's utilizing proverbs
When a person is obsessively washing their hands what is the best nursing action?
-gradually limit number of times per day
-identify triggers
-divert or distract
What are important characteristics of conduct disorder?
Ex: Henry Mesner Law and Order SVU
-aggression and cruelty to people/animals
-destruction of property, theft
-repetitive, aggressive behavior that violates the rights of others
-it's important to set clear, consistent boundaries and limitations
What is Transmagnetic stimulation?
Electromagnet placed on scalp that sends pulses to the brain 5 days a week for 4-6 weeks
What should be included in your risk assessment?
-has there been an attempt?
-current attempt?
-alcohol usage?
-do they have a plan?
-relationship status?
-are they white or native american?
-are they male or female?
What are you assessing in a Mental Status Exam?
-Appearance
-Behavior
-Thought Content
-Thought Process
-Orientation
-Speech
-Affect
-Concentration
-Judgement and Insight
What defense mechanism turns and negative into a positive?
I.e. hating your job, working harder at home to make sure the house is clean
Sublimation
What are the positive and negative symptoms of Schizophrenia?
Positive- delusions, hallucinations
Negative: Anhedonia, Flat Affect, Apathy, Anergia, Alogia, Avolition
What is the difference between major depressive disorder and persistent?
MDD- 5+ s/s for 2 weeks indicating hopelessness, loss of energy, insomnia
PDD- more days than not for past 2 years, multiple reoccurring episodes, more severe, high suicide rate
What are nursing interventions for a suicidal patient?
-enter a no suicide contract
-watch for med hoarding by doing frequent mouth checks
When is the angry patient at severe risk for bradycardia during treatment?
When given benzodiazepines and olanzapine at the same time.
They should be given within a number of hours of each other, never at the same time