Mood disorders
Characteristics of mania
Decreased need for sleep, Grandiosity, elevated energy and mood, racing thoughts, highly distractible
Signs of alcohol withdrawal?
Delirium Tremens: agitation, irritability, hallucinations, tremor, severe confusion
AN RN is assigned to work in the inpatient psychiatric ward where many of the patients admitted have know anger and irritability problems. What actions does the RN make to stay safe and ensure therapeutic communication.
Avoid wearing dangling jewelry, refresh memory on de-escalation techniques, Awareness of exits in each room and within the facility, be prepared to provide immediate verbal responses if behavior escalates.
Negative symptoms of schizophrenia
Positive symptoms of schizophrenia
flat affect, avolition (lack of drive), anhedonia (inability to feel pleasure), alogia (poverty of speech)
Delusions, hallucinations, flight of ideas, clang associations
biggest predictor of violence?
Previous history of violence
Nursing Education for Lithium use as bipolar treatment
Watch out for signs of toxicity: tremor, nausea/vomiting/diarrhea, blurred vision, lethargy.
Watch out for fluid and electrolyte imbalance - esp with getting sick and extraneous physical activity.
How long after last drink does RN need to monitor with CIWA?
When do symptoms often begin?
72 hours
Within 24 hours
What are some of the symptoms/signs the RN will watch out for/assess for in the severely depressed patient in relation to suicidal ideation/plan
Giving away possessions
A newfound sense of calmness/happiness
Access to firearms/dangerous medications/other lethal means of carrying out a plan
What are the most common medication treatments for schizophrenia and some examples
Anti-psychotics (2nd gen): Risperidone, Aripiprazole
1st gen: Haldol (haloperidol)
Common coping technique for someone wit somatic symptom disorder
Relaxation
When is ECT treatment used and what do you need to monitor immediately afterwords?
ECT used to treat bipolar when medications have failed. Need to monitor vitals immediately afterwards.
Common treatments for alcohol dependence
Antabuse: Aversion Therapy - must be alcohol free 12-24 hours
Vivitrol (1 week - 10 days alcohol free before starting
Acamprosate: 3-4 days
Naltrexone
When you the nurse get an admission and notice the patient is agitated, poor eye contact and a history of violence. The nurse should stand...
Close to exit, with clear way to remove self or grab another staff member
Battery
Negligence
Assault
Intentional Act (harmful offensive contact without consent)
Carelessness that causes harm
Threat or creation of fear of imminent harm
Common memory medications and their mechanisms of action
Donepezil/Aricept: Cholinesterase inhibitors
Rivastigmine/Exelon: Boost acetylcholine
Mementine/Namenda: NMDA Receptor Antagonists
What are some common treatments for bipolar and corresponding education needed
Lamotrigine: watch out for Stevens-Johnson syndrome
Carbamazepine: monitor liver function tests
Lithium: monitor lithium levels, thyroid, CMP, CBC
Opioid Use Symptoms:
Amphetamine Use symptoms:
Pinpoint Pupils
Dilated Pupils
What kind of nursing care would you expect for someone with dissociative identity disorder who was admitted for a suicide attempt with no memory of the attempt.
Place on a 1:1 for safety
Non-Therapeutic Communication
Giving advice, Falsely Re-assuring, Making Value Judgments, Asking "Why" Questions, Giving approval, Disapproving
Symptoms expected with anorexia
Thinning hair
weight loss
dry skin/lanugo
missed menses
weight loss
cardiac, respiratory disorders
When would you provide education on serotonin syndrome to a patient?
When patient is taking any or a combination of any medications that affect serotonin:
SSRIs, St. Johns Wort, Buspirone, tricyclics (TCAs), MAOIs
When would Carbamazepine(Tegretol) be used for a patient with alcohol withdrawal symptoms?
First 24-72 hours - when patient at risk for delirium tremens.
The reason a patient is ADMITTED to a psychiatric hospital they are:
A danger to themselves or others
Role of Forensic Nurse Examiner (formerly Sexual Assault Nurse Examiner)
Collecting evidence, and forensic examination, administering medications, connecting with resources
Symptoms expected with bulimia
Dental decay
Tooth erosion
Parotid Gland Enlargement
Low Potassium
Dry Mouth