Mood Disorders
A suicide risk factor
Conditions that put a client at higher risk
Previous suicide attempt
History of mental illness, physical illness , trauma, substance use
Family history
Lack of availability of social supports
History of child maltreatment
Impulsive or aggressive tendencies
Significant losses
Paradoxical Calm - be alert to sudden lifts in mood; as antidepressants take effect, may have increased energy with which to implement a suicide plan
The main neurotransmitter believed to cause schizophrenia
Dopamine
An assessment finding for anxiety
palpitations, racing heart, elevated BP, SOB, heartburn, tummyaches, restlessness, insomnia, increase use of restroom, decreased attention, impaired judgement, muscle tension, rapid speech, irritability, nervousness, impaired social/occupational functioning
An assessment finding for Bullimia
Within a normal weight range (usually)
Attempts to conceal binging/purging
Do NOT have the severe distorted self-image
Dental erosion
Finger callous from purging
Fasting or excessive exercise may also occur
Excessive vomiting, laxative, diuretic abuse may lead to dehydration and electrolyte imbalances
A personality disorder that is characterized by marked pattern of disregard for & violation of the rights of others (Prior to age 18 = Conduct Disorder)
Antisocial personality disorder
The drug class that interacts with tyramine
MAOI's
Isocarboxazid (Marplan)
Tranylcypromine (Parnate)
Phenelzine (Nardil)
Selegiline (Emsam)
2 positive signs of schizophrenia
Delusions (Fixed, False Beliefs)
Hallucinations (sensory perceptions without external stimuli)
Paranoia: extreme suspiciousness of others
Magical thinking: one’s thoughts/behaviors control situations
Grossly Disorganized/ Abnormal Motor Behavior (Catatonia)
Hyperactivity, Hypervigilance, Agitation, Hostility
Catatonic excitement (excessive and purposeless motor activity)
Stereotyped, repetitive movements, unusual mannerisms/postures
A fear of being in places or situations from which escape might be difficult or help might not be available
Agoraphobia
2 assessment findings for anorexia
Weight loss, >15 % of expected weight
Distortion of body image
Preoccupation with food
Refusal to eat
Fear of obesity
Amenorrhea
Dry skin/Lanugo
Hypothermia
Bradycardia
Hypotension
Distorted body image
Metabolic changes
Abnormal labs
Fluid & electrolyte imbalance
A priority nursing intervention for antisocial personality disorder
Set limits and establish consequences that can be enforced
The therapeutic level for lithium
1.0-1.5 mEq/L for acute mania
0.6-1.2 mEq/L for maintenance
2 nursing interventions re: safety
Assess for command hallucinations
Intervene at the first sign of agitation/aggression
Do not reinforce hallucinations or delusions
A disorder marked by recurrent obsessions or compulsions that are severe enough to be time-consuming or to cause marked distress or significant impairment
OCD
A syndrome where a series of negative intracellular electrolyte shifts associated with aggressive renourishment in a malnourished patient, poses a risk for hypophosphatemia, hypokalemia, hypocalcemia, and hypomagnesemia. Cardiovascular collapse, arrhythmias, altered mental status, and death can occur in individuals if left untreated.
Refeeding Syndrome
A personality disorder characterized by a pattern of intense, unstable and chaotic relationships with affective instability
Borderline Personality Disorder
A nursing intervention for lithium toxicity
Hold med, draw level, contact provider, push fluids
2 nursing interventions re: paranoia
Open medications and food in front of individual
Communication - simple, indirect questions
Keep promises
Give space
2 nursing interventions for OCD
Set limits on compulsive acts (rituals)
Administer Medications:
Luvox (Fluvoxamine) - SSRI
Anafranil (Clomipramine) - TCA
Zoloft (Serraline) - SSRI
Prozac (Floxetine) - SSRI
Paxil (Paroxetine) - SSRI
3 nursing interventions for eating disorders
Blind daily weights, locked bathroom for 1 hour, 30 minutes for meals, sitting with the patients while they eat to better observe intake, strick I&Os
The primary defense mechanism of individuals with BPD, and the impressions of others as either “all good” or “all bad” are a manifestation of this defense
Splitting
Two nursing interventions for mania
Provide finger foods, structured environment, set limits, monitor sleep, monitor liquid intake, de-escalation, always least restrictive first
An adverse side effect of Clozapine (Clozaril)
Agranulocytosis
3 nursing interventions for anxiety
Quiet atmosphere, 1:1
Cognitive restructuring (CBT)
Teaching and support adaptive coping strategies & problem-solving
Relaxation exercises
Discuss precipitants to anxiety
Education on reducing caffeine
Physical outlets
Administer medication (anxiolytic/antidepressant)
Patient will gain x pounds per week (amount to be established by client, nurse, and dietitian, usually 2-3lbs)
Client will drink x mL of fluid each hour during waking hours.
The therapy developed for BPD patients that covers mindfulness, interpersonal effectiveness, distress tolerance, emotional regulation
Dialectical Behavioral Therapy (DBT)