Term
| Tricyclic Antidepressants |
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Definition
Amitriptyline (Elavil) Prototype
MOA: Increases the amount of norepinephrine or resotoning or both in the CNS by blocking their reuptake at the presynaptic neurons. Inhibts more serotoning reuptake than norephinephrine. |
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Term
| Side effects of Tricyclic Antidepressants |
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Definition
| Anitcholinergic effects: No see, no pee, no poop, no spit. Confusion, weight gain and decreased libido |
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Term
| Uses for tricyclic antidepressants |
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Definition
| Panic disorder, depression, fibromyalgia, migraine headaches, OCD (clompiramine), bulimia, enuresis. |
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Term
| Nursing implications for Tricyclic antidepressants |
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Definition
| It takes 2 weeks or longer to acheive full therapeutic effect, sometimes up to 6-8 weeks for the depression to life. Report worsening of depression. Cannot give when taking an MAO inhibitor it would cause hypertensive crisis. Give at night and watch for orthostatic hypotention. Manage anticholinergic side effects.Should be monitored if takes 5HT supplements and st. john's wart. |
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Term
| Selective Serotonin Reuptake Inhibitors (SSRI) |
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Definition
Fluoxetine (Prozac)*Prototype
Citalopram (Celexa), Escitalopram (Lexapro),Fluvoxamine (Luvox), Paroxetine (Paxil), Sertaline (zoloft) |
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Term
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Definition
| Increase in serotonin levels by blocking its reuptake at the presynaptic memebrane. Results in more serotonin at the synapse promoting serotonin neurotransmission. |
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Term
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Definition
| anxiety, insomnia, agitation, irritability, weight gain, sexual dysfunction. |
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Term
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Definition
| Depression, OCD, PTSD, agoraphobia, generalized anxiety disorder, social anxiety, premenstrual dysphoric disorder (fluoxetine) |
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Term
| SSRI nursing implications |
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Definition
Monitor for weight gain, take in the morning (if cause sleepy take at night)
Treat sleeplessness with tazodone
May take up to 3 weeks to reach therapeutic blood levels
Stop taking SSRI for 5 weeks before introducing an MAOI
Stop the MAOI 2 weeks before introducing the SSRI |
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Term
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Definition
| Used for depression and anxiety disorders. Unpleasant withdrawal symptoms when abruptly stopped, weight gain 10-20lbs, sexula side effects, taken in 1st trimester can lead to ventral sepals defects. Need to taper off of medications 25% per month. |
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Term
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Definition
| Rare and life threatnening. Serotonin syndrom may occur when taking combinations of medications that affect serotonin levels. Serotonin syndrome is more likely to occur when starting or increasing a medication. The symptoms can occur within a few minutes to a few hours after taking the medication or combination of medications. Most often seen when patient is switched to an MAOI from SSRI. |
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Term
| Serotonin Syndrome Signs and Symptoms |
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Definition
| Restlessness, confusion, hallucinations, loss of coordination, fast heart beat, rapid changes in blood pressure, diaphoresis, shivering, tremor, ataxia, increased body temperature, overactive reflexes, myoclonus (twiching of the fibrils of a muscle), nausea, vomiting, and diarrhea. |
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Term
| Treatment of Serotonin Syndrome |
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Definition
| Discontinue all serotonin enhancing drugs, immediately, use anticonvulsants for seizures, serotonin antagonistic drugs may help, conzaepam/Klonopin for myoclonus, larzepam/Ativan for resltessness and agitation, use other symptomatic care as needed. Do not reintroduce serotonin drugs. |
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Term
| Serotonin/norepinepherine Reuptake Inhibotors (SNRI) |
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Definition
| Venlataxine (Effexor), Desvenlafaxine (PRESTIQ), nefazone (Seroszone), and Dulorine (Cymbalta) |
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Term
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Definition
| Effexor in doses over 225mg/day may cause hypertention in some patients |
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Term
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Definition
| Inhibiting the reuptake of selective serotonin and norephinephrine |
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Term
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Definition
| Depression and pain disorders |
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Term
| Norepinpherine and Dopamine Reuptake Inhibitor (NDRI) |
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Definition
| Bupropion (Wellbutrin), Zyban (smoking cessation), Virtazapine (Remeron) |
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Term
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Definition
| Blocks the reuptake of norepinepherine and dopamine receptors. May also inhibit the reuptake of serotonin. Contraindicated in pts with seizure disorders. |
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Term
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Definition
| A Person with a substantial disorder that affects cognitive, volitional, or emotional processes. It grossly impairs judgement, impairs capacity to recognize reality, and impairs the ability to control behavior. |
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Term
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Definition
Voluntary Admission
72 hour hold
5 day alcohol or drug hold
Short term certification is 90 days
Long term certification is not to exceed 6 months
Emergency medication up to 10 days
Can hold if danger to self, others, or grave disability |
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Term
| Rights of patients on involuntary admission |
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Definition
| Least restrictive environment, right to an attorney, treatment plan, must be allowed to sign in voluntarily if willing to do so, is given and signs bill of rights, has the right to refuse medication, |
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Term
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Definition
Court ordered medication- patient gan be given medications against their will
Insanity is a legal definition not used in the mental health setting
Not guilty by reason of insanity- ordered to a treatment facility and ordered released when found sane. |
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Term
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Definition
| Individual with worth and dignity, People have basic needs, behavior is meaningful and has a purpose. |
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Term
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Definition
Many people have symptoms or characteristics- depression, anxiety, manipulation, suspiciousness, compulsions.
Disorder: Interference with social and occupational functioning. Impairment in ADLs. |
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Term
Nure-Patient Relationship
Pre-orientation phase |
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Definition
| Explore past experiences and own feelings, explore fears, Assess personal strengths and limitations, Assess communication knowledge and skills, explore own values |
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Term
| Introductory Orientation Phase- Get Aquainted |
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Definition
| Introduce self and set contract, Ask patients why they seek help and why now, Sets the tone of the relationship, set goals with patient, establish trust in an atmosphere of acceptance. Explore patients thoughts and feelings, Prepare for termination, Patient tests the boundaries, |
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Term
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Definition
| The real work is accomplished here, work on the identified problems and goals, explore stress and stressors, promote developing insight, overcome resistance, develop coping strategies |
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Term
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Definition
| Review progress and goal attainment, help the patient set future goals, explore feelings of rejection, sadness, loss, anger, Discuss the meaning of the relationship except if schizzophrenic, Patient can act sicker to avoid leaving, Terminate completely |
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Term
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Definition
| Therapeutic, goal directed, patient oriented, disclosure to help pt, knowledge and skill, one sided for client |
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Term
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Definition
| Social, no set goals, past and future, mutual disclosure, no skill required,mutual sharing |
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Term
| Exceptions to confidentiality |
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Definition
| child abuse under 18 years old, elder abuse over 65 years old, medical emergency, subpeona from court, duty to warn |
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Term
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Definition
| Need to have genuineness and respect, empathy (feeling for patient), unconditional positive regard, be in control of own life and emotions. |
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Term
| Increasing self awareness of the nurse |
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Definition
Jahari Window- What is known to others and they don't know- blindspots
Listening to self and own reaction
Admit and deal with feelings toward patients
Monitor our buttons pushed
Assess own strengths,
work on limitations, seek feedback from others |
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Term
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Definition
| The person who originates the message |
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Term
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Definition
| The person who recieves the message |
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Term
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Definition
| Information transfered to the reciever |
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Term
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Definition
| Environment and setting of communication, |
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Term
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Definition
| verbal and nonverbal responses of the receiver |
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Term
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Definition
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Term
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Definition
| Accurately interpret patient responses use clarification and restatement, be aware of what patients dont say, |
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Term
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Definition
Be assertive in speaking with patients, DESC scripts in confrontation
Describe the situation, Express feeligns, Specify what you want, Consequence |
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Term
| What to do when you know what the problem is |
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Definition
Problem-solving
Define problem
When and how?
Propose solutions or alternatives
Pros and cons
Select solution
Evaluate application of solution
Make changes |
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Term
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Definition
Subjective feeling
Energy
No specific cause
Fear/specific cause
Contagious
Observable
For self-preservation |
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Term
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Definition
in day to day living
Motivates learning and produces growth & creativity
No affect on perception and taking in information |
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Term
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Definition
focuses only on immediate concerns
Perceptual field narrowed
Blocks out selected areas
Can attend to more areas if directed to |
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Term
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Definition
anxiety-significant reduction in perceptual field
Focus only on a specific detail
Behavior aimed at relieving anxiety
Needs direction to focus on other areas |
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Term
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Definition
severe disorganization occurs
Feels terror -Feels dread
Increased activity -Decreased ability to
Perception distorted relate or think
Feels like are dying |
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Term
| Biological Basis of Anxiety |
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Definition
Affects GABA (gamma-aminobutyric acid)
GABA:
Receptors in amygdala and hippocampus within limbic system (emotions)
Has an inhibiting effect in firing rates of cells
GABA reduces firing rate in areas of anxiety disorders
Mechanism in some medications for anxiety
Norepinephrine mediates the fight-flight response
Connected to amygdala & hippocampus (limbic system) and cerebral cortex (thoughts and processing)
Some antidepressants used for anxiety disorders
People with anxiety disorders may have hypersensitive 5-HT receptors and SSRIs used for anxiety disorders |
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Term
| Anxiety Assessment factors |
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Definition
Cognitive responses- thinking ability, perceptual fields, flight of ideas
Affective responses- Feelings, heart racing, pit in stomach, dread, terror
Behavioral responses- agitated, restless, pacing, fidgeting
Body responses- SNS response |
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Term
| Theoretical frameworks for anxiety |
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Definition
Psychoanalytic- conflict between id and superego
Interpersonal-from the bond between infant and mother
Behavioral- Results when something interferes with goal attainment
Biological- Brain chemicals regulate anxiety and body responds to SNS |
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Term
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Definition
Situational crisis
Maturational crisis
Threat to physical integrity
Medical disorders
Threats to self-esteem & body image
GeResponse affected by significance of & view of situation
Coping resources
Defense mechanisms
Coping responses
Problem-solving ability
Economic assets
Supportive people
Cultural & spiritual beliefs
netic makeup |
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Term
| Human responses to anxiety |
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Definition
Active problem- solving
Take action
What do you usually do to cope?
Use coping strategies
Read, movies, shopping, exercise, fishing, etc. |
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Term
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Definition
Use of substances
Irritability
Argumentativeness
Isolation/withdrawal
Can’t let go
Victim behavior
Gets stuck |
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Term
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Definition
Keep patient safe
Remain calm
Encourage verbalization, 1:1
Use distraction
Provide information
Provide a quiet environment
Discuss potential causes-precipitants
Ask what they usually do to cope
Assist with problem-solving
PRN medication if needed |
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Term
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Definition
Remain calm and stay with patient
Isolate patient
Decrease environmental stimulation
Administer medication
Benzodiazepine for panic attack
Provide structure
Be directive in instructions
Nonverbal intervention |
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Term
| Anxiety Evaluation and outcomes |
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Definition
Cognitive responses- ability to stay on topic, perceive information, thinks logically, making proper decisions
Affective responses- states is feeling less anxious, verbalizes feels better.
Behavioral responses- appears calm, not restless or agitated, sits still |
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Term
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Definition
| Avoiding unpleasant realities by ignoring or refusing to recognize them |
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Term
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Definition
| Process by which people make up for perceived weakness by emphasizing characteristics they deem more attractive. |
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Term
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Definition
| -offering socially acceptable explanations to justify unacceptable impulses, motives or behavior. |
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Term
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Definition
| translating anxiety into paralysis of the voluntary muscles or problems with the special senses. |
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Term
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Definition
| Shift of emotion from a person or place to another person or object. |
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Term
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Definition
| -Process by which people become like someone they admire by taking on characteristics of them. |
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Term
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Definition
| Returning to a former level of development |
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Term
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Definition
| Separation of mental or behavioral processes from the rest of consciousness. |
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Term
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Definition
| Splitting off emotional components of a thought. Separating thoughts and feelings. |
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Term
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Definition
| -Attributing one’s thoughts and emotions to another. |
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Term
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Definition
| Voluntarily excluding a painful or conflicted thought from awareness |
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Term
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Definition
| Act or communication that partially negates a previous one |
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Term
| Nursing Interventions for anxiety disorders |
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Definition
Quiet atmosphere
1:1 interactions
Ventilation of feelings
Cognitive restructuring
Learn new coping strategies
Intervene in unhealthy defense mechanisms
Problem-solving
Relaxation, meditation
Discuss precipitants to anxiety
Physical outlets (running, walking, swimming)
Administer medication as ordered
Nurse remains calm |
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Term
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Definition
| Valium (diazepam), Xanax (alprazolam), Ativan (lorazepam), Serax (oxazepam), Klonipin (clonazepam)(used in children), Tranxene (Clorazepate), Librium (Chlordiazepoxide), Paxipam (halazepam) |
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Term
| Side effects of Benzodiazipenes |
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Definition
| drowsiness, slurred speech, sleep disturbances, oversedation, |
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Term
| Benzodiazepine sleeping medications |
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Definition
| : Restoril (temazepam), Halcion (Triazolam), Dalmane (Flurazepam), ProSim (estraolam), Doral (quazepam) |
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Term
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Definition
: increases GABA release and receptor binding at synapses to decrease firing and makes
a person calmer. Some effect on the limbic system. |
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Term
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Definition
| : anxiety, nervousness, seizures, muscles spasms, status epilepticus, alcohol withdrawal |
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Term
| Benzodiazapine Nursing Implications |
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Definition
Monitor for oversedation side effects: slurred speech, sleeping, drowsiness.
Teach clients not to use alcohol which can potentiate the effects of valium.
Increased risk for congenital anomalies in the 1st trimester. Use with caution in women who become pregnant or who are pregnant.
It is excreted in breast milk and should be used with caution in nursing mothers.
Do not take with MAO inhibitors
Antacids may delay the absorption.
Used with caution in the elderly. Lower doses (one half to one third) should be
considered.
Slow IV administration of benzodiazepines. Valium/diazepam = 1 mg./minute.
For IM administration, give deeply in muscle to eliminate irritation.
PRN administration is preferable to regularly scheduled doses because of the
tendency for addiction to occur. Even a 6 month course of taking Xanax/alprazolam
can cause difficulty when trying to get patients off. The agitation and anxiety prevent
some from wanting to quit taking the medication.
Tapering is a safe way to discontinue because of risk for seizures. |
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Term
| Benzodiazapine Antagonist |
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Definition
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Term
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Definition
| Hydroxyzine (Vistaril, Atarax), diphenhydramine (Benadryl) (often used for anxiety in children) |
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Term
| Side effects of antihistamines |
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Definition
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Term
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Definition
| Short term management of anxiety and sleep |
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Term
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Definition
| Depresses subcortical centers. Has no dependence, tolerance or intoxication. Can be used for indefinite periods and with patients who abuse substances. |
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Term
| Anithistamine Nursing Implications |
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Definition
| Give Vistaril deep IM using Z-track method |
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Term
| Non Benzodiazapine Antianxiety Agents |
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Definition
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Term
| Side effects of buspirone |
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Definition
| : Headache, blurred vision, numbness, dizziness, excitement, feeling angry, nervousness, hostile behavior, nausea, and/or CHF. |
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Term
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Definition
| Generalized anxiety disorders, can be used to treat anxiety in medically compromised clients such as those who have asthma or COPD. |
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Term
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Definition
| Stimulates serotonin release from sending cells to synaptic clefts |
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Term
| Nursing implication of Buspirone |
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Definition
Alleviates anxiety and does not appear to have an addition potential.
Requires 2 weeks to reach a therapeutic blood level. Teach clients to continue taking it and
they may not feel better as soon.
Cannot eat grapefruit or drink grapefruit juice when taking buspirone.
Dosage: 45-60 mg. daily
When combined with SSRIs have better results. |
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Term
| Beta Blocker Used for anxiety |
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Definition
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Term
| Side effects of Proponalol |
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Definition
| Decreased sexual ability, drowsiness, difficulty sleeping, weakness, unusual tiredness. |
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Term
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Definition
| Blocks peripheral and central norepinephrine activity which blocks the fight or flight response. |
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Term
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Definition
Indications: Blood pressure must be high enough to take it.
Uses: Anxiety, GAD, PTSD, stage flight, migraine headaches |
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Term
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Definition
Used in treatment of OCD, (blocks the reuptake of serotonin)
Side effects: Nausea, nervousness, drowsiness, insomnia, worsening of seizures
Dose: 50-100 mg. daily |
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Term
| Tricyclic antidepressant: Clomiprimine (Anafranil) |
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Definition
Side effects: Anticholinergic effects, weight gain (18%), weight loss (5%), dry mouth, constipation, dizziness, headache, tachycardia, postural hypotension, memory dysfunction, ejaculatory dysfunction, nausea, diarrhea, somnolence, tremor, blurred vision, mania, urinary retention, orgasm incapacity, fatigue
Mechanism of Action: Its precise mechanism of action is unknown for OCD, but its ability to block the reuptake of serotonin (5-HT) is believed to be important. |
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