Term
| What assessment data would be most significant for a patient with temporal lobe damage? |
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Definition
| Assess for visual and auditory aphasia. Test if they can understand speech and writing. |
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Term
| What function should the nurse assess for a patient with limbic system damage? |
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Definition
| Test memory consolidation (short to long term), emotional capacity, and motivational behaviors |
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Term
| If a patient has lesions of the basal ganglia, what observations would the nurse expect to make? |
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Definition
| Basal ganglia is responsible for controlling precise, voluntary movements and stabilizing motor movements. Lesions result in abnormal motor movement such as in Parkinson's disease and Huntington's disease. Lesions of basal ganglia dysfunction occur while at rest. |
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Term
| What symptoms would a nurse expect to find in a person with a cerebellar lesion? |
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Definition
| The cerebellum coordinates muscle synergy and acitvity but does not initiate movement. Lesions of the cerebellum produce intention tremors on the same side of the body as the lesion. The motor dysfunction occur when the person is attemptign to move. |
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Term
| Explain the function of the reticular activating system. |
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Definition
-Integrates info from sensory pathways and projects to areas like thalamus and hypothalamus.
-Screening device that allows individuals to tune in some stimuli and out others
-Allows humans to fall asleep (when turned off = coma) |
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Term
| What part of the nervous system do anticholinergic medications inhibit? For what signs and symptoms should the nurse be alert? |
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Definition
| The parasympathetic nervous system is being inhibited. Anticholinergic cause dilated pupils, decreased lacrimation, dry mouth, tachycardia, and slowing of bowels and bladder. |
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Term
| What is the role of dopamine? |
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Definition
Located primarily in brain stem.
-Sythesized by tyrosine (dietary amino acid)
-MOA: excitatory
-Controls complex movements, involved in motivation and cognition, regulates emotional response
-Implicated in schizophrenia and movement disorders
-IMPORTANT: antipsychotic meds work by block the dopamine receptors and reducing dopamine acitivity |
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Term
| What is the role of norephinephrine? |
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Definition
Most prevalent NT in the NS
-MOA: excitatory
-Causes changes in attention, implicated in learning adn memory, sleep and wakefulness, mood
-Primarily located in the brain stem
-Deficit of NE is implicated in anxiety disorders and depression and social withdrawal and memory loss |
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Term
| What is the role of serotonin? |
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Definition
MOA: inhibitory
-Only found in the brain (no way to test how much so we give meds and see if there is an improvement
-Associated with depression
-Synthesized from tryptophan, a dietary amino acid
-Wakefulness, sleep, mood, sexual behaviors, regulates emotions |
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Term
| What is the role of acetylcholine? |
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Definition
MOA: excitatory or inhibitory
-Found in brain, spinal cord, and peripheral nervous system (particularly plentiful in neuromuscular junction in skeletal muscle)
-Synthesized from dietary intake of choline (red meat)
-Signals muscles to become more alert, controls sleep and wakefulness
-Important in psychiatry because people with alzheimers have low acetylcholine levels, muslces arent alert |
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Term
| What is the role of GABA? |
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Definition
MOA: Major inhibitory NT in brain
-Amino acid
-Modulates the other neurotransmitters (does not provide direct stimulus) |
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Term
| Why does enlargement of ventricles in the brain occur? |
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Definition
-Blockage of CSF outflow from within or from the brain
-Overproduction of CSF
-Brain atrophy resulting from the health of large numbers of cortical neurons
-Neurodevelopemental problems
-Enlarged ventricles associated with schizophrenia and alzheimers |
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Term
| What is the significance of the extrapyramidal system in movement disorders associated with psychotropic drug use? |
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Definition
| Any significant increase or decrease in the level of dopamine can result in extrapyramidal motor changes. Psychotropic drugs reduce the amount of dopamine in the brain. The substantia nigra and the basal ganglia use dopamine to communicate about the ongoing motor activity from the body, so when dopamine is reduced this communication is reduced causing Parkinson's like symptoms. |
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Term
| What do SSRIs do generally? |
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Definition
| Antidepressants, selectively inhibit serotonin reuptake to increase amount that stays in synaptic cleft |
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Term
| What do Antipsychotics do generally? |
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Definition
|
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Term
| What do antianxiety medications do generally? |
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Definition
|
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Term
| What are 3 objectives for nurses administering psychotropic drugs? |
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Definition
1. Reduce symptoms
2. Control Side effects
3. Proper education promoting adherence |
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Term
| How is the length of the washout period calculated before a new psychotropic drug can be administered? |
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Definition
| If a nurse gives the same drug dose at the same time, a steady state is achieved in four half lives. When discontinuing a drug, four half-lives are required to eliminate 96% of the drug. This period is referred to as the washout period. |
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Term
| Describe the anatomic dimension of the blood-brain barrier? |
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Definition
| Structure of the capillaries that supply blood to brain and prevent many molecules from slipping through, there are no gaps |
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Term
| Describe the physiologic dimension of the blood-brain barrier. |
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Definition
Chemical and transport system that recognizes and then allows certain molecules into the brain
-Lipid solubility important in determining if it can enter the brain
-Only drugs that are able to pass thorugh are effective in treating psychiatric disorders |
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Term
| Describe the metabolic dimension of the blood-brain barrier. |
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Definition
| Prevents molecules from entering by enzymatic action within the endothelial lining of the brain capillaries. |
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Term
| Common reasons that psychiatric patients give for not complying with prescribed drug treatment regimens. |
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Definition
-Sexual dysfunction
-Specific side effects
-Emotional dulling
-Cognitive slowing
-Denial of need
-Fear of becoming addicted
-Religious reasons
-Interferes with work |
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Term
| What are 6 areas for discussion when a nurse is giving medication education? |
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Definition
1. Side effects
2. Discuss safety issues
3. Attitude of patient and nurse about medications
4. Drug interactions
5. Instructions for older adult patients/pregnant or breast feeding patients
6. Awareness of metabolic differences in diverse races and ethnicities |
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Term
| Sociogenic theory of understanding schizophrenia |
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Definition
| People who live in inner cities with fewer opportunities and lower education, have fewer rewards, that their lives are so stressful that they can develop schizophrenia |
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Term
| Describe reactive psychosis theory of understanding schizophrenia. |
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Definition
| One time exposure to reactive event |
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Term
| Describe biologic theory of understanding schizophrenia. |
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Definition
| People with genetic predisposition for schizophrenia |
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Term
| What is the difference between positive and negative symptoms of schizophrenia? |
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Definition
Positive symptoms: deviant behaviors are presents
Negative symptoms: normal behaviors are absent, much poorer prognosis than positive symptoms |
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Term
| What are the five DSM IV subtypes of schizophrenia? |
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Definition
1. Catatonic: Mutism and Hyperexcited
2. Disorganized
3. Paranoied: Persecution and Grandiosity/Delusions
4. Undifferentiated
5. Residual: characteried by one previous episode |
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Term
| What is the physiologic difference between positive (type I) and negative (type II) schizophrenic symptoms? |
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Definition
Positive (type I)-Believed to be result of elevated dopamine levels affecting the limbic areas of the brain
Negative (type II)-Related to hypodopaminergic process. Can be caused by cortical structural changes. |
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Term
|
Definition
| Characterised by both affective and schizophrenic symptoms with substantial loss of occupational and social functioning. |
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Term
|
Definition
Display similar to schizophrenia but delusions have a basis in reality.
-Patients have never met criteria for schizophrenia
-Behavior is relatively normal except in relation to delusions
-Symptoms are not the result of a substance-induced or medical condition |
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Term
|
Definition
| Includes all psychotic disturbances that last less than 1 month and are not related to a mood disorder, a general medical condition or a substance induced disorder. |
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Term
| Schizophreniform disorder |
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Definition
| Displays symptosm that are typical of schizophrenia and last at least 1 month but no longer than 6 months. This cautious approach spares tha individual the lifelong diagnosis of schizophrenia |
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Term
| What 3 groups are personality disorders clustered into? |
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Definition
1. Cluster A: Characterized by schizoid, odd, eccentric behaviors
2. Cluster B: Characterized by dramatic, emotional, or erratic behaviors
3. Cluster C: Characterized by anxious or fearful behaviors |
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Term
|
Definition
| False sensory perceptions not associated with real external stimuli, might involve any of the five senses |
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Term
|
Definition
| Fixed, false belief, not consistent with the person's intelligence and culture; unamenable to reason |
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Term
|
Definition
| Absence of energy cause by changes in brain chemistry, anatomy, or both |
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Term
|
Definition
| Loss of pleasure in activities or interests previously enjoyed; a symptom noted in depression and schizophrenia |
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Term
|
Definition
| Words similar in sound, but not in meaning, that conjure up new thoughts |
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Term
|
Definition
| Psychopathologic repeating words of one person by another; noted in types of schizophrenia |
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Term
|
Definition
| Imitation of the body position of another |
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Term
|
Definition
| new word created by the patient for psychological reasons; noted in some types of schizophrenia |
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Term
| Traditional antipsychotic drugs |
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Definition
| Developed between 1950 and 1990, and are further divided based on potency. Essentially, the effects of traditional antipsychotics are r/t the blockade of a specific dopamine receptor |
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Term
|
Definition
| Newer agents from 1990 on. These agents are referred to as atypical because of the following characteristics: reduced or no risk for EPSEs, increased effectiveness in treating negative symptoms, minimal risk of tardive dyskinesia, reduced or no risk of elevated prolactin. |
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Term
|
Definition
Tract 1: Nigrostratal tract involved in movement and extrapyramidal disorders
Tract 2: Tuberoinfundibular tract modulates pituatary function and involved in neuroendocrine control and raised prolactin levels
Tract 3: Mesolimbic tact involved in emotional and sensory
Tract 4: Mesocortical tract involved in cognitive process |
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Term
| What are concerns when taking Clozapine? |
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Definition
| Can cause agranulocytosis, a potentially fatal illness |
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Term
| What are the indications for use of benzodiazepines? |
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Definition
| They reduce anxiety, promote sleep, and can produce hypnosis and amnesia |
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Term
| What is the difference between Buspirone and benzodiazepines? |
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Definition
| Unlike Benzos, Buspirone is not sedating, does not cause a high so has little abuse potential, has no cross-tolerance with sedatives or alcohol, does not produce dependence, withdrawal, or tolerance; but Busprione has delayed onset of antianxiety effect compared with benzodiazepines. |
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Term
| What difference in drug metabolism makes lorazepam and oxazepam good choices for treating anxiety in older adult patients? |
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Definition
| The metabolites in these drugs are inactive so the effects of the drug do not persist. |
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Term
| Discuss the nursing care that would be provided to a patient who has overdosed on benzodiazepines and alcohol. |
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Definition
| Effective overdose treatment begins with emptying the stomach by induced vomiting and gastric lavage, followed by activated charcoal. The nurse should monitor BP, Pulse, and respirations and provide supportive care as indicated |
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Term
| What specific interventions would be necessary if the patient receives flumazenil (Romazicon)? |
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Definition
| A response to flumazenil typically occurs within 30 to 60 seconds. 2 important considerations are that 1) it does not speed up the metabolism or excretion of benzodiazepines and 2) it has a short duration of action, so the patient could recover only to return to a preflumazenil state if not monitored by nurse |
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Term
| What makes the use of SSRIs attractive for the treatment of anxiety disorders? |
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Definition
| SSRI effectiveness in panic and other anxiety disorders can be partially explained by serotonin’s role in up-regulating GABA transmission in the prefrontal cortex. By up-regulating inhibitory neurons, a more inhibitory effect can be expected |
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Term
|
Definition
| Patterns of symptoms and behaviors in which anxiety is either the primary disturbance or a second problem that is recognized when the primary symptoms are removed |
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Term
|
Definition
| Patients have physical symptoms for which there is no known organic cause or physiologic mechanism |
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Term
|
Definition
| Mental states where identity, memory, or consciousness is disturbed or altered. |
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Term
|
Definition
| Positive internal motivations for a patient to report symptoms (medical reason to justify being unable to perform a task patient will feel better) |
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Term
|
Definition
| Positive external motivations that a patient may have for reporting symptoms (missing work, obtaining drugs |
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Term
| Identify a comprehensive list of nursing measures to relieve anxiety |
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Definition
1. Provide a calm and quiet environment
2. Ask patients to identify what and how they feel
3. Encourage patients to describe and discuss their feelings
4. Help patients identify possible causes of their feelings
5. Listen carefully for patients’ expressions of helplessness and hopelessness
6. Ask patients whether they feel suicidal or have a plan to hurt themselves.
7. Plan and involve patients in activities such as going for walks and playing recreational games. |
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Term
| Describe nursing interventions to help patients replace dysfunctional coping methods with effective coping strategies |
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Definition
• Discuss with patients their present and previous coping mechanisms.
• Discuss with patients the meaning of problems and conflicts
• Use supportive confrontation and teaching.
• Assist patients with exploring alternative solutions and behaviors.
• Encourage patient to test new adaptive coping behaviors through role-playing or implementation.
• Teach patients relaxation exercises.
• Promote the use of hobbies and recreational activities |
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Term
| Identify specific nursing interventions for a patient experiencing a panic attack |
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Definition
1. Stay with the patient who is having a panic attack, and acknowledge the patient’s discomfort.
2. Maintain a calm style and demeanor.
3. Speak in short, simple sentences, and give one direction at a time in a calm tone of voice.
4. If the patient is hyperventilating, provide a brown paper bag and focus on breathing with the patient.
5.Allow patients to pace or cry, which enables the release of tension and energy.
6. Communicate to patients that you are in control and will not let anything happen to them.
7. Move or direct patients to a quieter, less-stimulating environment. Do no touch these patients; touching can increase feelings of panic.
8. Ask patients to express their perceptions or fears about what is happening to them |
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Term
| Identify key nursing interventions for a patient with obsessive-compulsive disorder |
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Definition
1. Ensure that basic needs of food, rest, and grooming are met.
2. Provide patients with time to perform rituals.
3. Explain expectations, routines, and changes.
4. Be empathic toward patients and be aware of their need to perform rituals.
5. Assist patients with connecting behaviors and feelings.
6. Structure simple activities, games, or tasks for patients.
7. Reinforce and recognize positive nonritualistic behaviors. |
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Term
| Discuss key nursing interventions for a patient with ASD or PTSD |
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Definition
1. Be nonjudgemental and honest; offer empathy and support; acknowledge any unfairness or injustices related to the trauma.
2. Assure patients that their feelings and behaviors are typical reactions to serious trauma.
3. Help patients recognize the connections between the trauma experience and their current feelings, behaviors are typical reactions to serious trauma.
4. Help patients evaluate past behaviors in the context of the trauma, not in the context of current values and standards.
5. Encourage safe verbalization of feelings, especially anger.
6. Encourage adaptive coping strategies, exercise, relaxation techniques, and sleep-promoting strategies.
7. Facilitate progressive review (imaginal or in vivo) of the trauma and its consequences.
8. Encourage patients to establish or reestablish relationships |
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Term
| Devise a general list of nursing interventions for patients with somatoform disorders |
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Definition
1. Use a matter-of-fact, caring approach when providing care for physical symptoms.
2. Ask patients how they are feeling, and ask them to describe their feelings.
3. Assist patients with developing more appropriate ways to verbalize feelings and needs.
4. Use positive reinforcement, and set limits by withdrawing attention from patients when they focus on physical complaints or make unreasonable demands.
5. Be consistent with patients, and have all requests directed to the primary nurse providing care.
6. Use diversion by including patients in milieu activities and recreational games.
7. Do not push awareness of or insight into conflicts or problems. |
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Term
|
Definition
Neuromodulator
-Role in allergic response, GI secretions
-Some psychiatric meds blocks histamine, which causes sedation, weight gain, and hypotension |
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Term
|
Definition
| Endorphins and Enkephalins, Substance P, Somatostatin |
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Term
|
Definition
| 4 spaces within the brain |
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Term
|
Definition
Sense of smell
Motor control
Higher mental ability
Expressive language |
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Term
|
Definition
| Sensation such as touch, temperature pressure, pain |
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Term
|
Definition
| Interpreting visual stimuli and information |
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|
Term
|
Definition
|
|
Term
|
Definition
| Posture, coordination, muscle tone, memory of skills/habits |
|
|
Term
| What are 3 important facts about schizophrenia? |
|
Definition
1. High probability that it will become apparent in late adolescence or early adulthood remember it appears early, often seen in adolescence when brain maturation is nearly complete.
2. Stress is believed to play a role in onset and relapse
3. Dopamine antagonist drugs are therapeutically effective |
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Term
| What are the 3 phases of schizophrenia? |
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Definition
1. Acute phase with severe symptoms
2. Stabilizing phase in which patient improves
3. Stable phase in which symptoms might still be present but are not as severe and disabling |
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|
Term
| What are common stressors that trigger schizophrenia? |
|
Definition
1. Biologic: medical illness
2. Psychosocial: loss of a relationship
3. Sociocultural: homelessness
4. Emotional: persistent criticism |
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Term
|
Definition
| Motor restlessness, generally expressed as the inability to sit still caused by the dopamine blockade by ceratin types of neuroleptic medications (an extrapyramidal side effect) |
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Term
|
Definition
| Disturbed disorientation and motor activity, usually producing a jerky motion; an EPSE of neuropleptic medications related to their effect on dopamine receptors |
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Term
|
Definition
| Extrapyramidal syndrome that usually emerges late in the course of long term antipsychotic drug therapy; includes grimacing, buccolingual movements, and dystonia; might be irreversible |
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Term
| neuroleptic malignant syndrome |
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Definition
| A serious adverse effect of antipsychotic drugs. The nurse should routinely assess for NMS by taking the patient's temp and evaluating rigidity and tremors. |
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