Term
| What is the MOA for Lithium? |
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Definition
| Lithium inhibits the release of norepinephrine, serotonin, and dopamine while facilitating their reuptake into presynaptic terminals |
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Term
| What is the MOA for Valproates? |
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Definition
| Increase the inhibitory role of GABA, Suppression of sodium influc into the neuron, and suppression of calcium influx through specific calclium channels |
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Term
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Definition
| Effective for people who don't respond to lithium or valproates. Should not be taken with SSRIs-can cause serious toxic efects |
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Term
| What is the therapeutic range for lithium? |
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Definition
| 0.6-1.2 mEq/L, levels higher than 1.5mEq/L can be toxic, but typically moderate to severe toxicity only after blood levels exceed 2mEq/L |
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Term
| What is the relationship between sodium and lithium level? |
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Definition
| If dietary sodium intake increases, plasma lithium levels will likely drop, because lithium is excreted more rapidly. If sodium in the diet decreases, or if sodium is lost in ways other than through the kidneys, lithium levels increase. |
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Term
| What are 3 drugs that can elevate serum lithium levels? |
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Definition
1. Diuretics
2. NSAIDs
3. Indomethacin |
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Term
| What are 3 drugs that can lower serum lithium levels? |
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Definition
1. Alcohol
2. Acetazolamide
3. Caffeine |
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Term
| How often is Lithium effective? |
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Definition
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Term
| How do SSRIs, SNRIs, TCAs, MAOIs achieve their antidepressants effects? |
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Definition
1. SSRIs: Blocks the reuptake of serotonin
2. SNRIs: At lower doses they inhibit serotonin reuptake; at moderate to high doses, norepinephrine reuptake is inhibited.
3. TCAs: Block the reuptake of both norepinephrine and serotonin
4. MAOIs: only neurotransmitter that inhibit neurotransmitter breakdown as their primary mechanism of action |
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Term
| Why are SSRIS the first-line of treatment for depression? |
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Definition
| They have fewer side effects than TCAs and are far less dangerous than MAOIs. They also have fewer anticholinergic, cardiovascular, and sedating side effects. |
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Term
| Which class of antidepressants are of most concern relative to patient using them in a suicide attempt? |
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Definition
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Term
| What is the antidote for severe TCA poisoning? |
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Definition
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Term
| What are the side effects of MAOIs? |
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Definition
1. CNS hyperstimulation
2. Hypotension
3. Anticholinergic effects
4. Hepatic and hematologic dysfunction |
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Term
| How should a nurse expect to manage hypertensie crisis? |
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Definition
1. Discontinue MAOIs and contact physician
2. Monitor vital signs
3. Have the patient walk
4. Manage fever by external cooling
5. Institute supportive nursing care |
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Term
| Major Depressive Disorder |
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Definition
| Characterized by one or more major depressive episodes, which are defined as at least 2 weeks of depressed mood or loss of interest accompanied by at least 4 additional symptoms of depression. |
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Term
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Definition
| Characterized by at least 2 years of depressed mood for more days (ex/more than 50% of the time) than not accompanied by additional depressive symptoms, but that does not meet the criteria for major depression. Dysthymia is a disorder of chronicity. |
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Term
| DSM-IV-TR criteria for major depressive disorder |
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Definition
Symptoms that persist over a minimum of a 2-week period. A person must have at least 5 of the 9 criteria:
1. Depressed mood
2. Anhedonia
3. Significant change in weight
4. Insomnia or hypersomia
5. Increased or decreased psychomotor activity
6. Fatigue or energy loss
7. Feelings of worthlessness or guilt
8. Diminished concentration or indeciveness
9. Recurrent death or suicidal thoughts |
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Term
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Definition
| Mood disturbance of depression that generally occurs in younger populations and is more common in women. Expressed by increased apetite, weight gain, hypersomnia, leaden, paralysis, and extreme sensitivity. |
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Term
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Definition
| A disturbance of depression most often in older adults that might be misdiagnosed as dementia. The type of depression is characterized by anhedonia and an ability to be cheered up. |
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Term
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Definition
| Marked by significant psychomotor alterations, including immobility, excessive motor activity, mutism, echolalia, and inappropriate posturing. |
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Term
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Definition
| Mood disturbance that occurs during the first 30 days postpartum. It is the most comon medial complication of childbearing. |
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Term
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Definition
| A person has delusions and hallucinations in conjunction with mood disturbances. These perceptions tend to be mood congruent-perceptual problems delusions of guilt, delusions of deserved punishment, nihilistic delusion, and delusions of poverty. |
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Term
| Seasonal Affective Disorder (SAD) |
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Definition
| Depression occurring in conjunction with a seasonal change most often beginning in fall or winter and remitting in spring. |
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Term
| Describe 3 specific cultural variations in expression of depressive symptoms that a nurse might encounter. |
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Definition
A. Hispanic, Latino, and Mediterranean goups might descrive their sadness or guilt in terms of being nervous or having headaches and stomach
B. Individuals from Asian cultures might describe themselves as being out of balance or feeling weak and nervous
C. Native American and Asian: American groups withdraw fro meditation and personal growth as part their culture, so symptoms of depression my be overlooked, ignored or denied |
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Term
| Biologic theories of depression |
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Definition
| Depression might result from or cause atrophy of specific brain locations. For example, loss or neuron and white matter in the frontal lobes, cerebellum, and basal ganglia has been identified by a number scientists. |
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Term
| What are the 4 different physiologic theories of depression? |
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Definition
1. Psychoanalytic: Depression occurs as a result from an early life loss
2. Cognitive: Depression results when a person perceives stressful situations as being negative
3. Interpersonal: When a person has interpersonal difficulties, coping with individuals, life events, and life change scan be inordinately stressful and lead to depression
4. Behavioral: a person develops depression wehn he or she develops feelings of helplessness and unworthiness and then learns to use these attributes to evaluate life outcomes. |
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Term
|
Definition
| The presence of at least one psychiatric disorder in addition to a substance abuse or dependency problem |
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Term
| What effect do alcohol and other substances of abuse have on the symptoms of schizophrenia? |
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Definition
| Alcohol can increase the positive symptoms of schizophrenia |
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Term
| How should a nurse conduct an interview with an individual suspected to have a substance-related problem? |
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Definition
-Approach patient in a manner encouraging forthrightness
-Be matter-of-fact and nonjudgemental
-Display genuine concern to counter defensiveness
-Be aware of your own feelings and attitudes to avoid projecting them onto the patient
-Be careful of phrasing: for example labels like addict or alcoholic
-Evaluate patient's consumption in more detail if initial assessment data identifies high risk |
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Term
| What are the psychopharmacologic treatments for alcohol and drug related disorders? |
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Definition
-Disulfiram: makes drinking painful
-Naltrexone: decreases the pleasure of drinking
-Acamprosate: restores the chemical balance balance in the alcoholic brain
-Topiramate: Reduces the craving for alcohol
-Odansetron: Reduces the rewarding aspect of alcohol |
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Term
|
Definition
-Severe and can cause death
-Symptoms begin 8-12 hours after last dose
-Minor symptoms: anxiety, muscle twitching, tremor, progressive weaknes
-Serious symptoms: convulsions, delirium
-Untreated withdrawal symptoms might not decline in intensity for 1 week
-Detox requires cautious and gradual reduction of these drugs |
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Term
| Important aspects of nurse-patient relationship associated with the treatment of individuals with substance-related disorders. |
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Definition
-Nurses can help with coping skills
-Need to establish a trusting therapeutic relationship
-Be genuine, single most important thing
-Express empathy and provide a safe environment
-Engender empathy and provide a safe environment
-Confront denial and manage manipulation |
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Term
| Explain the neurobiologic reasons for the cognitive impairment of Alzheimer’s disease. |
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Definition
| Neuronal death and neurotransmitter deficiency |
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Term
| What neurotransmitter is the primary target of drug treatment of mild to moderate AD? |
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Definition
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Term
| Explain how inhibition of cholinesterase is of benefit to individuals with AD |
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Definition
| Cholinesterase breaks down acetylcholine into inactive metabolites. Because a loss of acetylcholine is the primary neurotransmitter loss in AD, attempting to prevent the breakdown of acetylcholine has proven to be effective. |
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Term
| What is the advantage of a drug that selectively inhibits AChE while not inhibiting BChE? |
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Definition
| • Drugs that inhibit both ChEs have greater potential for causing unnecessary and often adverse effects. For example, inhibiting BChE produces nausea and vomiting, diarrhea, facial flushing, sweating, rhinitis, bradychardia, and leg cramps |
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Term
| List the drugs currently under discussion as having some possible efficacy in preventing AD. |
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Definition
-NSAIDs: Some researchers believe that one of the ways in which neurons die is r/t low-burner inflammatory process. Some evidence that long-term use (more than 2 years) can play a preventative role if initiated 2 years or more before neurodegeneration begins.
-Statins: Some clinicians believe there is a relationship between high cholesterol levels and AD.
-Estrogen: Some researchers believe the decrease in estrogen level after menopause increases the risk of women developing AD.
-B and E vitamins: No real evidence that this helps. |
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Term
| In general, how do the symptoms of personality disorders differ from those of psychoses? |
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Definition
| Criteria for a personality disorder include experiences and behaviors that are very different from those that are usually expected in an individuals culture. The individual must have disturbances in two of the following areas: cognition, affect, interpersonal functioning, and impulse control. |
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Term
| For what reasons do individuals with personality disorders seek treatment? |
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Definition
| Not to change their personality, but want help for depression, anxiety, somatic symptoms, alcohol and chemical dependence and difficulties in work and personal relationships. |
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Term
| Identify the descriptive features for each cluster of personality disorders |
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Definition
| Cluster A is characterized by odd or eccentric behaviors. Cluster B is characterized by dramatic, emotional, or erratic behaviors. Cluster C is characterized by anxious or fearful behaviors. |
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Term
| Describe the clinical picture of an individual with paranoid PD, schizoid PD, and schizotypal PD. Describe nursing interventions and psychotherapeutic management for patients with each of these diagnoses. |
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Definition
-Paranoid Personality Disorder: suspicious and mistrustful of other people. Quick to respond with anger or rage if they feel threatened.
-Schizoid PD: These people keep people at an emotional distance and are loners and shy. The nurse-patient relationship should focus on trust, followed by identification and appropriate verbal expression of feelings. Slowly involving the patient in milieu and group activities, if possible, might help increase social skills.
-Schizotypal PD: These patient might have problems in thinking, perceiving, and communicating. They may appear and behave eccentrically, and are sensitive to the behavior of others. Interventions offering support, kindness, and gentle suggestions will help the patient become involved in activities with others. It is essential for the nurse to help the patient improve interpersonal relationships, social skills, and appropriate behaviors. Vocational counseling and assistance with job placement increase the patient’s opportunity for success. |
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Term
| Describe the clinical picture of an individual with antisocial PD. What biologic findings explain some of the behaviors and traits demonstrated by the antisocial individual? Identify unique aspects of the nurse-patient relationship that make working with antisocial patients particularly challenging. |
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Definition
| The main feature of antisocial personality disorder is a pattern of disregard for the rights of others, which is often demonstrated by repeated violations of the law. They abuse alcohol and other substances and can be promiscuous and feel no guilt about hurting others. Lying, cheating, and stealing are common. The nurse can initiate the therapeutic process by setting firm limits. These patients try to manipulate staff and bend rules for their own desires and needs. The nurse must be steadfast and consistent in confronting behaviors and enforcing rules and policies. |
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Term
| Describe the full range of symptoms and behaviors demonstrated by individuals with borderline PD. |
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Definition
| Features of borderline personality disorder include emotional dysregulation, anger, impulsivity, unstable relationships, identity or self-image disturbance, abandonments fears, self-mutilation, and suicidality. |
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Term
| How do biologic, environmental, and stress-related factors interact to produce the behaviors demonstrated by individuals with borderline PD? |
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Definition
| Biologic studies have indicated neurotransmitter dysregulation of the serotonin system, as seen in affective disturbances and impulsive behaviors. BPD is highly inheritable. Environmental factors include a chaotic home environment. Stress-related events might trigger the individual’s genetically based vulnerable temperament and create misery and frustration. |
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Term
| Discuss psychotherapeutic management, milieu management, and psychopharmacology used in the treatment of an individual with borderline PD. |
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Definition
| The use of empathy by the nurse while maintaining clear boundaries is important in establishing a relationship with the patient diagnosed with BPD. With the nurse’s assistance, the patient can identify and verbalize feelings, control negative behaviors, and slowly begin to replace them with appropriate actions. The use of a behavioral contract to decrease self-injurious behaviors in inpatient and outpatient settings provides the patient with clear expectations of behavior. |
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Term
| Compare and contrast the clinical pictures of an individual with narcissistic PD with an individual with histrionic PD. What are the similarities in nursing care? What are the differences? |
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Definition
-The patient with narcissistic PD displays grandiosity about his or her importance and achievements, while histrionic PD dramatizes events and draws attention to self.
-In histrionic PD, the nurse must provide support to facilitate independent problem solving and daily functioning and use positive reinforcement in the for of attention, recognition, or praise for unselfish or other-centered behaviors.
-In narcissistic Pd the nurse must use supportive confrontation to point our discrepencies between that which the patient says and that which actually exists to increase responsibility for self. Limit setting and consistency in approach are used to decrease manipulation and entitlement behaviors. |
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Term
| What are the dynamics underlying the dependent individual’s behaviors? What nursing measures can be helpful? |
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Definition
| Main characteristics are pervasive and excessive need to be taken care of that leads to submissive and clinging behaviors and fears of separation. The nurse slowly works on decision-making with the patient to increase responsibility for self in daily living. Patient also needs help with anxiety management and assertiveness. |
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Term
| What nursing interventions should be planned when an individual with an avoidant personality seeks help? |
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Definition
| The nurse supports and directs the patient in accomplishing small goals. Helping the patient to be assertive and develop social skills is necessary. Because of the patient’s anxiety, relaxation techniques are taught to enable the person to be successful in interactions. |
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Term
| What aspects of the personality of an individual with obsessive-compulsive personality disorder might a nurse find frustrating? |
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Definition
| There is little give-and-take in their interactions with others, and they are rigid, controlling, and cold. The patient is serious about all of his or her activities, so having fun or experiencing pleasure is difficult. |
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Term
| What nursing interventions should be planned when working with the individual with obsessive-compulsive personality disorder? |
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Definition
| The nurse needs to support the patient in exploring his or her feelings and in attempting new experiences and situations. The nurse helps the patient with decision-making and encourages follow-through behavior. |
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Term
| What is the most abused prescription drug in teh military? |
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Definition
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Term
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Definition
-pinpoint pupils
-respirations |
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Term
| What is an opioid treatment that dissolves under the tongue? |
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Definition
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Term
| What is the only FDA approved drug for children? |
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Definition
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Term
| What is the antidote for a HTN crisis? |
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Definition
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Term
| What is the treatment for lithium toxicity and what should you assess for if giving this med? |
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Definition
| Kayexalate: assess for lithium toxicity |
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Term
| What is an alternative drug for lithium? |
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Definition
| Valproic Acid (Dekote): can raise testosterone |
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Term
| What is the problem with Cognex (for Alzheimers)? |
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Definition
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Term
| Which Alzheimer's drug works best in moderate to severe levels? |
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Definition
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