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Unformatted text preview: MENTAL HEALTH TEST 1 REVIEW 1. Clozapine (Clozaril): know what normal WBC/ANC (absolute neutrophil count) is
a. Normal Range ANC = 1.5 - 8.0 (1,500 to 8,000)
b. Normal Range for WBC = 5k - 10k
c. HOLD MEDS IF ANC LOW:
i. Mild: 1,000 - 1,499 ANC, blood drawn 3x, weekly until back up to 1,500
ii. Moderate: going to hold med and order daily ANC was 606 and WBC was
1,300
iii. Severe: < 500 ANC, daily blood drawn
d. Can cause hypersalivation, lower sedation and weight gain
2. Know nurse patient relationship and phases of it ) (hildegard peplau)
a. Pre-orientation
b. Orientation: start termination or discharge plan
c. Working
d. Termination
e. Transference (Pt to RN)
i. Patient unconsciously transfers feelings toward the nurse that the patient
has towards someone else
f. Countertransference (RN to Pt)
i. Nurse unconsciously transfers feelings onto the patient that the nurse
has towards someone else
3. Know side effects of antipsychotic drugs
a. First Generation
i. typical,conventional
LOW potency (Elixir and IM formulation)
Chlorpromazine (Thorazine)
>What labs need to be checked?
Others:
Thioridaze (mellaril)
Mesoridazine (Serentil) Labs: Check Fasting Blood Sugar (FBS) and Fasting Lipid Panel (FLP)
>Common S/E of Low Potency Agents
● Anticholinergic
○ Dry Mouth
○ Constipation
○ Blurred Vision (student nurse offer a magazine to read,
student needs more teaching)
○ Urinary retention
○ Confusion
● Sedation-Histamine Blockage
● Adrenergic Blockage- Muscarinic/Hypotension
● EPS**
*The Dr. orders a pt. thorazine. The pt. spits the medication out
and is noncompliant. What action do you take next?
-contact the physician and recommend the medication in a liquid
form (patient advocate) MENTAL HEALTH TEST 1 REVIEW HIGH Potency (Elixir and IM formulation) **Give Benedryl, Cogentin, and Artane with High Potency drugs to
reduce EPS
Haloperidol (Haldol)
Common S/E:
● EPS:
- Dystonia- abnormal muscle tone that causes spasm
Fluphenazine (Prolixin)
- Akathisia- agitation, distress, and restlessness
>If patient is noncompliant to taking the
- Pseuodoparkinsonism- shuffle gait, drooling tremors,
medication, give Depot formulation IM
bradykinesia, rigidity (Wife state husband shuffling due to
every 4 weeks (Haldol) and every 2-4
this… clutter free environment)
weeks (Prolixin)
- hold haldol if notice a twitch and assess for involuntary
movement
Others:
Primozide (orap)
- tardive dyskinesia- difficulty moving
Thiothiexene (navane)
● Anticholinergic SE
Trifkuperazine (Stelazine)
● Sedation
Perphenazine (Trilafon)
● **Weight Gain!
Loxapine (loxitane) b. Atypical (Second generation)
i. effective for both positive and negative symptoms
c. MENTAL HEALTH TEST 1 REVIEW Clozapine (Clozaril)
>What lab level do you need to
look at? >Baseline CBC (WBC count), also causes hypersalivation Risperidone (Risperdal)
>What symptoms does it treat? > It’s an antipsychotic and it treats both positive and
negative symptoms Ziprasidone (Geodon)
>What do you need to check
before starting Geodon and
throughout the treatment? **EKG before starting Geodon (increase HR)
- Take with food or loses
- Less sedative other:
Olanzapine (zyprexa)
Quetiapaine Fumarate (seroquel)
Lurasidone HCL (Latuda)
Oral Disintegrating Tablets:
every 2 weeks IM Common S/E:
● Increased appetite
● Weight gain
● Hyperglycemia
● Hyperlipidemia- Also Monitor FBS/FLP* Olanzapine (Zyprexa Zydis)
Risperidone (Risperdal) M-Tab
c. Third Generation- dopamine system stabilizer
Aripiprazole- Abilify tablet abilify
discmelt (Oral tab)
Aripiprazole- Abilify Maintena IM (depot
formula
Aripiprazole Lauroxil- Aristada (depot
injection Common side effects:
- insomnia
- akathsia
Safety considerations
- metabolic changes
- ortho hypotension
- neutropenia
- neutropenia
- dysphagia
- dystonia 4. Maslows and Ericksons stages
a. Erikson’s eight Stages of development: MENTAL HEALTH TEST 1 REVIEW i. Infancy (birth-18 mos) Trust vs. mistrust
1. To develop a basic trust in the mothering figure and learn to
generalize it to others.
2. Non achievement results in emotional dissatisfaction w/ the self
and others, suspiciousness, and difficulty w/ interpersonal
relationships.
ii. Early childhood (18 mos-3 yrs) Autonomy vs. shame and doubt
1. To gain some self-control and independence within the
environment.
2. Non achievement results in lack of self-confidence, a lack of pride
in the ability to perform, a sense of being controlled by others and
a rage against the self.
iii. Late childhood (3 - 6 yrs) Initiative vs. guilt
1. To develop a sense of purpose and the ability to initiate and direct
own activities.
2. Non achievement results in feelings of inadequacy and a sense of
defeat. Guilt experienced to excessive degree. Child may view
him/herself as evil and deserving of punishment.
iv. School age (6 - 12 yrs) Industry vs. inferiority.
1. To achieve a self of self-confidence by learning, competing,
performing successfully and receiving recognition from significant
others, peers and acquaintance.
2. Non achievement results in difficulty in interpersonal
relationships b/c of feelings of personal inadequacy. Can’t
cooperate or compromise with others in group activities. May
become passive and meek or overly aggressive to cover up for
feelings of inadequacy.
v. Adolescence (12 - 20 yrs) Identity vs. role confusion.: a kid in a gang **
1. To integrate the tasks mastered in the previous stages into a
secure sense of self.
2. Non achievement results in sense of self-consciousness, doubt,
and confusion about one’s role in life. Personal values or goals for
one’s life are absent. Commitments to relationships w/ others are
nonexistent, but instead are superficial and brief. A lack of
self-confidence often expressed by delinquent and rebellious
behavior.
vi. Early adulthood (20 - 35 yrs) Intimacy vs. isolation.
1. To form an intense, lasting relationship or a commitment to
another person, cause, institution or creative effort.
2. Non achievement results in withdrawal, social isolation and
aloneness. Individual unable to form lasting, intimate
relationships, often seeking intimacy through numerous
superficial sexual contacts.
vii. Middle adulthood (35-65 yrs) Generativity vs. stagnation.
b. Freud’s psychosexual: Anal MENTAL HEALTH TEST 1 REVIEW 1. To achieve life goals established for oneself, while also
considering the welfare of future generations.
2. Non achievement results in lack of concern for the welfare of
others and total preoccupation with the self. Becomes withdrawn,
isolated and highly self-indulgent with no capacity for giving of the
self to others.
ii. Later years (65 yrs-death) Ego integrity vs. despair.
1. To review one’s life and derive meaning from both positive and
negative events, while achieving a positive sense of self-worth.
2. Non achievement results in a sense of self-contempt and disgust
with how life has progressed. Individual would like to start over
and have a second chance at life. Feels worthless and helpless to
change. Anger, depression and loneliness are evident.
c. Maslow’s Hierarchy of Needs:
1 - Biological & Physiological needs (air, food, drink, shelter, sex, sleep)
2 - Safety needs (protection, security, order, law, limits, stability)
3 - Belongingness and Love needs (family, relationships, work groups)
4 - Esteem needs (achievement, status, responsibility, reputation)
5 - Self-actualization (personal growth, self-fulfillment)
In a psych setting, pt complaining with SOB, you feel like they have anxiety and there is
nothing wrong with them, but you need to treat it as an emergency because the pt still
thinks that she can’t breath
5. Have to identify what ego, superego and id do
a. Ego: within the first few years of life as the child begins to interact with others,
the ego develops
i. problem solver and reality tester
1. “you have to delay gratification for right now”
b. Superego: last portion of the personality to develop, represents the moral
component of personality
i. represents the ideal rather than the real, seeks perfection, as opposed to
seeking pleasure or engaging reason
c. Id: source of all drives, instincts, reflexes, needs, genetic inheritance, and
capacity to respond, as well as the wishes that motivates us
i. lacks ability to problem solve
1. ex: hungry, screaming infant
2. a child is crying for a toy
6. Conscious preconscious subconscious
a. conscious - our level of awareness about ourselves and our environment
b. preconscious- thoughts that are unconscious at the particular moment in
question, but are not repressed and are therefore available for recall and easily
capable of become “conscious”
c. subconscious- information that we are not consciously aware of but we know
must exist due to behavior
7. Whats clanging?
a. rhyming ex: like a rapper (snoop dogg) MENTAL HEALTH TEST 1 REVIEW 8. Know all the words we talked about today… DA FUK?!?!
9. Cultural sensitivity
a. Nurse is still awareness of her own beliefs; but being considerate with other
cultures and never putting their own beliefs onto their patients. Recognizing a
patient's beliefs, practices, needs and preferences.
i. eastern - balance (mind body spirit unity)
ii. western- science ( meds)
iii. indigenous- harmony (nature)
10. Characteristic of nurse that is culturally competent
a. Cultural Awareness- nurses recognize that they as well as patients, have cultural
beliefs, values, and practices
b. Cultural Knowledge- obtained by seeking cultural information oneself in the
culture or consulting print and online resources
c. Cultural Encounters
d. Cultural Skill- performing a culturally sensitive assessment interviews and
adapting care to meet patient’s cultural needs and preferences
e. Cultural Desire- a general interest in the patient’s unique perspective enabling
nurses to provide considerate, flexible and respectful care to patients of all
cultures
11. Know reporting relationship and what you have to do
a. What do you have to do if someone is homicidal and has specific victim in mind?
-Warn person and tell the police
b. Tarasoff vs Regents of University of California (1974) ruled that psychotherapist
have the duty to warn a patient’s potential victim of potential harm. The
therapist also has the duty to protect that other person.
12. Know all about working with a psychotic patient and with nursing assessment, nursing
action → Mental Status Examination
a. appearance- grooming, dressed, level of hygiene, pupil dilation, facial
expression, height, weight, ect
b. behaviors- excessive or reduced body movements, peculiar body movements,
oto-repetitive gestures, LOC, balance, gait
c. Speech- rate, volume, disturbance, cluttering
d. moodi. affect (flat, blunt, animated, angry / withdrawn)
mood (sad, liable, euphoric)
e. Disorders of the form of thought
i. thought process( disorganized, coherent, flight of ideas, neologism,
thought blocking, circumstantiality)
ii. thought content ( delusions or obsessions)
f. Perceptual disturbances- hallucinations or delusions
g. Cognitioni. LOC- time, name place
ii. memory
iii. attention
iv. abstract thinking MENTAL HEALTH TEST 1 REVIEW v. insight and judgment
h. Ideas of harming self or others
i. suicidal or homicidal thoughts
ii. presence of a plan
iii. means of carrying plan
iv. opportunity of carrying out the plan
13. Know who needs to be put in seclusion and who doesn’t: someone who is danger to
others
a. GOAL: physical protection of client and/or others and staff only time seclusions
are used
i. the involuntary confinement of a patient alone in a room or area from which the
patient is physically prevented from leaving Patient is agitated (decrease stimuli, take him out from the situation, offer
1-on-1, offer meds, offer seclusion until behavior is controlled, then physical
containment procedure/show of force) (5 people, each extremity and the
torso) (Can an RN write a restraint order? YES if it is an emergency but needs
to be co-signed by an MD within an hour)
14. Pay attention to competency café and methods for times restraints and types of knots
a. 1st- decrease and remove from stimuli
b. 2nd- medication
c. 3rd- seclusion
d. 4th- 4 point restraints
i. both arms and both legs restrained
ii. quick- release knot used
iii. 1:1 observation required
iv. check pt every 15 mins
v. offering bathroom, foods, fluids every hour
e. Adults order is good for 4 hours
f. Children good for 2 hours
15. Therapeutic communication (a lot of scenarios)
a. Using Silence
b. Active Listening
c. Clarifying Techniques
i. Paraphrasing - restating what patient said using
different shorter words validating the accuracy
of the restatement
ii. Restating - the nurse mirrors the patient’s overt
and covert messages therefore echoing feelings
and content
iii. Reflecting - assisting patients to better
understand their own thoughts and feelings by
describing the apparent meaning of the
emotional tone of the patient’s verbal/nonverbal
behaviour
iv. Exploring
o MENTAL HEALTH TEST 1 REVIEW 16. Symptoms of a psychotic patient
a. What part of nursing process, and how would you deal with a schizophrenic
patient- don’t send off to read a book with others
17. Erickson’s: know the stages and ages that go along with that and what the task is
a. Identity vs. isolation
i. Intimacy: Ability to love deeply and commit oneself
ii. Isolation: Emotional isolation; egocentricity “There’s no one out
there for me”
18. Etiology of schizophrenia and physical changes in the brain. (Select ALL)
a. Enlarged lateral ventricles
b. Asymmetry
c. Atrophy of the cortex
d. Dilated 3rd ventricle
e. Prenatal exposure to influenza
*On test said psychosocial, not physical changes. 3 physical changes. It should be the 3
psychosocial changes: low income, move from family, etc
19. Neuroleptic malignant syndrome, Tardive dyskinesia, and what effects are
a. Neuroleptic malignant syndrome:rare and sometimes fatal reaction to a high
potency neuroleptic drug
i. symptoms:
1. muscle rigidity (dystonia, akinesia, mutism, obtundation, and
agitation),
2. fever (increased BP and sweating),
3. elevated WBC (count and creatinine phosphokinase, liver
enzymes, plasma myoglobin and myoglobinuria= renal failure)
ii. treatments: early detection, discontinuing of the antipsychotic, fluid
balance, rapid temperature control
1. mild cases treated with: bromocriptine (parlodel)
2. severe cases treated with: IV dantrolene (dantrium)
b. Tardive dyskinesia: difficulty moving, stiffness, jerky movements, body can’t
control
20. What would you do if found out patient was not taking their meds 4 days in a row?
a. Options (least severe first)
i. watch them swallow
ii. give them liquid form
iii. liquid form not available- give IM
iv. Pt. has right to refuse meds unless been through a Reise Hearing
1. if pt. is refusing but Dr. deems necessary for pt to take because
either danger to self or others
21. 1st generation like stelazine, thorazine
a. Causes photosensitivity
i. wear long sleeves and a hat
ii. Can damage the retina of the eye and the skin
st
22. S.E.: of 1 generation anti-psychotics: LIST OF SYMPTOMS: SELECT ALL THAT APPLY
a. Low potency symptoms MENTAL HEALTH TEST 1 REVIEW i. Dry mouth
ii. constipation
iii. blurred vision: do not send patient to go read a magazine
iv. urinary retention
v. confusion
b. High potency symptoms
i. dystonia
ii. Akathisia: pt shifting weight side to side
iii. pseudoparkinsonism “BEDREST”
1. bradykinesia
2. drooling
3. rigidity
4. shuffling gait
5. tremors
iv. Tardive dyskinesia: lip smacking, tongue rolling, pill rolling (WHATEVER IS
IN THE ATI BOOK)
23. Fidelity and beneficence : know the definition
a. fidelity- loyalty and faithfulness to the client and to one's duty
i. ex: client asks a nurse to be present when he talks to his mother for the
first time in a year. The nurse remains with the client during the
interaction
b. beneficence- The quality of doing good; can be described as charity
i. ex: a nurse helps a newly admitted client who has a psychotic disorder to
feel safe in the environme...
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- Summer '15
