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Mental Health
Exam 1
93
Nursing
Undergraduate 4
06/24/2012

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Term
Tricyclic Antidepressants
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.
Term
Side effects of Tricyclic Antidepressants
Definition
Anitcholinergic effects: No see, no pee, no poop, no spit. Confusion, weight gain and decreased libido
Term
Uses for tricyclic antidepressants
Definition
Panic disorder, depression, fibromyalgia, migraine headaches, OCD (clompiramine), bulimia, enuresis.
Term
Nursing implications for Tricyclic antidepressants
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.
Term
Selective Serotonin Reuptake Inhibitors (SSRI)
Definition
Fluoxetine (Prozac)*Prototype

Citalopram (Celexa), Escitalopram (Lexapro),Fluvoxamine (Luvox), Paroxetine (Paxil), Sertaline (zoloft)
Term
SSRI MOA
Definition
Increase in serotonin levels by blocking its reuptake at the presynaptic memebrane. Results in more serotonin at the synapse promoting serotonin neurotransmission.
Term
SSRI side effects
Definition
anxiety, insomnia, agitation, irritability, weight gain, sexual dysfunction.
Term
SSRI Uses
Definition
Depression, OCD, PTSD, agoraphobia, generalized anxiety disorder, social anxiety, premenstrual dysphoric disorder (fluoxetine)
Term
SSRI nursing implications
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
Term
Paxil/paroxetine
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.
Term
Serotonin syndrome
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.
Term
Serotonin Syndrome Signs and Symptoms
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.
Term
Treatment of Serotonin Syndrome
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.
Term
Serotonin/norepinepherine Reuptake Inhibotors (SNRI)
Definition
Venlataxine (Effexor), Desvenlafaxine (PRESTIQ), nefazone (Seroszone), and Dulorine (Cymbalta)
Term
Side Effects of SNRI
Definition
Effexor in doses over 225mg/day may cause hypertention in some patients
Term
MOA of SNRI
Definition
Inhibiting the reuptake of selective serotonin and norephinephrine
Term
Uses of SNRI
Definition
Depression and pain disorders
Term
Norepinpherine and Dopamine Reuptake Inhibitor (NDRI)
Definition
Bupropion (Wellbutrin), Zyban (smoking cessation), Virtazapine (Remeron)
Term
NDRI MOA
Definition
Blocks the reuptake of norepinepherine and dopamine receptors. May also inhibit the reuptake of serotonin. Contraindicated in pts with seizure disorders.
Term
Mentally Ill person
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.
Term
Mental Health Law
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
Term
Rights of patients on involuntary admission
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,
Term
Legal information
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.
Term
Philosophical basis
Definition
Individual with worth and dignity, People have basic needs, behavior is meaningful and has a purpose.
Term
Symptoms versus disorder
Definition
Many people have symptoms or characteristics- depression, anxiety, manipulation, suspiciousness, compulsions.

Disorder: Interference with social and occupational functioning. Impairment in ADLs.
Term
Nure-Patient Relationship
Pre-orientation phase
Definition
Explore past experiences and own feelings, explore fears, Assess personal strengths and limitations, Assess communication knowledge and skills, explore own values
Term
Introductory Orientation Phase- Get Aquainted
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,
Term
Working phase
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
Term
Termination phase
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
Term
Therapeutic relationship
Definition
Therapeutic, goal directed, patient oriented, disclosure to help pt, knowledge and skill, one sided for client
Term
Social relationship
Definition
Social, no set goals, past and future, mutual disclosure, no skill required,mutual sharing
Term
Exceptions to confidentiality
Definition
child abuse under 18 years old, elder abuse over 65 years old, medical emergency, subpeona from court, duty to warn
Term
Responses of the nurse
Definition
Need to have genuineness and respect, empathy (feeling for patient), unconditional positive regard, be in control of own life and emotions.
Term
Increasing self awareness of the nurse
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
Term
Sender
Definition
The person who originates the message
Term
Reciever
Definition
The person who recieves the message
Term
Message
Definition
Information transfered to the reciever
Term
Context
Definition
Environment and setting of communication,
Term
Feedback
Definition
verbal and nonverbal responses of the receiver
Term
Communication Roles
Definition
Constantly change
Term
Establishing Rapport
Definition
Accurately interpret patient responses use clarification and restatement, be aware of what patients dont say,
Term
Assertiveness
Definition
Be assertive in speaking with patients, DESC scripts in confrontation
Describe the situation, Express feeligns, Specify what you want, Consequence
Term
What to do when you know what the problem is
Definition
Problem-solving
Define problem
When and how?
Propose solutions or alternatives
Pros and cons
Select solution
Evaluate application of solution
Make changes
Term
Anxiety
Definition
Subjective feeling
Energy
No specific cause
Fear/specific cause
Contagious
Observable
For self-preservation
Term
Mild Anxiety
Definition
in day to day living
Motivates learning and produces growth & creativity
No affect on perception and taking in information
Term
Moderate anxiety
Definition
focuses only on immediate concerns
Perceptual field narrowed
Blocks out selected areas
Can attend to more areas if directed to
Term
Severe Anxiety
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
Term
Panic
Definition
severe disorganization occurs
Feels terror -Feels dread
Increased activity -Decreased ability to
Perception distorted relate or think
Feels like are dying
Term
Biological Basis of Anxiety
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
Term
Anxiety Assessment factors
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
Term
Theoretical frameworks for anxiety
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
Term
Precipitation of Anxiety
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
Term
Human responses to anxiety
Definition
Active problem- solving
Take action
What do you usually do to cope?
Use coping strategies
Read, movies, shopping, exercise, fishing, etc.
Term
Poor coping strategies
Definition
Use of substances
Irritability
Argumentativeness
Isolation/withdrawal
Can’t let go
Victim behavior
Gets stuck
Term
Anxiety Interventions
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
Term
Severe anxiety and panic
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
Term
Anxiety Evaluation and outcomes
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
Term
Denial
Definition
Avoiding unpleasant realities by ignoring or refusing to recognize them
Term
Compensation
Definition
Process by which people make up for perceived weakness by emphasizing characteristics they deem more attractive.
Term
Rationalization
Definition
-offering socially acceptable explanations to justify unacceptable impulses, motives or behavior.
Term
Conversion
Definition
translating anxiety into paralysis of the voluntary muscles or problems with the special senses.
Term
Displacement
Definition
Shift of emotion from a person or place to another person or object.
Term
Identification
Definition
-Process by which people become like someone they admire by taking on characteristics of them.
Term
Regression
Definition
Returning to a former level of development
Term
Dissociation
Definition
Separation of mental or behavioral processes from the rest of consciousness.
Term
Isolation
Definition
Splitting off emotional components of a thought. Separating thoughts and feelings.
Term
Projection
Definition
-Attributing one’s thoughts and emotions to another.
Term
Repression
Definition
Voluntarily excluding a painful or conflicted thought from awareness
Term
Undoing
Definition
Act or communication that partially negates a previous one
Term
Nursing Interventions for anxiety disorders
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
Term
Benzodiazapenes
Definition
Valium (diazepam), Xanax (alprazolam), Ativan (lorazepam), Serax (oxazepam), Klonipin (clonazepam)(used in children), Tranxene (Clorazepate), Librium (Chlordiazepoxide), Paxipam (halazepam)
Term
Side effects of Benzodiazipenes
Definition
drowsiness, slurred speech, sleep disturbances, oversedation,
Term
Benzodiazepine sleeping medications
Definition
: Restoril (temazepam), Halcion (Triazolam), Dalmane (Flurazepam), ProSim (estraolam), Doral (quazepam)
Term
Benzodiazapine MOA
Definition
: increases GABA release and receptor binding at synapses to decrease firing and makes
a person calmer. Some effect on the limbic system.
Term
Benzodiazapine Uses
Definition
: anxiety, nervousness, seizures, muscles spasms, status epilepticus, alcohol withdrawal
Term
Benzodiazapine Nursing Implications
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.
Term
Benzodiazapine Antagonist
Definition
Flumazenil
Term
Antihistamines
Definition
Hydroxyzine (Vistaril, Atarax), diphenhydramine (Benadryl) (often used for anxiety in children)
Term
Side effects of antihistamines
Definition
drowsiness
Term
Uses of antihistamines
Definition
Short term management of anxiety and sleep
Term
MOA of Antihistamines
Definition
Depresses subcortical centers. Has no dependence, tolerance or intoxication. Can be used for indefinite periods and with patients who abuse substances.
Term
Anithistamine Nursing Implications
Definition
Give Vistaril deep IM using Z-track method
Term
Non Benzodiazapine Antianxiety Agents
Definition
Buspirone (BuSpar)
Term
Side effects of buspirone
Definition
: Headache, blurred vision, numbness, dizziness, excitement, feeling angry, nervousness, hostile behavior, nausea, and/or CHF.
Term
Uses of Buspirone
Definition
Generalized anxiety disorders, can be used to treat anxiety in medically compromised clients such as those who have asthma or COPD.
Term
MOA of Buspirone
Definition
Stimulates serotonin release from sending cells to synaptic clefts
Term
Nursing implication of Buspirone
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.
Term
Beta Blocker Used for anxiety
Definition
Proponolol (Inderal)
Term
Side effects of Proponalol
Definition
Decreased sexual ability, drowsiness, difficulty sleeping, weakness, unusual tiredness.
Term
MOA of Proponalol
Definition
Blocks peripheral and central norepinephrine activity which blocks the fight or flight response.
Term
Uses of Proponalol
Definition
Indications: Blood pressure must be high enough to take it.
Uses: Anxiety, GAD, PTSD, stage flight, migraine headaches
Term
Fluvoxamine (Luvox) SSRI
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
Term
Tricyclic antidepressant: Clomiprimine (Anafranil)
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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