Psychiatric-Mental Health Certification Study Guide, Study notes of Nursing

Download Psychiatric-Mental Health Certification Study Guide and more Study notes Nursing in PDF only on Docsity! 1 / Study Guide for Psychiatric - Mental Health Certification/latest /must have/24/25 1.Brain Anatomy: Frontal Lobe, Temporal Lobe, Parietal Lobe, Occipital Lobe. 2.Frontal Lobe: *Higher level executive or cognitive functioning - Decision making, planning, organizing, impulse control. *Working memory *Personality 3.Temporal Lobe: *Important for hearing, interpret spoken language, learning and memory, and emotional responses. *Receptive aphasia - Inability to interpret spoken language; failure to receive input as speaker. May result from damage to Wernicke's area. *Auditory hallucinations involve temporal complex. 4.Hippocampus: *Responsible for consolidating long-term memories for facts/events. *Elevated levels of cortisol appear to damage hippocampus. 5.Amygdala: *Located in temporal lobe. *Important for detecting danger, recognizing emotions, recalling emotional aspects of life events. *Consider impairment when excessive fear, emotions, and impulsivity present. 6.Parietal Lobe: *Light touch, pressure, pain, temperature vibration, propriocep- tion. *Dysfunction includes graph-motor problem (drawing clock/copying figure) and spa- tial neglect. 7.Occipital Lobe: *Visual acuity *Visual hallucinations involve the visual cortex. *Damage can cause visual problems such as difficulty recognizing objects, identify- ing colors, and recognizing words. 8.Basal Ganglia: *Important for initiation of voluntary movement. *Dysfunction can contribute to extrapyramidal symptoms. 9.Hypothalamus: *Master regulatory center. *Regulates food and fluid intake, temperature, and pituitary gland 10.Cerebellum: *Movement, balance, and posture. *Ataxia - Wide based gait. *Romberg test - difficulties maintaining balance while eyes closed. 11.Brainstem: *Midbrain, pons, medulla. 2 / *Brainstem cells produce serotonin, dopamine, norepinephrine. *Motor control, mood, memory, motivation, metabolic state *Brain injury below decussation will have effects on same side of injury. *Brain injury above decussation will have impairments on opposite side 12.Neurotransmitters: *Dopamine - Attention and executive function, motivated behaviors, addictions, mood, movement, psychosis. *Serotonin - Mood, anxiety, appetite, eating behavior, sleep. *Epinephrine - Fight or flight response *Norepinephrine - Arousal, concentration, learning and memory, mood, stress. *Acetylcholine - Arousal, cognition, memory, contraction of skeletal muscle. *Glutamate - Excitation. GABA - Inhibition. 13.Heritability of mental disorders: *Bipolar - 85-89% *Schizophrenia - 82-84% *Alcoholism - 52-58% *Anxiety Disorder - 37-43% *Major Depression - 29-42% 14.Dementias: *Alzheimer's - Related to decrease in levels of acetylcholine (ACh). *Vascular - Cognitive functioning declines in stair-step fashion after CVA. *Pick's Disease (Front-temporal impairment) - Atrophy in the frontal and temporal brain regions (neuronal loss, gliosis, masses of cytoskeletal elements) *Lewy Body - Deposition of protein in the neurons. - May have visual hallucinations *HIV/AIDS - Presentation of apathy and cognitive and motor problems. *Tertiary syphilis (Neurosyphilis) 15.Peplau: *Identified nurses' role as participant/observer *Use of self - nurses observe own behavior: strengths, weaknesses, motivations, beliefs, actions, reactions. *Professional boundaries: clarify nurses roles as separate from patients personal relationships. *Nurse avoids social, personal, financial, personal relationship with patient. *Use of self-disclosure: nurses limit sharing of personal information. - Only when brief, focused, and relevant to the goals of therapy. *Avoid giving or receiving gifts. 5 / risk factors and promoting a healthy lifestyle. 28.Secondary Prevention (Screenings): *Actions and interventions promote EARLY DIAGNOSIS of symptoms and/or timely treatment near the beginning of a disorder of disease. *Blood pressure screening, screenings for depression, alcohol abuse, screenings for cognitive ability (dementia). 29.Tertiary Prevention (Teaching r/t existing problems): *Efforts and strategies designed to MINIMIZE handicapping effects of mental disorder and problem behav- iors. *Helping patients to cope more effectively with the necessary adjustments that a serious mental health disorder imposes. *Designed to address challenging behaviors that can be dangerous or disruptive enough to impair education/job achievement/Quality of life. Example: Patient and family engagement with ACT teams. 30.Cluster A personality disorders: *Paranoid - Suspicious, mistrustful, copes by projecting attributes/shortcomings to others to justify actions. *Schizoid - Asocial pattern: aloof, introverted, seclusive, uninterested in social activ- ities, apathetic, unengaged, copes by intellectualizing. 6 / *Schizotypal - Odd, bizarre, strange, magical, eccentric, socially anxious, secretive and private, easily overwhelmed by stimulation, bizarre acts, copes by undoing. 31.Cluster B personality disorders: *Antisocial personality - Impulsive, copes by acting out, i.e. criminal/psychopath. *Borderline personality - Manipulative, demanding, "all or nothing" *Histrionic - Seductive, dramatic, sexualizes relationships, attention- seeking, ex- traverted, superficial relationships. *Narcissistic - Arrogant, entitled, egotistical, sense of superiority. 32.Cluster C personality disorders: *Avoidant - Withdrawn, sensitive to rejec- tion/humiliation, shy and uncomfortable with others, sees self as inferior, copes using fantasy/daydreams. *Dependent - Need for social approval, submissive pattern, clingy, feels inadequate, relates to others in childlike/immature way, copes using introjections (Internalizing belief of others). *Obsessive-compulsive - Meticulous, rigid, disciplined, stubborn, concerned with order and conformity, copes using reaction-formation (doing opposite of feelings). 33.Electroconvulsive Therapy (ECT): *Side effects: reversible memory loss and confusion, headache, nausea, muscle aches. - Maintain NPO status. - 100% Oxygen 5L/min until spontaneous respirations return. - Give anticholinergic drug to minimize oral and respiratory secretions. - Give muscle relaxant to minimize risk of bone fractures or injuries (Succinyl- choline). 34.Disturbances of higher level cognitive function: *Aphasia - Disruption of language function (frontal and temporal lobes). *Apraxia - Disturbance in the organization of voluntary action (e.g., putting on ones clothes). *Agnosia - Disorganization of memory processes (temporal lobe). *Amnesia - Deterioration in intellectual and cognitive function. *Alogia - Poverty of speech. 35.Anorexia: - Refusal to maintain body weight at or above 85% BMI. - Can cause cardiac arrhythmias, amenorrhea (2 missed cycles), bradycardia, tachycardia, hypotension, hypothermia, edema, skin dryness, fine downy hair. - Megace (magestrol) used to increase appetite and prevent weight loss. 36.Bulimia: - Recurrent episodes of binge eating followed by vomiting/laxative abuse. 7 / - Metabolic disturbances, electrolyte abnormalities. - Result in loss of dental enamel, esophageal tears, scars on hand. 10 / (Tofranil), and Nortriptylin (Pamelor). *Have anti-cholinergic effects *Blurred vision, drowsiness - If anti-cholinergic toxicity, physostigmine will reverse symptoms. *Can cause orthostatic Hypotension. *Monitor for ECG changes (blockage of sodium channels can cause cardiac arrhyth- mias, and CNS symptoms/vertigo/seizures. - Also check liver function tests, CBC, thyroid function. - Contraindicated for elders. *Block the absorption (reuptake) of the neurotransmitters serotonin and norepineph- rine, making more of these chemicals available in the brain. - Also block other receptors causing unwanted side effects. *Improvement in energy/sleep in 1-2 weeks, full effect 3-4 weeks. 41.Clozapine (Clozaril) (Anti-psychotic) (300-450 mg daily max. 900 mg): *Risk of developing agranulocytosis (blood disorder in which bone marrow doesn't produce enough neutrophilis) - Flu-like symptoms (High Fever, sore throat, signs of infection) *Mandatory Blood tests (WBC monitored weekly x 6 months then Q2 weeks x 6 months then Q4 weeks). Increased risk for orthostatic hypotension. *Can cause Cardiomyopathy and Myocarditis. *Can contribute to metabolic syndrome (abdominal obesity, raised blood pressure, dyslipidemia (triglycerides/cholesterol), insulin resistance, pro-inflammatory state, pro-thrombic state. *Can contribute to NEUROLEPTIC MALIGNANT SYNDROME (Life threatening). *Muscular rigidity, dystonia, akinesia, mutism, mental dullness, agitation, shaking, altered mental status. 42.Lithium (900-1800 mg/day/divided doses) (Therapeutic level 0.6-1.2 mEq/L): *Used to treat the manic episodes of Bipolar disorder (Anti-convulsant). *Lithium affects the flow of sodium through nerve and muscle cells in the body. - Sodium affects excitation or mania. *Adverse effect: Polyuria/polydipsia (monitor sodium levels) *Renal Disease may reduce renal clearance and increase serum concentration. - Check BUN/Creatinine initially and Q6 months. *Limit sun exposure (increased risk of dehydration). 11 / *Avoid NSAIDS due to decreased renal clearance. *Risk of Lithium Toxicity (>2.0 mEq/L) **Symptoms - Vomiting, Diarrhea 12 / - Course tremors, jerking of arms/legs, difficulty walking. - Slurred speech, blurred vision, marked dizziness, CONFUSION. **Treatment: Fluid replacement, dialysis, SALT THERAPY (As the serum salt level increases, the lithium level decreases), Manage blood pressure. 43.Monoamine Oxidase Inhibitors (MAOIs): *Elevate the levels of norepineph- rine, serotonin, and dopamine by inhibiting an enzyme called monoamine oxidase. *Examples include Phenelzine (Nardil), Isocarboxazid (Marplan), Tranylcypromine (Parnate), Selegiline (Zelepar, Eldepryl, Emsam). *Avoid with other antidepressants (minimum 14 days after stopping MAOI) and certain pain medications (Methadone, Tramadol, cyclobenzaprine). *May cause orthostatic hypotension. *Risk of hypertensive crisis with pseudoephedrine/St/ John's Wort. *Avoid foods containing TYRAMINE (Preserved/aged food, Red Wine, Aged Cheese, Cured/smoked meats) - Can induce HYPERTENSIVE crisis R/T excessive tyramine. - Symptoms: Severe headache, tachycardia, sweating, fever, vomiting. 44.Haldol (Antipsychotic): *Haloperidol blocks receptors for the neurotransmitters (specifically the dopamine and serotonin type 2 receptors) on the nerves. *May cause Orthostatic Hypotension. *Not approved for treatment of Dementia-related behavior problems. *Prescribed with Cogentin (Benztropine) to control for Extra-Pyramidal side effects. - Sudden, often jerky, involuntary motions of the head, neck, arms, body, or eyes. - Including tremor, slurred speech, akathisia, dystonia, anxiety, distress, paranoia, and bradyphrenia (slowed thought process) 45.Antipsychotics: *Geodon (Ziprasidone) 40-200 mg/day. - Risk of QTC prolongation (monitor ECG). *Abilify (Aripiprazole) 10-15 mg BID. - Risk of akathisia, agitation, insomnia, headache, weight gain. *Risperdal (Risperidone) 2-8 mg/day. - Increase risk of hyperprolactinemia > 6 mg/day. *Zyprexa (Olanzapine) 10-20 mg/day. - Risk of metabolic syndrome and significant weight gain. *Seroquel (Quetiapine) 150-750 mg/day.