Psychiatric Nursing Exam: Treatments and Interventions, Exams of Nursing

Download Psychiatric Nursing Exam: Treatments and Interventions and more Exams Nursing in PDF only on Docsity!

Bipolar one disorder DSM five criteria - Correct Answers ✅Manic episode: 1+ week of a colon elevated, expansive or irritable mood and increase energy. 3+ symptoms from B: distractibility, indiscretion, irresponsible, grandiosity, flight of ideas, activity(Increase goal-orient), decreased need for sleep, talkativeness or pressured speech. Bipolar two DSM five criteria - Correct Answers ✅Hypo mania and major depressive disorder: hypo mania same as mania with decreased severity and duration and no functional impairment for episode of four or more days and no psychosis Mixed episodes (bipolar) - Correct Answers ✅Manic and depressive symptoms time by side usually with comorbid substance abuse increased risk of suicide and psychosis rapid cycling - Correct Answers ✅Four or more cycles per year no greater than a week well period Cyclothymia DSM-V Criteria - Correct Answers ✅Two or more years of mood cycling with dysthymia and hypo mania decreased intensity than bipolar disorder meets criteria for hypo mania but does not meet criteria for major depressive disorder Dysthymia DSM five criteria - Correct Answers ✅HE'S 2 SAD depressive symptoms lasting two or more years that is subsydromal

characterized by hopelessness decreased energy, decrease self-esteem for two years, abnormal sleep, abnormal appetite impaired decision- making. MAOÍ Mechanism of action generally - Correct Answers ✅Catalyzes the deamination of monoamines intracellularly and MAO transport Reuptake extracellular monoamines MAO-A Mechanism of action - Correct Answers ✅MAO-A Oxidizes serotonin norepinephrine and epinephrine MAO-B Mechanism of action - Correct Answers ✅Oxidizes phenylalanine MAO-A and MAO-B mechanism of action - Correct Answers ✅Oxidizes dopamine non-preferentially MAOs Neumonic -2 - Correct Answers ✅Date with Tyra banks with wine and cheese in Maui— can cause hypertensive crisis related to tyramine from aged food. MAWIs= my arms weight increased= effective for atypical depression

MAOs adverse effects-6 - Correct Answers ✅Hypertensive crisis, diet restriction, avoid meds, five week after Prozac, two week after other antidepressants, no other medications for two weeks after discontinuing MAOs diet restriction-4 compounds - Correct Answers ✅Tyrosine, high tyramine, tryptophan, phenylalanine Tyrosine foods-10 - Correct Answers ✅Aged cheese, aged wine, fava or broad bean pods, sauerkraut, soy sauce, tap or draft beer, overripe fruit, cured meat, spoiled food MAOs drugs to avoid- 6 - Correct Answers ✅Antidepressants, Dextromethorphan, stimulants, sympathomimetics, meperidine, disulfiram MAOs side effects 11 - Correct Answers ✅Increased weight, drowsy, dizzy, orthostatic hypotension, tremor, headache, dry mouth, constipation, change in sexual drive, peripheral Edema, sweating Tricyclic mechanism of action - Correct Answers ✅Inhibit 5HT2, norepinephrine, dopamine and reuptake slows. Amino group interferes with ASP - 98 in HSERT. Causing down regulation of receptors.

Tricyclic side effects - Correct Answers ✅Anticholinergic effects (dry mouth, blurred vision, constipation, urine retention, impotence). Histamine effects (sedation, increased weight). Adrenergic alpha receptor (postural hypotension). Direct membrane effects (decrease seizure threshold and arrhythmias). 5HT2 receptor (increase weight and decrease anxiety). Amitriptyline dosing/Class - Correct Answers ✅Start at 25 to 50 mg per day, titrate 25 to 50 mg per day per week, Max dose is 300 mg per day/TCA Names of tricyclics 10 - Correct Answers ✅Amitriptyline, nortriptyline, clomipramine, imipramine, protriptyline, doxepin, amoxapine, desipramine, mapratiline, tripramine Tricyclics are useful-2 - Correct Answers ✅Pain, migraine Tricyclics adverse effects-2 - Correct Answers ✅Overdoses are cardiotoxic, high potency increases the risk of mania Nortriptyline mnemonic - Correct Answers ✅No-triptyline equals less sedation and hypotension

Tricyclics mnemonic-2 - Correct Answers ✅Think car goes over tricycle to remember that an overdose is cardiotoxic. Do you remember mechanism think trans =serotonin and norepinephrine Chans= Na+ and Ca+ Ans= ACH and histamine Clomipramine mnemonic/class - Correct Answers ✅TCA- think comipramine for obsessive compulsive disorder Imipramine- pneumonic and class - Correct Answers ✅I'm peeingamine- nocturnal enuresis Unilateral electrode in ECT indications - Correct Answers ✅Typically first line because it has less cognitive side effects but has less efficacy What is ECT? - Correct Answers ✅The use of electrical shock current delivered to the brain to induce a seizure that treats depression. Goal is to reverse atrophy. ECT is FDA approved for what - Correct Answers ✅Bipolar disorder, schizophrenia, schizoaffective disorder, catatonia, neuroleptic malignant syndrome, treatment resistant refractory major depressive disorder

What is ECT schedule - Correct Answers ✅Typically Monday Wednesday Friday for 6 to 12 sessions Bilateral electrode placement in ECT indications - Correct Answers ✅Classic placement increases cognitive side effects but has better efficacy. Reserved for urgency such as life-threatening depression profound distress and catatonia ECT side effects and Risks 8 - Correct Answers ✅Cognitive side effects such as memory loss, head, neck, jaw pain, nausea, myalgia's procedure is low risk What is vagus nerve stimulation - Correct Answers ✅It's an implant in the chest that stimulates the left Vegas nerve by Paul stations and it's controlled by an on off switch that is activated by a magnet How does vagus nerve stimulation work - Correct Answers ✅Stimulates the brain stem nuclei which changes serotonin in the limbic and cortical systems Vagal nerve stimulation side effects-4 - Correct Answers ✅Voice altered, breathlessness, neck pain, no cognitive side effects

Vagus nerve stimulation is FDA approved for what in under investigation for what - Correct Answers ✅FDA approved for epilepsy and under investigation for major depressive disorder and bipolar disorder What is trans cranial magnetic stimulation - Correct Answers ✅Placement of rapid alternating magnets on scalp cause impulse to structures and is focused Goal of trans cranial magnetic stimulation - Correct Answers ✅Firing of neurons will alter pathology Trans cranial magnetic stimulation is FDA approved for and not approved for - Correct Answers ✅Approved for refractory treatment resistant depression It is not approved for bipolar disorder or schizophrenia What is cognitive therapy based on - Correct Answers ✅Negative thinking increase his depression vulnerability, this therapy challenges beliefs and assumptions related to depression Cognitive therapy indications 11 - Correct Answers ✅Depression, anxiety, PTSD, schizophrenia, phobia, OCD, bipolar disorder, sexual disorder, eating disorders, sleep disorders, substance abuse disorders

Cognitive therapy interventions - Correct Answers ✅Automatic thought restructuring, provide evidence just prove beliefs, antidepressants plus cognitive behavioral therapy is greater than just antidepressants and anti-depressants are greater than just cognitive behavioral therapy in efficacy What is interpersonal therapy based on - Correct Answers ✅Based on the theory that depression Arises from problematic patterns and relationships Interpersonal therapy indications 5 - Correct Answers ✅Indicated for depression, grief, interpersonal dispute, role transitions, interpersonal skill deficits Interpersonal therapy interventions 3 - Correct Answers ✅Increase relationship awareness, increase interpersonal skills, communication analysis What is behavioral therapy based on - Correct Answers ✅Deficits in reinforcers like present activities and positive interpersonal contacts increased depression vulnerability Behavioral therapy interventions 3 - Correct Answers ✅Increase activity level, structure goalsetting, interpersonal skills training

Dialectical behavioral therapy is based on - Correct Answers ✅Increasing emotional regulation Dialectical behavioral therapy Indications - Correct Answers ✅Borderline, bulimia, binge eating, PTSD, substance abuse Dialectical behavioral therapy interventions 4 - Correct Answers ✅Increase skills, mindful practice, monitoring/responding to crisis Involuntary commitment reasons - Correct Answers ✅Danger to self, danger to others, and self Neglect Are there main points of involuntary commitment - Correct Answers ✅1. Mental illness/developmental disability or drug/alcohol dependence. 2. It is treatable. 3. It is related to the danger to self or others Broad categories of suicide risk factors - Correct Answers ✅Psychological disorder, Nuro biological factors, social factors, psychological factors Psychological disorders related to suicide - Correct Answers ✅Bipolar is greater than depression however 50% are depressed at time of suicide

Neurobiological factors of suicide - Correct Answers ✅Decrease serotonin, hereditary, increase reaction of H PA system Social factors of suicide - Correct Answers ✅Economic recession, media reports of suicide, social isolation, decrease social belonging Psychological factors of suicide - Correct Answers ✅Decrease problem-solving and life satisfaction, increase hopelessness and impulsivity Suicidal ideation safety mnemonic - Correct Answers ✅DIOSMIO Detained, impatient, observe, sharp, medical clearance, injuries, or occult overdose Likelihood of attempt pneumonic - Correct Answers ✅Guns & ROSES recent attempt, ongoing thoughts, self harm, ethanol, substance abuse Capacity eval mnemonic - Correct Answers ✅CURBSID communicate, understand, risk, benefit, situation, impact, decision Likelihood of violence mnemonic - Correct Answers ✅PV'd MALES previous violence, male, adult, low intelligence, estranged, substance- abuse

Causes of delirium mnemonic - Correct Answers ✅DIMTOP drugs, infection, metabolic derangement, trauma, oxygen deprivation, psychological Substances that increase the risk of violence with intoxication Pneumonic - Correct Answers ✅PISSE PCP, inhalants, stimulants, steroids, ethanol Visual hallucinations medical cause mnemonic - Correct Answers ✅Visual hallucinations from disease of the viscera Signs and symptoms that suggest abuse mnemonic - Correct Answers ✅TEN4 Over & OUT torso, ears, neck, less than four months of age, all over the body, observable pattern, unexposed Body part, timing Suspected child abuse mnemonic - Correct Answers ✅Fuzzy DETAIL details are fuzzy or vague, denied, evolving, tardy, absent, inconsistent, lacking Catatonia mnemonic - Correct Answers ✅Turns a man into a manikin referring to the state of purposeless stupor

What is SIADH? - Correct Answers ✅syndrome of inappropriate antidiuretic hormone- increase ADH production equals more water retention in kidneys equals less serum sodium Medications thought to cause SIADH - Correct Answers ✅Carbamazepine, SSRI, amitriptyline, morphine Mood Disorder Questionnaire (MDQ) - Correct Answers ✅Screens for Bipolar Disorder- 13 questions based on bipolar DSM five criteria, screen every patient with depression MDQ Positive score - Correct Answers ✅Includes 7+ symptoms in question one, question two, moderate severe problem in question three Patient health questionnaire nine - Correct Answers ✅Screen all patients with depressive symptoms, nine question based on DSM five criteria for major depressive disorder Other causes of SIADH - Correct Answers ✅Medications, Traumatic brain injury, infections, cancer, hypothyroid

SIADH dysfunction - Correct Answers ✅Decreased serum osmolality equals increased urine osmolality related to vasopressin in kidney malfunction Patient health questionnaire nine scores - Correct Answers ✅0- equals minimal, 5-9 equals mild, 10-14 equals moderate, 15 or more is moderate or severe DSM five criteria for major depressive disorder - Correct Answers ✅Sad mood or anhedonia for two weeks or more, Plus for the following: sleep changes, cycle motor changes, appetite or weight change, decreased energy, guilt/worthless, difficulty concentrating/thinking/decisions, recurrent thought of suicide/death Major depressive disorder mnemonic - Correct Answers ✅SIGECAPs, Sleep, decrease interest, guilt, decreased energy, decreased concentration, how to say change, psycho motor agitation or retardation, suicide SIGECAPs, sleep, decrease interest, guilt, decreased energy, decreased concentration, how to say change, psycho motor agitation or retardation, suicide - Correct Answers ✅

Medical conditions that look like mania or depression 4 - Correct Answers ✅Substance abuse, metabolic, infection, neurological, cerebrovascular Bipolar disorder brain structure mnemonic - Correct Answers ✅Let's live outrageously forget consequences equals left lateral orbital frontal cortex Differentiating bipolar II disorder mnemonic - Correct Answers ✅BP II Equals lower lows Mania often seen symptoms mnemonic - Correct Answers ✅MANIA more activity not inherently affective. Increase goal directed activity is seen more than elevated mood Depression assessment across the lifespan mnemonic - Correct Answers ✅Reactive PLANETS reactivity, polarity, lability, attributability, normalcy, episodic, treatment response, severity Anti-depressants adverse effects 4 - Correct Answers ✅Serotonin syndrome, mania shift, suicidal ideation, bleeding Don't use anti-depression's with what disorders - Correct Answers ✅Bipolar and borderline personality disorder

Negative affective biased pneumonic - Correct Answers ✅NAB To nab the correct diagnosis and treatment. These patients don't see happiness like happy faces and if the treatment is working they will start to see that Atypical depression Mnemonic - Correct Answers ✅ATE typical increase eating, heaviness/Leaden paralysis/hypersomnia, rejection sensitivity Depression with psychotic features requires treatment with - Correct Answers ✅And anti-depressant and an antipsychotic Trazodone mnemonic - Correct Answers ✅TraZoBONE Z sleep aid, bone for priapism Venlafaxine mnemonic 2 - Correct Answers ✅Think fax because it is fast like a fax because it has rapid metabolism and discontinuation affects vENlafaxine Think hypertENsion like norepinephrine Duloxetine Mnemonic - Correct Answers ✅DUALoxetine for its door mechanism, and DULL oxetine because it can dull pain

Mirtazapine mnemonic - Correct Answers ✅MEALtazipine- related to increased appetite/weight and sedation Bupropion mnemonic 4 - Correct Answers ✅Bu DA NE to remember neurotransmitters. Think butane lighter because it is hot like sex related to no sexual side effects and also think to decrease smoking for smoking cessation. Think BUproprion to remember not to give to those with BUlimia or others at risk for seizures related to decreasing the seizure threshold. You don't use bupropion on with other disorders - Correct Answers ✅Traumatic brain injury, seizure disorder, neurological disorder, those who have had brain surgery, disorders with electrolyte. Abnormalities (eating disorders, severe renal or gastrointestinal issues) Used cautiously in substance abusers related to abuse potential because of psychotic symptoms at high doses. Can increase anxiety irritability and agitation Bupropion dosing - Correct Answers ✅The 12 hour give 100 mg daily to start then increase 100 mg daily every three weeks to a max dose of 200 mg twice a day. The 24 hour start at 150 mg then increase 150 mg each day every week to a maximum of 450 mg per day

Bupropion mechanism of action - Correct Answers ✅Like SSRI/SNRI, inhibits dopamine reuptake, an alpha three beta 4 nicotinic antagonist Bupropion side effects advantages and other uses 7 - Correct Answers ✅No sexual dysfunction, substance abuse especially nicotine, ADHD, increased energy, decreased appetite, good augmentation, low induction of mania Escitalopram adverse effects 2 - Correct Answers ✅QTc prolongation/SI escitalopram dosing - Correct Answers ✅Initial dose is 10 mg per day increase at 10 mg a day per week and the max dose is 30 mg a day Fluoxetine mnemonic - Correct Answers ✅FLUoxetine remember that the flu lasts 1 to 2 weeks which is related to the longer half-life of fluoxetine Fluoxetine interactions - Correct Answers ✅-Warfarin (flux can displace it) -St. John's wort (may cause Serotonin Syndrome) burn up and can overdose -Dabigatran P450 interactions are significant

Sertraline mnemonic - Correct Answers ✅SQUIRTraline related to its adverse effects of increased diarrhea and the benefit of a safe while pregnancy and breast-feeding sertraline indication/benefits - Correct Answers ✅MDD, OCD, PMDD middle of the road antidepressant with no buildup Paroxetine adverse effects - Correct Answers ✅Withdrawal symptoms, more sedating, increase appetite Paroxetine mnemonic - Correct Answers ✅Think pair of oxen related to it works fast and has a short half-life Paroxetine Interactions - Correct Answers ✅Potent CYP 2D6 Inhibitor and substrate equals many interactions Paroxetine dosing - Correct Answers ✅Immediate release start at 20 mg per day and titrate 10 to 20 mg per day per week max dose is 50 mg per day, Extended release start at 25 mg per day increase by 12.5 mg per day each week to a max dose of 62.5 mg

Anti-depressants side effects 10 - Correct Answers ✅Anhedonia, apathy, n/v, drowsy/dizzy, somnolence, headache, bruxism, vivid dreams, fatigue, change in sexual behavior. Antidepressant Mechanism on action - Correct Answers ✅Ser- residue determines potency (hSERT) SSRI (unk exact mech). sertraline dose - Correct Answers ✅Init 20mg/day, titrate 25-50mg/day every 1-2wk, max dose 200mg Fluoxetine indications - Correct Answers ✅Depression, d/c syndrome (give 20mg tab), for activation, noncompliance, and to decrease appetite Citalopram (Celexa) and Escitalopram (Lexapro) Pneumonic - Correct Answers ✅Think car seat for SEATalopram to remember to obtain an Electrocardiogram forQTC prolongation Carbamazepine treats - Correct Answers ✅First line and acute mania, acute/prophylaxis mania, anti-aggressive, rapid cycling, mix patience Carbamazepine labs - Correct Answers ✅Level range is 4-12, LFTs, CBC, EKG, multiple drug to drug interactions

Carbamazepine dosing - Correct Answers ✅100 milligrams a day initially then increase 200 mg per day everyone to four days to a max dose of 1.6 g per day Carbamazepine mnemonic - Correct Answers ✅CBZ Cranial nerve pain, bipolar disorder, seiZures. CarbamASIApine Do you remember that Asian dissent patients have an increased risk of Steven Johnson syndrome and are recommended to be screened Carbamazepine side effects - Correct Answers ✅Water retention, ataxia, n/v/d, rash, dizzy, sedation, confusion, transaminitis Carbamazepine adverse effects - Correct Answers ✅CNS, rash. Rarely SJS/toxic epidermal necrolysis. Black box warning for aplastic anemia, thrombocytopenia, leukopenia. Carbamazepine mechanism - Correct Answers ✅Block voltage- dependent sodium channels, anticholinergic, antidiuretic, antimania, anticonvulsant, antineuralgic, antiarrythmic Valproic Acid (Depakote) mnemonic - Correct Answers ✅ValproATE a folate PLaTe, folate linked to neural tube defects. Pancreatitis, Liver problems (hepatotoxic), Thrombocytopenia

Valproate (Depakote) indications - Correct Answers ✅Mania (equal to Li), comorbid sub. Abuse/anxious, mixed patient, rapid cycling Valproate labs - Correct Answers ✅LFT, HCG, CBC, steady state 4-5 days-12hr after last dose check level/CBC/LFT again, target level 50-125 Valproate side effects - Correct Answers ✅Depakote. liver toxicity, bone marrow depression, nausea, vomiting, amenorrhea (cessation of menstruation), alopecia (excessive hair loss), sedation, tremor and increased weight Valproate Dosing - Correct Answers ✅Initially 500-750mg/day Titrate 250-500mg every 1-3days, Max 1500-2500mg/day Valproate adverse effects - Correct Answers ✅Steven-Johnson syndrome, toxic epidermal necrolysis, NTD, PLT dysfunction, transaminitis, thrombocytopenia Lithium indications - Correct Answers ✅manic episodes in bipolar disorder and maintenance for prevention of such episodes, decreased efficacy in depression symptoms Lithium mnemonic for SEs? - Correct Answers ✅LI: Leukocytosis (increased WBCs)

T: Tremors/Thirst H: Hypothyroidism IU: Increased urine output M: Muscle weakness, mental disorders, memory loss Pregnancy: LIT for Low Implanted Tricuspid (Epstein's anomaly). Side Effects: LMNOP Lithium, Movement, Nephrotoxic, hypOthyroid, Pregnancy Lithium labs to monitor - Correct Answers ✅Li level- 0.6-1.2 after steady state of 5 days, 12 hr after dose, then at dose change or every 3 months, creatinine, HCG, TSH, CBC Lithium dosing - Correct Answers ✅Init 300-600mg/day titrate 300mg/day every 1-5 days to max 1800 mg/day (based on labs) Lithium side effects - Correct Answers ✅Hand tremor, polyuria/dypsia r/t ADH, thirst, muscle weakness, nausea, incoordination, acne, thyroid abnormal, dec. SZ threshold, non-sig leukocytosis, kidney fibrosis Init treatment acute mania and mnemonic - Correct Answers ✅Antipsychotic are quicker, Quietly Lifting Out Quitiepine, Lurazidone and Olanzapine

Lamotrigine mnemonic - Correct Answers ✅LamotrITCHgine r/t rash (Steven-Johnson) LAMOtrigine lamb greater than lion (BP depression) Lamotrigine (Lamictal) indications - Correct Answers ✅epilepsy, seizures, BP depression Lamotrigine (Lamictal) dosing - Correct Answers ✅Init dose 25mg/day, increase 25mg/day every 2wks (faster equals increased risk of rash), max 400mg/day. (If stopped for 5 or more days start again at 25 mg/day Lamotrigine (Lamictal) labs - Correct Answers ✅LFT Lamotrigine (Lamictal) adverse effects - Correct Answers ✅Steven- Johnson, toxic epidermal necrolysis, blood dyscrasias Lamotrigine (Lamictal) interactions - Correct Answers ✅VPA increases dose by double slower titration required and Sertraline increases dose Lamotrigine (Lamictal) side effects - Correct Answers ✅Nausea, diplopia, dizziness, unsteadiness, HA Rash, SJS, Hematologic, liver failure, ataxia, sedation

LAMOtrigine mechanism of action - Correct Answers ✅Na channel effect, possibly inhibits glutamate, weak affect on serotonin