Understanding Anxiety Disorders, Mood Disorders, and Somatic Illnesses, Exams of Nursing

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NURSING 221 Mental Health Exam Three Modules 7- 8 -9 & 10 Questions with Answers Latest Update T/F Depressed individuals who are newly taking antidepressant medication are at an increased risk for suicide - Correct Answers True T/F Antidepressant medications can be discontinued quickly by a client - Correct Answers False T/F Electroconvulsive therapy can be safely administered to pregnant women - Correct Answers True T/F Depressed individuals can experience a lack of energy known as anhedonia - Correct Answers False T/F A lithium level of 1.6 mEq/L is within the therapeutic range - Correct Answers False (0.6 to 1.2) Kindling Definition - Correct Answers A process by which seizure activity in the brain is initially stimulated by the cumulative effects of stress, low amounts of electrical impulses, or chemicals that sensitize the neuronal pathways Clients taking MAOIs and who eat foods containing tyramine risk experiencing a BLANK, which is potentially fatal - Correct Answers BLANK: hypertensive crisis An individual experiencing mania can exhibit rapidly changing emotions, also known as: - Correct Answers Liable What is the term that refers to having thoughts of killing oneself? - Correct Answers Suicidal Ideation Mild Anxiety Definition - Correct Answers Mild anxiety is a sensation that something is different and warrants special attention. Sensory stimulation increases and helps the person focus attention to learn, solve problems, think, act, feel, and protect him or herself. Mild anxiety often motivates people to make changes or engage in goal-directed activity. Mild Anxiety Physiological Responses: - Correct Answers Restlessness, Fidgeting, GI "butterflies", Difficulty Sleeping, Hypersensitivity to Noise. Moderate Anxiety Definition - Correct Answers Moderate anxiety is the disturbing feeling that something is definitely wrong; the person becomes nervous or agitated. In moderate anxiety, the person can still process information, solve problems, and learn new things with assistance from others. He or she has difficulty concentrating independently but can be redirected to the topic. Moderate Anxiety Physiological Responses: - Correct Answers Muscle Tension, Diaphoresis, Pounding Pulse, Headache, Dry Mouth, Fast Speech, GI Upset, Frequent Urination Severe Anxiety/Panic Definition - Correct Answers As the person progresses to severe anxiety and panic, more primitive survival skills take over, defensive responses ensue, and cognitive skills decrease significantly. A person with severe anxiety has trouble thinking and reasoning. Muscles tighten, and vital signs increase. The person paces; is restless, irritable, and angry; or uses other similar emotional-psychomotor means to release tension. In panic, the emotional-psychomotor realm predominates with accompanying fight, flight, or freeze responses. Adrenaline surge greatly increases vital signs. Pupils enlarge to let in more light, and the only cognitive process focuses on the person's defense. Severe Anxiety Physiological Response: - Correct Answers Severe headache, Nausea, vomiting, and diarrhea, Trembling, Rigid stance, Vertigo, Pale, Tachycardia, Chest pain Panic Physiological Responses: - Correct Answers May bolt and run or totally immobile and mute, Dilated pupils, Increased blood pressure and pulse, Flight, fight, or freeze Nursing Interventions Mild Anxiety: - Correct Answers Mild anxiety is an asset to the client and requires no direct intervention. People with mild anxiety can learn and solve problems and are even eager for information. Teaching can be effective when the client is mildly anxious. Nursing Interventions Moderate Anxiety: - Correct Answers With moderate anxiety, the nurse must be certain that the client is following what the nurse is saying. The client's attention can wander, and he or she may have some difficulty concentrating over time. Speaking in short, simple, and easy-to-understand sentences is effective; the nurse must stop to ensure that the client is still taking in information correctly. The nurse may need to redirect the client back to the topic if the client goes off on a tangent. Nursing Interventions: Panic - Correct Answers During panic anxiety, the person's safety is the primary concern. The nurse must keep talking to the person in a comforting manner, even though the client cannot process what the nurse is saying. Going to a small, quiet, and no stimulating environment may help reduce anxiety. The nurse can reassure the person that this is anxiety, it will pass, and he or she is in a safe place. The 2 Types of Suicide Indexation - Correct Answers Suicidal ideation means thinking about killing oneself. Active suicidal ideation is when a person thinks about and seeks ways to commit suicide. Passive suicidal ideation is when a person thinks about wanting to die or wishes he or she were dead but has no plans to cause his or her death Assessment of Risk for Suicide - Correct Answers A history of previous suicide attempts increases risk for suicide. The first 2 years after an attempt represents the highest risk period, especially the first 3 months. Those with a relative who committed suicide are at increased risk for suicide; the closer the relationship, the greater the risk Priority Intervention for Suicide - Correct Answers Intervention for suicide or suicidal ideation becomes the first priority of nursing care. The nurse assumes an authoritative role to help clients stay safe. In this crisis situation, clients see few or no alternatives to resolve their problems. The nurse lets clients know their safety is the primary concern and takes precedence over other needs or wishes. Anorexia Nervosa - Correct Answers is a life-threatening eating disorder characterized by the client's restriction of nutritional intake necessary to maintain a minimally normal bodyweight, intense fear of gaining weight or becoming fat, significantly disturbed perception of the shape or size of the body, and steadfast inability or refusal to acknowledge the seriousness of the problem or even that one exists. Bulimia Nervous - Correct Answers often simply called bulimia, is an eating disorder characterized by recurrent episodes of binge eating followed by inappropriate compensatory behaviors to avoid weight gain, such as purging, fasting, or excessively exercising. The amount of food consumed during a binge episode is much larger than a person would normally eat. Binge Eating Disorder - Correct Answers is characterized by recurrent episodes of binge eating; no regular use of inappropriate compensatory behaviors, such as purging or excessive exercise or abuse of laxatives; guilt, shame, and disgust about eating behaviors; and marked psychological distress. Night Eating Syndrome - Correct Answers is characterized by morning anorexia, evening hyperplasia (consuming 50% of daily calories after the last evening meal), and nighttime awakenings (at least once a night) to consume snacks. It is associated with life stress, low self-esteem, anxiety, depression, and adverse reactions to weight loss Pica - Correct Answers which is persistent ingestion of nonfood substances Rumination - Correct Answers or repeated regurgitation of food that is then richweed, swallowed, or spit out Orthopraxis Nervous - Correct Answers sometimes called orthopraxis, is an obsession with proper or healthful eating. Anorexia Risk Factors - Correct Answers Obesity, dieting at an early age, Issues of developing autonomy and having control over self and environment; developing a unique identity; dissatisfaction with body image, Family lacks emotional support; parental maltreatment; cannot deal with conflict, Cultural ideal of being thin; media focus on beauty, thinness, fitness; preoccupation with achieving the ideal body Bulimia Nervosa Risk Factors - Correct Answers Obesity; early dieting; possible serotonin and norepinephrine disturbances; chromosome 1 susceptibility, Self- perceptions of being overweight, fat, unattractive, and undesirable; dissatisfaction with body image, Chaotic family with loose boundaries; parental maltreatment including possible physical or sexual abuse, Weight related teasing Types of OCD: Excoriation Disorder - Correct Answers Excoriation disorder, skin- picking, also known as dermatillomania, is categorized as a self-soothing behavior; that is, the behavior is an attempt of people to soothe or comfort themselves, not that picking itself is necessarily a positive sensation. Types of OCD: Trichotillomania - Correct Answers chronic repetitive hair-pulling, is a self-soothing behavior that can cause distress and functional impairment. Onset in childhood is most common, but it can also persist into adulthood with development of anxiety and depression. Types of OCD: BDD - Correct Answers preoccupation with an imagined or slight defect in physical appearance that causes significant distress for the individual and interferes with functioning in daily life. The person ruminates and worries about the defect, often blaming all of life's problems on his or her "flawed" appearance, that is, the appearance is the reason the person is unsuccessful at work or finding a significant other, for feelings of unhappiness, and so forth. Types of OCD: Onychophagia - Correct Answers Chronic nail-biting Types of OCD: Monomania - Correct Answers compulsive buying, is an acquisition type of reward-seeking behavior. The pleasure is in acquiring the purchased object rather than any subsequent enjoyment of its use. Outcome/Goal Anxiety Disorder - Correct Answers For people with anxiety disorders, it is important to emphasize that the goal is effective management of stress and anxiety, not the total elimination of anxiety. Although medication is important to relieve excessive anxiety, it does not solve or eliminate the problem entirely. Learning anxiety management techniques and effective methods for coping with life and its stresses is essential for overall improvement in life quality. Characteristics of Panic Disorder - Correct Answers Panic disorder is composed of discrete episodes of panic attacks, that is, 15 to 30 minutes of rapid, intense, escalating anxiety in which the person experiences great emotional fear as well as physiological discomfort. The onset of panic disorder peaks in late adolescence and the mid-30s. Panic disorder is diagnosed when the person has recurrent, unexpected panic attacks followed by at least 1 month of persistent concern or worry about future attacks or their meaning or a significant behavioral change related to them. Panic Disorder Outcomes - Correct Answers Panic Disorder Outcomes: · The client will be free from injury. · The client will verbalize feelings. · The client will demonstrate use of effective coping mechanisms. · The client will demonstrate effective use of methods to manage anxiety response. · The client will verbalize a sense of personal control. · The client will reestablish adequate nutritional intake. · The client will sleep at least 6 hours per night. First Line and Second Line Medications for GAD - Correct Answers 1st Line GAD: Antidepressants (SNRI**, SSRI, Tricyclic) 2nd Line GAD: Benzodiazepines Generalized Anxiety Disorder - Correct Answers A person with GAD worries excessively and feels highly anxious at least 50% of the time for 6 months or more. Unable to control this focus on worry, the person has three or more of the following symptoms: uneasiness, irritability, muscle tension, fatigue, difficulty thinking, and sleep alterations. Benzodiazepines Teaching: - Correct Answers Short term, no longer than 4 to 6 weeks Avoid other CNS depressants, such as antihistamines and alcohol. Avoid caffeine. Take care with potentially hazardous activities, such as driving. Rise slowly from lying or sitting position. Use sugar-free beverages or hard candy. Drink adequate fluids. Take only as prescribed. Do not stop taking the drug abruptly. Buspirone Teaching - Correct Answers Rise slowly from sitting position. Take care with potentially hazardous activities, such as driving. Take with food. Report persistent restlessness, agitation, excitement, or euphoria to physician. Disruptive Behavior Disorder - Correct Answers Disruptive behavior disorders include problems with the person's ability to regulate his or her own emotions or behaviors. They are characterized by persistent patterns of behavior that involve anger, hostility, and/or aggression toward people and property. Mood Disorders: - Correct Answers Mood disorders interfere with a person's life, plaguing the individual with drastic and long-term sadness, agitation, or elation. Accompanying self-doubt, guilt, and anger alter life activities, especially those that pauses); flight of ideas (racing, often unconnected, thoughts); distractibility; increased activity or psychomotor agitation; and excessive involvement in pleasure-seeking or risk-taking activities with a high potential for painful consequences. The person's mood may be excessively cheerful, enthusiastic, and expansive, or the person may be irritable, especially when he or she is told no or has rules to follow. The person often denies any problems, placing the blame on others for any difficulties he or she experiences. Hypomania Definition - Correct Answers is a period of abnormally and persistently elevated, expansive, or irritable mood and some other milder symptoms of mania. The difference is that hypomanic episodes do not impair the person's ability to function (in fact, he or she may be quite productive) Bipolar I vs. Bipolar II - Correct Answers Bipolar I disorder—one or more manic or mixed episodes usually accompanied by major depressive episodes Bipolar II disorder—one or more major depressive episodes accompanied by at least one hypomanic episode Three Drug Types for Bipolar - Correct Answers Treatment for bipolar disorder involves a lifetime regimen of medications—either an ant manic agent called lithium or anticonvulsant medications used as mood stabilizers. Lithium Atypical Antipsychotics Anticonvulsants Anticonvulsants in Bipolar - Correct Answers used as mood-stabilizing agents in bipolar disorder because they modify nerve cell function. Carbamazepine (Tegretol), lamotrigine (Lamictal), and valproate (Depakote) are currently approved by the FDA for treating bipolar disorder. The drugs are typically used for patients who do not respond to lithium. Several anticonvulsants traditionally used to treat seizure disorders have proved helpful in stabilizing the moods of people with bipolar illness. Lithium Dosing & Required Assessments Prior - Correct Answers It is important to note that doses should be relatively low initially and may increase gradually according to regular measurements of serum drug levels. Before beginning lithium therapy, it is important to obtain baseline studies of renal, cardiac, and thyroid status because adverse drug effects involve these organ systems. Baseline electrolyte studies are also necessary. When lithium therapy begins, it is necessary to measure the serum drug concentration two or three times weekly in the morning, 12 hours (trough) after the last dose of the drug Dosage is based on serum drug levels, control of symptoms, and occurrence of adverse effects. Lithium in Bipolar - Correct Answers Lithium carbonate (Lithonia), the prototype, is a naturally occurring metallic salt that is used in patients with bipolar disorder, mainly to treat and prevent manic episodes. Long term treatment. Atypical Antipsychotics in Bipolar - Correct Answers used to decrease dopamine activity in the treatment of the mania phase of bipolar disorder, including reducing acute mania, psychomotor agitation, and psychosis. Currently, aripiprazole, olanzapine (immunotherapy or combination with fluoxetine), quetiapine, risperidone, and ziprasidone are approved by the FDA for this indication. Anorexia Treatment - Correct Answers Amitriptyline (Elavil) and the antihistamine cyproheptadine (Petrifaction) in high doses (up to 28 mg/day) can promote weight gain in inpatients with anorexia nervosa. Olanzapine (Zyprexa) has been used with success because of its antipsychotic effect (on bizarre body image distortions) and associated weight gain. Fluoxetine (Prozac) has some effectiveness in preventing relapse in clients whose weight has been partially or completely restored Bulimia Treatment - Correct Answers Since the 1980s, many studies have been conducted to evaluate the effectiveness of medications, primarily antidepressants, to treat bulimia. Drugs, such as desipramine (Norpramin), imipramine (Tofranil), amitriptyline (Elavil), nortriptyline (Pamela), phenelzine (Lardil), and fluoxetine (Prozac), were prescribed in the same dosages used to treat depression. In all the studies, the antidepressants were more effective than were the placebos in reducing binge eating. They also improved mood and reduced preoccupation with shape and weight; however, most of the positive results were short term. It may be that the primary contribution of medications is treating the comorbid disorders frequently seen with bulimia. Nursing Interventions for Eating Disorders - Correct Answers -nurse-client contract -stabilizing- highest priority -establish treatment protocols -weight at same time -procedure- some places don't let patient see their weight be obsessed -meals at certain times- maybe smaller meals many times a day -staff interacting appropriately -set time to eat- can't eat over 2 hr, have 30 min to eat -observed for an hour after eating- can't go to bathroom unless you stand there and watch -strict I&O -weighed first thing in morning with same scale -don't talk about food a lot with them-talk about other things -positive reinforcement -don't want to threaten if they don't eat they are going to get NGT forced down and force fed -if status doesn't improve then feeding tube may happen, but don't threaten -after nutrition is stabilized- talk about feelings regarding disorder and gaining weight -heart, BP, skin integrity (dry, don't bathe every day be dry) -look at mucous membrane, oral care very important -change perceptions of body and recognize positive things -develop realistic perception and food relationship -food diary- how do you feel -seen by dietician -if need to lose weight- how to go about it, diet, exercise (not discouraged from plateau) -interdisciplinary team- pharm (antidepressant), psychotherapy, cognitive therapy, family therapy, group therapy, OT, nutrition counselor, social worker -OCD- tricyclic Behavioral Manifestations of OCD - Correct Answers Clients with OCD often seem tense, anxious, worried, and fretful. They may have difficulty relating symptoms because of embarrassment. During assessment of mood and affect, clients report ongoing overwhelming feelings of anxiety in response to the obsessive thoughts, images, or urges. They may look sad and anxious. Many clients describe the obsessions as arising from nowhere during the middle of normal activities. The client recognizes that the obsessions are irrational, but he or she cannot stop them. During exploration of self-concept, the client voices concern that he or she is "going crazy." Feelings of powerlessness to control the obsessions or compulsions contribute to low self-esteem Symptoms: Severe anxiety Nursing Interventions for OCD - Correct Answers Nursing Interventions for OCD: Offer encouragement, support, and compassion. Be clear with the client that you believe he or she can change. Encourage the client to talk about feelings, obsessions, and rituals in detail. Gradually decrease time for the client to carry out ritualistic behaviors. Assist the client in using exposure and response prevention behavioral techniques. Encourage the client to use techniques to manage and tolerate anxiety responses. Assist the client in completing daily routine and activities within agreed-upon time limits. Encourage the client to develop and follow a written schedule with specified times and activities. OCD 1st & 2nd Line Medications - Correct Answers First Line: SSRI Antidepressants - Fluvoxamine (Lenox) & Sertraline (Zoloft) Second Line: second generation antipsychotics- Risperidone (Risperdal), Quetiapine (Seroquel), or Olanzapine (Zyprexa) OCD Treatment - Correct Answers Optimal treatment for OCD combines medication and behavioral therapy. SSRI antidepressants, such as fluvoxamine (Lenox) and sertraline (Zoloft), are first-line choices, followed by venlafaxine (Effexor). Treatment- resistant OCD may respond to second-generation antipsychotics such as risperidone (Risperdal), quetiapine (Seroquel), or olanzapine (Zyprexa). Antianxiety drugs are also used to treat OCD. Depression Nursing Interventions - Correct Answers The priority is to determine whether a client with depression is suicidal. If a client has suicidal ideation or hears voices commanding him or her to commit suicide, measures to provide a safe environment are necessary.