Exam 2 Mental Health Galen questions and answers final Lithium - Mood stabilizer, used for treatment of bipolar dis order Narrow therapeutic window Lithium Levels - 0.4-1.0 therapeutic 1.5 mild toxicity 1.5-2.0 advanced toxicity 2.0- 2.5 severe toxicity > 2.5 death Signs & Symptoms of Lithium Toxicity - Thirst, Tremors, Vomiting, Diarrhea, Muscle Weakness Bipolar I I Disorder - Episodes of hypomania (elation, high energy, but less than bipolar I) Does not experience psychosis Bipolar I Disorder - Episodes of mania (super elation, super energy, doesn't eat/drink/sleep, takes risks, spends excessive, hypersexual) May have hallucinations What is a priority when a Manic Bipolar I patient arrives at the ED? - 1. Medically evaluate 2. IVF 2. Benzodiazepines Nursing Interventions for Bipolar I Disorder - Limit Stimuli, Safety, Encourage Sleep, Set Limits Benztropine (Cogentin) - Used for treatment of EPS, pseudo -parkinson symptoms Signs & Symptoms of Neuroleptic Malignant Syndrome - Muscle rigidity, board -like, High temperature, diaphoretic, tachycardic Generation Three Antipsychotics - Aripiprazole (Abilify) Better side effect profile than generation one or two Treats positive and negative symptoms of schizophrenia Generation Two Antipsychotics (Atypical) - First line treatment, less chance of EPS Treats positive and negative symptoms of schizo phrenia Clozapine, Olanzapine, Quetiapine, Risperadone, Ziprasidone Metabolic Syndrom - Occurs with generation two antipsychotics (atypical) Weight gain, hyperglycemia, hyperlipidemia Generation One Antipsychotics - Treats positive symptoms of schizo phrenia Extrapyramidal Side Effects Chlorpromazine, Haloperidol, Fluphenazine Catonia - Moves very little or not at all Evaluate for hazards of immobility (edema, cyanosis, injury, skin impairment) Nursing Interventions for Delusions - Do not say yo u believe the delusion, don't try to talk the patient out of the delusion Explore delusion and how they feel about it If afraid of poisoning, let them eat prepackaged or wrapped food to establish trust Paranoid Schizophrenics - Most Dangerous If they feel that someone will harm them, they may assault them You do not know whom they feel is harmful Nursing Interventions for Hallucinations - Non-harmful: divert from hallucination and focus of feelings Command Hallucinations: Explore the halluc ination and assess for safety ("What are the voices saying? Do you recognize them?") Delusions - A thought that is not based upon reality Ex.) You feel that people are trying to hurt you Illusions - You see/ hear something, but perceive it wrong You see an IV pole and believe its a large snake. Hallucinations - Things that are not present, but are perceived through one of the five senses You see spiders on the walls Negative Symptoms of Schizophrenia - Flat affect, anergia, avolition, poverty of speech, no ADLs, anhedonia Positive Symptoms of Schizophrenia - Hallucinations, delusions, illusions, word salad, clang association Causes of Schizophrenia - Increased Levels of Dopamine Genetics/Biologics Environmental Issues Catharsis - Expressin g of feelings or emotions Universality - I am not alone, others share my problems Pre-orientation - Planning
