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N3481 Psychiatric Mental Health Study Guide Exam 2 2019
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N3481 Psychiatric Mental Health Study Guide Exam 2 / N3481 Psychiatric Mental Health Study Guide Exam 2 2019
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lOMoARcPSD|3920845N3481 Psychiatric Mental Health
Study Guide Exam 2
· Compare and contrast objectives with chapter content. Safety is always the first priority.
· Compare, contrast, define and give examples of positive and negative symptoms of schizophrenia
and identify specific medications for each.
o Positive symptoms (Hyperactive mesolimbic pathway)
▪ Hallucinations
▪ Delusions
▪ Disorganized Speech (Associative Looseness)
▪ Bizarre Behavior
o Negative symptoms (Hypofunction of mesocortical pathway)
▪ Blunted affect
▪ Poverty of Thought
▪ Loss of motivation
▪ Inability to experience pleasure of joy (anhedonia)
· Compare, contrast the typical and atypical antipsychotics discussing specific common side and
adverse effects as well as most appropriate patients for these meds.
o Typical (First Generation) (Dopamine Antagonists)
▪ Reduce dopaminergic transmission in the four dopamine pathways
• Mesocortical pathway impairment resulting in cognitive, emotional,
and affective impairments
• Mesolimbic pathway impairment resulting in positive effects
• Nigrostriatal pathway impairment resulting in Extrapyramidal Symptoms
• Tuberinfundibular pathway impairment results in Hyperprolactinemia
▪ Treat positive symptoms of schizophrenia
▪ Much less expensive than atypical antipsychotics
▪ Do not treat the source of the disease
▪ May cause EPS
▪ May cause anticholinergic side effects
▪ May cause sedation, orthostatic hypotension
▪ They may lower the seizure threshold
▪ Limited effect on negative symptoms
o Atypical (Second Generation) (Serotonin-dopamine antagonists)
▪ Diminishes negative as well as positive symptoms
▪ Less side effects encourages medication compliance
▪ Decreases paranoid thoughts and behavior
▪ Disadvantages
• Weight gain
• Metabolic abnormalities
• Increased risk of agranulocytosis, prolongation of QT interval,
neuroleptic malignant syndrome
· Compare, contrast, define and give examples of characteristics associated with schizophrenia such
as thought blocking, poverty of thought, neologisms, word salad, thought insertion/deletion, ideas of
reference, echolalia and give examples of each.
o Thought Blocking
▪ A reduction of stoppage of thought. Interruption of thought by hallucinations can
cause this
o Poverty of Thought
▪ Global reduction in quantity of thought. Also seen in depression
o Neologisms
▪ Words that have meaning for the patient but a different or nonexistent meaning to others.
o Word Salad
▪ Most extreme form of associative looseness, a jumble of words that is meaningless to
the listener.
o Thought insertion/deletion
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▪ The uncomfortable belief that someone else has inserted thoughts into the
brain (INSERTION)
▪ A belief that thoughts have been take or are missing (DELETION)
o Ideas of reference
▪ Beliefs or perceptions that irrelevant, unrelated, or innocuous things are referencing
them directly or have special personal significance
o Echolalia
▪ Pathological repeating of another’s words, occurring perhaps because of the
patient’s thought processes being so impaired that he is unable to generate speech of
his own.
· Compare, contrast, define and give examples of extrapyramidal side effects (EPS) pseudoparkinsonism,
dystonia, akathisia, tardive dyskinesia, and describe assessment tools, nursing interventions and
medication protocols for each.
o Acute dystonia
▪ Sudden, sustained contraction of one or more or several muscle groups, usually of the
head and neck. May be frightening or painful but unless they effect muscle groups of
the airway they are not dangerous. They cause significant anxiety and require prompt
treatment
o Akathisia
▪ Pacing, repetitive movements, inability to stay still. Can be mistaken for anxiety
or agitation
o Pseudoparkinsonism
▪ A temporary group of symptoms that look like Parkinson’s disease: tremor: reduced
accessory movement, reduced facial expression, shuffling gait, slowing of motor
behavior (bradykinesia)
o Tardive Dyskinesia
▪ Persistent EPS, can be permanent
▪ Involuntary rhythmic movement
▪ Usually begins in oral and facial muscles and progresses to include the fingers,
toes, neck, trunk, or pelvis. More common in women.
o Assessment Tools, Interventions, & Nursing Interventions
▪ Diphenhydramine (Benadryl) and Benztropine (Cogentin)
▪ Abnormal Involuntary Movement Scale (AIMS)
▪ Ingrezza (Valbenazine capsules)
• Treatment of tardive dyskinesia
· Compare, contrast, define and give examples of Neuroleptic Malignant Syndrome & Agranulocytosis;
identify specific medications that may cause, describe and discuss symptoms of each and best
practice
interventions and treatments.
o Neuroleptic Malignant Syndrome
▪ Reduced consciousness and responsiveness
▪ Increased muscular rigidity
▪ Autonomic dysfunction
▪ Less likely with SGA’s, more common with FGA’s
▪ Caused by EXCESSIVE dopamine blockade
▪ Mortality rate of 10%
o Agranulocytosis
▪ Most closely associated with clozapine
- Compare, contrast phases of schizophrenia: prodromal, acute or active, and residual and identify what
occurs in each.
o Prodromal
▪ Mild changes in thinking, reality resting, and mood, insufficient to meet the
diagnostic criteria for schizophrenia.
▪ Appear one month to a year before full blown episode
▪ Anxiety, obsessive thoughts, and compulsive behaviors may be present
▪ Deterioration in school/job performance and social functioning
• Person may feel they are “not right” or “something strange” is happening
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o Acute/Active
▪ Symptoms vary from mild to many and disabling.
▪ Hallucinations, delusions, apathy, social withdrawal, diminished affect,
anhedonia, disorganized behavior, impaired judgment, and cognitive regression.
▪ Difficulty coping as symptoms can no longer be concealed
o Residual
▪ Condition is stabilized with new baseline stablished
▪ Positive symptoms are usually absent or diminished but negative symptoms remain
▪ Ideally patient is able to live again independently or with family.
· Discuss strategies and the goals and outcomes for crisis intervention that address the immediate cause
of the crisis and restoration of emotional security and equilibrium
o Resolution depends on the interventions of the individuals and others
· Discuss the importance of assessing coping mechanisms in crisis intervention.
o If the problem is not resolved and coping skills are not effective, then anxiety can overwhelm the
person and lead to serious illness; assess for suicidal thoughts
· Discuss the concept of a crisis including what it is, how to assess, priority concerns and optimal
outcome for the crisis state.
o Crises are acute, time limited occurrences experienced as overwhelming emotional reactions
o Assess for suicidal thoughts and homicidal ideation or plans
o Make the patient feel safe, and lower the anxiety
o Listen carefully
o Maintain direct and creative approaches
o Assess the patient’s support systems
o Identify the needed social supports and rally them
o Identify the needed coping skills
o Plan acceptable interventions
o Schedule regular follow-up care to assess progress
· Compare and contrast the phases of Critical Incident Stress Debriefing (CISD) and Disaster
management continuum giving examples of each.
o CISD is a tertiary intervention directed toward a group that has experienced a crisis
o It is use to debrief:
▪ Staff members on an inpatient unit after the suicide of a patient
▪ Staff members after incidents of patient violence
▪ Crisis hotline volunteers
▪ Schoolchildren and school personnel after shootings
▪ Rescue and health care workers after responding to a natural disaster or terrorist attack.
o Phases
• Introductory phase —Meeting purpose is explained; an overview of the
debriefing process is provided; confidentiality is ensured; guidelines
are explained; team members are identified; and questions are
answered.
• Fact phase —Participants discuss the facts of the incident; participants
introduce themselves, tell their involvement in the incident, and
describe the event from their perspective.
• Thought phase —Participants discuss their first thoughts of the
incident.
• Reaction phase —Participants talk about the worst thing about the
incident—what they would like to forget, what was most painful.
• Symptom phase —Participants describe their cognitive, physical,
emotional, or behavioral experiences at the incident scene and
describe any symptoms they felt following the initial experience.
• Teaching phase e—The normality of the expressed symptoms is
acknowledged and affirmed; anticipatory guidance is offered regarding
future symptoms; the group is involved in stress management
techniques.
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