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ATI and Psych final review
Psych nursing vocab terms, medications, psychosis, types of behavior a...
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Concepts Of Psychiatric-Mental Health Nursing (NUR 4250)
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Nova Southeastern University
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ATI and final review
Vocabulary
Quizlets: quizlet/403436722/nursing120-final-flash-cards/
Anhedonia - lack of interest, enjoyment or pleasure from life's experiences.
Anosognosia (a.k. "lack of insight") neurological condition that impairs a person's ability to
understand their illness. It's a symptom of severe mental illness, such as schizophrenia
or bipolar disorder. Anosognosia is also associated with dementia and structural brain lesions,
such as those that occur in right hemisphere stroke patients.
Ethical Principles for Client Care
Autonomy: the right to make one’s own personal decisions, even when those decisions
might not be in that person’s own best interest.
Beneficence: action that promotes good for others, without any self-interest.
Fidelity: fulfillment of promises.
Justice: fairness in care delivery and use of resources. Treating all equally and fairly.
Nonmaleficence: a commitment to do no harm (ex: requesting a patient be transferred
to a different ward)
Veracity: a commitment to tell the truth.
Schizophrenia Positive
symptoms
Schizophrenia Negative symptoms
Positive symptoms: Manifestation
of things that are not normally
present. These are the most easily
identified manifestations.
Hallucinations
Paranoia
Delusions of grandeur
Alterations in speech,
clang associations
catatonia
Bizarre behavior (walking
backward constantly),
thoughts, speech
Negative symptoms: Absence of things that are normally
present. These manifestations are more difficult to treat
successfully than positive symptoms.
Affect: Usually blunted (narrow range of expression) or
flat (facial expression never changes).
Alogia: Poverty of thought or speech. The client might
sit with a visitor but only mumble or respond vaguely to
questions.
Anergia: Lack of energy.
Anhedonia: Lack of pleasure or joy. The client is
indifferent to things that often make others happy, such
as looking at beautiful scenery.
Avolition: Lack of motivation in activities and hygiene.
For example, the client completes an assigned task,
such as making their bed, but is unable to start the next
common chore without prompting. Lack of goal-
directed behavior.
Medications
Atomoxetine
Watch for dark urine ->Can lead to liver failure and death
Clozapine - (Clozaril) antipsychotic
will not be administered if the WBC count is not available. If ANC is < 1000 the
medication may be discontinued. Agranulocytosis can occur. Obtain baseline WBC and
monitor weekly, bi-weekly, to monthly per protocol.
Donepezil (cholinesterase inhibitors). Alzheimer’s and dementia.
Improves mental function (such as memory, attention, the ability to interact with others,
speak, think clearly, and perform regular daily activities) by increasing the amount of a
certain naturally occurring substance in the brain.
Sertraline: indicated for panic disorder, OCD, social anxiety disorder, and PTSD.
Benztropine (schizophrenia)
Escitalopram: indicated for GAD and OCD.
Fluoxetine: used for panic disorder, OCD, and PTSD.
Fluvoxamine: used for OCD and social anxiety disorder.
Fluoxetine – (SSRI) - OCD, borderline personality disorder. Used to reduce self-injury and
decrease repetitious behavior.
Antipsychotics: First-generation (conventional)
Select Prototype Medication: Chlorpromazine
Other Medications
Haloperidol, high potency
Fluphenazine, high potency
Loxapine, medium potency
Thiothixene, high potency
Perphenazine, medium potency
Lamotrigine – anticonvulsant – mood stabilizer
If develops a rash - report
Methylphenidate - stimulant, ADHD
tachycardia
Tranylcypromine
Should not take OTC meds like cough suppressants, diet pills, stimulants, ADHD
medications
Adverse affects of medications
Serotonin syndrome
Agitation, confusion, disorientation, difficulty concentrating, anxiety, hallucinations, myoclonus
(spastic, jerky muscle contractions), hyperreflexia, incoordination, tremors, fever, diaphoresis,
hostility, delirium, seizures, tachycardia, labile blood pressure, nausea, vomiting, diarrhea,
abdominal pain, coma leading to apnea, and death in severe cases
Therapy
Dialectical behavior therapy (DBT) – Borderline personality disorder – Provides cognitive and
behavioral techniques for clients who are suicidal and have BPD.
Validation therapy is a humanistic approach to communicating with people who have
dementia. Provides reorientation and validation for the clients who experience and
misperception of reality.
Systematic desensitization – OCD.
Interdisciplinary services – schizoaffective disorder.
Restraints
Document every 15 minutes
Remove one restraint at a time
Explain the need for the restraints to the client and family, emphasizing that the
restraints keep the client safe and are temporary.
Ask the client or guardian to sign a consent form.
Review the manufacturer’s instructions for correct application.
o Assess skin integrity, and provide skin care according to the facility’s protocol, for
example every 2 hr.
o Offer food and fluid.
o Provide a means for hygiene and elimination.
o Monitor vital signs.
o Offer range-of-motion exercises of extremities.
Pad bony prominences to prevent skin breakdown.
Secure/tie restraints to a part of the bed frame that can raise and lower when the bed
controls are used. Do not secure/tie restraints to the side rails of the bed. If restraints
with a buckle strap are not available, use a quick-release knot to tie the strap.
Make sure the restraints are loose enough for range of motion and that there is enough
room to fit two fingers between the restraints and the client.
Remove or replace restraints frequently to ensure good circulation to the area and allow
for full range of motion to the limbs.
Conduct an ongoing evaluation of the client.
Regularly determine the need to continue using the restraints. QS
Never leave the client alone without the restraints.
Check facility policy regarding types of restraints. Many facilities no longer use vest
restraints due to the risk for strangulation.
Document
Precipitating events
Mental Illness
Delirium
Allow time to perform rituals to decrease anxiety
Extreme distractibility
Impairments in memory, judgment, ability to focus, and ability to calculate,
which can fluctuate throughout the day. Disorientation and confusion often
worse at night and early morning.
Level of consciousness is usually altered and can rapidly fluctuate.
There are four types of delirium.
1. Hyperactive with agitation and restlessness
2. Hypoactive with apathy and quietness
3. Mixed, having a combination of hyper and hypo manifestations
4. Unclassified for those whose manifestations do not classify into the
other categories
affect, identity, and relationships, as well as splitting behaviors, manipulation,
impulsiveness, and fear of abandonment; often self-injurious and potentially suicidal;
ideas of reference are common; often accompanied by impulsivity
Histrionic: Shows others easily sway exaggerated emotions and self dramatization.
Characterized by emotional attention-seeking behavior, in which the person needs to be
the center of attention; often seductive and flirtatious
Narcissistic: Characterized by arrogance, grandiose views of self-importance, the need
for consistent admiration, and a lack of empathy for others that strains most
relationships; often sensitive to criticism. Has unrealistic expectations and believes they
should get special treatment. They need extreme admiration of others, have fantasies of
success and demonstrate arrogant behaviors
Cluster C (anxious or fearful traits; insecurity and inadequacy)
Avoidant: Fears of rejection and criticism. Unwilling to get involved socially unless they
feel accepted.. inhibition and avoidance of all situations that require interpersonal
contact, despite wanting close relationships, due to extreme fear of rejection; have
feelings of inadequacy and are anxious in social situations.
Dependent: extreme dependency in a close relationship with an urgent search to find a
replacement when one relationship ends. Needs excessive input from others
Obsessive-Compulsive: Preoccupation with details.. and perfectionism
with a focus on orderliness and control to the extent that the individual might not be
able to accomplish a given task.
Psychotic disorders
Cognitive Findings: Problems with thinking make it very difficult for the client to live
independently.
Disordered thinking
Inability to make decisions
Poor problem-solving ability
Difficulty concentrating to perform tasks
Short-term memory deficits
Impaired abstract thinking
Affective Findings: Manifestations involving emotions
Hopelessness
Suicidal ideation
Unstable or rapidly changing mood
Alterations in thought are false fixed beliefs that cannot be corrected by reasoning and are
usually bizarre. These include the following.
Ideas of reference: Misconstrues trivial events and attaches personal significance to
them, such as believing that others, who are discussing the next meal, are talking about
them
Persecution: Feels singled out for harm by others, such as being hunted down by the FBI
Grandeur: Believes that they are all powerful and important, like a god
Somatic delusions: Believes that their body is changing in an unusual way, such as
growing a third arm
Jealousy: Believes that their partner is sexually involved with another individual even
though there is not any factual basis for this belief
Being controlled: Believes a force outside their body is controlling them
Thought broadcasting: Believes their thoughts are heard by others
Thought insertion: Believes others’ thoughts are being inserted into their mind
Thought withdrawal: Believes their thoughts have been removed from their mind by an
outside agency
Religiosity: Is obsessed with religious beliefs
Magical thinking: Believes their actions or thoughts are able to control a situation or
affect others, such as wearing a certain hat makes them invisible to others
Alterations in speech
Associative looseness: Unconscious inability to concentrate on a single thought. Can
progress to flight of ideas in which the client’s speech moves so rapidly from one
thought to another that it is incoherent.
Neologisms: Made-up words that have meaning only to the client (“I tranged and
flittled”).
Echolalia: The client repeats the words spoken to them.
Clang association: Meaningless rhyming of words, often forceful, such as, “Oh fox, box,
and lox.”
Word salad: Words jumbled together with little meaning or significance to the listener
(“Hip hooray, the flip is cast and wide-sprinting in the forest.”).
Circumstantiality: Including multiple and unneeded details during a conversation, such
as describing in great detail the weather and clothes they are wearing when asked what
their plans are for the day.
Tangentiality: Starts talking about trivial information rather than focusing on the main
topic of conversation, such as talking about what they will have for lunch when the
discussion is about discharge medications.
Types of Psychotic Disorders –
types of psychotic disorders recognized and defined by the DSM-5-TR:
Schizophrenia: The client has psychotic thinking or behavior present for at least 6
months. Areas of functioning, including school or work, self-care, and interpersonal
relationships, are significantly impaired.
Schizotypal personality disorder: The client has impairments of personality (self and
interpersonal) functioning. However, impairment is not as severe as with schizophrenia.
Delusional disorder: The client experiences delusional thinking for at least 1 month. Self
or interpersonal functioning is not markedly impaired.
Brief psychotic disorder: The client has psychotic manifestations that last 1 day to 1
month in duration.
Schizophreniform disorder: The client has manifestations similar to schizophrenia, but
the duration is 1 to 6 months, and social/occupational dysfunction might not be apparent.
Substance abuse
Med for alcohol withdrawal - carbamezepine
PTSD
Feelings of isolation, feelings of detachment and estrangement
Difficulty and hypervigilance
Guided imagery
Will have nightmares, not sleep well
Verbal aggression is a manifestation
Hypervigilance - the nervous system is inaccurately filtering sensory information and the
individual is in an enhanced state of sensory sensitivity.
Anorexia nervosa
Drink 125 mL pf fluid each hour while awake
Weigh in the morning before oral intake
Observe client during meals and for 1 hr following
Planned exercise program only after they reach target weight
Client may have lanugo
Grief
Complicated
Client has difficulty carrying on normal activities following a loss
ECT
Severe MDD
Bipolar disorder, esp. during manic/depressive episodes.
Catatonia
Schizophrenia, esp. with severe symptoms or catatonia.
Suicidal ideation/behavior that poses an imminent risk.
Monitor client’s cardiac rhythm
Client can experience memory loss and confusion
NPO for 6 to 8 hours before treatment.
Remove dentures, glasses, contact lenses, hearing aids, hair pins and etc.
Void before treatment
Preop meds as ordered:
o Give either glycopyrrolate (Robinul) or atropine to prevent the potential
for aspiration and to help minimize bradyarrhythmias in response to electrical
stimulants.
seizure should last 30 to 60 seconds
12 Steps
o The client is responsible for their individual recovery (not their illness)
o The client should have a sponsor when they begin the program (increases
chances of recovery)
Alcohol withdrawal
Incident Reports
Recording of any occurrence that does not meet the standard of care
Report medication errors using the facility’s incident or occurrence form (ATI –
client was administered one-half dose of the prescribed dose of medication).
Therapeutic communication
“What are your concerns about taking this medication?”
Relationship Development
Therapeutic nurse-client relationships can occur only when each views the other as a unique
human being; when this occurs, both participants have needs met by the relationship.
The goal of a therapeutic nursing interaction is to promote client insight and behavioral change
directed toward client growth.
Preinteraction phase
Obtain information about the client from chart, significant others, or other health-team
members
Examine one’s own feelings, fears, and anxieties about working with a particular client
Orientation (introductory) phase
Create an environment for trust and rapport
Establish contract for intervention
Gather assessment data
Identify client’s strengths and weaknesses
Orientation phase
Formulate nursing diagnoses
Sublimation
Undoing
Splitting
Demonstrating an inability to reconcile negative and positive attributes of self or others
into a cohesive image
Adaptive Use: N/A
Maladaptive Use: A client tells a nurse that the nurse is the only one who cares about
them, yet the following day, the client refuses to talk to that nurse.
Anorexia
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ATI and Psych final review
Course: Concepts Of Psychiatric-Mental Health Nursing (NUR 4250)
271 Documents
Students shared 271 documents in this course
University: Nova Southeastern University
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ATI and final review
Vocabulary
Quizlets: https://quizlet.com/403436722/nursing120-final-flash-cards/
Anhedonia - lack of interest, enjoyment or pleasure from life's experiences.
Anosognosia (a.k.a. "lack of insight") neurological condition that impairs a person's ability to
understand their illness. It's a symptom of severe mental illness, such as schizophrenia
or bipolar disorder. Anosognosia is also associated with dementia and structural brain lesions,
such as those that occur in right hemisphere stroke patients.
Ethical Principles for Client Care
Autonomy: the right to make one’s own personal decisions, even when those decisions
might not be in that person’s own best interest.
Beneficence: action that promotes good for others, without any self-interest.
Fidelity: fulfillment of promises.
Justice: fairness in care delivery and use of resources. Treating all equally and fairly.
Nonmaleficence: a commitment to do no harm (ex: requesting a patient be transferred
to a different ward)
Veracity: a commitment to tell the truth.
Schizophrenia Positive
symptoms
Schizophrenia Negative symptoms
Positive symptoms: Manifestation
of things that are not normally
present. These are the most easily
identified manifestations.
Hallucinations
Paranoia
Delusions of grandeur
Alterations in speech,
clang associations
catatonia
Bizarre behavior (walking
backward constantly),
thoughts, speech
Negative symptoms: Absence of things that are normally
present. These manifestations are more difficult to treat
successfully than positive symptoms.
Affect: Usually blunted (narrow range of expression) or
flat (facial expression never changes).
Alogia: Poverty of thought or speech. The client might
sit with a visitor but only mumble or respond vaguely to
questions.
Anergia: Lack of energy.
Anhedonia: Lack of pleasure or joy. The client is
indifferent to things that often make others happy, such
as looking at beautiful scenery.
Avolition: Lack of motivation in activities and hygiene.
For example, the client completes an assigned task,
such as making their bed, but is unable to start the next
common chore without prompting. Lack of goal-
directed behavior.
Medications
Atomoxetine
Watch for dark urine ->Can lead to liver failure and death
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