| Anxiety | Obsessive-Compulsive Disorder | Somatic Symptom, Dissociative & Personality Disorders | Patient Intervention & Identification | Substance & Addictive Disorders |
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What is the first line of defense drug for an active panic attack?
benzodiazepines
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What are the signs and symptoms of OCD?
Categorized by recurrent obsessions or compulsions severe enough to be time-consuming or to cause marked distress or significant impairment
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What are the three classes of personality disorders? Describe each of them in 2 sentences or less.
Cluster A: • Paranoid PD, Schizoid PD, Schizotypal PD, Odd or eccentric behaviors
Cluster B: • Antisocial PD, Borderline PD, Narcissistic PD, Histrionic PD, Dramatic, emotional, or erratic behaviors Cluster C: • Dependent PD, Obsessive-Compulsive PD, Avoidant PD, Anxious or fearful behaviors |
John is diagnosed with histrionic personality disorder. What are the signs and symptoms you would expect John to exhibit?
• They’re attention-seeking, distractable, easily influenced by others (dependent)
• Dramatic, Excitable, and Emotional • Attention-seeking • Overly gregarious • Seductive • Manipulative • Exhibitionistic • Highly distractible • Difficulty paying attention to detail • Difficulty forming close relationships • Somatic complaints are common |
What is o Wernicke-Korsakoff syndrome?
• Wernicke's Encephalopathy
• Most serious form of thiamine deficiency w/ Alcohol Use • Symptoms include paralysis of the ocular muscles, diplopia, ataxia, somnolence, and stupor • If thiamine replacement therapy is not undertaken quickly, death will ensue. • Korsakoff's Psychosis • Syndrome of confusion, loss of recent memory, and confabulation • Frequently encountered in clients recovering from Wernicke's encephalopathy • Treatment is with parenteral or oral thiamine replacement |
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What are 5 appropriate interventions for an active panic attack?
REMAIN 1:1, keep patient safe, non-verbal intervention, decrease environmental stimuli, give clear, concise directions- use simple words and encourage deep breaths.
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What differentiates compulsions from obsessions?
Obsessions: Thoughts or Images (what person is obsessing over), Excessive, unwanted, intrusive, and persistent thoughts, impulses, or images causing anxiety and distress, and unable to be expunged by logic or reasoning. Not under the patient’s control; incongruent with the patient’s usual thought patterns
Compulsions - Actions or behaviors (Someone has a compulsory behavior). Repeatedly performed behaviors in a ritualistic fashion. Goal: preventing or relieving anxiety & distress caused by obsessions. Can involve an hour of their day |
What disorder is characterized by unrealistic or inaccurate interpretation of physical symptoms or sensations, leading to preoccupation and fear of having a serious disease?
Illness Anxiety Disorder (type of SSD)
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Stephanie comes into the clinic showing signs of an exaggerated sense of self-worth, an optimistic and cheerful mood; she is self-centered and shows little empathy when talking about her friend going through a hard time. What disorder is Stephanie showing increased symptoms of?
Narcissistic Personality Disorder
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Euphoria, relaxation, pain relief, apathy, detachment, impaired judgment, drowsiness, constricted pupils, nausea, constipation, slurred speech, respiratory depression are all signs of what kind of intoxication?
Opiates.
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What disorder is categorized as chronic, unrealistic, excessive anxiety, and worry for 6 months with no other known cause?
Generalized Anxiety Disorder (GAD)
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What are three nursing diagnoses for obsessive-compulsive disorder?
ineffective coping, ineffective role performance, ineffective ADLs Anxiety, Fear, powerlessness, social isolation, Self-Care Deficit & Deficient Knowledge
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What disorder is characterized by conscious, intentional feigning of physical and/or psychological symptoms? This disorder may also be imposed on another person under the care of the perpetrator or proxy.
Factitious Disorder/ Munchausen syndrome
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What are some nursing interventions you would implement while dealing with a patient experiencing an emotional outburst diagnosed with a borderline personality disorder?
• Establish a therapeutic relationship
• Focusing on strengths • Protection from self-harm, monitor suicidality • Avoid splitting: help them see the grey • Consistent staff • Limit setting and structure; limits on impulsivity • Group therapy |
What are the five medical complications of irresponsible alcohol consumption?
o Peripheral neuropathy - B vitamin deficiency leads to nerve damage, pain, burning, tingling, prickly sensations of extremities
o Alcoholic myopathy - acute or chronic condition, thought to result from same B vitamin deficiency o Alcoholic cardiomyopathy - accumulation of lipids in the myocardial cells (CHF) o Esophagitis - inflammation and pain in the esophagus o Gastritis - inflammation of the stomach lining o Pancreatitis - Acute (occurs 1 or 2 days after a binge) & Chronic (leads to pancreatic insufficiency) o Leukopenia/Thrombocytopenia - Impaired production & function of white blood cells/platelets o Fetal alcohol syndrome o Alcoholic hepatitis - long-term heavy alcohol use leads to enlarged liver; nausea and vomiting; lethargy; anorexia; elevated white blood cell count; fever; and jaundice; also, ascites and weight loss in severe cases o Cirrhosis of the liver - end-stage of alcoholic liver disease and is believed to be caused by chronic heavy alcohol use; widespread destruction of liver cells, which are replaced by fibrous (scar) tissue. • Complications of cirrhosis: Portal hypertension, Ascites, Esophageal varices & Hepatic encephalopathy |
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What disorder is characterized by recurrent unpredictable panic attacks, intense apprehension, and feelings of impending doom accompanied by intense physical discomfort?
Panic D/O
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What are the medications recommended for obsessive-compulsive disorders? Name three.
• Anti-anxiety meds like SSRIs or TCAs (Tricyclics)
• Why SSRIs? The obsessions cause anxiety and distress • Luvox (Fluvoxamine) SSRI • Anafranil (Clomipramine) Tricyclic • Zoloft (Serraline) SSRI • Prozac (Floxetine) SSRI • Paxil (Paroxetine) SSRI |
What are three interventions for somatic symptom disorders?
• Trying to ground the patient and reduce anxiety
• Nursing care of the individual with a somatic symptom disorder is aimed at relief of discomfort from the physical symptoms. • Individual psychotherapy • Group psychotherapy • Behavior therapy • Psychopharmacology/ Meds |
What type of therapy is good for Borderline Personality Disorder?
Dialectical Behavioral Therapy (DBT) - mindfulness, interpersonal effectiveness, distress tolerance, emotional regulation
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What drug can we give to help with Opioid withdrawal?
Clonidine (Catapres)- alpha 2 agonist, reduces symptoms of autonomic hyperactivity during opioid withdrawal: diarrhea, cramps, palpations and sweating (helps with symptoms of opioid withdrawal, it does not reduce opioid cravings)
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Describe six nursing interventions for anxiety.
reduce stimulation, reduce caffeine/stressors, intervene in unhealthy defense mechanisms, encourage healthy coping mechanisms, cognitive restructuring, ventilation of feelings, quiet atmosphere, stay one on one with the patient, and encourage therapy.
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What is the first-line treatment for OCD?
• TCA (Clomipramine)
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List three nursing diagnoses for borderline Personality Disorder.
Risk For Self-Mutilation
Chronic Low Self-Esteem Impaired Social Interaction Ineffective Coping |
Name and describe five interventions for all dissociative disorders.
• Improve coping mechanisms and resolve unresolved trauma/stress
• Assistance is provided to the client in an effort to determine strategies for coping with stress by means other than preoccupation with physical symptoms. • Nursing care of the individual with a somatic symptom disorder is aimed at relief of discomfort from the physical symptoms. • Individual psychotherapy • Hypnosis • Supportive care • Cognitive therapy • Group therapy • Integration therapy (DID) • Psychopharmacology |
Name three Alcohol use disorder Medications and why they are used.
Disulfiram- helps patient stop drinking- • Irreversibly inhibits aldehyde dehydrogenase enzyme (blocks alcohol metabolism).
Naltrexone- Another drug to help with opioid and alcohol dependence. Naltrexone (Revia, Vivitrol) - opioid receptor antagonist, reduces the rewarding & pleasurable effects of alcohol Acamprosate- • Inhibits excitatory glutamate neurotransmission & increases inhibitory gamma-aminobutyric acid (GABA) neurotransmission |
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