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Psychiatric Nursing Bullets, Lecture notes of Nursing

A list of 96 bullet points related to psychiatric nursing. It covers topics such as the stages of death and dying, defense mechanisms, anxiety, alcohol withdrawal, child abuse, Alzheimer's disease, electroconvulsive therapy, bipolar affective disorder, and psychotropic drugs. Each bullet point provides a concise piece of information that can be useful for nursing students studying psychiatric nursing.

Typology: Lecture notes

2022/2023

Available from 03/09/2023

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Bullets PSYCH
1. According to Kübler-Ross, the five stages of death and
dying are denial, anger, bargaining, depression, and
acceptance.
2. Flight of ideas is an alteration in thought processes
that’s characterized by skipping from one topic to
another, unrelated topic.
3. La belle indifférence is the lack of concern for a
profound disability, such as blindness or paralysis that
may occur in a patient who has a conversion disorder.
4. Moderate anxiety decreases a person’s ability to
perceive and concentrate. The person is selectively
inattentive (focuses on immediate concerns), and the
perceptual field narrows.
5. A patient who has a phobic disorder uses self-
protective avoidance as an ego defense mechanism.
6. In a patient who has anorexia nervosa, the highest
treatment priority is correction of nutritional and
electrolyte imbalances.
7. A patient who is taking lithium must undergo regular
(usually once a month) monitoring of the blood lithium
level because the margin between therapeutic and
toxic levels is narrow. A normal laboratory value is 0.5
to 1.5 mEq/L.
8. Early signs and symptoms of alcohol withdrawal
include anxiety, anorexia, tremors, and insomnia.
They may begin up to 8 hours after the last alcohol
intake.
9. Al-Anon is a support group for families of alcoholics.
10. The nurse shouldn’t administer chlorpromazine
(Thorazine) to a patient who has ingested alcohol
because it may cause oversedation and respiratory
depression.
11. Lithium toxicity can occur when sodium and fluid
intake are insufficient, causing lithium retention.
12. An alcoholic who achieves sobriety is called a
recovering alcoholic because no cure for alcoholism
exists.
13. According to Erikson, the school-age child (ages 6 to
12) is in the industry-versus-inferiority stage of
psychosocial development.
14. When caring for a depressed patient, the nurse’s
first priority is safety because of the increased risk of
suicide.
15. Echolalia is parrotlike repetition of another person’s
words or phrases.
16. According to psychoanalytic theory, the ego is the
part of the psyche that controls internal demands and
interacts with the outside world at the conscious,
preconscious, and unconscious levels.
17. According to psychoanalytic theory, the superego is
the part of the psyche that’s composed of morals,
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Bullets PSYCH

  1. According to Kübler-Ross, the five stages of death and dying are denial, anger, bargaining, depression, and acceptance.
  2. Flight of ideas is an alteration in thought processes that’s characterized by skipping from one topic to another, unrelated topic.
  3. La belle indifférence is the lack of concern for a profound disability, such as blindness or paralysis that may occur in a patient who has a conversion disorder.
  4. Moderate anxiety decreases a person’s ability to perceive and concentrate. The person is selectively inattentive (focuses on immediate concerns), and the perceptual field narrows.
  5. A patient who has a phobic disorder uses self- protective avoidance as an ego defense mechanism.
  6. In a patient who has anorexia nervosa, the highest treatment priority is correction of nutritional and electrolyte imbalances.
  7. A patient who is taking lithium must undergo regular (usually once a month) monitoring of the blood lithium level because the margin between therapeutic and toxic levels is narrow. A normal laboratory value is 0. to 1.5 mEq/L.
  8. Early signs and symptoms of alcohol withdrawal include anxiety, anorexia, tremors, and insomnia. They may begin up to 8 hours after the last alcohol intake.
  9. Al-Anon is a support group for families of alcoholics.
  10. The nurse shouldn’t administer chlorpromazine (Thorazine) to a patient who has ingested alcohol because it may cause oversedation and respiratory depression.
  11. Lithium toxicity can occur when sodium and fluid intake are insufficient, causing lithium retention.
  12. An alcoholic who achieves sobriety is called a recovering alcoholic because no cure for alcoholism exists.
  13. According to Erikson, the school-age child (ages 6 to
  1. is in the industry-versus-inferiority stage of psychosocial development.
  1. When caring for a depressed patient, the nurse’s first priority is safety because of the increased risk of suicide.
  2. Echolalia is parrotlike repetition of another person’s words or phrases.
  3. According to psychoanalytic theory, the ego is the part of the psyche that controls internal demands and interacts with the outside world at the conscious, preconscious, and unconscious levels.
  4. According to psychoanalytic theory, the superego is the part of the psyche that’s composed of morals,

values, and ethics. It continually evaluates thoughts and actions, rewarding the good and punishing the bad. (Think of the superego as the “supercop” of the unconscious.)

  1. According to psychoanalytic theory, the id is the part of the psyche that contains instinctual drives. (Remember i for instinctual and d for drive.)
  2. Denial is the defense mechanism used by a patient who denies the reality of an event.
  3. In a psychiatric setting, seclusion is used to reduce overwhelming environmental stimulation, protect the patient from self-injury or injury to others, and prevent damage to hospital property. It’s used for patients who don’t respond to less restrictive interventions. Seclusion controls external behavior until the patient can assume self-control and helps the patient to regain self-control.
  4. Tyramine-rich food, such as aged cheese, chicken liver, avocados, bananas, meat tenderizer, salami, bologna, Chianti wine, and beer may cause severe hypertension in a patient who takes a monoamine oxidase inhibitor.
  5. A patient who takes a monoamine oxidase inhibitor should be weighed biweekly and monitored for suicidal tendencies.
    1. If the patient who takes a monoamine oxidase inhibitor has palpitations, headaches, or severe orthostatic hypotension, the nurse should withhold the drug and notify the physician.
    2. Common causes of child abuse are poor impulse control by the parents and the lack of knowledge of growth and development.
    3. The diagnosis of Alzheimer’s disease is based on clinical findings of two or more cognitive deficits, progressive worsening of memory, and the results of a neuropsychological test.
    4. Memory disturbance is a classic sign of Alzheimer’s disease.
    5. Thought blocking is loss of the train of thought because of a defect in mental processing.
    6. A compulsion is an irresistible urge to perform an irrational act, such as walking in a clockwise circle before leaving a room or washing the hands repeatedly.
    7. A patient who has a chosen method and a plan to commit suicide in the next 48 to 72 hours is at high risk for suicide.
    8. The therapeutic serum level for lithium is 0.5 to 1. mEq/L.
  1. An alcoholic uses alcohol to cope with the stresses of life.
  2. The human personality operates on three levels: conscious, preconscious, and unconscious.
  3. Asking a patient an open-ended question is one of the best ways to elicit or clarify information.
  4. The diagnosis of autism is often made when a child is between ages 2 and 3.
  5. Defense mechanisms protect the personality by reducing stress and anxiety.
  6. Suppression is voluntary exclusion of stress- producing thoughts from the consciousness.
  7. In psychodrama, life situations are approximated in a structured environment, allowing the participant to recreate and enact scenes to gain insight and to practice new skills.
  8. Psychodrama is a therapeutic technique that’s used with groups to help participants gain new perception and self-awareness by acting out their own or assigned problems.
  9. A patient who is taking disulfiram (Antabuse) must avoid ingesting products that contain alcohol, such as cough syrup, fruitcake, and sauces and soups made with cooking wine.
    1. A patient who is admitted to a psychiatric hospital involuntarily loses the right to sign out against medical advice.
    2. “People who live in glass houses shouldn’t throw stones” and “A rolling stone gathers no moss” are examples of proverbs used during a psychiatric interview to determine a patient’s ability to think abstractly. (Schizophrenic patients think in concrete terms and might interpret the glass house proverb as “If you throw a stone in a glass house, the house will break.”)
    3. Signs of lithium toxicity include diarrhea, tremors, nausea, muscle weakness, ataxia, and confusion.
    4. A labile affect is characterized by rapid shifts of emotions and mood.
    5. Amnesia is loss of memory from an organic or inorganic cause.
    6. A person who has borderline personality disorder is demanding and judgmental in interpersonal relationships and will attempt to split staff by pointing to discrepancies in the treatment plan.
    7. Disulfiram (Antabuse) shouldn’t be taken concurrently with metronidazole (Flagyl) because they may interact and cause a psychotic reaction.
    8. In rare cases, electroconvulsive therapy causes arrhythmias and death.
  1. A patient who is scheduled for electroconvulsive therapy should receive nothing by mouth after midnight to prevent aspiration while under anesthesia.
  2. Electroconvulsive therapy is normally used for patients who have severe depression that doesn’t respond to drug therapy.
  3. For electroconvulsive therapy to be effective, the patient usually receives 6 to 12 treatments at a rate of 2 to 3 per week.
  4. During the manic phase of bipolar affective disorder, nursing care is directed at slowing the patient down because the patient may die as a result of self-induced exhaustion or injury.
  5. For a patient with Alzheimer’s disease, the nursing care plan should focus on safety measures.
  6. After sexual assault, the patient’s needs are the primary concern, followed by medicolegal considerations.
  7. Patients who are in a maintenance program for narcotic abstinence syndrome receive 10 to 40 mg of methadone (Dolophine) in a single daily dose and are monitored to ensure that the drug is ingested.
  8. Stress management is a short-range goal of psychotherapy.
  9. The mood most often experienced by a patient with organic brain syndrome is irritability.
    1. Creative intuition is controlled by the right side of the brain.
    2. Methohexital (Brevital) is the general anesthetic that’s administered to patients who are scheduled for electroconvulsive therapy.
    3. The decision to use restraints should be based on the patient’s safety needs.
    4. Diphenhydramine (Benadryl) relieves the extrapyramidal adverse effects of psychotropic drugs.
    5. In a patient who is stabilized on lithium (Eskalith) therapy, blood lithium levels should be checked 8 to 12 hours after the first dose, then two or three times weekly during the first month. Levels should be checked weekly to monthly during maintenance therapy.
    6. The primary purpose of psychotropic drugs is to decrease the patient’s symptoms, which improves function and increases compliance with therapy.
    7. Manipulation is a maladaptive method of meeting one’s needs because it disregards the needs and feelings of others.
    8. If a patient has symptoms of lithium toxicity, the nurse should withhold one dose and call the physician.
    9. A patient who is taking lithium (Eskalith) for bipolar affective disorder must maintain a balanced diet with adequate salt intake.
  1. Chlordiazepoxide (Librium) is the drug of choice for treating alcohol withdrawal symptoms.
  2. For a patient who is at risk for alcohol withdrawal, the nurse should assess the pulse rate and blood pressure every 2 hours for the first 12 hours, every 4 hours for the next 24 hours, and every 6 hours thereafter (unless the patient’s condition becomes unstable).
  3. Alcohol detoxification is most successful when carried out in a structured environment by a supportive, nonjudgmental staff.
  4. The nurse should follow these guidelines when caring for a patient who is experiencing alcohol withdrawal: Maintain a calm environment, keep intrusions to a minimum, speak slowly and calmly, adjust lighting to prevent shadows and glare, call the patient by name, and have a friend or family member stay with the patient, if possible.
  5. The therapeutic regimen for an alcoholic patient includes folic acid, thiamine, and multivitamin supplements as well as adequate food and fluids.
  6. A patient who is addicted to opiates (drugs derived from poppy seeds, such as heroin and morphine) typically experiences withdrawal symptoms within 12 hours after the last dose. The most severe symptoms occur within 48 hours and decrease over the next 2 weeks.
  7. Reactive depression is a response to a specific life event.
  8. Projection is the unconscious assigning of a thought, feeling, or action to someone or something else.
  9. Sublimation is the channeling of unacceptable impulses into socially acceptable behavior.
  10. Repression is an unconscious defense mechanism whereby unacceptable or painful thoughts, impulses, memories, or feelings are pushed from the consciousness or forgotten.
  11. Hypochondriasis is morbid anxiety about one’s health associated with various symptoms that aren’t caused by organic disease.
  12. Denial is a refusal to acknowledge feelings, thoughts, desires, impulses, or external facts that are consciously intolerable.
  13. Reaction formation is the avoidance of anxiety through behavior and attitudes that are the opposite of repressed impulses and drives.
  14. Displacement is the transfer of unacceptable feelings to a more acceptable object.
  15. Regression is a retreat to an earlier developmental stage.
  1. According to Erikson, an older adult (age 65 or older) is in the developmental stage of integrity versus despair.
  2. Family therapy focuses on the family as a whole rather than the individual. Its major objective is to reestablish rational communication between family members.
  3. When caring for a patient who is hostile or angry, the nurse should attempt to remain calm, listen impartially, use short sentences, and speak in a firm, quiet voice.
  4. Ritualism and negativism are typical toddler behaviors. They occur during the developmental stage identified by Erikson as autonomy versus shame and doubt.
  5. Circumstantiality is a disturbance in associated thought and speech patterns in which a patient gives unnecessary, minute details and digresses into inappropriate thoughts that delay communication of central ideas and goal achievement.
  6. Idea of reference is an incorrect belief that the statements or actions of others are related to oneself.
  7. Group therapy provides an opportunity for each group member to examine interactions, learn and practice successful interpersonal communication skills, and explore emotional conflicts.
    1. Korsakoff’s syndrome is believed to be a chronic form of Wernicke’s encephalopathy. It’s marked by hallucinations, confabulation, amnesia, and disturbances of orientation.
    2. A patient with antisocial personality disorder often engages in confrontations with authority figures, such as police, parents, and school officials.
    3. A patient with paranoid personality disorder exhibits suspicion, hypervigilance, and hostility toward others.
    4. Depression is the most common psychiatric disorder.
    5. Adverse reactions to tricyclic antidepressant drugs include tachycardia, orthostatic hypotension, hypomania, lowered seizure threshold, tremors, weight gain, problems with erections or orgasms, and anxiety.
    6. The Minnesota Multiphasic Personality Inventory consists of 550 statements for the subject to interpret. It assesses personality and detects disorders, such as depression and schizophrenia, in adolescents and adults.
    7. Organic brain syndrome is the most common form of mental illness in elderly patients.
    8. A person who has an IQ of less than 20 is profoundly retarded and is considered a total-care patient.
  1. A patient with Korsakoff’s syndrome may use confabulation (made up information) to cover memory lapses or periods of amnesia.
  2. People with obsessive-compulsive disorder realize that their behavior is unreasonable, but are powerless to control it.
  3. When witnessing psychiatric patients who are engaged in a threatening confrontation, the nurse should first separate the two individuals.
  4. Patients with anorexia nervosa or bulimia must be observed during meals and for some time afterward to ensure that they don’t purge what they have eaten.
  5. Transsexuals believe that they were born the wrong gender and may seek hormonal or surgical treatment to change their gender.
  6. Fugue is a dissociative state in which a person leaves his familiar surroundings, assumes a new identity, and has amnesia about his previous identity. (It’s also described as “flight from himself.”)
  7. In a psychiatric setting, the patient should be able to predict the nurse’s behavior and expect consistent positive attitudes and approaches.
  8. When establishing a schedule for a one-to-one interaction with a patient, the nurse should state how long the conversation will last and then adhere to the time limit.
    1. Thought broadcasting is a type of delusion in which the person believes that his thoughts are being broadcast for the world to hear.
    2. Lithium should be taken with food. A patient who is taking lithium shouldn’t restrict his sodium intake.
    3. A patient who is taking lithium should stop taking the drug and call his physician if he experiences vomiting, drowsiness, or muscle weakness.
    4. The patient who is taking a monoamine oxidase inhibitor for depression can include cottage cheese, cream cheese, yogurt, and sour cream in his diet.
    5. Sensory overload is a state in which sensory stimulation exceeds the individual’s capacity to tolerate or process it.
    6. Symptoms of sensory overload include a feeling of distress and hyperarousal with impaired thinking and concentration.
    7. In sensory deprivation, overall sensory input is decreased.
    8. A sign of sensory deprivation is a decrease in stimulation from the environment or from within oneself, such as daydreaming, inactivity, sleeping excessively, and reminiscing.
    9. The three stages of general adaptation syndrome are alarm, resistance, and exhaustion.
  1. A maladaptive response to stress is drinking alcohol or smoking excessively.
  2. Hyperalertness and the startle reflex are characteristics of posttraumatic stress disorder.
  3. A treatment for a phobia is desensitization, a process in which the patient is slowly exposed to the feared stimuli.
  4. Symptoms of major depressive disorder include depressed mood, inability to experience pleasure, sleep disturbance, appetite changes, decreased libido, and feelings of worthlessness.
  5. Clinical signs of lithium toxicity are nausea, vomiting, and lethargy.
  6. Asking too many “why” questions yields scant information and may overwhelm a psychiatric patient and lead to stress and withdrawal.
  7. Remote memory may be impaired in the late stages of dementia.
  8. According to the DSM-IV, bipolar II disorder is characterized by at least one manic episode that’s accompanied by hypomania.
  9. The nurse can use silence and active listening to promote interactions with a depressed patient.
  10. A psychiatric patient with a substance abuse problem and a major psychiatric disorder has a dual diagnosis.
    1. When a patient is readmitted to a mental health unit, the nurse should assess compliance with medication orders.
    2. Alcohol potentiates the effects of tricyclic antidepressants.
    3. Flight of ideas is movement from one topic to another without any discernible connection.
    4. Conduct disorder is manifested by extreme behavior, such as hurting people and animals.
    5. During the “tension-building” phase of an abusive relationship, the abused individual feels helpless.
    6. In the emergency treatment of an alcohol- intoxicated patient, determining the blood-alcohol level is paramount in determining the amount of medication that the patient needs.
    7. Side effects of the antidepressant fluoxetine (Prozac) include diarrhea, decreased libido, weight loss, and dry mouth.
    8. Before electroconvulsive therapy, the patient is given the skeletal muscle relaxant succinylcholine (Anectine) by I.V. administration.
    9. When a psychotic patient is admitted to an inpatient facility, the primary concern is safety, followed by the establishment of trust.
  1. Transvestism is a desire to wear clothes usually worn by members of the opposite sex.
  2. Tardive dyskinesia causes excessive blinking and unusual movement of the tongue, and involuntary sucking and chewing.
  3. Trihexyphenidyl (Artane) and benztropine (Cogentin) are administered to counteract extrapyramidal adverse effects.
  4. To prevent hypertensive crisis, a patient who is taking a monoamine oxidase inhibitor should avoid consuming aged cheese, caffeine, beer, yeast, chocolate, liver, processed foods, and monosodium glutamate.
  5. Extrapyramidal symptoms include parkinsonism, dystonia, akathisia (“ants in the pants”), and tardive dyskinesia.
  6. One theory that supports the use of electroconvulsive therapy suggests that it “resets” the brain circuits to allow normal function.
  7. A patient who has obsessive-compulsive disorder usually recognizes the senselessness of his behavior but is powerless to stop it (ego-dystonia).
  8. In helping a patient who has been abused, physical safety is the nurse’s first priority.
  9. Pemoline (Cylert) is used to treat attention deficit hyperactivity disorder (ADHD).
    1. Clozapine (Clozaril) is contraindicated in pregnant women and in patients who have severe granulocytopenia or severe central nervous system depression.
    2. Repression, an unconscious process, is the inability to recall painful or unpleasant thoughts or feelings.
    3. Projection is shifting of unwanted characteristics or shortcomings to others (scapegoat).
    4. Hypnosis is used to treat psychogenic amnesia.
    5. Disulfiram (Antabuse) is administered orally as an aversion therapy to treat alcoholism.
    6. Ingestion of alcohol by a patient who is taking disulfiram (Antabuse) can cause severe reactions, including nausea and vomiting, and may endanger the patient’s life.
    7. Improved concentration is a sign that lithium is taking effect.
    8. Behavior modification, including time-outs, token economy, or a reward system, is a treatment for attention deficit hyperactivity disorder.
    9. For a patient who has anorexia nervosa, the nurse should provide support at mealtime and record the amount the patient eats.
    10. A significant toxic risk associated with clozapine (Clozaril) administration is blood dyscrasia.
  1. Adverse effects of haloperidol (Haldol) administration include drowsiness; insomnia; weakness; headache; and extrapyramidal symptoms, such as akathisia, tardive dyskinesia, and dystonia.
  2. Hypervigilance and déjà vu are signs of posttraumatic stress disorder (PTSD).
  3. A child who shows dissociation has probably been abused.
  4. Confabulation is the use of fantasy to fill in gaps of memory.