H-psych

1.) Histrionic personality

--are Seductive

opioid withdrawal:

---Yawning ---Muscle aches

An *illusion* is a misperception of an actual stimulus.

A pt. is saying that it sounds like there is a roaring fire in the bathroom. In reality, the client's roommate has just turned the shower on full force.

A nurse is accompanying a client with a diagnosis of *anxiety disorder* who is pacing the halls and crying. When the client's pacing and crying worsen, the nurse suddenly feels uncomfortable and experiences a strong desire to leave. What is the most likely reason for what the nurse is experiencing? ----An empathic communication of anxiety

Because anxiety can be an interpersonal experience, it is *contagious*; the nurse then has a strong urge to get away.

dementia of the Alzheimer type (provide): 1. Simplifying the environment as much as possible and eliminating the need for decisions and choices

Clients with this disorder need a simple environment. Because of brain cell destruction they are unable to make choices.

obsessive-compulsive behavior

Developing a routine schedule of activities to reduce the need for the ritualistic behavior

1.) Borderline personality 2.) Antisocial

Manipulative personality--

In the *triggering phase*, the client's behavior is non-threatening and poses no danger to others.

Minimizing environmental stimuli and providing a calm, non-threatening environment likely will serve to help the client de-escalate and regain control.

s/s of HEROIN withdrawal: --sneezing --yawning --teary eyes

Research indicates that sneezing, yawning, and teary eyes are the first physical signs of withdrawal from heroin

*Suppression* keeps uncomfortable thoughts, feelings, and wishes in the subconscious.

suppression is used rarely by people with alcoholism.

A depressed client is admitted to the hospital after being found bleeding from a superficial self-inflicted gunshot wound. The client does not respond to any of the nurse's questions. What should the nurse do to assess the client's current potential for suicide? 1. Investigate the family's history of suicide. 2. Ask the client why he attempted to commit suicide. 3. Ask the family about any recent suicide attempts or threats by the client. 4. Examine the client for scars on the wrists or other signs of past suicide attempts.

(3) --Because the client refuses to talk, pertinent data must be obtained from the family. Although information on a family history of suicide may eventually be obtained, it does not have immediate relevance to the client's recent behavior. The client is not responding to questions; the client may not know the reason for the attempt. Conclusions about the presence of scars are assumptions and may not be accurate.

Lithium can trigger *hypothyroidism*. Nursing intervention: ----Educating the client regarding the management of hypothyroidism.

--(TSH) thyroid stimulating hormone-- levels-(2 to 10)

Positive symptoms of Schizophrenia:

---Delusions of grandeur ---Agitated Behavior ---Auditory hallucinations

Autism:

---repetitive activities ---Self-injurious behaviors ---Lack of communication with others

*olanzapine* (Zyprexa, Zydis)--Newer atypical antipsychotics--(tx. neg. symptoms) ---It dissolves instantly after oral administration.

Olanzapine (Zyprexa, Zydis) is an orally disintegrating tablet, meaning that it will instantly dissolve on contact with moisture. It can only be given orally.

*Rationalization* is making acceptable excuses for behavior.

this defense is used by people with alcoholism because it makes reality more acceptable.

Early signs of alcohol withdrawal:

--Tremors --Anorexia

When all members of a family blame one member for all their problems, *scapegoating* is occurring.

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With Alcoholics *confront* denial, projection and rationalization.

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situational crisis usually resolves within 1 to 2 months.

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Group Intervention working Phases: 1. The *initial Phase* or *Orientation phase* is characterized by: --High anxiety --Superficial interactions --Testing the therapist to see if he or she can be *trusted*.

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ADJECTIVE (matter-of-fact) ------unemotional and practical: "he was characteristically calm and matter-of-fact"

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A bipolar disorder client with a depressed episode will exhibit: 1. Paucity of verbal expression related to slowed thought processes

..As depression increases, thought processes become slower and verbal expression decreases due to lack of emotional energy.

Panic Disorders and Phobias: --It is a *chronic* condition that has exacerbations and remissions.

1. Acrophobia--Fear of *heights*. 2. Agoraphobia--Fear of crowds or open places. 3. Claustrophobia--Fear of closed-in places. 4. Hydrophobia--Fear of water 5. Nyctophobia--Fear of the *dark*. 6. Thanatophobia--Fear of *death*.

The parents of a* school-age* child tell the nurse that their child is tall, broad, and very active in sports, and so they are planning to enroll the child for strenuous competitive athletics. What is the best response from the nurse? ---"The child is not ready for strenuous activities."

The school-age child may look large and strong, but due to the child's age, he or she may not be ready for strenuous sports activities. The child may be interested in the sports activity, but may not be strong enough for strenuous work.

Malingering is a type of *manipulation* in which false or exaggerated symptoms are used *to obtain* a specific result, such as avoiding work or jail.

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How long after the last dose should the nurse schedule to have a client's blood drawn to evaluate the serum lithium level? ---{8 to 12 hours}

Absorption and excretion of lithium occur 8 to 12 hours after the last dose.

Electroconvulsive Therapy (ECT)- --After ECT: ---Check vitals every 15 min. until client is alert. ---Reorient client--(confusion is likely upon awakening) ---Short-term memory impairment may occur

Common complaints of ECT: --H/A --Muscle soreness --Nausea --Retrograde amnesia

s/s of moderate dementia: --Sundowning --Exaggeration of premorbid traits

Confusion and agitation with an inability to remain asleep that get worse or only occur at night (sundowning) are characteristics of moderate (stage 2) dementia. Moderate dementia is characterized by increasing dependence on environmental and social structures and by increasing psychological rigidity that accentuates previous traits and behaviors.

According to Erikson's developmental psychosocial theory, what is expected by 20 years of age?

Having a coherent sense of self and plans for self-actualization

sertraline (Zoloft)-SSRI-↑serotonin in the synaptic cleft-Antidepressant

S/E: --Dry Mouth --Constipation

*Projection* is the unconscious denial of unacceptable feelings and emotions in one's self while attributing them to others. (blaming someone else)

This defense mechanism commonly is used by clients with alcoholism because it helps make reality more acceptable.

*Older single men* with chronic health problems are at the highest risk of *suicide*.

This is because men have fewer social supports than women do. (Men are less social then women in general.) Less social support at times of stress can increase the risk of suicide. Also, chronic health problems can lead to learned helplessness, which can lead to depression.

Smith's five phase emotional assault cycle.

Triggering Phase Escalation Phase Crisis Phase Recovery Depression phase

Document objective factual assessment data and the client's *exact words* in cases of sexual abuse and rape.

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Children who exhibit behaviors associated with conduct disorder before the age of 10, rather than during adolescence, have a higher incidence of *antisocial personality disorder* during adolescence.

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Cocaine causes dependence due to it: --Blurs reality

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Decreased sodium intake can accelerate lithium retention, resulting in toxicity.

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Eating disorders are prevalent in *industrialized societies* that have an abundance of food; affected individuals likely equate food with pleasure, comfort, and love and may have been nurtured, punished, or rewarded with food.

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Foods high in thiamine: (for alcoholics) 1. lean beef 2. organ meat 3. nuts

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Manifestations of Depression: ---"I don't know" answers to questions ---Apathetic response to the environment (no interest) ---Neglect of personal hygiene

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Referred pain originates in one area of the body and is experienced (referred) in another part of the body that is not receiving the noxious stimulus directly.

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*Bipolar*-- --Irritability --Grandiosity --*Pressured Speech*---{is a tendency to speak rapidly and frenziedly, as if motivated by an urgency not apparent to the listener.}

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*Body dysmorphic disorder* is when a person believes that his or her body is deformed in some manner that is not readily observed by others.

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*Conduct disorder* is an antisocial behavior characterized by violation of laws, societal norms, and the basic rights of others without feelings of remorse or guilt.

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*Nutrition* is a priority in chemically dependent clients.

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*Sublimation* (the rechanneling of anxiety into constructive activities).

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2. The *middle or working phase* is characterized by: --Problem identification --The beginning of problem0solving --The beginning of the group sense of *"we"*.

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3. The *Termination phase* is characterized by: --Evaluation of the experience --The *expression of feelings* ranging from anger to joy.

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*Identification* is the unconscious wish to be like another person.

it is not commonly used by clients with an alcohol problem.

A client is admitted to the acute medical unit for severe *amphetamine intoxication*. Which medications should a nurse anticipate will be prescribed to counteract the effects of stimulant intoxication? Select all that apply. 1. Diazepam 2. Propranolol 3. Benztropine 4. Bupropion 5. Amitriptyline

(1,2) --Because stimulants act by increasing both adrenaline and dopamine, seizures may occur. ---Diazepam (Valium) can reduce the chance of seizures. ----Because amphetamines act by increasing adrenaline, which can stimulate the heart, propranolol (Inderal), a β-blocker, will decrease this adrenergic stimulation. --Benztropine (Cogentin), a cholinergic blocker, is not indicated as a treatment for stimulant intoxication. Bupropion (Wellbutrin) is contraindicated because it increases dopamine and adrenaline, which will exacerbate stimulant intoxication. Amitriptyline is contraindicated because it increases dopamine and adrenalin, which will exacerbate stimulant intoxication.

A depressed client is receiving *paroxetine* (Paxil). The nurse monitors this client for the side effects associated with this drug. Select all that apply. 1. Sexual dysfunction 2. Depressed respiration 3. Insomnia and restlessness 4. Hypertension or hypotension 5. Irregular menses or secondary amenorrhea

(1,3,4)--[SSRI--anticholinergic s/e; wt. Gain; give in the morning to avoid insomnia] --Genitourinary side effects of paroxetine (Paxil) include ejaculatory disorders, male genital disorders, and urinary frequency. --Depressed respiration is associated with opioids that depress the central nervous system (CNS). ---CNS side effects of paroxetine include insomnia, restlessness, dizziness, tremors, nervousness, and headache. ---Cardiovascular side effects of paroxetine include hypertension, orthostatic hypotension, palpitations, and vasodilation. ---Irregular menses and secondary amenorrhea are associated with tiagabine hydrochloride (Gabitril), an antiepileptic used for bipolar disorders.

Before a treatment requiring informed consent can be performed, what information must the client be given? 1. Alternative treatment options 2. The risks and benefits of the treatment 3. The risks involved in refusing the treatment 4. The nature of the problem requiring the treatment

-----For consent to be legal it must be informed. The information provided to the client includes the nature of the problem or condition, the nature and purpose of the proposed treatment, and the risks and benefits of the treatment. Alternative treatment options, the probability that the proposed treatment will be successful, and the risks involved in not consenting to the treatment must also be provided. Cost of the treatment is not considered relevant to informed consent.

The recommended approach for working with suspicious clients is to allow them to set the pace of the relationship. It is less threatening if they are the one to initiate contact.

----By being available on the unit but waiting for the client to approach

The nurse identifies that a client is expressing feelings of self-effacement. Which client assessment supports this conclusion? --Perception that no one is listening

---A perception that no one is listening conveys to others that the client feels too insignificant for anyone to listen. (*Self-effacement*)--the act or fact of keeping oneself in the background

What *defense mechanism* most often used by the physically abusive individual should the nurse include? --Displacement

---Displacement is a defense mechanism in which one's pent-up feelings toward a threatening person are discharged on less threatening others.

*Cognitive therapy* seeks to find underlying self-defeating beliefs and replace them with more reality-based positive beliefs. ----It encourages the use of cognitive restructuring (cognitive reframing) through positive self-talk and a rational mindset.

---Encouraging the client to replace these negative thoughts with positive thoughts. ---Helping the client modify the belief that anything less than perfection is unacceptable.

Somatoform Disorder:--*Conversion Type*-- --is characterized by *transferring* a mental conflict *into a* physical symptom for which there is no organic cause. ex.: blindness, paralysis, seizures, deafness & pseudocyesis (false pregnancy).

---Lack of concern---(La Belle Indifference) s/s: ---Calm ---Matter-of-Fact The symptoms prevent the individual from being forced to act in relation to a conflict or stressor; the client's symptoms thus reduce anxiety and remove the conflict. The individual demonstrates a lack of concern about the symptoms (la belle indifférence).

When planning care for a client who has just completed withdrawal from multiple-drug abuse, the nurse should take into consideration that this client probably is: --Unable to delay gratification (to resist temptation)

--Delayed gratification, or deferred gratification, is the ability to resist the temptation for an immediate reward and wait for a later reward.

*Lithium*--(0.5 to 1.5 mEq/L) ---If level is high--implement seizure precautions

--Teach pt. not to change SALT intake, especially athletes who eliminate salt thru sweating.

Electroconvulsive Therapy (ECT)- --Avoid using the word "shock" ---*atropine sulfate* is usually given 30 min. before tx. to dry oral secretions.

--a quick-acting muscle relaxant (*succinylcholine* [Anectine]) or a general anesthetic agent such as *methohexital sodium* is given to client before ECT.

Generalized anxiety disorders: --lasting *6 months or longer*.

--are unrealistic, excessive, or persistent anxiety and worry about two or more life circumstances.

Alcohol withdrawal symptoms begin shortly as 4 to 6 hours.

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List these client assessments in order of escalating aggression, from the lowest risk to the highest. 1. Increasing tension in facial expression 2. Having difficulty waiting to take turns during a group project 3. Pacing in the hall 4. Engaging in verbal abuse toward the nurse 5. Pushing another client while waiting in line to the dining room

Increasing tension in facial expression indicates increasing anxiety, but the client is still maintaining self-control. Impulsivity, as demonstrated by the inability to take turns with others, indicates that the client is having some difficulty setting limits on his or her own behavior. When anxiety escalates to the point of hyperactivity and pacing behaviors, the client is attempting to cope with the anxiety and to discharge physical and psychic energy. Engaging in verbal abuse may precipitate physical abuse and is a sign that the client is not able to maintain self-control. The laying on of the hands in an offensive manner is a physical act of aggression.

A woman is admitted to the emergency department with trauma that indicates possible abuse. List in priority order the appropriate nursing interventions. 1. Assisting in the treatment of the client's physical injuries 2. Gathering a more in-depth history 3. Encouraging the client to express her feelings 4. Providing information about safe houses

Treatment of physical injuries is always the priority of care. Further information about the client's history is needed to determine whether she is in an abusive situation. Allowing the client to express her feelings in a safe environment establishes trust, which is the foundation of psychosocial interventions. Information about community resources will provide alternatives to remaining in the abusive situation.

*Displacement* is a defense mechanism in which one's pent-up feelings toward a threatening person are discharged on less threatening others.

most often used by the physically abusive individual