NURS 412 Exam #1

chemically impaired nurse •It is estimated that __-__ percent of nurses suffer from the disease of chemical dependency. •________ is the most widely abused drug, followed closely by _______. •______ ___________ may be present if the person's source is outside the work area. Or, the person may rarely _____work if the substance source is at work. •Diverting patient medications •Increase in "_______" of drugs, higher incidences of ________ narcotic counts, and a higher record of _______ _____ drugs for other nurses may be present. •_____ concentration, difficulty meeting _________, inappropriate___________, and poor memory or recall •Usually _________ for work because not working _________ ability to divert medications. •Problems with ____________ •Irritability, tendency to isolate, elaborate_______ for behavior •__________ appearance, impaired motor coordination, slurred speech, ________ face, frequently using ________, mood swings. •Patient complaints of inadequate pain control, __________ in documentation State board response •May deny, suspend, or revoke a ________ based on a report of chemical abuse by a nurse •Diversionary laws allow impaired nurses to avoid disciplinary action by agreeing to seek___________

10-15 alcohol, narcotics high absenteeism miss wasting, incorrect signing out poor, deadlines, responses present, decreases relationships excuses unkempt flushed, bathroom discrepancies license treatment

essential features of schizophrenia •Diagnosis requires at least ___/5 types of psychotic symptoms one of which must be __________, __________, or ___________ speech. •Duration: at least ____ month cycle (___ month of active symptoms) •Illness usually begins gradually and builds across at least ___ months to full effect. 5 types of psychotic s/sx: 1. __________: a fixed, false belief not consistent w a person's intelligence or cultural background. the person cont to have the belief in spite of obvious proof that it is false and/or irrational (________ like president of USA) 2. _________: false sensory perceptions not assoc. w real external stimuli, may involve any of the 5 senses. ___________ (voice telling you what you have to do, the nurse needs to know what the voices are saying) •___________: false perceptions of sound; (_______ _________) •________ false visual perceptions that may consist of formed images, such as ppl, or of unformed images, such as flashes of light. •_________: false perceptions of the sense of touch, often of something on or under the skin. (___________: sensation that something is crawling on or under the skin) •_____________: false perception of taste (described as unpleasant tastes) •_____________: false perceptions of the sense of smell 3. __________ __________: AKA loose associations, mental associations are governed not by logic but by rhymes, puns, and other rules not apparent to the observer, or by no evident rule at all. To be regarded as psychotically disorganized, the speech must be so badly impaired that it interferes with ________________ 4. ____________ Behavior : not functioning on reality of what's happening 5. ____________ Symptoms: absence of things that are normally present - affect: usually ___________ (narrow range of expression) or _____ (facial expression never changes - _________: poverty of thought or speech. the pt may sit with a visitor but only mumble or respond vaguely to questions - _________: lack of energy - _____________: lack of pleasure or joy. the pt is indifferent to things that often make others happy, such as beautiful scenery; linked to an increased risk of _________ - ____________: lack of motivation in activities and hygiene

2 delusions, hallucinations, disorganized 6, 1 6 delusions acting hallucinations command auditory, hearing voices visual tactile formication gustatory olfactory disorganized speech communication abnormal negative blunted, flat alogia anergia anhedonia suicide avolition

•Alcohol withdrawal: Occurs within ___-____ hours of cessation of or reduction in heavy and prolonged alcohol use •The following withdrawal symptoms may occur: coarse ______ of hands, tongue, or eyelids; nausea or vomiting; malaise or _______; _____cardia; _________; elevated ___; ________; depressed mood or irritability; transient hallucinations or illusions; headache; and ________. In about 1% of alcoholic patients complicated withdrawal syndrome may progress to alcohol withdrawal _______ and concomitant medical problems may increase the risk.

4-12 tremor weakness tachy sweating BP anxiety insomnia delirium

Atypical antipsychotics - ____________ (Risperdal) THERAPEUTIC US: Treats both positive and negative symptoms of ________ ADVERSE DRUG REACTIONS • _______, insomnia, _________, and other CNS effects • Extrapyramidal effects (_______, _________, __________-like symptoms) - occur with higher doses of risperidone (but less often than with conventional antipsychotics) • Weight ___ , onset of new _________ or worsening of existing diabetes, increased __________ levels INTERVENTIONS • Monitor for drowsiness, insomnia, dizziness, and other CNS effects • Prepare to treat acute ________ with anticholinergic drug as prescribed • Prepare to treat __________ symptoms with anti-Parkinson drugs • Monitor ______, _________, and cholesterol/triglyceride levels periodically ADMINISTRATION • Mix _____ solution with juice, milk, water, or coffee; do not use tea or soft drinks • Remove rapidly disintegrating form from packaging immediately before administration • Administer long-acting IM form (Risperdal Consta) every ___ weeks using large gluteal muscle and supplied needle • Continue giving oral risperidone for ___ weeks after Risperdal Consta therapy has started CLIENT INSTRUCTIONS • Instruct client not to _____ or operate hazardous equipment until CNS effects are known • Instruct client to report symptoms of ___________ effects to provider • Instruct client to increase _______, eat a diet low in _____, ____, and calories • Instruct client to report ______ • Instruct diabetic clients to monitor ____ more closely CONTRAINDICATIONS • Psychosis related to __________ in older adults (increased risk of stroke) • Exposure to sunlight • Lactation • Children ( <5 for autism; <10 for BPD; <13 for schizophrenia) INTERACTIONS • May decrease effects of ___________ drugs • May increase effects of __________ drugs • __________ increases risperidone levels • Phenytoin, carbamazepine, phenobarbital, and rifampin _______ risperidone levels

Risperidone schizophrenia drowsiness, dizziness dystonia, akathisia, parkinson gain, DM, cholesterol dystonia parkinson weight, BG oral 2 3 drive extrapyramidal exercise, sugar, fat 3 P's BG dementia anti-Parkinson's antihypertensive clozapine decrease

A client, diagnosed with paranoid schizophrenia, states, "My roommate is plotting to have others kill me." Which is the appropriate nursing response? A."I find that hard to believe." B."What would make you think such a thing?" C."I know your roommate. He would do no such thing." D."I can see why you feel that way."

a

A polysubstance abuser makes the statement, "The green and whites do me good after speed." How might the nurse interpret the statement? a. The client abuses amphetamines and anxiolytics. b. The client abuses alcohol and cocaine. c. The client is psychotic. d. The client abuses narcotics and marijuana.

a

Brandon, a patient on the psychiatric unit, has been diagnosed with schizophrenia. He begins to tell the nurse about how the CIA is looking for him and will kill him if they find him. Brandon's belief is an example of which of the following? a. Delusion of persecution b. Delusion of reference c. Delusion of control or influenced. d. Delusion of grandeur

a

Dan begins attendance at AA meetings. Which of the following statements by Dan reflects the purpose of this organization? a. "They claim they will help me stay sober." b. "I'll dry out in AA, then I can have a social drink now and then." c. AA is only for people who have reached the bottom." d. If I lose my job, AA will help me find another."

a

Dan, who has been admitted to the alcohol rehabilitation unit after being fired for drinking on the job, states to the nurse, "I don't have a problem with alcohol. I can handle my booze better than anyone I know. My boss is a jerk! I haven't missed any more days than my coworkers." The defense mechanism that Dan is using is: a. Denial b. Projection c. Displacement d. Rationalization

a

Eric is a staff nurse on a surgical unit. He has been selected as leader of a newly established group of staff nurses organized to determine ways to decrease the number of medication errors occurring on the unit. Eric has definite ideas about how to bring this about. He has also applied for the position of Head Nurse on the unit and believes that if he is successful in leading the group toward achievement of its goals, he can also facilitate his chances for promotion. At each meeting, he addresses the group in an effort to convince the members to adopt his ideas. Which type of group and style of leadership is described in this situation? a. Task; autocratic b. Teaching; autocratic c. Self-help; democratic d. Supportive-therapeutic; laissez-faire

a

For the past 3 days, a student has skipped classes, cried constantly, experienced panic attacks, and is now exhibiting difficulty with short-term memory. In her assessment of this student, what crucial information should the nurse initially obtain prior to planning interventions? a)The student's description of the precipitating stressor b)The student's usual ability to cope with stress c)The student's available support system d)The student's access to community resources

a

Most cultures label behavior as mental illness on the basis of which of the following criteria? A. Incomprehensibility and cultural relativity B. Strength of character and ethics C. Goal directedness and high energy D. Creativity and good coping skills

a

Mr. White is admitted to the hospital after an extended period of binge alcohol drinking. His wife reports he had been a heavy drinker for a number of years. Labs report he has a blood alcohol of 250 mg/dL. He is placed on the chemical addiction unit for detoxification. When would the first signs of alcohol withdrawal symptoms be expected? A. Several hours after the last drink B. 2-3 days after the last drink C. 4-5 days after the last drink D. 6-7 days after the last drink

a

Sandra is the nurse leader of a supportive-therapeutic group for individuals with anxiety disorders. Violet, who is beautiful but lacks self-confidence, states to the group, "maybe if I became a blonde, my boyfriend would love me more." Larry responds, "Listen dummy, you need more than blonde hair to keep the guy around. A bit more in the brains department would help!" What type of member role is Larry assuming in this group? a.aggressor b. monopolizer c. blocker d. seducer

a

Amanda's mobile home was destroyed by a tornado. Amanda received only minor injuries but is experiencing disabling anxiety in the aftermath of the event. This type of crisis is called a.crisis resulting from traumatic stress. b.maturational/developmental crisis. c.dispositional crisis. d.crisis of anticipated life transitions. The most appropriate crisis intervention with Amanda (from question 3) would be to a. encourage her to recognize how lucky she is to be alive. b. discuss stages of grief and feelings associated with each. c. identify community resources that can help Amanda. d. suggest that she find a place to live that provides a storm shelter.

a b

____________: acceptance conveys an attitude of understanding and willingness to interact •Ex: "yes, I understand what you said."; eye contact/ ___________

accepting

nursing interventions for pt w schizophrenia and dx with social isolation related to inability to trust, panic anxiety, weak ego development, delusional thinking, regression 1. convey an __________ attitude by making ____, ______ contacts 2. show unconditional _________ _______ 3. ________ to be with pt during group activities that they find ________ or difficult 4. give _________ and ________ reinforcement for pts voluntary ___________ w others outcome criteria: - short term goal: pt will _______ attend therapy activities accompanied by trusted staff member w/in __ week - long-term goal: pt will ____________ spend time with other pts and staff members in group therapeutic activities

accepting, brief, frequent positive regard offer, frightening recognition, positive interactions willingly 1 volunatrily

Certain symptoms, such as feeling _________ and having ____________, usually go away within days of starting an antipsychotic medication. Symptoms like __________ usually go away within a few weeks, but the full effects of the medication may not be seen for up to ______ weeks. When a doctor says it is okay to stop taking a medication, it should be gradually _________ off— never ________ suddenly. Many people must stay on an antipsychotic continuously for months or years in order to stay well; treatment should be ___________ for each individual.

agitated hallucinations delusions 6 tapered stopped individualized

predisposing factors to substance-related disorders Biological factors •Genetics: Apparent hereditary factor, particularly with __________ •Biochemical: Alcohol may produce morphine-like substances in the brain that are responsible for ________ addiction. Psychological factors •Developmental influences -__________ __________ -Fixation in the ______ stage of psychosexual development • ____________ factors: Certain personality traits are thought to increase a tendency toward addictive behavior. • ___________ factors: Irrational thinking patterns have long been identified as a problem that is central in addictions. Sociocultural factors •_________ ___________: Children and adolescents are more likely to use substances with parents who provide model for substance use. -Use of substances may also be promoted within ____ group. -__________: Pleasurable effects from substance use act as a positive reinforcement for continued use of substance. • _______ and ethnic influences: Some cultures are more prone to substance abuse than are others.

alcoholism alcohol punitive superego oral personality cognitive social learning peer conditioning cultural

Anna, age 72, has been grieving the death of her dog, Lucky, for 3 years. She is not able to take care of her activities of daily living, and wants only to make daily visits to Lucky's grave. Her daughter has likely put off seeking help for Anna because: a. women are less likely to seek help for emotional problems than men are b. relatives often try to "normalize" the behavior, rather than label it mental illness c. she knows that all older people are expected to be a little depressed d. she is afraid that the neighbors "will think her mother is crazy"

b

Dan, who has been admitted to the alcohol rehabilitation unit after being fired for drinking on the job, states to the nurse, "I don't have a problem with alcohol. I can handle my booze better than anyone I know. My boss is a jerk! I haven't missed any more days than my coworkers." The nurse's best response is: a. "Maybe your boss is mistaken, Dan." b. "You are here because your drinking was interfering with your work, Dan." c. Get real, Dan! You're a boozer and you know it!" d. Why do you think your boss sent you here, Dan?"

b

From which of the following symptoms might the nurse identify a chronic cocaine user? a. clear, constricted pupils b. red, irritated nostrils c. muscle aches d. conjunctival redness

b

Josh, age 21, has been diagnosed with schizophrenia. He has been socially isolated and hearing voices telling him to kill his parents. He has been admitted to the psychiatric unit from the emergency department. The initial intervention for Josh is to: a. Give him an injection of haloperidol. b. Assess Josh to evaluate his safety toward himself and others. c. Place him in restraints. d. Order him a nutritious diet.

b

Nicole is the nurse leader of a childbirth preparation group. Each week, she shows various films and sets out various reading materials. She expects the participants to utilize their time on a topic of their choice or practice skills they have observed on the films. Two couples have dropped out of the group, stating, "This is a big waste of time." Which type of group and style of leadership is described in this situation? a. Task; democratic b. Teaching; laissez-faire c. Self-help; democratic d. Supportive-therapeutic; autocratic

b

Sandra is the nurse leader of a supportive therapeutic group for individuals with anxiety disorders. In this group, Helen talks incessantly. When someone else tries to make a comment, she refuses to allow him or her to speak. What type of member role is Helen assuming in this group? a aggressor b. monopolizer c. blocker d. seducer

b

The client hears the word "match." The client replies, "A match. I like matches. They are the light of the world. God will light the world. Let your light so shine." Which communication pattern does the nurse identify? A.Word Salad B.Loose Association C.Clang Association D.Ideas of Reference

b

The nurse is interviewing a patient on the psychiatric unit. The patient tilts his head to the side, stops talking in midsentence, and listens intently. The nurse recognizes these behaviors as a symptom of the patient's illness. What is the most appropriate nursing intervention for this symptom? a. Ask the patient to describe his physical symptoms. b. Ask the patient to describe what he is hearing. c. Administer a dose of benztropine. d. Call the physician for additional orders.

b

Which of the following is the primary goal in working with an actively psychotic, suspicious patient? a. Promote interaction with others. b. Decrease his anxiety and increase trust. c. Improve his relationship with his parents. d. Encourage participation in therapy activities.

b

Which of the following medications is the physician most likely to order for a client experiencing alcohol withdrawal syndrome? a. Haloperidol (Haldol) b. Chlordiazepoxide (Librium) c. Methadone (Dolophine) d. Phenytoin (Dilantin)

b

Which of the following statements by Anna might suggest that she is achieving resolution of her grief over Lucky's death? a."I don't cry anymore when I think about Lucky." b."It's true. Lucky didn't always mind me. Sometimes he ignored my commands." c."I remember how it happened now. I should have held tighter to his leash!" d."I won't ever have another dog. It's just too painful to lose them."

b

Marie, age 56, is the mother of five children. Her youngest child, who had been living at home and attending the local college, recently graduated and accepted a job in another state. Marie has never worked outside the home and has devoted her life to satisfying the needs of her husband and children. Since the departure of her last child from home, Marie has become more and more despondent. Her husband has become very concerned and takes her to the local mental health center. This type of crisis is called a.dispositional crisis. b.crisis of anticipated life transitions. c.psychiatric emergency. d.crisis resulting from traumatic stress. The most appropriate nursing intervention with Marie (from question 9) would be to a.refer her to her family physician for a complete physical examination. b.suggest she seek outside employment now that her children have left home. c.identify convenient support systems for times when she is feeling particularly despondent. d.begin grief work and assist her to recognize areas of self-worth separate and apart from her children.

b d

A patient recently admitted to the hospital reports to the nurse, "I don't understand why I was brought here. I was simply hanging out in my apartment, and the police said I had to come with them." This is an example of what symptom of schizophrenia? a. Delusions of reference b. Loose association c. Anosognosia d. Auditory hallucinations

c

Carol is the nurse leader of a bereavement group for widows. Nancy is a new member. She listens to the group and learns that Jane has been a widow for 5 years. Jane has adjusted well, and Nancy thinks maybe she can too. This is an example of which therapeutic factor? a. Universality b. Imitative behavior c. Installation of hope d. Imparting of information

c

Dan has been admitted to the alcohol rehabilitation unit after being fired for drinking on the job. Dan's drinking buddies come for a visits, and when they leave, the nurse smells alcohol on Dan's breath. Which of the following would be the best intervention with Dan at this time?a. search his room for evidence b. Ask, "Have you been drinking alcohol, Dan?" c. send a urine specimen from Dan to the lab for drug screening. d. Tell Dan, "These guys cannot come to the unit to visit you again."

c

Lucky sometimes refused to obey Anna and, indeed, did not come back to her when she called to him on the day he was killed. But Anna continues to insist "he was the very best dog. He always minded me. He did everything I told him to do" This represents the defense mechanism of: a. sublimation c. reaction formation b. compensation d. undoing

c

Symptoms of alcohol withdrawal include: a. euphoria, hyperactivity, and insomnia b. depression, suicidal ideation, and hypersomnia c. diaphoresis, nausea and vomiting, and tremors d. unsteady gait, nystagmus, and profound disorientation

c

The nurse is caring for a patient with schizophrenia. Orders from the physician include haloperidol (Haldol) 5 mg. IM STAT and then 3 mg PO tid, 2 mg benztropine PO bid prn. Why is haloperidol ordered? a. To reduce extrapyramidal symptoms b. To prevent neuroleptic malignant syndrome c. To decrease psychotic symptoms d. To induce sleep

c

The nurse is interviewing a patient on the psychiatric unit. The patient tilts his head to the side, stops talking in mid sentence, and listens intently. The nurse recognizes from these signs that the patient is likely experiencing which of the following? a. Somatic delusions b. Catatonic stupor c. Auditory hallucinations d. Pseudoparkinsonism

c

The nurse leader is explaining about group "curative factors" to members of the group. She tells the group that group situations are beneficial because members can see that they are not alone in their experiences. This is an example of which curative factor? a. altruism b. imitative behavior c. universality d. imparting of information

c

Three years ago, Anna's dog Lucky, whom she had for 16 years, was run over by a car and killed. Anna's daughter reports that since that time, Anna has lost weight, rarely leaves her home, and just sits and talks about Lucky. Anna's behavior would be considered maladaptive because: a. it has been more than 3 years since Lucky died b. her grief is too intense just over the loss of a dog c. her grief is interfering with her functioning d. people in this culture would not comprehend such behavior

c

Which of the following is a correct assumption regarding the concept of crisis? a. Crises occur only in individuals with psychopathology. b. The stressful event that precipitates crisis is seldom identifiable. c. A crisis situation contains the potential for psychological growth or deterioration. d. Crises are chronic situations that recur many times during an individual's life.

c

Jenny reported to the high school nurse that her mother drinks too much. She is drunk every afternoon when Jenny gets home from school. Jenny is afraid to invite friends over because of her mother's behavior. This type of crisis is called a. crisis resulting from traumatic stress. b. maturational/developmental crisis. c. dispositional crisis. d. crisis reflecting psychopathology The most appropriate nursing intervention with Jenny (from question 5) would be to a. make arrangements for her to start attending Al-Ateen meetings. b. help her identify the positive things in her life and recognize that her situation could be a lot worse than it is. c. teach her about the effects of alcohol on the body and that it can be hereditary. d. refer her to a psychiatrist for private therapy to learn to deal with her home situation.

c a

Andrew, a New York City firefighter, and his entire unit responded to the terrorist attacks at the World Trade Center. Working as a team, he and his best friend, Carlo, entered the area together. Carlo was killed when the building collapsed. Andrew was injured but survived. Since that time, Andrew has had frequent nightmares and anxiety attacks. He says to the mental health worker, "I don't know why Carlo had to die and I didn't!" This statement by Andrew suggests that he is experiencing a.spiritual distress. b.night terrors. c.survivor's guilt. d.suicidal ideation. Intervention with Andrew (from question 15) would include a.encouraging expression of feelings. b.antianxiety medications. c.participation in a support group. d.a and c. e.all of the above.

c e

Nursing interventions for inappropriate anger pt with ineffective coping - remain _____ when dealing w an angry pt - set verbal ____ on behavior. clearly delineate the consequences of inappropriate expression of anger, and always _____ ____ - have pt keep a _____ of angry feelings, what triggered them, and how they were handled - avoid ___________ patient when they become angry - help patient determine ____ _____ of anger - help pt find ______ ways to release tension, such as physical outlets, and more appropriate ways to express anger, such as seeking out _____ when feelings emerge - ____ _____ appropriate ways to express anger assertively such as, " i dislike being called names. I get angry when i hear you saying those things about me."

calm limits follow through diary touching true source alternative staff role model

codependent nurse •Classic characteristics -___________ -_______________ -__________ -______ communication recovery process 1. Stage I: The __________Stage. In this stage, codependent persons must begin to let go of the ______ that problems exist. This initiation of abstinence from blanket denial may be a very __________ and _______ period. 2. Stage II: The ___________ Stage. Reidentification occurs when the individuals are able to glimpse their true selves through a break in the denial system. They accept the label of __________ and take responsibility for their own __________ behavior. They ________ their limitations and are ready to _____ the issues of codependence. 3. Stage III: The _____ ______ Stage. In this stage, the recovering codependent must face the fact that relationships cannot be managed by force of ____. Each partner must be _________ and __________. The goal of this stage is to _____ from the struggles of life that exist because of prideful and willful efforts to control those things that are beyond the individual's power to control. Stage IV: The _______________ Stage. This is a stage of self-________ and willingness to ______ when codependents relinquish the power over others that was not rightfully theirs but reclaim the personal power that they do possess.

caretaking perfectionism denial poor survival denial emotional, painful reidentification codependent dysfunctional accept face core issues will independent, autonomous detach reintegration acceptance change

An individual who is addicted to heroin is likely to experience which of the following symptoms of withdrawal? a. increased heart rate and blood pressure b. tremors, insomnia, and seizures c. in-coordination and unsteady gate d. nausea and vomiting, diarrhea and diaphoresis

d

Anna states that Lucky was her closest friend, and since his death, there is no one who could ever replace the relationship they had. According to Maslow's hierarchy of needs, which level of need is not being met? a.) Physiological needs b.) Self-esteem needs c.) Safety and security needs d.) Love and belonging needs

d

Anna's dog, Lucky got away from her while they were taking a walk. He ran into the street and was hit by a car. Anna cannot remember any of these circumstances of his death. This is an example of what defense mechanism? a. Rationalization c. Denial b. Suppression d. Repression

d

Brandon, a patient on the psychiatric unit, has been diagnosed with schizophrenia. He begins to tell the nurse about how the CIA is looking for him and will kill him if they find him. Which of the following is the most appropriate response by the nurse? a. "That's ridiculous, Brandon. No one is going to hurt you." b. "The CIA isn't interested in people like you, Brandon." c. "Why do you think the CIA wants to kill you?" d. "I know you believe that, Brandon, but it's really hard for me to believe."

d

Crises occur when an individual a. is exposed to a precipitating stressor b. perceives a stressor to be threatening. c. has no support systems. d. experiences a stressor and perceives coping strategies to be ineffective.

d

Paul is the member of an anger management group. He knew that people did not want to be his friend because of his violent temper. In the group, he has learned to control his temper and form satisfactory interpersonal relationships with others. This is an example of which curative factor. a. catharsis b. altruism c. imparting of information d. development of socializing techniques

d

Sandra is the nurse leader of a supportive-therapeutic group for individuals with anxiety disorders. On the first day the group meets, Valerie speaks first and begins by sharing the intimate details of her incestuous relationship with her father. What type of member role is Nancy assuming in this group? a.aggressor b. monopolizer c. blocker d. seducer

d

The nurse is caring for a patient with schizophrenia. Orders from the physician include 5 mg haloperidol IM STAT and then 3 mg PO tid, 2 mg benztropine PO bid prn. Because benztropine was ordered on a prn basis, which of the following assessments by the nurse would convey a need for this medication? a. The patient's level of agitation increases. b. The patient complains of a sore throat. c. The patient's skin has a yellowish cast. d. The patient develops muscle spasms.

d

To treat a patient's hallucinations therapeutically, which nursing intervention should be implemented? A.Reinforce the perceptual distortions until the client develops new defenses B.Provide an unstructured environment C.Avoid making connections between anxiety-producing situations and hallucinations D.Distract the client's attention

d

Which of the following is the primary focus of family therapy for patients with schizophrenia and their families? a. To discuss concrete problem-solving and adaptive behaviors for coping with stress b. To introduce the family to others with the same problem c. To keep the patient and family in touch with the healthcare system d. To promote family interaction and increase understanding of the illness

d

Ginger, age 19 and an only child, left 3 months ago to attend a college of her choice 500 miles away from her parents. It is Ginger's first time away from home. She has difficulty making decisions and will not undertake anything new without first consulting her mother. They talk on the phone almost every day. Ginger has recently started having anxiety attacks. She consults the nurse practitioner in the student health center. This type of crisis is called a. crisis resulting from traumatic stress. b. dispositional crisis c. psychiatric emergency. d. maturational/developmental crisis. The most appropriate nursing intervention with Ginger (from question 7) would be to a.suggest she move to a college closer to home. b.work with Ginger on unresolved dependency issues. c.help her find someone in the college town from whom she could seek assistance rather than calling her mother regularly. d.recommend that the college physician prescribe an antianxiety medication for Ginger.

d b

role of the nurse in groups •Nurses participate in groups on a _____ ______ •Leads therapeutic groups (____ __________, self help, _______ readiness, accessing resources) •Uses knowledge of human behavior as individuals and groups which is essential to effective ________ ____________ •Advanced practice nurses lead ___________, ______ therapy, or ____________ groups

daily basis client education, discharge group leadership psychotherapy, family psychodrama

___________ Disorder: characterized by the presence of delusions that have been experienced by the person for at least ___ month •Persistent _________ ( chief characteristic) >___ month •Delusions can be entirely _________ (non-bizarre) •The existence of prominent delusions. Subtypes of delusional disorders include: -_________: someone (often of higher social station) is in love with a patient./ "everyone loves me" -__________: belief that they are all powerful and important, like a God -____________: a spouse or partner has been unfaithful -____________: a patient is being hounded, followed, or otherwise interfered with. (most common). Plotted against, cheated or defrauded, followed, spied on, poisoned, or drugged (the fbi has 'bugged' my room-> can also be named as __________ __________) - ___________: patients' body functions have altered, they smell bad, or they have a terrible disease ("my lungs don't work"; belief that centers on one's body functioning) -____________-: a patient is being talked about, perhaps in the press or on TV (belief that cues in the environment are specifically referring to them).

delusional 1 delusions, 1 believable erotomanic grandeur jealousy persecutory paranoid delusions somatic reference

types of cries •class I: _____________ crisis: An acute response to an external situational stressor - a husband having difficulty at work, and takes it out with abuse on his wife • class 2: Crisis of __________ ________ _____: Normal life-cycle transition that may be anticipated but over which the individual may feel a ____ of _____ - college student feels a lack of control when his wife has a baby and must increase his working hours from part time to full time •class 3: Crisis resulting from _______ _____: Precipitated by an unexpected, external stressor over which the individual has little or no control and from which he or she feels emotionally__________ and __________ - women who is a victim of violent rape may suffer from fear, flashbacks, and lack of focus •class 4: __________/_____________crisis: Occurs in response to a situation that triggers emotions related to unresolved conflicts in one's life - new mother may feel anxiety or disorganization and may shout at her husband and threaten to leave the child with children services •class 5: Crisis reflecting _____________: An emotional crisis in which preexisting psychopathology has been instrumental in precipitating the crisis or in which psychopathology significantly impairs or complicates adaptive resolution - women with BPD, may be found walking in traffic after she found out her therapist is moving •class 6: ___________ __________: A crisis situation in which general functioning has been severely impaired and the individual is rendered ____________ or unable to assume personal responsibility - high school student may react to a breakup by being hysterical and ingesting a entire bottle of valium tablets

dispositional anticipated life transitions lack, control traumatic stress overwhelmed, defeated maturational/developmental psychopathology psychiatric emergency incompetent

the means by which various cultures use space to communicate

distance

•Alcohol use during pregnancy can result in ______ ______ _______ disorders (FASDs). -Fetal alcohol syndrome (FAS): Problems with ________, ________, attention span, ____________, vision, and hearing •FAS characteristics -Abnormal _____ features -_____ head size -________ than avg ht -_____ body wt -Poor coordination -__________ behavior -__________ paying attn -_______ memory -Difficulty in school -____________ disabilities -Speech and language delays -Intellectual disability or low IQ -Poor reasoning and judgment skills -Sleep or sucking problems as a baby -Vision or hearing problems -Problems w heart, kidneys, or bones

fetal alcohol spectrum learning, memory, comm facial small shorter low hyperactive difficulty poor learning

•_____________: refers to the nurses ability to be open, honest, and real in interactions w the pt/ responds w truth and honesty - mental health pts can read ppl really well, being real even if you don't understand what they say

genuiness

_________ __________: acknowledging and indicating awareness is better than complimenting, which reflects the nurse's judgment •Ex: "hello, Mr. J. I notice that you made a ceramic ash try in OT." "I see you made your bed"

giving recognition

nursing interventions for pt w schizophrenia and dx with disturbed sensory perception: auditory/visual related to panic anxiety, extreme loneliness, and withdrawal into self 1. Observe for signs of ____________ 2. avoid ___________ the pt w/o warning them 3. an attitude of __________ will encourage the pt to share the content of the hallucination w you. 4. dont ________ the hallucination. Let pt know that you dont _____ the perception. 5. help the pt understand the connection b/w increased ______ and the presnece of ___________ 6. try to _________ the pt from hallucination 7. Listening to the ____ or watching ___ helps distract some pts from attn to the voices. Others have benefitted from an intervention called ______ ______- the pt is taught to say loudly, "go away" or "leave me alone" in a conscious effort to dismiss the auditory perception. outcome goals: - short term goal: Pt will ________ content of hallucinations w ____ or _____ w/in ___ week - long term goals: 1. pt will be able to define and test reality, reducing or eliminating the __________ of hallucinations 2. Pt will __________ understanding that the voices are a result of their ______ and demonstrate ways to ______ the hallucination

hallucinations touching acceptance reinforce, share anxiety, hallucination distract radio, tv voice dismissal discuss, nurse, therapist 1 occurrence verbalize illness interrupt

phases of crisis intervention Nurses may be called on to function as crisis _______ in virtually any setting committed to the practice of nursing. •Phase 1: Assessment- The nurse gathers Information regarding the precipitating ______ and the ______ ______ that prompted the individual to seek professional help. •Phase 2. Planning of _________ _____________ -From the assessment data, the nurse selects appropriate nursing diagnoses that reflect the _________ of the crisis situation. -Desired outcome criteria are established. -Appropriate nursing actions are selected, taking into consideration the _____ of crisis as well as the individual's __________, desired _________ and available __________ for support. •Phase 3. _______________ -The actions identified in the planning phase are ___________. -A ________-________ approach is used. The focus of the problem is on the ____ and _____ -Establish A rapid working relationship by showing unconditional __________,________ __________, and __________ to immediate needs. A problem-solving model becomes the basis for change. -Remain w the ppl who is experiencing panic anxiety -Discourage lengthy explanations or rationalizations of the situation; promote an atmosphere for verbalization of _____ _________ -Set firm ______ on aggressive, destructive behaviors. At high levels of anxiety, behavior is likely to be impulsive and regressive. Establish at the outset what's acceptable and whats not maintained consistency -_______ the problem that the person is facing. The nurse does this by describing their perception of the problem and comparing it with the individuals perception of the problem - __________ feelings of anger, guilt, helplessness, and powerlessness w/o judgment - assist the pt to select __________ coping strategies -ID external __________ __________ and new social networks from which the pt may seek in times of stress •Phase 4. Evaluation of _____ _________ and __________ planning -A ___________ is conducted to determine whether the stated objectives were _______. -A ____ ___ _________ is developed for the individual to deal with the stressor should it recur.

helpers stressor, resulting crisis therapeutic interventions immediacy type strengths, choices, resources Intervention implemented reality-oriented, here, now acceptance, active listening, attending true feelings limits clarify acknowledge alternative support systems crisis resolution anticipatory reassessment achieved plan of action

_______ _________: when the pt has a misperception of the environment, the nurse defines reality by expressing his or her perception of the situation w/o challenging the pt's perceptions

presenting reality

•____________: attributing feelings or impulses unacceptable to ones self to another person -Sue feels a strong sexual attraction to her track coach and tells her friend, "hes coming onto me"

projection

•Extended periods of functioning at the panic level of anxiety may result in __________. - At this extreme level of anxiety, a person isn't capable of __________ what is happening in the environment and may lose contact with ______. - _________: a significant thought disturbance in which reality testing is impaired, resulting in __________, ___________, disorganized speech, or catatonic behavior •Examples of psychotic disorders include ___________, schizoaffective, and delusional disorders.

psychosis processing reality psychosis hallucinations, delusions schizophrenia

tx modalities for schizophrenia Psychological treatments •Individual ___________: long-term therapeutic approach; difficult because of client's impairment in interpersonal functioning •_______ therapy: some success if occurring over the long-term course of the illness; less successful in acute, short-term treatment - Shown to be effective, particularly w outpatients and when combined w _____ treatment - Generally focuses on ____-____ plans, problems, and relationships -Effective in reducing social __________, increasing the sense of ___________, and improving ________ testing for pts w schizophrenia Program of ________ __________ ___________ (PACT) •Services are provided by a multidisciplinary team of -___________ -___________ - Social workers - Vocational rehabilitation therapists - ________ _________ counselors •Services are available ____ hours a day, ______ days a year •Services are provided wherever assistance by the client is required - In the person's ______ - Within the ___________ - In local _________ - Parks - Stores The primary goals of PACT are 1.To meet basic _____ and enhance______ 2.To improve _____ functioning 3.To enhance ___________ living 4.To lessen family _________ of providing care 5.To decrease __________ symptoms of mental illness 6.To minimize recurrent acute ________ of the illness

psychotherapy group drug real-life isolation, cohesiveness reality assertive community tx psychiatrists nurse substance abuse 24, 365 home neighborhood restaurants needs, QOL role independent burden debilitating episodes

therapeutic communication •_______ focus •_______________ •_____________ •Promotes ______ •Guided by Nurse's _______________

pt nonjudgemental objective trust code of ethics

Conditions Essential to Development of a Therapeutic Relationship

rapport, trust, respect, genuineness, empathy

•lets client know whether an expressed statement has or has not been understood

restating

Substance addiction •Use of the substance interferes with ability to fulfill ____ __________ •often the person would like to cut down or control use of substance but attempts ______, and continues to __________ •Intense __________ for the substance •Excessive amount of time spent trying to procure the substance or recover from its use • Use of the substance causes the person difficulty with ___________ relationships or to become socially _________ • Engages in __________ activities when impaired by the substance • __________ develops and the amount required to achieve the desired effect __________ -If injured, the patient may require __________ dose to achieve effective pain control. • Substance-specific symptoms occur upon discontinuation of use

role obligations fail, increase craving interpersonal, isolated hazardous tolerance, increases increased

typical and atypical antipsychotics both work to treat symptoms of __________ and the _______ phase of bipolar disorder. Several atypical antipsychotics have a "_________ ___________" of action than the older medications, and are used for treating bipolar depression or depression that has not responded to an antidepressant medication alone.

schizophrenia, manic broader spectrum

Peplau's four levels of anxiety -Mild: _________ a problem for the person. It prepares ppl for action, sharpens the _________, increases ____________ for productivity, inc ___________ field, and results in an heightened awareness of the environment -Moderate: Perceptual field (perception of what is really happening/ reality) begins to __________, attn span and ability to concentrate ________, increased muscular tension and ___________ are evident -Severe: Perceptual field diminishes _________, attn span extremely _________, and the person has much difficulty completing even the ____________ task, discomfort is experienced to the degree that virtually all overt behavior is aimed at relieving ___________ -Panic: The most __________ state. Person unable to focus on even one _______ within the environment. May experience ________ or _________, panic anxiety

seldom senses, motivation, perceptual diminish decreases restlessness greatly limited simplest anxiety intense detail hallucination, delusions

concerns regarding professional boundaries are commonly r/t the following issues: 1. _______-____________ 2. _____ _____: if offered, the nurse may share with other staff members 3. __________: when using caring touch make sure its appropriate, supportive, and welcomed. the nurse must be sensitive to these cultural nuances and aware when touching is crossing a personal boundary. 4. friendship or romantic association: must move from personal to professional, if it cant happen , the nurse must withdraw caring

self-disclosure gift-giving touch

phases of crisis phase 1: The individual is exposed to a precipitating __________. ________ increases; previous problem-solving techniques are _________. phase 2: When previous problem-solving techniques do not ________ the stressor, ___________- increases further. The person begins to feel a great deal of _________ at this point. Coping techniques that have worked in the past are attempted, only to create feelings of helplessness when they are not successful. Feelings of _________ and disorganization prevail. phase 3: All possible resources, both internal and external, are ______ on to resolve the problem and relieve the ____________. The person may try to view the problem from a different ___________ or even overlook certain aspects of it. New problem-solving techniques may be used, and if effective, resolution may occur at this phase, with the individual returning to a higher, a lower, or previous level of precrisis ____________. phase 4: If resolution does not occur in previous phases, the tension mounts beyond a further threshold or its burden increases over time to a _________ ______. Major disorganization of the individual occurs, often with drastic results. Anxiety may reach ____ levels. Cognitive functions are disordered, emotions are _____, and behavior may reflect the presence of ________ thinking.

stressor anxiety employed relieve, anxiety discomfort confusion called discomfort perspective functioning breaking point panic labile psychotic

•taking notice of a single idea or even a single word

focusing

acknowledging, indicating awareness

giving recognition

making oneself available

offering self

vocal component of spoken word; consists of pitch, tone, and loudness

paralanguage

•clarifying misconceptions that client may be expressing

presenting reality

As stress increases, _________________________ decreases

sense of reality

N pushing for answers to issues the client does not wish to discuss causes client to feel used and valued only for what is shared with the nurse

probing

the innate tendency to own space

territoriality

allows client to select topic

Giving broad openings

in teaching groups, ___________ and _________ are conveyed to a number of individuals

knowledge, information

The meaning of behaviors is determined within _________________.

individual cultures

the number of people within a given environmental space

density

N Requesting an ____________: asking "____" implies that client must defend his or her behavior or feelings

explanation, why

conveys positive regard

accepting

•delving further into a subject, idea, experience, or relationship

exploring

Sustained physical responses to stress occur after a ________ period of stress and promote susceptibility to many _________ of adaptation.

prolonged diseases

•striving to explain what is vague and searching for mutual understanding

seeking clarification and validation

physical setting of a group •Seating - No ___________ between members, ____ shape allows ______ __________ •Size -___-___ members is optimal for interaction and relationship development (Range __-___) •Membership - Open (___________ attendance and ___-_____) vs. closed (___ ____ ______ and ___________members)

-barriers, circle -eye contact 7-8, 2-15 flexible, on-going set time frame, consistent

ETOH withdrawal begins within ___-___ hour after last drink and may progress to _________ tremens on 2nd or 3rd day

4-6 delirium

•Alcohol intoxication: Occurs at blood alcohol levels between ____-____ mg/dL Symptoms of alcohol intoxication include disinhibition of ______ or ________ impulses, mood lability, _________ judgment, impaired social or occupational functioning, _______ speech, ___________, _________ gait, nystagmus, and ________ face.

100-200 sexual, aggressive impaired slurred incoordination unsteady flushed

effects of opioids on the body. •CNS: All opioids, opioid derivatives, and synthetic opioid-like drugs affect the _____. Common manifestations include __________, mood changes, and mental __________. Other common CNS effects include __________ and _____ reduction. •GI EFFECTS: Opioids exert a profound effect on the GI tract. These effects lead to a marked __________ in the movement of food through the GI tract. This is a notable therapeutic effect in the treatment of severe _______. However _________ and fecal impaction may be a problem for the chronic opioid user •CV EFFECTS: Morphine is used extensively to relieve pulmonary edema and the pain of ____ in cardiac clients. At high doses, opioids induce___________. •SEXUAL FXN: With opioid use, there is __________ sexual function and diminished libido. _________ ejaculation, impotence, and orgasm failure may occur.

CNS euphoria clouding drowsiness, pain decrease diarrhea, constipation MI hypotension decrease delayed

Conventional (typical) antipsychotics - ____________ ADVERSE DRUG REACTIONS - ______________ symptoms (EPS) include: • ________________: Tremor, shuffling gait, drolling, rigidity; may occur w/in first month of therapy • __________: Muscular weakness • ___________: Continuous restlessness and fidgeting; occurs w/in firs 2 months of therapy • _________ : Involuntary muscular movements [spasms] of face, arms, legs, and neck; occurs hours to days following first dose • ____________ crisis: Uncontrolled rolling back of the eyes • ________ __________ -syndrome of symptoms characterized by bizarre facial and tongue mvmts, a stiff neck, and difficulty swallowing • Anticholinergic effects - ____ mouth, ___________, _______ __________, blurred vision, _________ cardia • Dermatitis, ___________ when exposed to sunlight • __________ ___________ _________ (NMS): rare but potentially fatal complication. Include severe muscle _______, high_____, _____cardia, fluctuations in ____, ___________, and rapid deterioration of mental status to ______ and _____. INTERVENTIONS • Treat with ___ ________ or benzodiazepine • Be prepared to administer IM or IV anticholinergic, such as __________, in case of acute ______ • Switch client to an _________ antipsychotic • Monitor client for dry mouth, constipation, and urinary retention • Counsel client about _______ _________ • Monitor vital signs, periodic _____, and serum ________ levels • Use ________ measures and ___________ • Keep client __________ • Give benzodiazepines for anxiety ADMINISTRATION • Give oral dose with ____ and/or full glass of water to prevent GI effects • Give IM injection in large muscle; _____ sites • Keep client recumbent for ____ minutes after IM or IV dose due to possible _____________ • Give IV bolus no faster than __ mg/minute CLIENT INSTRUCTIONS • Instruct client to notify provider for feelings of inner ________, inability to sit ____ • Instruct client to notify provider if muscle _________, ________, and sluggish movements, drooling, and shuffling gait occur • Instruct client to notify provider for severe _______ of the neck and body • Instruct client to notify provider if __________ movements of tongue, face, limbs, trunk begin to occur • Chew gum or suck hard candy to treat ___ mouth • Increase ____ and _______ to prevent constipation • _________ just before taking drug dose • Instruct client to report _________, fainting spells, other cardiac symptoms • Instruct clients to wear gloves when handling ____________ • Instruct clients to avoid ____ exposure, use _______, wear protective clothing, wear __________ • Instruct client to report sudden ______ immediately to provider CONTRAINDICATIONS • Allergy to _____________ antipsychotic drugs • __________ withdrawal INTERACTIONS • CNS depressants increase _______ • _______ and _________ - space 2 hours from chlorpromazine administration due to poor absorption • Decreased blood level of ________ drugs

Chlorpromazine extrapyramidal pseudoparkinsonism akinesia akathisia dystonia oculogyric tardive dyskinesia dry, constipation, urinary retention, tachy photosensitivity neuroleptic malignant syndrome rigidity, fever, tachy, BP, diaphoresis, stupor, coma beta blocker benadryl dystonia atypical sexual dysfxn ECG, potassium cooling, antipyretics hydrated food rotate 30 hypotension 1 restlessness still rigidity, tremors spasms involuntary dry fluid/fiber urinate palpitations phenothiazine sun, sunscreen sunglasses fever phenothiazine alcohol sedation antacids, antidiarrheals seizures

Older or first-generation antipsychotic medications are also called conventional "_________" antipsychotics or "neuroleptics". Some of the common typical antipsychotics include: ______________ ____________ _____________ _______________

Chlorpromazine Haloperidol Perphenazine Fluphenazine

•Neglectful care of pt in regard to basic human needs or illness tx, extreme denial or prolonged overconcerns regarding pt.'s illness, depression, hostility and aggression

Disabled Family Coping related to difficulty coping with client's illness

•Inability to take responsibility for meeting basic health practices, hx of lack of health-seeking behavior, lack of expressed interest in improving health behaviors, demonstrated lack of knowledge regarding basic health practices, anosognosia

Ineffective Health Maintenance related to disordered thinking or delusions:

Newer or second generation medications are also called "__________" antipsychotics. Some of the common atypical antipsychotics include:

Risperidone Olanzapine Quetiapine Ziprasidone Aripiprazole Paliperidone Lurasidone

A client diagnosed with schizophrenia experiences identity confusion and communicates with the nurse using echolalia. What is the client attempting to do by using this form of speech? A.Identify with the person speaking B.Imitate the nurse's movements C.Alleviate alogia (poverty of speech) D.Alleviate avolition (lack of motivation)

a

Anna, who is 72 years old, is of the age when she may have experienced many losses coming close together. What is this called? a. Bereavement overload b. Normal mourning c. Isolation d. Cultural relativity

a

Anna has been a widow for 20 years. Her maladaptive grief response to the loss of her dog may be attributed to which of the following? Select all that apply. a. unresolved grief over the loss of her husband b. loss of several relatives and friends over the last few years c. repressed feelings of guilt over the way in which Lucky died d. inability to prepare in advance for the loss

a, b, c, d

A client admitted to the emergency department smells strongly of alcohol, and his wife reports he has been a heavy drinker for the last 25 years. Which of the following assessment findings are consistent with long-term chronic alcohol abuse? (Select all that apply.) a. The client reports weak leg muscles, and his gait is unsteady. b. The client's abdomen is distended. c. The client reports he was coughing up some blood. d. The client reports he has double vision. e. Blood tests reveal a low white blood cell count.

a, b, c, d, e

Recent research on the RAISE approach to treatment of schizophrenia incorporates which of the following elements as important to improving outcomes? (Select all that apply.) a. Early intervention at the first episode of psychosis b. Support for employment and/or educational pursuits c. Rapid, high-dose loading with antipsychotic medication d. Court-ordered sanctions for treatment e. Recovery-focused psychotherapy

a, b, e

education r/t antipsychotics The client should •Not stop taking the drug _________. To do so might produce withdrawal s/sx: ___/___, dizziness, gastritis, HA, tachy, ________, ____________ •Use ___________ and wear protective clothing when spending time _______. Skin is more susceptible to ___________, which can occur in as little as ___ minutes. •Report weekly (if receiving ______ therapy) to have blood levels drawn and to obtain a weekly supply of the drug •Be aware of possible risks of taking antipsychotics during ___________ •Not drink _______ while receiving antipsychotic therapy •Not consume other ____________ (including over-the-counter drugs) without the physician's knowledge. Many meds contain substances that interact w antipsychotics in a way that may be harmful

abruptly N/V, insomnia, tremulousness sunscreen, outside sunburn, 30 clozapine pregnancy etoh meds

nursing interventions for pt w schizophrenia and dx with disturbed thought process related to inability to trust, panic anxiety, or possible hereditary or biochemical factors 1. convey _____ of pts need for the false belief but indicate that you don't ______ the belief 2. dont ____ or ____ the belief. Use "_________ _______" as a therapeutic technique: "I understand that you believe this is true, but I personally find it hard to accept." 3. reinforce and focus on _______. Discourage long ruminations about the __________ thinking. Talk about ____ events and people. 4. If pt is highly sus, the following interventions may be helpful: - use same ____ as much as possible; be _____ and keep all ________ - avoid _______ contact; ask pt b4 ________ to perform a procedure, such as taking BP - avoid ________, _________, or talking _________ where pt can see but cant hear what is being said. - provide _________ food w can opener or serve food ______ style - ______ checks may be necessary following med admin to verify whether the pt is actually __________ the pills - provide activities that encourage a _________ relationship w the nurse or therapist. - maintain an _________, matter-of-fact, yet ________- approach outcome criteria: -short term goals: by the end of 2 weeks, pt will ________ and __________ that false ideas occur at times of increased _________. - long term goals: 1. by time of discharge from tx, pts verbalizations will reflect ______-based thinking w no evidence of __________ ideation 2. by time of discharge from tx, pt will be able to ____________ between delusional thinking and __________.

acceptance share argue, deny, reasonable doubt reality irrational, real staff, honest, promises physical, touching whispering, laughing, quietly canned, family mouth swallowing one-on-one assertive, genuine recognize, verbalize anxiety reality delusional differentiate reality

_____________ is a compulsive or chronic requirement. The need is so strong as to generate distress (either physical or psychological) if left unfulfilled.

addiction

Sedative/hypnotic use disorder • A profile of the substance -Barbiturates -Nonbarbiturate hypnotics -Antianxiety agents -Club drugs 1. The effects of CNS depressants are __________ w one another and with the behavioral state of the user. •The FDA began requiring ____ ____ warnings, its strongest warning label, for opioid analgesics, opioid cough products, and benzodiazepines based on evidence that the combo of opioids and benzo carries a particularly high risk for excessive sleepiness, resp. depression, coma, and death 2. CNS depressants are capable of producing physiological ________. 3. CNS depressants are capable of producing ________addiction. 4. cross-tolerance and cross-dependence may exist b/w various CNS depressants. •_____ _________ refers to a condition in which a person becomes resistant to the effects of one drug bc he or she has developed tolerance to another drug w similar pharm activity. ________ __________ is a condition in which a person can become dependent on more than one substance bc of their similar activity and effects.

addictive black box addictive psychological cross tolerance cross dependence

N Giving ______: tell the pt what to do or how to behave implies that the nurse knows what is _____t and nurtures the pt in the dependent role by discouraging __________ thinking.

advice best independent

Eugen Bleuler described schizophrenia as _________ blunting, loosening of __________, __________ (withdrawal), and ___________ (coexisting conflicting ideas), the 4 As. 1. _________ __________: Void of emotion, inappropriate affect (e.g. a young woman who laughs when told of the death of her mother). 2. _______ ___________: ideas shift from one unrelated subject to another and the person is unaware that topics are unconnected. (e.g. we wanted to take the bus, but the airport took all the traffic. Driving is the ticket when you want to get somewhere. No one needs a ticket to heaven. We have it all in our pockets.) 3.___________: ____________ into social isolation, emotional detachment, and lack of regard for social convention. Focusing on themselves to the exclusion of the external environment, leading to severe deterioration of social and occupational functioning. 4.______________: Coexisting conflicting ideas toward the same object, person or situation. These opposing emotions may interfere with the person's ability to make even a very simple ___________ (e.g., whether to have coffee or tea with lunch).

affective associations, autism, ambivalence affective blunting loose associations autism, withdrawal ambivalence, decision

N __________ OR _____________: indicating accord with or opposition to the pt's ideas or opinions implies that the nurse has the rights to pass judgment on whether the pts ideas or opinions are "_____" or "_____". Agreement prevents the pt from later modifying their POV w/o the risk of displeasing the nurse. Disagreement may provoke ____________ on the part of the pt

agreeing, disagreeing right, wrong defensiveness

Stimulant use disorder •A profile of the substance -_______________ -Synthetic stimulants -Non-amphetamine stimulants -______ -__________ -________ Many individuals who abuse or are addicted to CNS stimulants began using the substance for the ________-__________ effect in an attempt at ______ control. Chronic users tend to rely on CNS stimulants to feel more _______, more confident, and more decisive. They often fall into a pattern of taking "_______" in the morning and "________," such as _______ or sleeping pills, at night. The average American consumes ___ cups of coffee (about 200 mg of caffeine) per day and caffeine is consumed in various amounts by about 90 percent of the population. Next to caffeine, nicotine, an active ingredient in tobacco, is the most widely used psychoactive substance in U.S. society.

amphetamines cocaine caffeine nicotine appetite-suppressant weight powerful upper downer, alcohol

denial of illness

anosognosia

Side effects of antipsychotics -___________ effects: dry mouth, blurry vision, constipation, urinary retention, and tachycardia - ____/___/___ - Skin _____ - Sedation - ____________ _________ - ____________________ - Hormonal effects - ECG changes - __________salivation - Weight _________ (_______) - _______glycemia/diabetes - Increased risk of mortality in elderly clients with _________ - Reduction in _________ threshold - agranulocytosis - ____________ symptoms - __________ ____________ - _______________ ______________ ______________

anticholinergic N/V/D rash orthostatic hypotension photosensitivity hyper gain (atypical) hyper dementia seizure extrapyramidal tardive dyskinesia neuroleptic malignant syndrome

_____________ grief: The experiencing of the grief process before the actual loss occurs -Can decrease the __________ and __________ of response of grief

anticipatory length, intensity

_______________-- agents used to tx extrapyramidal side effects of antipsychotic drugs

antiparkinsonian

Psychopharmacology for schizophrenia •_____________ - Used to decrease _______ and psychotic symptoms of schizophrenia and other psychotic disorders •Action: - __________: dopaminergic blockers with various affinity for cholinergic, α-adrenergic, and histaminic receptors - _________: weak dopamine antagonists; potent 5HT2A antagonists; also exhibit antagonism for cholinergic, histaminic, and adrenergic receptors

antipsychotics agitation typicals atypicals

_____________ medications remain the mainstay of tx for psychotic disorders. ___________ antipsychotics have become the first line of therapy and tx both positive an dgeative s/sx of schizophrenia. They have a more favorable side-effect profile than the ___________ (_________) antipsychotics

antipsychotics atypical convention (typical)

psychological responses to stress -________ and ________ have been described as two major, primary psychological response patterns to stress. - A variety of thoughts, feelings, and behaviors are associated with each of these response patterns. -__________ is determined by the extent to which the thoughts, feelings, and behaviors interfere with an individual's __________

anxiety, grief adaptation functioning

Nursing interventions for the client with schizophrenia or other psychotic disorder are aimed at •Decreasing ___________ and establishing______ •Assisting client to define and test ______ •Encouraging ____________ with others •Ensuring ______ of client and others •Meeting client's __________ needs •Promoting adaptive ______ coping

anxiety, trust reality interactions safety self-care family

Anxiety -A diffuse ____________ that is vague in nature and is associated with feelings of _________ and ______________ -A feeling of discomfort and apprehension r/t fear of impending _______. The person may be unaware of the _________ of his or her anxiety, but its often accompanied by feelings of uncertainty and helplessness -Extremely __________ in our society -Mild anxiety (low levels) is adaptive and can provide ________ required for _________.

apprehension uncertainty, helplessness danger, source common motivation, functioning

N ___________ or ___________: sanctioning or denouncing the pts ideas or behavior implies that the nurses role is to pass ____________ on whether the pts ideas or behaviors are "good" or "bad" and that the pt is expected to please the nurse. The nurses acceptance of the pt is then seen as conditional depending on the pts behavior.

approving, disapproving judgment

nursing interventions for pt w schizophrenia and dx with Self-Care Deficit related to Withdrawal, Regression, Panic anxiety, Perceptual or cognitive impairment, Inability to trust 1. provide _________ with self-care needs as required. 2. encourage pt to perform as many activities as possible __________. provide positive ___________ for __________ accomplishments 3. use ______ comm to show pt whats expected and to minimize misinterpretation. provide __________ instructions for assistance in performing ADLs 4. _________ approaches may need to be taken with the pt whos not eating, such as allowing pt to ____ own canned or packaged foods; _____ style serving may be an option 5. if toileting needs aren't being met, establish a structured _____ for pt. outcome criteria -short: pt will verbalize a ______ to perform _____ by end of 1 week - long: pt will ______ ADLS in an __________ manner and demo a willingness to do so by time of discharge from tx

assistance independently reinforcement, independent concrete step-by-step creative open, family schedule desire, ADLS perform, independent

•putting into words the feelings the client has expressed only indirectly

attempting to translate words into feelings

active listening is described as ___________ to what the pt is saying through both verbal and nonverbal cues. Skills assoc w active listening include ___________ -Sitting ___________ facing the patient -maintaining an _____ posture - __________ forward toward the pt - establishing _____ _________ - being __________

attentiveness SOLER squarely open leaning eye contact relaxed

Anna's daughter notices that Anna appears to be listening to another voice when just the two of them are in a room together. When questioned, Anna admits that she hears someone telling her that she was a horrible caretaker for Lucky and did not deserve to ever have a pet. Which of the following best describes what Anna is experiencing? a.) Neurosis b.) Psychosis c.) Depression d.) Bereavement

b

•clearing defining goals and how they will be measured, attaching positive, neg, and aversive reinforcement to adaptive and maladaptive behavior, using simple, concrete instructions and prompts to elicit the desired behavior

behavioral therapy

N causes client to feel insignificant or unimportant

belittling feelings expressed

•Psychopharmacology for substance intoxication and substance withdrawal - Alcohol •______________ -________________ (Librium) is often used for substitution therapy in alcohol withdrawal to reduce life-threatening complications. •Anticonvulsants for mgmt of w/drawal _________ •Multivitamin therapy •__________ d/t being commonly deficient in alcoholics

benzodiazepines Chlordiazepoxide seizures thiamine

Mood stabilizers are used primarily to treat _________ _______, _______ _________ associated with other mental disorders, and in some cases, to augment the effect of other medications used to treat depression. ___________, which is an effective mood stabilizer, is approved for the treatment of mania and the maintenance treatment of bipolar disorder. Mood stabilizers work by decreasing _________ activity in the brain and are also sometimes used to treat: -_____________ (usually along with an antidepressant) - Schizo___________ Disorder - Disorders of impulse control - Certain mental illnesses in children _____________ medications are also used as mood stabilizers. They were originally developed to treat ___________, but they were found to help control unstable moods as well. One anticonvulsant commonly used as a mood stabilizer is __________ __________ (also called divalproex sodium). For some people, especially those with "mixed" symptoms of mania and depression or those with rapid-cycling bipolar disorder, valproic acid may work better than _______. Other anticonvulsants used as mood stabilizers include: - _____________ - Lamotrigine - Oxcarbazepine

bipolar disorder, mood swings lithium abnormal depression affective anticonvulsants seizures valproic acid lithium Carbamazepine

If a person with bipolar disorder is being treated with lithium, he or she should visit the doctor regularly to check the lithium levels his or her _____, and make sure the ______ and the _________ are working normally. Lithium is eliminated from the body through the __________, so the dose may need to be __________ in older people with reduced kidney function. Also, loss of water from the body, such as through sweating or diarrhea, can cause the lithium level to___, requiring a temporary ____________ of the daily dose. Although kidney functions are checked periodically during lithium treatment, actual damage of the kidney is uncommon in people whose blood levels of lithium have stayed within the therapeutic range.

blood, kidney, thyroid kidney lowered rise lowering

Giving ________ __________: allow the pt to direct the focus of the interaction and emphasize the importance of the pt's role in the comm process •"what would you like to talk about today?", "is there anything you want to discuss?"

broad openings

A client is admitted with a diagnosis of brief psychotic disorder, with catatonic features. Which symptoms are associated with the catatonic specifier? A.Strong ego boundaries and abstract thinking B.Ataxia and akinesia C.Stupor, muscle rigidity, and negativism D.Substance abuse and cachexia

c

A client who has been taking chlorpromazine (Thorazine) for several months presents in the ED with extrapyramidal symptoms (EPS) of restlessness, drooling, and tremors. What medication will the nurse expect the physician to order? A.Paroxetine (Paxil) B.Carbamazepine (Tegretol) C.Benztropine (Cogentin) D.Lorazepam (Ativan)

c

Benjamin is a member of an Alcoholics Anonymous group. He learned about the effects of alcohol on the body when a nurse from the chemical dependency unit spoke to the group. This is an example of which therapeutic factor? a. Catharsis b. Altruism c. Imparting of information d. Universality

c

Two students fail their introductory nursing course. One student plans to seek tutoring and retake the course next fall. The second student attempts suicide. Which of the following factors would have been influential in the development of the second student's crisis? a) The time of year in which the event occurred b) The presence of support systems c) A lack of adequate coping mechanisms d) The individual's family birth order

c

What is the desired outcome of working with an individual who has witnessed a traumatic event and is now experiencing panic anxiety?a.The individual will experience no anxiety. b.The individual will demonstrate hope for the future. c.The individual will maintain anxiety at manageable level. d.The individual will verbalize acceptance of self as worthy.

c

When Anna's daughter expresses concern about her mother's behavior and recommends she see a counselor, Anna declares, "I'm fine. There is nothing wrong with me!" Which of the following best describes Anna's response? a.) Grief resolution b.) Somatic disorder c.) Anosognosia d.) Intellectualization

c

When a patient suddenly becomes aggressive and violent on the unit, which of the following approaches would be best for the nurse to use first? a. Provide large motor activities to relieve the patient's pent-up tension. b. Administer a dose of prn olanzapine to keep the patient calm. c. Call for sufficient help to control the situation safely. d. Convey to the patient that his behavior is unacceptable and will not be permitted.

c

___________ refers to a significant _____ disturbance that may range from ______ (no motor activity) to _________ motor activity and agitation. Symptoms: •__________- excessive motor activity often purposeless or not goal oriented •___________ - verbatim repetition of someone else's words •____________ - imitating another person's physical behavior •__________ - facial contortions not made in response to noxious stimuli •___________ - repeated movements that seem to have a goal, but are excessive for the purpose •_________ - absence of speech •___________ - offering resistance to passive movement or repeatedly turns away from the examiner •____________ - assuming an unnatural or uncomfortable pose •________ __________ - maintaining a position for several minutes or more - Describes a cond in which the pt w schizophrenia allows body parts to be placed in _____ or __________ positions for ____ periods

catatonia, motor stupor, excessive agitation echolalia echopraxia grimace mannerisms mutism negativism posturing waxy flexibility bizarre, uncomfortable, long

Effects of alcohol on the body (cont'd) • _________ of the liver - the end-stage of alcoholic liver disease and is believed to be caused by chronic heavy alcohol use. There is widespread destruction of _____ cells, which are replaced by ______ (scar) tissue. • Complications of cirrhosis of the liver can include: -_________ _________: Elevation of blood pressure through the portal circulation results from defective blood flow through the cirrhotic liver -__________: •A condition, in which an excessive amount of serous fluid accumulates in the abdominal cavity, occurs in response to portal hypertension. The increased pressure results in the seepage of fluid from the surface of the liver into the abdominal cavity. -_________ ____________: Veins in the esophagus that become distended because of excessive pressure from defective blood flow through the cirrhotic liver. As this pressure increases, these varicosities can rupture, resulting in hemorrhage and sometimes death. -Hepatic encephalopathy: This serious complication occurs in response to the inability of the diseased liver to convert ______ to ____ for excretion. The continued rise in serum ______ results in progressively impaired mental functioning, ________, euphoria or depression, ____ disturbance, increasing _______, and progression to coma and eventual death. Tx includes complete abstention from ETOH; reduction of ________ in the diet -___________: Impaired production, function, and movement of white blood cells -_______________: Platelet production and survival are impaired as a result of the toxic effects of alcohol. -Sexual _______________ •In the short term, enhanced libido and failure of erection are common. •Long-term effects include gynecomastia, sterility, impotence, and decreased libido.

cirrhosis liver, fibrous portal hypertension ascites esophageal varices ammonia, urea ammonia apathy sleep confusion protein leukopenia thrombocytopenia dysfunction

____________: Defined by dysfunctional behaviors that are evident among members of the family of a chemically dependent person, or among family members who harbor secrets of physical or emotional abuse, other cruelties, or pathological conditions. Codependence has been called "a __________ relationship with _________" •Codependent people _________ their own needs for the fulfillment of others to achieve a sense of ________ •Derives ____-______ from others •Feels responsible for the __________ of others •Commonly _______ that problems exist •Keeps feelings in control, and often releases anxiety in the form of stress-related illnesses, or compulsive behaviors such as _____, spending, _______, or use of _________ •May have experienced _______ or emotional _______ as a child •_________ focused on _____ and know very little about how to direct their lives from their own ______ of _____

codependency dysfunctional, oneself sacrifice control self-worth happiness denies eating working, substances abuse, neglect outwardly, others sense, self

"An interactive process of transmitting between two or more entities."

communication

•Encouraging ___________: asking client to compare similarities and differences in ideas, experiences, or interpersonal relationships, helps the pt recognize life experiences that tend to recur and those aspects of life that are changeable •"was this episode _____ to...?", "how does this ______ w the time when...?" "what was your response the last time this situation occurred?"

comparison similar compare

______________:covering up a real or perceived weakness by emphasizing a trait one considers more desirable - Ex: a physically disabled boy is unable to participate in football, so he ________________ by becoming a great scholar

compensation compensates

•Empathy: fuels __________, feeling with people, a vulnerable choice, rarely begins with "___ _____", even if its "idk what to say rn but im glad you told me" - The nurses "accurately _________ or ________" what the pt is feeling and encourages the pt to explore these feelings

connection at least perceives, understands

Behavioral adaptation responses to anxiety -At the mild level, individuals employ various _________ __________ to deal with stress. A few of these include __________, __________-, __________

coping mechanisms eating, drinking, sleeping

Task Roles -______________: Clarifies ideas and suggestions made in the group; brings relationships together to pursue common goals -____________: Examines groups plans and performance, measuring against group standards and goals -_____________: Explains and expands upon group ideas and plans -___________: Encourages and motivates the group to perform at its best -_________: Outlines the tasks at hand for the group and proposes methods for solution -____________: Maintains direction in the group Maintenance Roles -________________: Relieves conflict within the group by assisting members to reach a compromise agreeable to all -____________: Offers recognition and acceptance of other's ideas and contributions -__________: Listens attentively to group interaction; is passive participant - _____________: Encourages acceptance of and participation by all members of the group - _______________: Minimizes tension within the group by intervening when disagreements produce conflict Individual/Personal Roles -____________: Expresses negativism and hostility toward others; may use sarcasm to degrade the status of others -___________: Resists group efforts; demonstrates rigid and sometimes irrational behavior that impede group progress -____________: Manipulates others to gain control; behaves in an authoritarian manner - ____-______: Uses the group to gain sympathy from others; seeks to increase self-confidence from group feedback; lacks concern for others or the group as a whole -_____________:Maintains control of the group by dominating the conversation -____________ seeker: Talks about personal accomplishments in an effort to gain attention or approval for self -_____________ Shares intimate/personal details about self with group; is the least reluctant of the group to share; may alarm others or inhibit group process with excessive premature self-disclosure

coordinator evaluator alaborator energizer initiator orientor compromiser encourager follower gatekeeper harmonizer aggressor blocker dominator help-seeker monopolizer recognition seducer

___________ refers to the nurses behavioral and emotional response to the pt. - the nurse should be supportively _____ by other staff members to identify their feelings and behaviors and recognize the occurrence of the phenomenon - may be helpful to have ___________ sessions with the nurse after encounters with pt

countertransference assisted evaluative

stimulant Withdrawal: often referred to as "_________." The dysphoria can be intense enough to result in increased risk for _______. Peak withdrawal symptoms usually occur within __-___ days of abstinence. •Amphetamine and cocaine withdrawal may result in ________, fatigue, _____ disturbances, and increased ___________ •Withdrawal from caffeine may include _________, fatigue, __________, ___________, muscle pain and stiffness, and nausea and vomiting. •Withdrawal from nicotine may include __________, anxiety, difficulty _____________, irritability, restlessness, and increased __________.

crashing suicide 2-4 dysphoria sleep, appetite headache, drowsiness, irritability dysphoria concentrating, appetite

______ is defined as a sudden event in one's life that disturbs homeostasis, during which usual coping mechanisms cannot resolve the problem

crisis

Aisha is a psychiatric nurse who has been selected to lead a group for women who desire to lose weight. The criterion for membership is that they must be at least 20 pounds overweight. All have tried to lose weight on their own many times in the past without success. At their first meeting, Aisha provides suggestions as the members determine what their goals will be and how they plan to go about achieving those goals. They decided how often they wanted to meet and what they planned to do at each meeting. Which type of group and style of leadership is described in this situation? a. Task group, autocratic leadership b. Teaching group, democratic leadership c. Self-help group, laissez faire leadership d. Supportive-therapeutic group, democractic leadership.

d

nursing interventions for the pt who has experienced a traumatic event and dx with anxiety (panic)/ fear 1. Determine_________ of anxiety/ fear present, associated behaviors, and reality of perceived threat 2. Note degree of _______________ 3. Create as ________ an area as possible. Maintain a ___, _______ manner. Speak in even tone using ______, _________ sentences 4. develop _________ relationship 5. ID whether incident has ___________ pre-existing or coexisting situations 6. Determine presence of physical s/sx (numbness, HA, tightness in chest, nausea, pounding heart) 7. ID __________ response (anger, shock, acute anxiety, panic, confusion, denial) record emotional changes 8. Discuss pts ___________ of what is causing anxiety 9. Assist pt to ______ any distortions being experienced. Share perceptions w pt. 10. Explore w pt or SO the manner in which pt has previously _______ w anxiety-producing events 11. Engage pt in learning new ______ behaviors (progressive muscle relaxation, thought-stopping) 12. Encourage use of __________ to manage _____ and vent ___________ such as anger and hostility 13. Give _________ __________ when pt demos better ways to manage anxiety and is able to calmly and realistically appraise the situation 14. Admin ____ as indicated: •Antianxiety-diazepam, alprazolam, oxazepam Antidepressants- fluoxetine, paroxetine, bupropion

degree disorganization quiet calm, confident short, simple trusting recativated psychological perception correct coped coping techniques, stress, emotions positive feedback meds

•___________: refusing to acknowledge the existence of a real situation or the feelings assoc. with it - A woman drinks ETOH every day, can't stop, and doesn't __________ that she has a problem.

denial, acknowledge

sedative/hypnotic disorder Patterns of use •Effects on the body: Sedative/hypnotic/anxiolytic compounds ________ the activity of the brain, nerves, muscles, and heart tissue. They reduce the rate of metabolism in a variety of tissues throughout the body, and in general, they depress any system that uses energy. These drugs are capable of producing all levels of _____ ________-from mild sedation to death. The level is determined by dosage and potency of the drug used. -Effects on sleep and dreaming: _________ amount of sleep time spent in dreaming -Respiratory ___________: inhibition of reticular activating system -Cardiovascular effects: ___________ -Renal function: may suppress _____ fxn -Hepatic effects: may produce ______ -Body temperature: can greatly _________ body temp -Sexual functioning: initial ________ in libido, then followed by the _________ to maintain an erection - •Patients may request prescription for sedative for not sleeping, etc. If the patient has a history of a substance use disorder what do we recommend first? -______ _________intervention because of risk of potentially addictive sedative.

depress CNS depression decrease depression hypotension urine jaundice decrease increase, inability non-pharm

Encouraging ___________ of ___________: asking the pt to verbalize their perceptions facilitates the pt's ability to develop awareness and understanding. For the pt experiencing hallucinations, it can facilitate both nurses and pts _____________ about what the patient's ___________ experiences are communicating •"____ ___ ______ about the voices you said you're hearing.", "what was it that increased your agitation during the group activity?", "are these voices you hear directing you to take some action?"

descriptions, perceptions clarification, perceptual tell me more

-feedback should be ___________ rather than evaluative and focused on the _________ rather than on the person. -feedback should be __________ rather than general. - feedback should be directed toward behavior that the pt has the capacity to _____ - feedback should impart ________, rather than offer advice. -feedback should be _____-____

descriptive behavior specific modify info well-timed

psychodrama •Group leader is the "_______" •Group members are the "_______" or "________" and agree to participate •_______ is him/her self with an unresolved conflict •Gives the participant a chance to try __________strategies for dealing with a troubling situation that could bring a more ________ outcome •All members ________ from the drama and processing the situation within the group •Nurses serve as audience or client, group leaders have ___________ degrees

director audience, actors client different, positive benefit graduate

Sympathy: drives ______________ - The nurse actually "___________" what the pt is feeling and experiences a need to alleviate distress/ feeling _____for

disconnection shares sorry

Substance withdrawal •Development of symptoms that occurs upon abrupt reduction or _____________ of a substance that has been used •Symptoms are _________ to the substance that has been used. •Disruption in physical and psychological functioning •Symptoms: ________ of hands, tongue, or eyelids; nausea or vomiting; _______ or weakness; _____cardia; sweating; elevated ___; anxiety; __________ mood or irritability; transient hallucinations or illusions; headache; and insomnia.

discontinuation specific tremors malaise, tachy BP, depressed

sedative/hypnotic •Intoxication -With these central nervous system (CNS) depressants, effects can range from __________ and _________ to ______ and death (with increasing dosages of the drug). •Withdrawal -Onset of symptoms depends on the ____-_____ of the drug from which the person is withdrawing. - Withdrawal symptoms associated with sedative/hypnotics include _________ _________: sweating or pulse rate greater than 100, increased hand ______, insomnia, nausea or vomiting, hallucinations, illusions, psychomotor agitation, anxiety, or ____ _______ seizures, and delirium.

disinhibition, aggressiveness, coma half-life autonomic hyperactivity tremors grand mal

planning and implementation of the nursing process for a client with substance use disorder. •Risk for injury - assess pts level of _____________ -keep the pt in a _____ environment; a private room is ideal. Provide ____ and _________ _____________ for detoxification - accompany and assist pt when _________ and use a _________ when transporting long distances. _____ headboard and side rails of bed with thick towels. - Institute _________ precautions - mon VS q _____ min -Administer substitution therapy. •Denial r/t weak, underdeveloped ego -Develop a ___________ nurse-pt relationship. Be ________. _______ all promises. - convey an attitude of ___________. -Identify ___________ behaviors or situations that have occured in its life an discuss how use of substances have been a contributing factor. - use __________ with caring. dont allow pt to fantasize their lifestyle - dont accept __________ or __________ as pt attempts to make excuses for his behavior - offer immediate _________ recognition of pts expressions of insight gained regarding illness and acceptance of responsibility •Ineffective coping -spend time with pt to Establish a __________ relationship. -Set ______on manipulative behaviors. -Explore _______ available to assist with stressful situations rather than resorting to _____ ______. - provide positive _________ of evidence of gratification delayed appropriately. Encourage the pt to be as _____ as possible in performing self-care. •Dysfunctional family processes -Review ________. -Provide __________. -_________ the family.

disorientation quiet, safe, supportive environment ambulating, wheelchair pad suicide 15 trusting, honest, keep acceptance maladaptive confrontation rationalization, projection positive trusting limits options substance abuse reinforcement independent history information involve

•______________: the transfer of feelings from one target to another that is considered less threatening or that is neutral -A pt is angry at his Dr. and doesn't ______ it but becomes verbally abusive w the nurse

displacement express

impaired comm (inappropriate responses), disordered thought sequencing, rapid mood swings, poor concentration, disorientation, stops talking in midsentence, tilts head to side as if to be listening

disturbed sensory perception

•delusional thinking; inability to concentrate; impaired volition; inability to problem solve, abstract, or conceptualize; extreme suspiciousness of others; inaccurate interpretation of the environment

disturbed thought processes

Voicing ______: expressing uncertainty about the validity of the pt's perceptions is a technique often used w pts experiencing __________ thinking •" its difficult to believe that the president of the us would be listening to allow our phone calls.", "I find that hard to believe or accept", "that seems rather doubtful to me"

doubt delusional

side effects of antipsychotic medicines: - __________ - ___________ - Restlessness - Weight _________ (the risk is higher with some _________ antipsychotic medicines) - ____ mouth - ___________ - N/V - Blurred vision - Low______ - Uncontrollable movements, such as tics and ___________ (the risk is higher with __________ antipsychotic medicines) - ___________ - A low number of _____, which fight infections A person taking an atypical antipsychotic medication should have his or her ________, ___________ levels, and ___________ levels monitored regularly by a doctor. Typical antipsychotic medications can also cause additional side effects related to physical movement, such as: - ___________ - Persistent muscle _________ -Tremors -Restlessness Long-term use of ________antipsychotic medications may lead to a condition called tardive dyskinesia (TD). TD causes muscle _________, commonly around the _________, that a person can't _________. TD rarely occurs while taking __________ antipsychotics.

drowsiness dizziness gain, atypical dry constipation BP tremors, typical seizures WBC weight, glucose, lipids rigidity spasms typical movements mouth, control atypical

At the mild to moderate level of anxiety, the strength of the ego is tested. _________ __________ ____________ are employed for protection

ego defense mechanisms

•__________: the ability to see beyond outward behavior and to understand the situation from the pt's POV - affects you personally, understanding from that persons perspective what is happening, you can understand for them whats happening

empathy

opioid Intoxication •Symptoms are consistent with the half-life of most opioid drugs and usually last for several hours. •Symptoms include initial _______followed by ________, dysphoria, psychomotor _________ or ________, and impaired judgment. •Severe opioid intoxication can lead to _________ ______, _____, and death.

euphoria apathy agitation, retardation resp. depression, coma

stimulant Intoxication •Amphetamine and cocaine intoxication produce ________, impaired judgment, _________, and changes in ______ (even coma or death, depending on amount consumed). •Caffeine intoxication usually occurs following consumption in excess of ____ mg. __________ and ________ are the most common symptoms.

euphoria confusion VS 250 restlessness, insomnia

social communication •Benefits __________ •Increase __________ •Provide ___________ •Meet ____________ need(s) •Ask/receives personal _______

everyone friendship enjoyment dependency advice

•Nurses must begin relationship development with a substance abuser by ___________ own attitudes and personal experiences with substances. If the nurse views these behaviors as morally wrong, it may be very difficult to suppress __________ feelings. •Various assessment tools are available for determining the extent of the problem a client has with substances. -Drug ____ and __________ -Clinical Institute Withdrawal Assessment of Alcohol Scale is an excellent tool that is used by many hospitals to assess ___ and _____ of ________ from alcohol. It may be used for initial assessment as well as ongoing monitoring of alcohol withdrawal symptoms. -Michigan Alcoholism Screening Test (MAST) -CAGE Questionnaire •Have you ever felt you should ____ _____on your drinking? •Have people _________ you by criticizing your drinking? •Have you ever felt bad or ______ about your drinking? •Have you ever had a drink first thing in the ________ to steady your nerves (____-___________) ?

examining judgmental hx, assessment risk, severity withdrawal Cut down Annoyed Guilty morning Eye-opener

pt/fam education of schizophrenia Nature of illness •What to ______ as illness progresses •____________ associated with illness •Ways for family to ___________ to behaviors associated with illness Management of the illness •Connection of exacerbation of symptoms to times of ______ •Appropriate __________ management •Side effects of ______________ •Importance of not ____________ medications •When to _________ health-care provider •___________ techniques •_______ _______ training •Daily living skills training Support services for schizophrenia •_________ assistance •_________ assistance •Caregiver support groups •________ care •Home health care

expect symptoms respond stress med med stop contact relaxation social skills legal financial respite

_____________: when the nurse hears the pt mention an issue or theme that seems relevant, the nurse asks the pt to explore this further. Exploring facilitates the pts development of awareness and understanding about events, thoughts, and feelings. However, if the pt chooses not to disclose further info, the nurse should refrain from _________or probing in an area that obvi creates discomfort. ex: "please explain that situation in _____ _________.", "tell me more about that particular situation" , "you mentioned feeling like no one cares about you. Tell me more about those feelings."

exploring pushing more detail

the fxn of supportive-therapeutic groups is to _________ members' learning how to deal effectively w _________ _______ in their lives examples •Grief support •Divorce support •Assertiveness training •_______ support groups •________ _________ survivors

facilitate emotional stress cancer sexual assualt

N Giving _________ __________: conveys that then nurse already knows the outcome of a situation and ___________ the pt's expressed concerns. It may discourage the pt from further expression of feelings if they believe the feelings will be downplayed or ridiculed.

false reassurance, minimizes

•Two or more individuals depending on each other for emotional, physical, and economic support. Family is self-defined.

family

__________ is a method of comm for helping the pt to develop self-awareness and consider modification of their behavior

feedback

____________: taking notice of a single idea or even a single word encourages specific discussion about a relevant issue and is esp. helpful w pts who are moving rapidly from one thought to another. However, focusing is very difficult for a pt w ________ __________so in this case the nurse shouldn't pursue focusing until the anxiety level lessens •"tell me more about this _______ ______."

focusing severe anxiety specific point

Schizophrenia is probably caused by a combination of factors, including: • __________ predisposition • ______________ dysfunction • _____________ factors • Psychosocial ______ Schizophrenia causes disturbances in •__________ processes •____________ •_____________ Result in a severe _________ of social and occupational functioning

genetic biochemical physiological stress thought perception affect deterioration

•striving to prevent anger or anxiety escalating to unmanageable level when stressor recurs

formulating plan of action

Crisis on the Inpatient Unit: Anger/Aggression Management Assessment •Anger can be identified by a cluster of characteristics that include: -___________ -___________ fists -_____-pitched voice -_______and shouting •Aggression can be identified by a cluster of characteristics that include: -__________; restlessness -Verbal/physical ______ -Threats of homicide or ______ -_____ voice; argumentative -_______ facial expression and body language Assessing risk factors •____________ is the key issue in management of aggressive or violent behavior. •Three factors are important considerations in identifying extent of risks. -____ _______ of violence -Client _______ -Current _______

frowning clenched low yelling pacing threats suicide loud tense prevention past hx dx behaviors

Counseling on a one-to-one basis can also be used to help the client who abuses substances. The relationship should be _____-directed, and the length of the counseling may ____ from weeks to years. The focus is on current _______, development of a working treatment relationship, and strengthening ____ assets. Counseling often includes the family or specific family members. In family counseling the therapist tries to help each member see how he or she has affected, and been affected by, the substance abuse behavior.

goal vary reality ego

therapeutic nurse-patient relationships are ________ __________. Ideally, the goal is mutually __________ on by the nurse and pt and is directed at _________ and growth promotion

goal-oriented agreed learning

Offering ______ _________: offer the pt encouragement to cont w minimal input from the nurse •"___ ___.", "and after that?"

general leads go on

predisposing factors of schizophrenia BIOLOGICAL influences •____________ - A growing body of knowledge indicates that genetics plays an important role in the development of schizophrenia •_______________ influences -One theory suggests that schizophrenia may be caused by an excess of __________ activity in the brain -Abnormalities in other neurotransmitters have also been suggested •Physiological influences -Factors that have been implicated include •_______ infection: Epidemiological data indicate a high incidence after prenatal exposure to ___________ •Anatomical abnormalities: ventricular ___________ is the most significant finding. •Histological changes in brain Psychological influences •___________ •Researchers now focus their studies of schizophrenia as a brain disorder. •Psychosocial theories probably developed early on out of a lack of information related to a biological connection. Environmental influences •Sociocultural factors: ________ has been linked with the development of schizophrenia. •__________ _____hypothesis: Poor social conditions seen as consequence of, rather than a cause of, schizophrenia. •_________ life events may be associated with exacerbation of schizophrenic symptoms and increased rates of relapse. __________ ______________ •Schizophrenia is most likely a __________ based disease, the onset of which is influenced by factors in the internal or external environment. -The etiology of schizophrenia remains _______. No single theory or hypothesis can substantiate a clear-cut explanation for the disease. The more research conducted, the more evidence is compelled in the support of the concept of multiple causation.

genetics biochemical dopamine viral influenza enlargement outated poverty downward drift stressful theoretical integration biologically unclear

____________: The subjective feeling of sorrow and sadness accompanied by emotional, physical, and social responses to the loss of a valued entity -The loss may be _____ or ___________ •5 Stages of grief ₋_________: shock and disbelief, "no it cant be true" ₋__________: "why me?, its not fair", envy and resentment toward ppl not affected by the loss ₋_____________: "if God will help me through this, I promise I will go to church every Sunday" ₋_____________: time of quiet desperation and disengagement from all association w the lost entity. ₋____________: feeling of peace regarding the loss

grief perceived, real denial anger bargaining depression acceptance

DISASTER NURSING Assessment •_____________ is a natural response following any loss, and it may be more extreme if the disaster is _________ experienced or witnessed. •Common behavioral responses include _______, disbelief, sadness, _________, fear, ______ disturbances, and increase in __________, _______, and __________ use. •Children may experience __________ _______, __________, and problems with ______________ Nursing diagnosis/outcome identification: some nursing dx that may be relevant include the following: 1.Risk for ______ 2.Risk for ___________ 3.Anxiety (panic) 4. _____ 5.Spiritual _________ 6.Risk for _____________ syndrome 7.Ineffective community ______ Outcome behaviors are identified as criteria for evaluation. The patient: •Demos behaviors necessary to ______ self from further injury •Id's ________ to prevent/reduce the risk of infection •Maintains anxiety at a _________ level •_________ beliefs and values about spiritual issues •Demos ability to deal w ________ _______ in an individually appropriate manner •Demos an __________ in activities to improve community functioning

grieving directly anger anxiety sleep caffeine, ETOH, nicotine separation anxiety, nightmares, concentrating injury infection fear distress PTSD coping protect interventions manageable expresses emotional reactions increase

Collection of individuals who share interests, values, norms, or purposes. Formed by choice, chance, or by circumstance.

group

Clients meet together with a therapist for sharing, support, gaining personal insight, and improving coping strategies

group therapy

positive s/sx of schizophrenia

hallucinations, delusions, alterations in speech, bizarre behavior

therapeutic comm: -Helps to promote ________ _________ - Assists in disclosing _________ which builds_____ - _________ their feelings and thoughts

healing behavior information, trust expresses

opioid Withdrawal •From short-acting drugs (e.g., _______) -Symptoms occur within ___-___ hours, peak within __-___ days, and gradually subside in 5 to 10 days. •From long-acting drugs (e.g., methadone) -Symptoms occur within __-___ days, peak between days __-___, and subside in 14 to 21 days. •From ultra-short-acting meperidine (Demerol) -Symptoms begin quickly, peak in __-___ hours, and subside in 4 to 5 days.

heroin 6-8, 1-3 1-3, 4-6 8-12

Maslow identified A "____________ of ________" - __________ ________________ as fulfillment of one's highest potential: being "psychologically __________, fully _________, highly evolved, and fully ________."

hierarchy, needs self actualization healthy, human, mature

curative factors of being in a group •Instillation of ______ (that issue can be resolved) •_____________ (that you are not alone) •Imparting __________ (instruction and advice) •__________ (sharing and concern for others) •Corrective recapitulation of the primary family group (acting out a ___-____) •Development of socializing techniques (_____ ________) •___________ behaviors (role model ________ behaviors) •______________ learning (interaction and personal insight) •Group ____________ (sense of belonging) •_____________ (expression of feelings - getting it off your chest) •Existential factors (change to improve ______)

hope universality information altruism do-over social behaviors imitative, positive interpersonal cohesiveness catharsis QOL

•______________: an attempt to inc self-worth by acquiring certain attributes and characteristics of an individual one admires -A teenager who required lengthy rehab after an accident decides to become a ____ as a result of his experiences.

identification PT

misperception or misinterpretation of real stimuli (sees something and thinks its something else)

illusion

Biological responses associated with fight-or-flight syndrome ___________ response: the hypothalamus stimulates the sympathetic NS, which results in the following physical effects: -Adrenal medulla releases NEP and EP into the blood. -Pupils _______ -Bronchioles dilate, and the ____ increases - increase in CO, ___, ____ __________ response: when the stress response isn't relieved immediately and the individual remains under stress for a long period, the hypothalamus stimulates the pit gland to release hormones that produce the following effects: -___________ stimulates adrenal cortex to release glucocorticoids and mineralocorticoids, resulting in increased gluconeogenesis and retention of ______ and water and decreased ______ and __________ responses

immediate dilate RR HR, BP sustained ACTH Na, immune, inflammatory

Horwitz describes cultural influences that affect how individuals view mental illness, which include -_____________: The inability of the general population to understand the motivation behind the behavior ("what in the world are they doing") -________ __________: The "normality" of behavior is determined by the culture. ("in my culture, we don't do that")

incomprehensibility cultural relativity

Age-related demographics •According to DSM5, the onset of schizophrenia usually occurs between the _____ _____ and the _____ ______ Sex-related demographics •The prevalence of schizophrenia is about the ______ in men & women •The onset is later in ______ than in men •The clinical course is less severe in women than in men Race-related demographics •______ racial differences in the prevalence of schizophrenia have been positively identified

late teens, mid 30s same women no

•_____________: an attempt to avoid expressing actual emotions associated w a stressful situation by using the intellectual processes of logic, reasoning, and analysis -Susans husband is being transferred w his job to a city far away from her parents. She hides anxiety by explaining to her parents the __________ assoc with the move

intellectualization advantages

therapeutic groups differ from group therapy in that the focus isn't on psychotherapy but on ________ and ___________ among group members w regard to selected issue. Group therapy is more focused on specific models of _________, and the leaders generally have advanced degrees in psychology, social work, nursing, or medicine.

interaction, relationships psychotherapy

N ___________: attempts to tell the pt the meaning of their experience. Erroneous interpretations may leave the pt feeling that the nurse doesn't understand him or her, or that the nurse is being smug.

interpreting

-________ distance is the closest distance that ppl will allow between themselves and others. -___________ distance is approx 18-40 inches and is reserved for close convos with friends or colleagues - ___________ distance is about 4-12 ft away, includes convos w strangers or acquaintances - __________ distance is one that exceeds 12 ft, like public speaking

intimate personal social public

•____________: a state of disturbance in cognition, perception, behavior, LOC, judgment, and other fxns attributable to the effects of a psychoactive drug. It may be marked by a physical and mental state of exhilaration and emotional frenzy or lethargy and stupor.

intoxication

•_____________: integrating the beliefs and values of another person into ones own ego structure -Children integrate their parents value system into the process of conscience formation. A child says to a friend, "don't cheat. Its wrong."

introjection

nursing interventions for the pt who has experienced a traumatic event and at risk for post-trauma syndrome 1. determine __________ in event 2. evaluate current ______ assoc/ w the event 3. listen for comments of taking on _________ 4. ID pts current _________ mechanisms 5. determine availability and usefulness of pts ______ _____, family, social contacts,and community resources 6. provide info of s/sx of post trauma response 7. id and discuss pts _____ and ________ 8. evaluate pts ________ of events 9. provide emotional and physical ________ by sitting w pt and offering solace 10. encourage expression of ______ 11. note presence of __________, reliving the incident, loss of _______, irritability, _________ and crying, and family or relationship _________. 12. provide a ____ and ____ environment 13. recommend participation in _______ sessions 14. admin meds such as ___________

involvement factors responsibility coping support systems strengths, vulnerabilities perception presence feelings nightmares appetite, numbness, disruption calm, safe debriefing antipsychotics

•_____________: separating a thought or memory from the feeling, tone, or emotion assoc with it -A young woman describes being attacked and raped w/o showing any __________

isolation emotion

Mood stabilizers side effects include: - __________, rash - Excessive _____ - Frequent ___________ Tremor (shakiness) of the ______ Nausea and vomiting - __________speech - Fast, slow, irregular, or pounding _______- - Blackouts - Changes in vision - Seizures - _____________ (seeing things or hearing voices that do not exist) - Loss of coordination - _________ of the eyes, face, lips, tongue, throat, hands, feet, ankles, or lower legs.

itching thirst urination hands slurred HR hallucinations swelling

•Teaching groups: exist to convey ________ and __________ to a number of individuals. Nurses can be involved in teaching groups of many varieties, such as _____ education, ___________ education, and effective parenting classes. These meeting usually have a set _____ frame or set _________ of meetings. Members learn from _______ __________ as well as from the instructor. The objective of teaching groups is verbalization or ____________ by the learner of the material presented by the end of the designated period EXAMPLES •Social skills •Daily living skills •Prepared _________ class •___________ classes •Medication information class •Diabetes - new patient class •Transition to discharge group

knowledge, information medication childbirth time number eachother demonstration childbirth parenting

leadership styles in groups Autocratic -Focus is on the________ - Leader likes to do things ____ ____ - _____ productivity - Low _______, ___________, and ownership Democratic •Focus is on the _______ •Leader is __________- information flows both directions •_______ productivity •High morale, __________, and ____________ Laissez-Faire •Focus ____________ •Leader is ______-___ and ___-______ •_____ productivity •_____ morale and enthusiasm, high _________

leader their way high morale, enthusiasm group facilitator high motivation, cohesiveness undetermined hands-off, non-directive low low, frustation

anticonvulsant medications may also: -Cause damage to the __________ or ___________, so people taking it should see their doctors regularly -Increase ___________ (a male hormone) levels in teenage girls and lead to a condition called _________ ___________ syndrome (a disease that can affect fertility and make the menstrual cycle become irregular) Medications for common adult health problems, such as diabetes, high blood pressure, anxiety, and depression may interact ______ with anticonvulsants.

liver, pancreas testosterone polycystic ovarian badly

Resolution of the grief response is thought to occur when an individual can _____ ______ on the relationship with the lost entity and accept both the _________ and the ______________ of the association.

look back pleasures, disappointments

Disturbances in thought processes manifested in speech •__________ __________ is characterized by communication in which ideas shift from one unrelated topic to another. Typically, the individual is unaware that the topics aren't connected. •___________: person invents new words, or neologisms, that are meaningless to others but have symbolic meaning to the person (e.g. "she wanted to give me a ride in her new uniphorum.") •_________ ___________: choice of words is governed by sounds. Often take the form of rhyming. (e.g. "its very cold. I am cold and bold. The gold has been sold".) •____ ______: group of words that are put together randomly, w/o any logical connection (e.g., "most forward action grows life doible plays circle uniform") •_____________: person delays in reaching the point of a communication bc of unnecessary and tedious details. The point or goal is usually met but only w numerous interruptions by the interviewer to keep the person on track of the topic being discussed •______________: veering away from a topic of discussion and difficulty maintaining focus and attn •_____________: persistently repeats the same word or idea in response to different questions. •_______________: repeating words or phrases spoken by another.

loose association neologism clang association word salad circumstantiality tangentiality perseveration echolalia

-The experience of guilt for having had a "____-____" relationship with the lost entity. ________ often lengthens the grieving process. -Anticipatory grieving is thought to ________ the grief response when the loss actually occurs. -__________ _________-: The length of the grief response is often extended when an individual has experienced a number of recent losses and when he or she is unable to complete one grieving process before another one begins.

love-hate guilt shorten bereavement overload

Interventions with the client who has experienced a traumatic event are aimed at 1._________ _________ at a manageable level 2.Encouraging ______ ___________ of beliefs and values about spiritual issues 3.Assistance to deal with ___________ ________ in an individually appropriate manner 4.Promotion of activities to improve ________ __________

mainating anxiety free expression emotional reactions community functioning

_________ ___________: verbalizing observations about a pt's behavior or appearance encourages the pt to develop awareness of how they are perceived by others and promotes exploration of issues that may be problematic •"you ______ sad today.", "I _____ you are pacing a lot", "I notice that when I ask you about whether you have thoughts about suicide you change the subject."

making observations appear notice

_________ ___________ to loss occur when a person is unable to progress satisfactorily through the stages of grieving to achieve resolution.

maladaptive responses

N Making stereotyped comments, clichés, and trite expressions: trite expressions are ____________ in a nurse-pt relationship. When the nurse uses meaningless expressions, it encourages a ______ response from the pt. •"how are you?", "hang in there.", "it'll work out." •Better alt: choose words, sentences and non-verbal language that convey a _________ interest in encouraging the pt to share more about the pts thoughts, feelings, and behaviors.

meaningless similar sincere

Psychotic Disorder Associated with Another Medical Condition •Prominent hallucinations and delusions are directly attributable to a general__________ _________ - Must have a known __________ __________ between the physical condition It's often difficult to determine that a physical illness or medical condition has caused any mental disorder. Here are a few pointers: •Timing of _____: Mental or behavioral symptoms that begin shortly after the start of the physical illness offer a pretty obvious etiological clue. •Remission follows treatment for the physical issue. ____________ of symptoms: As the physical disorder worsens, so do the behavioral or emotional symptoms.

medical condition physiological connection onset proportionality

_________ ________ is defined as "the successful adaptation to stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are age-appropriate and congruent with local and cultural norms."

mental health

___________ ___________ is defined as "maladaptive responses to stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are incongruent with the local and cultural norms and interfere with the individual's social, occupational, or physical functioning."

mental illness

Aggressive behaviors can be classified as ____ (e.g. sarcasm), ___________ (e.g. slamming doors), _________ (e.g. threats of physical violence against others), or ___________ (e.g. physical acts of violence against others) •Reactive aggression: _____-based and ____________ •Proactive aggression: __________ and _____________ •_______ is a requisite in the definition of aggression

mild moderate severe extreme fear, impulsive predatory, calculated intent

Cognitive and behavioral therapies are helpful in training clients to monitor _____ and ________ _______ that lead to substance abuse. With these therapies, clients also learn to _____ substance use and to ____ with cravings and the temptation to _________

moods thought patterns avoid cope relapse

__________ __________ is an evidence-based, pt-centered style of comm that facilitates pt's exploration of their own motivations for behavior change and guide sthe ot to explore the advantages and disadvantages of their decisions

motivational interviewing

•Psychopharmacology for substance intoxication and substance withdrawal (cont'd) -Opioids •Narcotic antagonists -_____________ •Methadone: to ________ w/drawal symptoms •Buprenorphine to tx opiate __________ •Clonidine: _________ opioid w/drawal symptoms

naloxone (narcan) suppress addiction suppress

client and family education for a substance use. Topics for discussion with the client and family include the _____ of the illness, including the _______ of the substance on the body and ways in which use of the substance affects _____. __________of the illness, including activities to substitute in times of _____, relaxation techniques, and the essentials of good __________. Support services •_________ assistance •__________ assistance •_______ (or other support group specific to another substance) •_______________ support person Management of the illness 1. Activities to __________ for (substance) in times of _____ 2. ____________ techniques •Progressive relaxation •Tense and relax •Deep breathing •Problem-solving skills 3. Essentials of good _________

nature, effects life, management stress nutrition financial legal AA one-to-one substitute, stress relaxation nutrition

values, attitudes, and beliefs can influence comm in numerous ways. For example, prejudiced is expressed through _______ _______

negative stereotyping

socially acceptable mood-altering substances by Americans are

nicotine, caffeine, alcohol

___________- expression is a primary component of comm (___to ___%) in which meaning is assigned to various gestures and patterns of behavior Components of nonverbal communication •Physical __________ and _____ •Body _________ and ____________ •______ •_____ expressions •_____ behavior •Vocal cues or ___________--

nonverbal comm 70-90 appearance, dress movement, posture touch facial eye paralanguage

prognosis A return to full premorbid functioning is ____ ______ Factors associated with a positive prognosis include: •Good __________ functioning •_____ age at onset •______ gender •Abrupt onset precipitated by a ________ event •Associated mood disturbance •_____ duration of active-phase symptoms •________ residual symptoms •Absence of structural brain ___________ •Normal ___________ functioning •Family history of _____ disorder •No family history of ____________

not common premorbid later female stressful brief minimal abnormalities neurological mood schizophrenia

-Anxiety at the moderate to severe level that remains unresolved over an extended period can contribute to several ____________ disorders. -Extended periods of repressed severe anxiety can result in ______________ patterns of behaving. -____________: psychiatric disturbances characterized by excessive anxiety that's expressed directly or altered through defense mechanisms. It appears as a symptom, such as an obsession, compulsion, phobia or sexual dysfunction

physiological psychoneurotic neuroses

member roles w/in a groups •______ roles - help with group progress or activities, complete the task if a group •___________ roles - enhance group processes •___________/________ roles - meet individual needs but sometimes interfere with group progress or function

task maintenance individual/personal

•"Tell me about...", "help me understand/clarify", opening a door for your pts, goal is to open the convo not stagnant it

offering general leads

________ _________: willingness to spend time w the pt and show interest on an unconditional basis helps to inc pt's feelings of ____-_____ •"ill stay w you awhile", "how are you feeling today?", "im interested in hearing your thoughts about the group you just attended"

offering self self-worth

groups can be ____ ended (when members leave and others join at any time while the group is active) or _____ ended (when groups have a predetermined, fixed time frame and all members join at the same time and leave when the group disbands).

open closed

nursing interventions for the pt who has experienced a traumatic event and dx with spiritual distress 1. determine pt's religious/ spiritual ________-, current __________, and presence of ________ 2. establish environment that promotes _____ ________ of feelings and concerns. Provide ____, ______ setting when possible. 3. _______ to pts and SO expression of anger, concern, alienation for God, belief that situation is a punishment for wrongdoing, and similar concerns 4. note sense of ______, feelings of hopelessness and ____________, lack of motivation to _______ 5. listen to expressions of inability to find meaning in life and reason for living. evaluate for _________ ________ 6. determine _______ ________ available to pt. 7. ask how you can be most _______. Convey ____________ of pts spiritual beliefs and concerns 8. make time for __________ discussion of philosophic issues and questions about spiritual impact of current situation 9. discuss __________ b/w grief and guilt, and help pt to ID and deal w each, assuming ___________ for own actions, expressing _______ of the consequences of acting out of _____ _______ 10. use therapeutic comm skills of _________ and ________ _______ 11. encourage pt to experience meditation, prayer, forgiveness. Provide info that anger w God is a normal part of the _______ process. 12. assist pt to develop ____ for dealing w life situation 13. ID and refer to resources that can be helpful, such as pastoral/parish nurse or religious counselor, crisis counselor, psychotherapy, AA, ETC 14. encourage participation in _______ _______.

orientation, involvement, conflicts free expression calm, peaceful listen futility. helplessness, self-help suicidal ideation support systems helpful, acceptance nonjudgmental difference responsibility, awareness, false guilt reflection, active listening grieving process goals support groups

•A common feature of disasters is that they __________ local resources and _________ the _______ and _______ of the community. •Disasters leave victims with a ___________ sense of ______and ____-_____ and varying amounts of ________ _____________

overwhelm threaten, fxn, safety damaged, safety, well-being emotional trauma

Opioids exert both a sedative and an analgesic effect, and their major medical uses are for the relief of ____, the treatment of _________, and the relief of __________. _________ develops and ___________ occurs, leading the individual to procure the substance by whatever means is required to support the habit.

pain diarrhea coughing tolerance addiction

AA groups are based on the concept of ___ __________—acceptance and understanding from others who have experienced the same problems in their lives. Requirement for membership is a desire on the part of the alcoholic person to ___ ________. Each new member is assigned a ________ ___________ from whom he or she may seek assistance when the __________ to drink occurs. •Alcoholics Anonymous (AA) -A major ____-_____ organization for the treatment of _________ -Based on the concept of: •_____ support •__________ •____________ from others who have experienced the same problem -The 12 steps that embody the philosophy of AA provide specific guidelines on how to attain and maintain _________ -_________ ___________ is promoted as the only cure; the person can never safely return to _______ ___________

peer support stop drinking support person temptation self-help, alcoholism peer acceptance understanding sobriety total abstinence social drinking

•Whether individuals experience a crisis in response to a stressful situation depends on three factors: -The individual's ___________ of the event -The availability of __________ ____________ -The availability of adequate ________ ___________

perception situational supports coping mechanisms

Substance addiction •___________ dependence -Need for increasing __________ to produce the desired effects •_____________ dependence -Overwhelming _________ to repeat the use of a particular drug to produce pleasure or avoid discomfort

physical amount psychological desire

Effects of alcohol on the body •__________ _______, characterized by: Peripheral nerve damage, results in Pain, Burning, Tingling, ______ sensations of the extremities. Researchers believe it is the direct result of deficiencies in the ____ vitamins, particularly ________. _________ deficiencies are common in chronic alcoholics bc of insufficient intake of nutrients as well as the toxic effect of alcohol that results in __________ of nutrients. This is reversible with abstinence from alcohol and restoration of nutritional deficiencies, but permanent _______ _________, and ________ can occur with continued use. • ________ __________: Thought to result from same B vitamin deficiency that contributes to peripheral neuropathy -Acute: Sudden onset of muscle ____, _________, and weakness; _______ tinge to the urine; rapid rise in muscle __________ in the blood -Chronic: Gradual _______ and ________ in skeletal muscles •_________ _____________: Most serious form of thiamine deficiency in alcoholic patients -_______ of the ocular muscles, ________, ataxia, somnolence, and stupor. Requires ___________ replacement therapy immediately. • _________ _________: identified by a Syndrome of confusion, loss of recent memory, and confabulation in alcoholic patients •________ _____________: Effect of alcohol on the heart is an accumulation of ______ in the myocardial cells, resulting in _________ and a weakened condition. Tx is total permanent _______ from ETOH •____________: Inflammation and pain in the esophagus. •It also occurs because of frequent _________ associated with alcohol abuse. • ____________ : Effects of alcohol on the stomach include inflammation of the stomach lining characterized by epigastric distress, nausea, vomiting, and distention • Pancreatitis -Acute: Usually occurs ____-____ days after a binge of excessive alcohol consumption. Symptoms include constant, severe _______ pain; nausea and vomiting; and abdominal __________. -Chronic: Leads to pancreatic insufficiency resulting in _________, malnutrition, weight _____, and _____________ • _____________ _____________ -Inflammation of the liver Caused by long-term heavy alcohol use -Symptoms: _______ and tender liver; nausea and vomiting; lethargy; ___________; elevated _____ count; fever; and _________. Also _____ and weight loss in severe cases.

peripheral neuropathy prickly B, thiamine nutritional malabsorption muscle wasting, paralysis alcoholic myopathy pain, swelling, reddish enzymes wasting, weakness Wernicke's encephalopathy paralysis, diplopia thiamine Korsakoff's psychosis alcoholic cardiomyopathy lipids enlargement abstinence esophagitis vomiting gastritis 1-2 epigastric distention steatorrhea loss DM alcoholic hepatitis enlarged anorexia WBC jaundice ascites

Of all the mental illnesses, schizophrenia undoubtedly results in the greatest amount of _________, __________, and ______ costs. It presents an enormous threat to _____ and _____________.

personal, emotional, social life, happiness

Formulating a ____ of ______: encouraging the pt to id a plan for behavior change promotes developing better _____ ______ •"what could you do _________ if you were faced w this situation in the future?", "what are some steps you could take to manage your anger w/o punching someone ?", "what is one thing you would be willing to try to decrease your anxiety instead of using alcohol?"

plan, action coping skills differnetly

symptoms of schizophrenia are categorized as __________ (an excess or distortion of normal functions) or ___________ (a diminution or loss of normal functions)

positive negative

development of an alcohol use disorder - Phase I: __________ phase: characterized by the use of ALCOHOL FOR ITS EFFECTS IN RELIEVING EVERYDAY __________ and ___________ of life - Phase II: ______ ______ phase: begins with ________-brief periods of amnesia that occur during or immediately following a period of drinking. ETOH is now a drug that is ___________. common behaviors include sneaking drinks or _______ drinking, preoccupation w drinking and maintaining the supply of ETOH, rapid __________ of drinks, and further ________. the person feels enormous _____ and becomes very ________ about their drinking. excessive use of ____ and __________ is evident. - phase III: ________ phase: the person has lost _______, and physiological addiction is clearly evident. This loss of control has been described as the inability to ____ whether or not to drink. ______ drinking, lasting from a few hours to several weeks, is common. Characterized by ______, LOC, squalor, and degradation. ______ and __________ are common CM. Drinking is the total ______ and they are willing to risk everything. The person may have experienced loss of ____, _____, family, friends, and most especially self-_________. -phase IV: _________ phase: characterized by emotional and physical disintegration. the person is usually _________ more than they are _____. Profound helplessness and self-_____. May result in ________. Life-threatening ________ manis may be evident in every system of the body. Unmanaged _______ from ETOH results in terrifying syndrome of symptoms that include ____________, tremors, __________, severe agitation, and panic. for long-term, heavy drinkers, abrupt withdrawal of alcohol can be ______

prealcoholic stress, tensions early alcoholic, blackouts required secret gulping blackouts guilt defensive denial, rationalization crucial, control choose binge sickness anger, aggression focus job, marriage respect chronic intoxicated, sober pity psychosis physical withdrawal hallucinations convulsions fatal

in all interpersonal transactions, both the sender and receiver bring certain _______________ conditions to the exchange that influence both the intended message and the way in which its interpreted. Examples: -ones _________ system - internalized attitudes and beliefs - _________ or _________ - social status - gender - background __________ and experience - age or developmental level - and the type of ________ in which the comm takes place

pre-existing value culture, religion knowledge environment

Phases of a Therapeutic Nurse-Client Relationship 1. ______________ phase: ___________ for the first encounter w pt; exploring _____-_________ 2. orientation (introductory) phase: nurse and pt become __________; establish _____ and formulate contract for ___________ 3. _________ phase: therapeutic ____ of the relationship is accomplished during this phase; promote patient ______ 4. ____________: involves bringing a therapeutic __________ to the relationship; evaluate ____ attainment and ensure therapeutic _________

preinteraction, preparation self-perceptions acquainted truts, intervention working, work change termination conclusion goal, closure

4 stages of schizophrenia -Phase I: _________ phase: Those that occur _____ there is clear evidence of illness and may include distinctive personality traits or behaviors. •Social maladjustment •__________ thoughts and behavior •____ and ___________ •______ peer relationships •Doing __________ in school •___________ behavior -phase II: __________ phase: Prodromal symptoms more clearly manifest as signs of developing illness of schizophrenia. Begins w a change from ___________ functioning and extends until the onset of frank ____________ symptoms. •Lasts from a few _____ to a few ______ •Deterioration in role functioning and social withdrawal •Substantial functional ___________ •______ disturbance, anxiety, irritability •___________ mood, _____ concentration, fatigue •Perceptual _________, ideas of reference, and suspiciousness herald onset of psychosis -phase III: _________ __________ phase (acute schizophrenic episode) In the active phase of the disorder, psychotic symptoms are _________ • _________, ___________, etc. • ___________ in work, social relations, and self-care -phase IV: ___________ phase •Symptoms similar to those of the _________ phase •_____ affect and impairment in ____ functioning are prominent

premorbid, before antagonizes shy, withdrawn poor poorly antisocial prodromal premorbid psychotic weeks, years impairment sleep depressed, poor abnormalities active psychotic prominent hallucinations, delusions impairments residual prodromal flat, role

N ____________: persistent questioning of the pt and pushing for answers to issues the pt doesn't wish to discuss or doesn't know the answers to may contribute to the pt feeling used only for what info the nurse is seeking and may place the pt on the ___________.

probing defensive

Novinsky and associates describe a _______ _________ thats characterized by anxiety and tension, verbal abuse, profanity, and increasing hyperactivity

prodromal syndrome

Nursing interventions for inappropriate anger pt with risk for self-directed or other-directed violence 1. observe for escalation of anger (__________ __________): inc motor activity, pounding, slamming, tense posture, defiant affect, clenched teeth and fists, arguing, demanding, and challenging or threatening staff 2. when these behaviors are observed, first ensure that sufficient ___ are available to help w a potentially violent situation. ______ to defuse the anger beginning w the _____ ______ means 3. techniques for dealing w aggression include: - _______ _______ - physical outlets - ___________ - call for __________ - seclusion or ___________: should be last resort - observation and documentation: every ___ minutes, pt should be monitored to ensure circulation to extremities isnt compromised - ongoing assessment: assess patients _______ for restraint removal or education - debriefing: helps to process the ______ of the intervention

prodromal syndrome staff attempt least restrictive talking down medication assistance restraints 15 readiness impact

N Indicating the existence of an external source of power: attributing the source of thoughts, feelings, and behavior to something to someone other than the pt encourages the pt to ______ blame on their thoughts and behaviors on others rather than ____________- the responsibility personally.

projecting accepting

Maladaptive grief responses -____________ response: characterized by an intense preoccupation w memories of the lost entity for many years after the loss has occurred -__________/__________ response: the individual becomes fixed in the denial stage of the grieving process -_______ response: fixed in the anger stage of grieving, may culminate in pathological ____________

prolonged delayed/inhibited distorted, depression

The minimum therapeutic goal of crisis intervention is _____________ resolution of the individual's immediate crisis and ____________ to at least the level of functioning that existed before the crisis period. A maximum goal is improvement in __________ above the _______ level.

psychological restoration functioning precrisis

characteristics of a crisis 1. Crisis occurs in all individuals at one time or another and is not necessarily equated with ______________. 2. Crises are precipitated by specific __________ events. 3. Crises are _______ by nature. What may be considered a crisis situation by one individual may not be so for another. 4. Crises are _____, not chronic, and are _______ in one way or another within a brief period. 5. A crisis situation contains the potential for psychological _____ or ______________

psychopathology identifiable personal acute, resolved growth, deterioration

•a severe mental condition in which there is a disorganization of the personality, deterioration in social functioning, and loss of contact w or distortion of reality. There may be evidence of hallucinations (false sensory perceptions not assoc w real external stimuli) and delusions (fixed, false beliefs). Can occur w or w/o the presence of organic impairment.

psychosis

Antipsychotic medicines are primarily used to manage ___________. The word "psychosis" is used to describe conditions that affect the ____, and in which there has been some loss of contact with _________, often including __________ (false, fixed beliefs) or _________ (hearing or seeing things that are not really there). It can be a symptom of a physical condition such as drug abuse or a mental disorder such as ____________, bipolar disorder, or very severe depression (also known as "psychotic depression").

psychosis mind reality delusions, hallucinations schizophrenia

•_____________: "implies special feelings on the part of both the pt and the nurse based on acceptance, warmth, friendliness, common interest, a sense of trust, and a nonjudgmental attitude". good reputation by building a relationship with respect, trust, reliability, consistent - introduce yourself, make eye contact

rapport

•________________: attempting to make excuses or formulate logical reasons to justify unacceptable feelings or behaviors -John tells the rehab nurse, " I drink bc it's the only way I can deal with my bad marriage and my worse job

rationalization

•__________ _________: preventing unacceptable or undesirable thoughts or behaviors from being expressed by exaggerating opposite thoughts or types of behaviors -Jane hates nursing. She attended nursing school to please her parents. During career day, she speaks to prospective students about the _____________ of nursing as a career.

reaction formation excellence

phases of group development •Preorientation (preintervention): asking the nurse their ___________ to lead a group, asking about ___________, being mentally prepared to do this task Phase I:________ or __________ •Establish _____, ______, rapport, and social norms. Begin __________ planning. Phase II: _________ or ___________ •Facilitation of ______ _______ and _________ ________. Resolve ______. Taking ______. Group member feeling of ________ develops. Phase III: ______ or ____________ •Prepare early for __________ and potential feeling of loss. Review ______ and __________. Celebrate ________________.

readiness biases initial, orientation rules, goals discharge middle, working problem solving, decision making conflicts, action, ownership final, termination ending, goals, progress accomplishments

•directs questions or feelings back to client so that they may be recognized and accepted

reflecting

____________: questions and feelings are referred back to the pt so that the pt is empowered to actively engage in problem-solving rather than simply asking the nurse for advice •Pt: "don't you think I should tell my boss im not putting up with that?", Nurse: " what do ________________________?", Pt: "she makes me so upset!", Nurse: "so you're feeling angry at your boss?"

reflecting you think you should do

•____________: responding to stress by retreating to an earlier level of development and the comfort measures assoc. w that level of functioning -When 2 yo jay is hospitalized for tonsilitis, he will drink only from a bottle, although his mother states he has been drinking from a cup for 6 months.

regression

nursing interventions for pt w schizophrenia and dx with Impaired Verbal Communication related to, Panic anxiety, _________, Withdrawal, Disordered unrealistic thinking 1. attempt to ________ incomprehensible comm patterns. seek _______ and _________--- by stating "is it that you mean...?" or "i don't understand what you mean by that. would you explain it to me?" 2. maintain ______ assignments as consistently as possible 3. the technique of _________ the _______ is used w the pt whos struggling to communicate thoughts and feelings 4. anticipate and fulfill pts needs until functional ______ pattern returns 5. __________ pt to ________ PRN. call the pt by _____. validate those aspects of comm that help differentiate b/w what's real and not real. 6. explanations must be provided at pts level of ____________ outcome criteria: -short: pt will demonstrate the ability to remain on ____ topic using appropriate, intermittent ___ contact for __ minutes w the nurse or therapist -long: by time of discharge, the pt will demonstrate ability to carry on _______ comm in a ________- acceptable manner with HCPS and peers

regression decode, validation clarification staff verbalizing, implied comm orient, reality, name comprehension one eye 5 verbal, socially

N ______________: refusing to consider or showing contempt for the pts ideas or behavior may cause the pt to d/c interaction w the nurse for fear of further ___________

rejection x2

outcome criteria for pt w schizophrenia The pt: •Demonstrates an ability to _____ to others satisfactorily •Recognizes distortions of ______ •Has not___________ self or others •Perceives self _____________ •Demonstrates ability to perceive the environment __________ •Maintains _________ at a manageable level •Relinquishes need for delusions and hallucinations •Demonstrates ability to _______ others •Uses _____________ verbal communication in interactions with others •Performs self-care activities ______________

relate reality harmed realistically correctly anxiety trust appropriate independently

•_____________: involuntarily blocking unpleasant feelings, and experiences from one's awareness -A trauma victim is unable to ___________ anything about the traumatic event

repression remember

____________: when a person can look back after the loss and remember the times. Length of the grief process is entirely individual; it can last from a few weeks to years; it is influenced by a number of factors.

resolution

•________: to believe in the dignity and worth of an individual regardless of their unacceptable behavior, aka ___________ ________ _____________ -want the pt to trust that we will act in our best interest, and we want them to respect that we have the best goals for them -Calling the pt by ______ -Spending time w pt -Allowing for sufficient ____ to answer the pts questions and concerns -Promoting an atmosphere of __________ during therapeutic interactions w the pt or when the pt may be undergoing physical examination or therapy -Always being open and ______ w the pt, even when the truth may be difficult to discuss -Striving to ___________ the motivation behind the pt's behavior, regardless of how unacceptable it may seem

respect unconditional positive regard name time privacy honest understand

nursing diagnosis and outcome identification for clients with substance use disorder. •Ineffective Denial related to weak, underdeveloped ego -Outcome: Client will demonstrate acceptance of _________ for own behavior and ___________ association between personal ________ and ___ of substance(s). •Ineffective Coping related to inadequate coping skills and weak ego -Outcome: Client will be able to demonstrate more adaptive _______ mechanisms that can be used in _________situations (instead of taking substances). •Imbalanced Nutrition less than body requirements/Fluid volume deficit related to drinking or taking drugs instead of eating -Outcome: Client will be _____ from signs or symptoms of __________/____________ •Risk for Infection related to malnutrition and altered immune condition -Outcome: Shows ___ signs or symptoms of _______. •Chronic Low Self-Esteem related to weak ego, lack of positive feedback -Outcome: Exhibits evidence of increased ___-____ by attempting new projects without fear of _______ and by demonstrating less __________ behavior toward others. •Deficient Knowledge (effects of substance abuse on the body) related to denial of problems with substances evidenced by abuse of substances -Outcome: Verbalizes _________ of abstaining from use of substances to maintain _______ _________ •For the client withdrawing from CNS depressants -Risk for Injury related to CNS __________ •For the client withdrawing from CNS stimulants -Risk for _______ related to intense feelings of lassitude and __________, "crashing," suicidal ideation

responsibility acknowledge problems, use coping stressful free malnutrition/dehydration no, infection self-worth failure defensive importance optimal wellness agitation suicide depression

____________: repeating the main idea of what the pt has said lets the pt know whether an expressed statement has been understood and gives him or her the chance to continue, or to clarify if necessary. •Pt: "I cant study. My mind keeps wandering." Nurse: "you have trouble concentrating." Pt: "I can't take that new job. What if I cant do it?" Nurse: " you're afraid you will fail in this new position."

restating

Substance intoxication •Development of a ____________ syndrome of symptoms following excessive use of a substance •Direct effect on the _______ •Disruption in physical and psychological _____________ •___________ is disturbed and social and occupational functioning is ________ •Symptoms: disinhibition of sexual or aggressive impulses, mood lability, impaired judgment, impaired social or occupational functioning, ______ speech, incoordination, unsteady gait, nystagmus, and flushed face.

reversible CNS functioning judgement, impaired slurred

N Defending: to defend what client has criticized implies that client has no_____ to express ideas, opinions, or feelings

right

the psychodrama setting provides the pt w a _____ and less ___________ atmosphere than the real life situation in which to express and work through ___________ conflicts.

safer, threatening unresolved

Catatonic symptoms are essentially the _____, whether they occur in patients with a mood disorder, schizophrenia, or a physical disorder. A patient with another medical condition is more likely to have the characteristic symptoms of what is called __________ ________. These include __________ and ________ ________. Such patient may also ____, stop eating, or become ____. -The catatonic features usually associated with mania include _________, __________, and ____________. These patients may also refuse to keep their ______ on. -Depressed patients may show markedly reduced ______(even to the point of _____), mutism, negativism and mannerisms.

same retarded catatonia posturing, waxy flexibility, drool mute hyperactivity impulsivity, combativeness clothes mobility stupor

Schizophreniform Disorder •Same symptoms as __________ with the exception that the duration of the disorder has been at least ___ month but less than ___ months. If s/sx persist longer ___ months, the dx is changed to _____________. •Relatively rapid _____ and __________ •Diagnosis requires at least ___ of the ____ psychotic symptoms, at least one of which must be delusions, hallucinations, or disorganized speech. •Patients recover fully within ___ ___________; thought to have a good prognosis if pts affect isnt __________ or ____

schizophrenia 1, 6 6, schizophrenia onset, offset 2/5 6 months blunted, flat

Schizoaffective Disorder • ___________ symptoms accompanied by a strong element of symptomatology associated with the mood disorders, either ____ or __________ •____ episode or major ______ episode lasts half or more of the total time involved. For at least 2 weeks during this time the patient exhibits the criteria for ___________ without having a _____episode. - Key element: Presence of hallucinations &/or delusions (_________) that occur for at least ___ weeks in absence of major _____ episode. -Combo of ________ and _____ disorder

schizophrenic manic, depression manic, depressive schizophrenia, mood psychosis 2, mood schizophrenia, mood

Seeking _______ and ___________: striving to explain that which is vague or incomprehensible and searching for mutual understanding facilitates and increases understanding for both pt and nurse. •"im not sure that I understand. Would you please explain?", "Tell me if my understanding agrees with yours.", "Do I understand correctly that you said...?"

seeking validation, clarification

difficulty carrying out tasks assoc w hygiene, dressing, grooming, eating, and toileting

self-care deficit

Placing the event in time or __________: encouraging the pt to ID the sequence of events and when they occurred in time facilitates organizing one's thoughts and their experiences •"what happened ____?", "what happened next?", "was this before or after...?", "when did this happen?"

sequence first

In self-help groups, members _______ the same type of problem and _____ each other to prevent __________ r/t that problem. Allow pts to talk about their fears and relieve feelings of ________ while receiving comfort and _______ from others undergoing similar experiences •Led by members of ______ examples •__________ _____________ •Parents without Partners •Weight Watchers •Narcotics Anonymous

share help decompensation isolation advice group AA

Forbidden phrases* "You _______..." *"You'll have to..." *"You _____..." *"If it ____ _____, I'd..." *"_____ don't you..." *"I think you..." *"It's the _________ on this unit." *"Don't ______." *"Everyone..." *"Why...?" *"Just a second..." *"___ ________..."

should cant were me why policy worry i know

___________ is effective/powerful/loud; antipsychotics slow thinking down/ thought process is delayed so ________ gives them time to think through what they really want to say. •_________ encourages the pt to organize thoughts and put them into words and allows the pt time to think about the significance of events, thoughts, and feelings. Allowing the pt to break the silence often provides the nurse w important info about the pt's __________- concerns.

silence x 3 foremost

withdrawal, sad dull affect, need-fear dilemma, preoccupation w/ own thoughts, expression of feelings of rejection or of aloneness imposed by others, uncommunicative, seeks to be alone

social isolation

•used to help pts manage struggles w interpersonal relationships and comm, which are often complicated by pt's inability to accurately perceive responses in others

social skills training

8 functions of a group •___________: teaching social norms •___________: ones fellow group members are available in time of need. Ppl derive a feeling of _________ and _________from group involvement •__________ ________: group members provide assistance in endeavors that are beyond the capacity of one person alone or when results can be achieved more effectively as a team •___________: members of a group provide the joy and pleasure that ppl seek from interactions w significant others, brings __________ and _____________ •Information sharing: ________ takes place w/in groups. Knowledge is gained when individual members learn how others in the group have resolved situations similar to those w which they are currently teaching •__________ _________: this function relates to the ways in which groups enforce the established norms. As group members interact, they begin to influence each other regarding the expected norms for comm and behavior; regulate ______ and ______________ •_____________: groups help to bring about improvement in existing conditions by providing support to individual members who seek to bring about change. Groups have power that individuals alone do not. ____________ to being about _______ •___________: an example of the governing function is that of _______ and _________ rules being made by committees w/in a larger organization

socialization support security, understanding task completion camaraderie friendliness, belonging learning normative influence behavior, comm empowerment encouragement, change governance enforcing, setting

the fxn of task groups is to _________ _______, make __________, and achieve a __________ _____________

solve problems, decisions, specific outcome

•Task group: the fxn of a task group is to accomplish a specific outcome or task. The focus is on ________ __________and _______ ___________ to achieve this outcome. Often a _________ is placed on completion of the task, and such importance is placed on a satisfactory outcome that _______ in the group may be smoothed over or ignored in order to focus on the priority at hand examples •Hospital ____________ •Interdepartmental team meetings •Planning committees •_________ ________ committee •Nursing faculty curriculum committee •_____ leadership

solving problems making decisions deadline conflict committees discharge planning SNA

Hans Selye defined _______ as "the state manifested by a specific syndrome which consists of all the nonspecifically induced changes within a biologic system." This syndrome has come to be known as "_______ __________" syndrome. Selye's general adaptation syndrome has three distinct stages: 1. _________ reaction stage: during this stage, the responses of the fight or flight syndrome are initiated. 2. Stage of ___________: the individual uses the physiological responses of the first stage as a defense in an attempt to adapt to the stressor. If adaptation occurs, the third stage is prevented or delayed. Physiological symptoms may disappear. 3. Stage of ___________: this stage occurs when there is a prolonged exposure to the stressor to which the body has become adjusted. The adaptive energy is __________, and the individual can no longer draw from the resources for adaptation described in the first 2 stages. Diseases of adaptation may occur. W/o intervention for reversal, exhaustion, and even death ensues.

stress flight or flight alarm resistance exhaustion depleted

•Any _______ situation can precipitate a ____. •Assistance with problem solving during the crisis period preserves _____-______ and promotes _______ with resolution.

stressful, crisis self-esteem, growth

The Catatonic Features Specifier •Catatonic features may be associated with other psychotic disorders, such as brief psychotic disorder, schizophrenia, schizoaffective disorder, and substance-induced psychotic disorder •Symptoms include: -______ and muscle ________ or excessive, purposeless _____ activity -________ __________, negativism, _________, ____________

stupor, rigidity, motor waxy flexibility, echolalia, echopraxia

•_____________: rechanneling of drives or impulses that are personally or socially unacceptable into activities that are constructive -A mother whose son was killed by a drunk driver channels her anger and energy into being the president of mothers against drunk drivers

sublimation

Substance-Induced Psychotic Disorder: psychotic symptoms linked to the _____________ •The presence of prominent hallucinations and delusions that are judged to be directly attributable to substance __________ or __________ •Most occurrences resolve without _______

substance intoxication, withdrawal tx

A client who has a co-existing _________ disorder and ____ ________ may be assigned to a special program that targets the _______ ___________. Traditional counseling approaches use more ________ than that which is considered appropriate for clients with dual diagnoses. Most dual diagnosis programs take a more ______ and less __________ approach.

substance, mental illness dual diagnosis confrontation supportive, confrontational

Brief Psychotic Disorder •_______ onset of symptoms •May or may not be preceded by a severe __________ __________ •Episode usually includes ___________, _________, or disorganized speech. •Lasts at least ___ _____, but less than ___ ______ •___________ completely •Individual experiences _________ turmoil or overwhelming perplexity or __________. - can be termed as a " __________ __________" : someone murders their family but doesn't remember doing it ; usually happens after a stressful event

sudden psychosocial stressor delusions, hallucination 1 day, 1 month recovers emotional, confusion psychotic break

•_____________: the voluntary blocking of unpleasant feelings and experiences from ones awareness -Scarlett says " I don't want to think about that now. Ill think about that tomorrow"

suppression

nursing interventions for pt w schizophrenia and dx with Risk for Violence: Self-directed or Other-directed related to Extreme __________, Panic anxiety, Catatonic excitement, Rage reactions, ________- hallucinations ("jump in front of traffic") 1. maintain a low level of _____ in pts environment (low _________, few people, simple decor, low _____) 2. observe behavior _________. do this while carrying out routine activities 3. remove all __________ objects from pts environment 4.__________ at first sign of inc anxiety, agitation, or verbal or behavioral aggression. offer _______ feelings. 5. its important to maintain a ____ attitude toward pt. as the pts __________ increases, offer some alternatives: participating in _________ __________, _________ about the situation, taking some ________ meds. 6. have sufficient _____ available to indicate a show if strength to the ot if it becomes necessary. 7. if pt isn't calmed by "_____ ____" or by meds, use of mechanical _______ may be necessary 8. ensure that pt in restraints is assessed at least q____ to ensure that circulation isn't compromised 9. as agitation decreases, assess the pts __________ for restraint removal or reduction. remove ____ restraint at a time while assessing the pts response. outcome criteria: -short: 1. pt will recognize signs of increasing _______ and _________- and report to staff for _________ with intervention. 2. Pt will not _____ self or others -long: Pt will not _____ self or others

suspiciousness command stimuli, lighting noise frequently dangerous intervene empathetic calm, anxiety physical activity, talking, antianxiety staff talking down restraints 15 min readiness one anxiety, agitation assistance harm harm

•___________: when you feel sorry for someone, may not have connection, not a lot of commitment/investment

sympathy

useful phrases *"_____ ____ about..." *"____ ____..." *"I'd like to _______ what you're thinking..." *"______ ____ _____ thoughts...?" *"____ _____ ________ that...?" *"What are you feeling?" *"___ _______ as if..."

tell me go on discuss what are your it seems

_______________ ____________: Caregiver verbal and nonverbal techniques that focus on the care receivers needs and advance the promotion of healing and change. Encourages exploration of feelings and fosters understanding of behavioral __________. Its ___________, discourages ____________, and promotes _____

therapeutic comm motivation nonjudgmental defensiveness trust

An interaction between two people (usually a caregiver and a care receiver) in which input from both participants contributes to a climate of healing, growth promotion, and/or illness prevention

therapeutic relationship

__________- occurs when the pt unconsciously displaces to the nurse feelings formed toward a person from their past - the nurse should work w pt in sorting out the ____ from the present - assist the pt into identifying the ________, and reassign a new and more appropriate meaning to the nurse-pt relationship. - guide pt to _______ by teaching them to assume ____________ for their own behaviors, feelings, and thoughts, and to assign correct meanings to the relationships based on _______ circumstances instead of ____.

transference past transference independence, responsibility presnet past

the effects of stimulants on the body. -Stimulation of the CNS results in _______, restlessness, anorexia, _______, agitation, and increased motor activity. Amphetamines, nonamphetamine stimulants, and cocaine produce increased __________, decrease in fatigue, elation and ________, and subjective feelings of greater mental agility and muscular power. - Amphetamines can induce _________ systolic and diastolic blood pressure, _________ heart rate, and cardiac arrhythmias. These drugs also relax __________ smooth muscle. Inhaled cocaine can cause pulmonary __________, chronic bronchiolitis, and _________. ________ ingestion can result in increased heart rate, palpitations, extrasystoles, and cardiac arrhythmias. _______ stimulates the sympathetic nervous system, resulting in an increase in heart rate, blood pressure, and cardiac contractility, thereby increasing myocardial oxygen consumption and demand for blood flow. - Gastrointestinal effects: decrease in GI tract motility commonly results in ____________. Contraction of the bladder sphincter makes _________ difficult. Caffeine exerts a _______ effect on the kidneys. Nicotine stimulates the hypothalamus to release antidiuretic hormone, __________ the excretion of urine. -CNS stimulants appear to __________ sexual urges in both men and women. Women, more than men, report that stimulants make them feel sexier and have more orgasms. Some men may experience sexual dysfunction with the use of stimulants.

tremors, insomnia alertness euphoria increased increased bronchial hemorrhage pneumonia caffeine nicotine constipation urination diuretic reducing increase

Evaluation questions for schizophrenia •Has client established _____ with at least one staff member? •Is anxiety level maintained at a ___________ level? •Is ___________ thinking still prevalent? •Is client able to interrupt escalating anxiety with adaptive _________ mechanisms? •Is client easily _________? •Is client able to ________ with others appropriately?

trust manageable delusional coping agitated interact

•___________: one must feel confidence in that person's presence, reliability, integrity, veracity, and sincere desire to provide assistance when requested; the nurse must possess an aura of trustworthiness, which requires a sense of ____-___________ -Providing a blanket when pt is cold, providing food when the pt is hungry, keeping _______, being ______ (saying idk to a ? But ill try to find out) and then ___________ through, simply and clearly providing reasons for certain policies, procedures, and rules -Providing a written, structured schedule of activities -Attending activities w the pt if he or she is reluctant to go alone -Being _____________ in adhering to unit guidelines -___________ to the pts preferences, requests, and opinions and making collaborative decisions concerning his or her care -Ensuring ___________; providing reassurance that what is discussed will not be repeated outside the boundaries of the health care team

trust self-confidence promises, honest following consistent listening confidentilaity

•___________: symbolically negating or canceling out an experience that one finds intolerable - Joe is nervous about his new job and yells at his wife. On his way home, he stops and buys her flowers

undoing

N Introducing an __________ ______: when the nurse prematurely changes the subject, it conveys to the pt that the nurse doesn't wat to discuss the original topic any further. This may occur in order to get to something that the nurse wants to discuss w the pt or to get away from a topic that he or she would prefer not to discuss.

unrelated topic

•Substance-related disorders are composed of two groups: the substance-____ disorders (___________) and the substance-________ disorders (intoxication, withdrawal, delirium, neurocognitive disorder, psychosis, bipolar, depressive, OCD, anxiety, sexual dysfunction, and sleep disorders).

use, addiction induced

the instrument of delivery for the process of interpersonal nursing is the therapeutic ____ of _____, which requires that the nurse possess a strong sense of _____ ___________ and ______ ______________

use, self self-awareness, self-understanding

N blocks discussion with client and avoids helping client identify and explore areas of difficulty

using denial

allows client to take control of the discussion, if he or she so desires

using silence

Putting into words what the client has only implied or said indirectly

verbalizing the implied

___________ ____ ___________: putting into words what the pt has only implied or said indirectly is a technique that can be helpful w pts experiencing impaired verbal communication •Pt: "I cant talk about this... you haven't been where i've been", nurse: " does it seem like no one else could understand your thoughts and feelings unless they've had the same experiences you've had?", pt: "i,...idk where to begin.", nurse: " so it feels overwhelming to think about sharing the details of this experience."

verbalizing the implied

•expressing uncertainty as to the reality of client's perception

voicing doubt

•Family therapy - specialized form of group intervention in which the pt is the ____ _____ rather than any one individual and the goal is to facilitate _____ in the family _____. -Treatment modality that sees the family as a ____, rather than an __________. Treatment is delivered in the context of the participating family. Goal is ______ ______, rather than change in any one individual. Also requires a _______________ degree.

whole family change system unit individual system change graduate

•___________ is the physiological and mental readjustment that accompanies the discontinuation of an addictive substance. The substance-specific syndrome includes clinically-significant physical signs and symptoms as well as psychological changes such as disturbances in thinking, feeling, and behavior.

withdrawal

The term schizophrenia was first coined in 1908 by Swiss psychiatrist, Eugen Bleuler. Bleuler's definition: As: Affective blunting, loosening of associations, autism (____________), and __________ (coexisting conflicting ideas). Schizophrenia is often described as "_________ into _______" Schizophrenia refers to thinking that is not bound to _____ but reflects the private _________ world of the individual - _______ and __________.

withdrawal ambivalence withdrawal, self reality perceptual hallucinations delusions

Attempting to translate _____ into ___________: when the pt has difficulty identifying feelings or feelings are expressed indirectly , the nurse tries to "__________" what has been said and to find clues to the underlying true feelings •Pt: "Im just an empty pit", nurse: "It sounds like you are feeling __________, is that right?"

words, feelings desymbolize hopeless