Psych Part 2

sexual abuse

any form of sexual contact or exposure with or without consent or in circumstance in which the victim is incapable of giving consent.

sexual assault

any type of activity to which the victim does not consent, ranging from inappropriate touching or penetration.

peripheral neuropathy

characterized by peripheral nerve damage resulting in pain, burning, tingling, or prickly sensations of the extremitities. thought to be the result of vitamin b and thiamine deficiencies.

antipsychotic examples

clozapine chlorpromazine (Thorazine)

defense mechanisms with anxiety

compensation, conversion, denial, displacement, dissociation, identification, intellectualization, introjection, projetion, rationalization, reaction formation, regression, repression, splitting, sublimination, suppression, undoing

economic abuse

controlling a persons access to economic resources making IND financially dependent. forbidding school attendance or employment keeps a person dependent.

nursing interventions with adult abuse

crisis intervention, TX all physical wounds first, figure out how to question victim without perpetrator being in the room, may need to get entire team involved to figure out what is going on with this PT, never leave her alone, documentation needs to be good and sound, need to assist PT into developing a safety plan, plan needs to be good and solid in order to have a chance to be successful if they leave, provide resources and referrals. adult has to want to press charges if within sound mind

synthetic marijuand

(botanicals and potpurri) bought at gas stations

CIWA protocol

(clinical institute withdrawal assessment) assess for every hour after medicated until PT no longer scores. check HR and BP, assess for anxiety, nausea, LOC, tremors total score of 7 or more- medication (Librium, ativan, clonidine, carbamazepine/ given PO or IV)

mild anxiety

(normal) occurs in the normal experience of everyday living. S/S: slight discomfort, restless, irritability, figit, foot tapping, hightened perceptual field, focus is flexible. aware of anxiety. able to work effieciently toward a goal and examine alternatives.

magnesium

1.5-2.5

sodium

135-145

phosphorus

2.8 - 4.5

normal caloric intake

25 cal/kg/day

addiciton

3 stages early: desire to repeat first pleasurable experience which equals the frequent patterns of use and then they begin to ignore their responsibilities. middle:(most crucial) intoxicating episodes increase and tolerance develops chronic: tolerance for the chemical is quite high and the need for that substance leads to loss of control of ones behavior. individual is very dependent upon the substance.

albumin

3.5-5

potassium

3.5-5.0

calcium

9-10.5

chloride

98-106

substance abuse

Any unnecessary or improper use of chemical substances for nonmedical purposes.

methamphetamines

CNS stimulant drug that is similar in structure to amphetamines. need psuedophedrine to make it. end product is a white odor less, bitter tasting crystalline powder that easily dissolves in water or alcohol ( can be made in pill form). can be taken orally, injected, or inhaled. made with household products such as bathroom cleaner, acetone, ammonia. short term use: increased wakefulness, increased physical activity, decreased appetite, rapid HR, IR heartbeat, increased BP, hyperthermia. long term use: extreme weight loss, severe dental problems, anxiety, confusion, insomnia, mood disturbances, violent behavior, paranoia, hallucinations and delusions. may become addicted after first use. need to get it becomes very intense. very dangerous, will go to extreme lengths to obtain it.

assessment of behavioral change

FRAMES and the 5 A's for behavioral change Feedback: provide IND about information of drug use and comparisons of patterns and problems Responsibilty: have to make them see they are responsible for their own behavior Advice and risks: let them know what the risks are if they continue on this path of substance use Menu: what are some alternatives for them, rehab? 12 step program? Empathy: need to be empathetic to someone who has a substance abuse problem. Self evocacy: encourage confidence that that IND can change their behavior is the PT ready top change? are they motivated?

date rape

GHB, rohypnol, ketamine- relaxes muscles and causes IND to black out, check respiration function.

cycle of cocaine use

IND uses, increased energy, confidence, and alertness, euphoria, excitability, irritability, anxiety, and restlessness as drug is wearing off, possible psychosis, neurotransmitter depletion, deep depression, drug hunger, self medicate, cycle repeats

anxiety disorder

IND with anxiety disorders use rigid, repetitive, and ineffective behaviors to try to control anxiety. IND experience emotional and physical response.

general anxiety disorder

IND worries more time than they are not. fret about numerous things they cannot control. impact of everyday life. excessive or unreasonable worry or apprehension that is out of proportion to the actual likelihood of the anticipated event. piglet

anorexia TX

PT needs psychotherapy. what caused this obsession with weight and when did it begin? nutrition. look into the perception of the problem, their eating habits, mental status, HX of dieting, methods to achieve weight control, what value is attached to a specific weight and shape, interpersonal and social functioning, physiological parameters. PT may need to be admitted to Med Surg to treat complications or to facility that treats eating disorders. provide immediate medical attention for less than 10 percent body fat, systolic BP less than 90, HR less than 50, temp less than 96, arythmias. may need IV to restore electrolytes, feeding tube, may be court ordered if at risk of harming themselves. must be medically stable before psychology TX. psychosocial interventions: make sure PT is safe, mileu therapy, IND psychotherapy, group therapy. meds: may need antidepressant to treat underlying depression. fluoxetine, helps to reduce obsessive compulsive behaviors. not prescribed until PT meets maintenance weight because it will cause weight gain or weight loss. education: adequate amount of calories, ways to control thought process and decrease anxiety, coping skills. PT must be weighed often, do not tell when they will be weighed or let them see the scale. let them be active participant in treatment plan. IND needs to feel like they have some sense of control. must wait 30 minutes before they go to room or bathroom to avoid purging activities. intervene with excessive exercising.

opiate use

S/S: drowsiness, euphoria, mood changes, nausea, constipation, constriction of pupils but not pinpoint pupils. (pinpoint = OD) high doses can cause hypotension, respiratory depression. OD S/S: pinpoint pupils, shallow respirations, seizure, coma, death. (TX: NARCAN) W/D S/S- wet (watery eyes, runny nose, clammy skin, diarhhea, dilated pupils, panic, tremors, muscle cramps, lacrimation, rhinorrhea) check HR and BP- if elevated give clonidine. addiction TX: methadone, buprenporphine (suboxone) levoalphaacetylmethadol, naltraxone. (only temporary)

nursing interventions

TX are based on certain philosophy and offer different types of therapy. disease model of TX: substance abuse is a diseas, has acute and chronic signs and symptoms, a pattern of progression, and physical pathological conditions (ex 12 step program, AA, NA) medical model: considers addictions from a public health, chronic and acute infectious disease perspective. psychiatric model: substance abuse is seen as an underlying emotional conflict or mental disorder. sociocultural model: substance abuse can be treated by changing an IND environment and teaching people how to develop new responses to their current environment.

before TX intervention can begin

WD and detox must happen first. meds used in detox depends what they are WD from. ex: disulfiram (anabuse), methadone, lorazepam, chlordiazepoxide. once detox has occurred, focus turns to to emotional problems. why do they keep going back to consuming drugs and or alcohol.

criteria for substance use disorder

a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance- related problems.

intimate partner violence

a criminal act of physical, emotional, economic, or sexual abuse between an assailant and a victim who most commonly are or were in an intimate relationship

substance use disorder

a pathological use of a substance that leads to a disorder of the use. Symptoms fall into four major groupings: impaired control, social impairment, risky use, and physical effects (intoxication, tolerance, withdrawal)

obsession

a thought or impulse or images that reoccur and cannot be dismissed

serotonin syndrome S/S

abdominal pain, diarrhea, seating, fever, tachycardia, elevated BP and HR, confusion, delirium, myoclonus (muscle spasms), increased motor activity, irritability, hostility, and mood change.

honeymoon stage

abuser or perpetrator becomes very loving, may bring gifts to victim, apologizes over and over for their actions. victim believes they are sorry and they are going to change and action wont happen again.

alcoholic cardiomyopathy

accumulation of lipids in the myocardial cells resulting in enlargement. symptoms include decreased exercise intolerance, tachycardia, dyspnea, edema, palpitations, and nonproductive cough.

acute battering

actual incident occurs, tension becomes unbearable. victim may provoke an incident just to get it over with. victim may try to cover up injury or look for help.

pancreatitis

acute: 1 to 2 days after a binge; symptoms include severe epigastric pain, nausea, vomiting, and abdominal distention. chronic: leads to pancreatic insufficiency resulting in steatorrhea, malnutrition, weight loss, and diabetes mellitus.

intermittent explosive disorder

aggressive then immediately calm. characterized by discrete episodes of failure to resist aggressive impulses resulting in serious assaultive acts or destruction of property. diagnosis criteria: several discrete episodes of failure to resist aggressive impulses that result in serious assaultive acts or destruction of property. the degree of aggressiveness expressed during the episodes is grossly out of proportion to any precipitating psychosocial stressors. the aggressive episodes are not better accounted for by another mental disorder and are not due to the direct physiological effects of a substance. TX: commonly treated with mood stabilizers, anticonvulsants, SSRI, and beta blockers. group therapy is more useful than individual therapy. family therapy is helpful when the PT is an adolescent or young adult.

sexual dysfunction

alcohol interferes with normal production and maintenance if female and male hormones.

substance classes associated with substance use disorder

alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives, stimulants, tobacco, (other)

chemicals of abuse

alcohol, narcotics (natural, synthetic,, semisynthetic), stimulants, cannabis, hallucinogens, designer drugs, inhalants, prescription medications.

pharmcological interventions

antidepressants: SSRI (first line of TX) monitor for serotonin syndrome (confused, elevated temp, myoclonus), given in higher dosage. citalopram, escitalopram, fluoxetine, paroxentine, fluvoxamine, sertraline tricyclics MAOI (last reort) SNRI benzos: only if PT is in panic level (addictive) nonbenzos antihisamines beta blockers anticonvulsants: anxiety is sever enough to cause mood swings

elder abuse

any act that causes physical, verbal, financial, or psychological injury or exploitation as well as the physical neglect of an aged adult. can be physical, emotional, sexual, or economic. under reported majority is committed by spouse and children.

cocaine

available as a white powder drug, usually cut with sugar, laundry detergent. can be injected, inhaled, or ingested. produces an immediate rush of energy, vigor, feelings of well being, can lead to mental dependency, over use can cause overstimulation of the CNS and can dissolve the nasal septum. blocks the conduction of electrical impulses within nerve cells involved in sensory transmission, it also blocks the reuptake of NE, DA, and 5-HT (norepenephrine, dopamine, serotonin) OD S/S: respiratory distress, ataxia, convulsions, stroke, MI, coma, death OD TX: antipsychotics, medical management WD S/S: depression, paranoia, lethargy, anxiety, insomnia, nausea, vomiting, sweating, chills, intense craving for drug WD TX: desipramine (be sure to monitor PT)

avoidance symptoms

avoid thoughts, feelings or memories related to original trauma, avoidance of external reminders

sexual assault and rape assessment

be nonjudgmental, if IND calls and informs you they have been raped or sexual assaulted- advise them to get to ER immediately and not to shower or change clothes, they have evidence on them and we need to collect it, when PT arrives- take them to the back and put them in a safe place, TX physical injuries, crisis intervention while collecting evidence, see if facility has a SANE nurse, contact if so. do not leave PT alone, do thorough documentation. follow facilities policy for documentation, limit contact to few health care providers, sign a consent for physical exam, any evidence collected has to go through chain of custody.. if any part is broken it will be invalid in court if PT wants to press charges.

last goal of TX

behavorial change. PT has to be motivated.

generalized anxiety disorder (GAD)

benzos used concurrently with SSRI or SNRI

theories about anxiety

biological: neurotransmitters acting funky (GABA is out of wack) social: failed social interactions as a child- negative results psychodynamic: ID vs ego behavorial: learned (being around other anxious PPL make you anxious)

brain and alcohol

brain will be severely effected by alcohol consumption. frontal lobe- responsible for judgement, cognition, coordination, inhibition. these actions are depressed. nausea occurs.

nonbenzodiazepines examples

buspirone (BuSpar) zolpidem (Ambien) ramelteon (Rozerem)

coping skills with anxiety

can be negative, adaptive, or maladaptive. must ASSESS. need to find a positive coping mechanism. positive: reading, exercising, leisure activites, relaxation techniques. negative: drugs, drinking, over eating, sleeping too much

stimulants

can cause CSN stimulation. ex: cocaine (immediate rush of energy, feelings of well being, cycle of use), crack, amphetamines, methamphetamines.

complications of anorexia

cardiac arhythmias, peripheal neuropathy, acrocyanosis, leukopenia, lymphocytosis, hypokalemic alkalosis, osteoporosis, fatty degeneration in liver, abnormal thyroid function, prolonged QT intervals, bradycardia, hypotensive, tachycardic upon exertion, hair loss, muscle wasting, contractures.

bulimia complications

cardiac arythmias, cardiac arrest, sever dehydration, sever erosion of teeth, loss of dental arch, esophageal tears, abdominal pain, death.

domestic violence

causing harm or attempting to cause physical harm to a family or household member; placing a family or household member in fear of physical or mental harm; causing or attempting to cause a family or household member to engage in in voluntary sexual activity by force, threat or force, or duress; engaging in an activity that would cause a reasonable person to feel terrorized. frightened, intimidated, threatened, or molested.

acute stress disorder

characterized by intense emotional reactions after exposure to a traumatic event. exposure to actual threat, intrusive symptoms, negative mood, dissociative symptoms, avoidance symptoms, arousal symptoms. 3 days to 1 month after traumatic experience.

PTSD

characterized by intense emotional reactions after exposure to a traumatic event. onset and duration differs from ASD special features: flashbacks same symptoms as ASD benzos are not assisting PT into working through feelings only masking them (not preferred) exposure therapy will be a slow process. more than 1 month duration.

addiction

defined as a compulsive, abnormal dependence on a substance or on a behavior S/S: fatigue, insomnia, headache, seizure disorder, changes in mood, anorexia or weight loss, vague physical complaints, overabundant use of mouthwash or toiletries, appearing older that stated age, unkempt appearance, leisure activities that involve alcohol or other drugs, sexual dysfunction, decreased libido, erectile dysfunction, trauma secondary to falls, auto accidents, fights, burns, DWI (more than one citation suggests dependence), failure of standard doses of sedatives to have a therapeutic effect, financial problems, frequent reference to to substance indicating preoccupation with and importance of in persons life, problems in areas of life function (frequent job changes, marital conflict, separation, and or divorce, work related accidents, tardiness, absenteeism, legal problems, arrests, social isolation, and estrangement from friends and or family.

designer drugs

defined as substances created by underground chemists who alter the molecular structure of existing drugs. ecstasy aka skittles, beans, scooby snacks. acts s a mild hallucinogen. effects: increased feelings, empathy, confusion, memory loss, decreased consciousness, suppresses the need to eat, drink, sleep, hyperthermia, seizures, coma death- monitor for overheating. rohypnol aka roofies: date rape drug, causes partial amnesia. GHB: date rape drug. relieves anxiety and produces relaxation. combined use with alcohol can also cause nausea, loss of muscle control, difficulty breathing. ice bath salts: aka purple wave, vanilla wave. effects similar to that of amphetamines and cocaine. can be swallowed, smoked, snorted, injected. ketamine aka special k: used as a veterinary tranquilizer. typically cooked into a white powder for snorting. effects: floaty, trippy effect, out of body experience. side effects: referred to as a k hole: complete detachment from the body, inability to move.

conduct disorder

diagnosis criteria: a repetitive and persistent pattern of behavior in which the basic rights of others or major age appropriate societal norms or rules are violated, as manifested by the presence of at least 3 of the following in the past 12 months with at least on in the past 6 months: aggression to people and animals- often bullies, threatens, or intimidates others, often initiates physical fights, has used a weapon that can cause serious physical harm to others, physically cruel to people of animals, stolen while confronting a victim, forced someone into sexual activity. destruction of property- has deliberately engaged in fire setting with the intention of causing serious damage, has deliberately destroyed others property deceitfulness or theft- has broken into someone elses house, building, or car. often lies to obtain goods or favors or to avoid obligations. has stolen items on nontrivial value without confronting the victim. serious violation of rules- often stays out at night despite parental prohibition, beginning before age 13. has run away from home overnight at least twice while living in the parental or parental surrogate home or once without returning for a lengthy period. is often truant from school, beginning before age 13. the disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning. the individual is age 18 years or older and does not meet criteria for antisocial personality disorder. -this IND violates the rights of others, has a disregard or rules. TX: behavior therapy, family therapy, aversion therapy (continuing to act out will get IND in boot camp or jail).

benzodiazepines examples

diazepam lorazepam triazolam temazepram midazolam chlordiazepoxide alprazolam

alcohol dependence TX

disulfiram/ antabuse. blterm-14ocks aldehyde dehydrogenase from breaking down acetaldehyde into acetic acid, therefore the acetaldehyde accumulates, which is very toxic to the liver and causes sudden and severe sickness and can cause liver damage/ cell death. clients cannot have alcohol in their system and take this medication, therefore, this medication will be started at least 24 hours after the last drink. reaction: intense nausea and vomiting, throbbing headache, flushing skin, respiratory difficulties, confusion. Teaching: must avoid any type of alcohol, ingested or touched. can cause sudden cell death. med alert bracelet needed. not prescribed until completely recovered from alcohol withdrawal, which may be several days. naltrexone/ reiva. blocks euphoric effects and feeling of intoxication acamprosate

nursing assessment for adult abuse

does PT appear anxious or avoidant? is there a delay in care, bruises or broken bones in healing stages? are they depressed, suicidal? guilt, do they blame theirselves? is there incongruency between their injury and their story?

LSD (lysergic acid diethylamide)

effects of use- hallucinations, distorted perceptions, distortions of time and space, illusions, emotional liability, tremors, nausea, and vomiting. OD S/S: possible panic, psychosis, seizures, respiratory arrest hyperthermia. TX: minimize stimuli, medical management, monitor PT. WD S/S: none but may experience flashbacks for several months since last dose

bulimia

episodes of excessive and uncontrollable intake of a large amount of food alternating with compensatory activities such as self inducing vomiting, use of cathartics and or diuretics, and self starvation. diagnosis criteria: recurrent episodes of binge eating. an episode of binge eating is characterized by both of the following: eating in a discrete period an amount of food that is definitely larger than most people would eat during a similar period and under similar circumstances; a sense of lack of control over eating during the episode. recurrent inappropriate compensatory behavior to prevent weight gain such as self induced vomiting, misuse of laxatives, diuretics, enemas, or other medications, fasting or excessive exercise. the binge eating and inappropriate compensatory behavior both occur on average at least twice a week for 3 months. self evaluation is unduly influenced by body shape and weight. the disturbance does not occur exclusively during episodes of anorexia nervosa.

elder abuse interventions

establish trust, always treat physical wounds first, good documentation principles, AL has law to report all elder abuse, follow facilities policy and procedures for reporting, what documentation is needed what chain of command to follow, arrange community resources, visiting nurse.

substance use/ abuse help

everyone is affected. codependence develops. be aware of the S/S of use, dependence, OD, WD, tolerance, relapse. assess for motivation to change, be nonjudgemental. know about the resources in your area. common defense mechanisms among users is denial. resources: AA, AL-Anon, Alateen, NA, brafor health services, NAMI, SAMHSA.gov

agoraphobia

excessive anxiety or fear a about being in places or situations from which escape might be difficult or embarrassing or in which help might not be available. the IND begins to avoid situations take therapy to them. baby steps.

overview impulse control disorders nursing interventions

explore impact of childs behavior on family life, assist the immediate and extended family to access available support systems, discuss how to make the home safe, discuss realistic behavioral goals, teach behavior modification techniques, give support and encouragement, provide education about medications, refer parents to local self help groups, advocate with the educational system.

EMDR

eye movement desensitization and reprocessing. popular for treating PTSD uses the clients own rapid, rhythmic eye movements to dampen the power of emotionally charged memories of past traumatic events. child: march around the room while talking about what makes them anxious to get both sides of the brain working

neglect

failure to provide for physical, emotional, educational, and medical needs.

impulse control disorders

failure to resist an impulse, drive, or temptation to perform an act that is harmful to the person or others. an increasing sense of tension or arousal before committing the act. an experience of pleasure, gratification, or relief at the time of committing the act. following the act there may not be regret, self reproach, or guilt.

SSRI examples

fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), and escitalopram (Lexapro).

severe anxiety

focus on one particular detail or many scattered details, difficulty noticing what is going on in their own environment. problem solving feels impossible, perceptual field greatly reduced. S/S: feeling of dread, confusion, purposeless activity, feel of impending doom, chest discomfort or pain, dizziness, nausea, diaphoresis, withdrawal, loud and rapid speech, threats and demands.

bulimia psychotherapeutic management

focus on stabilization of weight without purging behaviors. may need to be hospitalized if in a psychiatric or medical crisis, respite is needed from a chaotic home life, PT cannot obtain TX in his/her community.

physical abuse signs in child abuse

hair missing from parts of their scalp by being jerked up by their hair, broken bones that are in various stages of healing that have never been reported, cigarrette burns.

trichotillomania and excoriation (obsessive compulsive disorder)

hair pulling and skin picking

alcohol

hard liquor (whiskey, brandy, gin, vodka) other (wine, beer). distillation increases alcohol content. consumption causes depressant effects on CNS. has a high solubility in water, therefore it collects in organs that have a high water content. (your brain) metabolized by the liver. excreted by the lungs and kidneys. blood alcohol content (see handout)

hallucinogens

natural and synthetic substance that alters ones perception of reality. can result in flashbacks and mental health problems. mescaline (active ingredient of the peyote cactus), LSD, PCP

CAGE questionnaire

has anyone told you that you need to cut down, has anyone annoyed you about how much you drink, do you feel guilty about your drinking, have you ever had to have an eye opener (drink first thing in the morning) IND answers yes to any- need further assessment by the DR.

CIWA protocol

headache, N/V, tremors, agitation, hallucinations, confusion, anxiety, agitation. 0 to 7 none to severe greater than 7 medicate with pam's or chlordiazepoxede (librium) re evaluate Q 15 minutes

thrombocytopenia

impaired platelet production, placeing the alcoholic at risk for hemorrhage

leukopenia

impaired production, function, and movement of WBS.

alcohol W/D symptoms

important to assess for WD symptoms B/C onset of symptoms are within 6 - 8 hours of last drink. S/S: irritability, anxiety, tremors, increase VS (HR, BP), diaphoresis, slurred speech, disorientation, hallucinations, seizures, GI disturbances, possible death if not treated accordingly. assess with CIWA.

child abuse

includes physical and mental injury, sexual abuse, and neglect. a nurse is required by law to report any suspicions of abuse. when assessing look for congruency with injury and story, has there been a delay in TX, when you further question child or parent does the story start changing?

cognitive behavioral therapy

incorporates a range of psychotherapeutic theories and practices including behavior therapy, behavior modification, and cognitive therapy. intense focus on thought processes and belief systems common techniques: informational interventions, self monitoring and symptom diary, cognitive restructuring. process of displaying involuntary or sub threshold physiological processes, usually bu electronic instrumentation and learning to voluntarily influence those processes by making changes in cognition therapeutic tool to facilitate learning on how to self reguale autonomic functions to improve health

anorexia TX psychotherapeutic management

increase weight to at least 90% of the average body weight for the PT height. helping PT reestablish appropriate eating behavior. increase self-esteem.

arousal symptoms

increased startle response, irritability, anxiety, self-destructive or reckless behavior, and sleep disturbances

esophagitis

inflammation and pain in the esophagus due to the toxic effects of the alcohol on the esophageal mucosa.

alcoholic hepatitis

inflammation of the liver caused by long term heavy alcohol use. clinical manifestations: enlarged and tender liver, nausea and vomiting, lethargy, anorexia, elevated WBC, fever, jaundice, in more severe cases, ascites and weight loss.

gastritis

inflammation of the stomach lining characterized by epigastric distress, nausea, vomiting, and distention. alcohol breaks down stomachs mucosal barrier allowing hydrochloric acid to erode the stomach wall.

physical abuse

infliction of physical pain or bodily harm such as slapping, punching, hitting, choking, pushing, restraining, biting, throwing, and burning.

intrusive symptoms

intrusive memories, nightmares, mental images flashbacks. psychological distress at exposure to internal or external cues associated with the trauma. physiological reactions to internal or external cues.

psychotherapeutic management with eating disorders

is PT is hospitalized the focus is on weight restoration. after he PT is medically stable, then TX can begin on changing the PT perception about their body and long term goals can be made, cognitive behavior therapy has been most helpful with treating eating disorders. the nurse must assess the PT readiness to change (motivation to change)

relapse

know that relapse will most likely happen but can be used as a learning opportunity. usually takes multiple times.

how alcohol works after you ingest it

liver breaks down alcohol (enzyme alcohol dehydrogenase metabolizes alcohol to acetaldehyde and hydrogen. the next enzyme aldehyde dehydrogenase metabolizes acetaldehyde to acetic acid (which is vinegar) so the IND excretes that and you can smell it on the IND

power and control wheel

look at how to explain to the victim the perpetrators actions. try to get victim to understand what is going on and that it is a cycle that will not stop. using intimidation: perpetrator may make victim afraid by using looks, acts, or gestures, smashing things that belong to the victim, abusing pets , displaying weapons. using emotional abuse: putting victim down, making them feel bad about themselves, making them think they are crazy and making it all up, humiliating them in front of the abusers friends. using isolation: the abuser begins to control what the victim does, who she sees, who she talks to, what she reads. where she goes.. eventually bad enough to where she cant leave home, cuts ties with all her family and friends. minimizing denying and blaming: the perpetrator makes light of the abuse, doesnt take her concerns seriously saying it was her fault if she would have just done what he told her then it wouldnt have happened. using children: using child against victim by making them feel guilty about the children, using children to relay messages, can get to the point where children pick up on abusers behavior and think its ok and start to abuse as well using male privilege: treating victim as she is a servant wont let her make any decisions, lets her know her only role is to make dinner, do chores, and make babies. using economy abuse: prevents her from getting or keeping a job, gets her to ask for money because he is control of all the finances, so she has no source of income at all. using coercion and threats: making threats to harm her, leave her, commit suicide if she tries to leave him.

elder abuse assessment

look for bruises on upper arms, broken bones, dehydration, malnourishment, overmedication, misuse of money by children or legal guardian.

anorexia PT presents

low weight, cold extremities, peripheal edema, constipation, muscle weakness, cardiovascular abnormalities, amenorrhea, yellow skin, impaired renal function, decreased bone density, anemic panycytopenia, hypocalemia. check thyroid levels. PT needs thorough assessment.

spousal rape

make sure IND understands that just because you are married if the spouse does not consent it is still rape.

phobias

marked fear or anxiety about a particular situation, object. fear is irrational and persistent. TX: systematic desensitization (may take months) social TX:SSRI or SNRI are considered first line treatment however benzos by themselves are not effective

panic anxiety

markedly disturbed behavior, unable to process what is going on. focus lost, problem solving gone. S/S: terror, immobility, severe hyperactivity, inability to speak, numbness, tingling, SOB, overheating, palpitations, severe withdrawal, hallucinations, delusion, out of touch with reality. Priority is safety. Pt needs to be admitted.

bulimia TX

mileu management, bring PT into psych facility, meds for underlying anxiety or depression, counseling, IND or group psychotherapy, get to root of problem. when did this IND engage in this behavior. education: teach healthy eating, proper coping mechanisms. assess how PT feels about themselves, use FRAMES.

therapeutic interventions with anxiety and phobias

milieu therapy, therapeutic communication, IND psychotherapy, biofeedback, eye desensitization and reprocessing, promotion of self care, integrative therapy, health teaching, cognitive behavioral therapy, exposure therapy, diary of S/S and causes, abdominal breathing, progressive muscle relaxation, guided imagery, music, dietary changes, exercise (yoga, pilates, tai chi, stretching)

alcohol relapse TX

naltrexone, acamprosate, vivitrol

narcortics

naturally occurring, synthetics, semisynthetics. used to relieve pain, diarrhea, cough. can cause physical dependence. opiates: naturally occurring substances derived from opium (which comes from poppy) such as morphine. semisynthetics such as heroin. synthetics such as methadone, oxycodone, codeine. all the same S/S

phobia theories

neurobiological: amygdala: neurotransmitters acting funky social: failed social interactions as a child psychodynamic: ID vs ego behavioral: learned

psychopharmacology with eating disorder

no actual medication is approved to eating disorders but medicaations may be prescribed to help treat anxiety, depression, or co-morbid conditions associated with eating disorders

seperation anxiety disorder

normal at 8 months peaks at 18 months and then declines. exhibits developmentally inappropriate levels of concern over being away from significant other may fear that something horrible will happen to the other person and that it will result in permanent seperation distracts from normal activities (intense) manifests as GI disturbances and headaches characteristics for adult seperation: harm avoidance, worry, shyness, uncertainty, fatigue, lack of self direction

bulimia PT presents

normal to slightly low weight, dental erosions on the back of teeth, carotid swelling, calluses or scars on back of hand, peripheal edema, muscle weakening, abnormal lab values, electrolytes out of wack, cardiovascular abnormalities, severe electrolyte imbalance can lead to death, cardiac failure. PT has problems with self concept, depression, substance use, possible impulsive stealing.

aphetamines

originally manufactured to treat depression, narcolepsy, hyperactivity, and obeesity. available by prescription only (monthly). increase alertness, metabolic rate, can over stimulate the CNS. OD and WD mimic cocaine.

dissociative symptoms

persistent or recurrent feelings of detachment from oneself or one's surroundings; include depersonalization and derealization

making a plan to leave

personalized safety guide, checklist of items to take, advice PT to know where their identification is, if there is any children- need birth certificates for theirself and child, social security cards, any school or medical records, if they have money take it with them, driver license, keys to house car or office (only if they own them), any medications, change of clothes, welfare paperwork, passports, work permits, divorce papers, insurance papers, pictures, only items that are sentimental value that they own themselves. take favorite toy or blanket for child so they will feel more secure. once plan is developed and IND understands the plan, make sure they know of a place to go. are they going to shelter? reach out to family members or friend? plan may not work the first time. victim may not be ready or have everything together with their safety plan.

PCP (phencyclidine)

physical symptoms of use: increased BP, increased temp, ataxia, repetitive jerking, agitated movements, nystagmus. psychological symptoms: beligerence, bizare behaviors, hallucinations, impaired judgement, paranoia, impulsive unpredicatable behaviors. OD S/S: seizure, coma, death. OD TX: comfort measures. WD S/S: none

nursing assessment

physical: assess CNS, head and neck for ocular abnormalities, chest for breathing difficulties, abdomen for large girth, skin for sores, nutritional status psychosocial assessment: general appearance, general behaviors, emotional state, social support, motivation, behavioral change diagnostic testing/ alcohol and drug levels

body dysmorphic disorder (obsessive compulsive disorder)

preoccupation with an imagined defective body part resulting in obsessional thinking and compulsive behavior such as mirror checking and camouflaging.

obsessive-compulsive disorder

presence of obsessions, compulsions, or both and are time consuming or cause impairment in social, occupational, or other important areas of functioning. fearful something bad might happen if compulsion is not performed.

impulse control disorders implementation

psychosocial interventions: limit setting, behavorial contract, counseling, for children and adolescents use role playing. meds: tricyclic antidepressants, anxiety meds, mood stabilizers, antipsychotic. safety is very important of self, IND, and entire unit. seclusion and restraints if needed. use standing orders HCP must assess PT within 1 hour.

two problems related to impulse control disorders

pyromania (deliberate fire starting) and kleptomania (urge to steal objects not needed for personal use or monetary value)

substance dependence among nurses

reasons: see medications as a solution to problems, have access should work when sick so do whatever is necessary, IND believes "if we know about it, its not really a problem, or it wont happen to us". signs: changes in behavior such as tardiness or missing work, decline in work performance such as poor charting or sloppy charting ,missed doses of meds. what to do: follow chain of command, express concern to supervisor.

panic disorder

recurrent panic attacks and the worry that there will be more panic attacks. brief period of intense fear or discomfort, reaches peak within minutes. S/S: palpitations, sweating, trembling or shaking, sensations of SOB, choking, chest pain, nausea, abdominal distress, feeling unsteady, light headed or faint, chills, parasthesia, fear of going crazy. SSRI generally prescribed in higher doses, SNRI prescribed in usual doses are considered first line TX

naltrexone (revia)

reduces or eliminates alcohol craving. blocks euphoric feeling in opoids.

anorexia nervosa

refusal to maintain a minimally normal weight for height and express intense fear of gaining weight. criteria for diagnosis: refusal to maintain body weight at or above a minimally normal weight for age and height or failure to make expected weight gain during a period of growth , leading to a body weight less than 85% of what is expected. intense fear of gaining weight or becoming fat, even though underweight. disturbance in the way in which ones body weight or shape is experienced, undue influence of body weight or shape on self evaluation, or denial of seriousness of current low body weight. in females, postmenarchial amenorrhea. restricted caloric intake, significantly low BMI, binging or purging behaviors

child abuse interventions

required by law to report any suspicion of abuse. documentation is very important, establish trust, care for physical wounds, help to build self esteem or parenting skills (how to manage child acting out). use drawings or play therapy, understand childs body parts and what they may refer to them as. follow policy and procedure for reporting.

alcohol OD symptoms

respiratory depression, mental confusion, unconsciousness. TX: charcoal to induce vomiting.

moderate anxiety

results in selective inattention and some diminished thinking. S/S: narrowed perceptual field, focus is on the source of anxiety, confused, problem solving is not at optimal level. slight discomfort, voice tremors, change in voice pitch, poor concentration, shakiness, somatic complaints such as headaches or back aches, increased pulse of respirations, pacing

compulsion

ritualistic behaviors an IND performs in attempt to relieve anxiety

treatment for stress disorder

same as anxiety disorder. psychotherapy (exposure based) (CBT), family therapy, vocational rehabilitation, group therapy, relaxation techniques, medications, EMDR, systematic desensitization

PT and family education with

self assessment educate that caffeine is associated with an increased risk of anxiety decrease stimuli teach positive and healthy coping mechanisms

social anxiety disorder

severe anxiety or fear provoked by exposure to social or a performance situation that could be evaluated negatively bu others. IND doesnt want to be center of attention

resources for abuse

shelters. safe place. safe place crisis line, national coalition against domestic violence, cramers children center, one place of the shoals. may have to use codes to communicate safely.

tension building

stress begins to build up, abuser or perpetrator becomes more agitated, victim becomes fearful and victim begins to make efforts to appease the abuser or perpetrator

inhalants

substances may be inhaled directly from the container (huffing) or placed in a bag or other container and then inhaled. most common substance: alcohol solvents, glue, gas, paint thinner, hair spray, spray paint. effects high associated with feelings of well being, excitement, sexual aggression, lessened sense of right and wrong,, loss of judgement (effects the frontal lobe) intoxication: delusions, hallucinations, anxiety, confusion complications: sudden death, hyperactive motor responses, loss of coordination, seizures

alcoholic myopathy

sudden onset of muscle pain, swelling, and weakness; a reddish tinge in the urine caused by myoglobin, a breakdown of muscle excreted in the urine; and a rapid rise in muscle enzymes in the blood. thought to be the result of vitamin b deficiency.

impulse control disorders assessment

suicide risk. self assessment.

nursing interventions with eating disorder

teamwork and collaboration with dieticians, therapist, psychiatrist, nurses, and PT have to be involved. monitor PT VS and electrolyte levels, weight on routine basis, void before weighing, monitor daily caloric intake, accompany PT to bathroom, limit time spent in bathroom, limit physical activity. have to make contract that states they will reach certain weight and agree with TX plan.

cycle of violence

tension building, acute battering, honeymoon. cycle always repeats. may take days or months but always repeats.

cannabis

the hemp plant cannabis sativa grown in many tropical and temperate climates all over the world. historically used to treat pain, decreased appetite, muscle and GI spasms, asthma, depression. marijuana- the dried leaves of the plant. hashish- dried resin from the top of the leave. hash oil- distilled oils of hashish. typically smoked but can be eaten (edibles). paraphernalia: scales, rolling papers, bongs, bubblers, water pipes, vaporizers, roach clips, gas masks, brownie mix. S/S: mild euphoria, confidence, grandiosity, relaxation, red eyes, dry mouth, increased appetite. no physical OD or WD symptoms.

family violence

the intentional intimidation, abuse or neglect of children, adults or elders by a family member, intimate partner or caretaker in order to gain power and control over the victim.

milieu management with eating disorder

the milieu provides a safe therapeutic environment for the PT to effect behavioral changes and to improve the psychological health and functioning of the IND

emotional abuse

the undermining of a persons self worth. constant criticism, humiliating, diminishing ones abilities, name calling, intimidating, isolating, and damaging relationships with others.

complications with alcohol abuse

thiamine deficiency, korsakoff syndrome (secondary dementia with profound memory loss. S/S: amnesia, dementia, psychosis/ nontreatable/ thiamine given for 3- 5 months), wernikes encephalopathy (delirium with cranial nerve. S/S: dysfunction, altered gait, nystagmus, lateral orbital palsy, unequal pupil size/ treatable/ thiamine for 1- 2 weeks/ often seen with korsakoff syndrome)

banana bag

thiamine, folic acid, and 3 grams of magnesium sulfate

sexual abuse signs in child abuse

torn bloody underwear, bruises, STDs, inflammation in genitalia.

crack

type of processed cocaine made by combining baking soda or ammonia and heating the mixture to remove the hydrochloric molecules which results in the crack rock. usually vaporized in a pipe or smoked with tobacco or marijuana. concentrated from of cocaine so it reaches the brain immediately (produces high within 4 to 6 seconds, intense but doesn't last long) followed by a deep depression. tolerance and addiction develop quickly.

rape

type of sexual assault; nonconsensual vaginal, anal, or oral penetration obtained by force, threat of bodily harm, or when a person is incapable of giving consent.

anticonvulsant examples

valproate (depakote) carbamazepine (tegretol) lamotrogine (lamictal)

SNRI examples

venlafaxine (Effexor) duloxetine (Cymbalta)

oppositional defiant disorder

very mouthy. diagnosis criteria: a pattern of angry or irritable mood, argumentative or defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least 4 of the following and exhibited during interaction with at least one IND who is not a sibling: angry or irritable mood- often loses temper, often touchy or easily annoyed, often angry and resentful. argumentative or defiant behavior- often argues with authority figures or for children and adolescents, with adults. often deliberately annoys others, often blames others for his or her mistakes or misbehavior. vindictiveness- has been spiteful or vindictive at least twice within the past 6 months. -the disturbance in behavior is associated with distress in the IND or others in their immediate social context, or it impacts negatively on social, educational, occupational, or other important areas of functioning. -the behaviors do not occur exclusively during the course of psychotic, substance use, depressive, or bipolar disorder. -remember: disobedient defiant behavior toward authoritative figures without going so far as to violate the rights of others. TX: behavioral therapy, family therapy. IND needs to see the behavior effects others. role play.

tolerance

where it takes more and more of a substance to produce an effect, individual doesn't respond to the substance as they did initially. causes increase of dosage to produce "effect".

cirrhosis of the liver

widespread destruction of liver cells which are replaced by fibrous cells. clinical manifestations: nausea and vomiting, anorexia, weight loss, abdominal pain, jaundice, edema, anemia, blood coagulation abnormalities. complications of cirrhosis: portal hypertension, ascites, esophageal varices, hepatic encephalopathy.

helpful response to abuse

you did not cause this. you are not a burden. you did not ask for this. make sure they understand it is not their fault.