uworld mental health

defense mechanisms list

1.) Regression 2.) Denial 3.) Displacement 4.) Rationalization 5.) Intellectualization 6.)Projection 7.) Reaction formation 8.) Identification 9.) Sublimation 10.) undoing

A key feature of attention-deficit hyperactivity disorder (ADHD) is hyperactivity;

A key feature of attention-deficit hyperactivity disorder (ADHD) is hyperactivity; however, some children with ADHD behave aggressively and have difficulty controlling anger, especially when frustrated or if unable to meet demands and challenges. An immediate intervention to help settle an out-of-control child is deep breathing. Taking slow, deep breaths relaxes the body, slows the heart rate, and distracts the child from inappropriate behaviors. Asking the child to blow up a balloon provides an easy mode of distraction and engages the child in a deep breathing exercise. After the child is calm, the nurse and the child can further discuss the disruptive behavior. Nursing interventions include the following: Stay calm and remove the child from the source of frustration/anger Assist the child in calming down with deep breathing exercises Discuss what precipitated the behavior and why the behavior is wrong Discuss acceptable ways of expressing anger and frustration Acknowledge that controlling anger is difficult Provide rewards for appropriate behavior Discuss the consequences of inappropriate behavior

Acute stress disorder (ASD)

Acute stress disorder (ASD) occurs following a traumatic or extremely stressful event. ASD is characterized by intrusive memories of the event, negative mood, dissociative symptoms (eg, altered sense of reality), and arousal and reactivity symptoms (eg, hyperactive sensory state, sleep disturbances, difficulty concentrating, easily startled). If these symptoms continue beyond a month after the event, the diagnosis becomes post-traumatic stress disorder. Nursing interventions for a client with ASD include: Assessing for ideas and plans to commit self-harm Assessing for ineffective coping (eg, use of drugs and alcohol) Assessing impact of ASD on the client's job performance, relationships, sleep pattern, and ability to perform activities of daily living Explaining that feelings and/or symptoms occurring after traumatic events are normal, as this can help alleviate the client's anxiety

Alcohol is a toxin that causes central nervous system depression.

Alcohol is a toxin that causes central nervous system depression. Acute alcohol intoxication can cause confusion, coordination impairment, drowsiness, slurred speech, mood swings, and uninhibited actions. Alcohol can also cause hypoglycemia, especially in clients with diabetes mellitus. Although the client is intoxicated, it is difficult to determine if the confusion is caused by alcohol or hypoglycemia or both. The priority is to monitor blood glucose during the night to watch for hypoglycemia, which would require immediate intervention.

An important step toward self-management of hallucinations is for the client to recognize that the hallucinations are not real.

An important step toward self-management of hallucinations is for the client to recognize that the hallucinations are not real. When a client is experiencing hallucinations, the nurse needs to reinforce reality and acknowledge how the client may be feeling. The nurse can point out his/her own perceptions without denying the client's experience. It is nontherapeutic to argue with or challenge the client about the hallucination, saying, for example, "How could a man get into your room? This is a locked hospital unit." Examples of additional therapeutic responses to a client who is experiencing hallucinations include the following: "I don't see anything, but I understand that what you are seeing may be very upsetting to you." "I understand that you are worried about the voices you are hearing. They are a part of your disease and not real." "I know the voices seem real to you and may be scary. I do not hear the voices."

anorexia nervosa

Anorexia nervosa Clinical features BMI <18.5 kg/m2 Fear of weight gain, distorted body image Medical complications Osteoporosis Amenorrhea Lanugo, hair loss, dry skin Gastroparesis, constipation Enlarged parotid glands (if binge/purge type) Hypotension, hypothermia, bradycardia Cardiac atrophy, arrhythmias

anorexia nervosa

Anorexia nervosa is an eating disorder characterized by distorted body image, profound fear of weight gain, a strong desire to be thin, and being unwilling to maintain a healthy body weight. The client engages in behaviors to lose weight, including not eating, purging, extreme exercise, and use of laxatives and diet pills. Psychosocial issues leading to anorexia are the focus of ongoing therapy, usually on an outpatient basis. However, certain criteria require hospitalization and include body weight below 75% of ideal, suicidal behavior, or medical conditions resulting from starvation.

Mild alcohol withdrawal symptoms

Anxiety, insomnia, tremors, diaphoresis, palpitations, gastrointestinal upset, intact orientation onset last drink 6-24 hr

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, distractibility, and/or hyperactivity

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, distractibility, and/or hyperactivity. Children experiencing hyperactivity are typically restless, have difficulty remaining seated, talk excessively, blurt out answers, and interrupt others. Inattention is characterized by a reduced ability to focus, distractibility, and failure to complete tasks. A diagnosis of ADHD can be made when a child (age: <17 years) exhibits multiple symptoms of hyperactivity/impulsiveness and/or inattentiveness for at least 6 months

auditory hallucinations

Auditory hallucinations are the most common form of hallucination, noted by falsely perceived sounds, most often in the form of voices. Command hallucinations are a specific type of auditory hallucination, during which voices instruct the client to perform specific actions, often demanding harm to the client or others. Clients who are alone and experiencing command hallucinations that are homicidal or suicidal in nature require immediate intervention to ensure the safety of themselves and others

reaction formation

Behaving in a manner or expressing a feeling opposite of one's true feelings ex: A parent who is resentful of an "unplanned" child becomes overprotective of that child

Bipolar disorder is a psychiatric condition characterized by cycling periods of depression and mania.

Bipolar disorder is a psychiatric condition characterized by cycling periods of depression and mania. Clients with acute mania often display elevated mood, increased and excessive activity levels, and altered decision-making that can result in high-risk behavior (eg, hypersexuality, excessive spending). Clients with mania are also easily distractible, leading to neglect of personal needs (eg, hydration, nutrition, sleep, hygiene) and the need for medical intervention. When managing the nutritional needs of clients with mania, the nurse should frequently offer energy- and protein-dense foods that are easily carried and consumed (eg, sandwiches, shakes, hamburgers, pizza slices, burritos, fruit juices, granola bars). These "on-the-go" foods promote nutritional intake in clients who are unable to sit down and complete a traditional meal

Borderline personality disorder Clinical features

Borderline personality disorder Clinical features Pervasive pattern of behavior beginning at early adulthood; ≥5 of the following:Unstable self-image Feelings of emptiness, Unstable relationships, Abandonment fears, Mood instability (intense reactivity lasting hours to days), Inappropriate anger, Transient paranoia or dissociation Impulsivity (eg, substance abuse, binge eating), Recurrent suicidality, self-injury (eg, cutting) Treatment Psychotherapy Adjunctive pharmacotherapy for mood instability, transient psychosis, or comorbid disorders

What is borderline personality disorder (BPD)?

Borderline personality disorder (BPD) is a mental health disorder characterized by unstable relationships and self-image, mood lability, excessive anger, fear of abandonment, impulsive behaviors, and recurrent suicidal behavior. Clients with BPD may use these behaviors to gain a response from others when there is a real or perceived risk of abandonment from a significant other. A borderline personality disorder is characterized by unstable relationships and self-image, mood lability, excessive anger, fear of abandonment, impulsive behaviors, and recurrent suicidal behavior. Suicidal threats and behaviors must be taken seriously and evaluated immediately for suicidal intent.

Bulimia Nervosa (BN)

Bulimia nervosa (BN) is characterized by cycles of uncontrollable overeating (ie, binging) followed by compensatory behaviors to avoid weight gain (eg, purging). Purging behaviors include self-induced vomiting, prolonged fasting, laxative abuse, and excessive exercise. Although clients with BN often have a healthy body weight, they have constant concerns about their personal appearance and others' perceptions of them, as well as the desire to be in control over their bodies. Nursing interventions for a client with BN include: Assessing the client's readiness to change maladaptive behaviors (eg, purging). Clients may not overtly recognize symptoms and may not be aware of the consequences of their behaviors . Designating a staff member to monitor the client during and after meals (at least 1 hr) to prevent purging behaviors and hiding food (ie, prevents binging) . Encouraging the client to journal about feelings associated with food. Journaling helps the client recognize underlying feelings and emotions which contribute to maladaptive eating patterns . Initiating a structured meal schedule that prevents the client from binging on food throughout the day and feeling guilty afterward . Monitoring for signs of electrolyte imbalances because purging behaviors may result in hypokalemia, placing the client at risk for cardiac arrhythmias

ADHD (Attention-Deficit Hyperactivity Disorder)

Children with attention-deficit hyperactivity disorder (ADHD), predominantly inattentive type, have trouble holding attention on tasks or play activities, experience difficulty organizing tasks and activities, and are easily distracted/side-tracked. They cannot give close attention to detail and dislike and/or avoid tasks that require mental effort over a long period. The key nursing intervention to help the child with ADHD adjust to hospitalization is providing a calm, structured, organized, and consistent environment. A written chart or list of daily activities will help remind the child of what to expect and what will happen at any given time. A structured environment helps these children organize their thoughts and activities

The legal criteria for involuntary admission include

Clients have the right to refuse hospital admission and treatment. However, all states and provinces have laws and procedures for involuntary admission that require clients to receive inpatient treatment for a psychiatric disorder against their will. The legal criteria for involuntary admission include: The individual appears to be an imminent danger to self or others . The individual has a grave disability (ie, is unable to adequately care for basic needs [food, clothing, shelter, medical care, personal safety]) as a result of a mental illness

Clients receiving treatment for depression and suicidal ideation must be carefully monitored for indications of increasing intent. During the client interview, the nurse should assess:

Clients receiving treatment for depression and suicidal ideation must be carefully monitored for indications of increasing intent. During the client interview, the nurse should assess: Access to psychiatric medications Availability of help during a crisis (eg, counselor, family) Future goals and plans Home and work environment risks Overall affect and level of energy Possible access to weapons Clients who articulate long-term personal goals and family milestones are less likely to attempt suicid

Clients with Alzheimer disease (AD) often exhibit behavioral problems (eg, agitation, resisting care) due to cognitive decline. Behavioral management techniques include:

Clients with Alzheimer disease (AD) often exhibit behavioral problems (eg, agitation, resisting care) due to cognitive decline. Behavioral management techniques include: Acknowledgement of the client's emotions, which reduces feelings of being isolated and misunderstood (Option 5) Reassurance that the client will be kept safe from harm Distraction (eg, photographs, music, television) to divert the client's attention Redirection to simple tasks (eg, folding towels/napkins, stacking plates

Clients with OCD

Clients with OCD engage in rituals and behaviors that help reduce the anxiety or stress rooted in their obsessions (recurrent thoughts, impulses, or images that cause notable distress). If the ritual is interrupted, the client will experience increased anxiety. A client with compulsive behavior often does not realize the amount of time or how many times the same activity has been performed. By providing reflective feedback about the client's behavior, the nurse is acknowledging the behavior in a nonjudgmental manner. The nurse should also help the client become involved in other activities and problem-solving skills. Therapeutic approaches to a client with OCD include pointing out the amount of time the client has spent performing an activity and redirecting the client to another activity.

Clients with antisocial personality disorder

Clients with antisocial personality disorder have a pattern of disregard for and violation of the rights of others. They manipulate others for personal gain and lack empathy.

Clients with major depressive disorder sometimes actually opt for ___ because it is the only treatment that works for them.

Clients with major depressive disorder experience feelings of worthlessness, low self-esteem, hopelessness, and guilt. Anger is turned inward and they may misinterpret reality and have an idealistic perception of a lost entity. They may blame themselves for what has happened, such as losing a loved one or being fired from a job. The nurse needs to remain nonjudgmental, listen to the client attentively, and convey a caring and accepting attitude to promote trust. Allowing the client to identify and verbalize feelings, including anger, in a comfortable environment will help the client see the situation in a more realistic way and come to terms with what has happened.

Clients with persecutory delusion

Clients with persecutory delusions (paranoid delusions) believe that they are being persecuted or harmed (eg, spied on, cheated, followed, poisoned). Focusing on the client's feelings secondary to the delusion is an example of empathy, one of the most important parts of the therapeutic nurse-client relationship. When nurses attempt to understand clients' feelings and their meaning, clients realize that someone is trying to understand them and the nurse-client relationship grows (Option 3). Focusing on reality and verbally reinforcing it will decrease the time that the client spends thinking about the delusions

Clients with schizoid personality disorder

Clients with schizoid personality disorder exhibit social detachment and an inability to express emotion. They do not enjoy close relationships and prefer to be aloof and isolated.

Clients with schizophrenia

Clients with schizophrenia have difficulty initiating and maintaining social interactions with other people. The nurse can facilitate interpersonal functioning by providing one-on-one interaction in which the client can practice basic social skills in a non-threatening way. Once the client feels more comfortable, the nurse can encourage participation in activities that require some interaction with others. Impaired social interaction is one of the negative symptoms of schizophrenia; others include the following: Inappropriate, flat, or bland affect, and apathy Emotional ambivalence, disheveled appearance Inability to establish and move toward goal accomplishment Lack of energy, pacing and rocking, odd posturing Regressive behavior, inability to experience pleasure Seeming lack of interest in the world and people It is the negative symptoms of schizophrenia that affect a client's ability to establish personal relationships and manage day-to-day social interactions. The positive symptoms of schizophrenia (hallucinations, delusions, thought impairment) often improve with psychotropic medications; negative symptoms tend to persist even with medication. Psychosocial and supportive treatment, including psychotherapy, education, behavioral training, cognitive therapy, and social skills therapy, may be beneficial in improving the quality of life for clients with schizophrenia.

Codependent behaviors are those that allow the codependent person to maintain control by fulfilling the needs of the addict first

Codependent behaviors are those that allow the codependent person to maintain control by fulfilling the needs of the addict first. Behaviors such as keeping the addiction secret, suffering physical or psychological abuse from the addict, not allowing the addict to suffer the consequences of actions, and making excuses for the addict's habit are hallmarks of codependency. If the addict isn't happy, the codependent person will try to make the addict happy. Codependent persons will focus all their attention on others at the expense of their own sense of self. Codependent spouses, friends, and family members keep the client from focusing on treatment; this behavior is counterproductive to both themselves and the client.

What is co-dependency?

Codependent spouses, friends, and family members can impede the treatment progress of clients with substance use disorders. Codependent behaviors include making excuses for a client's drug/alcohol use, putting a client's needs before one's own, and not allowing a client to suffer the consequences of actions.

Cogntive behavioral therapy (CBT)

Cognitive behavioral therapy (CBT) can be effective in treating anxiety disorders, eating disorders, depressive disorders, and medical conditions such as insomnia and smoking. These types of disorders are characterized by maladaptive reactions to stress, anxiety, and conflict. CBT requires that the client learn the skill of self-observation and to apply more adaptive coping interventions. CBT involves 5 basic components: Education about the client's specific disorder Self-observation and monitoring - the client learns how to monitor anxiety, identify triggers, and assess the severity Physical control strategies - deep breathing and muscle relaxation exercises Cognitive restructuring - learning new ways to reframe thinking patterns, challenging negative thoughts Behavioral strategies - focusing on situations that cause anxiety and practicing new coping behaviors, desensitization to anxiety-provoking situations or events

delirium tremors due to alcohol withdrawal .

Confusion, agitation, fever, tachycardia, hypertension, diaphoresis, hallucinations last drink onset : 48-96 hr

Displacement

Displacement Transferring thoughts & feelings toward one person or object onto another person or object A person who is angry with a boss com

What is displacement?

Displacement, one of many ego defense mechanisms, occurs when a person shifts uncomfortable feelings or impulses about one situation or person to a substitute situation or person deemed acceptable to receive these uncomfortable feelings or impulses

dissociative identity disorder

Dissociative identity disorder is a condition in which 2 or more identities alternately control the client's behavior. The alternate identities likely develop as a response to abuse or traumatic events and serve to protect the client from stressful memories. The client may not be aware of the alternate identities and may be confused by "lost time" and gaps in memory. Switching between identities occurs as a reaction to stress and individual triggers. The goal of treatment is to integrate the identities into one personality while maintaining safety. The client should journal about feelings and dissociation triggers and use a grounding technique (eg, deep breathing, rubbing a stone, counting coins) to counter dissociative episodes . Identities may be volatile and should be monitored for indications of harm to self or others . The nurse should attempt to form trusting, therapeutic relationships with each identity to explore feelings and facilitate identity integration

During the end-of-life process,

During the end-of-life process, the client and family members typically go through several emotional stages, each requiring therapeutic communication techniques by the nurse. The nurse can help the client and family by providing a few minutes of time and attention. The nurse should validate the family's needs by providing emotional support.

Types of impaired thought processes seen in individuals with schizophrenia include the following:

Echolalia - repetition of words, usually uttered by someone else Tangentiality - going from one topic to the next without getting to the point of the original idea or topic Word salad - a mix of words and/or phrases having no meaning except to the client. Example: "Here what comes table, sky, apple." Clang associations - rhyming words in a meaningless, illogical manner. Example: "The pike likes to hike and Mike fed the bike near the tyke." Perseveration - repeating the same words or phrases in response to different questions

Electroconvulsive therapy (ECT)

Electroconvulsive therapy (ECT) induces a generalized seizure by passing an electrical current through electrodes applied to the scalp. Although the exact mechanism is unknown, 15-20-second seizures are proven effective in treating mood disorders (eg, major depression, bipolar disorder) and schizophrenia. Client teaching includes: NPO status is required for 6-8 hours prior to treatment except for sips of water with medications . Anesthesia (eg, methohexital, propofol) and a muscle relaxant (eg, succinylcholine) will be administered; clients are unconscious and feel no pain during the procedure. Driving is not permitted during the course of ECT treatment Temporary memory loss and confusion in the immediate recovery period are common side effects of ECT

End-of-life

End-of-life care includes providing psychosocial support to the client's family members and assisting them through the dying process. This is accomplished by providing factual, open, and honest communication while conveying empathy. The nurse can reduce family members' fear and anxiety by helping them anticipate what to expect as death becomes imminent, while using the therapeutic communication technique of offering self

End-of-life decisions (eg, hospice, code status)

End-of-life decisions (eg, hospice, code status) often overwhelm clients and medical decision-makers due to the magnitude of the choices and feelings of guilt that may accompany decisions. Clients and their families may lean on hospital staff to guide these decisions. These moral and ethical dilemmas require the nurse to have strong therapeutic communication skills. When discussing decisions related to client care, the nurse should facilitate exploration of the client's emotions, values, and beliefs, rather than offer personal opinions. Nurses can promote self-exploration by using open-ended questions and guiding phrases

Attention deficit hyperactivity disorder

Inattentive &/or hyperactive/impulsive symptoms for ≥6 months Inattentive symptoms: difficulty focusing, distractible, does not listen or follow instructions, disorganized, forgetful, loses/misplaces objects Hyperactive/impulsive symptoms: fidgety, unable to sit still, "driven by a motor," hypertalkative, interrupts, blurts out answers Several symptoms present before age 12 Symptoms occur in at least 2 settings (home, school) & cause functional impairment Subtypes: predominantly inattentive, predominantly hyperactive/impulsive, combined type

Individuals with borderline personality disorder

Individuals with borderline personality disorder (BPD) live in fear of rejection and abandonment. To avoid abandonment, they use manipulation and control, often unconsciously, to prevent a person from leaving. The manipulative behavior may be of a positive nature, such as the use of flattery, or a negative nature, such as distancing from the other person. An individual with BPD may also engage in self harm or suicidal behaviors in an attempt to gain attention from the other person and keep that person from leaving. For this client, the nursing care plan must include the assignment of different staff members. This will help diminish the client's dependence on a particular individual and help the client learn to relate to more than one person.

Individuals with dependent personality disorder have a persistent and extreme need to be taken care of that manifests as submissive and clinging behaviors and fear of separation

Individuals with dependent personality disorder have a persistent and extreme need to be taken care of that manifests as submissive and clinging behaviors and fear of separation. Additional characteristics of dependent personality disorder may include: Difficulty in making day-to-day decisions An excessive need for advice, reassurance, and nurturance from others Lack of self-confidence - afraid to do things on one's own Afraid of confrontation or expressing disagreement with others Feelings of helplessness and anxiety when alone; fear of being unable to take care of oneself

obsessive-compulsive personality disorder

Individuals with obsessive-compulsive personality disorder are typically self-willed and obstinate, punctual, pay attention to rules and regulations, and need to control both internal and external experiences. These traits are very extreme and result in rigidity and inflexibility. In this scenario, a change has been made in the client's schedule for the day and is outside of the client's control. This could cause significant distress and impaired functioning so that the client feels emotionally paralyzed.

Individuals with paranoid personality

Individuals with paranoid personality disorder have a pervasive distrust and suspicion of others; they believe that people's motives are malicious and assume that others are out to exploit, harm, or deceive them. These thoughts permeate every aspect of their lives and interfere with their relationships. Individuals with paranoid personality disorder are usually difficult to get along with as they may express their suspicion and hostility by arguing, complaining, making sarcastic comments, or being stubborn. Because these clients do not trust others, they have a strong need to be self-sufficient and maintain a high degree of control over their environment.

Intimate partner violence (IPV)

Intimate partner violence (IPV) is physically, emotionally, verbally, sexually, or economically abusive behavior inflicted by one partner against another in an intimate relationship, to maintain power and control. Nurses must be aware of the risk factors and signs of IPV to recognize victims of abuse and to intervene (eg, separating the victim from the abuser during the health history interview, providing information about community resources). Features of IPV include: The abusive partner exhibits intense jealousy and possessiveness (Option 3). The victim of IPV chooses to stay in the relationship for a variety of reasons (eg, fear for life, financial or child custody concerns, religious beliefs) (Option 4). The abuse begins or intensifies during

Repression

Keeping unacceptable thoughts or traumatic events buried in the unconscious EX: A person who was raped cannot recall the even

Long-term treatment with medication alone is not necessarily the best approach to treat insomnia. Nonpharmacological strategies for improving sleep hygiene include:

Long-term treatment with medication alone is not necessarily the best approach to treat insomnia. Nonpharmacological strategies for improving sleep hygiene include: Avoiding naps throughout the day Engaging in physical activity or exercise, preferably at least 5 hours before bedtime Receiving at least 20 minutes of natural sunlight each day, ideally in the morning, to improve sleep patterns Avoiding caffeinated beverages after noon Avoiding alcohol and/or smoking at bedtime Participating in a relaxing activity before bedtime (eg, warm bath, reading, listening to soft music) Decreasing environmental stimuli; making sure the bedroom is dark, cool, and quiet Avoiding heavy meals or large amounts of fluids at bedtime Drinking a cup of warm milk or eating a small amount of carbohydrates before bedtime, which promotes comfort and relaxation to aid sleepiness

Major predisposing factors for the development of delirium in hospitalized clients include:

Major predisposing factors for the development of delirium in hospitalized clients include: Advanced age Underlying neurodegenerative disease (stroke, dementia) Polypharmacy Coexisting medical conditions (eg, infection) Acid-base/arterial blood gas imbalances (eg, acidosis, hypercarbia, hypoxemia) Metabolic and electrolyte disturbances Impaired mobility - early ambulation prevents delirium Surgery (postoperative setting) Untreated pain and inadequate analgesia

What is rationalization?

Making excuses for behaviors that are considered unacceptable

nursing care for client with anorexia

Nursing care includes: Assisting the client in reflecting on triggers for dysfunctional eating and fears and feelings related to gaining weight Maintaining strict documentation of dietary protein and calorie intake to ensure healthy weight gain Remaining with the client during and 1 hour following meals to ensure intake and prevent purging behaviors Establishing a weekly weight-gain goal (typically 2-3 lb/wk [0.91-1.36 kg/wk]) Weighing the client at the same time each morning (after voiding and before any oral intake) and wearing the same clothing to assess efficacy of nutritional support Limiting physical activity initially and gradually increasing as oral intake improves Not focusing on food initially, but encouraging participation in meal planning as the client nears target weight

Obsessive-compulsive disorder

Obsessive-compulsive disorder is characterized by obsessions (ie, persistent and intrusive thoughts, impulses, or images) and compulsions (ie, ritualistic, repetitive behaviors performed to reduce anxiety or prevent an adverse event). Clients are aware that such behavior is irrational, but performing the actions provides relief, which compels them to continue. Initially, nursing care includes: Assisting the client to identify circumstances that increase anxiety Offering positive feedback when the client engages in nonritualistic behavior (eg, group activities, board games) Remaining nonjudgmental and empathetic and using reflective communication Cognitive-behavioral therapy (eg, thought stopping)

Postmortem care of a child is a highly stressful and emotional time for family and staff members

Postmortem care of a child is a highly stressful and emotional time for family and staff members. After death, the psychosocial care of the family and the bond between parent and child should be facilitated through specific interventions intended to assist parents through the grieving process. Parents should be allowed as much time as they need with the child's body and should not be rushed while they say goodbye. The nurse should be present to provide emotional support and identify if parents wish to help participate in some or all care activities, such as bathing and dressing the child. Parents should be allowed time to cuddle with and speak, read, or sing to the child, as well as perform special activities associated with cultural belief

What is projection?

Projection involves feeling uncomfortable with an impulse or feeling and easing the anxiety by assigning it to another person. An example is a husband with thoughts of infidelity who then accuses his wife of being unfaithful.

Rationalization

Rationalization Using excuses to explain away threatening circumstances "I did poorly on the test because the questions were so trick

What is the sublimation defense mechanism?

Redirecting negative impulses into positive behavior

Reduced appetite and low energy level are common clinical findings in major depressive disorder

Reduced appetite and low energy level are common clinical findings in major depressive disorder. The lethargy accompanying the depressed mood makes it difficult for a client with this diagnosis to even get up and out of bed. Personal hygiene and grooming are neglected, and there is no desire to interact with others. The client needs direction and structure in performing activities of daily living (ADLs); waiting for the client to feel more energetic and initiate activity and interaction on one's own is not helpful. Assisting the client with ADLs helps convey a sense of caring, provides an opportunity for interaction with the nurse, and helps raise the client's self estee

What is resilience?

Resilient people readily deal with the stress they face by using interventions such as deep breathing, meditation, thought interruption, and muscle relaxation.

Regresssion

Returning to a previous level of development ex; An adult has a "temper tantrum" when stuck in traffic

Risk factors for suicide

Risk factors for suicide Demographic Females attempt more; males complete more Advanced age Socioeconomic extremes Unemployment (eg, job loss, retirement) Health Mental health disorder (eg, depression) Chronic or terminal illness History of alcohol or substance abuse Interpersonal Family history of suicide or abuse Single, divorced, widowed Sudden loss or change in support system Social isolation Other Aggressive or impulsive behavior Past attempts Organized or lethal plan

school phobia

School phobia (also known as school refusal or school avoidance) is a childhood anxiety disorder in which the child experiences an irrational and persistent fear of going to school. Having the child return to school immediately is the best approach for resolving school phobia and is associated with a faster recovery. If necessary, gradual exposure to the school environment can be implemented; the child can attend school for a few hours and then gradually increase the time to a full day. A gradual approach may decrease the child's sensitization to the classroom. If the child is allowed to remain out of school, the problem will only worsen, with potential deterioration of academic performance and social relationships.

The nurse should recognize the following characteristics associated with histrionic personality disorder:

Self-dramatizing, exaggerated or shallow emotional expression Attention-seeking, needs to be the center of attention Overly friendly and seductive, attempts to keep others engaged Demands immediate gratification and has little tolerance for frustration An individual with histrionic personality disorder displays these behaviors and characteristics persistently. The signs and symptoms are maladaptive and have a negative impact on the client's social, interpersonal, and occupational life.

Serotonin Syndrome

Serotonin can be increased by the addition or high doses of serotonergic medication, or by some herbal medications (eg, St. John's wort), placing clients at risk for serotonin syndrome. Symptoms may include mental status changes (eg, anxiety, agitation, disorientation), autonomic dysregulation (eg, hyperthermia, diaphoresis, tachycardia/hypertension), and neuromuscular hyperactivity (eg, tremor, muscle rigidity, clonus, hyperreflexia). The nurse should call this client back to investigate the symptoms further.

seizure last onset of alcohol intake

Single or multiple generalized tonic-clonic 12- 48 hr

Social Anxiety Disorder (Social Phobia)

Social anxiety disorder (SAD) is characterized by an excessive and persistent fear of social or performance situations in which the client is exposed to strangers and the possibility of scrutiny by others. Examples of such social interactions include meeting unfamiliar people, being observed eating or drinking in public, and giving a speech. The client may fear criticism, embarrassment, humiliation, and rejection from unfamiliar people in unfamiliar social situations and will exhibit physical symptoms of anxiety such as sweating, trembling, palpitations, diarrhea, and blushing.

Social anxiety disorder (ie, social phobia)

Social anxiety disorder (ie, social phobia) is characterized as intense anxiety or fear when exposed to a public or social situation (eg, public speaking, eating or drinking in front of others). Clients who have social anxiety disorder tend to avoid participating in social situations because of the heightened anxiety and insecurity they experience. Treatment of social phobias may include medication (eg, selective serotonin reuptake inhibitors, benzodiazepines) and psychotherapy (eg, cognitive-behavioral therapy, systematic desensitization) to assist in developing effective coping strategies. As part of systematic desensitization, the client is gradually exposed to the phobic trigger, which in turn decreases anxiety. Effective coping with social phobia is demonstrated by: Experiencing increased comfort while engaging in phobic situations (eg, drinking a cola while watching people eat) Developing insight and verbalizing feelings about the irrational fear Distracting oneself by focusing on something other than the phobic situation (eg, preparing for a meeting while drinking a latte)

Suicide risk assessment:

Suicide risk assessment: evaluate ideation, method, plan, intent Suicidal ideation Wish to die, not wake up (passive) Thoughts of killing self (active) Method/Accessibility Thoughts of specific methods (eg, weapons, pills) Accessibility of method (eg, medication, gun access) Lethality of method (eg, gunshot to head, jumping from a high floor, potentially lethal overdose of pills) Preparations/planning Steps were taken toward making a suicide attempt: collecting pills, obtaining a gun, giving valuables away, writing a will or suicide note Specific planning of time, place, details Intent Strength of intention to act on suicidal thoughts Time frame (next 48 hr, weeks to months)

Sundowning

Sundowning refers to the increased confusion experienced by an individual with dementia; it occurs at night, when lighting is inadequate, or when the client is excessively fatigued. Wandering is a common associated behavior. A client with mild-to-moderate dementia may need frequent reality reorientation to promote appropriate behaviors. However, with advanced dementia, reality orientation may not be effective and might cause the client to feel anxious, leading to inappropriate behaviors and aggression. In this situation, validation therapy is more appropriate and involves recognizing and exploring the client's feelings and concerns but not reinforcing or arguing with any incorrect perceptions.

Introjection

Taking on the qualities or attitudes of others without thought or examination A person may take on the political views of a famous, admired actor

grief

The practices, needs, and experiences of grief vary greatly among individuals. Nurses caring for grieving clients must skillfully use therapeutic communication techniques to strengthen the nurse-client relationship and support clients in exploring emotions and experiences. Reflection (eg, acknowledging client statements) and using open-ended questions or statements assist the client in exploring emotions and allow for expression of needs Nurses may also suggest strategies and share resources (eg, support group) to facilitate the client's grieving process

The priority for possible domestic abuse victims is to remove them from any sources of immediate danger, including suspected abusers.

The priority for possible domestic abuse victims is to remove them from any sources of immediate danger, including suspected abusers. Such clients should be questioned and assessed alone so that the suspected abusers do not guide their answers or intimidate them from providing truthful responses. In this case, the spouse appears angry and should, as a priority, be removed from the room to prevent further potential harm to the client or staff

The priority nursing action is to explore the content of the hallucinations

The priority nursing action is to explore the content of the hallucinations. This client may be experiencing command auditory hallucinations that could lead to self-directed or other-directed injury and harm. After the content of the hallucinations has been explored, implementing an intervention may be necessary to reduce the potential for violence. Hallucinations are false sensory perceptions that have no external stimuli. They can occur in any of the 5 senses. Auditory hallucinations are the most common, followed by visual, tactile (touch), olfactory (smell), and gustatory (taste). Additional ways to deal with hallucinations include the following: Telling the client that you know they are real to the client but that you do not hear the voices (or see the vision, feel the sensation) Not arguing with or challenging the client about the hallucinations Directing the client to a reality-oriented topic of conversation or activity

Therapeutic communication

Therapeutic communication allows the nurse to develop a healthy interpersonal relationship with the client. A "why" question is often avoided as it is viewed negatively by clients and can make them feel defensive about their choices or emotions

Alcohol hallucinations

Visual, auditory, or tactile; intact orientation; stable vital signs last drink onset: 12-48 hr

When speaking with a child about abuse, the nurse should be direct and honest.

When speaking with a child about abuse, the nurse should be direct and honest. The nurse should allow the child to disclose the abuse at a comfortable pace, rather than probe for additional information. The nurse should use open-ended questions and avoid leading questions and statements. Guidelines for the interview: Speak with the child in private Be honest about reporting requirements Use language appropriate to the child's age Avoid making assumptions or communicating anger, shock, or disapproval Reassure the child about not being at fault or in trouble

What is compensation?

covering up a real or perceived weakness by emphasizing a trait one considers more desirable perceived deficit in one area and making up for it by overachieving in another. An example is someone not doing well academically who focuses on doing well in sports.

intimate partner violence (IPV) i

intimate partner violence (IPV) is physically, emotionally, verbally, sexually, or economically abusive behavior inflicted by one partner against the other in an intimate relationship to maintain power and control. During pregnancy, added emotional and financial stress may trigger or escalate abuse. The abuse can endanger the health and safety of both mother and fetus. The nurse should work closely with survivors of IPV to ensure their safety in the event of escalating violence. Appropriate interventions include the following: Assess the client for thoughts of self-harm because the client may view suicide as the only way out of the relationship Collaborate with the health care team to develop a safety plan, which facilitates rapid escape from escalating violence. Components of a safety plan include a secure location to reside and an emergency kit with essential items Follow facility guidelines for reporting, documenting, gathering evidence, and/or photographing injuries. Thorough documentation of details of the injury on a body map will be needed to facilitate any legal proceeding

what is undoing defense mechanism

pt attempts to "undo" an unwanted thought (eg an obsession) by engaging in contrary behavior (eg a compulsion)

reaction formation (defense mechanism)

reaction formation involves transforming an unacceptable feeling or impulse into its opposite. An example is a client with cancer who fears dying but behaves in an overly optimistic and fearless manner about his treatment and prognosis.

risk factors of elderly abuse and manifestation

risk factors Female Dementia, chronic mental illness Functional impairments Social isolation Shared living environment Poor socioeconomic status/financial stress Manifestations of abuse Physical & sexual abuse Atypical abrasions, lacerations, contusions, fractures Pain not consistent with reported etiology Anogenital injuries Newly acquired STI Psychological & verbal abuse Change in behavior/personality Depression/anxiety Neglect Inadequate nutrition or hydration Pressure injuries Deterioration in comorbid conditions Financial exploitation Failure to adhere to medication regimen Multiple missed appointments Unpaid expenses or rent payments

suicide risk & protective factors Risk factors

suicide risk & protective factors Risk factors Psychiatric disorders, prior suicide attempts Hopelessness Never married, divorced, separated Living alone Unemployed or unskilled Physical illness Family history of suicide, family discord Access to firearms Substance abuse, impulsivity Protective factors Social support/family connectedness Pregnancy Parenthood Religion & participation in religious

What is intellectualization?

taking intellectual aspects and detaching the emotional aspects of the situation?

Sublimation

transforming unacceptable thoughts or needs into acceptable actions A person may turn to box to deal with aggression

types of impaired thought processes seen in individuals with schizophrenia include the following:

types of impaired thought processes seen in individuals with schizophrenia include the following: Neologisms - made-up words or phrases usually of a bizarre nature; the words have meaning to the client only. Example: "I would like to have a phjinox." Concrete thinking - literal interpretation of an idea; the client has difficulty with abstract thinking. Example: The phrase, "The grass is always greener on the other side," would be interpreted to mean that the grass somewhere else is literally greener Loose associations - rapid shifting from one idea to another, with little or no connection to logic or rationality

What is identification?

when you dress/act a certain way to be like someone you look up to

two common misunderstandings about ADHD

wo common misunderstandings about ADHD are that children outgrow it as they become adults, and that dietary modifications (eg, restricting additives and/or sugar) will improve or "cure" the symptoms. Neither statement is true. These individuals learn to cope with and manage their symptoms as they grow older, but they do not outgrow ADHD.