Mental Health Chapters 14, 16, 18-21

Nursing interventions for Constipation

Increase fluid and dietary fiber intake; client may need a stool softener if unreleived

Alexithymia

Difficulty identifying and expressing feelings

Symptoms of Delirium

Difficulty with attention Easily distractible Disoriented May have sensory disturbances such as illusions, misinterpretations, or hallucinations Can have sleep-wake cycle disturbances Changes in psychomotor activity May experience anxiety, fear, irritability, euphoria, or apathy

The nurse is caring for a client who has been taking fluphenazine (Prolixin) for 2 days. The client suddenly cries out, his neck twists to one side, and his eyes appear to roll back in the sockets. Which PRN medication should be administered to the client?

Diphenhydramine (Benadryl), 25 mg, IM, PRN

Tactile defensiveness

Discomfort at being touched by another person

A client with late moderate stage dementia has been admitted to a long-term care facility. Which of the following nursing interventions will help the client to maintain optimal cognitive function?

Discuss pictures of children and grandchildren with the client

Symptoms of Antisocial personality disorder

Disregard for rights of others, rules, and laws Violation of the rights of others Lack of remorse for behavior Shallow emotions Lying Rationalization for own behavior Poor judgment Impulsivity Irritability and aggressiveness Lack of insight Thrill-seeking behaviors Exploitation of people in relationships Poor work history Consistent irresponsibility

When interviewing any client with a personality disorder, the nurse would assess for which of the following?

Disruption in some aspects of his/her life

Nursing interventions for helping client to cope and control emotions

Identifying feelings Journal entries Moderating emotional responses Decreasing impulsivity Delaying gratification

Which of the following is used to treat enuresis?

Imipramine (Tofranil)

Echopraxia

Imitation of the movements and gestures of someone an individual is observing

Nursing interventions for Urinary retention

Instruct client to report any frequency or burning with urination; report to physician if no improvement over time

Nursing interventions for Orthostatic hypotension

Instruct client to rise slowly from sitting or lying position; wait to ambulate until no longer dizzy or light-headed

Nursing interventions of antisocial personality disorder

Limit setting; confrontation; teach client to solve problems effectively and manage emotions of anger or frustration; promoting responsible behavior; consistent adherence to rules and treatment plan; helping clients solve problems and control emotions; enhancing role performance

Drug of choice for affective aggression (normal)

Lithium Anticonvulsants Low-dose antipsychotics

IQ for profound reatardation

Less than 20

Hematologic symptoms related to weight loss

Leukopenia, anemia, thrombocytopenia, hypercholesterolemia, and hypercarotenemia

Nursing interventions for entering therapeutic relationships

Limit setting Confrontation

Drug of choice for Emotional lability

Lithium Carbamazepine - Tegretol Antipsychotics

Example of word salad

"Corn, potatoes, jump up, play game, grass, cupboard."

Acrocyanosis

Blue hands and feet

Religiosity

Delusional religious focus

Lanugo

Fine, baby-like hair over body

Onset of dementia

Gradual and insidious

Mental Retardation Disorders

Mild Moderate Severe Profound

Dental symptoms related to purging (vomiting and laxative abuse)

Erosion to dental enamel, particularly front teeth

Tic

a sudden, rapid, recurrent, nonrhythmic, stereotyped motor movement or vocalization

Apraxia

impaired ability to execute motor functions despite intact motor abilities

Satiety

satisfaction of appetite

A client with somatization disorder has been attending group therapy. Which of the following statements indicates that therapy is having a positive outcome for this client?

"I feel better physically just from getting a chance to talk."

Which of the following statements indicates the caregivers accurate knowledge about the needs of a parent at the onset of the moderate stage of dementia?

"I need to spend more time with my parent doing things we both enjoy."

Example of Verbigeration

"I want to go home, go home, go home, go home."

Which of the following statements would indicate that teaching about somatization disorder has been effective?

"I will feel better when I begin handling stress more effectively."

Example of clang associations

"I will take a pill if I go up the hill but not if my name is Jill, I don't want to kill."

Which of the following statements by the caregiver of a client newly diagnosed with dementia requires further intervention by the nurse?

"I will try to find new and different things to do every day."

Example of Neologisms

"I'm afraid of grittiz. If there are any grittiz here, I will have to leave. Are you a grittiz?"

Which of the following statements would indicate family teaching about schizophrenia had been effective?

"It's a relief to find out what we did not cause our son's schizophrenia."

The nurse has been teaching a caregiver about donepezil (Aricept). The nurse knows that teaching has been effective by which of the following statements?

"This medication will slow the progress of Alzheimer's disease temporarily."

Example of Stilted language

"Would you be so kind, as a representative of Florence Nightingale, as to do me the honor of providing just a wee bit of refreshment, perhaps in the form of some clear spring water?"

The client's family asks the nurse, "What is hypochondriasis?" The best response by the nurse is, "Hypochondriasis is

A persistent preoccupation with getting a serious disease

IQ for Severe Retardation

20 to 35

IQ for Moderate Retardation

35 to 50

IQ for Mild Retardation

50 to 70

Drugs Causing Delirium

Anesthesia Anticonvulsants Anticholinergics Antidepressants Antihistamines Antihypertensives Antineoplastics Antipsychotics Aspirin Barbiturates Benzodiazepines Cardiac glycosides Cimetidine Hypoglycemic agents Insulin Narcotics Propranolol Reserpine Steroids Thiazide diuretics

Thought insertion

A delusional belief that others are putting ideas or thoughts into the client's head; that is, the ideas are not those of the client

Thought withdrawal

A delusional belief that others are taking the client's thoughts away and the client is powerless to stop it

Thought Broadcasting

A delusional belief that others can hear or know what the client is thinking

No-self harm contract

A client promises not to engage in self-harm and to report to the nurse when he/she is losing control

Positive self-talk

A cognitive-behavioral technique in which the client changes thinking about the self from negative to positive

Thought stopping

A cognitive-behavioral technique to alter the process of negative or self-critical thought patterns

Which of the following underlying emotions is commonly seen in a passive-aggressive personality disorder?

Anger

Stuttering

A disturbance of the normal fluency and time patterning of speech.

Delusions

A fixed, false belief not based in reality

Alogia

A lack of any real meaning or substance in what the client says

Tardive Dyskinesia

A late-onset, irreversible neurologic side effect of antipsychotic medications; characterized by abnormal, involuntary movements such as lip smacking, tongue protrusion, chewing, blinking, grimacing, and choreiform movements of the limbs and feet

Example of Somatic delusions

A male client may say that he is pregnant, or a client may report decaying intestines or worms in the brain

Dementia

A mental disorder that involves multiple cognitive deficits, usually involving memory impairment with progressive deterioration that includes all cognitive funcitoning

Rett's disorder

A pervasive developmental disorder characterized by the development of multiple deficits after a period of normal functioning. It occurs exclusively in girls and persists throughout life. Develops between birth and 5 months of age. The child loses motor skills and beings showing stereotyped movements instead. Loses interest in the social environment, and severe impairment of expressive and receptive language becomes evident as the child grows older.

Asperger's disorder

A pervasive developmental disorder characterized by the same impairments of social interaction and restricted stereotyped behaviors seen in autistic disorder, but there are no language or cognitive delays. This rare disorder occurs more often in boys and the effects are generally lifelong.

Neuroleptic Malignant Syndrome (NMS)

A potentially fatal, idiosyncratic reaction to an antipsychotic or neuroleptic drug

Ghost sickness

A preoccupation with death and the deceased frequently observed among members of some Native American tribes. Symptoms include bad dreams, weakness, feelings of danger, loss of appetite, fainting, dizziness, fear, anxiety, hallucinations, loss of consciousness, confusion, feelings of futility, and a sense of suffocation

Bouffee delirante

A syndrome found in West Africa and Haiti, involves a sudden outburst of agitated and aggressive behavior, marked confusion, and psychomotor excitement. It is sometimes accompanied by visual and auditory hallucinations or paranoid ideation

Decatastrophizing

A technique that involves learning to assess situations realistically rather than always assuming a catastrophe will happen

Pseudoparkinsonism

A type of extrapyramidal side effect of antipsychotic medication; includes shuffling gait, masklike faces, muscle stiffness, continuous or cogwheel rigidity, drooling, and akinesia

Drug Intoxication causes of delirium

Anticholinergics, lithium, alcohol, sedatives, and hypnotics

Neuroleptics

Antipsychotic medications

Drug of choice for Acute and psychosis

Antipsychotics

Transient psychotic symptoms that occur with borderline personality disorder are most likely treated with which of the following?

Antipsychotics

Reproductive symptoms related to weight loss

Amenorrhea and low levels of lutenizing and follicle-stimulating hormones

Drug of choice for predatory/hostility/cruetly

Antipsychotics Lithium

When the client describes fear of leaving his apartment as well as the desire to get out and meet others, it is called:

Ambivalence

Positive or hard symptoms of schizophrenia

Ambivalence, associative looseness, delusions, echopraxia, flight of ideas, hallucinations, ideas of reference, perservation

Neuropsychiatric symptoms related to weight loss

Abnormal taste sensation, apathetic depression, mild organic, mental symptoms, and sleep disturbances

Lack of volition

Absence of will, ambition, or drive to take action or accomplish tasks

The nurse understands that secondary gain for the client with a somatoform disorder can include:

Acceptable absence from work Freedom from daily chores Increased attention from family Provision of care by others

The most important short-term goal for the client who tries to manipulate others would be to

Acknowledge own behavior

Psychotic Symptoms

Acute and psychosis Chronic and low-level psychotic-like symptoms

Symptoms of Schizotypal personality disorder

Acute discomfort in relationships; cognitive or perceptual distortions, eccentric behavior

Nursing interventions for Akathisia

Administer medications as ordered; assess for effectiveness

Nursing interventions for Extrapyramidal side effects or neuroleptic-induced parkinsonism

Administer medications as ordered; assess for effectiveness

Nursing interventions for dystonic reactions

Administer medications as ordered; assess for effectiveness; reassure client if he/she is frightened

Aggression/Impulsivity Symptoms

Affective aggression Predatory/hostility/cruelty Organic-like aggression Ictal aggression

Symptoms of Conduct Disorder

Aggression to people and animal Bullies, threatens, and intimidates others Physical fights Use of weapons Forced sexual activity Cruelty to people or animals Destruction of property Fire setting Vandalism Deliberate property destruction Deceitfulness and theft Lying Shoplifting Breaking into house, building, or car Cons others to avoid responsibility Serious violation of rules Stays out overnight without parental consent Runs away from home overnight Truancy from school

Drug Withdrawal causes of delirium

Alcohol, sedatives, and hypnotics

Negative or soft symptoms of schizophrenia

Algoia, anhedonia, apathy, blunted affect, catatonia, flat affect, lack of volition

Which of the following interventions is most appropriate in helping a client with early-stage dementia complete activities of daily living?

Allow enough time for the client to complete ADLs as independently as possible

Anorexia nervosa

An eating disorder characterized by the client's refusal or inability to maintain a minimally normal body weight, intense fear of gaining weight or becoming fat, significantly disturbed perception of the shape or size of the body, and steadfast inability to refusal to acknowledge the existence or seriousness of a problem

Limit setting

An effective technique that involves three steps: stating the behavioral limit, identifying the consequences if the limit is exceeded, and identifying the expected or desired behavior

Zar

An experience of spirits possessing a person is seen in Ethiopia, Somalia, Egypt, Sudan, Iran, and other North African and Middle Eastern societies. The afflicted person may laugh, shout, wail, band his/her head on a wall, or be apthetic and withdrawn, refusing to eat or carry out daily tasks. Locally, such behavior is not considered pathologic.

Personality

An ingrained, enduring pattern of behaving and relating to self, others, and the environment; includes perceptions, attitudes, and emotions

Dependent personality disorder

Characterized by a pervasive and excessive need to be taken care of, which leads to submissive and clinging behavior and fears of separation

Pharmacologic treatment of autistic disorder

Antipsychotics such as haloperidol, or risperidone, may be effective for specific target symptoms such as temper tantrums, aggressiveness, self-injury, hyperactivity and stereotyped behaviors. Other medications such as naltrexone, clomipramine, clonidine and stimulants to diminish self-injury and hyperactive and obsessive behaviors

Mood in delirium

Anxious, fearful if hallucination, weeping, irritable

Dystonic reactions

Appear early in the course of treatment and are characterized by spasms in discrete muscle groups such as the neck muscles or eye muscles. These spasms may be accompanied by protrusion of the tongue, dysphagia, and laryngeal and pharyngeal spasms that can compromise the client's airway.

A teaching plan for the client taking an antipsychotic medication will include

Apply sun block lotion before going outdoors Drink sugar-free beverages for dry mouth Rise slowly from a sitting position

Somatic delusions

Are generally vague and unrealistic beliefs about the client's health or bodily functions. Factual information or diagnostic testing does not change these beliefs.

Nursing interventions for Helping the client identify emotions and develop non-food-related coping strategies

Ask the client to identify feelings Self-monitoring using a journal Relaxation techniques Distraction Assist client to change stereotypical beliefs

A client with bulimia is learning to use the technique of self-monitoring. Which of the following interventions by the nurse would be most beneficial for this client?

Ask the client to write about all feelings and experiences related to food

Interventions for clients with dementia that follow the psychosocial model of care include:

Asking the client about the place where they were born Finding activities that engage the client's attention Providing unrelated distractions when the client is agitated

Nursing interventions for depressive personality disorder

Assess self-harm risk; provide factual feedback, promote self-esteem; increase involvement in activities

Nursing interventions for Blurred vision

Assess side effect, which should improve with time; report to physician if no improvement

Nursing interventions for Tardive dyskinesia

Assess using tool such as AIMS; report occurrence or score increase to physician

Stereotypic movement disorder

Associated with many genetic, metabolic, and neurologic disorders and often accompanies mental retardation.

Attention-Deficit and Disruptive Behavior Disorders

Attention deficit hyperactivity disorder Conduct disorder Oppositional defiant disorder

The family of a client with schizophrenia asks the nurse about the difference between conventional and atypical antipsychotic medications. The nurse's answer is based on which of the following?

Atypical antipsychotics are dopamine and serotonin antagonists; conventional antipsychotics are only dopamine antagonists

Pervasive Developmental Disorders

Autistic disorder Rett's disorder Childhood disintegrative disorder Asperger's disorder

Client/Family Education for antisocial personality disorder

Avoiding use of alcohol and other drugs Appropriate social skills Effective problem-solving skills Managing emotions such as anger and frustration Taking a time-out to avoid stressful situations

Schizoid personality disorder

Characterized by a pervasive pattern of detachment from social relationships and a restricted range of emotional expression in interpersonal settings

Client Education for Eating Disorders

Basic nutritional needs Harmful effects of restrictive eating, dieting and purging Realistic goals for eating Acceptance of healthy body image

A nurse doing an assessment with a client with anorexia nervosa would expect to find which of the following?

Belief that dieting behavior is not a problem History of dieting at a young age Performance of rituals or compulsive behavior Views self as overweight or obese

Projection

Blaming other people, institutions, or events for their own difficulties. It is common for such clients to blame the government for personal problems.

Common simple motor tics

Blinking, jerking the neck, shrugging the shoulders, grimacing and coughing

Soma

Body

Cardiac symptoms related to weight loss

Bradycardia, hypotension, loss of cardiac muscle, small heart, cardiac arrhythmias including atrial and ventricular premature contractions, prolonged QT interval, ventricular tachycardia, and sudden death

Duration of Delirium

Brief, hours to days

Antisocial personality disorder

Characterized by a pervasive pattern of disregard for and violation of the rights of others and with the central characteristics of deceit and manipulation

Histrionic personality disorder

Characterized by a pervasive pattern of excessive emotionality and attention seeking

Drug of choice for Ictal aggression/abnormal

Carbamazepine - Tegretol Diphenylhydantoin - Dilantin Benzodiazepines

Nursing interventions for Sedation

Caution about activities requiring client to be fully alert, such as riving a car

Nursing interventions for Photosensitivity

Caution client to avoid sun exposure; advise client when in the sun to wear protect clothing and sun blocking lotion

Family risk factors for bulimia nervosa

Chaotic family when loose boundaries; parental maltreatment including possible physical or sexual abue

Passive-aggressive personality disorder

Characterized by a negative attitude and a pervasive pattern of passive resistance to demands for adequate social and occupational performance

Narcissistic personality disorder

Characterized by a pervasive pattern of grandiosity, need for admiration and lack of empathy

Obsessive-compulsive personality disorder

Characterized by a pervasive pattern of preoccupation with perfectionism, mental and interpersonal control, and orderliness at the expense of flexibility, openness, and efficiency

Schizotypal personality disorder

Characterized by a pervasive pattern of social and interpersonal deficits marked by acute discomfort with and reduced capacity for close relationships as well as by cognitive or perceptual distortions and behavioral eccentricities

Avoidant personality disorder

Characterized by a pervasive pattern of social discomfort and reticence, low self-esteem, and hypersensitivity to negative evaluation

Separation anxiety disorder

Characterized by anxiety exceeding that expected for developmental level related to separation from home or those to whom the child is attached.

Schizophrenia, residual type

Characterized by at least one previous, though not a current episode; social withdrawal; flat affect; and looseness of associations

Schizophrenia, disorganized type

Characterized by grossly inappropriate or flat affect, incoherence, loos associations, and extremely disorganized behavior

Schizophrenia, catatonic type

Characterized by marked psychomotor disturbance, either motionless or excessive motor activity. Motor immobility may be manifested by catalepsy or stupor. Excessive motor activity is apparently purposeless and is not influenced by external stimuli

Childhood distintegrative Disorder

Characterized by marked regression in multiple areas of functioning after at least 2 years of apparently normal growth and development. Typical age onset is 3-4 years. Child has the same social and communication deficits and behavioral patterns seen with autistic disorder. Is rare and occurs more often in boys.

Schizophrenia, undifferentiated type

Characterized by mixed schizophrenic symptoms along with disturbances of thought, affect, and behavior

Night eating syndrome

Characterized by morning anorexia, evening hyperphagia, and nighttime awakenings at least once a night to consume snacks. It is associated with life stress, low self-esteem, anxiety, depression and adverse reactions to weight loss. Most people are obese. Treatment with SSRI antidepressants has shown positive effects

Schizophrenia, paranoid type

Characterized by persecutory or grandiose delusions, hallucinations, and occasionally excessive religiosity or hostile and aggressive behavior.

Feeding disorder of infancy or early childhood

Characterized by persistent failure to eat adequately, which results in significant weight loss or failure to gain weight. Equally common among boys and girls and occurs most often during the first year of life.

Selective mutism

Characterized by persistent failure to speak in social situations where speaking is expected such as school.

Paranoid personality disorder

Characterized by pervasive mistrust and suspiciousness of others

Depressive personality disorder

Characterized by pervasive pattern of depressive cognitions and behaviors in various contexts

Grandiose delusions

Characterized by the client's claim to association with famous people or celebrities, or the client's belief that he/she is famous or capable of great feats

Shenjing shuariuo

China. Physical and mental fatigue, dizziness, headache, pain, sleep disturbance, memory loss, GI problems, sexual dysfunction

Drug of choice for Organic-like aggression

Cholinergic agonists - donepezil Imipramine - Tofranil

Anxiety Symptoms

Chronic cognitive Chronic somatic Severe anxiety

Common simple vocal tics

Clearing the throat, grunting, sniffling, snorting, and barking

Example of Religious Delusions

Client claims to be the Messiah or some prophet sent from God, believes that God communicates directly to him or her that he/she has "special" religious mission in life or special religious powers.

Ideas of reference

Client's inaccurate interpretation that general events are personally directed to him or her, such as hearing a speech on the news and believing the message has personal meaning

Psychosis

Cluster of symptoms including delusions, hallucinations, and grossly disordered thinking and behavior

Pain symptoms of somatization disorder

Complaints of headache, pain in the abdomen, head, joints, back, chest, rectum; pain during urination, menstruation, or sexual intercourse

When assessing a client with delirium, the nurse will expect to see:

Confusion Impaired level of consciousness Rapid onset of symptoms

Moderate Dementia

Confusion is apparent, along with progressive memory loss. The person can no longer perform complex tasks but remains oriented to person and place. He/she still recognizes familiar people. Toward the end of this stage, the person loses the ability to live independently and requires assistance because of disorientation to time and loss of information such as address and telephone number. The person may remain in the community if adequate caregiver support is available, but some people move to supervised living situations

The nurse understands that effective limit setting for children includes

Consistent enforcement of limit by entire team Explaining the consequences of exceeding limits Informing the child of rule or limit

An effective nursing intervention for the impulsive and aggressive behaviors that accompany conduct disorder is

Consistent limit setting

Character

Consists of concepts about the self and the external world

Hyperhagia

Consuming 50% of daily calories after the last evening meal

Binge eating

Consuming a large amount of food in a discrete period of usually 2 hours or less

Pseudoneurologic symptoms of somatization disorder

Conversion symptoms such as impaired coordination or balance, paralysis or localized weakness, difficulty swallowing or lump in throat, aphonia, urinary retention, hallucinations, loss of touch or pain sensation, double vision, blindness, deafness, seizures; dissociative symptoms such as amnesia; or loss of consciousness other than fainting

Which of the following are initial goals for treating the severely malnourished client with anorexia nervosa?

Correction of electrolyte imbalances Nutritional rehabilitation Weight restoration

Which of the following is normal adolescent behavior?

Critical of self and others

Sociocultural risk factors for anorexia nervosa

Cultural ideal of being thin; media focus on beauty, thinness, fitness; preoccupation with achieving the ideal body

Sociocultural risk factors for bulimia nervosa

Cultural ideal of being thin; media focus on beauty, thinness, fitness; preoccupation with achieving the ideal body; weight-related teasing

Which of the following statement is true regarding eating disorders?

Cultures where beauty is linked to thinness have an increased risk for eating disorders

Gastrointestinal symptoms related to weight loss

Delayed gastric emptying, bloating, constipation, abdominal pain, gas, and diarrhea

Which of the following are considered to be positive signs of schizophrenia?

Delusions Hallucinations Disorganized thinking

Mood in dementia

Depressed and anxious in early stage, labile mood, restless pacing, angry outbursts in later stages

Self-transcendence

Describes the extent to which a person considers himself/herself to be an integral part of the universe. Are spiritual, unpretentious, humble, and fulfilled. These traits are helpful when dealing with suffering, illness or death. Are practical, self-conscious, materialistic and controlling. They may have difficulty accepting suffering, loss of control, personal and material losses and death

Symptoms of Schizoid personality disorder

Detached from social relationships, restricted affect; involved with things more than people

Motor Skills Disorder

Developmental coordination disorder

Learning Disorder

Diagnosed when a child's achievement in reading, mathematics, or written expression is below that expected for age, formal education and intelligence. Interfere with academic achievement and life activities requiring reading, math, or writing.

Personality disorders

Diagnosed when personality traits become inflexible and maladaptive and significantly interfere with how a person functions in society or cause the person emotional distress

Schizoaffective disorder

Diagnosed when the client has the psychotic symptoms of schizophrenia and meets the criteria for major affective or mood disorder.

The nurse would assess for which of the following characteristics in a client with narcissistic personality disorder?

Entitlement

A nurse doing an assessment with a client with bulimia would expect to find which of the following?

Dissatisfaction with body shape and size Feelings of guilt and shame about eating behavior Near-normal body weight for height and age Strong desire to please others

Command Hallucinations

Disturbed auditory sensory perceptions demanding that the client take action, often to harm self or others, and are considered dangerous; often referred to as "voices"

Interventions for delusions with schizophrenic patients

Do not openly confront the delusion or argue with the client Establish and maintain reality for the client Use distracting techniques Teach the client positive self-talk, positive thinking and to ignore delusional beliefs

Client/Family Education for Medication Management: Antipsychotics

Drink sugar-free fluids and eat sugar-free hard candy to ease the anticholinergic effects of dry mouth Avoid calorie-laden beverages and candy because they promote dental caries, contribute to weigh gain, and do little to relieve dry mouth Constipation can be prevented or relieved by increasing intake of water and bulk-forming foods in the diet and by exercising Stool softeners are permissible, but laxatives should be avoided Use sunscreen to prevent burning. Avoid long periods of time in the sun, and wear protective clothing. Photosensitivity can cause you to burn easily. Rising slowly from a lying or sitting position prevents falls from orthostatic hypotension or dizziness due to a drop in blood pressure. Wait until any dizziness has subsided before you walk. Monitor the amount of sleepiness or drowsiness you experience. Avoid driving a car or performing other potentially dangerous activities until your response time and reflexes seem normal. If you forget a dose of antipsychotic medication, take it if the dose is only 3 to 4 hours late. If the missed dose is more than 4 hours late or the next dose is due, omit the forgotten dose. If you have difficulty remembering your medication, use a chart to record doses when taken, or use a pillbox labeled with dosage times and/or days of the week to help you remember when to take medication.

Dermatologic symptoms related to weight loss

Dry, cracking skin due to dehydration, languo, edema, and acrocyanosis

Nursing interventions for helping clients solve problems and control emotions

Effective problem-solving skills Decreased impulsivity Expressing negative emotions such as anger or frustration Taking a time-out from stressful situations

Metabolic symptoms related to purging (vomiting and laxative abuse)

Electrolyte abnormalities, particularly hypokalemia, hypochloremic alkalosis, hypomagnesemia, and elevated BUN

A child is taking pemoline (Cylert) for ADHD. The nurse must be aware of which of the following side effects?

Elevated liver function tests

Mood dysregulation Symptoms

Emotional lability Atypical depression/dysphoria Emotional detachment

Elimination Disorder

Encopresis Enuresis

Nursing interventions for Weight gain

Encourage balanced diet with controlled portions and regular exercise; focus on minimizing gain

Nursing interventions for obsessive-compulsive personality disorder

Encourage negotiation with others; assist client to make timely decisions and complete work, cognitive restructuring techniques

When planning care for a client with somatization disorder, the nurse would include the following interventions:

Encouraging the client to participate in daily routine activities Help the client see the relationship between physical symptoms and life stress/events Validate the client's physical and emotional distress

Perimyolysis

Erosion to dental enamel

Binge eating disorder

Essential features are recurrent episodes of binge eating; no regular use of inappropriate compensatory behaviors, such as purging or excessive exercise or abuse of laxatives; guilt, shame, and disgust about eating behaviors; and marked psychologic distress. Frequently affects people over age 35 and it occurs often in men. Individuals are more likely to be overweight or obese, overweight as children, and teased about their weight at an early age. 35% reported that it proceeded dieting; 65% reported dieting before.

Client/Family Education for Somatoform disorders

Establish daily health routine, including adequate rest, exercise and nutrition Teach about relationship of stress and physical symptoms and mind-body relationship Educate about proper nutrition, rest, and exercise Educate client in relaxation techniques, progressive relaxation, deep breathing, guided imagery, and distraction such as music or other activities Educate client by role-playing social situations and interactions Encourage family to provide attention and encouragement when client has fewer complaints Encourage family to decrease special attention when client is in "sick" role

Nursing interventions for eating disorders

Establishing nutritional eating patterns Helping the client identify emotions and develop non-food-related coping strategies Helping the client deal with body image issues Providing client and family education

Symptoms of Histrionic personality disorder

Excessive emotionality and attention seeking

Polydipsia

Excessive water intake

The nurse working with a client with antisocial personality disorder would expect which of the following behaviors?

Exploitation of other clients Seeking special privileges Superficial friendliness toward others

Communication disorders

Expressive language disorder Mixed receptive and expressive language disorder Phonologic disorder Stuttering

Complex motor tics

Facial gestures, jumping, or touching or smelling an object

Hallucinations

False sensory perceptions or perceptual experiences that do not really exist

Family risk factors for anorexia nervosa

Family lacks emotional support; parental maltreatment; cannot deal with conflict

Symptoms of Anorexia Nervosa

Fear of gaining weight or becoming fat even when severely underweight Body image disturbance Amenorrhea Depressive symptoms such as depressed mood, social withdrawal, irritability, and insomnia Preoccupation with thoughts of food Feelings of ineffectiveness Inflexible thinking Strong need to control environment Limited spontaneity and overly restrained emotional expression Complaints of constipation and abdominal pain Cold intolerance Lethargy Emaciation Hypotension, hypothermia, and bradycardia Hypertrophy of salivary glands Elevated BUN Electrolyte imbalances Leukopenia and mild anemia Elevated liver function studies

Persecutory

Feeling victimized or spied on

Depersonalization

Feelings of being disconnected from himself or herself; the client feels detached from his/her behavior

Apathy

Feelings of indifference toward people, activities, and events

Hyperactive/Impulsive Behaviors of Attention-deficit hyperactivity disorder

Fidgets Often leaves seat Runs or climbs excessively Can't play quietly Is always on the go; driven Talks excessively Blurts out answers Interrupts Can't wait for turn Is intrusive with siblings/playmates

Math disorder may go undetected until the child reaches

Fifth grade

Referential delusions

Ideas of reference involve the client's belief that television broadcasts, music, or newspaper articles have special meaning him/her

Word Salad

Flow of unconnected words that convey no meaning to the listener

Treating clients with anorexia nervosa with a selective serotonin reuptake inhibitor antidepressant such as fluoxetine (Prozac) may present which of the following problems?

Fluoxetine can cause appetite suppression and weight loss

Shared psychotic disorder

Folie a deux. Two people share a similar delusion. The person with this diagnosis develops this delusion in the context of a close relationship with someone who has psychotic delusions

Mild Dementia

Forgetfulness is the hallmark of beginning. It exceeds the normal, occasional forgetfulness experienced as part of the aging process. The person has difficulty finding words, frequently loses objects, and begins to experience anxiety about these losses. Occupational and social settings are less enjoyable and the person may avoid them. Most people remain in the community during this stage.

Symptoms of Deterioration of language function

Forgetting names of common objects such as chair or table, palilalia or echoing sounds, and echoing words that are heard or echolallia

Articulation

Forming sounds that are part of speech

Nursing interventions of dependent personality disorder

Foster client's self-reliance and autonomy; teach problem-solving and decision-making skills; cognitive restructuring techiques

Associative looseness

Fragmented or poorly related thoughts and ideas

Clang associations

Ideas that are related to one another based on sound or rhyming rather than meaning.

Nursing interventions for enhancing role performance

Identifying barriers to role fulfillment Decreasing or eliminating use of drugs and alcohol

A teaching plan for the parents of a child with ADHD should include:

Give instructions in short simple steps Keep track of positive comments the child is given Provide a reward system for completion of daily tasks

Teaching for methylphenidate (Ritalin) should include which of the following?

Give the medication after meals

Symptoms of Narcissistic personality disorder

Grandiose, lack of empathy, need for admiration

A client with delirium is attempting to remove the intravenous tubing from his arm, saying to the nurse, "Get off me! Go away!" The client is experiencing which of the following?

Hallucinations

Anhedonia

Having no pleasure or joy in life; losing any sense of pleasure from activities formerly enjoyed

Nursing interventions for Somatoform disorders

Health teaching Establish a daily routine Promote adequate nutrition and sleep Expression of emotional feelings Recognize relationship between stress/coping and physical symptoms Keep a journal Limit time spent on physical complaints Limit primary and secondary gains Emotion-focused coping strategies such as relaxation techniques, deep breathing, guided imagery, and distraction Problem-focused coping strategies such as problem-solving strategies and role-playing

Nursing interventions for passive-aggressive personality disorder

Help client to identify feelings and express them directly; assist client to examine own feelings and behavior realistically

Interventions for hallucinations with schizophrenic patients

Help present and maintain reality by frequent contact and communication with client Elicit description of hallucination to protect client and others. The nurse's understanding of the hallucination helps him/her know how to calm or reassure the client Engage the client in reality-based activities such as card playing, occupational therapy, or listening to music

Emotion-focused coping strategies are designed to accomplish which of the following outcomes?

Helping the client manage the intensity of symptoms

Causes of mental retardation

Hereditary conditions such as Tay-Sachs disease or fragile X syndrome Early alterations in embryonic development such as trisomy 21 or maternal alcohol intake that cause fetal alcohol syndrome Pregnancy or perinatal problems such as fetal malnutrition, hypoxia, infections, and trauma Medical conditions of infancy such as infection or lead poisoning Environmental influences such as deprivation of nurturing or stimulation

Ambivalence

Holding, seemingly contradictory beliefs or feelings about the same person, event, or situation

Body image

How a person perceives his/her body, that is, a mental self-image

Client/Family Education for Schizophrenic clients

How to manage illness and symptoms Recognizing early symptoms of relapse Developing a plan to address relapse signs Importance of maintenance prescribed medication regimen and regular follow-up Avoiding alcohol and other drugs Self-care and proper nutrition Teaching social skills through education, role modeling and practice Seeking assistance to avoid or manage stressful situations Counseling and educating family/significant others about the biologic causes and clinical course of schizophrenia and the need for ongoing support Importance of maintenance contact with community and participating in supportive organizations and care

Metabolic symptoms related to weight loss

Hypothyroidism, symptoms include lack of energy, weakness, intolerance to cold, and bradycardia, hypoglycemia, and decreased insulin sensitivity

Physiologic or metabolic causes of delirum

Hypoxemia, electrolyte disturbances, renal or hepatic failure, hypoglycemia or hyperglycemia, dehydration, sleep deprivation, thyroid or glucocorticoid disturbances, thiamine or vitamin B12 deficiency, vitamin C, niacin, or protein deficiency, cardiovascular shock, brain tumor, head injury, and exposure to gasoline, paint solvents, insecticides, and related substances

Early signs of schizophrenia relapse

Impaired cause-and effect reasoning Impaired information processing Poor nutrition Lack of sleep Lack of exercise Fatigue Poor social skills, social isolation, loneliness Interpersonal difficulties Lack of control, irritability Mood swings Ineffective medication management Low self-concept Looks and acts different Hopeless feelings Loss of motivation Anxiety and worry Disinhibition Increased negativity Neglecting appearance Forgetfulness

Developmental coordination disorder

Impaired coordination severe enough to interfere with academic achievement or activities of daily living. Becomes evident as a child attempts to crawl or walk or as an older child tries to dress independently or manipulate toys such as building blocks. Often coexists with communication disorder.

When working with a client with a personality disorder, the nurse would expect to assess the following:

Impaired interpersonal relationships Inability to empathize with others Minimal insight

Thought processes in dementia

Impaired thinking, eventual loss of thinking abilities

Level of consciousness in delirium

Impaired, fluctuates

Nursing interventions for schizoid personality disorder

Improve client's functioning in the community; assist client to find case manager

Grandiosity

In fantasy or behavior

Reading and written expression disorders are usually identified

In the first grade

Autism spectrum disorders

Includes autistic disorder, Rett's disorder, childhood disintegrative disorder, and Asperger's disorder

Cluster C of personality disorders

Includes people who appear anxious and or fearful and includes avoidant, dependent, and obsessive-compulsive personality disorders

Cluster B of personality disorders

Includes people who appear dramatic, emotional, or erractic and includes antisocial, borderline, histrionic, and narcissistic personality disorders

Cluster A of personality disorders

Includes people whose behavior appears odd or eccentric and includes paranoid, schizoid, and schizotypal personality disorders

Dhat

Indian culture. Hypochondriacal concern about semen loss

The nurse is caring for a client with a conversion disorder. Which of the following assessments will the nurse expect to see?

Indifference about the physical symptoms

The nurse recognizes which of the following as a common behavioral sign of autism?

Indifference to being hugged or held

Limit setting involves three steps:

Inform clients of the rule or limit Explain the consequences if clients exceed the limit State expected behavior

Symptoms of Loss of Memory

Initial stages, recent memory loss such as forgetting food cooking on the stove Later stages, remote memory loss such as forgetting names of children, occupation

Akathisia

Intense need to move about; characterized by restless movement, pacing, inability to remain still, and the client's report of inner restlessness

Gustatory hallucinations

Involve a taste lingering in the mouth or the sense that food tastes like something else. The taste may be metallic or bitter or may be represented as a specific taste.

Visual hallucinatoins

Involve seeing images that do not exist at all, such as lights or a dead person, or distortions such as seeing a frightening monster instead of the nurse. They are the second most common type of hallucinations.

Olfactory hallucinations

Involve smells or odors. They may be a specific sent such as urine or feces or a more general scent such as rotten or rancid odor. This type of hallucination often occurs with dementia, seizures, or cerebrovascular accidents

Cenesthetic hallucinations

Involve the client's report that he/she feels bodily functions that are usually undetectable

Persecutory/paranoid delusions

Involve the clients belief that "others" are planning to harm the client or are spying, following, ridiculing, or belittling the client in some way. Sometimes the client cannot define who these "others" are.

Reactive attachment disorder

Involves a markedly disturbed and developmentally inappropriate social relatedness in most situations. Usually begins before 5 years of age and is associated with grossly pathologenic care such as parental neglect, abuse, or failure to meet the child's basic physical or emotional needs.

Mixed receptive-expressive language disorder

Involves an impaired ability to communicate through verbal and sign languages along with difficulty understanding an determining the meaning of words and sentences. May be acquired as a result of neurologic injury or insult to the brain.

Expressive language disorder

Involves an impaired ability to communicate through verbal and sign languages. Child has difficulty learning new words and speaking in complete and correct sentences; his/her speech is limited

Phonologic disorder

Involves problems with articulation

Developmental risk factors for anorexia nervosa

Issues of developing autonomy and having control over self and environment; developing a unique identity; dissatisfaction with body image

Hiva-byung

Korean culture. Suppressed anger causes insomnia, fatigue, panic, indigestion, and generalized aches and pains

The client who hesitates 30 seconds before responding to any question is described as having

Latency of response

Symptoms of Dementia

Loss of memory Deterioration of language function Loss of ability to think abstractly and to plan, initiate, sequence, monitor, or stop complex behaviors; the client loses the ability to perform self-care activities

Musculoskeletal symptoms related to weight loss

Loss of muscle mass, loss of fat, osteoporosis, and pathologic fractures

Drug of choice for Chronic and low-level psychotic-like symptoms

Low-dose antipsychotics

Drug of choice for Severe anxiety

MAOIs Low-dose antipsychotics

Drug of choice for Chronic somatic anxiety

MAOIs SSRIs

Drug of choice for Atypical depression/dysphoria

MAOIs SSRIs Antipsychotics

Waxy Flexibility

Maintenance of posture or position over time even when it is awkward or uncomfortable

Nursing interventions of narcissistic personality disorder

Matter-of-fact approach; gain cooperation with needed treatment; teach client any needed self-care skills

Speech in delirium

May be slurred, rambling, pressured, irrelevant

Paranoia

May extend to feelings of being singled out for menial tasks, treated as stupid, or more closely monitored than other employees

The nurse is talking with a woman who is worried that her mother has Alzheimer's disease. The nurse knows that the first sign of dementia is

Memory loss that is more than ordinary forgetfulness

Cerebral Infection causes of delirium

Meningitis, encephalitis, HIV, syphillis

Psyche

Mind

Inattentive behaviors of Attention-deficit hyperactivity Disorder

Misses details Makes careless mistakes Has difficulty sustaining attention Doesn't seem to listen Does not follow though on chores or homework Has difficulty with organization Avoids tasks requiring mental effort Often loses necessary things Is easily distracted by other stimuli Is often forgetful in daily activities

Symptoms of Paranoid personality disorder

Mistrust and suspicions of others; guarded, restricted affect

Nursing considerations for Sertraline (Zoloft)

Monitor for nausea, loss of appetite, diarrhea, headache, insomnia, sexual dysfunction; avoid alcohol

Nursing considerations for Paroxetine (Paxil)

Monitor for nausea, loss of appetite, dizziness, dry mouth, somnolence or insomnia, sweating, sexual dysfunction; avoid alcohol

Nursing considerations for Fluoxetine (Prozac)

Monitor for rash, hives, insomnia, headache, anxiety, drowsiness, nausea, loss of appetite, avoid alcohol

Dysphoric

Mood that involves unhappiness, restlessness, and malaise

The nurse would expect to see all of the following symptoms in a child with ADHD except

Moody, sullen, and pouty behavior

Time-out

Retreat to a neutral place to give the opportunity to regain self-control

When teaching a client about memantine (Namenda) the nurse will include:

Namenda can cause elevated blood pressure

Paroxetine (Paxil) has been prescribed for a client with a somatoform disorder. The nurse instructs the client to watch for which of the following side effects?

Nausea

Gastrointestinal symptoms of somatization disorder

Nausea; bloating; vomiting other than during pregnancy; diarrhea or intolerance of several foods

Nursing interventions for promoting client's safety

No self-harm contract Safe expression of feelings and emotions

Speech in dementia

Normal in early stage; progressive aphasia in later stage

Level of consciousness in dementia

Not affected

Example of Echolalia

Nurse: "Can you tell me how you're feeling?" Client: "Can you tell me how you're feeling, how you're feeling?"

Example of perservation

Nurse: "How have you been sleeping lately?" Client: "I think people have been following me." Nurse: "Where do you live?" Client: "At my place people have been following me." Nurse: "What do you like to do in your free time?" Client: "Nothing because people are following me."

Biologic risk factors for anorexia nervosa

Obesity, dieting at an early age

Biologic Risk factors for bulimia nervosa

Obesity; early dieting; possible serotonin and norepinephrine disturbances; chromosome 1 susceptibility

Kinesthetic hallucinations

Occur when the client is motionless but reports the sensation of bodily movement. The bodily movement is something unusual, such as floating above the ground.

Body image disturbance

Occurs when there is an extreme discrepancy between one's body image and the perceptions of others and extreme dissatisfaction with one's body image.

Perception in dementia

Often absent, but can have paranoia, hallucinations, or illusions

Religious Delusions

Often center around the second coming of Christ or another significant religious figure or prophet. These religious delusions appear suddenly as part of the client's psychosis and are not part of his or her religious faith or that of others.

Fantasy relationship

Often includes someone the client has met only briefly.

Psychomotor retardation

Overall slowed movements; a general slowing of all movements; slow cognitive processing and a slow verbal interaction

Symptoms of Depressive personality disorder

Pattern of depressive cognitions and behaviors in a variety of contexts

Symptoms of Passive-aggressive personality disorder

Pattern of negative attitudes and passive resistance to demands for adequate performance in social and occupational situations

Perservation

Persistent adherence to a single idea or topic; verbal repetition of a sentence, word, or phrase, resisting attempts to change the topic

Extrapyramidal Side Effects

Reversible movement disorders induced by antipsychotic or neuroleptic medication

Severe Dementia

Personality and emotional changes occur. The person may be delusional, wander at night, forget the names of his/her spouse and children, and require assistance in activities of daily living. Most people live in nursing facilities when they reach this stage unless extraordinary community support is available

Borderline personality Disorder

Pervasive and enduring pattern of unstable interpersonal relationships, self-image, and affect; marked impulsivity; frequent self-mutilation behavior

Feeding and Eating Disorders

Pica Rumination Disorder Feeding disorder of infancy or early childhood

Nursing interventions for confrontation

Point out problem behavior Keep client focused on self

Symptoms of obsessive-compulsive personality disorder

Preoccupation with orderliness, perfectionism, and control

A client who developed numbness in the right hand could not play the piano at a scheduled recital. The consequence of the symptom, not having to perform, is best described as

Primary gain

Duration of Dementia

Progressive deterioration

Nursing interventions of borderline personality disorder

Promote safety; help client to cope and control emotions; cognitive restructuring techniques; structure time; teach social skills; teaching effective communication skills; entering therapeutic relationship

Nursing interventions for clients with schizophrenia

Promoting safety of client and others and right to privacy and dignity Establishing therapeutic relationship by establishing trust Using therapeutic communication, clarifying feelings and statements when speech and thoughts are disorganized or confused Client and family teaching Establishing community support systems and care

Family and friends Education for Eating Disorders

Provide emotional support Express concern about client's health Encourage client to seek professional help Avoid talking only about weight, food intake, and calories Become informed about eating disorders It is not possible for family and friends to force the client to eat. The client needs professional help from a therapist or psychiatrist.

Catatonia

Psychomotor disturbance, either motionless or excessive motor

Qi-gong

Psychotic reaction is an acute, time-limited episode characterized by dissociative, paranoid, or other psychotic symptoms that occur after participating in the Chinese folk health-enhancing practice of qi-gong. Especially vulnerable are those who become overly involved in the practice.

Onset of delirium

Rapid

Cogwheeling rigidity

Ratchet-like movements of joints

Drug-related causes of delirium

Reactions to anesthesia, prescription medications, or illicit drugs

Learning Disorders

Reading disorder Mathematics disorder Disorder of written expression

Nursing interventions for Helping the client deal with body image issues

Recognize benefits of a more near-normal weight. Assist to view self in ways not related to body image Identify personal strengths, interests, and talents

The overall goal of psychiatric rehabilitation is for the client to gain

Recovery from the illness

Symptoms of Bulimia nervosa

Recurrent episodes of binge eating Compensatory behavior such as self-induced vomiting, misuse of laxatives, diuretics, enema, or other medications, or excessive exercise Self-evaluation overly influenced by body shape and weight Usually within normal weight range, possibly underweight or overweight Restriction of total calorie consumption between binges, selecting low-calorie foods while avoiding foods perceived to be fattening or likely to trigger a binge Depressive and anxiety symptoms Possible substance use involving alcohol or stimulants Loss of dental enamel Chipped, ragged, or moth-eaten appearance of teeth Increased dental caries Menstrual irregularities Dependence on laxatives Esophageal tears Fluid and electrolyte abnormalities Metabolic alkalosis from vomiting Metabolic acidosis from diarrhea Mildly elevated serum amylase levels

Interventions for coping with socially inappropriate behaviors with schizophrenic patients

Redirect client away from problem situations Deal with inappropriate behaviors in a nonjudgmental and matter-of-fact manner, give factual statements; do not scold Reassure others that the client's inappropriate behaviors or comments are not his/her fault, without violating client confidentiality Try to reintegrate the client into the treatment milieu as soon as possible Do not make the client feel punished or shunned for inappropriate behaviors Teach social skills through education, role modeling, and practice

Treatment of autistic disorder

Reduce behavioral symptoms Promote learning and development, particularly the acquisition of language skills

Tactile hallucinations

Refer to sensations such as electricity running through the body or bugs crawling on the skin. Found most often in clients undergoing alcohol withdrawal; they rarely occur in clients with schizophrenia

Locura

Refers to a chronic psychosis experienced by Latinos in the United States and Latin America. Symptoms include incoherence, agitation, visual and auditory hallucinations, inability to follow social rules, unpredictability, and possibly, violent behavior

Latency of response

Refers to hesitation before the client responds to questions

Temperament

Refers to the biologic processes of sensation, association and motivation that underlie the integration of skills and habits based on emotion

Cooperativeness

Refers to the extent to which a person sees himself or herself as an integral part of human society. Highly cooperative people are described as empathetic, tolerant, compassionate, supportive, and principled. Are self-absorbed, intolerant, critical, unhelpful, revengeful, and opportunistic; they look out for themselves without regard for the rights and feelings of others

Cognitive restructuring techniques include all of the following except

Relaxation

The nurse is planing discharge teaching for a client taking Clozapine (Clozaril). Which of the following is essential to include?

Remind the client to go to the lab to have blood drawn for a white blood cell count

Complex vocal tics

Repeating words and phrases out of context, corprolalia, palilallia, and echolalia.

Echolalia

Repetition or imitation of what someone else says; echoing what is heard

Drug of choice for Emotional detachment

SSRIs Atypical antipsychotics

Drug of choice for Chronic cognitive anxiety

SSRIs MAOIs Benzodiazepines

Gastrointestinal symptoms related to purging (vomiting and laxative abuse)

Salivary gland and pancreas inflammation and enlargement with an increase in serum amylase, esophageal and gastric erosion or rupture, dysfunctional bowel, and superior mesenteric artery syndrome

Neuropsychiatric symptoms related to purging (vomiting and laxative abuse)

Seizures related to large fluid shifts and electrolyte disturbances, mild neuropathies, fatigue, weakness, and mild organic mental symptoms

Which of the following is an example of a cognitive-behavioral technique?

Self-monitoring

Developmental risk factors for bulimia nervosa

Self-perceptions of being overweight, fat, unattractive, and undesirable; dissatisfaction with body image

Examples of Cenesthetic hallucinations

Sensation of urine forming or impulses being transmitted through the brain

Systemic Infection causes of delirium

Sepsis, urinary tract infection, pneumonia

When working with a client with a paranoid personality disorder, the nurse would use which of the following approaches?

Serious

Nursing interventions for paranoid personality disorder

Serious, straightforward approach; teach client to validate ideas before taking action; involve client in treatment planning

Sexual symptoms of somatization disorder

Sexual indifference, erectile or ejaculatory dysfunction, irregular menses, excessive menstrual bleeding, vomiting throughout pregnancy

Memory in dementia

Short- then long-term memory impaired, eventually destroyed

Memory in delirium

Short-term memory impaired

Blunted Affect

Showing little or a slow-to-respond facial expression; few observable facial expressions

Flat Affect

Showing no facial expression

Nursing interventions for establishing nutritional eating patterns

Sit with the client during meals and snacks Offer liquid protein supplement if client is unable to complete meal Adhere to treatment program guidelines regarding restrictions Observe client following meals and snacks for 1 to 2 hours Weigh client daily in uniform clothing Be alert for attempts to hide or discard food or inflate weight

Sangue dormido

Sleeping blood. Portuguese Cape Verde Islands. Pain, numbness, tremors, paralysis, seizures, blindness, heart attack, miscarriage

Akinesia

Slowness and difficulty initiating movement

Symptoms of Avoidant personality disorder

Social inhibitions, feelings of inadequacy; hypersensitive to negative evaluation

Koro

Southeast Asia culture. Belief that penis is shrinking and will disappear in abdomen resulting in death

Falling-out episodes

Southern United States, Caribbean Islands. Sudden collapse; person cannot see or move

Oculogyric crisis

Spasms in the eye muscles

Torticollis

Spasms in the neck muscles

Self-directedness

The extent to which a person is responsible, reliable, resourceful, goal oriented, and self-confident. Are realistic and effective and can adapt their behavior to achieve goals. Are blaming, helpless, irresponsible, and unreliable. They cannot set and pursue meaningful goals.

Nursing interventions for limit setting

State the limit Identify consequences of exceeding the limit Identify expected or acceptable behavior

Verbigeration

Stereotyped repetition of words or phrases that may or may not have meaning to the listener

Nursing interventions for Neuroleptic malignant syndrome

Stop all antipsychotic medication; notify physician immediately

Nursing interventions for Seizures

Stop medication; notify physician; protect client from injury during seizure, provide reassurance and privacy for client after seizure

Thought Blocking

Stopping abruptly in the middle of a sentence or a train of thought; sometimes client is unable to continue the idea

Symptoms of Dependent personality disorder

Submissive and clinging behavior; excessive need to be taken care of

Tic Disorders

Tourette's disorder Chronic motor or tic isorder Transient tic disorder

The nurse is working with a client with anorexia nervosa. Even though the client has been eating all her meals and snacks, her weight has remained unchanged for 1 week. Which of the following interventions is indicated?

Supervise the client closely for 2 hours after meals and snacks

Nursing interventions of avoidant personality disorder

Support and reassurance; cognitive restructuring techniques; promote self-esteem

Nursing interventions of histrionic personality disorder

Teach social skills; provide factual feedback about behavior

Clients with a histrionic personality disorder are most likely to benefit from which of the following nursing interventions?

Teaching social skills

Client/Family Education for Borderline personality disorder

Teaching social skills Maintaining personal boundaries Realistic expectations of relationships Teaching time structuring Making a written schedule of activities Making a list of solitary activities of combat boredom Teaching self-management through cognitive restructuring Decatastrophizing situation Thought stopping Positive self-talk Using assertiveness techniques such as "I" statements Using distraction, such as walking or listening to music

Confrontation

Technique designed to highlight the incongruence between a person's verbalizations and actual behavior; used to manage manipulative or deceptive behavior

Thought processes in delirium

Temporarily disorganized

Schizophreniform disorder

The client exhibits the symptoms of schizophrenia but for less than the 6 months necessary to meet the diagnostic criteria for schizophrenia. Social or occupational functioning may or may not be impaired

Brief psychotic disorder

The client experiences the sudden onset of at least one psychotic symptom, such as delusions, hallucinations, or disorganized speech or behavior, which lasts from 1 day to 1 month. The episode may or may not have an identifiable stressor or may follow childbirth

Delusional disorder

The client has one or more nonbizzare delusions, the focus of the delusion is believable. Psychosocial functioning is not markedly impaired, and behavior is not obviously odd or bizarre.

The nurse is evaluating the progress of a client with bulimia. Which of the following behaviors would indicate that the client is making positive progress?

The client identifies healthy ways of coping with anxiety

Example of Grandiose delusions

The client may claim to be engaged to a famous movie star or related to some public figure, such as claiming to be the daughter of the president of the United States, or he or she may claim to have found a cure for cnacer

Examples of Referential delusions

The client may report that the president was speaking directly to him on a news broadcast or that special messages are sent through newspaper articles

Examples of Persecutory/paranoid delusions

The client may think that food has been poisoned or that rooms are bugged with listening devices. Sometimes the "persecutor" is the government, FBI, or other powerful organization. Occasionally, specific individuals, even family members, may be named as the "persecutor"

Auditory hallucinations

The most common type of hallucination, involve hearing sounds, most often voices, talking to or about the client. There may be one or multiple voices; a familiar or unfamiliar person's voice may be speaking

Moderate Conduct Disorder

The number of conduct problems increases as does the amount of harm to others. Examples include vandalism and theft

Severe Conduct Disorder

The person has many conduct problems that cause considerable harm to others. Examples include forced sex, cruelty to animals, use of weapon, burglary and robbery

Mild Conduct Disoder

The person has some conduct problems that cause relatively minor harm to others. Examples include lying ,truancy, and staying out late without permission

Rumination disorder

The repeated regurgitation and rechewing of food. The child brings up partially digested food up into the mouth and usually rechews and reswallows the food. Does not involve nausea, vomiting, or any medical condition. Is relatively uncommon and occurs more often in boys. It results in malnutrition, weight loss, and death in about 25% of affected infants.

Which of the following is true about clients with hypochondriasis?

They may interpret normal body sensations as signs of disease

Nursing interventions for cognitive restructuring techniques

Thought stopping Decatastrophizing

Abnormal Involuntary Movement Scale (AIMS)

Tool used to screen for symptoms of movement disorders or side effects of neuroleptic medications

A teenaged girl is being evaluated for an eating disorder. Which of the following would suggest anorexia nervosa?

Unrealistic perception of body size

Symptoms of Borderline personality disorder

Unstable and intense relationships, unstable self-image, and affect, impulsivity and recklessness, and recurrent self-mutilative behavior or suicidal threats or gestures; fear of abandonment, real or perceived; chronic feelings of emptiness and boredom; labile mood; irritability; polarized thinking about self and others, splitting; impaired judgment; lack of insight; transient psychotic symptoms such as hallucinations demanding self-harm

Nursing interventions for Dry mouth

Use ice chips or hard candy for relief

Coprolalia

Use of socially unacceptable words, frequently obscene

Stilted language

Use of words or phrases that are flowery, excessive, and pompous

Perception in delirium

Visual or tactile hallucinations, delusions

Command hallucinations

Voices are demanding that the client take action, often to harm self or others, and are considered dangerous

Neologisms

Words invented by the client

Creutzfeldt-Jakob disease

a central nervous system disorder that typically develops in adults 40 to 60 years of age and involves altered vision, loss of coordination or abnormal movements, and dementia

Self-monitoring

a cognitive-behavioral technique designed to help clients manage their own behavior

Pick's disease

a degenerative brain disease that particularly affects the frontal and temporal lobes and results in a clinical picture similar to that of Alzheimer's disease

Munchausen syndrome

a factitious disorder where the person intentionally causes injury or physical symptoms to self to gain attention and sympathy from health care providers, families, and others

Autistic disorder

a pervasive developmental disorder characterized by impairment of growth and development milestones, such as impaired communication with others, lack of social relationships even with parents, and stereotyped motor behaviors

Alzheimer's disease

a progressive brain disorder that has a gradual onset but causes an increasing decline in functioning, including loss of speech, loss of motor function, and profound personality and behavioral changes, such as those involving paranoia, delusions, hallucinations, inattention to hygiene, and belligerence

La belle indifference

a seeming lack of concern or distress; a key feature of conversion disorder

Parkinson's disease

a slowly progressive neurologic condition characterized by tremors, rigidity, bradykinesia, and postural instability

Delirium

a syndrome that involves disturbance of consciousness accompanied by a change in cognition

Bulimia nervosa

an eating disorder characterized by recurrent episodes, at least twice a week for 3 months, of binge eating followed by inappropriate compensatory behaviors to avoid weight gain such as purging, fasting, or excessively exercising

Huntington's disease

an inherited, dominant gene disease that primarily involves cerebral atrophy, demyelination, and enlargement of the brain ventricles

Flight of ideas

continuous flow of verbalization in which the person jumps rapidly from one topic to another

Somatoform Disorder

characterized as the presence of physical symptoms that suggest a medical condition without a demonstrate organic basis to fully account for them.

Amnestic disorder

characterized by a disturbance in memory that results directly from the physiologic effects of a general medical condition or from the persisting effects of a substance such as alcohol or other drugs

Attention deficit hyperactivity disorder (ADHD)

characterized by inattentiveness, overactivity, and impulsiveness

Somatization disorder

characterized by multiple, recurrent physical symptoms in a variety of bodily systems that have no organic or medical basis

Conduct disorder

characterized by persistent antisocial behavior in children and adolescents that significantly impairs their ability to function in social, academic, or occupational areas

Pervasive developmental disorders

characterized by pervasive and usually severe impairment of reciprocal social interaction skills, communication deviance, and restricted, stereotypical behavioral patterns

Factitious disorder

characterized by physical symptoms that are feigned or inflicted for the sole purpose of drawing attention to oneself and gaining the emotional benefits of assuming the sick role

Confabulation

clients may make up answers to fill in memory gaps; usually associated with organic brain problems

Reframing

cognitive-behavioral technique in which alternative points of view are examined to explain events

Purging

compensatory behaviors designed to eliminate food by means of self-induced vomiting or use of laxatives, diuretics, enemas, or emetics

Pain disorder

composed of discrete episodes of panic attacks, that is, 15 to 30 minutes of rapid, intense, escalating anxiety in which the person experiences great emotional fear as well as physiologic discomfort

Aphasia

deterioration of language function

Nursing interventions of schizotypal personality disorder

develop self-care skills; improve community functioning; social skills training

Vascular dementia

has symptoms similar to those of Alzheimer's disease, but onset is typically abrupt and followed by rapid changes in functioning, a plateau of leveling-off period, more abrupt changes, another leveling-off period, and so on

Agnosia

inability to recognize or name objects despite intact sensory abilities

Time away

involves leaving clients for a short period and then returning to them to reengage in interaction; used in dementia care

Tourette's disorder

involves multiple motor tics and one or more vocal tics, which occur many times a day for more than 1 year

Distraction

involves shifting the client's attention and energy to a different topic

Internalization

keeping stress, anxiety, or frustration inside rather than expressing them outwardly

Enmeshment

lack of clear role boundaries between persons

Pica

persistent ingestion of nonnutritive substances, such as paint, hair, cloth, leaves, sand, clay or soil

Therapeutic play

play techniques are used to understand the child's thoughts and feelings and to promote communication

Body dysmorphic disorder

preoccupation with an imagined or exaggerated defect in physical appearance

Disease conviction

preoccupation with the fear that one has a serious disease

Hypochondriasis

preoccupation with the fear that one has a serious disease or will get a serious disease

Disease phobia

preoccupation with the fear that one will get a serious disease

Hysteria

refers to multiple, recurrent, physical complaints with no organic basis

Palilalia

repeating words or sounds over and over

Stereotypic movements

repetitive, seemingly purposeless movements; may include waving, rocking, twirling objects, biting fingernails, banging the head, biting or hitting oneself, or picking at the skin or body orifices

Conversion disorder

sometimes called conversion reaction; involves unexplained, usually sudden deficits in sensory or motor function related to an emotional conflict the client experiences but does not handle directly

Going along

technique used with clients with dementia; providing emotional reassurance to clients without correcting their misperceptions or delusions

Emotion-focused coping strategies

techniques used to assist clients to relax and reduce feelings of stress

Problem-focused coping strategies

techniques used to resolve or change a person's behavior or situation or to manage life stressors

Executive Functioning

the ability to think abstractly and to plan, initiate, sequence, monitor, and stop complex behavior

Malingering

the intentional production of false or grossly exaggerated physical or psychological symptoms

Secondary gain

the internal or personal benefits received from others because one is sick, such as attention from family members, comfort measures, and being excused from usual responsibilities and tasks

Primary gain

the relief of anxiety achieved by performing the specific anxiety-driven behavior; the direct external benefits that being sick provides, such as a relief of anxiety, conflict, or distress

Encopresis

the repeated passage of feces into inappropriate places, such as clothing or the floor, by a child who is at least 4 years of age either chronologically or developmentally

Enuresis

the repeated voiding of urine during the day or at night into clothing or bed by a child at least 5 years of age either chronologically or developmentally

Somatization

the transference of mental experiences and states into bodily symptoms

Supportive touch

the use of physical touch to convey support, interest, and caring; may not be welcome or effective with all clients

Reminiscence therapy

thinking about or relating personally significant past experiences in a purposeful manner to benefit the client

Korsakoff's syndrome

type of dementia caused by long-term excessive alcohol intake that results in a chronic thiamine or vitamin B deficiency

Psychosomatic

used to convey the connection between the mind, psyche, and the body, soma, in states of health and illness

Munchausen syndrome by proxy

when a person inflicts illness or injury on someone else to gain the attention of emergency medical personnel or to be a hero for "saving" the victim