Mental Health Final Exam

Rationalization (defense mechanism)

- Attempting to make excuses or formulate logical reasons to justifying unacceptable feelings or behaviors. EX: John tells the rehab nurse, "I drink because its the only way I can deal with my bad marriage and awful job."

Body dysmorphic disorder - assessment

- Characterized by the exaggerated belief that the body is deformed or defective in some specific way - If true defect is present, the person's concern is unrealistically exaggerated and grossly excessive.

Psychopharmacological intervention of ASD - common side effects of risperidone

- Drowsiness - Increased appetite - Fatigue - Constipation - Dizziness - Weight gain - Breast enlargement - When administering risperidone, caution must be maintained concerning less common but more serious possible side effects, including neuroleptic malignant syndrome, tardive dyskinesia, hyperglycemia, and diabetes.

FOr client with binge eating disorder

- Help identify positive attributes. - Refer client to a support or therapy group.

Energizer

Encourages and motivates group to perform at its maximum potential

Initiator

Outlines the task at hand for the group and proposes methods for solution

Types of groups - teaching groups

The focus is to convey knowledge and information to a number of individuals

negative symptoms - apathy

disinterest in the environment

Nursing diagnosis for bipolar disorder - risk for violence: self-directed or other-directed related to?

- manic excitement - delusional thinking - hallucinations - impulsivity

delerium - autonomic manifestations

- tachycardia - sweating - flushed face - dilated pupils - elevated blood pressure - are common with delirium

Grief - anticipatory grieving is thought to?

shorten the grief response when the loss actually occurs.

Anxiety

subjective emotional response to that stressor- individuals face anxiety on a daily basis

blocker

resists group efforts; demonstrates rigid and sometimes irrational behaviors that impede group progress

Phases of group development - Phase III. Final or termination phase

- A sense of loss, precipitating the grief process, may be experienced by group members. - The leader encourages the group members to discuss these feelings of loss and to reminisce about the accomplishments of the group. - Feelings of abandonment may be experienced by some members. Grief for previous losses may be triggered.

Application of the nursing process/assessment - physical assessment

- Assessment for diseases of various organ systems that can induce confusion, loss of memory, and behavioral changes - Neurological examination to assess mental status, alertness, muscle strength, reflexes, sensory perception, language skills, and coordination Assessment of physical systems by both the nurse and the physician has two main emphases: (1) signs of damage to the nervous system and (2) evidence of diseases of other organs that could affect mental function. In the neurological examination, the patient is asked to perform maneuvers or answer questions that are designed to elicit information about the condition of specific parts of the brain or peripheral nerves. Testing will assess mental status and alertness, muscle strength, reflexes, sensory perception, language skills, and coordination.

Medication for specific disorders - phobic disorders - anxiolytics

- Benzodiazepines have been successful in the treatment of social anxiety disorder (social phobia) - Controlled studies have shown the efficacy of alprazolam and clonazepam in reducing symptoms of social anxiety.

Medications for specific disorders - phobic disorders - antihypertensive agents

- Beta-blockers, propranolol and atenolol, have been tried with success in clients experiencing anticipatory performance anxiety - This type of phobic response produces symptoms such as sweaty palms, racing pulse, trembling hands, dry mouth, labored breathing, nausea, and memory loss - The beta-blockers appear to be quite effective in reducing these symptoms in some individuals.

Bulimia nervosa

- Bulimia refers to an excessive, insatiable appetite. - Bulimia nervosa is an episodic, uncontrolled, compulsive, rapid ingestion of large quantities of food over a short period of time (bingeing), followed by inappropriate compensatory behaviors to rid the body of the excess calories. - The food consumed during a binge often has a high-caloric content, a sweet taste, and a soft or smooth texture that can be eaten rapidly, sometimes even without being chewed. - The bingeing episodes often occur in secret and are usually only terminated by abdominal discomfort, sleep, social interruption, or self-induced vomiting.

Major depressive disorder

- Characterized by depressed mood - Loss of interest or pleasure in usual activities - Symptoms present for at least 2 weeks - No history of manic behavior - Cannot be attributed to use of substances or another medical condition - The diagnosis will also identify the degree of severity of symptoms (mild, moderate, or severe) and whether there is evidence of psychotic, catatonic, or melancholic features

Childhood depression symptoms - ages 3-5

- Common symptoms may include accident proneness, phobias, aggressiveness, and excessive self-reproach for minor infractions - The incidence among preschool children is estimated to be between 0.3% and 0.9%.

Depression - risk for suicide related to?

- Depressed mood - Feelings of worthlessness - Anger turned inward on the self - Misinterpretations of reality

Trauma-related disorders treatment - eye movement desensitization and reprocessing

- EMDR has been shown to be an effective therapy for P T S D and other trauma-related disorders. - The exact biological mechanisms by which EMDR achieves its therapeutic effects are unknown. - Some studies have indicated that eye movements cause a decrease in imagery vividness and distress, as well as an increase in memory access.

Adapting to levels of anxiety - at the mild level, individuals employ various coping mechanisms to deal with stress. A few of these include:

- Eating - Drinking - Sleeping - Physical exercise - Coping skills are coping behaviors that enhance one's adaptation.

Predisposing factors to gambling disorder - biological influences

- Genetic: Increased incidence among family members - Physiological: Abnormalities in neurotransmitter systems

Outcomes for the client

- Has not experienced injury. - Maintains reality orientation consistent with cognitive level of functioning. - Manages own self-care with assistance. - Expresses positive feelings about self, past accomplishments, and hope for the future. - Compensates adaptively for diminished sensory perception.

Outcomes: Borderline Personality Disorder - the client

- Has not harmed self - Seeks out staff when desire for self-mutilation is strong - Is able to identify true source of anger - Expresses anger appropriately - Relates to more than one staff member - Completes activities of daily living independently - Does not manipulate one staff member against the other to fulfill own desires

Risk factors for suicide - socioeconomic status

- Individuals in the very highest and lowest social classes have higher suicide rates than those in the middle class.

The nursing process

- Is a systematic framework for the delivery of nursing care - Uses a problem-solving approach - Is goal-directed, with its objective being the delivery of quality client care - Is dynamic, not static. It is an ongoing process that continues for as long as the nurse and client have interactions directed toward change in the client's physical or behavioral responses.

sexual assault - Profile of the victimizer

- It is difficult to profile a rapist because they comprise a heterogenous group and are not distinguished by looks or intelligence. - Sadock et al identify that the underlying motives of rape perpetrators can be classified into four group

Grief - resolution

- Length of the grief process is entirely individual - It can last from a few weeks to years - is influenced by a number of factors(recent losses and anticipation of the loss)

Planning and implementation - hospitalization may be necessary in cases of:

- Malnutrition - Dehydration - Severe electrolyte imbalance - Cardiac arrhythmia or severe bradycardia - Hypothermia - Hypotension - Suicidal ideation

Role of the nurse in milieu therapy - nurses are also responsible for:

- Medication administration - Development of a one-to-one relationship - Setting limits on unacceptable behavior - Client education

Dignosis/Outcome Identification: ODD

- Noncompliance with therapy related to negative temperament, denial of problems, underlying hostility - Defensive coping related to retarded ego development, low self-esteem, unsatisfactory parent/child relationship - Low self-esteem - Impaired social interaction

Assessment of IDD - focus on?

- Nurses must assess strengths, as well as limitations, to encourage the client to be as independent as possible. - It is important to include family members in the planning and implementation of care.

Client/Family Education - for the obese client, how to:

- Plan a reduced-calorie, nutritious diet - Read food content labels - Establish a realistic weight loss plan - Establish a planned program of physical activity

Patient/Family education - nature of the illness

- Possible causes - What to expect - Symptoms

For a client with anorexia nervosa or bulimia

- Promote feelings of control. - Help client realize perfection is unrealistic.

Nursing care of the client with a trauma-related disorder is aimed at:

- Reassurance of safety - Decrease in maladaptive symptoms - Demonstration of more adaptive coping strategies - Adaptive progression through the grieving process

Diagnosis/Outcome Identification: ADHD

- Risk for injury related to impulsive and accident-prone behavior and the inability to perceive self-harm - Impaired social interaction related to intrusive and immature behavior - Low self-esteem related to dysfunctional family system and negative feedback - Noncompliance with task expectations related to low frustration tolerance and short attention span

Diagnosis/outcome identification for tourette disorder

- Risk for self-directed or other-directed violence related to low tolerance for frustration - Impaired social interaction related to impulsiveness, oppositional, and aggressive behavior - Low self-esteem related to embarrassment associated with tic behaviors

Isolation: Defense Mechanism

- Separate a thought or memory from the feeling tone or emotion associated with it. EX: Without showing any emotion, a young women describes being attacked and raped.

Medication for specific disorders - panic and GAD - antidepressants:

- Several antidepressants are effective as major antianxiety agents - The tricyclics clomipramine and imipramine have been used with success in clients experiencing panic disorder - However, because of the advent of SSRIs, tricyclics are less widely used because of their tendency to produce severe side effects at the high doses required to relieve symptoms of panic disorder.

Predisposing factors associated with somatic symptom disorders - biochemical

- Studies have indicated that tryptophan catabolism may be abnormal in clients with somatic symptom disorders. Decreased levels of serotonin and endorphins may play a role in the sensation of pain. Serotonin is probably the main neurotransmitter involved in inhibiting the firing of afferent pain fibers. - decreased levels of serotonin and endorphins may play a role in the etiology of somatic symptom disorder, predominantly pain.

Psychopharmacology for substance intoxication and substance withdrawal - barbituate withdrawal

- Substitution therapy for CNS depressant withdrawal is most commonly applied with the long-acting barbiturate phenobarbital (Luminal). - The dosage required to suppress withdrawal symptoms is administered. - When stabilization has been achieved, the dose is gradually decreased by 30 mg/day until withdrawal is complete. - Long-acting benzodiazepines are commonly used for substitution therapy when the abused substance is a nonbarbiturate CNS depressant.

Conditions that promote a therapeutic community - involvement

- The environment must encourage involvement so that patients develop a sense of social community - Common dining areas, small group seating arrangements, and community meetings to discuss aspects of community living are examples of elements that promote involvement.

Respect

- To show respect is to believe in the dignity and worth of an individual regardless of his or her unacceptable behavior. - The attitude is nonjudgmental, and the respect is unconditional in that it does not depend on the behavior of the patient to meet certain standards.

Trust

- To trust another, one must feel confidence in that person's presence, reliability, integrity, veracity, and sincere desire to provide assistance when requested - Trust is the basis of a therapeutic relationship. The nurse working in psychiatry must perfect the skills that foster the development of trust.

Other risk factors for suicide

- Use of alcohol and barbiturates - Psychosis with command hallucinations - Affliction with a chronic, painful, or disabling illness - Family history of suicide - L G B T Q individuals have a higher risk of suicide than do their heterosexual counterparts - Having attempted suicide previously increases the risk of a subsequent attempt. About half of those who ultimately commit suicide have a history of a previous attempt. - Loss of a loved one through death or separation - Bullying - lack of employment or increased financial burden

effects of alcohol on the body - Pancreatitis - acute

- Usually occurs 1 or 2 days after a binge of excessive alcohol consumption. - Symptoms include constant, severe epigastric pain; nausea and vomiting; and abdominal distention.

Risk factors for suicide - ethnicity

- Whites are at the highest risk for suicide, followed by Native Americans, African Americans, Hispanic Americans, and Asian Americans.

Depression - disturbed thought processes related to?

- Withdrawal into self - Underdeveloped ego - Punitive superego - Impaired cognition fostering negative perception of self or environment

Risk factors - gender

- Women attempt suicide more often, but more men succeed. - Men commonly choose more lethal methods than do women. - Transgender risk

Alcoholics anonymous

- a major self-help organization for the treatment of alcoholism - AA groups are based on the concept of peer support—acceptance and understanding from others who have experienced the same problems in their lives(peer support). - acceptance - one drink = one drunk - Requirement for membership is a desire on the part of the alcoholic person to stop drinking. - Each new member is assigned a support person from whom he or she may seek assistance when the temptation to drink occurs.

Within the therapeutic community setting, the client is expected to learn?

- adaptive coping - interaction and relationship skills, that can be generalized to other aspects of his or her life.

Narcissistic Personaltiy Disorder - A FAME GAME

- admiration required in excessive amounts - fantasizes about unlimited success, brillance - arrogant - manipulative - envious of others - grandiose sense of importance - associates with special people - me first attitude - empathy lacking for others

Treatment modalities for trauma-related disorders - phsychopharmacology

- antidepressants - antihypertensives - anxiolytics - other medications

Conditions that promote a therapeutic community

- containment - structure - involvement - support - validation

Examples of task roles

- coordinator - evaluator - elaborator - energizer - initiator - orienter

Substance Use Disorder: Criteria

- cravings to use the substance - wanting to cut down or stop but not managing to - taking the substance in larger amounts or for longer than you are meant to - neglecting other parts of your life because of substance use - continuing to use, eeven when it causes problems in relationships - using substances when it puts you in danger

Symptom information of bipolar disorder

- delusions or hallucinations may or may not be part of clinical picture - onset of symptoms may reflect seasonal pattern

Outcomes for the schizophrenic client

- demonstrates an ability to relate to others satisfactorily - recognizes distortions of reality - has not harmed self or others - percieves self realistically - demonstrates ability to perceive the environment correctly - maintains anxiety at manageable level - relinquishes need for delusions and hallucinations - demonstrates ability to trust others - uses appropriate verbal communication in interactions with others - performs self-care activities independently

How does motivational interviewing work?

- express empathy - avoid arguments - develop discrepency - support self-efficacy

Aggressive

- eye rolling - finger pointing - angry or forceful words - focused on your words - rude or bossy

Predisposing factors - biological theories(chemical imbalance in the brain)

- genetics: twin and family studies and other genetic studies - biochemical influences: possible excess of norepinephrine and dopamine

Mental illness - Horwitz describes two elements that affect how individuals view mental illness:

- incomprehensibility - cultural relativity

Assertive

- making eye contact - calm but firm voice - respecting your rights and the rights of others - statements that begin with I

Types of bipolar disorder

- mania: up, up, up - hypomania: up - mixed states: up and down at the same time - rapid cycling: 4 or more episodes(hypomania and depression) within 12 months - euthymia: balanced, normal mood and affect - dysthymia: chronically low - mild depression: low - depression: low, low, kiw

Alzheimer's Disease - stage one

- no apparent symptoms - in the first stage of the illness, there is no apparent decline in memory despite changes that are beginning to occur in the brain - alzheimers accounts for 50-80% of all cases of NCD

Intoxication symptoms

- perception loss - hearing and sight effects - slow reactions - bad judgement - impaired handling - poor tracking - processing is slowed - under-estimate impairment

Impaired social interaction interventions

- set limits on manipulative behaviors - do not argue, bargain, or try to reason with the client - provide positive reinforcement

symptoms of depression episode - SIGECAPS

- sleep - interest/irritable - guilt - energy - concentration - appetite - psychomotor slowing - sucicidal

Documentation of the Nursing Process - APIE

A problem-oriented system, PIE charting uses accompanying flow sheets that are individualized by each institution

primitive defense mechanisms

denial, regression, acting out, dissociation, compartmentalization, projection, reaction formation

Inhalant-induced disorder - intoxication

•Dizziness; ataxia •Euphoria; excitation; disinhibition •Nystagmus; blurred vision; double vision •Slurred speech •Hypoactive reflexes •Psychomotor retardation; lethargy •Generalized muscle weakness •Stupor or coma (at higher doses) - develops during or shortly after use of or exposure to volatile inhalants

echopraxia

repeating movements that are observed

Predisposing factors - sociocultural theories - societal influences

- Aggressive behavior is primarily a product of one's culture and social structure. - The American culture was founded on a general acceptance of violence as a means of solving problems. - Societal influences also contribute to violence when individuals realize that their needs and desires are not being met relative to other people.

positive symptoms of schizophrenia

- delusions - hallucinations

Occipital lobe

- vision - color perception

In the US, the lifetime prevalence of schizophrenia is about?

1%

Epidemiology of depression - seasonality

Affective disorders are more prevalent in the winter and in the fall.

Stigmatization

Attitude of devaluing a person because of a particular characteristic or illness

Therapeutic communication techniques - exploring

Delving further into a subject, idea, experience, or relationship

A model for making ethical decisions - evaluation

Evaluate outcomes

Member roles - individual(personal) roles

Fulfilling personal or individual needs

Therapeutic factors of groups - corrective recapitulation of the primary family group

Group members are able to re-experience early family conflicts that remain unresolved

A model for making ethical decisions - problem identification

Identify the conflict between two or more alternative actions.

Types of somatic symptom disorders - illness anxiety disorder

Illness anxiety is an unrealistic or inaccurate interpretation of physical symptoms or sensations, leading to preoccupation and fear of having a serious disease. The fear becomes disabling and persists despite reassurance that no organic pathology can be detected.

Nontherapeutic Communication Techniques - approving or disapproving

Implies that the nurse has the right to pass judgment on the "goodness" or "badness" of the patient's behavior

Therapeutic factors of groups - universality

Individuals come to realize that they are not alone in the problems, thoughts, and feelings they are experiencing

Classifications within statutory and common law - civil law

Protects the private and property rights of individuals and businesses - Private individuals or groups may bring a legal action to court for breach of civil law - Torts - Contracts

Therapeutic communication techniques - Verbalizing the implied:

Putting into words what patient has only implied

Nursing diagnosis for client withdrawing from CNS stimulants

Risk for suicide related to intense feelings of lassitude and depression, "crashing," suicidal ideation

Member Roles - Task roles

Serving to complete the task of the group

Therapeutic communication techniques - Seeking clarification and validation

Striving to explain what is vague and searching for mutual understanding

Therapeutic communication techniques - Formulating plan of action:

Striving to prevent anger or anxiety escalating to unmanageable level when stressor recurs

mature defense mechanisms

Supression Sublimation

Therapeutic communication techniques - focusing

Taking notice of a single idea or even a single word

Informed consent elements - knowledge

The client has received adequate information on which to base his or her decision.

Anticipatory grief

The experiencing of the grief process before the actual loss occurs

Therapeutic communication techniques - Making observations

Verbalizing what is observed or perceived

Predisposing factors: ODD - biological influences

What role, if any, genetics, temperament, or biochemical alterations play in the etiology of O D D is still unclear. Some studies have identified genetic influences in the establishment of a child's temperament, but there is not clear evidence of this connection in O D D.

Nursing diagnoses - hopelessness related to?

an absence of support systems and a perception of worthlessness

delusions of control

believe their feelings, thoughts, and actions are being controlled by other people - aliens are controlling your thoughts or that they have special powers and they can control things

Predisposing factors to depression - physiological influences: Other physiological conditions

collagen disorders, such as systemic lupus erythematosus (SLE) and polyarteritis nodosa; cardiovascular disease, such as cardiomyopathy, congestive heart failure, and myocardial infarction; infections, such as encephalitis, hepatitis, mononucleosis, pneumonia, and syphilis; and metabolic disorders, such as diabetes mellitus and porphyria - secondary depression

Nigrostriatal

dopamine deficiency causes decreased movement(dystonia, parkinson like symptoms)

Major goal of family therapy

facilitate system change rather than focus on any one individual as the one in need of treatment

Hallucinations

false sensory experiences, such as seeing something in the absence of an external visual stimulus

Trauma-related disorders treatment - prolonged exposure therapy

is a type of behavioral therapy somewhat similar to implosion therapy or flooding. It can be conducted in an imagined or real (in vivo) situation.

intellectural developmental disorder - general intellectual functioning

is measured by both clinical assessment and a person's performance on I Q tests.

follower

listens attentively to group interaction; is a passive participant

Special concerns for elderly people - sexual abuse

nonconsensual sexual contact of any kind with an older adult

Treatment modalities for adjustment disorders - psychopharmacology

not commonly treated with medications, as their effect may be temporary and only mask the real problem, and psychoactive drugs carry the potential for physiological and psychological dependence.

Mesolimbic dopamine pathways and schizophrenia

overactive dopamine causes postive symptoms

Negative symptoms - associated features - pacing and rocking

pacing back and forth and rocking the body

Goals are often achieved through use of what?

problem-solving model

Therapeutic interpersonal relationship

process by which nurses provide care for patients in need of psychosocial intervention

Normal effects of aging on the body

- Age-related changes occur at different rates for different individuals, although in actuality, when growth stops, aging begins. - There are many biological changes that occur with the aging process. - One of the most dramatic changes that occurs in aging is the loss of elastin in the skin. - This effect, as well as changes in collagen, causes aged skin to wrinkle and sag. - Excessive exposure to sunlight compounds these changes and increases the risk of developing skin cancer. - The age-related decline in the cardiovascular system is thought to be the major determinant of decreased tolerance for exercise and loss of conditioning and the overall decline in energy reserve. - The aging heart is characterized by modest hypertrophy and loss of pacemaker cells, resulting in a decrease in maximal heart rate and diminished cardiac output. - Thoracic expansion is diminished by an increase in fibrous tissue and loss of elastin. - Pulmonary vital capacity decreases, and the amount of residual air increases. - Scattered areas of fibrosis in the alveolar septa interfere with the exchange of oxygen and carbon dioxide. - These changes are accelerated by the use of cigarettes or other inhaled substances. - Skeletal aging involving the bones, muscles, ligaments, and tendons probably generates the most frequent limitations on activities of daily living experienced by aging individuals. - Loss of muscle mass is significant, although this occurs more slowly in men than in women. - Demineralization of the bones occurs at a rate of about 1% per year throughout the life span in both men and women. - The teeth show a reduction in dentine production, shrinkage and fibrosis of root pulp, gingival retraction, and loss of bone density in the alveolar ridges. - There is some loss of peristalsis in the stomach and intestines, and gastric acid production decreases. - Levels of intrinsic factor may also decrease, resulting in vitamin B12 malabsorption in some aging individuals. - A significant decrease in absorptive surface area of the small intestine may be associated with some decline in nutrient absorption. - A decreased level of thyroid hormones causes a lowered basal metabolic rate. - Decreased amounts of adrenocorticotropic hormone may result in less efficient stress response. - Age-related declines in renal function occur because of a steady attrition of nephrons and sclerosis within the glomeruli over time. - Vascular changes affect blood flow to the kidneys, which results in reduced glomerular filtration and tubular function. - In men, enlargement of the prostate gland is common as aging occurs. - Prostatic hypertrophy is associated with an increased risk for urinary retention and may also be a cause of urinary incontinence. - Aging results in changes in both cell-mediated and antibody-mediated immune responses. - The size of the thymus gland declines continuously from just beyond puberty to about 15% of its original size at age 50. - The consequences of these changes include a greater susceptibility to infections and a diminished inflammatory response that results in delayed healing. - With aging, there is an absolute loss of neurons, which correlates with decreases in brain weight of about 10% by age 90. - The brain has enormous reserve, and little cerebral function is lost over time, although greater functional decline is noted in the periphery. - Some of the age-related changes within the nervous system may be due to alterations in neurotransmitter release, uptake, turnover, catabolism, or receptor functions. - Visual acuity begins to decrease in mid-life. - Presbyopia (blurred near vision) is the standard marker of aging of the eye. It is caused by a loss of elasticity of the crystalline lens, and results in compromised accommodation. - Hearing changes significantly with the aging process. - Gradually over time, the ear loses its sensitivity to discriminate sounds because of damage to the hair cells of the cochlea. The most dramatic decline appears to be in perception of high-frequency sounds. - Beyond 70 years of age, taste sensitivity begins to decline related to atrophy and loss of taste buds. - taste discrimination decreases, and bitter taste sensations predominate. - Sensitivity to sweet and salty tastes is diminished. - The deterioration of the olfactory bulbs is accompanied by loss of smell acuity. - Although the primary sensory changes that occur specifically related to aging are in hearing and vision, sensitivity to touch and pain may also decline or change with age related to less blood flow to nerve endings, in the spinal cord, or to the brain. - These changes have critical implications for the elderly in their potential inability to use sensory warnings to escape serious injury.

Planning/Implementation - ineffective coping

- Initially meet the client's dependency needs - Provide a structured schedule of activities

Phase 1 - premorbid phase

- shy and withdrawn - poor peer relationships - doing poorly in school - antisocial behavior

temporal lobe

- understanding language - behavior - memory - hearing

With schizophrenia, there is a severe deterioration of?

social and occupational functioning

Hypomania

somewhat milder form of mania

Active listening acronym - SOLER - R:

relax

Active listening acronym - SOLER - S:

Sit squarely facing the patient. This gives the message that the nurse is there to listen and is interested in what the patient has to say.

Case manager

responsible for negotiating with multiple healthcare providers to obtain a variety of services for the client. - Nurses are exceptionally qualified to serve as case managers - Several years of experience as a registered nurse is usually required for employment as a case manager.

Types of schizophrenia and other psychotic disorders - schizophreniform disorder

same symptoms as schizophrenia with the exception that the duration of the disorder has been 1-6 months

Nontherapeutic Communication Techniques - defending

To defend what the patient has criticized implies that the patient has no right to express ideas, opinions, or feelings

Interpersonal communication techniques

"tools" of psychosocial intervention

Predisposing factors - biological influences - genetics

- A hereditary predisposition to eating disorders has been hypothesized. - Anorexia nervosa is more common among sisters and mothers of those with the disorder than it is among the general population.

Intellectualization Defense Mechanism

- An attempt to avoid expressing actual emotions associated with a stressful situation by using the intellectual process of logic, reasoning and analysis.

Depression - powerlessness related to?

- Complicated grieving process - Lifestyle of helplessness

Leadership styles - democratic

- Focus is on members, who are encouraged to participate fully in problem-solving of group issues, including taking action to effect change. - Production is somewhat lower than with autocratic leadership, but morale is much higher.

Planning/Implementation - disturbed body image

- Help client see his or her body image is distorted. - Involve client in activities that reinforce positive sense of self. - Make referrals to support groups.

Neurocognitive disorder due to Huntington's - predisposing factors

- Huntington's disease is transmitted as a Mendelian dominant gene. - Damage occurs in the areas of the basal ganglia and the cerebral cortex. - The patient usually declines into a profound state of dementia and ataxia. - Average course of the disease is based on age at onset. Huntington's disease is transmitted as a Mendelian dominant gene. Damage is seen in the areas of the basal ganglia and the cerebral cortex. The onset of symptoms usually occurs between age 30 and 50 years. The patient usually declines into a profound state of cognitive impairment and ataxia (muscular incoordination).

Other nursing diagnosis related to depression

- Imbalanced nutrition less than body requirements - Insomnia - Self-care deficit(All related to depressed mood)

Theories of aging - activity theory

- In direct opposition to the disengagement theory is the activity theory of aging, which holds that the way to age successfully is to stay active. Sadock, Sadock, and Ruiz report that growing evidence supports the importance of remaining socially active for both physical and emotional well-being. - Cultural expectations are influential, and as older Americans are identified as reaping the benefits of physical and social activity, cultural expectations begin to shift.

Conditions essential to development of a therapeutic relationship

- rapport - trust - respect - genuineness - empathy

11th principle of rape culure

CONSENT - rolerance of the behaviors at the bottom supports or excuses those higher up. To change outcomes, we must change the culture - if you see something, say something

Therapeutic communication techniques - Placing the event in time or sequence

Clarifies the relationship of events in time

Therapeutic communication techniques - Presenting reality

Clarifying misconceptions that the patient may be expressing

Depression - spiritual distress related to?

Complicated grieving process over loss of valued object evidenced by anger toward God, questioning meaning of own existence, inability to participate in usual religious practices

Gender prevalence of depression

Depression is more prevalent in women than in men by about 2 to 1 - women have higher concentrations of monoamine oxidase (a neurotransmitter associated with depression) - greater vulnerability to thyroid dysfunction - hormone changes - increased sensitivity to stress (and higher prevalence of anxiety disorders), multiple social roles, and poorer coping mechanisms

positive symptoms - Hallucinations

False sensory perceptions not associated with real external stimuli

Treatment modalities for personality disorders - pharmacotherapy for antisocial personality disorder

For antisocial personality disorder, pharmacotherapy is generally not recommended unless it is being used to treat a comorbid condition and, among the cluster C group of personality disorders, no randomized trials have been published that support pharmacological treatment for these disorders.

Treatment modalities for personality disorders - psychopharmacology for borderline personality disorder

For the treatment of BPD, symptom-targeted pharmacotherapy has been identified as an important adjunct. Antipsychotic medications show some benefits in treating cognitive-perceptual symptoms, SSRIs show some benefit in treating emotional dysregulation, and mood-stabilizing agents have shown some benefit in treating emotional dysregulation and impulsive aggressive symptoms.

Predisposing factors - theories of suicide - anger turned inward

Freud believed that suicide was a response to the intense self-hatred that an individual possessed. The anger had originated toward a love object, but was ultimately turned inward against the self. He interpreted suicide to be an aggressive act toward the self that often was really directed toward others.

A model for making ethical decisions - assessment

Gather the subjective and objective data about a situation. Consider personal values as well as values of others involved in the ethical dilemma.

Functions of a group - task completion

Group members provide assistance in endeavors that are beyond the capacity of one individual alone or when results can be achieved more effectively as a team.

Types of groups - task groups

Groups are formed to accomplish a specific outcome or task

Eight core functions of EHRs - reporting and population health management

Healthcare organizations are required to report healthcare data to government and private sectors for patient safety and public health.

Somatic type

Involved illusion relating to body functions and sensations - worms under skin

Erotomanic type

Involves delusions and which another person, usually of higher status, is in love with the individual

Jealous type

Involves delusions in which the person believes that a sexual partner is being unfaithful

identification defense mechanism

It involves the victim adopting the behavior of a person who is more powerful and hostile towards them.

Assessment of ASD

It is important to understand the symptoms of A S D along a spectrum and with varying levels of functionality. Some individuals who meet criteria for autism spectrum disorder may be highly functional and highly intelligent in spite of communication impairments and repetitive or restrictive behaviors.

The recovery model for bipolar disorder

Learning how to live a safe, dignified, full, and self-determined life in the face of the enduring disability which may, at times, be associated with serious mental illness

Therapeutic factors of groups - group cohesiveness

Members develop a sense of belonging rather than separating the individual ("I am") from group ("we are").

How do nurses possess therapeutic use of self?

Nurses must possess self-awareness, self-understanding, and a philosophical belief about life, death, and the overall human condition.

Discuss the symptoms and assessment of ODD

O D D is characterized by passive-aggressive behaviors such as stubbornness, procrastination, disobedience, carelessness, negativism, testing of limits, resistance to directions, deliberately ignoring the communication of others, and unwillingness to compromise. Other symptoms that may be evident are running away, school avoidance, school underachievement, temper tantrums, fighting, and argumentativeness.

Active listening acronym - SOLER - O:

Observe an open posture. Posture is considered "open" when arms and legs remain uncrossed. This suggests that the nurse is "open" to what the patient has to say. With a "closed" posture, the nurse can convey a somewhat defensive stance, possibly invoking a similar response in the patient.

Predisposing facotrs to dissociative disorders - genetics

Preliminary research does not show evidence of significant genetic contribution. - The overwhelming majority of adults with DID have a history of physical and sexual abuse

Nontherapeutic Communication Techniques - probing

Pushing for answers to issues that the patient does not wish to discuss causes the patient to feel used and valued only for what is shared with the nurse

Therapeutic communication techniques - Attempting to translate words into feelings:

Putting into words the feelings the patient has expressed only indirectly

Nontherapeutic Communication Techniques - Interpreting

Results in the therapist telling the patient the meaning of his or her experience

cardiac arrhythmia

ST segment and T wave changes usually related to electrolyte imbalances

Predisposing factors associated with somatic symptom disorders - family dynamics

Some families have difficulty expressing emotions openly and resolving conflicts verbally. When this occurs, the child may become ill, and a shift in focus is made from the open conflict to the child's illness, leaving unresolved the underlying issues that the family cannot confront openly. Thus, somatization in the child brings some stability to the family, as harmony replaces discord and the child's welfare becomes the common concern. - teritary gain

Mental illness - cultural relativity

The "normality" of behavior is determined by the culture

Ebstein's anomaly

Tricuspid flaps fused to inside of right ventricle; creates constant opening between atrium & ventricle - this is the risk if take lithium during pregnancy

Risk for suicide - nonsuicidal self-injuring behavior(NSSIB)

Typically a nonlethal, repetitive act used to reduce distress rather than end one's life

Physical responses to stress - Selye's general adaptation syndrome has three distincy stages: Stage of resistance

Using the physiological responses of the first stage, the person attempts to adapt to the stressor. If adaptation occurs, the third stage is prevented or delayed. Physiological symptoms may disappear.

negative symptoms - Asocial - social isolation

a focus inward on the self to the exclusion of the external environment

Treatment - social treatments - family therapy

aimed at helping family members cope with long-term effects of the illness

Effects of alcohol on the body - at low doses

alcohol produces relaxation, loss of inhibitions, lack of concentration, drowsiness, slurred speech, and sleep.

sexual assault - Profile of the victimizer - sexual sadists

aroused by inflicting pain

dehydration

assessment includes thirst, orthostatic hypotension, tachycardia, elevated sodium levels, and other symptoms

Psychodrama - group members who do not participate in the drama act as the?

audience, and the group leader is called the director

severe bradycardia

below 50 beats per minute

negative symptoms - avolition - emotional ambivalence

coexistence of opposite emotions toward same object, person, or situation

Schizophrenia requires treatment that is?

comprehensive and presented in a multidisciplinary effort

Nursing diagnosis for schizophrenia - disabled family coping related to?

difficuly cooping with client's illness

Nursing diagnosis for schizophrenia - ineffective health maintence related to?

disordered thinking or delusions

Evaluator

examines group plans and performance, measuring against group standards and goals

Elaborator

explains and expands upon group plans and ideas

Delusions

false beliefs, often of persecution or grandeur, that may accompany psychotic disorders - irrational, false, and the individual maintains of true despite the contrary

Predisposing factors - psychological factors - developmental influences

focuses on a punitive superego and fixation at the oral stage of psychosexual development. Individuals with punitive superegos turn to drugs to diminish unconscious anxiety and increase feelings of power and self-worth.

Flooding(implosion) - total immersion

forced, prlonged expsure to the actual stimulus that provoked the original trauma - not possible for every phobia

Ethical principles

fundamental guidelines that influence decision-making

Medical treatment modalities - pharmaceutical agents for depression - trazodone(Desyrel)

good choice for patients with insomnia

Medical treatment modalities - pharmaceutical agents for depression - dominergic agents

helpful in treatment of severe apathy

negative symptoms - anosognosia

lack of insight - anergia: lack of energy - anhedonia: inability to experience pleasure - lack of abstract thinking ability(concrete thinking)

Another risk factor for suicide?

nationality

Medical treatment modalities - pharmaceutical agents for depression - tricyclic antidepressants

often avoided due to anticholinergic and cardiac side effects

Expected clinical exam findings with increased blood alcohol concentrations

- 0.02-0.05: diminished fine motor coordination - 0.05-0.1: impaired judgement, coordination - 0.1-0.15: difficulty with gait and balance - 0.15-0.25: lethargy, difficulty sitting upright without assistance - 0.25-0.3: coma in the nonhabituated drinker - 0.3-0.4: respiratory depression

Mild IDD

- 85% - can generally learn reading, writing, and math skills between third and sixth grade levels. May have jobs and live independently

Documentation of the Nursing Process - APIE format

- A = Assessment: A complete client assessment is conducted at the beginning of each shift. Results are documented under this section in the progress notes. Some institutions elect instead to use a daily client assessment sheet designed to meet the specific needs of the unit. Explanation of any deviation from the norm is included in the progress notes. - P = Problem: A problem list, or list of nursing diagnoses, is an important part of the A P I E method of charting. The name or number of the problem being addressed is documented in this section. - I = Intervention: Nursing actions are performed, and directed at the resolution of the problem. - E = Evaluation: Outcomes of the implemented interventions are documented, including an evaluation of client responses to determine the effectiveness of nursing interventions and the presence or absence of progress toward resolution of a problem.

Schizotypal personality disorder

- A more severe form of schizoid personality pattern - Affects approximately 3% of the population - Individuals with schizotypal personality disorder display odd and eccentric behavior but not to the level of schizophrenia. Schizotypal personality is marked by symptoms that look more like schizophrenia than those in schizoid personality in that the individuals show significant peculiarities in thinking, behavior, and appearance. Studies indicate that schizotypal personality disorder has a prevalence of around 3%.

Alzheimer's Disease - stage two

- very mild change - The individual begins to lose things or forget names of people. - Losses in short-term memory are common. - The individual is aware of the intellectual decline and may feel ashamed, becoming anxious and depressed, which in turn may worsen the symptom. - Maintaining organization with lists and a structured routine provide some compensation. - These symptoms often are not noticed by others and do not interfere with the individual's ability to work or live independently.

tort

- violation of a civil law in which an individual has been wronged - One party claims wrongful conduct on the part of another and seeks compensation - This may be something done intentionally or unintentionally.

Predisposing factors of schizophrenia - physiological factors

- viral infections(mostly in utero) - anatomical abnormalities(major car accident with concussion) - electrophysiology - epilepsy - Huntington's disease - birth trauma - head injury in adulthood - alcohol abuse - cerebral tumor - cerebrovascular accident - systemic lupus erythematosus

Client family education - nature of illness

- what to expect as illness progresses - symptoms associated with illness - ways for family to respond to behaviors associated with illness - when to call provider - when to come to hospital - how to interact with patient

Science of addiction

- when a person takes a drug, or engages in other addictive activities, the neurotransmitter dopamine is released in a cluster of nerve cells called the nucleus accumbens(sometimes called the pleasure center of the brain) - the hippocampus responds to the dopamine by recording memories of pleasure, and the amygdala creates a conditioned response to stimuli like a cigarette or needles, meaning that when the person sees these cues theyll have an intense craving for the substance or activity - repeated exposure causes nerve cells in the nucleus accumbens and the prefrontal cortex, which is concerned with planning, to communicate in a way that leads the person to seek out the drug or activity and want to do it more - over time, the person gets used to the feeling of pleasure they get from taking drugs or doing another addictive activity and so they need to do it more and more to get the same satisfaction and satify their cravings. They have a hard time feeling happy when they are not on the drug or doing the activity they are addicted to because their brain has gotten used to the feeling of pleasure the drug or activity gives it

Marital rape

- which has been recognized only in recent years as a legal category, is the case in which a spouse may be held liable for sexual abuse directed at a marital partner against that person's will. - Historically, with societal acceptance of the concept of women as marital property, the legal definition of rape held an exemption within the marriage relationship. - In 1993, marital rape became a crime in all 50 states, under at least one section of the sexual offenses code.

Avoiding liability - effective communication

- with patients and other caregivers - The SBAR model of reporting information, which stands for situation, background, assessment, and recommendations, has been identified as a useful tool for effective communication with caregivers - Establishing rapport with clients encourages open and honest communication.

Occupational therapist

- works with patients to help develop independence in performance of ADLs - focus is on rehabilitation and vocational training in which patients learn to be productive, thereby enhancing self-esteem - creative activities and therapeutic relationship skills are used

Process recordings

- written reports of verbal interactions with patients. - They are written by the nurse or student as a tool for improving communication techniques.

Alcoholics anonymous - 12 steps

. Admit powerlessness over alcohol. 2. Believe that a greater power could restore sanity. 3. Make a decision to turn their lives over to the care of God. 4. Make a moral inventory. 5. Admit wrongs. 6. Become ready to have God remove defects of character. 7. Ask God to remove shortcomings. 8. Make a list of all persons harmed. 9. Make direct amends to such people wherever possible except when to do so would injure them or others. 10. Continue to take personal inventory and admit wrongdoing. 11. Seek to improve conscious contact with God. 12. Carry the message to other alcoholics.

Predisposing factors - biological theories - neurochemical factors

A number of studies have revealed a deficiency of serotonin (measured as a decrease in the levels of 5-hydroxyindole acetic acid [5-HIAA] in the cerebrospinal fluid of depressed clients who attempted suicide. These studies, as well as postmortem studies, have supported the hypothesis that deficiencies in CNS serotonin are associated with suicide.

Predisposing factors - psychological factors - cognitive factors

Irrational thinking patterns are a problem that is central in addictions. When these thought patterns are unchallenged, they may culminate in additional addictions, even when a person stops using the drug to which they first became addicted. Some examples include denial, projection, and rationalization.

Predispoing factors associated with somatic symptom disorders - learning theory - illness anxiety disorder

Past experience with serious or life-threatening physical illness, either personal or that of close relatives, can predispose the person to illness anxiety disorder. - Once an individual has experienced a threat to biological integrity, he or she may develop a fear of recurrence. The fear of recurring illness generates an exaggerated response to minor physical changes, leading to excessive anxiety and health concerns.

Obsessive-Compulsive Disorder - assessment data

Recurrent obsessions or compulsions that are severe enough to be time-consuming or to cause marked distress or significant impairment

Nursing diagnosis for client withdrawing from CNS depressants

Risk for Injury related to C N S agitation

Predisposing factors - theories of suicide - shame and humiliation

Some individuals have viewed suicide as a "face-saving" mechanism—a way to prevent public humiliation following a social defeat such as a sudden loss of status or income. Often, these individuals are too embarrassed to seek treatment or other support systems.

Predisposing factors - psychodynamic influences

Suggests that eating disorders result from very early and profound disturbances in mother-infant interactions, resulting in: - Delayed ego development - Unfulfilled sense of separation-individuation Psychodynamic theories suggest that the development of an eating disorder is rooted in an unfulfilled sense of separation-individuation. When events occur that threaten the vulnerable ego, feelings of lack of control over one's body emerge.

The impact of preexisting conditions - there are four kinds of distance in interpersonal interactions - social distance

The distance for conversation with strangers or acquaintances

The impact of preexisting conditions - there are four kinds of distance in interpersonal interactions - personal distance

The distance for interactions that are personal in nature

The impact of preexisting conditions - there are four kinds of distance in interpersonal interactions - public distance

The distance for speaking in public or yelling to someone some distance away

Therapeutic factors of groups - existential factors

The group is able to assist individual members to take direction of their own lives and to accept responsibility for the quality of their existence.

Milieu therapy or therapeutic community

a scientific structuring of the environment to effect behavioral changes and to improve the psychological health and functioning of the individual.

classic conditioning

a type of learning in which one learns to link two or more stimuli and anticipate events

Symptoms in generalized anxiety disorder

are intense enough to cause clinically significant impairment in social, occupational, or other important areas of functioning. The individual often avoids activities or events that may result in negative outcomes, or spends considerable time and effort preparing for such activities. Anxiety and worry often result in procrastination in behavior or decision making, and the individual repeatedly seeks reassurance from others.

Primary neurocognitive disorders

are those in which the disorder itself is the major sign of some organic brain disease not directly related to any other organic illness (e.g., Alzheimer disease).

Types of laws - statutory law

are those that have been enacted by a legislative body such as a state legislature or the U.S. Congress.

Mania can occur as a?

biological(organic) or psychological disorder, or as a response to substance use or a general medical condition

The term manic-depressive was first coined in 1913, and the american psychiatric association adopted the term?

bipolar disorder in 1980

Unresolved moderate to severe anxiety can contribute to physiological disorders, including:

cardiovascular, gastrointestinal, neoplastic, neurological, and pulmonary conditions.

Treatment - psychological treatments - behavior therapy

chief drawback has been inability to generalize to community setting after client ahs been discharged from treatment

Positive symptoms - associative looseness - clang associations

choice of words is governed by sound(often rhyming)

Major neurocognitive disorder

constitutes what was previously described as dementia - In progressive neurodegenerative conditions, these two diagnoses may serve to identify earlier and later stages of the same disorder.

Prementrual dysphoric disorder(PMDD)

depressed mood, excessive anxiety, mood swings, and decreased interest in activities during the week prior to menses, improving shortly after the onset of menstruation, and becoming minimal or absent in the week postmenses.

New trends of depression

depression is increasing among American teens and young adults, particularly adolescent girls. From 2005 to 2014, the incidence rose from 4.5% to 5.7% for teenage boys and from 13.1% to 17.3% for teenage girls (Mojtabai, Oflen & Han, 2016). The reasons for these increases are unclear, but the overall preponderance of evidence has led some researchers to consider depression "the common cold of psychiatric disorders" and this generation to be an "age of melancholia."

Phobias - life experiences

early expereinces may set the stage for phobic reactions later in life

Depersonalization

feelings of detachment from one's mental processes or body

Neurocognitive disorders

impairment in the cognitive functions of thinking, reasoning, memory, learning, and speaking - Neurocognitive describes cognitive functions closely linked to particular areas of the brain that have to do with thinking, reasoning, memory, learning, and speaking. Neurocognitive disorder is an impairment of these cognitive functions.

Predisposing factors - theories of suicide - interperonal therory: Durkheims three social categories - altruistic suicide

is the opposite of egoistic suicide. The individual who is prone to altruistic suicide is excessively integrated into the group. The group is often governed by cultural, religious, or political ties, and allegiance is so strong that the individual will sacrifice his or her life for the group.

The recovery model - although there is no cure for bipolar disorder, recovery is possible in the sense of?

learning to prevent and minimize symptoms, and to successfully cope with the effects of the illness on mood, career, and social life

Postive symptoms - associative looseness - neologisms

made-up words that have meaning only to the person who invents them

monopolizer

maintains control of the group by dominating the conversation

Nurses are constantly faced with the challenge of?

making difficult decisions regarding good and evil or life and death. - Legislation determines what is "right" or "good" within a society(Nursing competency and accountability are compromised when the nurse is not knowledgeable about the law and the rights of patients under their care)

Bipolar disorder is characterized by?

mood swings from profound depression to extreme euphoria(mania), with intervening periods of normalcy

Treatment modalities for adjustment disorders - individual psychotherapy

most common treatment for adjustment disorder. Individual psychotherapy allows the client to examine the stressor that is causing the problem, possibly assign personal meaning to the stressor, and confront unresolved issues that may be exacerbating this crisis.

Medical treatment modalities - pharmaceutical agents for depression - selective serotonin reuptake inhibitors

often considered first-line due to favorable side-effect profile

Fight or slight response also occurs in response to?

psychological or emotional stimuli - These stressors are often not resolved as rapidly as some physical stressors.

Ethical principles - Beneficence

refers to the duty to benefit the good of others. Nurses who act in the interest of their clients are beneficent. This includes knowing when to act on a client's behalf.

intelletual developmental disorder - adaptive functioning

refers to the person's ability to adapt to requirements of activities of daily living and the expectations of his or her age and cultural group.

Special concerns for elderly people - neglect

refusal or failure to fulfill any part of a persons obligation or duties to an older adult

Nursing diagnosis for bipolar disorder - imbalanced nutrition less than body requirements related to?

refusal or inability to sit still long enough to eat, evidenced by loss of weight, amenorrhea

Treatment modalities for adjustment disorders - behavior therapy

replace ineffective response patterns with more adaptive ones. The situations that promote ineffective responses are identified, and carefully designed reinforcement schedules, along with role modeling, and coaching are used to alter the maladaptive response patterns.

Effects of alcohol on the body - Wernicke's encephalopathy

represents the most serious form of thiamine deficiency in alcoholics. - Symptoms include paralysis of the ocular muscles, diplopia, ataxia, somnolence, and stupor. - If thiamine replacement therapy is not undertaken quickly, death will ensue.

Types of lawsuits that occur in psychiatric nursing - breach of confidentiality

revealing aspects about a client's case, or even for revealing that an individual has been hospitalized, if that person can show that making this information known resulted in harm.

psychosis

significant thought disturbance in which reality testing is impaired - Individuals may experience delusions, hallucinations, disorganized speech, or catatonic behavior.

Ethical dilemmas

situations that require individuals to make a choice between two equally unfavorable alternatives - there is evidence to support both moral right and wrongness related to each choice - This does not mean that all ethical issues are dilemmas: A dilemma only arises when there is no a clear reason to choose one option over another, and that there are desirable and undesirable outcomes to both. - Taking no action is considered an action taken.

Treatment - psychological treatments - group therapy

some success if occuring over the long-term course of the illness; less successful in acute, short-term treatment

Milieu therapy came into its own during the 1960s, 1970s, and early 1980s when psychiatric inpatient treatment provided?

sufficient time to implement programs of therapy aimed at social rehabilitation. - Nursing's focus of establishing interpersonal relationships with clients fit well within this concept of therapy - Patients were encouraged to be active participants in their therapy, and individual autonomy was emphasized.

The standards of practice for psychiatric nursing are written around the six steps of the nursing process - assessment

systematic process by which the registered nurse, through interaction with the patient, family, groups, communities, populations, and healthcare providers, collects and analyzes data. This information is used to establish a database to determine the best possible care for the client.

Other schizophrenia spectrum and psychotic disorders - delusional disorder

the existence of prominent, nonbizarre delusions - erotomanic type - grandiose type - jealous type - persecutory type - somatic type - mixed type - delusions of reference - delusions of control

Effects of alcohol on the body - acute alcoholic myopathy

the individual experiences a sudden onset of muscle pain, swelling, and weakness. These symptoms are usually generalized, but pain and swelling may selectively involve the calves or other muscle groups.

Types of schizophrenia and other psychotic disorders - substance- and medication-induced psychotic disorder

the presence of prominent hallucinations and delusions that are judged to be directly attributable to substance intoxication or withdrawal

Types of lawsuits that occur in psychiatric nursing - Defamation of character

they share false or malicious information that is detrimental to the client's reputation. - When this information is in writing, it is referred to as libel - When it is spoken, it is called slander.

Types of schizophrenia and other psychotic disorders - catatonic disorder due to anotehr medical condition

this diagnosis is made when the catatonic symptoms are directly attributable to the physiolgoical consequences of a general medical condition - walk slow, do not talk, eat slow, rigid, everything is so slow, stupor, negativism

Mesocortical

underactive dopamine causes negative symptoms

Psychopharmacology for bipolar disorder - for depressive phase

use antidepressants with care(may trigger mania due to serotonin content)

Special concerns of elderly people - physical abuse

use of physical force against an older adult that may result in bodily injury, physical pain, or impairment

Client outcomes for dissociative disorders

•Can recall events associated with a traumatic or stressful situation (dissociative amnesia). •Can verbalize the extreme anxiety that precipitated the dissociation (depersonalization-derealization disorder). •Can demonstrate more adaptive coping strategies to avert dissociative behaviors in the face of severe anxiety (depersonalization-derealization disorder). •Verbalizes understanding of the existence of multiple personality states and the purposes they serve (dissociative identity disorder). •Is able to maintain a sense of reality during stressful situations (depersonalization-derealization disorder).

Paranoid Personality Disorder clinical picture

•Constantly on guard •Hypervigilant •Ready for any real or imagined threat •Trusts no one •Constantly tests the honesty of others •Suspicious •Insensitive to the feelings of others •Overly sensitive to criticism/opposition •Blames shortcomings on others •Tends to misinterpret minute cues •Magnifies and distorts cues in the environment •Does not accept responsibility for his or her own behavior

Evaluation

•Does the client recognize when anger is getting out of control? •Can the client seek out staff instead of expressing anger in an inappropriate manner? •Can the client use other sources for rechanneling anger (e.g., physical activities)? •Has harm to others been avoided? •Can the client follow rules and regulations of the therapeutic milieu with little or no reminding? •Can the client verbalize which behaviors are appropriate and which are not? •Does the client express a desire to change? •Can the client delay gratifying own desires in deference to those of others when appropriate? •Does the client refrain from manipulating others to fulfill own desires? •Does the client fulfill activities of daily living willingly and independently? •Can the client verbalize methods of achieving and maintaining optimal wellness? •Can the client verbalize community resources from which he or she can seek assistance with daily living and healthcare needs when required?

Client outcomes for somatic symptom disorders

•Effectively uses adaptive coping strategies during stressful situations without resorting to physical symptoms (somatic symptom disorder). •Interprets bodily sensations rationally; verbalizes understanding of the significance the irrational fear held for him or her; and has decreased the number and frequency of physical complaints (illness anxiety disorder and somatic symptom disorder). •Is free of physical disability and is able to verbalize understanding of the possible correlation between the loss of or alteration in function and extreme emotional stress (conversion disorder).

Nursing process - evaluation for substance use disorder

•Has detoxification occurred without complications? •Is the client still in denial? •Does the client accept responsibility for his or her own behavior? Has he or she acknowledged a personal problem with substances? •Has a correlation been made between personal problems and the use of substances? •Does the client still make excuses or blame others for use of substances? •Has the client remained substance-free during treatment? •Does the client cooperate with treatment? •Does the client refrain from manipulative behavior and violation of limits? •Is the client able to verbalize motivation toward alternative adaptive coping strategies to substitute for substance use? Has the use of these strategies been demonstrated? Does positive reinforcement encourage repetition of these adaptive behaviors? •Has nutritional status been restored? Does the client consume a diet adequate for his or her size and level of activity? Is the client able to discuss the importance of adequate nutrition? •Has the client remained free of infection during hospitalization? •Is the client able to verbalize the effects of substance abuse on the body?

Outcome identification for substance use disorder

•Has not experienced physical injury. • Has not caused harm to self or others. • Accepts responsibility for own behavior. • Acknowledges association between personal problems and use of substance(s). • Demonstrates more adaptive coping mechanisms that can be used in stressful situations (instead of taking substances). • Shows no signs or symptoms of infection or malnutrition. • Exhibits evidence of increased self-worth by attempting new projects without fear of failure and by demonstrating less defensive behavior toward others. • Verbalizes importance of abstaining from use of substances in order to maintain optimal wellness.

Evaluation: Borderline Personality Disorder

•Has the client avoided self-harm? •Can the client correlate times of desire for self-harm to times of elevation in level of anxiety? •Can the client discuss feelings with staff (particularly feelings of depression and anger)? •Can the client identify the true source toward which the anger is directed? •Can the client verbalize understanding of the basis for his or her anger? •Can the client express anger appropriately? •Can the client function independently? •Can the client relate to more than one staff member? •Can the client verbalize the knowledge that the staff members will return and are not abandoning the client when leaving for the day? •Can the client separate from the staff in an appropriate manner? •Can the client delay gratification and refrain from manipulating others in order to fulfill own desires? •Can the client verbalize resources within the community from whom he or she may seek assistance in times of extreme stress?

Evaluation for the client with anorexia, bulimia, or binge eating disorder and associated obesity:

•Has the client been able to develop a more realistic perception of body image? • Has the client acknowledged that past self-expectations may have been unrealistic? • Does the client accept self as less than perfect? • Has the client developed adaptive coping strategies to deal with stress without resorting to maladaptive eating behaviors? - Behavioral change will be required by the client and family members.

Evaluation

•Has the client escaped injury from falls, burns, or other means to which he or she is vulnerable because of age? •Can caregivers verbalize means of providing a safe environment for the client? •Does the client maintain reality orientation at an optimum for his or her cognitive functioning? •Can the client distinguish between reality-based and non-reality-based thinking? •Can caregivers verbalize ways in which to orient the client to reality, as needed? •Is the client able to accomplish self-care activities independently to his or her optimum level of functioning? •Does the client seek assistance for aspects of self-care that he or she is unable to perform independently? •Does the client express positive feelings about himself or herself? •Does the client reminisce about accomplishments that have occurred in his or her life? •Does the client express some hope for the future? •Does the client wear eyeglasses or a hearing aid, if needed, to compensate for sensory deficits? •Does the client consistently look at others in the face to facilitate hearing when they are talking to him or her? •Does the client use helpful aids, such as signs identifying various rooms, to help maintain orientation? •Can the caregivers work through problems and make decisions regarding care of the elderly client? •Do the caregivers include the elderly client in the decision-making process, if appropriate? •Can the caregivers demonstrate adaptive coping strategies for dealing with the strain of long-term caregiving? •Are the caregivers open and honest in the expression of feelings? •Can the caregivers verbalize community resources to which they can go for assistance with their caregiving responsibilities? •Have the caregivers joined a support group?

Evaluation of tourette disorder

•Has the client refrained from causing harm to self or others during times of increased tension? • Has the client developed adaptive coping strategies for dealing with frustration to prevent resorting to self-destruction or aggression to others? • Is the client able to interact appropriately with staff and peers? • Is the client able to suppress tic behaviors when he or she chooses to do so? • Does the client set a time for "release" of the suppressed tic behaviors? • Does the client verbalize positive aspects about self, particularly as they relate to his or her ability to manage the illness? • Does the client comply with treatment in a nondefensive manner?

Short-term evaluation may be facilitated by gathering information using the following types of questions:

•Has the individual been reassured of his or her safety? •Is this evidenced by a decrease in panic anxiety? •Have wounds been properly cared for and provisions made for follow-up care? •Have emotional needs been attended to? •Has trust been established with at least one person to whom the client feels comfortable relating the abusive incident? •Have available support systems been identified and notified? •Have options for immediate circumstances been presented? Healthcare workers who have contact with the individual long after the immediate crisis has passed may conduct a long-term evaluation. •Is the individual able to conduct activities of daily living satisfactorily? •Have physical wounds healed properly? •Is the client appropriately progressing through the behaviors of grieving? •Is the client free of sleep disturbances (nightmares, insomnia); psychosomatic symptoms (headaches, stomach pains, nausea/vomiting); regressive behaviors (enuresis, thumb-sucking, phobias); and psychosexual disturbances? •Is the individual free from problems with interpersonal relationships? •Has the individual considered the alternatives for change in his or her personal life? •Has a decision been made relative to the choices available? •Is he or she satisfied with the decision that has been made?

Evaluation of IDD

•Have nursing actions providing for the client's safety been sufficient to prevent injury? • Have all of the client's self-care needs been fulfilled? Can he or she fulfill some of these needs independently? • Has the client been able to communicate needs and desires so that he or she can be understood? • Has the client learned to interact appropriately with others? • When regressive behaviors surface, can the client accept constructive feedback and discontinue the inappropriate behavior? • Has anxiety been maintained at a manageable level? • Has the client learned new coping skills through behavior modification? Does the client demonstrate evidence of increased self-esteem because of the accomplishment of these new skills and adaptive behaviors? • Have primary caregivers been taught realistic expectations of the client's behavior and methods for attempting to modify unacceptable behaviors? • Have primary caregivers been given information regarding various resources from which they can seek assistance and support within the community?

Evaluation of client with ADHD

•Have the nursing actions directed at client safety been effective in protecting the child from injury? •Has the child been able to establish a trusting relationship with the primary caregiver? •Is the client responding to limits set on unacceptable behaviors? •Is the client able to interact appropriately with others? •Is the client able to verbalize positive statements about self? •Is the client able to complete tasks independently or with a minimum of assistance? Can he or she follow through after listening to simple instructions? •Is the client able to apply self-control to decrease motor activity?

Evaluation of conduct disorder

•Have the nursing actions directed toward managing the client's aggressive behavior been effective? • Have interventions prevented harm to others or others' property? • Is the client able to express anger in an appropriate manner? • Has the client developed more adaptive coping strategies to deal with anger and feelings of aggression? • Does the client demonstrate the ability to trust others? Is he or she able to interact with staff and peers in an appropriate manner? • Is the client able to accept responsibility for his or her own behavior? Is there less blaming of others? • Is the client able to accept feedback from others without becoming defensive? • Is the client able to verbalize positive statements about self? • Is the client able to interact with others without engaging in manipulation?

Child abuse - behavioral indicators of neglect

•Is frequently absent from school. •Begs or steals food or money. •Lacks needed medical or dental care, immunizations, or glasses. •Is consistently dirty and has severe body odor. •Lacks sufficient clothing for the weather. •Abuses alcohol or other drugs. •States that there is no one at home to provide care. The possibility of neglect may be considered when the parent or other adult caregiver: •Appears to be indifferent to the child. •Seems apathetic or depressed. •Behaves irrationally or in a bizarre manner. •Is abusing alcohol or other drugs.

Evaluation: Separation anxiety disorder

•Is the client able to maintain anxiety at a manageable level (i.e., without temper tantrums, screaming, or clinging)? •Have complaints of physical symptoms diminished? •Has the client demonstrated the ability to cope in more adaptive ways in the face of escalating anxiety? •Have the parents identified their role in the separation conflict? Are they able to discuss more adaptive coping strategies? •Does the client verbalize an intention to return to school? •Have nightmares and fears of the dark subsided? •Is the client able to interact with others away from the attachment figure? •Has the precipitating stressor been identified? Have strategies for coping more adaptively to similar stressors in the future been established? - botht he client and the family memnbers will have to change their behavior

Evaluation of ODD

•Is the client cooperating with the schedule of therapeutic activities? Is the level of participation adequate? • Is the client's attitude toward therapy less negative? • Is the client accepting responsibility for problem behavior? • Is the client verbalizing the unacceptability of his or her passive-aggressive behavior? • Is he or she able to identify which behaviors are unacceptable and substitute more adaptive behaviors? • Is the client able to interact with staff and peers without defending behavior in an angry manner? • Is the client able to verbalize positive statements about self? • Is increased self-worth evident with fewer manifestations of manipulation? • Is the client able to make compromises with others when issues of control emerge? • Is anger and hostility expressed in an appropriate manner? Can the client verbalize ways of releasing anger adaptively? Is he or she able to verbalize true feelings instead of allowing them to emerge through use of passive-aggressive behaviors?

Specific characteristics relating to trauma have been identified as crucial elements in the determination of an individual's long-term response. They include:

•Severity and duration of the stressor • Extent of anticipatory preparation for the event • Exposure to death • Numbers affected by life threat • Amount of control over recurrence • Location where the trauma was experienced (for example, familiar surroundings, at home, in a foreign country) Variables that are considered important in determining an individual's response to trauma include: • Degree of ego-strength • Effectiveness of coping resources • Presence of preexisting psychopathology • Outcomes of previous experiences with stress/trauma • Behavioral tendencies (temperament) • Current psychosocial developmental stage • Demographic factors (for example, age, socioeconomic status, education) It has also been suggested that the quality of the environment in which the individual attempts to work through the traumatic experience is correlated with the outcome. Environmental variables include: • Availability of social supports • The cohesiveness and protectiveness of family and friends • The attitudes of society regarding the experience • Cultural and subcultural influences

Indicators of emtoional almatreatment may include the following behaviors from the child:

•Shows extremes in behavior, such as overly compliant or demanding behavior, extreme passivity, or aggression • Is either inappropriately adult (e.g., parenting other children) or inappropriately infantile (e.g., frequently rocking or head-banging) • Is delayed in physical or emotional development • Has attempted suicide • Reports a lack of attachment to the parent Emotional abuse may be suspected when the parent or other adult caregiver: • Constantly blames, belittles, or berates the child. • Is unconcerned about the child and refuses to consider offers of help for the child's problems. - Overtly rejects the child.

Personality

•The totality of emotional and behavioral characteristics that are particular to a specific person and that remain somewhat stable and predictable over time.

It has been suggested that an individual who has experienced previous trauma is more likely to develop symptoms after a stressful life event. Hollander and Simeon also report on studies that suggest an endogenous opioid peptide response may assist in the maintenance of chronic P T S D. Opioids, including endogenous opioid peptides, have the following psychoactive properties:

•Tranquilizing action •Reduction of rage/aggression •Reduction of paranoia •Reduction of feelings of inadequacy •Antidepressant action

Outcome criteria for adjustment disorders

•Verbalizes acceptable grieving behaviors •Demonstrates a reinvestment in the environment •Accomplishes activities of daily living independently •Demonstrates ability to function adequately •Accepts change in health status •Sets realistic goals for the future •Demonstrates ability to cope effectively with change in lifestyle

What to say for suicide

- Acknowledge the situation. Talking directly can be important; this can show that you are not afraid to have a real conversation about the loss they have experienced. Example: "I heard that _____ died by suicide." Using the word "suicide" can be scary, but showing that you are able to talk more openly about what happened can be a way of showing that you are willing to discuss the full extent of the loss. Always make sure you choose an appropriate time and place to have a conversation like this, so your friend can feel safe talking to you about their loss. - Express your concern. Show your friend that you are aware that this has affected them and that you are there when they need help. Example: "I'm sorry to hear that this happened. I am here when you need me." - Reflect on their emotions. One way of demonstrating to your friend that you are able to hear their story is by reflecting back to them what they are saying. Example: "You're sad and confused about why all this happened." - Be genuine in your communication, and don't hide your feelings. It is OK to show that you are also saddened by the loss and that you do not have all the answers. Example: "I'm not sure what to say, but I want you to know I care." - Offer your support. Sometimes the most powerful thing you can do for someone is just letting them know that you are there for them when they need you. Example: "I want you to know I'm here for you. Tell me what I can do." - Ask how he or she feels. Don't assume you know how the bereaved person feels on any given day. Sometimes just asking a friend how they feel allows the opportunity for your friend to express their feelings.

Nursing intervention for the client with an adjustment disorder is aimed at:

- Adaptive progression through the grief process - Helping the client achieve acceptance of a change in health status - Assisting with strategies to maintain anxiety at a manageable level

Nursing process: assessment - demographics

- Age - Gender - Ethnicity/race - Marital status - Socioeconomic status / Occupation - Lethality and availability of method - Religion - Family history of suicide - Military history

The impact of preexisting conditions - age or developmental level

- Age influences communication, especially during adolescence. - Words such as "dude," "groovy," "clueless," "awesome," "cool," and "wasted" have had special meaning for different generations of adolescents. - The technological age has produced a whole new language for today's adolescents. - Developmental influences on communication may relate to physiological alterations. - One example is American Sign Language, the system of unique gestures used by many people who are deaf or hearing impaired. Individuals who are blind at birth never learn the subtle nonverbal gesticulations that accompany language and can totally change the meaning of the spoken word.

Substance-induced neurocognitive disorder - predisposing factors - occurs as a result of reactions to or the overuse or abuse of, substances such as?

- Alcohol - Inhalants - Sedatives, hypnotics, and anxiolytics - Medications that cause anticholinergic side effects - Toxins, such as lead and mercury N C D can occur as the result of substance reactions, overuse, or abuse. Symptoms are consistent with major or mild neurocognitive disorder, and persist beyond the usual duration of intoxication and acute withdrawal. Substances that have been associated with the development of N C D's include alcohol, sedatives, hypnotics, anxiolytics, and inhalants. Drugs that cause anticholinergic side effects, and toxins such as lead and mercury, have also been implicated.

Effects of alcohol on the body - sexual dysfunction

- Alcohol can interfere with the normal production and maintenance of female and male hormones. - For women, this can mean changes in the menstrual cycles and a decreased or lost ability to become pregnant. - For men, the altered hormone levels result in a diminished libido, decreased sexual performance, and impaired fertility, and gynecomastia may develop secondary to testicular atrophy. - In the short term, enhanced libido and failure of erection are common. - Long-term effects include gynecomastia, sterility, impotence, and decreased libido.

Anxiety may be associated with intoxication or withdrawal from any of the following substances:

- Alcohol, sedatives, hypnotics, or anxiolytics - Amphetamines or cocaine - Hallucinogens - Caffeine - Cannabis

Inhalant use disorder - profile of the substance

- Aliphatic and aromatic hydrocarbons are found in substances such as fuels, solvents, adhesives, aerosol propellants, and paint thinners. - induced by substances such as fuels, solvents, adhesives, aerosol propellants, and paint thinners. - Common examples include gasoline, varnish remover, lighter fluid, airplane glue, rubber cement, cleaning fluid, spray paint, shoe conditioner, and typewriter correction fluid. - Toluene (methylbenzene, toluol, phenylmethane) is a common ingredient in many of the substances that are inhaled and is responsible for the mind-altering effects that occur after inhalation.

Effects of opioids on the body

- All opioids, opioid derivatives, and synthetic opioid-like drugs affect the CNS. - Common manifestations include euphoria, mood changes, and mental clouding. - Other common CNS effects include drowsiness and pain reduction. - The antitussive response is due to suppression of the cough center within the medulla. - The nausea and vomiting commonly associated with opiate ingestion is related to the stimulation of the centers within the medulla that trigger this response. - Opioids exert a profound effect on the GI tract. - Both stomach and intestinal tone are increased, whereas peristaltic activity of the intestines is diminished. - These effects lead to a marked decrease in the movement of food through the GI tract. - This is a notable therapeutic effect in the treatment of severe diarrhea. - In fact, no drugs have yet been developed that are more effective than the opioids for this purpose. - Morphine is used extensively to relieve pulmonary edema and the pain of myocardial infarction in cardiac clients. - At high doses, opioids induce hypotension, which may be caused by direct action on the heart or by opioid-induced histamine release. - With opioid use, there is decreased sexual function and diminished libido. - Delayed ejaculation, impotence, and orgasm failure may occur.

Referral

- Although structured screening has been established as a critical first step to improving care, controversy arises over: - How much care can be provided in nonpsychiatric settings? - When is it appropriate to refer a patient to a specialist for treatment? - If nurses lack clarity about their roles and responsibilities, referring the patient to needed services is unlikely to happen. - Patient-centered care involves collaboration with the patient in the referral process. - Listen to the patient, empower them in decision making around their care, and establish a collaborative partnership. - Patients who are at high risk of hurting themselves or are unaware they have significant symptoms of mental illness need to be referred to a restrictive environment (even against their own will).

Sexual aspects of normal aging

- Americans have grown up in a society that has liberated sexual expression for all other age groups. - Americans still retain certain Victorian standards regarding sexual expression by elderly people. - Cultural stereotypes play a large part in the misperception many people hold regarding the sexuality of older adults. - Cultural stereotypes play a large part in the misperception many people hold regarding the sexuality of older adults. Sexuality and the sexual needs of elderly people are frequently misunderstood, condemned, stereotyped, ridiculed, repressed, and ignored. Negative stereotyped notions concerning sexual interest and activity of the elderly are common. Some of these include ideas that older people have no sexual interests or desires, that they are sexually undesirable, or that they are too fragile or too ill to engage in sexual activity. With reasonable good health and an interesting and interested partner, there is no inherent reason why individuals should not enjoy an active sexual life well into late adulthood.

Neurocognitive disorder due to traumatic brain injury - predisposing factors

- Amnesia is the most common neurobehavioral symptom following head trauma. - Repeated head trauma can result in dementia pugilistica with symptoms of Emotional lability, Dysarthria, Ataxia, and Impulsivity is caused by an impact to the head or other mechanisms of rapid movement or displacement of the brain within the skull, with one or more of the following: loss of consciousness, post-traumatic amnesia, disorientation and confusion, or neurological signs. Other symptoms may include confusion and changes in speech, vision, and personality.

Characteristics that Maslow believed self-actualized individuals possess:

- An appropriate perception of reality - The ability to accept oneself, others, and human nature - The ability to manifest spontaneity - The capacity for focusing concentration on problem-solving - A need for detachment and a desire for privacy - Independence, autonomy, and a resistance to enculturation - An intensity of emotional reaction - A frequency of "peak" experiences that validate the worthwhileness, richness, and beauty of life - An identification with humankind -The ability to achieve satisfactory interpersonal relationships - A democratic character structure and a strong sense of ethics - Creativity - A degree of nonconformance

Adolescence depression symptoms include

- Anger, aggressiveness - Running away - Delinquency - Social withdrawal - Sexual acting out - Substance abuse - Restlessness, apathy - loss of self esteem - sleeping and eating disturbances - restlessness - apathy - they act different than their baseline - harder to recognize in an adolescent than in a younger child

Treatment of senescence

- Antidepressant medication - Antidepressant medications are administered with consideration for age-related physiological changes in absorption, distribution, elimination, and brain receptor sensitivity - Electroconvulsive therapy Psychotherapies - Electroconvulsive therapy (ECT) is an important alternative for treatment of major depression in the elderly, especially considering the problematic side effects of antidepressants in this population. - Other therapeutic approaches include interpersonal, behavioral, cognitive, group, and family psychotherapies.

Psychopharmacology for depression

- Antidepressant medication is generally considered first-line treatment for severe clinical depression, but is also used in other depressive disorders - These include tricyclic, tetracyclic, and heterocyclic antidepressants, monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), selective norepinephrine reuptake inhibitors (SNRIs) and SSRI/SNRI combination drugs. - It is important to note that antidepressant medication can be lethal in overdose, so depressed/suicidal patients must be observed closely and suicide risk assessed frequently.

Antisocial personality disorder

- Antisocial personality disorder is a pattern of socially irresponsible, exploitative, and guiltless behavior that reflects a general disregard for the rights of others. - These individuals exploit and manipulate others for personal gain and are unconcerned with obeying the law.

Diagnosis/Outcome Identification: Separation anxiety disorder

- Anxiety (severe) related to family history, temperament, overattachment to parent, negative role modeling - Ineffective coping related to unresolved separation conflicts and inadequate coping skills evidenced by numerous somatic complaints - Impaired social interaction related to reluctance to be away from attachment figure

Depersonalization-Derealization disorder - symptoms are often accompanied by:

- Anxiety and depression - Fear of going insane - Obsessive thoughts - Somatic complaints - Disturbance in the subjective sense of time

Epidemiological statistics - economic status

- Approximately 4.6 million persons age 65 years or older were below the poverty level in 2016. More than 4.6 million (9.5%) persons, age 65 or older, were below the poverty level in 2016, and when the U.S Census Bureau figures adjusted for regional variations in cost of housing, other benefits, and out-of-pocket expenses for needs such as medical care, the percentage of those living below the poverty level rose to 14.5% (AoA, 2018). Older women had a higher poverty rate than older men, and older Hispanic women living alone had the highest poverty rate. Poor people who have worked all their lives can expect to become poorer in old age, and others will become poor only after becoming old. However, there are a substantial number of affluent and middle-income older persons. Of individuals 75 years or older, 76% owned their own homes in 2016 (AoA, 2018). However, the housing of this population of Americans is usually older and less adequate than that of the younger population; therefore, a higher percentage of income must be spent on maintenance and repairs. The AoA reports that in 2016, 44% of older adults living in houses spent more than 33% of their income on housing costs.

Additional symptoms may appear as NCD progresses:

- Apraxia, which is the inability to carry out motor activities despite intact motor function, may develop. - the individual may be irritable, moody, or exhibit sudden outbursts over trivial issues. - The ability to work or care for personal needs independently will no longer be possible. - These individuals can no longer be left alone because they are at serious risk for accidents.

Inhalant use disorder - patterns of use for inhalants

- As Inhalant substances are readily available, legal, and inexpensive, they are the drug of choice among children, teens, and young adults. - Highest usage is by youths ages 12 to 17. - Methods of use include "huffing," which is a procedure in which a rag soaked with the substance is applied to the mouth and nose, and the vapors are breathed in. - Another common method is called "bagging," in which the substance is placed in a paper or plastic bag and inhaled from the bag by the user. - The substance may also be inhaled directly from the container or sprayed in the mouth or nose.

Narcissistic Personality Disorder - predisposing factors

- As children, fears, failures, or dependency needs were responded to with criticism, disdain, or neglect. - Parents were often narcissistic themselves. - Parents may have overindulged the child and failed to set limits on inappropriate behavior. - Several psychodynamic theories exist regarding the predisposition to narcissistic personality disorder. Skodol and Gunderson suggest that, as children, these individuals had their fears, failures, or dependency needs responded to with criticism, disdain, or neglect. They grow up with contempt for these behaviors in themselves and others and are unable to view others as sources of comfort and support. Martinez-Lewi suggests that the parents of individuals with narcissistic personality disorder were often narcissistic themselves. The parents were demanding, perfectionistic, and critical, and they placed unrealistic expectations on the child. Narcissism may also develop from an environment in which parents attempt to live their lives vicariously through their child. They expect the child to achieve the things they did not achieve, possess that which they did not possess, and have life better and easier than they did.

Body mass index

- Assessment for the presence of an eating disorder requires an understanding of body mass index. - B M I equals weight (kg) divided by height (m) squared. - The B M I range for normal weight is 20 to 24.9. - overweight is defined as a B M I of 25.0 to 29.9. - obesity is defined as a B M I of 30.0 or greater. - The average American woman has a B M I of 26, and fashion models typically have B M Is of 18. - Anorexia nervosa is characterized by a B M I of 17 or lower. - In extreme anorexia nervosa, the B M I may be less than 15.

Assessment of elderly patients

- Assessment of elderly people must consider the possible biological, psychological, sociocultural, and sexual changes that occur in the normal aging process. - Age alone does not preclude the occurrence of these changes, and each client must be assessed as a unique individual. Older adults are likely to have multiple physical problems that contribute to problems in other areas of their lives. Nursing the elderly is a multifaceted, challenging process because of the multiple changes occurring at this time in the life cycle, and the way in which each change affects every aspect of the individual. Several considerations are unique to assessment of the elderly. Assessment of the older person's thought processes is a primary responsibility. Knowledge about the presence and extent of disorientation or confusion will influence the way in which the nurse approaches elder care. Information about sensory capabilities is also extremely important. Because hearing loss is common, the nurse should lower the pitch and loudness of his or her voice when addressing the older person. Looking directly into the face of the older person when talking facilitates communication. Knowledge of the client's functional capabilities is essential for determining the physiological, psychological, and sociological needs of the elderly individual.

Autism spectrum disorder

- Autism spectrum disorder (A S D) is characterized by a withdrawal of the child into the self and into a fantasy world of his or her own creation. - Prevalence is about 1 in 59 children. - A S D occurs more often in boys than in girls. - Onset occurs in early childhood. - A S D often runs a chronic course. Autism spectrum disorder is a heterogenous group of neurodevelopmental syndromes characterized by a wide range of communication impairments and restricted, repetitive behaviors. In the DSM-IV-TR, the category of Autism Spectrum Disorders encompassed a broad spectrum of diagnoses that included autistic disorder, Rett's disorder, childhood disintegrative disorder, pervasive developmental disorder not otherwise specified, and Asperger's disorder. The DSM-5 groups these disorders into a single diagnostic category. The diagnosis is adapted to each individual by clinical specifiers and associated features. A S D is characterized by a withdrawal of the child into the self and into a fantasy world of his or her own creation. The child has abnormal or impaired development in social interaction and communication, and a restricted repertoire of activity and interests, some of which may be considered somewhat bizarre. The CDC Autism and Developmental Disabilities Monitoring (ADDM) Network estimates that 1 in 59 children in the United States is identified with A S D, a number that has more than doubled since 2000. It occurs about 4 times more often in boys than in girls. Almost half of individuals with A S D have an average or above average IQ.

What else should you not do on antidepressants?

- Avoid drinking alcohol while taking antidepressant therapy. - These drugs potentiate the effects of each other. - Do not use other medications, including over-the-counter medications, without the physician's approval(hypertensive crisis)

Planning/Implementation - risk for suicide

- Be direct. - Maintain close observation at irregular intervals. - Encouraging verbalizations of honest feelings - Goals for treating clients who are at risk for suicide should center on preventing the client from harming him or herself. Interventions include assessing frequently for the presence of suicidal ideation, maintaining close observation, and identifying resources the client may use as a support system.

Hallucinogen use disorder - patterns of use

- Because cognitive and perceptual abilities are so affected by these substances, the user must set aside time from normal daily activities for indulging in the consequences. - LSD, like other hallucinogens, does not lead to the development of physical addiction or withdrawal symptoms. - PCP is usually taken episodically, in binges that can last for several days. - However, some chronic users take the substance daily. - Psilocybin is an ingredient of the Psilocybe mushroom indigenous to the United States and Mexico. - Ingestion of these mushrooms produces an effect similar to that of LSD but of a shorter duration. - Mescaline is the only hallucinogenic compound used legally for religious purposes today by members of the Native American Church of the United States. - It is the primary active ingredient of the peyote cactus. - Salvia is an herb from the mint family that has hallucinogenic effects when dried leaves are chewed, extracted juices are consumed, or smoke from the leaves is inhaled. - Among the very potent hallucinogens of the current drug culture are those that are categorized as derivatives of amphetamines. - These include 2,5-dimethoxy-4-methylamphetamine (DOM, STP), MDMA, and MDA. At lower doses, these drugs produce the "high" associated with CNS stimulants. - At higher doses, hallucinogenic effects occur.

Planning and implementation - risk for trauma

- Because the individual has impairments in cognitive and psychomotor functioning, it is important to ensure that the environment be made as safe as possible to prevent injury. - Short- and long-term goals should center around preventing injuries, and interventions include adjusting furniture and bed position and assisting the patient with ambulation. - For an agitated patient, maintain a low level of stimuli to try to mitigate irritability, hostility, aggression, and psychotic behaviors. - When caring for a patient who wanders, keep the individual on a structured schedule, and provide a safe enclosed space for wandering.

Treatment modalities for personality disorders - behavioral/cognitive therapy

- Behavioral strategies offer reinforcement for positive change. Social skills training and assertiveness training teach alternative ways to deal with frustration. - Cognitive strategies help the client recognize and correct distorted and irrational thinking patterns. There is also some limited evidence that cognitive therapy is beneficial for clients with schizotypal personality disorder.

Pharmacological Intervention: Tourette Disorder - pharmacological intervention for it is most effective when it is combined with other therapy, such as?

- Behavioral therapy - Individual counseling or psychotherapy - Family therapy

Medication for specific disorders - panic and GAD - anxiolytics(benzodiazepines)

- Benzodiazepines have been used with success in the treatment of generalized anxiety disorder - They can be prescribed on an as-needed basis when the client is feeling particularly anxious - Alprazolam, lorazepam, and clonazepam have been particularly effective in the treatment of panic disorder.

Senecence

- Bereavement overload - High percentage of suicides among elderly - Symptoms of depression often confused with symptoms of neurocognitive disorder - Depression is the most common psychiatric disorder of the elderly

Predisposing factors - biological influences - neurochemical influences

- Bulimia nervosa may be associated with the neurotransmitters serotonin and norepinephrine. - Anorexia nervosa may be associated with high levels of endogenous opioids. Neurochemical influences in bulimia may be associated with the neurotransmitters serotonin and norepinephrine. This hypothesis has been supported by the positive response these individuals have shown to therapy with selective serotonin reuptake inhibitors (SSRIs). Some studies have found high levels of endogenous opioids in the spinal fluid of clients with anorexia, promoting the speculation that these chemicals may contribute to denial of hunger. Some of these individuals have been shown to gain weight when given naloxone, an opioid antagonist. The etiology of binge eating disorders is unknown. Brain imaging studies of people with binge eating disorders reveal increased activity in the orbitofrontal cortex, which are the centers associated with reward and pleasure responses, such as those seen in response to substances of abuse. This has supported the hypothesis that binge eating disorder may be an illness of addiction.

Stimulant use disorder - what are they?

- CNS stimulants are identified by the behavioral stimulation and psychomotor agitation they induce. - Groups within this category are classified according to similarities in mechanism of action. - Psychomotor stimulants induce stimulation by augmentation or potentiation of the neurotransmitters norepinephrine, epinephrine, or dopamine. - The general cellular stimulants such as caffeine and nicotine exert their action directly on cellular activity.

Outcomes for the caregivers

- Can problem-solve effectively regarding care of the elderly client. - Demonstrate adaptive coping strategies for dealing with the stress of caregiver role. - Openly express feelings. - Express desire to join a support group of other caregivers.

Evaluation

- Can the client recognize signs and symptoms of escalating anxiety? - Can the client use skills learned to interrupt the escalating anxiety before it reaches the panic level? - Can the client demonstrate the activities most appropriate for him or her that can be used to maintain anxiety at a manageable level (for example, relaxation techniques, physical exercise)? - Can the client maintain anxiety at a manageable level without medication? - Can the client verbalize a long-term plan for preventing panic anxiety in the face of a stressful situation? - Can the client discuss the phobic object or situation without becoming anxious? - Can the client function in the presence of the phobic object or situation without experiencing panic anxiety? - Can the O C D client refrain from performing rituals when anxiety level rises? - Can the O C D client demonstrate substitute behaviors to maintain anxiety at a manageable level? - Does the O C D client recognize the relationship between escalating anxiety and the dependence on ritualistic behaviors for relief? - Can the client with trichotillomania refrain from hair-pulling? - Can the client with trichotillomania successfully substitute a more adaptive behavior when urges to pull hair occur? - Does the client with body dysmorphic disorder verbalize a realistic perception and satisfactory acceptance of personal appearance?

Effects of cannabis on the body

- Cannabis ingestion induces tachycardia and orthostatic hypotension. - With the decrease in blood pressure, myocardial oxygen supply is decreased. - Tachycardia, in turn, increases oxygen demand. - Marijuana produces a greater amount of "tar" than its equivalent weight in tobacco. - Because marijuana is most commonly smoked, larger amounts of tar are deposited in the lungs, promoting deleterious effects to the lungs. - Although the initial reaction to the marijuana is bronchodilation, thereby facilitating respiratory function, chronic use results in obstructive airway disorders. - Frequent marijuana users often have laryngitis, bronchitis, cough, and hoarseness. - Cannabis smoke contains more carcinogens than tobacco smoke. - Some studies have shown that, with heavy marijuana use, men may have a decrease in sperm count, motility, and structure. - In women, heavy marijuana use may result in a suppression of ovulation, disruption in menstrual cycles, and alteration of hormone levels. - Many people report a feeling of being "high." - Symptoms include feelings of euphoria, relaxed inhibitions, disorientation, depersonalization, and relaxation. - At higher doses, sensory alterations may occur, including impairment in judgment of time and distance, recent memory, and learning ability. - Physiological symptoms may include tremors, muscle rigidity, and conjunctival redness. - Toxic effects are generally characterized by panic reactions. - Very heavy usage has been shown to precipitate an acute psychosis that is self-limited and short-lived once the drug is removed from the body. - Heavy long-term cannabis use is also associated with a condition called amotivational syndrome. - Amotivational syndrome is defined as lack of motivation to persist in or complete a task that requires ongoing attention. - Marijuana is reported to enhance the sexual experience in both men and women. - The intensified sensory awareness and the subjective slowness of time perception are thought to increase sexual satisfaction. - Marijuana also enhances the sexual functioning by releasing inhibitions for certain activities that would normally be restrained.

Cannabis use disorder - patterns of use

- Cannabis products are usually smoked in the form of loosely rolled cigarettes. - Cannabis can also be taken orally when it is prepared in food, but about two to three times the amount of cannabis must be ingested orally to equal the potency of that obtained by the inhalation of its smoke. - In its 2014 National Survey on Drug Use and Health, SAMHSA reported that an estimated 22.2 million Americans age 12 years or older were current illicit drug users of marijuana. - This estimate represents almost 8.4% of the population age 12 years old or older.

Neurocognitive disorder due to parkinson's - predisposing factors

- Caused by a loss of nerve cells located in the substantia nigra and a decrease in dopamine activity - Cerebral changes in N C D due to Parkinson's disease sometimes resemble those of A D N C D is observed in as many as 75% of patients with Parkinson's disease. In this disease, there is a loss of nerve cells located in the substantia nigra, and dopamine activity is diminished, resulting in involuntary muscle movements, slowness, and rigidity. Tremor in the upper extremities is characteristic.

Neurocognitive disorder due to HIV - predisposing factors

- Caused by brain infections with opportunistic organisms or by the H I V-1 virus directly - Symptoms may range from barely perceptible changes to acute delirium to profound cognitive impairment. Infection with the human immunodeficiency virus-type 1 (H I V-1) can result in a N C D called H I V-1-associated cognitive/motor complex. A less severe form, known as H I V-1-associated minor cognitive/motor disorder, also occurs. In the early stages, neuropsychiatric symptoms may be manifested by barely perceptible changes in a person's normal psychological presentation. Severe cognitive changes, particularly confusion, changes in behavior, and sometimes psychoses, are not uncommon in the later stages.

Anorexia nervosa

- Characterized by a morbid fear of obesity - Symptoms include gross distortion of body image, preoccupation with food, and refusal to eat. - Anorexia refers to a prolonged loss of appetite. - Anorexia nervosa is characterized by a morbid fear of obesity. Symptoms include gross distortion of body image, preoccupation with food, and refusal to eat. - Body image is a subjective concept of one's physical appearance based on personal perceptions of self and the reaction of others. - The distortion in body image is manifested by the individual's perception of being fat when he or she is obviously underweight or even excessively thin.

Dependent Personality Disorder

- Characterized by a pattern of relying on others for emotional support - Lack of self confidence - Extreme reliance on others - Dependent personality disorder is characterized by lack of self-confidence and extreme reliance on others to take responsibility for them. This mode of behavior is evident in the tendency to allow others to make decisions, to feel helpless when alone, to act submissively, to subordinate needs to others, to tolerate mistreatment by others, to demean oneself to gain acceptance, and to fail to function adequately in situations that require assertive or dominant behavior.

Oppositional Defiant Disorder(ODD)

- Characterized by a persistent pattern of angry mood and defiant behavior - Occurs more frequently than is usually observed in individuals of comparable age and developmental level - Interferes with social, educational, or vocational activities Oppositional defiant disorder (O D D) is characterized by a persistent pattern of angry mood and defiant behavior that occurs more frequently than is usually observed in individuals of comparable age and developmental level, and interferes with social, educational, occupational, or other important areas of functioning. The disorder typically begins by 8 years of age and usually not later than early adolescence. Prevalence estimates range from 2% to 16%, and common comorbid disorders include A D H D, anxiety, major depressive disorder, conduct disorder, and substance use disorders.

Paranoid Personality Disorder

- Characterized by a pervasive, persistent, and inappropriate mistrust of others - Individuals with this disorder are suspicious of others' motives and assume that others intend to exploit, harm, or deceive them. - The disorder is more common in men than in women. - Paranoid personality disorder is defined as a pattern of pervasive mistrust and suspiciousness of others, and misinterpretation of others' motives as malevolent. This pattern begins by early adulthood and remains present in a variety of contexts. Prevalence has been estimated at 1% to 4% of the general population, and is often only diagnosed when the individual seeks treatment for a mood or anxiety disorder. The disorder is more commonly diagnosed in men than in women.

Narcissistic Personality Disorder

- Characterized by an exaggerated sense of self-worth - Lack of empathy - Belief in an inalienable right to receive special consideration - Prevalence of the disorder is estimated between 1% to 6%. - Diagnosed more often in men than in women Persons with narcissistic personality disorder have an exaggerated sense of self-worth. They lack empathy, and are hypersensitive to the evaluation of others. They believe that they have the inalienable right to receive special consideration and that their desire is sufficient justification for possessing whatever they seek. - The concept of narcissism has its roots in the 19th century. Early psychoanalysts viewed it as a normal phase of psychosexual development. The prevalence of narcissistic personality disorder is estimated at 1% to 6%. It is diagnosed more often in men than in women.

Obsessive-Compulsive Personality Disorder

- Characterized by inflexibility about the way in which things must be done - Devotion to productivity at the exclusion of personal pleasure - Relatively common - Occurs more often in men than in women - Within the family constellation, it appears to be most common in oldest children. - Individuals with obsessive-compulsive personality disorder are very serious and formal and have difficulty expressing emotions. They are overly disciplined, perfectionistic, and preoccupied with rules. They are inflexible about the way in which things must be done and have a devotion to productivity to the exclusion of personal pleasure. - An intense fear of making mistakes leads to difficulty with decision making. The disorder is relatively common and occurs more often in men than in women. Within the family constellation, it appears to be most common in oldest children. Recurrent obsessions and compulsions are absent in this personality disorder and if the client presents with such symptoms, they are diagnosed with obsessive-compulsive disorder rather than obsessive-compulsive personality disorder

Schizoid Personality Disorder

- Characterized primarily by a profound defect in the ability to form personal relationships - Failure to respond to others in a meaningful emotional way - Diagnosis occurs more frequently in men than in women. - Prevalence within the general population has been estimated at 3% to 5%. - Schizoid personality disorder is characterized primarily by a profound defect in the ability to form personal relationships; others often see them as eccentric, isolated, or lonely. These individuals display a lifelong pattern of social withdrawal, and their discomfort with human interaction is apparent.

Adjustment disorders predisposing factors - psychosocial theories

- Childhood trauma, dependency, arrested development - Constitutional factor (birth characteristics) - Developmental stage and timing of the stressor - Available support systems - Dysfunctional grieving process

Predisposing factors - psychological theories - learning theory

- Children learn to behave by imitating their role models. - Individuals who were abused as children or whose parents disciplined with physical punishment are more likely to behave in an abusive manner as adults.

Medical treatment modalities - pharmaceutical agents for anxiety(should not be used routinely for prolonged periods)

- Chlordiazepoxide (Librium) - Alprazolam (Xanax) - Lorazepam (Ativan) - Oxazepam (Serax) - Diazepam (Valium) - No barbituates (confusion and paradoxical excitement) Antianxiety medications may be helpful but should not be used routinely or for prolonged periods. The least toxic and most effective of the antianxiety medications are the benzodiazepines. Examples include diazepam (Valium), chlordiazepoxide (Librium), alprazolam (Xanax), lorazepam (Ativan), and oxazepam (Serax). The drugs with shorter half-lives (e.g., lorazepam and oxazepam) are preferred to those longer-acting medications (e.g., diazepam), which promote a higher risk of oversedation and falls. Barbiturates are not appropriate as antianxiety agents because they frequently induce confusion and paradoxical excitement in elderly individuals.

Medication for hair pulling disorder

- Chlorpromazine - Amitriptyline - Lithium carbonate - Selective serotonin reuptake inhibitors and pimozide - Olanzapine

Adjustment disorders predisposing factors - biological aspects

- Chronic disorders, such as neurocognitive or intellectual developmental disorders, are thought to impair the ability of an individual to adapt to stress, causing increased vulnerability to adjustment disorder. - Genetic factors also may influence individual risks for maladaptive response to stress.

Nursing diagnosis for substance use disorder - chronic low self-esteem

- Chronic low self-esteem related to weak ego, lack of positive feedback - Outcome: Exhibits evidence of increased self-worth by attempting new projects without fear of failure and by demonstrating less defensive behavior toward others.

Predisposing factors to OCD and related disorders - psychoanalytic theory

- Clients with O C D have weak, underdeveloped egos. - Aggressive impulses are channeled into thoughts and behaviors that prevent the feelings of aggression from surfacing and producing intense anxiety fraught with guilt.

Nursing diagnoses for adjustment disorders

- Complicated grieving related to real or perceived loss of any concept of value to the individual, evidenced by interference with life functioning, developmental regression, or somatic complaints. - Risk-prone health behavior related to change in health status requiring modification in lifestyle (for example, chronic illness, physical disability), evidenced by inability to problem-solve or set realistic goals for the future. NOTE: This diagnosis would be appropriate for the person with adjustment disorder if the precipitating stressor was a change in health status. - Anxiety (moderate to severe) related to situational and/or maturational crisis evidenced by restlessness, increased helplessness, and diminished productivity.

Outcomes ODD: the client:

- Complies with treatment by participating in therapies without negativism - Accepts responsibility for his or her part in the problem - Takes direction from staff without becoming defensive - Does not manipulate other people - Verbalizes positive aspects about self - Interacts with others in an appropriate manner

Types of groups - self-help groups

- Composed of individuals with a similar problem - Serve to reduce the possibilities of further emotional distress leading to pathology and necessary treatment - May or may not have a professional leader; run by members; leadership often rotates from member to member - weight watchers, AA, parents without partners

Antisocial personlity disorder - CALLOUS MAN

- Conduct disorder before age of 15 - current age at least 18 - antisocial acts; commit acts that are grounds for Arrest - Lies frequently - Lacunae - Lacks a superego - Obligations not honored - Unstable(cant plan ahead) - Safety of self and others ignored - Money problems(spouse and children are not supported) - Aggressive, Assaultive - Not occurring exclusively during schizophrenia or mania - They have difficulty sustaining consistent employment and in developing stable relationships. - In the United States, prevalence is estimated to be about 3% in the general population, but in prison populations the prevalence is 50% or higher. It is more common in men than in women, among the lower socioeconomic classes, and particularly so among highly mobile inhabitants of impoverished urban areas.

Planning/Implementation - ineffective impulse control

- Convey a nonjudgmental attitude. - Practice stress management techniques. - Offer support and encouragement.

Planning/Implementation: Borderline Personality Disorder - Complicated grieving

- Convey an accepting attitude. - Explore with the client the true source of anger.

The standards of practice for psychiatric nursing are written around the six steps of the nursing process - specific interventions include:

- Coordination of care between other members of the healthcare team. - Health teaching and health promotion to promote a safe environment. - Consultation to influence the identified plan and enhance abilities of other clinicians to provide services. - Prescriptive authority, procedures, referrals, treatments, and therapies used with accordance with state and federal laws and regulations. - Incorporation of knowledge of pharmacological, biological, and complementary interventions with applied clinical skills to restore the healthcare consumer's health and prevent further disability. - Provide, structure, and maintain a safe, therapeutic, recovery-oriented environment in collaboration with healthcare consumers, families, and other healthcare clinicians. - Use the therapeutic relationship and counseling interventions to assist healthcare consumers in their individual recovery journeys by improving and regaining their previous coping abilities, fostering mental health and preventing mental disorder and disability. - Conduct individual, couples, group, and family psychotherapy using evidence-based psychotherapeutic frameworks and the nurse-client therapeutic relationship.

Compensation : Defense Mechanism

- Covering up a real or perceived weakness by emphasizing a trait one considers more desirable. EX: A handicapped boy is unable to participate in football, so he compensates by becoming a great scholar.

Therapeutic nurse-patient relationship - Orientation(introductory) phase

- Create an environment for trust and rapport. - Establish contract for intervention. - Gather assessment data. - Identify patient's strengths and limitations - Formulate nursing diagnoses. - Set mutually agreeable goals. - Develop a realistic plan of action. - Explore feelings of both patient and nurse.

What does stigmatization do?

- Creates a barrier to effective mental illness treatment in primary care, emergency rooms, medical surgical settings, and in psychiatric settings. - Knowledge gaps, clinical skills, and stigma need to be addressed in nonpsychiatric settings.

Documentation of the Nursing Process - Focus Charting: DAR format

- D = Data: Information that supports the stated focus or describes pertinent observations about the client - A = Action: Immediate or future nursing actions that address the focus, and evaluation of the present care plan along with any changes required - R = Response: Description of the client's responses to any part of the medical or nursing care

Sexual aspects of normal aging - physical changes in women associated with sexuality

- Decline in ovarian function - Reduced production of estrogen - Vaginal dryness - Menopausal symptoms (hot flashes, night sweats, sleeplessness, irritability, mood swings, migraine headaches, urinary incontinence, weight gain) - Some women choose to take hormone replacement therapy Menopause may begin anytime during the 40s or early 50s. During this time, there is a gradual decline in the functioning of the ovaries and the subsequent production of estrogen, which results in a number of changes. The walls of the vagina become thin and inelastic, the vagina itself shrinks in both width and length, and the amount of vaginal lubrication decreases noticeably. Orgastic uterine contractions may become spastic. All of these changes can result in painful penetration, vaginal burning, pelvic aching, or irritation upon urination.

Sexual aspects of normal aging - physical changes in men associated with sexuality

- Decline in testosterone production - Erectile dysfunction - Decrease in testicular size - Decrease in amount of ejaculate - Viable sperm are produced well into old age Testosterone production declines gradually over the years, beginning between ages 40 and 60. A major change resulting from this hormone reduction is that erections occur more slowly and require more direct genital stimulation to achieve. There may also be a modest decrease in the firmness of the erection in men older than age 60. The refractory period lengthens with age, increasing the amount of time following orgasm before the man may achieve another erection. The volume of ejaculate gradually decreases, and the force of ejaculation lessens.

Predisposing factors to depression - biochemical influences

- Deficiency of norepinephrine, serotonin, and dopamine has been implicated. - acetylcholine is not included because cholinergic agents have profound effects on mood, sleep, electroencephalograms, and neuroendocrine function - Excessive cholinergic transmission may also be a factor.

Predisposing factors to depression - physiological influences: hormonal disorders

- Depression is associated with dysfunction of the adrenal cortex and is commonly observed in both Addison's disease and Cushing's syndrome - Other endocrine conditions that may result in symptoms of depression include hypoparathyroidism, hyperparathyroidism, hypothyroidism, and hyperthyroidism - An imbalance of the hormones estrogen and progesterone has been implicated in the predisposition to premenstrual dysphoric disorder (PMDD) although the exact etiology is unknown

Clinical depresssion vs depression symptoms

- Depression is the oldest and one of the most frequently diagnosed psychiatric illnesses. - Transient symptoms are normal, healthy responses to everyday disappointments in life. - Pathological depression occurs when adaptation is ineffective..

Predisposing factors to IDD - sociocultural and other mental disorders(15% to 20%)

- Deprivation of nurturance and social stimulation - Impoverished environments associated with poor prenatal and perinatal care and inadequate nutrition - Severe mental disorders such as autism spectrum disorder Between 15% and 20% of cases of intellectual disability may be attributed to deprivation of nurturance and social stimulation and to impoverished environments associated with poor prenatal and perinatal care and inadequate nutrition. Additionally, other mental disorders, such as autism spectrum disorder, can result in intellectual disability.

Application of the Nursing Process: Boarderline Personality Disorder

- Designated as "borderline" because of the tendency of these clients to fall on the border between neuroses and psychoses. - Instability of interpersonal relationships - Unstable self-image - Marked impulsivity - Intensity of affect and behavior - Chronic depression - On the bipolar spectrum? - Historically, there have been a group of clients who did not classically conform to the standard categories of neuroses or psychoses. The designation "borderline" was introduced to identify these clients who seemed to fall on the border between the two categories. Other terminology that has been used in an attempt to identify this disorder includes ambulatory schizophrenia, pseudoneurotic schizophrenia, and emotionally unstable personality. - Individuals with borderline personality disorder always seem to be in a state of crisis and have frequent mood swings. Their affect is one of extreme intensity, and their behavior reflects frequent changeability. These changes can occur within days, hours, or even minutes. They are sometimes described as "thriving on chaos" because their behaviors frequently generate chaos, particularly in interpersonal relationships.

Medical treatment modalities - delerium

- Determination and correction of the underlying causes - Staff to remain with patient at all times to monitor behavior and provide reorientation and assurance - Room with low stimulus level - Low-dose antipsychotic agents to relieve agitation and aggression - Benzodiazepines commonly used when etiology is substance withdrawal The first step in the treatment of delirium should be the determination and correction of the underlying causes. Additional attention must be given to fluid and electrolyte status, hypoxia, anoxia, and diabetic problems. Staff members should remain with the patient at all times to monitor behavior and provide reorientation and assurance. The room should maintain a low level of stimuli. Some physicians prefer not to prescribe medications for the patient with delirium, reasoning that additional agents may only compound the syndrome of brain dysfunction. However, psychosis with agitation and aggression demonstrated by the patient with delirium may require chemical and/or mechanical restraint for his or her personal safety. Choice of specific therapy is made with consideration for the patient's clinical condition and the underlying cause of the delirium.

Evaluation for suicide

- Develop and maintain a more positive self-concept. - Learn more effective ways to express feelings to others. - Achieve successful interpersonal relationships. - Feel accepted by others and achieve a sense of belonging - Evaluation of the suicidal client is an ongoing process accomplished through continuous reassessment of the client, as well as determination of goal achievement. Once the immediate crisis has been resolved, extended psychotherapy may be indicated. - A suicidal person feels worthless and hopeless. These goals serve to instill a sense of self-worth, while offering a measure of hope and a meaning for living.

Opioid use disorder - patterns of use/abuse

- Development of opioid addiction may follow one of two typical behavior patterns. The first occurs in the individual who has obtained the drug by prescription from a physician. Abuse and addiction occur when the individual increases the amount and frequency of use, justifying the behavior as symptom treatment. - The second pattern of behavior associated with addiction to opioids occurs among individuals who use the drugs for recreational purposes and obtain them from illegal sources. Tolerance develops and addiction occurs, leading the individual to procure the substance by whatever means is required to support the habit.

Depression - social isolation/impaired social interaction related to?

- Developmental regression - Egocentric behaviors - Fear of rejection or failure of the interaction

Predisposing factors to dissociative disorders - neurobiological

- Dissociative amnesia may be related to neurophysiological dysfunction. - Electroencephalogram abnormalities have been observed in some clients with D I D. - Possible serotonin involvement in depersonalization - The fact that depersonalization has been evidenced with migraines and with marijuana use, responds to SSRIs, and is seen in cases where L-tryptophan, a serotonin precursor, is depleted, all suggest some level of serotonergic involvement in this dissociative symptom.

Epidemiological statistics of dissociative disorders

- Dissociative amnesia occurs most frequently under conditions of war or during natural disasters. In recent years, there has been an increase in the number of reported cases, possibly attributed to increased awareness of the phenomenon, and identification of cases that were previously undiagnosed. - Dissociative amnesia can occur at any age but is difficult to diagnose in children because it is easily confused with inattention or oppositional behavior. - Estimates of the prevalence of dissociative identity disorder (DID) vary widely. - The disorder occurs from five to nine times more frequently in women than in men. - Onset likely occurs in childhood, although manifestations of the disorder may not be recognized until much later. - Clinical symptoms usually are not recognized until late adolescence or early adulthood. - The prevalence of severe episodes of depersonalization-derealization disorder is unknown. - It is thought that single brief episodes may occur at some time in as many as half of all adults, particularly when under severe psychosocial stress, when sleep deprived, during travel to unfamiliar places, or when intoxicated with hallucinogens, marijuana, or alcohol. - statistically quite rare

Dissociative Identity Disorder

- Dissociative identity disorder (DID) was formerly called multiple personality disorder. - This disorder is characterized by the existence of two or more personalities in a single individual. - These different personality states are sometimes referred to as alter identities. - Only one of the personalities is evident at any given moment, and one of them is dominant most of the time over the course of the disorder. - Transition from one personality state to another may be sudden or gradual, and can be dramatic. - Although questions persist about whether this disorder has been overdiagnosed, there are certainly individuals who present with this condition of fragmented identity, and most have been victims of severe childhood physical and sexual abuse. - Before they are diagnosed with DID, many individuals are misdiagnosed with depression, borderline and antisocial personality disorders, schizophrenia, epilepsy, or bipolar disorder.

Planning and implementation - disturbed thought/processes/impaired memory and disturbed sensory perception

- Disturbed thought processes has been defined as a disruption in cognitive operations and activities. - Disturbed sensory perception is defined as a "change in the amount or patterning of incoming stimuli accompanied by a diminished, exaggerated, distorted, or impaired response to such stimuli." - Impaired memory is defined as the "inability to remember or recall bits of information or behavioral skills." - The goal of treating patients with these disruptions should be to help the patient maintain reality orientation. - There are many interventions that a nurse can use to help achieve this goal, including using clocks, calendars, and signs and providing the patient with items that may help promote feelings of security and orientation. - For patients with delusions and hallucinations, it is important to discourage delusional thinking, provide reassurance that the patient is safe, and focus on real situations and people.

Pharmacotherapy for alcoholism - disulfiram(Antabuse)

- Disulfiram (Antabuse) is a drug that can be administered as a deterrent to drinking to individuals who abuse alcohol. - Ingestion of alcohol while disulfiram is in the body results in a syndrome of symptoms that can produce a great deal of discomfort for the individual. - Disulfiram therapy is not a cure for alcoholism, but rather a measure of control to avoid impulse drinking. - Clients receiving disulfiram therapy are encouraged to seek other assistance with their problem, such as with AA or other support groups, to aid in the recovery process.

Documentation of the Nursing Process

- Documentation of the steps of the nursing process is often considered as evidence in determining certain cases of negligence by nurses. - It is also required by some agencies that accredit healthcare organizations. - documentation must bear written testament to the use of the nursing process.

The cycle of battering - phase I - the tension-building phase

- During this phase, the woman senses that the man's tolerance for frustration is declining. - He becomes angry with little provocation but, may be quick to apologize. - The woman may become very nurturing and compliant, anticipating his every whim in an effort to prevent his anger from escalating. - She may just try to stay out of his way. - Minor battering incidents may occur during this phase and the woman accepts the abuse as legitimately directed toward her. - She assumes the guilt for the abuse. - The minor battering incidents continue, and the tension mounts as the woman waits for the impending explosion. - The abuser begins to fear that his partner will leave him. - His jealousy and possessiveness increase. - Phase I may last from a few weeks to many months or even years.

Effects of alcohol on the body - gastritis

- Effects of alcohol on the stomach include inflammation of the stomach lining characterized by epigastric distress, nausea, vomiting, and distention - Alcohol breaks down the stomach's protective mucosal barrier, allowing hydrochloric acid to erode the stomach wall. Damage to blood vessels may result in hemorrhage.

Application of the nursing process/assessment - other diagnositic evaluations may include:

- Electroencephalogram - Computed tomography scan - Positron emission tomography - Magnetic resonance imaging - Lumbar puncture to examine cerebrospinal fluid - Amyloid P E T scan techniques Other diagnostic evaluations may be made by electroencephalogram (E E G), which measures and records the brain's electrical activity. With CT scanning, an image of the size and shape of the brain can be obtained. MRI is used to obtain a computerized image of soft tissue in the body. It provides a sharp detailed picture of the tissues of the brain. A lumbar puncture may be performed to examine the cerebrospinal fluid for evidence of C N S infection or hemorrhage. Positron emission tomography (P E T) is used to reveal the metabolic activity of the brain, an evaluation some researchers believe is important in the diagnosis of A D. New amyloid P E T scan techniques are able to identify amyloid beta plaques and tau neurofibrillary tangles in the brain, but these tests are primarily being used in research and clinical trials (Mayo Clinic, 2018b).

Planning and implementation - obesity

- Encourage diary of food intake. - Provide instruction about medications. Obesity is defined as a condition in which "an individual accumulates abnormal or excessive fat for age and gender that exceeds overweight." Goals should include verbalizing and understanding what must be done to lose weight and change eating patterns to result in steady weight loss. Interventions should include discussing feelings and emotions associated with eating, formulating an eating plan, and identifying realistic goals for weekly weight loss.

Planning/Implementation: ODD

- Encouraging cooperation with therapy - Helping client accept responsibility for own behaviors - Promoting increased feelings of self-worth - Assisting in the development of socially appropriate behaviors in interactions with others Noncompliance with therapy, defensive coping, low self-esteem, and impaired social interaction should be the focus of nursing care. Goals for treatment of a child with O D D should focus on completing tasks willingly, accepting responsibility for behaviors, demonstrating feelings of self-worth, and interacting with staff and peers appropriately. Interventions should include creating a structured plan of therapeutic activities, providing immediate positive feedback, ensuring goals are realistic, and explaining passive-aggressive behaviors.

Planning/Implementation: Conduct disorder - nursing care of the client with a conduct disorder is aimed at:

- Ensuring safety of client and others - Assisting in the development of socially appropriate behaviors in interactions with others - Encouraging client to accept responsibility for own behaviors - Promoting increased feelings of self-worth Risk for violence, impaired social interaction, defensive coping, and low self-esteem should be the focus of nursing care. Goals for treatment of a child with CD should focus on keeping the client from harming others, helping the client interact with staff and peers, accepting responsibility for behaviors, and helping increase self-worth. Interventions should include monitoring for violent behavior, redirecting violent behavior with physical outlets, developing a trusting relationship, providing group situations, and setting limits on manipulative behavior.

Planning/Implementation: ADHD - nursing interventions for the child with ADHD are aimed at:

- Ensuring that the client remains free of injury - Encouraging appropriate interactions with others - Increasing feelings of self-worth - Fostering motivation for compliance with tasks Risk for injury, impaired social interaction, low self-esteem, and noncompliance should be the focus of nursing care. Goals for treatment of a child with A D H D should focus on preventing injury, observing limits on intrusive behavior, demonstrating increased feelings of self-worth, and completing assigned tasks independently. Interventions should include ensuring the client has a safe environment, developing a trusting relationship, offering recognition of successful endeavors, and establishing goals that allow the client to complete tasks.

Attention Deficit/Hyperactivity Disorder(ADHD)

- Essential features of A D H D include developmentally inappropriate degrees of inattention, impulsiveness, and hyperactivity. The essential behavior pattern of a child with attention-deficit/hyperactivity disorder (A D H D) is one of inattention and/or hyperactivity and impulsivity. Hyperactivity is excessive psychomotor activity that may be purposeful or aimless, accompanied by physical movements and verbal utterances that are usually more rapid than normal. Inattention and distractibility are common with hyperactive behavior. Impulsiveness is the trait of acting without reflection and without thought to the consequences of the behavior; an abrupt inclination to act (and the inability to resist acting) on certain behavioral urges. Onset of the disorder is difficult to diagnose in children younger than 4 years of age because their characteristic behavior is much more variable than that of older children. In making the diagnosis of A D H D, the DSM-5 criteria are further specified according to current clinical presentation. These subtypes include a combined presentation (meeting the criteria for both inattention and hyperactivity/impulsivity), a predominantly inattentive presentation, and a predominantly hyperactive/impulsive presentation.

Planning and implementation - denial

- Establish trusting relationship. - Avoid arguing or bargaining with the client. Denial is defined as a "conscious or unconscious attempt to disavow the knowledge or meaning of an event to reduce anxiety and/or fear, leading to the detriment of health." Goals should include understanding the correlations between emotional issues and eating behaviors, and coping with emotional issues in a more adaptive manner. Interventions should include acknowledging the client's anger at feelings of loss of control and encouraging the client to verbalize feelings.

Schizotypical personality disorder - predisposing factors

- Evidence suggests that schizotypal personality disorder is more common among the first-degree biological relatives of people with schizophrenia than among the general population. It is now considered as part of the genetic spectrum of schizophrenia. Twin studies reveal a higher incidence in monozygotic twins than dizygotic twins. - Psychological and environmental factors may also interact with genetic vulnerability in the development of schizotypal personality traits. - Affective blandness, peculiar behaviors, and discomfort with interpersonal relationships may provoke other children to avoid relationships with them, or worse, engage in bullying, which reinforces their withdrawal from others. - early family dynamics characterized by indifference, impassivity, formality - leading to a pattern of discomfort with personal affection and closeness

Psychopharmacological intervention: ADHD - CNS sitmulants

- Examples: Dextroamphetamine, methamphetamine, lisdexamfetamine, methylphenidate, dexmethylphenidate, dextroamphetamine/amphetamine mixture - Side effects: Insomnia, anorexia, weight loss, tachycardia, decrease in rate of growth and development - Children on A D H D drugs had a higher risk of injury-related hospital admissions. Pharmacological intervention and particularly stimulants are considered the first line of treatment for A D H D. The mechanism of action is unclear, but because these drugs are known to elevate dopamine and norepinephrine levels, it has been hypothesized that their effectiveness is in response to neurotransmitter dysregulation. They have generally mild side effects, but they are contraindicated in anyone with cardiac problems or risks for cardiac problems. One study explored whether use of stimulants had an impact on reducing injuries and hospital admissions for children with A D H D. They found that children on A D H D drugs (mostly stimulants) had a twofold higher risk of injury-related hospital admissions than among those not treated with A D H D drugs. They also found that children who were on A D H D drugs and psychotropic drugs such as antipsychotics and benzodiazepines had 5 times increased risk for injuries and hospital admissions than those who were on A D H D medication alone.

Predisposing factors to depression - physiological influences: electrolyte disturbances

- Excessive levels of sodium bicarbonate or calcium can produce symptoms of depression, as can deficits in magnesium and sodium. - Potassium is also implicated in the syndrome of depression

Outcomes of ASD - the client:

- Exhibits no evidence of self-harm - Interacts appropriately with at least one staff member - Demonstrates trust in at least one staff member - Is able to communicate so that he or she can be understood by at least one staff member - Demonstrates behaviors that indicate he or she has begun the separation/individuation process

Predisposing factors to depression - object loss theory

- Experiences loss of significant other during first 6 months of life - Feelings of helplessness and despair - Early loss or trauma may predispose client to lifelong periods of depression.

Antisocial Personality Disorder - Common behaviors

- Exploitation and manipulation of others for personal gain - Belligerent and argumentative - Lacks remorse - Unable to delay gratification - Low frustration tolerance - Inconsistent work or academic performance - Antisocial personality disorder is a pattern of socially irresponsible, exploitative, and guiltless behavior that reflects a general disregard for the rights of others. These individuals exploit and manipulate others for personal gain and are unconcerned with obeying the law. They have difficulty sustaining consistent employment and in developing stable relationships. - Their pattern of impulsivity may be manifested in failures to plan ahead, culminating in sudden job, residence, or relationship changes. When things go their way, individuals with this disorder act cheerful, even gracious and charming. Because of their low tolerance for frustration, this pleasant exterior can change very quickly. - Failure to conform to societal norms - Impulsive and reckless - Inability to function as a responsible parent - Inability to form lasting monogamous relationship - Satisfying interpersonal relationships are not possible because individuals with antisocial personalities have learned to place their trust only in themselves. They have a philosophy that "it's every man for himself," and that one should stop at nothing to avoid being manipulated by others. - One of the most distinctive characteristics of individuals with antisocial personality is their tendency to ignore conventional authority and rules. They act as though established social norms and guidelines for self-discipline and cooperative behavior do not apply to them. They are flagrant in their disrespect for the law and for the rights of others.

A model for making ethical decisions - Planning

- Explore the benefits and consequences of each alternative. - Consider principles of ethical theories. - Select an alternative.

Types of somatic symptom disorders - factitious disorder

- Factitious disorders involve conscious, intentional feigning of physical or psychological symptoms. - Individuals with factitious disorder pretend to be ill in order to receive emotional care and support commonly. To accomplish this, they may aggravate existing symptoms, induce new ones, or even inflict painful injuries on themselves. - feigns disease in an attempt to gain sympathy, attention, or reassurance to themselves - hospital shopping - extensive medical records - often well spoken and intelligent

Specific phobia

- Fear of specific objects or situations that could conceivably cause harm, but the person's reaction to them is excessive, unreasonable, and inappropriate - Exposure to the phobic object produces overwhelming symptoms of panic, including palpitations, sweating, dizziness, and difficulty breathing

Predisposing factors to IDD - pregnancy and perinatal factors

- Fetal malnutrition, viral or other infections during pregnancy - Trauma or complications during delivery that deprive the infant of oxygen - Premature birth Approximately 10% of cases of intellectual disability are the result of circumstances that occur during pregnancy or during the birth process. Examples of the latter include trauma to the head incurred during the process of birth, placenta previa or premature separation of the placenta, and prolapse of the umbilical cord.

Client/Family education - support services

- Financial assistance - Legal assistance - Alcoholics Anonymous (or other support group specific to another substance) - One-to-one support person

Patient/Family Education - support services

- Financial assistance - Legal assistance - Caregiver support groups - Respite care - Home healthcare

Treatment modalities: psychopharmacology - medications that have been tried with some success for anorexia nervosa include:

- Fluoxetine (Prozac) - Clomipramine (Anafranil) - Cyproheptadine (Periactin) - Chlorpromazine (Thorazine) - Olanzapine (Zyprexa) Trials of fluoxetine (Prozac) have shown some evidence of weight gain and, in general, SSRIs may be beneficial in the treatment of comorbid depression, but they also carry a black box warning about the risk of increasing suicide ideation in adolescents.

Treatment modalities: psychopharmacology - medications that hvae been tried with some success for bulimia nervosa include:

- Fluoxetine (Prozac) - Imipramine (Tofranil) - Desipramine (Norpramine) - Amitriptyline (Elavil) - Nortriptyline (Aventyl) - Phenelzine (Nardil) Fluoxetine (Prozac) has been found to be useful in the treatment of bulimia nervosa. A dosage of 60 mg/day (triple the usual antidepressant dosage) was found to be most effective. It is possible that fluoxetine, a selective serotonin reuptake inhibitor, may decrease the craving for carbohydrates. Other antidepressants, such as imipramine (Tofranil), desipramine (Norpramine), amitriptyline (Elavil), nortriptyline (Aventyl), and phenelzine (Nardil), also have been shown to be effective in controlled treatment studies.

Medical treatment modalities - pharmaceutical agents for sleep disturbances(for short-term therapy only)

- Flurazepam (Dalmane) - Temazepam (Restoril) - Triazolam (Halcion) - Zolpidem (Ambien) - Zaleplon (Sonata) - Ramelteon (Rozerem) - Eszopiclone (Lunesta) - Trazodone (Desyrel) - Mirtazapine (Remeron) Sleep problems are common in patients with N C D and often intensify as the disease progresses. Sleep disturbances are among the problems that most frequently initiate the need for placement of the patient in a long-term care facility. Some physicians treat sleep problems with sedative-hypnotic medications. The benzodiazepines may be useful for some patients but are indicated for relatively brief periods only. Examples include flurazepam (Dalmane), temazepam (Restoril), and triazolam (Halcion). Daytime sedation and cognitive impairment, in addition to paradoxical agitation in elderly patients, are of particular concern with these medications. The nonbenzodiazepine sedative-hypnotics zolpidem (Ambien), zaleplon (Sonata), eszopiclone (Lunesta), and ramelteon (Rozerem) and the antidepressants trazodone (Desyrel) and mirtazapine (Remeron), are also prescribed. Daytime sedation may also be a problem with these medications. As previously stated, barbiturates should not be used in elderly patients.

Leadership styles - autocratic

- Focus is on the leader, on whom the members are dependent for problem-solving, decision making, and permission to perform. - Production is high, but morale is low.

Predisposing factors to dissociative disorders - psychodynamic theory

- Freud described dissociation as repression of distressing mental contents from conscious awareness. - Current psychodynamic explanations reflect Freud's concepts that dissociative behaviors are a defense against unresolved painful issues.

Bulimia signs and symptoms

- Gastric acid in the vomitus also contributes to the erosion of tooth enamel. - normal weight - In rare instances, the individual may experience tears in the gastric or esophageal mucosa. - Some individuals develop calluses on the dorsal surface of their hands, typically on knuckles. This feature is called Russell's Sign, after the British psychiatrist who first described it. - swollen salivary glands - rupture in the esophageal wall - gastric reflux - dehydration and hypokalemia - inflammation of the esophagus - abnormal heart rhythms - peptic ulcers - constipation

Predisposing factors - biological aspects

- Genetic vulnerability to panic disorder has been supported by family and twin studies. - Structural brain imaging studies in patients with panic disorder have implicated pathological involvement in the temporal lobes, particularly the hippocampus, and the amygdala and the frontal cerebral cortex have also been noted in clients with anxiety disorders. - Abnormal elevations of blood lactate have been noted in clients with panic disorder. Likewise, infusion of sodium lactate into clients with anxiety neuroses produced symptoms of panic disorder. - Stronger evidence exists for the involvement of the neurotransmitter norepinephrine in the etiology of panic disorder. Norepinephrine is known to mediate arousal, and it causes hyperarousal and anxiety. This fact has been demonstrated by a notable increase in anxiety following the administration of drugs that increase the synaptic availability of norepinephrine, such as yohimbine. The neurotransmitters serotonin and gamma aminobutyric acid (GABA) are thought to be decreased in anxiety disorders.

Predisposing factors - ADHD

- Genetics - Biochemical theory - Anatomical influences - Prenatal, perinatal, and postnatal factors A number of studies have revealed supportive evidence of genetic influences in the etiology of A D H D. Twin studies show an increased risk for monozygotic twins and a risk of 2 to 8 times for siblings and parents of an A D H D child. Adoption studies reveal that biological parents of children with A D H D have more psychopathology than the adoptive parents. It is believed that certain neurotransmitters such as dopamine, norepinephrine, and possibly serotonin are involved in producing the symptoms associated with A D H D, but their involvement is still under investigation. Some studies have implicated alterations in specific areas of the brain in individuals with A D H D. Brain imaging studies show decreased volume and activity in the prefrontal cortex, anterior cingulated, globus pallidus, caudate, thalamus, and cerebellum. Maternal smoking, intrauterine exposure to toxic substances, including alcohol, and maternal infections during pregnancy have also been associated with higher risks for A D H D. Perinatal and postnatal influences that may contribute to A D H D are low birth weight, trauma, early infancy infections, or other insults to the brain during this period.

Predisposing factors - biological factors

- Genetics appear to be involved in the development of substance use disorders, especially alcoholism. Children of alcoholics are four times more likely than other children to become alcoholics. Studies with monozygotic and dizygotic twins have demonstrated that monozygotic twins have a higher rate for concordance of alcoholism than dizygotic twins. - Evidence supports the idea that changes in brain structure and brain neurochemistry occur in the process of developing addiction. Neuronal pathways that are responsible for sensing pleasure and reward, once activated, are believed to be responsible for pleasurable sensations associated with these drugs, as well as creating a "memory" that triggers desire for repeated use of the drug. These pathways are referred to as the brain-reward circuitry.

Predisposing factors to OCD and related disorders - biological aspects

- Genetics: Possible with trichotillomania - Neuroanatomy: Possible abnormalities in basal ganglia and orbitofrontal cortex with O C D - Physiology: Some individuals with O C D exhibit electroencephalogram changes. - Biochemical factors: Possible decrease in serotonin with O C D and body dysmorphic disorder

Risk-prone health behavior goals and interventions

- Goals for treatment should include helping the client discuss lifestyle change and formulating a plan to incorporate those changes. - Interventions include encouraging the client to talk about his or her lifestyle, helping with decision making, and ensuring that the client is knowledgeable about the physiology of the change in health status.

Treatment modalities for personality disorder - milieu or group therapy

- Group therapy is especially appropriate for individuals with antisocial personality disorder, who respond more adaptively to support and feedback from peers. In milieu or group therapy, feedback from peers is more effective than in one-to-one interaction with a therapist.

The aging individual

- Growing old is not popular in youth-oriented American culture. - Sixty-six million "baby boomers" will reach their 65th birthdays by the year 2030, placing more emphasis on the needs of an aging population. The disciplines of gerontology (the study of the aging process), geriatrics (the branch of clinical medicine specializing in problems of the elderly), and geropsychiatry (the branch of clinical medicine specializing in psychopathology of the elderly population) are expanding rapidly in response to the demands of an aging population. Growing old in a society that is obsessed with youth may have a critical impact on the mental health of many people.

Hallucinogen use disorder - profile of the substance

- Hallucinogenic substances are capable of distorting an individual's perception of reality and the ability to alter sensory perception and induce hallucinations. - Some of the manifestations have been likened to a psychotic break. - Many of the hallucinogenic substances have structural similarities. - Some are produced synthetically; others are natural products of plants and fungi.

Documenation of the nursing process - problem-oriented recording

- Has a list of problems as its basis - Uses subjective, objective, assessment, plan, intervention, and evaluation format

Outcomes: IDD - the client:

- Has experienced no physical harm - Has had self-care needs fulfilled - Interacts with others in a socially appropriate manner - Has maintained anxiety at a manageable level - Is able to accept direction without becoming defensive - Demonstrates adaptive coping skills in response to stressful situations

Criteria for measuring ourcomes for the client

- Has experienced no physical harm to self - Discusses loss with staff and family members - No longer idealizes or obsesses about the lost entity - Sets realistic goals for self - Attempts new activities without fear of failure - Is able to identify aspects of self-control over life situation - Expresses personal satisfaction and support from spiritual practices - Interacts willingly and appropriately with others - Is able to maintain reality orientation - Is able to concentrate, reason, and solve problems - Eats a well-balanced diet with snacks, to prevent weight loss and maintain nutritional status. - Sleeps 6 to 8 hours per night and reports feeling well rested. - Bathes, washes and combs hair, and dresses in clean clothing without assistance.

Outcome criteria - the patient:

- Has not experienced physical injury. - Has not harmed self or others. - Has maintained reality orientation to the best of his or her capability. - Is able to communicate with consistent caregiver. - Fulfills activities of daily living with assistance (or for patient who is unable: has needs met, as anticipated by the caregiver). - Discusses positive aspects about self and life.

Outcomes: Conduct disorder - the client:

- Has not harmed self or others - Interacts with others in a socially appropriate manner - Accepts direction without becoming defensive - Demonstrates evidence of increased self-esteem by discontinuing exploitative and demanding behaviors toward others

Outcomes: Tourette Disorder - the client

- Has not harmed self or others - Interacts with staff and peers in an appropriate manner - Demonstrates self-control by managing tic behavior - Follows rules without becoming defensive - Verbalizes positive aspects about self

Evaluation

- Has self-harm to the client been avoided? - Have suicidal ideations subsided? - Does the client know where to seek assistance outside of the hospital when suicidal thoughts occur? - Has the client discussed the recent loss with the staff and family members? - Is he or she able to verbalize feelings and behaviors associated with each stage of the grieving process and recognize his or her position in the process? - Have obsession with, and idealization of, the lost object subsided? - Is anger toward the lost object expressed appropriately? - Does the client set realistic goals for self? - Is the client able to verbalize positive aspects about self, past accomplishments, and future prospects? - Can the client identify areas of life situation over which he or she has control?

Nursing Process: Assessment - CAGE questionnaire

- Have you ever felt you should Cut down on your drinking? - Have people Annoyed you by criticizing your drinking? - Have you ever felt bad or Guilty about your drinking? - Have you ever had a drink first thing in the morning to steady your nerves (Eye-opener)?

The Institute of Medicine identified a set of eight core functions that EHR systems should perform in the delivery of safer, higher-quality, and more efficient healthcare. These eight core capabilities include the following:

- Health information and data - Results management - Order entry/order management - Decision support - Electronic communication and connectivity - Patient support - Administrative processes - Reporting and population health management

Planning/Implementation: Separation Anxiety Disorder - nursing care of a child with separation anxiety disorder is aimed at:

- Helping the client maintain anxiety at a manageable level in the face of separation from a significant other - Assisting with development of more adaptive coping strategies - Developing trust and demonstrating the ability to interact appropriately with others Severe anxiety, ineffective coping, and impaired social interaction should be the focus of nursing care. Goals for treatment of a child with separation anxiety disorder should focus on helping the client maintain anxiety, demonstrating use of more adaptive coping strategies, and helping the client spend time with others without excessive anxiety. Interventions should include assuring the client of his or her safety and security, encouraging the parents and child to identify more adaptive coping strategies, and attending groups with the child and supporting efforts to interact with others.

Predisposing factors for histrionic personality disorder

- Heredity may be a factor because histrionic disorder is apparently more common among first-degree biological relatives of people with the disorder than in the general population. - From a psychosocial perspective, learning experiences may contribute to the development of histrionic personality disorder. The child may have learned that positive reinforcement was contingent on the ability to perform parentally approved and admired behaviors. It is likely that the child rarely received either positive or negative feedback. - possible link to nonreadrenergic and serotinergic systems - possible hereditary factor - biogenetically determined temperament - learned behavior patterns

Predisposing factors - family influences

- Historically, family influences were heavily considered as factors, but there is not sufficient evidence to support these claims. - Family members should be involved in treatment rather than blamed for the issue. Historically, parents have often been presumed to be overcontrolling and perfectionistic, which is then misconstrued as causing pathology in their children. There is not sufficient evidence to support these claims and, in fact, they may have contributed to a resistance toward seeking healthcare based on parents' fears that they will be judged as "bad" or "the cause of the problem." Certainly, conflicts arise in a family when a child starves him or herself, but it has become clear that family members need to be involved in treatment rather than shunned or blamed, and family-based approaches have been demonstrated as evidence-based treatments.

Introduction - survivors of abuse or neglect

- Human trafficking, which includes sex trafficking is another form of child abuse that is a significant public health concern. - Prevalence statistics are difficult to compile, but sex trafficking of children has been reported in all 50 U.S. states, and traffickers have been known to prey on children as young as 9 years of age. - Abuse affects all populations equally. - Abuse is often cyclical in that many abusers were themselves victims of abuse as children. - Child abuse became a mandatory reportable occurrence in the United States in 1968. - Responsibility for the protection of elders from abuse rests primarily with the states. In 1987, Congress passed amendments to the Older Americans Act of 1965 that provide for state Area Agencies on Aging to assess the need for elder abuse prevention services.

Neurocognitive Disorder due to other conditions

- Hypothyroidism - Hyperparathyroidism - Pituitary insufficiency - Uremia - Encephalitis - Brain tumor - Pernicious anemia - Thiamine deficiency Multiple sclerosis - Pellagra - Uncontrolled epilepsy - Cardiopulmonary insufficiency - Fluid and electrolyte imbalances - Central nervous system and systemic infections - Systemic lupus erythematosus

Components of suicide

- Ideation: Has suicide ideas that are current and active, especially with an identified plan - Substance abuse: Drinks alcohol, perhaps excessively, or uses other mood-altering drugs - Purposelessness: Expresses thoughts that there is no reason to continue living - Anger: Expresses uncontrolled anger or feelings of rage - Trapped: Expresses the belief that there is no way out of the current situation - Hopelessness: Expresses lack of hope and perceives little chance of positive change - Withdrawal: Expresses desire to withdraw from others or has begun withdrawing - Anxiety: Expresses anxiety, agitation, and/or changes in sleep patterns - Recklessness: Engages in reckless or risky activities with little thought of consequences - Mood: Displays dramatic mood shifts IS PATH WARM?

Predisposing factors: ODD - family influences

- If power and control are issues for parents, or if they exercise authority for their own needs, a power struggle can be established between the parents and the child, which sets the stage for the development of O D D. Opposition during various developmental stages is both normal and healthy. Children first exhibit oppositional behaviors at around 10 or 11 months of age, again as toddlers between 18 and 36 months of age, and finally during adolescence. Pathology is considered only when the developmental phase is prolonged, or when there is overreaction in the child's environment to his or her behavior.

True or False of suicide

- If someone talks about suicide, they aren't serious. False - you are no longer depressed, you are no longer suicidal. False - If someone is serious about suicide, there's no stopping them. False - Most people complete suicide by overdose. False(firearms) - You shouldn't ask about suicidal thoughts, you might give them the idea to do it. False - The idea that people who talk about suicide do not commit suicide. In reality, 8 out of 10 people who kill themselves have given clues and warnings about their intentions. - Improvement after severe depression means that the risk of suicide is over. In reality, most suicides occur within 3 months after the beginning of improvement. - Suicidal threats should be considered attention-seeking behavior. In reality, all suicidal behavior must be approached with the gravity of the potential act in mind

Predisposing factors for autism spectrum disorder

- Imaging studies have revealed a number of alterations in major brain structures of individuals with A S D. Total brain volume, the size of the amygdala, and the size of the striatum have all been identified as enlarged in very young children and there is evidence of a decrease in size over time. - Research has revealed strong evidence that genetic factors play a significant role in the etiology of A S D. About 15% of A S D cases are related to a known genetic mutation. In most cases, its expression is related to multiple genes. DNA studies have implicated areas on several chromosomes that contain genes that may contribute to the development of autism spectrum disorder. Some of the prenatal risk factors that have been associated with development of A S D include advanced parental age, fetal exposure to valproate, gestational diabetes, and gestational bleeding.

Nursing diagnoses for eating disorder

- Imbalanced nutrition: Less than body requirements - Deficient fluid volume (risk for or actual) - Ineffective denial - Imbalanced nutrition: More than body requirements related to compulsive overeating - Disturbed body image / low self-esteem - Anxiety (moderate to severe)

Neurocognitive disorder symptoms

- Impairment exists in abstract thinking, judgment, and impulse control. - Conventional rules of social conduct are disregarded. - Personal appearance and hygiene are neglected. - Language deficits. - Personality changes. In N C D, impairment is evident in abstract thinking, judgment, and impulse control. The conventional rules of social conduct are often disregarded. Behavior may be uninhibited and inappropriate. Personal appearance and hygiene are often neglected.

Epidemiological statistics - employment

- In 2016, 9.6 million Americans age 65 and older were in the labor force. With the passage of the Age Discrimination in Employment Act in 1967, forced retirement has been virtually eliminated in the workplace. It is well accepted that involvement in purposeful activity is vital to successful adaptation and perhaps even to survival at any age. More and more adults over 65 are remaining active in employment environments.

Historical perspectives of suicide

- In ancient Greece, suicide was an offense against the state, and individuals who committed suicide were denied burial in community sites. - In the culture of the imperial Roman army, individuals sometimes resorted to suicide to escape humiliation or abuse. - In the Middle Ages, suicide was viewed as a selfish or criminal act - During the Renaissance, the view became more philosophical, and intellectuals could discuss suicide more freely. - Most philosophers of the 17th and 18th centuries condemned suicide, but some individuals began to associate suicide with mental illness.

Theories of aging - developmental task theory

- In contrast to the personality trait theories of aging, this theory holds that there are activities and challenges that one must accomplish at predictable, changing stages in life to achieve successful aging. - Erikson described the primary task of old age as being able to see one's life as having been lived with integrity. - In the absence of achieving that sense of having lived well, the older adult is at risk for becoming preoccupied with feelings of regret or despair.

Role of the nurse in group interventions

- In healthcare settings, nurses serve on or lead task groups that create policy, describe procedures, and plan client care - They are also involved in a variety of other groups aimed at the institutional effort of serving the consumer - Nurses are encouraged to use the steps of the nursing process as a framework for task group leadership - In psychiatry specifically, nurses may lead various types of therapeutic group - To function effectively in the leadership capacity for these groups, nurses need to be able to understand the various processes that occur in groups - They also need to be able to select the most appropriate leadership style for the type of group being led

Evaluation for trauma-related disorders

- In the final step of the nursing process, a reassessment is conducted to determine if the nursing actions have been successful in achieving the objectives of care. • Can the client discuss the traumatic event without experiencing panic anxiety? • Does the client voluntarily discuss the traumatic event? • Can the client discuss changes that have occurred in his or her life because of the traumatic event? • Does the client have "flashbacks?" • Can the client sleep without medication? • Does the client have nightmares? • Has the client learned new, adaptive coping strategies for assistance with recovery? • Can the client demonstrate successful use of these new coping strategies in times of stress? • Can the client verbalize stages of grief and the normal behaviors associated with each? • Can the client recognize his or her own position in the grieving process? • Is guilt being alleviated? • Has the client maintained or regained satisfactory relationships with significant others? • Can the client look to the future with optimism? • Does the client attend a regular support group for victims of similar traumatic experiences? • Does the client have a plan of action for dealing with symptoms if they return?

The incestuous relationship

- In these cases, there is usually an impaired sexual relationship between the parents. - Communication between the parents is ineffective, which prevents them from correcting their problems. - Typically, the father is domineering, impulsive, and physically abusing; whereas the mother is passive and submissive, and denigrates her role as wife and mother. - Onset of the incestuous relationship typically occurs when the daughter is 8 to 10 years of age and commonly begins with genital touching and fondling. - In the beginning, the child may accept the sexual advances from her father as signs of affection. - As the incestuous behavior continues and progresses, the daughter usually becomes more bewildered, confused, and frightened, never knowing whether her father will be paternal or sexual in his interactions with her. - Although the oldest daughter in a family is most vulnerable to becoming a participant in father-daughter incest, some fathers form sequential relationships with several daughters. - If incest has been reported with one daughter, it should be suspected with all of the other daughters.

The cycle of battering - Phase III - Calm, Loving, Respite("Honeymoon") Phase

- In this phase, the batterer becomes extremely loving, kind, and contrite. - He promises that the abuse will never recur and begs her forgiveness. - He believes he now can control his behavior, and because now that he has "taught her a lesson," he believes she will not "act up" again. - During this phase, the woman relives her original dream of ideal love and chooses to believe that this is what her partner is really like. - This loving phase becomes the focus of the woman's perception of the relationship. - Although phase III usually lasts somewhere between the lengths of time associated with phases I and II, it can be so short as to almost pass undetected. In most instances, the cycle soon begins again with renewed tensions and minor battering incidents.

Common nursing diagnosis for clients with somatic symptom disorders include:

- Ineffective coping evidenced by numerous physical complaints (somatic symptom disorder) - Deficient knowledge [psychological causes for physical symptoms] (somatic symptom disorder) - Chronic pain (somatic symptom disorder) - Fear (illness anxiety disorder) - Disturbed sensory perception (conversion disorder) - Self-care deficit (conversion disorder) - Deficient knowledge (psychological factors affecting medical condition)

Predisposing factors to IDD - general medical conditions acquired in infancy or childhood

- Infections (example meningitis, encephalitis) - Poisonings (example insecticides, medications, lead) - Physical traumas (for example, head injuries, asphyxiation, hyperpyrexia) General medical conditions acquired during infancy or childhood account for approximately 5% of cases of intellectual disability. They include infections, such as meningitis and encephalitis; poisonings, such as from insecticides, medications, and lead; and physical trauma, such as head injuries, asphyxiation, and hyperpyrexia.

Describe the effects of inhalants on the body

- Inhalants can cause both central and peripheral nervous system damage. - Neurological damage, such as ataxia, peripheral and sensorimotor neuropathy, speech problems, and tremors, can occur. - Respiratory effects of inhalant use range from coughing and wheezing to dyspnea, emphysema, and pneumonia. - There is increased airway resistance due to inflammation of the passages. -- Abdominal pain, nausea, and vomiting may occur. - A rash may be present around the individual's nose and mouth. - Acute and chronic renal failure and hepatorenal syndrome have occurred. - Renal toxicity from toluene exposure has been reported.

Introjection: Defense Mechanism

- Integrating the beliefs and values of another individual into ones own ego structure. EX: Children integrate their parents value system into the process of conscience formation.

Intellectual Development Disorder

- Intellectual developmental disorder (I D D) has its onset prior to age 18 years and is characterized by impairments in measured intellectual performance and adaptive skills across multiple domains. "disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual, social, and practical domains." The incidence rate in the general population is about 1%, and onset occurs during the developmental period. The level of severity is based on adaptive functioning within the three domains.

Outcomes: Separation Anxiety Disorder - the client:

- Is able to maintain anxiety at manageable level - Demonstrates adaptive coping strategies for dealing with anxiety when separation from attachment figure is anticipated - Interacts appropriately with others and spends time away from attachment figure to do so

Outcomes for a patient with anxiety

- Is able to recognize signs of escalating anxiety and intervene before reaching panic level (panic and G A D) - Is able to maintain anxiety at manageable level and make independent decisions about life situation (panic and G A D) - Functions adaptively in the presence of the phobic object or situation without experiencing panic anxiety (phobic disorder) - Verbalizes a future plan of action for responding in the presence of the phobic object or situation without developing panic anxiety (phobic disorder) - Is able to maintain anxiety at a manageable level without resorting to the use of ritualistic behavior (O C D) - Demonstrates more adaptive coping strategies for dealing with anxiety than ritualistic behaviors (O C D) - Verbalizes a realistic perception of his or her appearance and expresses feelings that reflect a positive body image (body dysmorphic disorder) - Verbalizes and demonstrates more adaptive strategies for coping with stressful situations (hair-pulling disorder)

Treatment modalities: behavior modification - successess have been observed when the client:

- Is allowed to contract for privileges based on weight gain - Has input into the care plan - Clearly sees what the treatment choices are - The client has control over eating, over the amount of exercise pursued, and even over whether or not to induce vomiting - staff and cleint agree about goals and system of rewards

Treatment modalities: behavior modification

- Issues of control are central to the etiology of these disorders. - For the program to be successful, the client must perceive that he or she is in control of the treatment. Efforts to change the maladaptive eating behaviors of clients with anorexia nervosa and bulimia nervosa have become the widely accepted treatment. The importance of instituting a behavior modification program with these clients is to ensure that the program does not "control" them. Issues of control are central in these disorders.

Interventions with family and friends of suicide victims

- It has long been recognized that the bereavement process in families where a member has taken their own life is complicated and requires an understanding by healthcare providers of some unique burdens of this type of loss. - Encourage him or her to talk about the suicide. - Discourage blaming and scapegoating. - Listen to feelings of guilt and self-persecution. - Talk about personal relationships with the victim - Recognize differences in styles of grieving. - Assist with development of adaptive coping strategies. - Identify resources that provide support.

Assess for client with substance use disorder

- It is important for a nurse to examine his or her feelings about working with a client who abuses substances. If the nurse views these behaviors as morally wrong, it may be very difficult to suppress judgmental feelings. - Motivational interviewing is an approach that can be used in the assessment and intervention process for clients with any disorder, although it first gained popularity in treatment of substance use disorders. Its focus is on using skills such as empathy and reflection to explore the client's motivation, strengths, and readiness for change. - nurses must begin §relationship development with a substance abuser by examining own attitudes and personal experiences with substances. What are my drinking patterns? Do I see substance use as a sign of weakness? How do I feel about people who are intoxicated? If I drink, why do I? If I abstain, why do I? Has the use of alcohol by me or others affected my life in any way?

Chlildren, infant, and adolesence emotional problems

- It is often difficult to determine whether a child's behavior indicates emotional problems. - An emotional problem exists if behavioral manifestations: - Are not age appropriate - Deviate from cultural norms - Interfere with adaptive functioning

Other theories of suicide

- Joiner's interpersonal-psychological theory - The Three Step Theory

Functions of a group - information sharing

- Learning takes place within groups - Knowledge is gained when individual members learn how others in the group have resolved situations similar to those with which they are currently struggling.

Obsessive Compulsive Personality Disorder - LOW MIRTH

- Leisure activity is minimal - Organizational focus - Work and productivity predominale - Miserly spending habits - Inflexible around morals, values - Rigidity and stufbbornnes - Task Completion impaired by perfectionism - Hoards items - Individuals with obsessive-compulsive personality disorder are inflexible and lack spontaneity. They are meticulous and work diligently and patiently at tasks that require accuracy and discipline. They are especially concerned with matters of organization and efficiency and tend to be rigid and unbending about rules and procedures. Social behavior tends to be polite and formal. They are very "rank conscious," a characteristic that is reflected in their contrasting behaviors with "superiors" as opposed to "inferiors." They tend to be very solicitous to and ingratiating with authority figures. With subordinates, however, the compulsive person can become quite autocratic and condemnatory.

Less primitive/more mature defense mechanisms

- Less primitive defense mechanisms are a step up from the primitive defense mechanisms in the previous section. - Many people employ these defenses as adults, and while they work okay for many, they are not ideal ways of dealing with our feelings, stress and anxiety. - If you recognize yourself using a few of these, don't feel bad - everybody does.

Epidemiological Factors: Anorexia nervosa

- Lifetime prevalence for an episode of anorexia nervosa is 2.4% to 4.3%. - Men account for 25% of those with anorexia and bulimia and 36% of those with binge eating disorders. - social risks The prevalence of anorexia nervosa has increased since the mid-20th century both in the United States and in Western Europe. Epidemiological studies have found that across all ages and genders, the lifetime prevalence for an episode of anorexia nervosa is 2.4% to 4.3% (Call, Attie & Walsh, 2017). Once thought to be rare among males, more recent data (Woolridge & Lemberg, 2016) identifies that men account for 25% of those with anorexia and bulimia, and 36% of those with binge eating disorders. The authors also note that, for the first time, the incidence in males may be increasing at a more rapid rate in females. Social interests may also play a role in the prevalence of eating disorders. Among females, ballet training carries a seven times greater risk of developing anorexia nervosa. Among males, the evidence of eating disorders is more prevalent among those participating in wrestling.

Predisposing factors to gambling disorder - psychosocial influences

- Loss of a parent before age 15 - Inappropriate parental discipline - Exposure to gambling activities as an adolescent - Family emphasis on material and financial symbols - Lack of family emphasis on saving, planning, and budgeting

Documentation of the Nursing Process - Focus Charting

- Main perspective is to choose a "focus" for documentation. The focus for documentation can be a nursing diagnosis, current client concern or behavior, significant cahnge in the client status or behavior, significant event in the clients therapy - The focus cannot be a medical diagnosis. - Focus charting uses a data, action, and response format.

Planning/Implementation - anxiety(panic)

- Maintain calm, nonthreatening approach. - Keep the immediate surroundings low in stimuli. - Teach the client signs of escalating anxiety. - Use simple words and brief messages.

Therapeutic nurse-patient relationship - Working Phase

- Maintain trust and rapport. - Promote patient's insight and perception of reality. - Use problem-solving model to work toward achievement of established goals. - Overcome resistance behaviors. - Continuously evaluate progress toward goal attainment.

Hallucinogen-induced disorder - intoxication

- Maladaptive behavioral or psychological changes include marked anxiety or depression, ideas of reference, fear of losing one's mind, paranoid ideation, and impaired judgment. - Perceptual changes occur while the individual is fully awake and alert and include intensification of perceptions, depersonalization, derealization, illusions, hallucinations, and synesthesias. - Because hallucinogens are sympathomimetics, they can cause tachycardia, hypertension, sweating, blurred vision, papillary dilation, and tremors. - occurs during or shortly after using the drug - Symptoms include perceptual alteration, depersonalization, derealization, tachycardia, and palpitations.

Historical perspective of depression

- Many ancient cultures believed in the supernatural or divine origin of mood disorders. - Hippocrates believed that melancholia was caused by an excess of black bile, a heavily toxic substance produced in the spleen or intestine, that affected the brain.

Medical treatment modalities for dissociative symptom disorders

- Many cases of dissociative amnesia resolve spontaneously when the individual is removed from the stressful situation. - For other, more refractory conditions, intravenous administration of amobarbital is useful in the retrieval of lost memories. - In some instances, psychotherapy is used as the primary treatment. - Techniques of persuasion and free or directed association are used to help the client remember. - In other cases, hypnosis may be required to mobilize the memories. - Cognitive therapy has an added benefit that when the client begins to correct cognitive distortions about the associated trauma they may develop better recall of details about traumatic events. - The goal of therapy for the client with DID is to optimize the client's function and potential. - The achievement of integration (a blending of all the personalities into one) is usually considered desirable, but some clients choose not to pursue this lengthy therapeutic regimen. - In these cases, resolution, or a smooth collaboration among the subpersonalities, may be all that is realistic. - Clients are assisted to recall past traumas in detail. - They must mentally reexperience the abuse that caused their illness. - This process, called abreaction, or "remembering with feeling," is so painful that clients may actually cry, scream, and feel the pain they felt at the time of the abuse. - Information about the treatment of depersonalization-derealization disorder is sparse and inconclusive. - Various psychiatric medications have been tried, both singly and in combination: antidepressants, mood stabilizers, anticonvulsants, and antipsychotics. Results have been sporadic at best. - If other psychiatric disorders, such as schizophrenia, are evident, they too may be treated pharmacologically. For clients with evident intrapsychic conflict, analytically oriented insight psychotherapy may be useful. - Some clients with depersonalization-derealization disorder have benefited from hypnotherapy or cognitive-behavioral therapy (CBT).

Stimulant use order - patterns of use

- Many individuals who abuse or are addicted to CNS stimulants began using the substance for the appetite-suppressant effect in an attempt at weight control. - Chronic users tend to rely on CNS stimulants to feel more powerful, more confident, and more decisive. - They often fall into a pattern of taking "uppers" in the morning and "downers," such as alcohol or sleeping pills, at night. - The average American consumes two cups of coffee (about 200 mg of caffeine) per day, and caffeine is consumed in various amounts by about 90% of the population. - Next to caffeine, nicotine, an active ingredient in tobacco, is the most widely used psychoactive substance in U.S. society.

Substance use disorders

- Many patients may deny using substances, because they fear legal consequences. - Substance use during pregnancy may have legal consequences, which can deter prenatal care. - Establishment of trust, clear communication about why this information is being collected, and how it will be used are important first steps in the screening process.

Risk factors for suicide - psychiatric illness

- Mood and substance use disorders are the most common psychiatric illnesses that precede suicide. Other psychiatric disorders that account for suicidal behavior include: - Schizophrenia - Personality disorders - Anxiety disorders - Severe insomnia is associated with increased risk of suicide.

What else can put you at risk for suicide

- Mood disorders (major depression and bipolar disorders) are the most common disorders that precede suicide. - Individuals with substance use disorders are also at high risk. - Other psychiatric disorders in which suicide risks have been identified include anxiety disorders, schizophrenia, anorexia nervosa, and borderline and antisocial personality disorders. - Individuals may leave both behavioral and verbal clues as to the intent of their act. - Examples of behavioral clues that may indicate a decision to carry out the intent include giving away prized possessions, getting financial affairs in order, writing suicide notes, and sudden lifts in mood. - Lack of a meaningful network of satisfactory relationships may implicate an individual at a high risk for suicide during an emotional crisis - Adverse life events in combination with other risk factors such as depression may lead to suicide - Life stresses accompanied by an increase in emotional disturbance include the loss of a loved person either by death or divorce, problems in major relationships, changes in roles, or serious physical illness. - The ability to tolerate losses and disappointments is often compromised if those losses and disappointments occur during various stages of life in which the individual struggles with developmental issues - The individual should be assessed with regard to previous psychiatric treatment for depression, alcoholism, or previous suicide attempts. Medical history should be obtained to determine the presence of chronic, debilitating, or terminal illness. Is there a history of depressive disorder in the family, and has a close relative committed suicide in the past?

Risks associated with electroconvulsive therapy

- Mortality - permanent memory loss - brain damage

The impact of preexisting conditions - gender

- Most cultures have gender signals that are recognized as either masculine or feminine and provide a basis for distinguishing between members of each gender. - Roles have historically been identified as either male or female. - Gender signals are beginning to change in the United States as gender roles become less distinct.

Are defense mechanisms unconscious or conscious mechanisms?

- Most defense mechanisms are fairly unconscious - that means most of us don't realize we're using them in the moment. - Some types of psychotherapy can help a person become aware of what defense mechanisms they are using, how effective they are, and how to use less primitive and more effective mechanisms in the future

Electronic Documenation

- Most healthcare facilities have implemented, or are in the process of implementing, some type of electronic health records (E H R's) or electronic documentation system - Federal regulations and programs have incentivized the move to EHR's by requiring them in order to receive Medicare and Medicaid reimbursement. As of 2015, progressive reductions in reimbursement will be initiated for healthcare providers who are not demonstrating meaningful use of EHR's. - EHR's have been shown to improve both the quality of client care and the efficiency of the healthcare system.

Treatment modalities for gambling disorder

- Most pathological gamblers deny that they have a problem, and most gamblers only seek treatment due to legal difficulties, family pressures, or other complaints. - Behavior therapy, cognitive therapy, and psychoanalysis have been used with pathological gambling, with various degrees of success. - Some medications have been used with effective results in the treatment of pathological gambling. - SSRIs and clomipramine have been used successfully in the treatment of pathological gambling as a form of obsessive-compulsive disorder. - Lithium, carbamazepine, and naltrexone have also shown to be effective. - cognitive therapy - motivational interviewing

Psychopharmacology for substnace intoxication and substance withdrawal

- Naltrexone, which was approved in 1984 for the treatment of heroin abuse, works on the same receptors in the brain that produce the feelings of pleasure when heroin or other opiates bind to them. - The efficacy of selective serotonin reuptake inhibitors (SSRIs) in the decrease of alcohol craving among alcohol-dependent individuals has yielded mixed results. - In August, 2004, the FDA approved acamprosate (Campral), which is indicated for the maintenance of abstinence from alcohol in patients with alcohol addiction who are abstinent at treatment initiation. - Nalmenfene(Revex)

Risk for suicide

- National attention to suicide rates within specific groups has raised awareness of the need for screening/intervention among both lay people and healthcare providers. - Specific screening is especially important for groups who may not be forthcoming with their thoughts of suicide. - Examples: military personnel with P T S D, older adults with depression, trauma victims - A brief screening is not enough to prevent suicide in some individuals. - Defensive medicine: doing the minimum number of interventions needed to "meet the letter of the law. " - Depression, substance abuse issues, and/or chronic pain are risk factors for suicide in patients in primary care settings. - Establishing trust, a collaborative relationship, and a willingness to discuss issues from various vantage points are all essential in identifying the needed level of care or referral. - Patients with psychiatric comorbidities should be referred to specialized mental-healthcare services. - Those who exhibit N S S I B in response to command hallucinations need immediate medical attention.

neglect of elder

- Neglect implies failure to fulfill the physical needs of an individual who cannot do so independently. - Unintentional neglect is inadvertent, whereas intentional neglect is deliberate. - Another type of abuse, dubbed "granny-dumping" by the media, involves abandoning elderly individuals at emergency departments, nursing homes, or other facilities—literally leaving them in the hands of others when the strain of caregiving becomes intolerable. - Elder victims often minimize the abuse or deny it has occurred. The elderly person may be unwilling to disclose information because of fear of retaliation, embarrassment about the existence of abuse in the family, protectiveness toward a family member, or unwillingness to institute legal action. Adding to this unwillingness to report is the fact that infirm elders are often isolated, so their mistreatment is less likely to be noticed by those who might be alert to symptoms of abuse. For these reasons, detection of abuse in the elderly is difficult at best. - The 65-and-older age group has become the fastest growing segment of the population. Within this segment, the number of elderly older than age 75 has increased most rapidly. This trend is expected to continue well into the 21st century. Dependency appears to be the most common precondition in domestic abuse. Changes associated with normal aging or induced by chronic illness often result in loss of self-sufficiency in the elderly person, requiring that they become dependent on another for assistance with daily functioning. - The stress inherent in the caregiver role is a factor in most abuse cases. Some clinicians believe that elder abuse results from individual or family psychopathology. Others suggest that even psychologically healthy family members can become abusive as the result of the exhaustion and acute stress caused by overwhelming caregiving responsibilities. - Children who have been abused or witnessed abusive and violent parents are more likely to evolve into abusive adults. In some families, abusive behavior is the normal response to tension or conflict, and this type of behavior can be transmitted from one generation to another. - Because so many elderly individuals are reluctant to report personal abuse, healthcare workers need to be able to detect signs of mistreatment when they are in a position to do so.

Psychological aspects of normal aging - psychiatric disorders in later life

- Neurocognitive disorders - Delirium - Depression - Schizophrenia - Anxiety disorders - Substance use disorders - Sleep disorders - Cognitive disorders, depressive disorders, phobias, and alcohol use disorders are among the most common psychiatric illnesses in later life. - Many factors may influence symptomatology, including medical conditions and medications. - Neurocognitive disorders (NCDs) are the most common causes of psychopathology in the elderly. - About half of these disorders are of the Alzheimer's type, which is characterized by an insidious onset and a gradually progressive course of cognitive impairment. - Delirium is one of the most common and critical forms of psychopathology in later life. A number of factors have been identified that predispose elderly people to delirium, including structural brain disease, reduced capacity for homeostatic regulation, and impaired vision and hearing, among others. - Depressive disorders are the most common affective illnesses occurring after the middle years. The incidence of increased depression among elderly people is influenced by the variables of physical illness, functional disability, cognitive impairment, and loss of a spouse. - Schizophrenia is an illness that typically begins in young adulthood. In most instances, individuals who manifest psychotic disorders early in life show a decline in psychopathology as they age. - Most anxiety disorders begin in early to middle adulthood, but some appear for the first time after age 60. Because the autonomic nervous system is more fragile in older persons, the response to a major stressor is often quite intense. - It is believed that the incidence of substance abuse and addiction in older adults may have been underdiagnosed, but nationwide attention to the epidemic use and abuse of opioid pain medication has shed light on this problem in the elderly population. Older adults use prescription and over-the-counter (OTC) medications at least three times as frequently as the general population (Jeste, 2017) and may have more difficulty tolerating some drugs, particularly some long-acting drugs, sedative hypnotics, and benzodiazepines. For these reasons (and others), older adults are an at-risk population for substance use disorders and should be screened for prescription, OTC, and other substance use to identify an emerging problem. - Sleep disorders are very common in the aging individual. Roughly 50% of older adults report difficulty initiating or maintaining sleep, and these disorders may contribute to cognitive changes.

HPA axis and depression

- Neuroendocrine disturbances may play a role in the pathogenesis or persistence of depressive illness - In clients who are depressed, the normal system of hormonal inhibition fails, resulting in a hypersecretion of cortisol - Thyrotropin-releasing factor (TRF) from the hypothalamus stimulates the release of thyroid-stimulating hormone (TSH) from the anterior pituitary gland - Diminished TSH response to administered TRF is observed in approximately 25% of depressed persons and appears to be associated with an increased risk for relapse despite treatment with antidepressants.

Characteristics of fetal alcohol syndrome

- No amount of alcohol during pregnancy is considered safe, and alcohol can damage a fetus at any stage of pregnancy. - Women with alcohol-related disorders have a 35% risk of having a child with defects. - Learning difficulties - Speech and language delays - Intellectual disability - Poor reasoning skills - Sleep and sucking problems as a baby - Vision or hearing problems - Problems with the heart, kidneys, or bones - Abnormal facial features - Small head size - Shorter-than-average height - Low body weight - Poor coordination - Hyperactive behavior - Difficulty paying attention - Poor memory - Difficulty in school

Predisposing factors - avoidant personality disorder

- No clear cause is known. - May be a combination of biological, genetic, and psychosocial influences - Primary psychosocial influence: Parental rejection and censure, which are often reinforced by peers - There is no clear cause of avoidant personality disorder. Contributing factors are most likely a combination of biological, genetic, and psychosocial influences. Some infants who exhibit traits of hyperirritability, crankiness, tension, and withdrawal behaviors may possess a temperamental disposition toward an avoidant pattern. Psychosocial influences may include childhood trauma or neglect, leading to fears of abandonment or to viewing the world as a hostile and dangerous place.

Epidemiology of depression - race and culture

- No consistent relationship between race and affective disorder has been reported. - Problems have been encountered in reviewing racial comparisons - Clinicians tend to underdiagnose mood disorders and to overdiagnose schizophrenia in clients who have racial or cultural backgrounds different from their own. This misdiagnosis may result from language barriers between clients and physicians who are unfamiliar with cultural aspects of nonwhite clients' language and behavior.

Treatment modalities: psychopharmacology

- No medications are specifically indicated for eating disorders. - Various medications have been prescribed for associated symptoms of Anxiety and Depression

Antisocial Personality Disorder

- Not often seen in most clinical settings - Most frequently encountered in prisons, jails, and rehabilitation services - When clients are seen, it is commonly a way to avoid legal consequences. - Sometimes they are admitted to the healthcare system by court order for psychological evaluation. Individuals with antisocial personality disorder are seldom seen in most clinical settings, and when they are, it is commonly a way to avoid legal consequences. Sometimes they are admitted to the healthcare system by court order for psychological evaluation. Most frequently, however, these individuals may be encountered in prisons, jails, and rehabilitation services.

Role of the nurse in milieu therapy - nurses are also responsible for client education:

- Nurses must be able to assess learning readiness in individual clients - Topics for client education in psychiatry include information about medical diagnoses, side effects of medications, the importance of continuing to take medications, and stress management, among others. - Some topics must be individualized for specific clients, whereas others may be taught in group situations.

Planning/Implementation for aging client

- Nursing care of the aging individual is aimed at protection from injury caused by age-related physical changes or altered thought processes related to cerebral changes. - The nurse is also concerned with preserving dignity and self-esteem in an individual who may have come to be dependent on others for his or her survival. - Assistance is provided with self-care deficits while encouraging independence to the best of the client's ability. - Reminiscence therapy is encouraged. Protection from injury and preserving dignity and self-esteem should be the focus of nursing care for the elderly individual. Interventions should include several changes to the client's environment, frequent monitoring of the client, providing simple, structured environments, encouraging the client to express honest feelings, and encouraging group activities, to name a few.

Planning/Implementation for the victim of absue

- Nursing intervention for the victim of abuse or neglect is to provide shelter and promote reassurance of his or her safety - focus on treating physical wounds, beginning healthy grief resolution, helping the client exhibit control over their life, and helping the client demonstrate behaviors consistent with age-appropriate growth and development.

Therapeutic nurse-patient relationship - preinteraction phase

- Obtain information about the patient from chart, significant others, or other health team members. - Examine one's own feelings, fears, and anxieties about working with a particular patient

Frontotemporal neurocognitive disorder - predisposing factors

- Occurs as a result of shrinking of the frontal and temporal anterior lobes of the brain - Previously called Pick's disease - Exact cause is unknown, but genetics appears to be a factor. - Symptoms tend to fall into two clinical patterns: (1) behavioral and personality changes and (2) speech and language problems.

Assessment: Separation anxiety disorder

- Onset may occur as early as preschool age, rarely as late as adolescence. - Child has difficulty separating from the mother in most cases. - Separation results in tantrums, crying, screaming, complaints of physical problems, and clinging behaviors. Age at onset of this disorder may be as early as preschool age. It rarely begins as late as adolescence. In most cases, the child has difficulty separating from the mother. Occasionally, the separation reluctance is directed toward the father, siblings, or other significant individual to whom the child is attached. Anticipation of separation may result in tantrums, crying, screaming, complaints of physical problems, and clinging behaviors. Reluctance or refusal to attend school occurs in the majority of these children. Up to 80% of children with school refusal meet criteria for separation anxiety disorder. Younger children may "shadow" or follow around the person from whom they are afraid to be separated. During middle childhood or adolescence, they may refuse to sleep away from home. Interpersonal peer relationships are usually not a problem with these children. They are generally well liked by their peers and are reasonably socially skilled. Worrying is common and relates to the possibility of harm coming to self or to the attachment figure. Younger children may even have nightmares to this effect. Specific phobias are not uncommon.

withdrawal

- Onset of symptoms depends on the half-life of the drug from which the person is withdrawing. - Severe withdrawal from C N S depressants can be life-threatening. - With short-acting sedative/hypnotics, symptoms may begin between 12 and 24 hours after the last dose, reach peak intensity between 24 and 72 hours, and subside in 5 to 10 days. Withdrawal symptoms from substances with longer half-lives may begin within 2 to 7 days, peak on the fifth to eighth day, and subside in 10 to 16. Severe withdrawal is most likely to occur when a substance has been used at high dosages for prolonged periods. Withdrawal symptoms associated with sedative/hypnotics include autonomic hyperactivity, increased hand tremor, insomnia, nausea or vomiting, hallucinations, illusions, psychomotor agitation, anxiety, or grand mal seizures.

Physical conditions that influence group dynamics - membership: open-ended groups

- Open-ended groups are those in which members leave and others join at any time while the group is active - The continuous movement of members in and out of the group creates the type of discomfort described previously that encourages unsettled behaviors in individual members and fosters the exploration of feelings.

psychopharmacology for substance intoxication and substance withdrawal - opioids

- Opioid intoxication is treated with narcotic antagonists such as naloxone (Narcan), naltrexone (ReVia), or nalmefene (Revex). - In 2015, the FDA approved an intranasal form of naloxone hydrochloride under a fast track approval process in response to the continued increase in deaths associated with drug overdose, particularly from respiratory depression and arrest. - Methadone, if ordered, is given on the first day in a dose sufficient to suppress withdrawal symptoms. - The dose is then gradually tapered over a specified time. In October 2002, the FDA approved two forms of the drug buprenorphine for treating opiate addiction. - Buprenorphine is less powerful than methadone, but is considered to be somewhat safer and causes fewer side effects. - Clonidine (Catapres) also has been used to suppress opiate withdrawal symptoms. - As monotherapy, it is not as effective as substitution with methadone, but it is nonaddicting.

Comorbidity: ADHD

- Oppositional defiant disorder - Conduct disorder - Anxiety - Depression - Bipolar disorder - Substance use disorders - Depression and anxiety may be treated concurrently with A D H D. - Substance use disorder and bipolar disorder must be stabilized before beginning treatment for A D H D. The prevalence of comorbid psychiatric disorders with A D H D may be as high as 84%. The APA (2013) reports that in children with A D H D who have both symptoms of inattention and hyperactivity/impulsivity, oppositional defiant disorder co-occurs about 50% of the time. Other comorbidities include conduct disorder, specific learning disorder, anxiety, depression, and intermittent explosive disorder. While bipolar mania and A D H D share many core features, children with bipolar I disorder exhibit symptoms that wax and wane; children with A D H D have more persistent continuous symptoms. Bipolar disorder and A D H D can coexist.

Treatment modalities for gambling disorder - gambling anonymous

- Organization modeled after A A - Only requirement for membership is an expressed desire to stop gambling - Reformed gamblers help others resist the urge to gamble.

Systemic desensitization

- Other forms of behavior therapy include systematic desensitization and implosion therapy (flooding). In systematic desensitization, the client is gradually exposed to the phobic stimulus, either in a real or imagined situation. In implosion therapy, the therapist "floods" the client with information concerning situations that trigger anxiety in him or her. The therapist describes anxiety-provoking situations in vivid detail and is guided by the client's response; the more anxiety provoked, the more expedient is the therapeutic endeavor. - the client works out a hierarchy of fear from the least frightening to the most frightening, the cleint learns relaxations, the client works through the hierarchy learning to use relaxation techniques in teh presence of the feared object

how old is old?

- Our prehistoric ancestors probably had a life span of 40 years, with an average life span of around 18 years. - The average life expectancy for a child born in the United States today is 76.3 years for men and 81.2 years for women. - Whether one is considered "old" must be self-determined, based on variables such as attitude, mental health, physical health, and degree of independence. The concept of "old" has changed drastically over the years. An improvement in the standard of living was not evident until about the middle of the 17th century when assured food supply, changes in food production, better housing conditions, and more progressive medical treatments, began to contribute to declining mortality rates and substantial increases in longevity. Myths and stereotypes of aging have long obscured our understanding of the aged and the process of aging. Ideas that all elderly individuals are sick, depressed, obsessed with death, senile, and are incapable of change affect the way elderly people are treated. Healthcare workers should see aging people as individuals, each with specific needs and abilities, rather than as a stereotypical group. Some individuals may seem "old" at 40, whereas others may not seem "old" at 70. In the final analysis, whether one is considered "old" must be self-determined.

Obessive-Compulsive Personality Disorder Predisposing factors

- Overcontrol by parents - Notable parental lack of positive reinforcement for acceptable behavior - Frequent punishment for undesirable behavior - Genetic vulnerability - Genetic vulnerability may be a predisposing factor because it is noted to occur more frequently in first-degree biological relatives than in the general population. In the psychoanalytical view, the parenting style in which the individual with obsessive-compulsive personality disorder was reared is one of over-control. These parents expect their children to live up to their imposed standards of conduct and condemn them if they do not. In this environment, individuals become experts in learning what they must not do to avoid punishment and condemnation rather than what they can do to achieve attention and praise.

Differences between PTSD and adjustment disorder

- PTSD symptoms can also seem similar to adjustment disorder because both are linked with anxiety that develops after exposure to a stressor - with PTSD, this stressor is a traumatic event - with adjustment disorder, the stressor does not have to be severe or outside the "normal" human experience

Predisposing factors - separation anxiety disorder - family influences

- Parental overprotection - Insecure parent-child attachment - Maternal depression - Role modeling Studies have shown a relationship between life events and the development of anxiety disorders. Significant changes or losses often coincide with the development of the disorder. Children of mothers who were stressed during pregnancy also appear to be at greater risk for developing separation anxiety disorder. Various theories expound on the idea that anxiety disorders in children are related to attachment issues with the mother. Three family influences that have demonstrated an increased risk for anxiety disorders in children include parental overprotection, insecure parent-child attachment, and maternal depression. Some parents may also transfer their fears and anxieties to their children through role modeling. For example, a parent who becomes significantly fearful and apprehensive when confronted with unfamiliar circumstances, such as a job or residence change, teaches the child that this is an appropriate response.

Predisposing factors: conduct disorder - family influences

- Parental rejection, neglect, aggression - Inconsistent management with harsh discipline - Lack of parental supervision These factors related to family dynamics have been implicated as contributors in the predisposition to conduct disorder and are typically in combination with one another to create a pattern of chaotic disruption in family life.

Peplaus four levels of anxiety - severe anxiety

- Perceptual field diminishes greatly - concentration centers on one particular detail only or on many extraneous details - Attention span is extremely limited - the individual has much difficulty completing even the simplest task - Physical symptoms may include headaches, palpitations, and insomnia. - Emotional symptoms may include confusion, dread, and horror - Virtually all overt behavior is aimed at relieving the anxiety.

Non substance addictions - gambling disorder

- Persistent and recurrent problematic gambling behavior that intensifies when the individual is under stress. - As the need to gamble increases, the individual may use any means required to obtain money to continue the addiction. - Gambling behavior usually begins in adolescence, although compulsive behaviors rarely occur before young adulthood. - The disorder usually runs a chronic course, with periods of waxing and waning. - The disorder interferes with interpersonal relationships, social, academic, or occupational functioning.

Personality Traits

- Personality traits are characteristics with which an individual is born or develops early in life. - They influence the way in which he or she perceives and relates to the environment and are quite stable over time.

Spcial concerns for elderly people - suicide

- Persons 85 years of age and older represent a disproportionately high percentage of individuals who commit suicide. - The group at highest risk appears to be white men experiencing loneliness, financial problems, physical illness, loss, and/or depression. In 2016, the highest rates of suicide occurred in those aged 45 to 54, but the second-highest rates were among those aged 85 and older (American Foundation for Suicide Prevention [AFSP], 2018). The AFSP also reports that men, and particularly white men (in all age groups), die by suicide more often than do women. Predisposing factors include loneliness, financial problems, physical illness, loss, and depression. It has been suggested that increased social isolation may be a contributing factor to suicide among the elderly. The number of elderly individuals who are divorced, widowed, or otherwise living alone has increased, and being a widow is associated with a higher risk for depression and suicide (Sadock et al, 2015). Components of intervention with a suicidal elderly person should include demonstrations of genuine concern, interest, and caring; indications of empathy for their fears and concerns; and help in identifying, clarifying, and formulating a plan of action to deal with the unresolved issue.

Intimate partner violence - prevalence and intimate partner violence

- Physical abuse between domestic partners may be known as spouse abuse, domestic or family violence, wife or husband battering, or intimate partner violence (IPV). - Data from the U.S. Bureau of Justice Statistics reflect the following: 76% of victims of intimate violence were women, women ages 25 to 34 experienced the highest per capita rates of intimate violence, and most of the perpetrators were current or former boyfriends or girlfriends - During the same period, 35.5% of domestic violence incidents were identified as "serious violent crime" that included rape or sexual assault, robbery, and/or aggravated assault, and around 9% involved serious injuries. - Many of the victimizations are not reported to the police, and the main reason given for not reporting is that it was "considered a personal matter."

Nonverbal Communication components

- Physical appearance and dress - Body movement and posture - Touch - Facial expressions - Eye behavior - Vocal cues or paralanguage

Effects of alcohol on the body - thrombocytopenia

- Platelet production and survival is impaired as a result of the toxic effects of alcohol. - This places the alcoholic at risk for hemorrhage. - Abstinence from alcohol rapidly reverses this deficiency.

Predisposing factors - antisocial personality disorder

- Possible genetic influence - Having a disruptive behavior disorder as a child (attention deficit/hyperactivity disorder; conduct disorder) - History of severe physical abuse - Absent or inconsistent parental discipline - Extreme poverty - Removal from the home - Antisocial personality is more common among first-degree biological relatives of those with the disorder than among the general population. Twin and adoptive studies have implicated the role of genetics in antisocial personality disorder, especially for the personality traits of callousness and unemotional responses, which may be more definitive of psychopathy. - Characteristics associated with temperament in the newborn may be significant in the predisposition to antisocial personality disorder. - Parents who bring their children with behavior disorders to clinics often report that the child displayed temper tantrums from infancy and would become furious when awaiting a bottle or a diaper change. - The likelihood of developing antisocial personality disorder is increased if the individual had attention deficit/hyperactivity disorder and conduct disorder as a child. - Other brain imaging studies have identified deficits in prefrontal cortex gray matter, which regulates cognitive control and inhibition, and decreased activity in the amygdala, which is responsible for modulating fearful or threatening stimuli. - Antisocial personality disorder frequently arises from a chaotic home environment. - Parental deprivation during the first 5 years of life appears to be a critical predisposing factor in the development of antisocial personality disorder. - Separation due to parental delinquency appears to be more highly correlated with the disorder than is parental loss from other causes. - Studies have shown that antisocial personality disorder in adulthood is highly associated with physical abuse and neglect, teasing, and lack of parental bonding in childhood. - Severe physical abuse was found to be particularly correlated to violent offending, triggering the development of a pattern of reactive aggression that is persistent over one's lifetime. - When they are identified in children and adolescents, the diagnosis is conduct disorder, and the common symptoms are bullying, fighting, physical cruelty to animals, destruction of property, and theft, among others.

Dependent Personality Disorder predisposing factors

- Possible hereditary influence - Stimulation and nurturance are experienced exclusively from one source. - A singular attachment is made by the infant to the exclusion of all others. - An infant may be genetically predisposed to a dependent temperament. Twin studies measuring submissiveness have shown a higher correlation between identical twins than fraternal twins. - Psychosocially, dependency is fostered in infancy when stimulation and nurturance are experienced exclusively from one source. The infant becomes attached to one source to the exclusion of all others. A problem may arise when parents become overprotective and discourage independent behaviors. Dependent behaviors may be subtly rewarded in this environment, and the child may come to fear a loss of love or attachment from the parental figure if independent behaviors are attempted.

Nursing diagnosis for PTSD

- Post-trauma syndrome related to distressing event considered to be outside the range of usual human experience, evidenced by flashbacks, intrusive recollections, nightmares, psychological numbness related to the event, dissociation, or amnesia. - Complicated grieving related to loss of self as perceived before the trauma or other actual or perceived losses incurred during or after the event evidenced by irritability and explosiveness, self-destructiveness, substance abuse, verbalization of survival guilt, or guilt about behavior required for survival.

Childhood depression

- Precipitated by a loss - Focus of therapy: Alleviate symptoms and strengthen coping skills - Parental and family therapy - recovery is facilitated by emotional support and guidance to family members - hyperactivity, delinquency, school problems, psychosomatic complaints, sleeping and eating disturbances, social isolation, delusional thinking, and suicidal thoughts or actions.

Fetal Alcohol syndrome

- Prenatal exposure to alcohol can result in a broad range of disorders to the fetus, known as fetal alcohol spectrum disorders (FASDs), the most common of which is fetal alcohol syndrome (FAS). - Fetal alcohol syndrome includes physical, mental, behavioral, and/or learning disabilities with lifelong implications. - Other FASDs include alcohol-related neurodevelopmental disorder (ARND) and alcohol-related birth defects (ARBD). - problems with learning, memory, attention span, communication, vision, and hearing

Peplaus four levels of anxiety - mild axiety

- Prepares people for action - It sharpens the senses, increases motivation for productivity, increases the perceptual field, and results in a heightened awareness of the environment - Learning is enhanced, and the individual is able to function at his or her optimal level. - seldom a problem

Nursing Process Assessment

- Presenting symptoms/medical-psychiatric diagnosis - Interpersonal support system - Suicidal ideas or acts(Seriousness of intent, Plan, Means, Verbal and behavioral clues) - Analysis of the suicidal crisis(Precipitating stressor, Relevant history, Life-stage issues) - Psychiatric/medical/family history - Coping strategies

Medication with electroconvulsive therapy

- Pretreatment medication - muscle relaxant - short-acting anesthetic

reaction formation (defense mechanism)

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

Intimate partner violence - why do they stay?

- Probably the most common response that battered women give for staying is that they fear for their life and/or the lives of their children •Fear of retaliation •For the children •For financial reasons •Lack of a support network •Religious reasons •Hopefulness •Lack of attention to the danger It is important to recognize that when a victim leaves an abusive relationship they are at a 75% greater risk of being killed by the partner, and the abuse often does not stop once they have left.

Effects of alcohol on the body - leukopenia

- Production, function, and movement of the white blood cells are impaired in chronic alcoholics. - places the individual at high risk for contracting infectious diseases, and the likelihood of a complicated recovery.

Phases of group development - Phase II. Middle or working phase

- Productive work toward completion of the task is undertaken. - The leader role diminishes and becomes one that is more of a facilitator. - Trust has been established among the members and cohesiveness exists. - Conflict is managed by the group members themselves.

Therapeutic Nurse-Patient Relationship -- termination phase - therapeutic conclusion of relationship occurs when?

- Progress has been made toward attainment of the goals. - A plan of action for more adaptive coping with future stressful situations has been established. - Feelings about termination of the relationship are recognized and explored.

Examples of maladaptive grief repsonses

- Prolonged responses characterized with intense preoccupation with the lost entity. - Delayed or inhibited responses in which the individual becomes stuck in the denial stage of the grieving process. - Distorted responses in which the individual becomes stuck in the anger stage of the process.

Theories of aging - wear and tear theory

- Proponents of this theory believe that the body wears out on a scheduled basis. - A related theory suggests that free radicals, which are the waste products of metabolism, accumulate and cause damage to important biological structures. - According to this theory, these free radicals cause DNA damage, cross-linkage of collagen, and the accumulation of age pigments.

Planning/implementation with ASD

- Protection of the child from self-harm - Improvement in social functioning - Improvement in verbal communication - Enhancement of personal identity Goals for treatment of a child with autism spectrum disorder should focus on preventing self-harm, helping the client initiate social interaction, establishing a means of communicating needs, and helping the client to develop ego identity. Interventions should include working with the child on a one-on-one basis, giving positive reinforcement, and assisting the child in recognizing separateness.

Somatic symptom disorders - psychological factors affecting medical condition

- Psychological factors may play a role in virtually any medical condition. - With this diagnosis, there is evidence of a general medical condition that has been precipitated by or is being perpetuated by psychological or behavioral circumstances.

Characteristics of sexual assault

- Rape can occur at any age; however, the most recent statistics suggest that the highest-risk age group is females under the age of 34, those with lower income, and those living in rural areas. - Most sexual assault victims are single women, and the attack frequently occurs in or close to the victim's own neighborhood. - Although women are at highest risk for being victims of rape perpetrated by males, women or other men may also victimize males. - Rape survivors who present themselves for care shortly after the crime has occurred likely may be experiencing an overwhelming sense of violation and helplessness. - who has classically defined what has been described as rape trauma syndrome, identified two emotional patterns of response that may occur within hours after a rape and with which healthcare workers may be confronted in the emergency department or rape crisis center.

Substance use disorders

- Rates of opioid abuse have reached epidemic levels in the United States. - Opioid addiction can lead to overdose. - Methamphetamine use has also increased significantly. - Methamphetamine withdrawal is associated with an increased risk for suicide. - Numerous physical and psychological consequences of long-term alcohol use are well documented.

Depression - complicated grieving related to?

- Real or perceived loss - Bereavement overload

The chemically impaired nurse - peer assistanfe programs serve to assist impaired nurses to:

- Recognize their impairment - Obtain necessary treatment - Regain accountability within the profession - In 1982, the American Nurses Association (ANA) House of Delegates adopted a national resolution to provide assistance to impaired nurses. Since that time, the majority of state nurses' associations have developed (or are developing) programs for nurses who are impaired by substances or psychiatric illness. The individuals who administer these efforts are nurse members of the state associations, as well as nurses who are in recovery themselves. For this reason, they are called peer assistance programs.

Predisposing factors - biological theories - neurophysiological influences

- Research demonstrates consistently that lower volume of the amygdala plays a role in aggression. - The amygdala, which is responsible for impulse control and affective processing appears to be less well modulated in people with aggression, and responses to fear are reduced. - The limbic prefrontal cortex also has a primary role in aggression; smaller volumes of left-sided gray matter and greater right-sided volume have been noted in people with aggressive traits. - Studies have associated increased dopamine release with aggression, and low levels of striatal serotonin have been associated with increases in impulsivity and aggression. - Evidence supports that high plasma (and low cerebrospinal fluid) concentrations of 5-HIAA serotonin are associated with aggression. - Research is showing that a complex interaction between testosterone and cortisol levels is associated with aggression.

Neurocognitive disorders due to AD - predisposing factors - neurotransmitter alterations

- Research has indicated that in the brains of Alzheimer's patients, the enzyme required to produce acetylcholine is dramatically reduced. - This decrease in production of acetylcholine reduces the amount of the neurotransmitter that is released to cells in the cortex and hippocampus, resulting in a disruption of the cognitive processes.

Avoidant personality disorder - RIDICULE

- Restrained within relationships - Inhibited in interpersonal situations - Disapproval expected at work - Inadequate(view of self) - Criticism is expected in social situations - Unwilling to get involved - Longs for attachment to tothers - Embarrassment is the feared emotion - Individuals with this disorder are awkward and uncomfortable in social situations. From a distance, others may perceive them as timid, withdrawn, or perhaps cold and strange. Those who have closer relationships with them, however, soon learn of their sensitivities, touchiness, evasiveness, and mistrustful qualities. Their speech is usually slow and constrained, with frequent hesitations, fragmentary thought sequences, and occasional confused and irrelevant digressions. They are often lonely, and express feelings of being unwanted.

Reversible neurocognitive disorder

- Reversible N C D may be more appropriately termed temporary dementia. Truly reversible N C D occurs in only a small percentage of cases and might be more appropriately termed temporary.

Nursing diagnosis for substance use disorder - risk for infection

- Risk for infection related to malnutrition and altered immune condition - Outcome: Shows no signs or symptoms of infection.

Planning/Implementation: IDD - the care plan should focus on:

- Risk for injury - Self-care deficit - Impaired verbal communication - Goals for treatment of a child with intellectual disability should focus on preventing injury, improving self-care, and meeting communication needs. Interventions should include creating a safe environment for the client, preventing physical aggression and acting out behaviors, identifying aspects of self-care that are within the client's capabilities, and fulfilling needs until communication patterns are established. - Although the plan of care is directed toward the individual client, it is essential that family members or primary caregivers participate in the ongoing care of the client with I D D.

Diagnoses/Outcome identification for IDD

- Risk for injury related to altered physical mobility or aggressive behavior - Self-care deficit related to altered physical mobility or lack of maturity - Impaired verbal communication related to developmental alteration - Impaired social interaction related to speech deficiencies or difficulty adhering to conventional social behavior - Delayed growth and development related to isolation from significant others; inadequate environmental stimulation; genetic factors - Anxiety (moderate to severe) related to hospitalization and absence of familiar surroundings - Defensive coping related to feelings of powerlessness and threat to self-esteem - Ineffective coping related to inadequate coping skills secondary to developmental delay

Diagnosis/Outcome identification - conduct disorder

- Risk for other-directed violence related to characteristics of temperament, peer rejection, negative parental role models, dysfunctional family dynamics - Impaired social interaction related to negative parental role models, impaired peer relations leading to inappropriate social behaviors - defense coping - low self-esteem

Nursing Diagnosis - Antisocial Personality Disorder

- Risk for other-directed violence related to rage reactions, negative role-modeling, inability to tolerate frustration - Defensive coping related to dysfunctional family system - Chronic low self-esteem related to repeated negative feedback resulting in diminished self-worth - Impaired social interaction related to negative role modeling and low self-esteem - Ineffective health maintenance, evidenced by demonstration of inability to take responsibility for meeting basic health practices

Assessment of ASD - diagnosis/outcome identification

- Risk for self-mutilation or self-injury related to neurological, cognitive, or social deficits; impaired social interaction related to an inability to trust; neurological alterations, evidenced by lack of responsiveness to, or interest in, people - Impaired verbal communication related to withdrawal into the self; neurological alterations, evidenced by an inability or unwillingness to speak; lack of nonverbal expression - Disturbed personal identity related to neurological alterations; delayed developmental stage, evidenced by difficulty separating own physiological and emotional needs and personal boundaries from those of others

Nursing Diagnosis: Borderline Personality Disorder

- Risk for self-mutilation related to parental emotional deprivation - Risk for suicide related to unresolved grief - Risk for other-directed violence related to underlying rage - Complicated grieving related to maternal deprivation during rapprochement phase of development internalized as a loss, with fixation in anger stage of grieving process - Impaired social interaction related to extreme fears of abandonment and engulfment - Disturbed personal identity related to underdeveloped ego - Anxiety (severe to panic) related to unconscious conflicts based on fear of abandonment - Chronic low self-esteem related to lack of positive feedback

Nursing diagnosis/outcome identification for neurocognitive disorders

- Risk for trauma - Disturbed thought processes - Impaired memory - Disturbed sensory perception - Risk for other-directed violence - Impaired verbal communication - Self-care deficit - Situational low self-esteem - Grieving

Diagnosis and outcome identification for elderly patient

- Risk for trauma - Hypothermia - Decreased cardiac output - Ineffective breathing pattern - Risk for aspiration - Impaired physical ability - Imbalanced nutrition, less than body requirements - Constipation - Stress urinary incontinence - Urinary retention - Disturbed sensory perception - Insomnia - Chronic pain - Self-care deficit - Risk for impaired skin integrity - Disturbed thought processes - Complicated grieving - Risk for suicide - Powerlessness - Low self-esteem - Fear - Disturbed body image - Ineffective sexuality pattern - Sexual dysfunction - Social isolation - Risk for trauma (elder abuse) - Caregiver role strain

Risk factors for suicide - age

- Risk of suicide increases with age, particularly among men. - White men older than 80 years are at the greatest risk of all age, gender, and race groups.

Psychopharmacological interventions for ASD - medications

- Risperidone - Aripiprazole risperidone (Risperdal; in children and adolescents 5 to 16 years) and aripiprazole (specifically Abilify; in children and adolescents 6 to 17 years).

Medical treatment modalities - NCD - pharmaceutical agents for agitation, aggression, hallucinations, thought disturbances, and wandering

- Risperidone (Risperdal) - Olanzapine (Zyprexa) - Quetiapine (Seroquel) - Ziprasidone (Geodon) Historically, physicians have prescribed antipsychotic medications to control agitation, aggression, hallucinations, thought disturbances, and wandering in patients with N C D. The atypical antipsychotic medications, such as risperidone, olanzapine, quetiapine, and ziprasidone, are often favored because of their lessened propensity to cause anticholinergic and extrapyramidal side effects. In 2005, however, following review of a number of studies, the F D A ordered black-box warnings on drug labels of all the atypical antipsychotics, noting that the drugs are associated with an increased risk of death in elderly patients with psychotic behaviors associated with N C D.

Documentation of the Nursing Process - SOAPIE format

- S = Subjective data: Information gathered from what the client, family, or other source has said or reported. - O = Objective data: Information gathered through direct observation by the person performing the assessment; may include a physiological measurement such as blood pressure or a behavioral response such as affect. - A = Assessment: The nurse's interpretation of the subjective and objective data. - P = Plan: The actions or treatments to be carried out (may be omitted in daily charting if the plan is clearly explained in the written nursing care plan and no changes are expected). - I = Intervention: Those nursing actions that were actually carried out. - E = Evaluation of the problem following nursing intervention (some nursing interventions cannot be evaluated immediately, so this section may be optional).

Persistent depressive disorder(dysthymia)

- Sad or "down in the dumps" - No evidence of psychotic symptoms - Essential feature is a chronically depressed mood for Most of the day, More days than not, and At least 2 years - identified as early onset(before 21), or late onset(21 or older)

Planning/Implementation: Tourette Disorder

- Safety of client and others - Encouraging interpersonal interaction using appropriate behaviors - Promoting increased feelings of self-worth Risk for violence, impaired social interaction, and low self-esteem should be the focus of nursing care. Goals for treatment of a child with Tourette disorder should focus on keeping the client from harming themselves or others, helping the client interact with staff and peers, and helping increase self-worth. Interventions should include monitoring for self-destructive behavior, redirecting violent behavior with physical outlets, providing group situations, and setting limits on manipulative behavior.

Screening, Brief Intervention, and Referral to Treatment(SBIRT)

- Screening quickly assesses the severity of substance use and identifies the appropriate level of treatment. - Brief intervention focuses on increasing insight and awareness regarding substance use and motivation toward behavioral change. - Referral to treatment provides those identified as needing more extensive treatment with access to specialty care.

Physical conditions that influence group dynamics

- Seating can change the dynamic of a group - Seating should be set up so there is no barrier between the members. For example, a circle of chairs is better than chairs set around a table. - Members should be encouraged to sit in different chairs each meeting. This openness and change creates a feeling of discomfort that encourages anxious and unsettled behaviors that can then be explored within the group.

Common side effects of ariprprazole

- Sedation - Fatigue - Weight gain - Vomiting - Somnolence - Tremor - In clinical studies with aripiprazole, the most frequently reported adverse events included sedation, fatigue, weight gain, vomiting, somnolence, and tremor. The most common reasons for discontinuation of aripiprazole were sedation, drooling, tremor, vomiting, and extrapyramidal disorder.

Psychological aspects of normal aging - adaptation to the tasks of aging - maintenance of self-identity

- Self-concept and self-image appear to remain stable over time. - Factors that have been shown to favor good psychosocial adjustment in later life are: - Sustained family relationships - Maturity of ego defenses - Absence of alcoholism - Absence of depressive disorder - Maintaining a positive self-concept and identity is important in successful aging. Individuals who tend toward a rigid self-identity and a negative self-concept will struggle with any changes and adaptations faced in the process of aging.

Psychological aspects of normal aging - memory functioning

- Short-term memory seems to deteriorate with age, but long-term memory does not show similar changes. - Time required for memory scanning is longer for both recent and remote recall among older people. - Mentally active people show less memory decline than those who are not mentally active. Age-related memory deficiencies and slower response times have been extensively reported in the literature. Although short-term memory seems to deteriorate with age, perhaps because of poorer sorting strategies, long-term memory does not show similar changes.

Outcomes - Antisocial Personality Disorder - the Client

- Shows regard for the feeling of others - Can verbalize which behaviors are not acceptable - Does not manipulate others for personal gain - Can verbalize which of his or her behaviors are not acceptable - Shows regard for the rights of others by delaying gratification of own desires when appropriate

Neurocognitive disorder due to lewy body disease - predisposing factors

- Similar to A D, but progresses more rapidly - Appearance of Lewy bodies in the cerebral cortex and brainstem - Progressive and irreversible however, it tends to progress more rapidly, and there is an earlier appearance of visual hallucinations and Parkinsonian features. Depression and delusions are also common symptoms in this population. The disease is progressive and irreversible, and may account for as many as 25% of all N C D cases.

Assessment of tourette disorder

- Simple motor tics include eye blinking, neck jerking, shoulder shrugging, and facial grimacing. - Complex motor tics include squatting, hopping, skipping, tapping, and retracing steps. - Vocal tics include words or sounds such as squeaks, grunts, barks, sniffs, snorts, coughs, and, in rare instances, a complex vocal tic involving the uttering of obscenities. - Palilalia - Echolalia The motor tics of Tourette disorder may involve the head, torso, and upper and lower limbs. Initial symptoms may begin with a single motor tic, most commonly eye blinking, or with multiple symptoms. Initially, tics tend to occur in the face and neck and progress downward to the torso and lower limbs over time. Simple motor tics include movements such as eye blinking, neck jerking, shoulder shrugging, and facial grimacing. The more complex motor tics include squatting, hopping, skipping, tapping, and retracing steps. Vocal tics include various words or sounds such as squeaks, grunts, barks, sniffs, snorts, coughs, and in rare instances, a complex vocal tic involving the uttering of obscenities. Vocal tics may include repeating certain words or phrases out of context, repeating one's own sounds or words (palilalia), or repeating what others say (echolalia). The movements and vocalizations are experienced as compulsive and irresistible, but they can be suppressed for varying lengths of time. Many report a buildup of tension as they attempt to suppress tics to the point where they feel the tic must be expressed against their will. Tics are often worse during periods of stress or excitement and better during periods of calm.

Epidemiology of depression - marital status

- Single and divorced people are more likely to experience depression than are married persons or persons with a close interpersonal relationship (differences occur in various age groups). - marital and social stress was associated with an increased risk for depression - it may be that lack of social connectedness, rather than marital status, is associated with a higher incidence of depression

Schizoid Personality Disorder - SIR SAFE

- Solitary lifestyle - Indifferent to praise or criticism - Relationships of no interest - Sexual expereinces not of interest - Activities not enjoyed - Friends lacking - Emotionally cold and detached - shy, anxious, uneasy, inappopriately serious about everything, have difficulty acting in a lighthearted manner, no spontaneity

Predisposing factors associated with somatic symptom disorders - learning theory

- Somatic complaints are often reinforced when the sick person learns that he or she: - May avoid stressful obligations or be excused from unwanted duties (primary gain) - May become the prominent focus of attention because of the illness (secondary gain) - May relieve conflict within the family because concern is shifted to the ill person and away from the real issue (tertiary gain)

Types of somatic symptom disorders - somatic symptom disorder

- Somatic symptom disorder is a syndrome of multiple physical symptoms that cannot be explained medically and are associated with mental. - Symptoms may be vague, dramatized, or exaggerated in their presentation, and an excessive amount of time and energy is devoted to worry and concern about the symptoms. - Individuals with somatic symptom disorder are totally convinced that their symptoms are related to organic pathology, and will reject any implication that stress or psychosocial factors play any role. The disorder is chronic, with symptoms beginning before age 30. Anxiety and depression are frequent comorbidities. - one or more somatic symptoms that disrupt daily lift - somatic symptoms greater than 6 months - 2 of below: high health related anxiety, disproportionate and persistant concerns about the seriousness of ones medical condition, excessive time and energy

Differences in rights

- Some rights are explicitly determined by laws, whereas others have been established by organizations such as the National League for Nursing or the American Hospital Associatio - Even though guidelines outlined by these organizations are not legally binding, nurses are still considered responsible for upholding the rights outlined.

Client Family education - nature of the illness

- Stages of grief and symptoms associated with each stage - What is depression? - Why do people get depressed? - What are the symptoms of depression?

Special concerns of elderly people - retirement

- Statistics reflect that a larger percentage of Americans are living longer and that many of them are retiring earlier. Retirement has both social and economical implications for elderly individuals. - Retirement is often anticipated as an achievement in principle, but met with a great deal of ambiguity when it actually occurs. Although leisure has been acknowledged as a legitimate reward for workers, leisure during retirement historically has lacked the same social value. Historically, many women have derived a good deal of their self-esteem from their families. Likewise, many men have achieved self-esteem through work-related activities. With the termination of these activities may come a loss of self-worth, resulting in depression in some individuals who are unable to adapt satisfactorily. - Because retirement is generally associated with a 20% to 40% reduction in personal income, the standard of living after retirement may be adversely affected. Most older adults derive post-retirement income from a combination of Social Security benefits, public and private pensions, and income from savings or investments. Medicare and Medicaid were established by the government to provide medical care benefits for elderly and indigent Americans. State and federal governments jointly fund the Medicaid program, and coverage varies significantly from state to state. Medicare covers only a percentage of healthcare costs; therefore, to reduce risk related to out-of-pocket expenditures, many older adults purchase private "medigap" policies designed to cover charges in excess of those approved by Medicare. - The magnitude of retirement earnings depends almost entirely on pre-retirement income. The poor will remain poor, and the wealthy are unlikely to lower their status during retirement; however, for many in the middle classes, the relatively fixed income sources may be inadequate, possibly forcing them to face financial hardship for the first time in their lives.

Special concerns for elderly people - elder abuse

- Statistics regarding the prevalence of elder abuse are difficult to determine. - It is estimated that 1 in 10 older adults in the United States is a victim of abuse - However, a study in 2015 found that only 45% of older adult (over 65) victims of violence reported those crimes to the police - The abuser is often a relative who lives with the elderly person and may be the assigned caregiver. - Typical caregivers who are likely to be abusers of the elderly were described by Murray and associates (2009) as being under economic stress, substance abusers, themselves the victims of previous family violence, and exhausted and frustrated by the caregiver role. - Identified risk factors for victims of abuse included being a white female age 70 or older, being mentally or physically impaired, being unable to meet daily self-care needs, and having care needs that exceeded the caretaker's ability.

Effects of stimulants on the body

- Stimulation of the CNS results in tremor, restlessness, anorexia, insomnia, agitation, and increased motor activity. - Amphetamines, nonamphetamine stimulants, and cocaine produce increased alertness, a decrease in fatigue, elation and euphoria, and subjective feelings of greater mental agility and muscular power. - Amphetamines can induce increased systolic and diastolic blood pressure, increased heart rate, and cardiac arrhythmias. - These drugs also relax bronchial smooth muscle. - Cocaine intoxication typically produces a rise in myocardial demand for oxygen and an increase in heart rate. - Severe vasoconstriction may occur and can result in myocardial infarction, ventricular fibrillation, and sudden death. - Inhaled cocaine can cause pulmonary hemorrhage, chronic bronchiolitis, and pneumonia. - Caffeine ingestion can result in increased heart rate, palpitations, extrasystoles, and cardiac arrhythmias. - Caffeine induces dilation of pulmonary and general systemic blood vessels and constriction of cerebral blood vessels. - Nicotine stimulates the sympathetic nervous system, resulting in an increase in heart rate, blood pressure, and cardiac contractility, thereby increasing myocardial oxygen consumption and demand for blood flow. - Gastrointestinal effects of amphetamines are somewhat unpredictable, but a decrease in GI tract motility commonly results in constipation. - Contraction of the bladder sphincter makes urination difficult. - Caffeine exerts a diuretic effect on the kidneys. - Nicotine stimulates the hypothalamus to release antidiuretic hormone, reducing the excretion of urine. - CNS stimulants appear to increase sexual urges in both men and women. - Women, more than men, report that stimulants make them feel sexier and have more orgasms. - Some men may experience sexual dysfunction with the use of stimulants.

Predisposing factors to OCD and related disorders - Psychosocial influences related to trichotillomania

- Stressful situations - Disturbances in mother-child relationship - Fear of abandonment - Recent object loss - Possible childhood abuse or emotional neglect

Reminisence therapy

- Studies have indicated that reminiscence, or thinking about the past and reflecting on it, may promote better mental health in old age. - Life review is related to reminiscence, but differs from it in that it is a more guided or directed cognitive process that constructs a history or story in an autobiographical way.

Paranoid Personlity disorder - predisposing factors

- Studies have revealed a higher incidence of paranoid personality disorder among relatives of clients with schizophrenia than among control subjects. - Psychological predisposing factors, as is the case with many personality disorders, include a history of childhood trauma, such as neglect. People with paranoid personality disorder may have been subjected to parental antagonism and harassment. They learned to perceive the world as harsh and unkind, and react to it with protective vigilance and mistrust.

Psychological aspects of normal aging - adaptation to the tasks of aging - dealing with death

- Studies show that elderly people do not fear death itself. - They fear abandonment, pain, and confusion. - Death anxiety among the aging is apparently more of a myth than a reality. Death anxiety is a universal phenomenon, and attitudes about death are a result of cumulative life experiences. As more people are living longer, there has been a resurgence of interest in research about death anxiety. Interestingly, death anxiety seems to be the highest during middle age and, by later adulthood, stabilizes. Addressing these issues with middle-aged clients may be in the interest of primary or secondary prevention in the aging process.

The chemically impaired nurse

- Substance abuse and addiction is a problem that has the potential for impairment in an individual's functioning, and this becomes an especially serious problem when the impaired person is responsible for the lives of others. - Approximately 10% of the general population suffers from chemical addiction. It is estimated that 10% to 15% of nurses suffer from this disease, with alcohol the most widely abused drug, followed closely by narcotics. - Nurses who abuse substances have an added vulnerability because they are often handling controlled substances when providing patient care. - Some states require observers to report nurses who have substance-abuse problems to the state board of nursing.

Psychopharmacology for substance intoxication and substance withdrawal - hallucinogens and cannabinols

- Substitution therapy is not required with these drugs, but when adverse reactions such as anxiety or panic occur, benzodiazepines (e.g., diazepam or chlordiazepoxide) may be prescribed to prevent harm to the client or others. - Psychotic reactions may be treated with antipsychotic medications.

Pharmacotherapy for alcoholism - alcohol withdrawal

- Substitution therapy may be required to reduce the life-threatening effects of intoxication or withdrawal from some substances. - Benzodiazepines are the most widely used group of drugs for substitution therapy in alcohol withdrawal. Chlordiazepoxide (Librium), oxazepam (Serax), lorazepam (Ativan), and diazepam (Valium) are the most commonly used agents. - Some physicians may order anticonvulsant medication for management of withdrawal seizures. - Multivitamin therapy, in combination with daily injections or oral administration of thiamine, is common protocol. - Thiamine is commonly deficient in chronic alcoholics.

The chemically impaired nurse - during the suspension period

- Successful completion of an inpatient, outpatient, group, or individual counseling treatment program - Evidence of regular attendance at nurse support groups or 12-step program - Random negative drug screens - Employment or volunteer activities - When a nurse is deemed safe to return to practice, he or she may be closely monitored for several years and required to undergo random drug screenings.

Suicide

- Suicide is the act of taking one's own life - Many religions believe that suicide is a sin, and so it is strictly forbidden. - In the field of psychiatry, suicide is considered an irrational act associated with mental illness and most commonly with depression. - More than 90% of all persons who commit or attempt suicide have a diagnosed mental disorder. - suicide is not a diagnosis or a disorder; it is a behavior

Adolescence depression treatment with?

- Supportive psychosocial intervention - Antidepressant medication - All antidepressants carry a Food and Drug Administration warning for increased risk of suicidality in children and adolescents. - hospitalization if suicide risk or parents cannot help

Symptoms of a panic attack

- Sweating, trembling, shaking - Shortness of breath, chest pain, or discomfort - Nausea or abdominal distress - dizziness, chills, or hot flashes - Numbness or tingling sensations - Derealization or depersonalization - Fear of losing control or "going crazy" - Fear of dying

Moderate depression

- Symptoms associated with dysthymic disorder - Affective: Helpless, powerless - Behavioral: Slowed physical movements, slumped posture, limited verbalization - Cognitive: Retarded thinking processes, difficulty with concentration - Physiological: Anorexia or overeating, sleep disturbance, headaches

Transient depression

- Symptoms at this level of the continuum are not necessarily dysfunctional. - Affective: The "blues" - Behavioral: Some crying - Cognitive: Some difficulty getting mind off of one's disappointment - Physiological: Feeling tired and listless - Transient depression subsides quickly and the individual is able to refocus on other goals and achievements.

Cannabis intoxication

- Symptoms include impaired motor coordination, euphoria, anxiety, a sensation of slowed time, impaired judgment and memory, and social withdrawal. - Physical symptoms include conjunctival injection (red eyes), increased appetite, dry mouth, and tachycardia. - The impairment of motor skills lasts for 8 to 12 hours and interferes with the operation of motor vehicles. - Cannabis intoxication delirium is marked by significant cognitive impairment and difficulty performing tasks.

Symptoms of hallucinogen induced disorder

- Symptoms of PCP intoxication are unpredictable and are dose related. - They may include impulsiveness, impaired judgment, assaultiveness, and belligerence, or the individual may appear calm, stuporous, or comatose. - Physical symptoms include vertical or horizontal nystagmus, hypertension, tachycardia, ataxia, diminished pain sensation, muscle rigidity, and seizures. - Symptoms of ketamine intoxication appear similar to those of PCP.

Client/Family Education - nature of the illness

- Symptoms of anorexia nervosa and bulimia nervosa - What constitutes obesity? - Causes of eating disorders - Effects of the illness or condition on the body

Mild depression

- Symptoms of mild depression are identified by clinicians as those associated with normal grieving. - Affective: Anger, anxiety - Behavioral: Tearful, regression - Cognitive: Preoccupied with loss - Physiological: anorexia, insomnia

Information for family and friends of suicidal client

- Take any hint of suicide seriously. Anyone expressing suicidal feelings needs immediate attention. - Do not keep secrets. Suicidal individuals are ambivalent about dying, and suicidal behavior is a cry for help. It is that ambivalence that leads the person to confide to you the suicidal thoughts. - Be a good listener. If people express suicidal thoughts or feel depressed, hopeless, or worthless, be supportive. Let them know you are there for them and are willing to help them seek professional help. - Many people find it awkward to put into words how another person's life is important for their own well-being, but it is important to stress that the person's life is important to you and to others. Emphasize in specific terms the ways in which the person's suicide would be devastating to you and to others. - Express concern for individuals who express thoughts about committing suicide. - Familiarize yourself with suicide intervention sources, such as mental health centers and suicide hotlines. - Ensure that access to firearms or other means of self-harm are restricted. - Acknowledge and accept their feelings and be an active listener. - Try to give them hope and remind them that what they are feeling is temporary. - Stay with them. Do not leave them alone. Go to where they are, if necessary. - Show love and encouragement. Hold them, hug them, and touch them. Allow them to cry and express anger. - Help them seek professional help. - Remove any items from the home with which the person may harm himself or herself. - If there are children present, try to remove them from the home. Perhaps another friend or relative can assist by taking them to their home. - DO NOT: judge suicidal people, show anger toward them, provoke guilt in them, discount their feelings, or tell them to "snap out of it."

Alcohol use disorder - phase III

- The Crucial Phase - In this phase, the individual has lost the inability to choose whether or not to drink, and addiction is clearly evident. Binge drinking is common. These episodes are characterized by sickness, loss of consciousness, squalor, and degradation. In this phase, the individual is extremely ill. Anger and aggression are common manifestations. By this phase of the illness, it is not uncommon for the individual to have experienced the loss of job, marriage, family, friends, and most especially, self-respect.

Alcohol use disorder - phase II

- The Early Alcoholic Phase - This phase begins with blackouts, and alcohol stops being a source of pleasure or relief for the individual but rather a drug that is required. Common behaviors include sneaking drinks or secret drinking, preoccupation with drinking and maintaining the supply of alcohol, rapid gulping of drinks, and further blackouts. The individual feels enormous guilt and becomes very defensive about his or her drinking.

Alcohol use disorder - phase I

- The Prealcoholic Phase - this phase is when alcohol is used to relieve the everyday stress and tensions of life. As a child, the individual may have observed parents or other adults drinking alcohol and enjoying the effects. Tolerance develops, and the amount required to achieve the desired effect increases steadily.

Treating codependence - stage II

- The Reidentification Stage. - Reidentification occurs when the individuals are able to glimpse their true selves through a break in the denial system. - They accept the label of codependent and take responsibility for their own dysfunctional behavior. - They accept their limitations and are ready to face the issues of codependence.

Medication for OCD and body dysmorphic disorder - antidepressants

- The SSRIs fluoxetine, paroxetine, sertraline, and fluvoxamine have been approved by the FDA for the treatment of O C D. - The tricyclic antidepressant clomipramine was the first drug approved by the FDA in the treatment of O C D. - Clomipramine is more selective for serotonin reuptake than any of the other tricyclics. - Its efficacy in the treatment of O C D is well established, although the adverse effects, such as those associated with all the tricyclics, may make it less desirable than the SSRIs. - The most positive results of pharmacological therapy with body dysmorphic disorder have been with clomipramine (Anafranil) and fluoxetine (Prozac). - These medications have been shown to reduce symptoms in more than 50% of clients with the disorder.

Treating codependence - stage I

- The Survival Stage - In this stage, codependent persons must begin to let go of the denial that problems exist. - This initiation of abstinence from blanket denial may be a very emotional and painful period.

Psychological aspects of normal aging - learning ability

- The ability to learn continues throughout life, although it is strongly influenced by interests, activity, motivation, health, and experience. - Adjustments do need to be made in teaching methodology and time allowed for learning. The ability to learn is not diminished by age. Studies, however, have shown that some aspects of learning do change with age. The ordinary slowing of reaction time with age for nearly all tasks or the over-arousal of the central nervous system may account for lower performance levels on tests requiring rapid responses.

Common risk factors for vascular dementia

- The cause of vascular N C D is directly related to an interruption of blood flow to the brain. - Symptoms result from the death of nerve cells in regions nourished by diseased vessels. - Various diseases and conditions that interfere with blood circulation have been implicated. - Hypertension leads to damage to the lining of blood vessels. - This can result in rupture of the blood vessel with subsequent hemorrhage or an accumulation of fibrin in the vessel with intravascular clotting and inhibited blood flow. - Cognitive impairment can occur with multiple small infarcts (sometimes called "silent strokes") over time or with a single cerebrovascular insult that occurs in a strategic area of the brain. - diabetes, high blood pressure, high cholesterol, coronary heart disease, peripheral artery disease

Client/Family Education related to antidepressants

- The client should continue to take the medication even if symptoms have not subsided, because the therapeutic effect may not be seen for as long as 4 weeks - The client should use caution when driving or operating dangerous machinery - Drowsiness and dizziness can occur - Do not discontinue use of the drug abruptly - To do so might produce withdrawal symptoms, such as nausea, vertigo, insomnia, headache, malaise, nightmares, and the return of symptoms for which the medication was prescribed - Report occurrence of any of the following symptoms to the physician immediately: sore throat, fever, malaise, yellowish skin, unusual bleeding, easy bruising, persistent nausea/vomiting, severe headache, rapid heart rate, difficulty urinating, anorexia/weight loss, seizure activity, stiff or sore neck, and chest pain. Rise slowly from a sitting or lying position to prevent a sudden drop in blood pressure - take frequent sips of water, chew sugarless gum, or suck on hard candy if dry mouth is a problem - Good oral care (frequent brushing, flossing) is very important.

Introduction to Caring for Patients With Mental Illness and Substance Use Disorders in General Practice Settings

- The client with mental illness has historically been misunderstood, misdiagnosed, and mistreated. - Genetic, neurological, neurochemical, and environmental influences differentiate general human behavior from clinical illness. - Without clear education and appreciation for these symptoms as distressing signs of neurological illness, clients will continue to remain at risk for lack of treatment/mistreatment of both psychiatric and physical illness.

Signs of a codependent relationship

- The codependent person is able to achieve a sense of control only through fulfilling the needs of others. - Personal identity is relinquished, and boundaries with the other person become blurred. - The codependent person disowns his or her own needs and wants in order to respond to external demands and the demands of others. - Codependence has been called "a dysfunctional relationship with oneself." - providing money to support a habit - denying the problem - avoiding conflict at all costs even if it means denying that there is even a problem - feeling responsible for your partners thoughts, feelings, and actions - making excuses to cover up your partners substance abuse - saying yes to your loved one when you want to say no - providing care for the person when addiction symptoms present physically - putting your partners needs above your own - neglecting your own self-care and needs - turning to drugs or alcohol to cope with the dress or dysfunction of the situation

Historical aspects of somatic and dissociative disorders

- The concept of hysteria is at least 4,000 years old and probably originated in Egypt. The name has been in use since the time of Hippocrates. - Over the years, symptoms of hysterical neuroses have been associated with witchcraft, demonology, and sorcery; dysfunction of the nervous system; and unexpressed emotion. Freud observed that, under hypnosis, clients with hysterical neurosis could recall past memories and emotional experiences that would relieve their symptoms. This led to his proposal that unexpressed emotion can be "converted" into physical symptoms. - Freud viewed dissociation as a type of repression, an active defense mechanism used to remove threatening or unacceptable mental contents from conscious awareness. Despite the fact that the study of dissociative processes dates back to the 19th century, scientists still know remarkably little about the phenomena.

Substance or medication induced depressive disorder

- The depressed mood is associated with intoxication or withdrawal from substances such as alcohol, amphetamines, cocaine, hallucinogens, opioids, phencyclidine-like substances, sedatives, hypnotics, or anxiolytics. - The symptoms meet the full criteria for a relevant depressive disorder - A number of medications have also been known to evoke mood symptoms, including anesthetics, analgesics, anticholinergics, anticonvulsants, antihypertensives, antiparkinsonian agents, antiulcer agents, cardiac medications, oral contraceptives, psychotropic medications, muscle relaxants, steroids, and sulfonamides. - considered to be the direct result of physiological effects of a substance

Neurocognitive disorder due to prion disease - predisposing factors

- The disorder is attributable to prion disease (e.g., Creutzfeldt-Jakob disease or bovine spongiform encephalopathy). - Onset of symptoms typically occurs between ages 40 and 60 years; course is extremely rapid, with progression from diagnosis to death in less than 2 years. - 5% to 15% of cases have a genetic component. This disorder is identified by its insidious onset, rapid progression, and manifestations of motor features of prion disease, such as myoclonus or ataxia, or biomarker evidence. Five percent to 15% of cases have a genetic component. The clinical presentation is typical of the syndrome of mild or major N C D, along with involuntary movements, muscle rigidity, and ataxia.

Hallucinogens effects on the body

- The effects produced by hallucinogens are highly unpredictable. The variety of effects may be related to dosage, the mental state of the individual, and the environment in which the substance is used. - These effects are not always pleasurable, and toxic reactions such as intense levels of anxiety, fear, and stimulation may occur. Flashbacks or spontaneous repetition of a previous experience may occur in the absence of the substance.

Avoiding liability - accurate and complete documentation in the medical record

- The electronic health record (EHR) has been identified as the best way to document and share this information - The use of best sources for informatics is also identified as an important standard for quality and safety in nursing education

Conditions that promote a therapeutic community - Containment

- The environment is contained to create a sense of safety and security - Patients who are struggling with strong suicidal intentions, for example, often find that locked doors and lack of access to easy methods of self-harm provide the containment they need to resist self-destructive impulses.

Conditions that promote a therapeutic community - support

- The environment must be supportive and affirming rather than rigid or punitive - The nurse plays an active role offering emotional support, reinforcing the expectations within the community environment to promote supportive interaction, and redirecting patients who are struggling to accomplish therapeutic interaction with others - Support also includes creating a sense that patients are not only involved in treatment but are empowered in decision making and direction around their care.

Conditions that promote a therapeutic community - validation

- The environment must support and affirm the needs of the individual both within and separate from the community - Active, empathic listening to the patient's perceptions and concerns and promoting autonomy are examples of validation.

Conditions that promote a therapeutic community - structure

- The environment needs to have a structure that promotes the goals of treatment - This includes a schedule of activities so that patients know what, when, and where activities are taking place - Group therapies, for example, are scheduled at specific times so the patient can structure their day to attend - Knowing to whom they should go (perhaps a primary nurse or team leader) to express concerns, ask for medication, or contact other team members is another aspect of unit structure that promotes therapeutic outcomes.

Tourette disorder

- The essential feature of Tourette disorder is the presence of multiple motor tics and one or more vocal tics. - Onset may be as early as 2 years, but occurs most commonly around age 6 or 7. - The disorder is more common in boys than in girls. Tourette disorder is characterized by the presence of multiple motor tics and one or more vocal tics, which may appear simultaneously or at different periods during the illness. This may cause distress or interfere with social, occupational, or other important areas of functioning.

Introduction - child abuse and related fatalities continue to be a?

- The evidence also supports that these forms of violence most often occur before the age of 25 for both men and women. - Child abuse and related fatalities continue to be a significant health concern. - It is well documented that adverse childhood experiences (ACEs) such as abuse and neglect can have a major impact on health and well-being throughout one's life. - ACE studies have found that as the number of ACE events increase, so do risks for myocardial infarction, asthma, diabetes, coronary heart disease, depression, disability, unemployment, mental distress, and other health problems

Predisposing factors - sociocultural factors

- The family appears to be an important influence in substance use. Various studies have shown that children and adolescents are more likely to use substances if they have parents who provide a model for substance use. - Peers also often exert a great deal of influence in the life of the child or adolescent. - Conditioning is a term used to describe a learned response that occurs after repeated exposure to a stimulus. Substance abuse can become a learned response from the substance itself, as well as the environment where use occurs. - An individual's culture can also establish patterns of substance use. For example, a high incidence of alcohol addiction has existed within the Native American culture, whereas the incidence of alcohol addiction among Asians is relatively low.

Sedative/Hypnotic use disorder - two main patterns

- The first is one of an individual whose physician originally prescribed the drug as treatment for anxiety or insomnia. Use of the medication is justified on the basis of treating symptoms, but as tolerance grows, more and more of the medication is required to produce the desired effect. - Substance-seeking behavior is evident as the individual seeks prescriptions from several physicians in order to maintain sufficient supplies. - The second pattern involves young people in their teens or early 20s who use substances that were obtained illegally for recreational use. This pattern of intermittent use leads to regular use and extreme levels of tolerance. Combining use with other substances is not uncommon. Physical and psychological addiction leads to intense substance-seeking behaviors, most often through illegal channels.

Treatment modalities - crisis intervention

- The focus of the initial interview and follow-up with the client who has been sexually assaulted is on the rape incident alone. Problems identified but unassociated with the rape are not dealt with at this time. The goal of crisis intervention is to help survivors return to their previous lifestyle as quickly as possible. - The client should be involved in the intervention from the beginning. This promotes a sense of competency, control, and decision making. Because an overwhelming sense of powerlessness accompanies the rape experience, active involvement by the survivor is both a validation of personal worth and the beginning of the recovery process.

Treatment modalities - family therapy

- The focus of therapy with families who use violence is to help them develop democratic ways of solving problems. Studies show that the more a family uses the democratic means of conflict resolution, the less likely they are to engage in physical violence. Families need to learn to deal with problems in ways that can produce mutual benefits for all concerned, rather than engaging in power struggles among family members. - Therapy sessions with all family members together may focus on problems with family communication. Members are encouraged to express honest feelings in a manner that is nonthreatening to other family members. Active listening, assertiveness techniques, and respecting the rights of others are taught and encouraged.

Medical treatment modalities for somatic symptom disorders

- The goal of psychotherapy is to help clients develop healthy and adaptive behaviors, encourage them to move beyond their somatization, and manage their lives more effectively. Treatment is initiated with a complete physical examination to rule out organic pathology. Clients may be more amenable to psychotherapeutic treatment, particularly stress management, when it is conducted in a medical setting. - Group therapy may be helpful for somatic symptom disorders because it provides a setting where clients can share their experiences of illness, can learn to verbalize thoughts and feelings, and can be confronted by group members and leaders when they reject responsibility for maladaptive behaviors. - report that several studies support cognitive behavior therapy as an effective strategy for reducing symptoms in clients with somatic diseases. - Psychoeducation has also been identified as beneficial and includes teaching the patient that the symptoms may be related to or exacerbated by stress and anxiety. - This teaching should be done in the context of a trusting relationship between the healthcare provider and the client because the client may resist the suggestion that physical symptoms could have a psychological foundation. - Psychoeducation for family members and other support systems focuses on teaching these individuals to reward the client's autonomy, self-sufficiency, and independence while being careful not to reinforce passivity and dependence associated with the sick role. - This process becomes more difficult when the client is very regressed and the sick role is well established. - In conversion disorder, symptoms usually abate spontaneously, but behavior therapy may be beneficial. - Medication treatment is not effective unless it is being used to treat underlying depression or anxiety. - When antidepressant therapy is warranted, SSRIs are generally preferred. - Anxiety may be treated in the short term with antianxiety agents such as benzodiazepines but long-term use should be avoided because of the potential for addiction. - In the treatment of conversion disorders, parenteral amobarbital or lorazepam may be helpful in revealing historical information related to trauma.

Planning and implementation - self-care deficit

- The goals of treating patients with self-care deficit should be to assist the patient in A D L's they can perform, and fulfill any needs that they cannot. - Interventions include providing guidance and support, minimizing confusion, and performing ongoing assessment of the patient's ability and anticipating needs.

Psychodrama participants

- The group leader is called the "director," whereas the client will play the role of his or herself and is called the "protagonist." - This allows the client to express true feelings toward other individuals in their lives who are played by other group members. - the protagonist is selected to portray a life situation. - Other members of the group play the roles of people with whom the protagonist has unresolved issues.

Psychological aspects of normal functioning - intellectual functioning

- The intellectual abilities of older people do not decline, but they do become obsolete. - The age of their formal educational experiences is reflected in their intelligence scoring. There appears to be a high degree of regularity in intellectual functioning across the adult age span. Crystallized abilities, or knowledge acquired in the course of the socialization process, tend to remain stable over the adult life span. Fluid abilities, or abilities involved in solving novel problems, tend to decline gradually from young to old adulthood.

Physical conditions that influence group dynamics - size

- The larger the group, the less time is available to devote to individual members - In larger groups, more aggressive individuals are most likely to be heard, whereas quieter members may be left out of the discussions altogether - Studies have indicated that a composition of seven or eight members provides a favorable climate for optimal group interaction and relationship development.

Epidemiolgoical statistics - living arrangements

- The majority of individuals age 65 years or older live alone, with a spouse, or with relatives. The majority of individuals age 65 or older live alone, with a spouse, or with relatives (AoA, 2018). In 2016, 1 million adults over 60 were caregivers to one or more grandchildren living with them. A small percentage, 3.1% of people over the age of 65, live in institutions. This percentage increases dramatically with age, ranging from 1% for persons 65 to 74 years to 3% for persons 75 to 84 years, and 9% for persons 85 and older.

Primitive defense mechanisms

- The more primitive a defense mechanism, the less effective it works for a person over the long-term. - more primitive defense mechanisms are usually very effective short-term, and hence are favored by many people and children especially (when such primitive defense mechanisms are first learned). - Adults who don't learn better ways of coping with stress or traumatic events in their lives will often resort to such primitive defense mechanisms as well.

Epidemiological statistics - health status

- The number of days in which usual activities are restricted because of illness or injury increases with age. - Emotional and mental illnesses also increase over the life cycle. The (CDC) reports that approximately 80% of older adults have at least one chronic condition, and 50% have two or more. The most commonly occurring conditions among the elderly population are hypertension (71%), arthritis (49%), heart disease (31%), cancer (25%), and diabetes (21%). Emotional and mental illnesses increase over the life cycle. Depression is particularly prevalent, and suicide is a serious problem among elderly Americans. Prevalence of major depression is estimated at between 1% and 5% for the general population of older adults, but that may rise to as high as 13.5% for older adults requiring hospitalization or home healthcare.

Personality development

- The nurse must understand normal personality development before he or she can assess what is maladaptive. - Variables in development include (but are not limited to) heredity, temperament, experiential learning, and social interaction. - A number of theorists have attempted to provide information about personality development. - Most suggest it occurs in an orderly, stepwise fashion and that these stages overlap as maturation occurs at different rates in different individuals. Sullivan, Erikson, and Mahler each proposed their own three stages of personality development

The standards of practice for psychiatric nursing are written around the six steps of the nursing process - planning

- The nurse will develop a care plan that is individualized to the client's mental health problems, condition, or needs and is developed in collaboration with the client, significant others, and interdisciplinary team members - For each diagnosis identified, the most appropriate interventions are selected.

Hoarding disorder

- The persistent difficulty discarding possessions regardless of their value. - Additionally, there can be a need for excessive acquiring of items (by purchasing or other means). - More men than women are diagnosed with this disorder - The severity of the symptoms, regardless of when they begin, appears to become more severe with each decade of life. Associated symptoms include perfectionism, indecisiveness, anxiety, depression, distractibility, and difficulty planning and organizing tasks. In addition to O C D, hoarding is associated with high comorbidity for dependent, avoidant, schizotypal, and paranoid personality disorders.

Guidelines for treatment of the suicidal client on an outpatient basis

- The person should not be left alone. Arrangements must be made for the client to stay with family or friends. If this is not possible, hospitalization should be reconsidered. - A "no suicide" contract may be established with the client, but only as an adjunct to other interventions. The focus of this intervention is to formulate a written or verbal contract that the client will not harm himself or herself in a stated period of time. - Enlist the help of family or friends to ensure that the home environment is safe from dangerous items, such as firearms or stockpiled drugs. Give support persons the telephone number of the counselor, or an emergency contact person in the event that the counselor is not available. - Appointments may need to be scheduled daily or every other day at first, until the immediate suicidal crisis has subsided. - Establish rapport and promote a trusting relationship. It is important for the suicide counselor to become a key person in the client's support system at this time. - Be direct. Talk openly and matter-of-factly about suicide. Listen actively and encourage the expression of feelings, including anger. - Discuss the current crisis situation in the client's life. Use the problem-solving approach. - Help the client identify areas of the life situation that are within his or her control, and those that the client does not have the ability to control. Discuss feelings associated with these control issues. - The physician or nurse practitioner may prescribe antidepressants for an individual who is experiencing suicidal depression. It is wise to prescribe no more than a 3-day supply of the medication, with no refills.

Epidemiological statistics - illness anxiety disorder

- The prevalence of illness anxiety disorder, closely associated with the former, now deleted diagnosis of hypochondriasis, is especially difficult to establish because this disorder is new in the DSM-5. - The best estimate is based on data about the prevalence of hypochondriasis, which is identified at between 3% and 8%. - More research is needed to better understand the epidemiological statistics for each of these disorders.

Epidemiological Statistics of somatic symptom disorders

- The prevalence of somatic symptom disorder is estimated to be anywhere from 0.1% to 11.6%. - this as a disorder that affects men and women equally. - Lifetime prevalence rates of conversion disorder vary widely. Statistics within the general population have ranged from 5% to 30%. - The disorder occurs more frequently in women than in men and more frequently in adolescents and young adults than in other age groups. A higher prevalence exists in lower socioeconomic groups, rural populations, among those with less education, and among military personnel who have been exposed to combat situations

Benefits of psychodrama

- The psychodrama setting provides the patient with a safer and less threatening atmosphere than the real situation in which to express true feelings. - When the drama has been completed, group members from the audience discuss the situation they have observed, offer feedback, express their feelings, and relate their own similar experiences. In this way, all group members benefit from the session, either directly or indirectly.

Screening - purpose

- The purpose of screening is to identify clinically significant symptoms that require further assessment and intervention. - The use of screening tools is better than clinical judgment alone in the diagnosis of mental illness. - Horowitz and associates (2013) developed a two-item nursing screen for suicide risk in any medical setting. - The screen asked the patient two questions: "In the past month, have you had thoughts about suicide?" "Have you ever made a suicide attempt?" - A yes answer to either question prompted a third question: "Are you having thoughts of suicide right now?" - Nursing managers have an integral role in equipping their staff nurses with screening tools that are valid, reliable, time-efficient, and user-friendly. - Many screening tools are free to use and widely accessible, while others are copyrighted, proprietary, and associated with a fee for use.

Hair-pulling disorder(Trichotillomania)

- The recurrent pulling out of one's own hair that results in noticeable hair loss - Preceded by increasing tension and results in sense of release or gratification - The disorder is not common, but it occurs more often in women than in men - Comorbid psychiatric disorders are common with hair-pulling disorder. Some of these include mood disorders, eating disorders, anxiety disorders, substance abuse disorders, and personality disorders—most commonly, histrionic, borderline, and obsessive-compulsive.

A client whom a nurse attends to have the following rights:

- The right to treatment: a patient cannot be hospitalized and then denied appropriate treatment for his or her diagnoses. - The right to refuse treatment (including medication): unless the treatment is required to prevent death or serious harm. In psychiatric care, however, patients may be hospitalized because they are of harm to themselves or others, and treatment may be administered without the consent of the patient in order to protect themselves or others. - The right to the least restrictive treatment alternative: have the right to whatever level of treatment is effective without limiting their freedom. The effort should be made to think in terms of restrictiveness when treating patients in a psychiatric setting.

Epidemiolgical factors of suicide

- The second-leading cause of death among Americans 10 to 34 years of age - The fourth-leading cause of death for ages 35 to 54 - The eighth-leading cause of death for ages 55 to 64 - 2018: Suicide was the tenth leading cause of death overall in the United States, claiming the lives of over 48,000 people. - With a steady incline in rates of suicide, it has become a major healthcare problem in the United States today. Reports of dramatic rises in suicide rates among military personnel since 2008 have led to greater public awareness, concern, and interest in research on this topic.

Medications for specific disorders - phobic disorders - antidepressants

- The tricyclic imipramine and the monoamine oxidase inhibitor (MAOI) phenelzine have been effective in diminishing symptoms of agoraphobia and social anxiety disorder - In recent years, the SSRIs have become the first-line treatment of choice for social anxiety disorder, and paroxetine and sertraline have been approved for this purpose.

Suppression: Defense Mechanism

- The voluntary blocking of unpleasant feelings and experiences from ones awareness. EX: "I don't want to think about that now. I'll think about that tomorrow."

Cognitive theory models focus on the cognitive appraisal of an event and the assumptions that an individual makes about the world. Epstein outlined three fundamental beliefs that most people construct within a personal theory of reality:

- The world is benevolent and a source of joy. - The world is meaningful and controllable. - The self is worthy (for example, lovable, good, and competent). - As life situations occur, some disequilibrium is expected to occur until accommodation for the change has been. An individual is vulnerable to trauma-related disorders when the fundamental beliefs are invalidated by a trauma that cannot be comprehended.

Treatment modalities

- Therapy can be beneficial to a client suffering from bipolar disorder. - Supportive psychotherapy is designed to help the client identify their personal strengths and explore adaptive coping mechanisms. - Insight-oriented psychotherapy, which is rooted in Freudian psychology, is designed to help the client identify, explore, and resolve internal psychological conflicts that are contributing to anxiety. - Cognitive therapy strives to assist the individual to reduce anxiety responses by altering cognitive distortions. Anxiety is described as being the result of exaggerated, automatic thinking. Cognitive therapy for anxiety is brief and time limited, usually lasting from 5 to 20 sessions. Brief therapy discourages the client's dependency on the therapist, which is prevalent in anxiety disorders, and encourages the client's self-sufficiency. - Behavior modification has been used to treat trichotillomania. Various techniques have been tried, including covert desensitization and habit-reversal therapy (HRT). These may include a system of positive and negative reinforcements in an effort to modify the hair-pulling behaviors. With HRT, in an attempt to extinguish the unwanted behavior, the individual learns to become more aware of the hair pulling, identify times of occurrence, and substitute a more adaptive coping strategy. - Many treatment modalities are available that may be used alone or in combination with medication to treat anxiety. Examples include deep breathing exercises, progressive muscle relaxation, imagery, mindfulness meditation, and exercise.

Treatment modalities - individual psychotherapy

- Therapy, whether in a one-on-one environment or with a group, can be beneficial to a client suffering from depression. - Interpersonal psychotherapy focuses on the client's current interpersonal relations. Interpersonal psychotherapy with the depressed person is designed to encourage the client to continue working and participating in regular activities, helping the client resolve complicated grief reactions, and helping the client recover enhanced social functioning. - Group therapy forms an important dimension of multimodal treatment for the depressed client. The element of peer support provides a feeling of security, as troublesome or embarrassing issues are discussed and resolved. Therapy groups help members gain a sense of perspective on their condition and encourage them to link up with others who have common problems. - family therapy works with families of clients with mood disorders to resolve the symptoms and initiate or restore adaptive family functioning. - In cognitive therapy, the individual is taught to control thought distortions that are considered to be a factor in the development and maintenance of mood disorders. The general goals in cognitive therapy are to obtain symptom relief as quickly as possible, to assist the client in identifying dysfunctional patterns of thinking and behaving, and to guide the client to evidence and logic that effectively tests the validity of the dysfunctional thinking.

Predisposing factors - biological influences - neuroendocrine abnormalities

- There has been some speculation about a primary hypothalamic dysfunction in anorexia nervosa. - Support for primary hypothalamic dysfunction in anorexia nervosa is gathered from the fact that many people with anorexia experience amenorrhea before the onset of starvation and significant weight loss.

Neurocognitive disorders due to AD - predisposing factors - genetic factors

- There is clearly a familial pattern for some forms of A D with as many as 40% of A D patients having a family history for the disease and some families exhibiting a pattern of inheritance that suggests possible autosomal-dominant gene transmission. - Some studies indicate that early-onset cases are more likely to be familial than late-onset cases, and that from one third to one half of all cases may be of the genetic form.

Childhood depression symptoms - ages 6-8

- There may be vague physical complaints and aggressive behavior - They may cling to parents and avoid new people and challenges. - They may lag behind their classmates in social skills and academic competence.

Common characteristics of individuals with neuroses include:

- They are aware that they are experiencing distress. - They are aware that their behaviors are maladaptive. - They are unaware of any possible psychological causes of the distress. - They feel helpless to change their situation. - They experience no loss of contact with reality - negative or obessive thoughts that are constant and to the point that it interferes with your functioning

Sociocultural aspects of normal aging - in virtually all cultures, the elderly share some basic needs and interests:

- They choose to live the most satisfying life possible until their demise. - They want protection from hazards, and release from the weariness of everyday tasks. - They want to be treated with the respect and dignity that is deserving of individuals who have reached this pinnacle in life. - They want to die with the same respect and dignity. - In some cultures, the aged are the most powerful, the most engaged, and the most respected members of society. - This has not been the case in American culture, with the exception of several subcultures, such as Latino Americans, Asian Americans, and African Americans. Old age brings many important socially induced changes, some of which have the potential for negative effect on both the physical and mental well-being of older persons. In American society, old age is defined arbitrarily as being 65 years or older, because that is the age when most people have been able to retire with full Social Security and other pension benefits. There is little doubt that most individuals choose to live the most satisfying life possible for as long as possible. They want protection from hazards and release from the weariness of everyday tasks. They want to be treated with the respect and dignity that is deserving of individuals who have reached this pinnacle in life. Historically, the aged have had a special status in society. Even today, in some cultures the aged are the most powerful, the most engaged, and the most respected members of the society. This has not been the case in the modern industrial societies, although trends in the status of the aged differ widely between one industrialized country and another. Many negative stereotypes color the perspective on aging in the United States. Ideas that elderly individuals are always tired or sick, slow and forgetful, isolated and lonely, unproductive, and angry determine the way younger individuals relate to the elderly in this society. Assisted living centers, retirement apartment complexes, and even entire retirement communities intended solely for individuals over age 50, are becoming more and more common. In 2013, more than half (61%) of persons age 65 and older lived in 13 states, with the largest numbers in California, Florida, Texas, New York, and Pennsylvania. Employment is another area in which the elderly experience discrimination. Although compulsory retirement has been virtually eliminated, discrimination still exists in hiring and promotion practices. Many employers are not eager to retain or hire older workers.

Common characteristics of individuals with psychoses include:

- They exhibit minimal distress. - They are unaware that their behavior is maladaptive. - They are unaware of any psychological problems. - They are exhibiting a flight from reality into a less stressful world or into one in which they are attempting to adapt.

Functions of a group - normative influence

- This function relates to the ways in which groups enforce the established norms - As group members interact, they begin to influence each other about what are the expected norms for communication and behavior.

The cycle of battering - Phase II - the acute battering incident

- This phase is the most violent and the shortest, usually lasting up to 24 hours. - It most often begins with the batterer justifying his behavior to himself. - By the end of the incident, however, he cannot understand what has happened, only that in his rage he has lost control over his behavior. - In some instances, the woman may intentionally provoke the behavior. - Having come to a point in phase I in which the tension is unbearable, long-term battered women know that once the acute phase is behind them, things will be better. - The beating is severe, and many women can describe the violence in great detail, almost as if dissociation from their bodies had occurred. - The batterer generally minimizes the severity of the abuse.

Role of the nurse in milieu therapy - nurses are also responsible for setting limits on unacceptable behavior:

- This requires stating to the client in understandable terminology what behaviors are not acceptable and what the consequences will be should the limits be violated. - These limits must be established, written, and carried out by all staff - Consistency in carrying out the consequences of violation of the established limits is essential if the learning is to be reinforced.

Theories of aging - immunity theory

- This theory describes an age-related decline in the immune system. - As people age, their ability to defend against foreign organisms decreases, resulting in susceptibility to diseases such as cancer and infection. - These aging cells become unable to distinguish between themselves and foreign proteins and begin to attack themselves.

Theories of aging - disengagement theory

- This theory describes the process of withdrawal by older adults from societal roles and responsibilities. - According to the theory, this withdrawal process is predictable, systematic, inevitable, and necessary for the proper functioning of a growing society. - Older adults were said to be happy when social contacts diminished and responsibilities were assumed by a younger generation. - The benefit to the older adult is thought to be in providing time for reflecting on life's accomplishments and for coming to terms with unfulfilled expectations. - The benefit to society is thought to be an orderly transfer of power from old to young.

Theories of aging - genetic theory

- This theory suggests that life span and longevity changes are predetermined. - The finding that there are similar life spans among identical twins and children of parents with a long life span supports this. - A second genetic theory identifies aging as a process of genetic mutations that essentially create "errors" in transmission of information with the outcome being molecules that no longer function properly. - Genome studies of aging cells and tissues have shown a variable "DNA methylation drift" which creates changes in aging stem cells that culminates in reduced stem cell plasticity, stem cell exhaustion, and focal defects that can lead to illnesses such as cancer.

Theories of aging - continuity theory

- This theory, also known as the developmental theory, is a follow-up to the disengagement and activity theories. - It emphasizes the individual's previously established coping abilities and personal character traits as a basis for predicting how the person will adjust to the changes of aging. - Basic lifestyle characteristics are likely to remain stable in old age, barring physical or other types of complications that necessitate change. - A person who has enjoyed the company of others and an active social life will continue to enjoy this lifestyle into old age. - One who has preferred solitude and a limited number of activities will probably find satisfaction in a continuation of this lifestyle.

Borderline Personality Disorder common behaviors

- Thrive on chaos - Inability to be alone - Clinging and distancing behaviors - Splitting - Manipulation - Self-destructive behaviors - Impulsivity - Chronically empty - Depression is common in clients with this disorder, and before the inclusion of borderline personality disorder in the DSM, many of these clients were diagnosed with depressive disorder. Underlying the depression is a sense of rage that is sporadically turned inward on the self and externally on the environment. - Because of this chronic fear of abandonment, clients with borderline personality disorder have little tolerance for being alone. They prefer a frantic search for companionship, no matter how unsatisfactory, to sitting with feelings of loneliness, emptiness, and boredom. The client with borderline personality disorder commonly exhibits a pattern of interaction with others that is characterized by clinging and distancing behaviors. When clients are clinging to another individual, they may exhibit helpless, dependent, or even childlike behaviors. Splitting is a primitive ego defense mechanism that is common in people with borderline personality disorder. It arises from their lack of achievement of object constancy and is manifested by an inability to integrate and accept both positive and negative feelings. These shifting allegiances and valuing/devaluing responses can generate conflict, anger, and frustration in staff members (or in any interpersonal relationships) unless this dynamic is clearly understood and managed appropriately. In their efforts to prevent the separation they so desperately fear, clients with this disorder become masters of manipulation. Virtually any behavior becomes an acceptable means of achieving the desired result: relief from separation anxiety. Repetitive, self-mutilative behaviors are classic manifestations of borderline personality disorder. Although these acts can be fatal, most commonly they are manipulative gestures designed to elicit a rescue response from significant others. Suicide attempts are quite common and result from feelings of abandonment following separation from a significant other. Other types of destructive behaviors include cutting, scratching, and burning. Various theories abound regarding why these individuals are able to inflict pain on themselves. One hypothesis suggests they may have higher levels of endorphins in their bodies than most people, thereby increasing their threshold for pain. Individuals with borderline personality disorder have poor impulse control based on primary process functioning. Impulsive behaviors associated with borderline personality disorder include substance abuse, gambling, promiscuity, reckless driving, and binging and purging. Many times these behaviors occur in response to real or perceived feelings of abandonment.

Role of the nurse in milieu therapy

- Through use of the nursing process, nurses manage the therapeutic environment on a 24-hour basis. - Nurses have the responsibility for ensuring that the client's physiological and psychological needs are met.

active listening

- To listen actively is to be attentive to what patient is saying, both verbally and nonverbally. - Several nonverbal behaviors have been designed to facilitate attentive listening.

Client Family Education for substance use disorder

- Topics for discussion with the client and family include the nature of the illness, including the effects of the substance on the body and ways in which use of the substance affects life. - Management of the illness includes activities to substitute in times of stress, relaxation techniques, and the essentials of good nutrition. - Management of the illness - Progressive relaxation, tense and relax, deep breathing, autogenics - Problem-solving skills

Treatment modalities: psychopharmacology - medications that have been tried with some success for binge eating disorder with obesity include:

- Topiramate (Topamax) - Lisdexamfetamine (Vyvanse) High-dose SSRIs have demonstrated some effectiveness in promoting weight loss for patients with binge eating disorder, but the weight loss was temporary, and weight gain typically occurred after the medication was discontinued. Two medications, topiramate and lisdexamfetamine (a dopamine-norepinephrine reuptake inhibitor, originally used in the treatment of ADHD), have demonstrated benefits in reducing incidents of binge eating.

Predisposing factors to intellectual developmental disorder - disruptions in embryonic development

- Toxicity associated with maternal ingestion of alcohol or other drugs - Maternal illnesses and infections during pregnancy - Complications of pregnancy Conditions that result in early alterations in embryonic development account for approximately 30% of intellectual disability cases. Damages may occur in response to toxicity associated with maternal ingestion of alcohol or other drugs. Fetal alcohol syndrome is an example, and this disorder has been identified as one of the leading preventable causes of intellectual disability. Maternal illnesses and infections during pregnancy, and complications related to them, can result in congenital intellectual disability.

Agoraphobia can be caused by what?

- Traveling in public transportation - Being in open spaces - Being in shops, theaters, or cinemas - Standing in line or being in a crowd - Being outside of the home alone in other situations

Psychopharmacology for substance intoxication and substance withdrawal - stimulants

- Treatment of stimulant intoxication usually begins with minor tranquilizers such as chlordiazepoxide and progresses to major tranquilizers such as haloperidol (Haldol). - Antipsychotics should be administered with caution because of their propensity to lower seizure threshold. - Withdrawal from CNS stimulants is not the medical emergency observed with CNS depressants. - Treatment is usually aimed at reducing drug cravings and managing severe depression. The client is placed in a quiet atmosphere and allowed to sleep and eat as much as needed or desired. Suicide precautions may need to be instituted. Antidepressant therapy may be helpful in treating symptoms of depression.

Nursing process: Planning and implementation for dissociative disorder

- Treatment should be focused on concepts such as deficient knowledge, impaired memory, and disturbed personal identity. - Goals should include helping the client in verbalizing the reasons for fragmented reality, recovering deficits in memory, and verbalizing psychological factors for the condition. Interventions include discussing adaptive methods of stress management, exposing the client to stimuli that represent pleasant experiences from the past, and helping the client identify stressful situations that may trigger issues such as transitioning from one personality to another. - Nursing care for the client with a dissociative disorder is aimed at restoring normal thought processes. - Assistance is provided to the client in an effort to determine strategies for coping with stress by means other than dissociation from the environment.

Nursing process: Planning and Implementation somatic symptom disorder

- Treatment should be focused on concepts such as ineffective coping, fear of having a serious disease, disturbed sensory perception, and deficient knowledge. - Goals should include helping the client cope with stress, interpreting bodily sensations correctly; recovering lost or altered function, and verbalizing psychological factors affecting physical condition. Interventions should include identifying gains that the physical symptoms are providing, discussing adaptive methods of stress management, providing support and encouragement, and exploring the client's feelings and fears. - Nursing care of the individual with a somatic symptom disorder is aimed at relief of discomfort from the physical symptoms. - Assistance is provided to the client in an effort to determine strategies for coping with stress by means other than preoccupation with physical symptoms.

TEN 4 FACESP

- Trunk - Ears - Neck - 4 years or younger - Any bruising on a child less than 4 months - frenulum - auricular area - cheek - eyes - sclera - patterned bruising

Application of the nursing process/assessment - the patient history - areas of concern to be addressed

- Type, frequency, and severity of mood swings - Personality and behavioral changes - Extreme emotional reactions - Cognitive changes - Language difficulties - Orientation to person, place, time, and situation - Appropriateness of social behavior - Current and past use of medications, drugs, and alcohol - Possible exposure to toxins - Patient and family history of specific illnesses Nurses play a significant role in acquiring patient history, including the specific mental and physical changes that have occurred and the age at which the changes began. Key areas of concern with gathering patient history include: type, frequency, and severity of mood swings, personality and behavioral changes, and catastrophic emotional reactions; cognitive changes, such as problems with attention span, thinking process, problem-solving, and memory (recent and remote); and language difficulties. Other key areas of concern include orientation to person, place, time, and situation; appropriateness of social behavior; current and past medication usage; history of other drug and alcohol use; possible exposure to toxins. Knowledge regarding the history of related symptoms or specific illnesses (e.g., Huntington's disease, A D, Pick's disease, or Parkinson's disease) in other family members is also useful.

Predisposing factors - psychological theories - psychodynamic theory

- Unmet needs for satisfaction and security result in an underdeveloped ego and a poor self-concept. - Aggression and violence supply the individual with a dose of power and prestige that increases self-esteem.

Schizotypical personality disorder - UFO AIDER

- Unusual perceptions - Friendless except for family - odd beliefs, thinking, and speech - affect: inappopriate, constricted - ideas of references - doubts others(suspicious) - eccentric(appearance/behavior) - reluctant in social situations, anxious

delerium - symptoms

- Usually begin abruptly - Can have a slower onset if underlying etiology is systemic illness or metabolic imbalance - Duration is usually brief and subsides completely on recovery from underlying determinant - Symptoms of delirium usually begin abruptly if caused by an event such as a head injury or seizure. Other times, they may take several hours or days to develop. A slower onset is more common if the cause is a systemic illness. While the duration of delirium is usually brief (symptoms usually diminish over a 3- to 7-day period upon elimination of the underlying cause), the age of the patient and duration of the delirium can influence the rate of resolution. Delirium may transition into a more permanent cognitive disorder.

Nursing process - assessment

- Various assessment tools are available for determining the extent of the problem a client has with substances. - Drug history and assessment - Clinical Institute Withdrawal Assessment of Alcohol Scale - Michigan Alcoholism Screening Test (M A S T) - C A G E Questionnaire - AUDIT-C - The Clinical Institute Withdrawal Assessment of Alcohol Scale is an excellent tool that is used by many hospitals to assess the risk and severity of withdrawal from alcohol. It may be used for initial assessment as well as ongoing monitoring of alcohol withdrawal symptoms. - Other screening tools exist for determining whether an individual has a problem with substances. Two such tools include the Michigan Alcoholism Screening Test and the CAGE Questionnaire. Some psychiatric units administer these surveys to all clients who are admitted to help determine if there is a secondary alcoholism problem in addition to the psychiatric problem for which the client is being admitted.

Application of the nursing process/assessment - diagnostic laboratory evaluation - include blood and urine to test for:

- Various infections - Hepatic and renal dysfunctions - Diabetes or hypoglycemia - Electrolyte imbalances - Metabolic and endocrine disorders - Nutritional deficiencies - Presence of toxic substances The nurse also may be required to help the patient fulfill the physician's orders for special diagnostic laboratory evaluations. Many of these tests are routinely included with the physical examination and may include evaluation of blood and urine samples to test for the following: various infections; hepatic and renal dysfunction; diabetes or hypoglycemia; electrolyte imbalances; metabolic and endocrine disorders; nutritional deficiencies; and the presence of toxic substances, including alcohol and other drugs.

Predisposing factors to depression - cognitive theory

- Views primary disturbance in depression as cognitive rather than affective. - Three cognitive distortions that serve as the basis for depression: Negative expectations of the environment, Negative expectations of the self, Negative expectations of the future - The underlying cause of the depression is cognitive distortions that result in negative, defeated attitudes - These cognitive distortions arise out of a defect in cognitive development, and the individual feels inadequate, worthless, and rejected by others - Outlook for the future is one of pessimism and hopelessness.

Theories of aging - neuroendocrine theory

- Vladimir Dilman, MD first developed this theory in 1954. Dilman subsequently worked with another physician, Ward Dean to update this theory in the early 1990s. - The theory suggests that as humans age the hypothalamus declines in its ability to regulate hormones, becomes less sensitive to them, and consequently hormone secretion and hormone effectiveness declines. - Some believe that hormone replacements impacted by the hypothalamus may be a future treatment to counter the effects of aging but more research is needed.

Patient/Family Education - Management of the illness

- Ways to ensure patient safety - How to maintain reality orientation - Provide assistance with activities of daily living - Nutritional information - Difficult behaviors - Medication administration - Matters related to hygiene and toileting

Goals and the problem-solving model

- Weigh benefits and consequences of each alternative. - Help patient select an alternative. - Encourage patient to implement the change. - Provide positive feedback for patient's attempts to create change. - Help patient evaluate outcomes of the change and make modifications as required.

Symptoms of anorexia nervosa

- Weight loss is extreme, usually more than 15% of expected weight. - Other symptoms include hypothermia, bradycardia, hypotension, edema, lanugo, and a variety of metabolic changes. - Amenorrhea is typical and may even precede significant weight loss. - There may be an obsession with food. - Feelings of anxiety and depression are common. Weight loss in clients with anorexia nervosa is usually accomplished by reduction in food intake and often extensive exercising. Self-induced vomiting and the abuse of laxatives or diuretics also may occur. Weight loss is excessive. For example, the individual may present for healthcare services weighing less than 85% of expected weight. Other symptoms include hypothermia, bradycardia, hypotension with orthostatic changes, peripheral edema, lanugo (fine, neonatal-like hair growth), and a variety of metabolic changes. Amenorrhea (absence of menstruation) usually follows weight loss, but sometimes happens early on in the disorder, even before severe weight loss has occurred. Individuals with anorexia nervosa may be obsessed with food. For example, they may hoard or conceal food, talk about food and recipes at great length, or prepare elaborate meals for others, only to restrict themselves to a limited amount of low-calorie food intake. Compulsive behaviors, such as hand washing, may also be present. Age at onset is usually early to late adolescence, and psychosexual development is often delayed. Feelings of depression and anxiety often accompany the disorder.

Trauma

- Well-accepted as an essential psychosocial issue that should be conducted with patients when they first enter a healthcare setting. - Violence and trauma are linked to a high risk for injury, unhealthy coping mechanisms, and other illnesses such as arthritis, irritable bowel syndrome, and chronic pain. - Most individuals affected by violence are women and children. - Trauma in childhood is linked to significant cognitive, social, psychological, and neurobiological changes. - It can contribute to many physical and mental problems, and early death. - Many people with childhood trauma are reluctant to share critical information due to denial, guilt/shame, or a fear of consequences for sharing the information. - Nurses should recognize the risk for unwittingly retraumatizing a patient if there is a lack of awareness or a lack of sensitivity to the impact of that trauma.

friendship or romantic association

- When a nurse is acquainted with a patient, the relationship must move from one of a personal nature to professional - If the nurse is unable to accomplish this separation, he or she should withdraw from the nurse-patient relationship - Romantic, sexual, or similar personal relationships are never appropriate between nurse and patient

Treatment modalities for personality disorder - psychotherapy

- While Hatchett reviewed the literature specifically related to treatment for antisocial personality disorders, other researchers identify in their literature reviews that, for personality disorders in general, there is strong evidence of the effectiveness of psychotherapeutic interventions. Still other researchers identify that treatment focused on tackling the defense mechanisms associated with each of the personality disorders may be a more effective way to mediate improvement. - Depending on the therapeutic goals, psychotherapy with personality disorders may be time-limited interpersonal psychotherapy, or it may involve long-term psychoanalytic therapy. Interpersonal psychotherapy may be particularly appropriate because personality disorders largely reflect problems in interpersonal relationship skills.

Withdrawal from opioids

- With short-acting drugs such as heroin, withdrawal symptoms occur within 6 to 8 hours after the last dose, peak within 1 to 3 days, and gradually subside over a period of 5 to 10 days. - With longer-acting drugs such as methadone, withdrawal symptoms begin within 1 to 3 days after the last dose, peak between days 4 and 6, and are complete in 14 to 21 days. - Withdrawal from the ultra-short-acting meperidine begins quickly, reaches a peak in 8 to 12 hours, and is complete in 4 to 5 days.

Sedative/Hypnotic-Induced Disorder - intoxication

- With these central nervous system (C N S) depressants, effects can range from disinhibition and aggressiveness to coma and death (with increasing dosages of the drug). - the presence of clinically significant maladaptive behavioral or psychological changes that develop during, or shortly after, use of one of these substances. These changes may include inappropriate sexual or aggressive behavior, mood lability, impaired judgment, or impaired social or occupational functioning. Other symptoms that may develop with excessive use of CNS depressants include slurred speech, incoordination, unsteady gait, nystagmus, impairment in attention or memory, and stupor or coma. Taken recreationally, "club drugs" can produce a state of disinhibition, excitement, drunkenness, and amnesia. They have been widely implicated as "date rape" drugs, their presence being easily disguised in drinks. They produce anterograde amnesia, rendering the inability to remember events experienced while under their influence.

Conduct Disorder

- With this disorder, there is a persistent pattern of behavior in which the basic rights of others and major age-appropriate societal norms or rules are violated. - Childhood-onset type - Adolescent-onset type With conduct disorder (CD), there is a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated. Physical aggression is common, and peer relationships are disturbed. This is one of the most frequent reasons that children and adolescents are referred for psychiatric intervention. Prevalence estimates range from 2% to more than 10%, the prevalence rises from childhood to adolescence, and it is more common in males than females. There is a higher male predominance among those with the child-onset subtype. A number of comorbidities are common with conduct disorder, including A D H D, mood disorders, learning disorders, and substance use disorders.

Planning/Implementation - complicated grieving

- a disorder that occurs after the death of a significant other (or any other loss of significance to the individual), in which the experience of distress accompanying bereavement fails to follow normative expectations and manifests in functional impairment - Develop a trusting relationship with the client. - Encourage the client to express emotions. - Communicate that crying is acceptable - Goals for treating clients who are experiencing complicated grieving should include identifying coping strategies, recognizing the client's own position in the grieving process, and progressing toward resolution. Interventions include determining the stage of grief in which the client is fixed, teaching the stages of grief, and encouraging the client to reach out for support to complete the process

The adult survivor of incest - common characteristics

- a fundamental lack of trust resulting from an unsatisfactory parent-child relationship, which causes low self-esteem and a poor sense of identity. - If they do muster the courage to report the incest, particularly to the mother, they sometimes are not believed. - The child develops feelings of guilt with the realization over the years that the parents are using him or her in an attempt to solve their own problems. - Childhood sexual abuse commonly disrupts the development of a normal association of pleasure with sexual activity. - Peer relationships are often delayed, altered, inhibited, or perverted. - The conflicts associated with pain (either physical or emotional) and sexual pleasure experienced by children who are sexually abused are commonly manifested symbolically in adult relationships. - Women who were abused as children commonly enter into relationships with men who abuse them physically, sexually, or emotionally. - Adult survivors of incest who decide to come forward with their stories usually are estranged from nuclear family members. - They are blamed by family members for disclosing the "family secret" and are often accused of overreacting to the incest. - Frequently, the estrangement becomes permanent when family members continue to deny the behavior and the individual is accused of lying. - promiscuity - absence of pleasure with sexual activity - low self-esteem and poor sense of identity

Effects of alcohol on the body - Korsakoff's psychosis

- a syndrome of confusion, loss of recent memory, and confabulation in alcoholics. - It is frequently encountered in clients recovering from Wernicke's encephalopathy. In the United States, the two disorders are usually considered together and are called Wernicke-Korsakoff syndrome. - Treatment is with parenteral or oral thiamine replacement.

Empathy

- ability to see beyond outward behavior and to understand the situation from the patient's point of view - With empathy, the nurse can accurately perceive and understand the meaning and relevance of the patient's thoughts and feelings.

Delerium

- acute - fluctuating - impaired awareness - disturbed attention - poor working memory and immediate recall - delusions often short-lived or changing - fragmented sleep

Epidemiology of bipolar disorder

- affects 4.4% of american adults - gender difference is equal - average age at onset is 25 years - occurs more often in the higher socioeconomic classes - sixth-leading cause of disability in the middle-age group

Special concerns of elderly people - long term care - potential need for services is predicted by:

- age - health - mental health status - socioeconomic and demographic factors - marital status, living arrangement, and the informal support network - Long-term care facilities are defined by the level of care they provide. They may be skilled nursing facilities, intermediate care facilities, or a combination of the two. Most elderly individuals prefer to remain in their own homes or in the homes of family members for as long as this can meet their needs without deterioration of family or social patterns. Many elderly individuals are placed in institutions as a last resort only after efforts have been made to keep them in their own or a relative's home. - In determining who in our society will need long-term care, several factors have been identified that appear to place people at risk. Because people grow older in very different ways, and the range of differences becomes greater with the passage of time, age is becoming a less relevant characteristic than it was historically. However, because of the high prevalence of chronic health conditions and disabilities, as well as the greater chance of diminishing social supports associated with advancing age, the 65-and-older population is often viewed as an important long-term care target group. Level of functioning, as determined by the ability to perform various behaviors or activities—such as bathing, eating, mobility, meal preparation, handling finances, judgment, and memory—is a measurable risk factor. The need for ongoing assistance from another person is critical in determining the need for long-term care. - Mental health problems are risk factors in assessing the need for long-term care. Many of the symptoms associated with certain mental disorders (especially neurocognitive disorders), such as memory loss, impaired judgment, impaired intellect, and disorientation, would render the individual incapable of meeting the demands of daily living independently. - Low income generally is associated with greater physical and mental health problems among the elderly. Because many elderly individuals have limited finances, they are less able to purchase care resources available outside of institutions, although Medicare and Medicaid now contribute a limited amount to this type of noninstitutionalized care. - Individuals who are married and live with a spouse are the least likely of all disabled people to be institutionalized. Those who live alone without resources for home care and with few or no relatives living nearby to provide informal care are at higher risk for institutionalization. - State and national licensing boards perform periodic inspections to ensure that standards set forth by the federal government are being met. These standards address quality of patient care, as well as adequacy of the nursing home facility.

Common medications used for Tourette Disorder

- antipsychotics - alpha agonists Systematic review of current evidence supports the efficacy of antipsychotic agents, both typical and atypical agents, and the use of alpha 2-adrenergic agonist agents (such as clonidine) in treating tics. Medications that are used in treating Tourette disorder include antipsychotics and alpha agonists. The conventional antipsychotics, haloperidol (Haldol) and pimozide (Orap), have been approved by the FDA for control of tics and vocal utterances associated with Tourette disorder. These drugs have been widely investigated and have proved to be highly effective in alleviating these symptoms. They are often not the first-line choice of therapy, however, because of their propensity for severe adverse effects. Haloperidol is not recommended for children younger than 3 years of age, and pimozide should not be administered to children younger than 12 years. Clonidine (Catapres) and guanfacine (Tenex; Intuniv) are alpha-adrenergic agonists that are approved for use as antihypertensive agents. The extended-release forms have been approved by the FDA for the treatment of A D H D. These medications may be used for treatment of Tourette disorder because of their favorable side-effect profile and because they are often effective for comorbid symptoms of A D H D, anxiety, and insomnia.

Somatic symptom disorders

- are characterized by physical symptoms suggesting medical disease but without demonstrable organic pathology or a known pathophysiological mechanism to account for them. - Includes somatic symptom disorder, illness anxiety disorder, conversion disorder, factitious disorders

Dissociative disorders

- are defined by a disruption in the usually integrated functions of consciousness, memory, and identity - Dissociative responses occur when anxiety becomes overwhelming. Defense mechanisms that normally govern consciousness, identity, and memory break down, and behavior occurs with little or no participation on the part of the conscious personality. - Includes depersonalization/derealization disorder, dissociative amnesia, dissociative identity disorder

chaplain

- assesses, identifies, and attends to the spiritual needs of individuals and their family members - provides spiritual support and comfort as requested by the individual or family - may provide counseling if educational background includes this type of preparation

Depressive disorder associated with another medical condition

- attributable to the direct physiological effects of a general medical condition - The depression causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Types of hallucinations

- auditory - visual - tactile(worms under skin) - gustatory(taste) - olfactory(smell)

Symptoms of Post-Traumatic Stress Disorder(PTSD)

- avoiding thinking of the trauma - avoiding talking of the trauma - easily frightened - negative mood - negative thinking - always on guard - avoiding places - avoiding activities - flashbacks - cannot concentrate - aggressive behavior - loss of interest - feeling guilt and shame - substance abuse - sleeping difficulty - bad dreams - sustained high level of anxiety or arousal - general numbing of responsiveness - unable to remember certain aspects of the trauma

Nursing process - evaluation of the patient with NCD

- based on a series of short-term goals rather than on long-term goals. Outcomes must be measured in terms of slowing down the process rather than stopping or curing the problem. - Has the patient experienced injury? - Does the patient maintain orientation to time, person, place, and situation to the best of his or her cognitive ability? - Is the patient able to fulfill basic needs? Have those needs unmet by the patient been fulfilled by caregivers? - Is confusion minimized by familiar objects and a structured, routine schedule of activities? - Do the prospective caregivers have information regarding the progression of the patient's illness? - Do caregivers have information regarding where to go for assistance and support in the care of their loved one? - Have the prospective caregivers received instruction in how to promote the patient's safety, minimize confusion and disorientation, and cope with difficult patient behaviors (e.g., hostility, anger, depression, agitation)?

Intimate partner violence - profile of the victim

- battered women represent all age, racial, religious, cultural, educational, and socioeconomic groups - low self-esteem - inadequate support systems - some grew up in abusive homes - Battered women may be married or single, housewives or business executives. Many women who are battered have low self-esteem, commonly adhere to feminine sex-role stereotypes, and often accept the blame for the batterer's actions. Feelings of guilt, anger, fear, and shame are common. They may be isolated from family and support systems. - Some women who are in violent relationships grew up in abusive homes and may have left those homes, even gotten married, at a very young age in order to escape the abuse. The battered woman views her relationship as male dominant, and as the battering continues, her ability to see the options available to her and to make decisions concerning her.

Child abuse - Examples of emotional injury

- belittling or rejecting the child - ignoring the child - blaming the child for things over which he or she has no control - isolating the child from normal social experiences - using harsh and inconsistent discipline - being invasive - belitting through comments or sarcasm - brow-beating - bullying - confinement in dark places - constantly criticising - controlling - demeaning - harassing - humiliating - ignoring - innuendos - isolating - intimidating - manipulating - mortifying - name-calling - rejecting - ridiculing - scapegoating - screaming and raging - silent treatment - verbally assaulting

Borderline Personality Disorder Predisposing Factors - Biological Influences

- biochemical: possible serotonergic defect - genetic: possible familial connection with depression - Patients with borderline personality disorder have a high incidence of major depressive episodes, and antidepressants have demonstrated benefits in some cases. This fact and supporting information from brain imaging studies have led to the hypothesis that serotonin and/or norepinephrine dysregulation may contribute to the development of BPD. - An increased prevalence of major depression and substance use disorders in first-degree relatives of individuals with borderline personality suggest there may be complex genetic vulnerabilities as well as environmental influences. Patients with borderline personality disorder (BPD) are 5 times more likely to have a first-degree relative with BPD.

Predisposing factors - biological theories: physiological influences

- brain lesions(encephalitis, stroke) - enlarged ventricles - medication side effects(steroids, ADD/ADHD meds, anticonvulsants, narcotics can trigger bipolar disorder in those that are predisposed to develop it)

Medication conditions that may produce anxiety symptoms

- cardiac, endocrine, respiratory, neurological - cardiac conditions, such as myocardial infarction, congestive heart failure, and mitral valve prolapse; - endocrine conditions, such as hypoglycemia, hypo- or hyperthyroidism, and pheochromocytoma; - respiratory conditions, such as chronic obstructive pulmonary disease and hyperventilation - neurological conditions, such as complex partial seizures, neoplasms, and encephalitis.

The codependent nurse

- caretaking, perfectionism, denial, poor communication - Certain characteristics of codependence have been associated with the profession of nursing. - A shortage of nurses combined with the increasing ranks of seriously ill clients may result in nurses providing care and fulfilling everyone's needs but their own. - Many healthcare workers who are reared in homes with a chemically addicted person or otherwise dysfunctional family are at risk for having any unresolved codependent tendencies activated. - They are attracted to a profession in which they are needed, but they nurture feelings of resentment for receiving so little in return. - Their emotional needs go unmet; however, they continue to deny that these needs exist.

Patient and Family Education - Nature of the illness

- causes of bipolar disorder - cyclic nature of the illness - symptoms of depression and mania

Bipolar 2 disorder

- charactereized by bouts of major depression and episodic occurrence of hypomania - has never met criteria for full manic episode - have to have an episode of hypomania and clinical depression

Stress-related disorders - Adjustment disorders

- characterized by a maladaptive reaction to an identifiable stressor or stressors that results in the development of clinically significant emotional or behavioral symptoms. - This response occurs within 3 months after onset of the stressor and has persisted for no longer than 6 months after the stressor has ended(exception: related to bereavement subtype) - The individual shows impairment in social and occupational functioning or exhibits symptoms that are in excess of an expected reaction to the stressor. - The symptoms are expected to remit soon after the stressor is relieved, or if the stressor persists, when a new level of adaptation is achieved

Avoidant personality disorder

- characterized by extreme sensitivity to rejection and social withdrawal - prevalence is about 2% to 3% and is equally common in men and women - The individual with avoidant personality disorder is extremely sensitive to rejection, and because of this may lead a very socially withdrawn life. It is not that he or she is asocial; in fact, there may be a strong desire for companionship. The extreme shyness and fear of rejection, however, create needs for unusually strong assurances of unconditional acceptance. - Prevalence of the disorder in the general population is about 2% to 3%, and it appears to be equally common in men and women.

Symptoms of hypomania

- cheerful mood - increased motor activity - rapid flow of ideas; heightened perception - distracted - difficult to initiate goal directed activity - socialable - inappropriate - several nights with little to no sleep and act fine

Cyclothymic disorder

- chronic mood disturbance - at least 2 year duration - numerous episodes of hypomania and depressed mood of insufficient severity to meet the criteria for either bipolar 1 or 2 disorder

Electroconvulsive therapy for bipolar disorder - episodes of mania may be treated with ACT when:

- client does not tolerate medication - client fails to respond to medication - client life is threatened by dangerous behavior or exhaustion

Role of the nurse in group interventions - nurses who work in psychiatry may lead various types of therapeutic groups such as?

- client education groups - assertiveness training - support groups for clients with similar problems - parent groups - transition to discharge groups

The recovery model for bipolar disorder - in bipolar disorder, the recovery is a continuous process:

- client identifies goals - client and clinician develop a treatment plan - cleint and clinician work on strategies to help the individual manage the bipolar illness - clinician serves as support person to help the individual achieve the previously identified goals

Bipolar 1 disorder

- client is expericing or has experienced a full syndrome of manic or mixed symptoms(have to have a true manic episode) - MAY also have experienced episodes of depression(not necessary for diagnosis) - psychotic(delusions, hallucinations) or catatonic features may be present - MORE SEVERE

The standards of practice for psychiatric nursing are written around the six steps of the nursing process - diagnosis

- clinical judgments about individual, family, or community experiences/responses to actual or potential health problems/life processes - This provides the basis for selection of nursing interventions - The diagnosis should be congruent with accepted classification systems such as the NANDA International Nursing Diagnosis Classification

Alcohol withdrawal

- coarse tremor of hands, tongue, or eyelids; nausea or vomiting; malaise or weakness; tachycardia; sweating; elevated blood pressure; anxiety; depressed mood or irritability; transient hallucinations or illusions; headache; and insomnia. - In about 1% of alcoholic patients, complicated withdrawal syndrome may progress to alcohol withdrawal delirium and concomitant medical problems may increase the risk. - occurs within 4 to 12 hours of cessation of or reduction in heavy and prolonged alcohol use

Withdrawal symptoms

- cold shakes - chills and sweating - fever like symptoms - mood swings - anxiety and depression - bone pain - vomiting - insomnia - diarrhea

Childhood depression symptoms - ages 9-12

- common symptoms include morbid thoughts and excessive worrying - They may reason that they are depressed because they have disappointed their parents in some way - There may be a lack of interest in playing with friends - The incidence of depression among school-age children is estimated to be around 2% to 3%.

Predisposing factors - tourette disorder - environmental factors

- complications of pregnancy - low birth weight - head trauma - carbon monoxide poisoning - childhood infections Some studies have shown that environmental influence, such as maternal alcohol use during pregnancy, low birth weight, complications during childbirth, and infection, may be associated with the development of Tourette disorder. Further research is needed to confirm these influences.

Maintenance roles examples

- compromiser - encourager - follower - gatekeeper - harmonizer

Psychiatric clinical nurse specialist or psychiatric nurse practitioner function in group therapy

- conducts individual, group, and family therapy - presents educational programs from nursing staff - provides consultation services to nurses who require assistance in the planning and implementation of care for individual clients - may also prescribe and manage the medication regime

Client family education - management of the illness

- connection of exacerbation of symptoms to times of stress - appropriate medication management - side effects of medications - importance of not stopping medications - when to contact healthcare provider - relaxation techniques - social skills training - daily living skills training

Epidemiological factors: binge eating disorder

- consists of recurrent episodes of eating significantly more than most people would in a similar period of time under similar circumstances. - occur at least once a week for 3 months Its prevalence is estimated at 4% of the U.S. population It is estimated that approximately 50% to 75% of people seeking medical attention for severe obesity have a binge eating disorder.

Hospitalization commitment - involuntary commitments - Involuntary outpatient commitment

- court-ordered process used to compel a person with mental illness to submit to outpatient treatment - Eligibility criteria for IOC include a history of repeated decompensation requiring involuntary hospitalization, the likelihood of deterioration requiring inpatient commitment, the presence of severe and persistent mental illness, and the risk of becoming homeless, violent, or suicidal.

Predisposing factors - psychosocial theories

- credibility of psychosocial theories has declined in recent years - bipolar disorder is vieweed as a disease of the brain - thought that adverse childhood events(trauma) can lead to bipolar disorder - bipolar disorder is result of genetic, biological, and psychosocial stressors

Support services for bipolar patient and family

- crisis hotline - support groups - individual psychotherapy - legal/financial assistance

negative symptoms of schizophrenia

- decreased motivation - decreased need for social interaction - flat affect(no range of emotion) - decreased speech - decreased movement

Planning and implementation - impaired verbal communication

- decreased, delayed, or absent ability to receive, process, transmit, and/or use a system of symbols - The goal of treating patients with impaired verbal communication is to ensure that the patient is able to make their needs known and that needs are anticipated and fulfilled. - Interventions include keeping interactions calm and reassuring, using nonverbal gestures, and maintaining consistency.

Effects on the body of sedative/hypnotic use disorder

- depress the activity of the brain, nerves, muscles, and heart tissue. - Barbiturate use decreases the amount of sleep time spent in dreaming. During drug withdrawal, dreaming becomes vivid and excessive. Rebound insomnia and increased dreaming are not uncommon with abrupt withdrawal. - Barbiturates are capable of inhibiting the reticular activating system, resulting in respiratory depression, and can be lethal in overdose. In addition, additive effects can occur with the concurrent use of other CNS depressants, also effecting a life-threatening situation. - Hypotension may be a problem with large doses. Only a slight decrease in blood pressure is noted with normal oral dosage. High dosages of barbiturates may result in decreased cardiac output, decreased cerebral blood flow, and direct impairment of myocardial contractility. - In doses high enough to produce anesthesia, barbiturates may suppress urine function. - At the usual sedative/hypnotic dosage, however, there is no evidence that they have any direct action on the kidneys. - Barbiturates may produce jaundice with doses large enough to produce acute intoxication. Barbiturates stimulate the production of liver enzymes, resulting in a decrease in the plasma levels of both the barbiturates and other drugs metabolized in the liver. - High doses of barbiturates can greatly decrease body temperature. It is not significantly altered with normal dosage levels. - CNS depressants have a tendency to produce a biphasic response. There is an initial increase in libido, presumably from the primary disinhibitory effects of the drug. In men, this initial response is then followed by a decrease in the ability to maintain an erection.

Signs and symptoms of sexual abuse 12+ years

- disclosure - genital injuries - self mutilation of breasts/genitals - pregnancy - sexually transmitted diseases - prostutition

Signs and symptoms of sexual abuse under 5 year olds

- disclosure - genital injuries - sexually transmitted diseases - vivid details of actual activity - compulsive masturbation - sexual drawings - sexualized play usually acting out explicit sexual acts

Signs of symptoms of sexual abuse 5-12 year olds

- discolsure - genitual injuries - sexually transmitted diseases - sexual stories/poems - exposing themselves - masturbation in contextual inappopriate fashion - sexually active - suicide attempts - running away - alcohol and drug abuse

symptoms of mania and hypomania episode - DIGFAST

- distractible - irritable/indiscretion - grandiose - flight of ideas - activity increased - sleep - talkative

Common signs and symptoms of delerium

- disturbed attention and awareness - reduced level of alertness or arousal - acute onset and fluctuating course - fragmented sleep - disordered thought process - disorientation to time and place - executive dysfunction - memory impairment - visuspatial deficits - abnormalities of language - psychomotor agitation or retardation - reality distortion, including illusions, hallucinations, and delusions - labile affect - asterixis - frontal release signs - The symptoms of delirium can develop rapidly over a short period of time. These symptoms include difficulty sustaining and shifting attention; the person is extremely distractible and must be repeatedly reminded to focus attention. Disorganized thinking prevails and is reflected by speech that is rambling, irrelevant, pressured, and incoherent, and that unpredictably switches from subject to subject. Reasoning ability and goal-directed behavior are impaired. Disorientation to time and place is common, and impairment of recent memory is invariably evident.

Nursing interventions for disturbed thought process

- do not argue or deny the belief(say the voices, rather than them) - reinforce and focus on reality(tell them about what is going on in hospital)

Antipsychotics client and family education

- do not discontinue abruptly - use sunblock when outdoors - risk slowly from a sitting or lying position - avoid alcohol and OTC medications - continue to take the medication, even if feeling well and as through it is not needed; symptoms may return if medication is discontinued

Calcium channel blocker - verapamil patient and family education

- do not discontinue the drug abruptly - rise slowly from sitting or lying position to prevent sudden drop in BP - report irregular heartbeat, chest pain, SOB, dizziness, swelling of hands and feet, mood swings, severe and persistent headache

Client/Family Education

- do not stop taking the drug abruptly because symptoms will come back - use sunscreen and wear protective clothing when spending time outdoors - report weekly(if recieiving clozapine therapy) to have blood levels drawn and to obtain a weekly supply of the drug(watch clozely for agranulocytosis) - be aware of possible risks of taking antipsychotics during prengnacy - do not drink alcohol(hypotension) - do not consume other medications(OTC drugs too) without physician knowledge - rise slowly from a sitting or lying position to prevent orthostatic hypotension - smoking cessation(it is an inducer)

Things to not do when destigmatizing

- dont say someone is crazy - dont use mental illnesses in colloquial speech - dont say im so depressed or i had a panic attack if inture - dont use terminology for death casually - dont undermine or put down mental illness treatment such therapy, counseling, coping skills - dont negatively refer to psychological medications

Sedative/Hypnotic Use disorder

- drugs of diverse chemical structures that are all capable of inducing varying degrees of CNS depression, from tranquilizing relief of anxiety to anesthesia, coma, and even death. - They are generally categorized as barbiturates, nonbarbiturate hypnotics, and antianxiety agents.

Inhalant-induced disorder - physical intoxication

- drunk, dazed, or dizzy - slurred or disoriented speech - red or runny nose and eyes - spots or sores around mouth - unusual breath odor or chemical odor on clothing - nausea and or loss of appetite - signs of pain or other products in unusual places, such as on face, lips, nose, or fingers - chronic inhalant abusers may exhibit symptoms such as hallucinations, anxiety, excitability, irritability, restlessness or anger

The modern concept of manic-depressive illness began to emerge in the 19th century, with terms such as?

- dual-form insanity - circular insanity

Cannabis withdrawal

- dysphoria - anxiety - insomnia - nausea - anorexia - headache

Stimulant withdrawal(amphetamines and cocaine)

- dysphoria - lethargy - hypersomnia - hyperphagia - increased dreaming - bradycardia - intense craving

Sexual assault - the long-term effect depend largely on the individuals?

- ego strength - social support system - treatment as a victim

Acute mania symptoms

- elation and euphoria; a continuous high - flight of ideas; accelerated; pressured speech - hallucinations and delusions - excessive motor activity - social and sexual inhibition - little need for sleep - racing thoughts - easily distracted - faster movements - excessive makeup and jewlery - inappropriate dress

Deep brain stimulation

- electrode is implanted with the intent of stimulating brain function - However, this procedure, unlike VNS, is a deep implant that requires craniotomy - Currently, DBS is reserved for patients with severe, incapacitating depression or obsessive compulsive disorder

music therapist

- encourages patients in self-expression through music - patients listen to music, play instruments, sing, dance, and compose songs that help them get in touch with feelings and emotions that they may not be able to experience in any other way

Negative symptoms - common regressive behaviors exhibited by hospitalized patients

- engaging in quiet baby talk - being incontinent - crying - sucking on objects or body parts - masturbating - verbally abusing staff - whining - being mute - needing a comfort object like a stuffed animal - playing possum or dumb - being physically aggressive - rocking - pacing - temper tantrums - bed wetting

Interventions for PTSD

- establishing a trusting relationship - obtaining an accurate history about the trauma - encouraging the client to talk about the trauma - assisting in comprehending the trauma.

Stimulant intoxication(amphetamines and cocaine)

- euphoria or affective blunting; changes in sociability; hypervigilance; interpersonal sensitivity; anxiety, tension, or anger; stereotyped behaviors; or impaired judgment. In severe amphetamine intoxication, symptoms may include memory loss, psychosis, and violent aggression. - Intoxication from caffeine usually occurs following consumption in excess of 250 mg. Symptoms include restlessness, nervousness, excitement, insomnia, flushed face, diuresis, GI disturbance, muscle twitching, rambling flow of thought and speech, tachycardia or cardiac arrhythmia, periods of inexhaustibility, and psychomotor agitation.

Evaluation

- evaluation of the effectiveneness of the nursing interventions is measured by fulfillment of the outcome criteria - has the client avoided personal injury? - has violence to the client or others been prevented? - has agitation subsided? - have nutritional status and weight been stabilized? - have delusions and hallucinations ceased? - is the client able to make decisions about own self-care? - is behavior socially acceptable? - is the client able to sleep 6-8 hours per night and awaken feeling rested? - does the client understand the importance of maintenance medication therapy?

Outcomes for bipolar patient

- exhibits no evidence of physical injury - has not harmed self or others - is no longer exhibiting signs of physical agitation - eats a well-balanced diet with snacks to prevent weight loss and maintian nutritional status - verbalizes an accurate interpretation of the environment - verbalizes that hallucinatory activity has ceased and demonstrates no outward behavior indicating hallucinations - accepts responsibility for own behaviors - does not manipulate others for gratification of own needs - interacts appropraitely with others - is able to fall asleep within 30 minutes of retiring - is able to sleep 6-8 hours per night

psychological aspects of normal aging - adaption to the tasks of aging - loss and grief

- experience many losses - mourning has become a lifelong process - bereavement overload - attachment to others By the time individuals reach their 60s and 70s, they have experienced numerous losses, and mourning has become a lifelong process. Unfortunately, with the aging process comes a convergence of losses, the timing of which makes it impossible for the aging individual to complete the grief process in response to one loss before another occurs. Because grief is cumulative, this can result in bereavement overload, which has been implicated in the predisposition to depression in the elderly. Social networks contribute to the well-being of seniors by promoting socialization and companionship, elevating morale and life satisfaction, buffering the effects of stressful events, providing a confidant, and facilitating coping skills and mastery.

Light therapy

- exposure to light, has been shown to be an effective treatment for seasonal affective disorder - The light therapy is administered by a 10,000-lux light box, which contains white fluorescent light tubes covered with a plastic screen that blocks ultraviolet rays - The mechanism of action is believed to be related to retinal stimulation, which triggers a reduction of melatonin and an increase in serotonin in the brain.

Sexual assault - victim responses

- expressed response pattern - controlled response pattern - compunded rape reaction - silent rape reaction

Nursing diagnosis for bipolar disorder - risk for injury related to?

- extreme hyperactivity - increased agitation - lack of control over purposeless and potentially injurious movements

Nursing diagnosis for schizophrenia - risk for violence: self-directed or other-directed related to:

- extreme suspiciousness - panic anxiety - catatonic excitement - rage reactions - command hallucinations

acute dystonia

- facial frimacing - involuntary upward eye movement - muscle spasms of the tongue, face, neck, and back(back muscle spasms cause trunk to arch forward) - laryngeal spasms

Nursing interventions for imapired verbal communication

- facilitate trsut and understanding - orient the client to reality

Father vs mother in incestuous relationship

- father: domineering, impulsive, physically abusive - mother: passive, submissive, and denigrates her role of wife and mother. Often aware of the relationship, but uses denial or keeps quiet out of fear of being abused by her husband

Flooding(Implosion) - discovering the stimulus is harmless:

- fear explosion therapy - developed by Levis and Stampi - the underlying theory behind flooding is that a phobia is learned fear, and needs to be unlearned by exposure to the thing that you fear

Client family education - support services

- financial assistance - legal assistance - caregiver support groups - respite care - home healthcare

A mneumonic for discontinuation symptoms from antidepressants

- flu like symptoms - insomnia - nausea - imbalance - sensory disturbances - hyperarousal

Role of the nurse in psychiatry

- focuses on helping the client successfully adapt to stressors within the environment - Goals are directed toward changes in thoughts, feelings, and behaviors that are age-appropriate and congruent with local and cultural norms. - Therapy is very often team-, or interdisciplinary, oriented - It is important for a nurse to know his or her role within this team and their involvement in the treatment regimen. - Typically, the nurse's contribution to the interdisciplinary treatment regimen will focus on establishing trust on a one-to-one basis, giving positive feedback for small day-to-day accomplishments in an effort to build self-esteem, and assisting with and encouraging independent self-care.

Christian ethics

- focusing on love, forgiveness, and honesty - All decisions about right and wrong are centered upon a love for God and treating others with respect.

Vagal nerve stimulation

- found to improve the client's mood - This treatment involves implanting an electronic device in the skin to stimulate the vagus nerve - The mechanism of action is not known, but preliminary studies have shown that many patients with chronic recurrent depression improved when treated with VNS - Trials are ongoing to determine its effectiveness.

Mental health technician(also called psychiatric aide or assistant or psychiatric technician)

- functions under the supervision of the psychiatric nurse - provides assistance to patients in the fulfillment of their activities of daily living - assists activity therapists as required in conducting their groups - may also participate in one-to-one relationship development

Effects of alcohol on the body - alcohol cardiomyopathy

- generally relates to congestive heart failure or arrhythmia. - Effect of alcohol on the heart is an accumulation of lipids in the myocardial cells, resulting in enlargement and a weakened condition - Symptoms include decreased exercise tolerance, tachycardia, dyspnea, edema, palpitations, and nonproductive cough. - Changes may be observed by electrocardiogram, and congestive heart failure may be evident on chest x-ray films. - Treatment is total permanent abstinence from alcohol. - Treatment of the congestive heart failure may include rest, oxygen, digitalization, sodium restriction, and diuretics. - The death rate is high for individuals with advanced symptomatology.

Sxhizophrenia is probably caused by a combination of factors including:

- genetic predisposition(10% if parents have it) - biochemical dysfynction - physiological factors - psychosocial stress(alcohol may trigger it) - anatomical factors - being exposed to toxins in the womb

Predisposing factors - tourette disorder - biological factors

- genetics - biochemical factors - structural factors Various genetic studies including twin studies and adoption studies all support a genetic basis for Tourette disorder. Although the evidence supports that this is an inherited disorder, recent studies suggest that the pattern of inheritance is complex, probably involving several genes influenced by environmental factors. In addition, genetic studies suggest that A D H D and obsessive-compulsive disorder (OCD) are genetically related to Tourette disorder; as many as 50% of patients with Tourette disorder also have A D H D and up to 40% have OCD. Abnormalities in levels of dopamine, choline, N-acetylaspartate, creatine, myoinositol, and norepinephrine have all been demonstrated in neuroimaging studies, and the effectiveness of antipsychotic medication in suppressing tics also supports neurotransmitter involvement in Tourette disorder. Neuroimaging brain studies have been consistent in finding dysfunction in the area of the basal ganglia. The frontal lobes, the cortex, and abnormalities in the circuits that connect these regions have also been implicated in the pathology of this disorder. As yet, although many influences have been identified, the direct cause is still unknown.

Predisposing factors: conduct disorder - biological influences

- genetics - temperament - neurobiological factors Family, twin, and adoptive studies have revealed a significantly higher number of individuals with conduct disorder among those who have family members with the disorder. Although genetic factors appear to be involved in the etiology of conduct disorder, little is yet known about the actual mechanisms involved in genetic transmission. There is some evidence though, of the distinction between behaviors that appear to be genetic versus environmental risk factors. The term temperament refers to personality traits that become evident very early in life and may be present at birth. As early as 2 years of age, children who show signs of an irritable temperament, poor compliance, inattentiveness, and impulsivity can begin to show signs of conduct disorder at later ages. Sadock et al identify three neurobiological findings relevant to conduct disorders. First, neuroimaging studies identify decreased gray matter in limbic structures, bilateral insula, and the left amygdala. Second, studies have found high plasma concentration of serotonin and low levels in cerebrospinal fluid, both of which are correlated with aggression and violence. The third finding was that aggressive children had "significantly greater relative right frontal brain activity at rest than healthy controls."

Predisposing facotrs - separation anxiety disorder - biological influences

- genetics - temperament A greater number of children with relatives who manifest anxiety problems develop anxiety disorders than children with no such family patterns. The results are significant enough to speculate that there is a hereditary influence in the development of separation anxiety disorder, but the mode of genetic transmission has not been determined. It is well established that children differ from birth, or shortly thereafter, on a number of temperamental characteristics.

Prognosis - factors associated with a positive prognosis(outcome)

- good premorbid functioning - later age at onset - female(estrogen modulation of dopamine) - abrupt onset precipitated by a stressful event - associated mood disturbance - brief duration of active-phase symptoms - minimal residual symptoms after active psychosis - absence of structural brain abnormalities - normal neurological functioning - no family history of schizophrenia - people who do not use substances that increase dopamine(cocaine, meth)

1-3 days without alcohol

- hallucinations - mental confusion - irritability - withdrawal seizures - increased blood pressure

Epidemiological factors: obesity

- has been defined as a body mass index (B M I) of 30 or greater. - 68.5% of adult Americans are overweight, and 35% of these are in the obese range.

Evaluation questions for nursing process

- has client established trust with at least one staff member? - is anxiety level maintained at a manageable level? - is the patient taking their medications? - is the client easily agitated? - is client able to interact with others appropriately? - is client able to interrpt escalating anxiety with adaptive coping mechanisms? - is delusional thinking still prevalent?

Goals of treatment

- healthy grief resolution - helping the client demonstrate the ability to deal with emotional reactions in an appropriate way - establishing meaningful goals for the future. - helping the client verbalize feelings associated with the trauma - verbalizing a sense of optimism and hope for the future.

Hallucinogens effects on the body - psychological

- heightened response to color, sounds - distorted vision - sense of slowed time - magnified feelings - paranoia, panic - euphoria, peace - depersonalization - derealization - increased libido

Goals for complicated grieving

- helping the client express anger toward the lost entity - helping the client verbalize behaviors associated with the normal stages of grief - Interventions include developing a trusting relationship with the client, assisting the client in discharging pent-up anger, and encouraging the client to review his or her perception of the loss.

the impact of preexisting conditions - social status

- high-status persons are associated with gestures that communicate their higher-power position. ' - For example, they use less eye contact, have a more relaxed posture, use louder voice pitch, place hands on hips more frequently, are "power dressers," have greater height, and maintain more distance when communicating with individuals considered to be of lower social status.

How to tell between ADHD and manic episode

- history of depression or low mood - change in baseline behavior(a child with ADHD always has high energy)

Types of mania

- hypomania - mania - delerious mania

Examples of recovery thinking

- i cant have just one - substance use is dangerous to my health - i can get help for my problem - its best to stay sober - i dont need to use to have a good time

Examples of addictive thinking

- i need drugs to numb the pain - im tough and can handle it - i deserve it - i need an occasional boost - ill feel more confident - itll take my mind of things - i can have just one - it doesnt affect me

What is the problem-solving model?

- identify the patient's problem - promote discussion of desired changes - discuss aspects that cannot realistically be changed and ways to cope with them more adaptively - discuss alternative strategies for creating changes that the patient desires to make

Biological responses associated with fight-or-flight can include:

- immediate responses (release of norepinephrine and epinephrine, increased respiration rate, increased heart rate) - sustained responses (increased gluconeogenesis, increased basal metabolic rate, decrease in secretion of sex hormones)

ASD vs PTSD

- in ASD symptoms are time limited: up to 1 month following the trauma - if the symptoms last longer than 1 month, the diagnosis is PTSD

Phase 3 - acute schizophrenic episode

- in the active phase of the disorder, psychotic symptoms are prominent - delusion - hallucinations - impairment in work, social relations, and self care

Histrionic Personality Disorder - I CRAVE SIN

- inappopraite behavior(seductive or provacative) - center of attention - relationships are seen as closer than they really are - apperance is most important - vulnerable to others suggestions - emotional expression is exaggered - shifting emotions, shallow - impressionistic manner of speaking(lacks detail) - novelty is craved

Assessment of ADHD

- inattention - hyperativity - inpulsivity - A major portion of the hyperactive child's problems relate to difficulties in performing age-appropriate tasks. Hyperactive children are highly distractible and have extremely limited attention spans. They often shift from one uncompleted activity to another.

Treatment modalities for bipolar disorder

- individual psychotherapy(IPSRT) - group therapy - family therapy(family is the client) - cognitive therapy

mneumonic for remembering possible causes of delerium - IWATCHDEATH

- infection - withdrawal - acute metabolic - traumatic injury - CNS lesion - hypoxia - deficiency of vitamins - endocrine - acute vascular - toxins(including medications) - heavy metals

Effects of alcohol on the body - alcoholic hepatitis

- inflammation of the liver caused by long-term heavy alcohol use. - Symptoms include an enlarged and tender liver, nausea and vomiting, lethargy, anorexia, an elevated white blood cell count, fever, and jaundice. - Ascites and weight loss may be evident in more severe cases. - With treatment—which includes strict abstinence from alcohol, proper nutrition, and rest—the individual can experience complete recovery. - Severe cases can lead to cirrhosis or hepatic encephalopathy.

Other Legal issues in mental health nursing

- informed consent - restraints and seclusion(false imprisonment

Opioid induced disorders - intoxication signs

- initial euphoria followed by apathy, dysphoria, psychomotor agitation or retardation, and impaired judgment. - Physical symptoms include pupillary constriction, drowsiness, slurred speech, and impairment in attention or memory. - head nodding - scratching(due to histamine release) - reduced respiratory rate - constricted pupils - drooping eyelids

Dementia

- insidious - gradual deterioration - awareness is often clear until advanced stages - attention is often good until advanced stages - poor short-term memory - delusions are more fixed - sleep disturbances: sleep-wake reversal

Epidemiological factors: bulimia nervosa

- is decreasing in recent years, with a lifetime prevalence of 2% among women. - It occurs primarily in societies that emphasize thinness. - Onset of bulimia nervosa occurs in late adolescence or early adulthood. Among college women, about 20% experience transient bulimic symptoms during their college years. Cross-cultural research suggests that bulimia nervosa occurs primarily in societies that place emphasis on thinness as the model of attractiveness for women and where an abundance of food is available.

Planning/Implementation: Borderline Personality Disorder - Impaired social interaction

- is defined as "insufficient or excessive quantity or ineffective quality of social exchange." - Goals should include helping the client interact appropriately with others. Interventions include rotating staff members to work with the client, exploring feelings that are related to fears of abandonment, and providing education, support, and referral resources for family members. - Help the client understand that you will be available. - Explore feelings that are related to fears of abandonment and engulfment.

Planning/Intervention - defensive coping

- is defined as "repeated projection of falsely positive self-evaluation based on a self-protective pattern that defends against underlying perceived threats to positive self-regard." - Goals should include having the client verbalize personal responsibility for difficulties experienced in interpersonal relationships, and helping the client demonstrate the ability to interact with others without becoming defensive, rationalizing behaviors, or expressing grandiose ideas. Interventions include making the client aware of which behaviors are acceptable and which are not, providing the appropriate environment, and helping the client gain insight into his or her behavior. - do not attempt to coax or convince the client to do the right thing - provide positive feedback - talk about past behaviors

Planning/Intervention - risk for violence directed at others

- is defined as "vulnerable to behaviors in which an individual demonstrates that he or she can be physically, emotionally, and/or sexually harmful to others." - Goals for care include discussing angry feelings and situations, and preventing the client from harming others. Interventions include maintaining a low level of stimuli in the client's environment, helping the client identify the true object of his or hostility, and having sufficient staff available to present a show of strength. - convey accepting attitude - observe clients behavior frequently - maintain and convey calm attitude

Planning/Implementation: Borderline Personality Disorder - Risk for self-mutilation/risk for self-directed or other-directed violence

- is defined as "vulnerable to deliberate self-injurious behavior causing tissue damage with the intent of causing nonfatal injury to attain relief of tension." - Risk for self-directed or other-directed violence is defined as "vulnerable to behaviors in which an individual demonstrates that he or she can be physically, emotionally, and/or sexually harmful to self or others." - Goals for care should include preventing the client from harming themselves or others. Interventions should include securing a verbal contract from the client that they will seek out a staff member when the urge to self-mutilate occurs, and removing all dangerous objects from the client's environment. - observe clients behavior frequently - try to redirect violent behavior with physical outlets for the clients anxiety

touch

- is required to perform the many therapeutic procedures involved in the physical care of patients - Caring touch is the touching of patients when there is no physical need - Touching or hugging can be beneficial when it is implemented with therapeutic intent and has the consent of the patient - There are times when touch should be avoided or considered with extreme caution.

delirious mania symptoms

- labile mood - panic anxiety - clouding of consciousness - disorientation - frenzied psychomotor activity - cannot stop long enough to eat or drink - exhaustion and possibly death without intervention

Passive

- lack of eye contact - looking down - not expressing your feelings or needs - avoiding problems

Prodromal phase

- lasts from a few weeks to a few years - deterioration in role functioning and social withdrawal - substantial functional impairment - depressed mood, poor concentration, fatigue, social withdrawl, cognitive impairment, more difficulty processing, non reality thoughts that interfere with their function - sudden onset of obessive-compulsive behavior

10 key ingredients for trauma-informed care

- lead and communicate - engage patients in planning - train all staff - create a safe environment - prevent secondary trauma - build an informed workforce - involve patient in treatment - screen for trauma - use trauma-specific treatment - engage patients

Predisposing factors to depression - learning theory

- learned helplessness - the individual who experiences numerous failures learns to give up trying - Seligman theorized that learned helplessness predisposes individuals to depression by imposing a feeling of lack of control over their life situation.

The impact of preexisting conditions - values, attitudes, and beliefs

- learned ways of thinking. - Children generally adopt the value systems and internalize the attitudes and beliefs of their parents - Children may retain this way of thinking into adulthood or develop a different set of attitudes and values as they mature.

Of all mental illnesses, schizophrenia probably causes more:

- lengthy hospitalizations - 1/3 attempt suicide and 1 in 10 complete suicide - chaos in family life - fears - exorbitant costs tp people and government

Side effects of lithium carbonate - LMNOP

- leukocytosis - movement(tremor) - nephrogenic diabetes insipidus - hypOthyroidism - pregnancy

Developmental implications: childhood and adolescence

- lifetime prevalence of pediatric and adolescent bipolar disorders is estimated at about 1% - diagnosis is difficult - in children, bipolar disorder is considered a chronic condition with a high rate of relapse(hard to maintain medication compliance)

Psychopharmacology for bipolar disorder - for mania:

- lithium carbonate - anticonvulsants - verapamil - antipsychotics

Predisposing factors to depression - psychoanalytical theory

- loss is internalized and becomes directed against the ego - Freud posited that melancholia occurs after the loss of a loved object, either actually by death or emotionally by rejection, or the loss of some other abstraction of value to the individual. Freud indicated that in melancholia, the depressed patient's rage is internally directed because of identification with the lost object. Freud believed that the individual predisposed to melancholia experienced ambivalence in love relationships.

Intimate partner violence - profile of the victimizer

- low self-esteem - pathologically jealous - "dual personality" - limited coping ability - severe stress reactions - views spouse as a personal possession - Men who batter usually present a "dual personality," one to the partner and one to the rest of the world. They are often under a great deal of stress, but have limited ability to cope with the stress. The typical abuser is very possessive and perceives his spouse as a possession. He becomes threatened when she shows any sign of independence or attempts to share herself and her time with others. - The abusing man typically wages a continuous campaign of degradation against his female partner. He insults and humiliates her and everything she does at every opportunity. He strives to keep her isolated from others and totally dependent on him.

Effects of alcohol on the body - cirrhosis

- may be caused by anything that results in chronic injury to the liver, but it is also the end-stage of alcoholic liver disease and results from long-term chronic alcohol abuse. - There is widespread destruction of liver cells, which are replaced by fibrous (scar) tissue. - Symptoms include nausea and vomiting, anorexia, weight loss, abdominal pain, jaundice, edema, anemia, and blood coagulation abnormalities. - Treatment includes abstention from alcohol, correction of malnutrition, and supportive care to prevent complications of the disease.

gift-giving

- may be part of the therapeutic process for people who receive care. - Cultural belief and values may also enter into the decision of whether to accept a gift from a patient. - Accepting financial gifts is never appropriate, but in some instances nurses may be permitted to suggest instead a donation to a charity of the patient's choice. - If acceptance of a small gift of gratitude is deemed appropriate, the nurse may choose to share it with other staff members who have been involved in the patient's care.

Case manager function in group therapy

- may serve as the leader of the team - collaborates with other members of the IDT to ensure that the IDT care plan is implemented effectively and efficiently - may coordinate referral needs and follow-up appointments post-discharge - some case managers also conduct utilization review functions

Psychiatrist function in group therapy

- may serve as the leader of the team - responsible for diagnosis and treatment of mental disorders - Prescribes medication and other somatic therapies - performs ongoing assessment and medication management

Patient and Family Education - management of the illness

- medication management(compliance) - assertive techniques(stand up for yourself and your feelings rather than being aggressive, clear messages, calm, delivery is in a controlled manner without becoming emotional) - anger management(therapy, it is hard when are impulsive and irritable)

Four dopamine pathways and schizophrenia

- mesolimbic - mesocortical - nigrostriatal - tuberohypophyseal

drugs that can cause psychotic symptoms

- methamphetamine - alcohol - cannibus - cocaine

Alzheimer's Disease - stage three

- mild cognitive decline - In this stage, there is interference with work performance, which becomes noticeable to coworkers. - The individual may get lost when driving his or her car. - Concentration may be interrupted. - There is difficulty recalling names or words, which becomes noticeable to family and close associates.

Dialectical behavior therapy

- mindfullness: being aware of the present moment without judgement - emotion regulation: undersanding and reducing vulnerability to emotions, changing unwanted emotions - distress tolerance: getting through crisis situations without making things worse and accepting really as it is - interpersonal effectiveness: getting interpersonal objectives met, maintaining relationships, and increasing self-respect in relationships

Azheimers disease - stage four

- moderate cognitive decline - At this stage, the individual may forget major events in personal history, such as his or her own child's birthday; experience declining ability to perform tasks, such as shopping, cooking, and managing personal finances; or be unable to understand current news events. - He or she may deny that a problem exists by covering up memory loss with confabulation (creating imaginary events to fill in memory gaps). Depression and social withdrawal are common. - At this stage, the individual requires some assistance to maintain safety.

Alzheimers Disease - stage five

- moderately severe cognitive decline - At this stage, individuals lose the ability to perform some A D L's independently, such as hygiene, dressing, and grooming, and require some assistance to manage these tasks on an ongoing basis. - They may forget addresses, phone numbers, and names of close relatives. - They may become disoriented about place and time, but they maintain knowledge about themselves. - Frustration, withdrawal, and self-absorption are common.

Epidemiological data about trauma

- more than half of all individuals will experience a traumatic event in their lifetime, but less than 10% will develop PTSD - the traumatic event is described as one that is "outside the range of usual human experience: - PTSD is more common in women than in men

Mature defense mechanisms

- most constructive and helpful to most adults, but may require practice and effort to put into daily use. - While primitive defense mechanisms do little to try and resolve underlying issues or problems, mature defenses are more focused on helping a person be a more constructive component of their environment. - People with more mature defenses tend to be more at peace with themselves and those around them.

Where does sexual assault most commonly occur

- most victims are single women - the attack often occurs near their own neighborhoods - victim likely expereinces a sense of violation and helplessness

The four major specific phobia categories

- natural environment(astraphobia - lightening, hydrophobia - water, dendrophobia - trees) - animals(equinophobia - horses, batrachophobia - lizard, cynophobia - dogs) - mutilation/medical treatment(dentophobia - dentists, trypanophobia - needles, hemophobia - blood) - siutations(claustrophobia, aerophobia - planes, glossophobia - speaking)

Hallucinogens effects on the body - physiological

- nausea/vomiting - chills - pupil dilation - increased blood pressure, pulse - loss of appetite - insomnia - elevated blood sugar - decreased respirations

Neurocognitive disorder progression - late stages

- near full dependence and inactivity - memory impairment is severe and the physical signs and symtpoms become more obvious - unawareness of time and place - unable to find way around - difficulty recognizing relatives, friends, familar objects - bladder/bowel incontinence - increasing need for assisted self-care - difficulty walking, confined to wheelchair/bed - behavioral changes: agression toward caregiver

Predisposing factors to trauma-related disorders - learning theory

- negative reinforcement leads to the reduction in an aversive experience, thereby reinforcing and resulting in repitition of the behavior - avoidance behaviors - psychic numbing

Suicide warning signs

- negative view of self - hoelessness - isolation, feeling alone - aggressive - irritability - possessing lethal means - feeling like a burden to others - drastic mood and behavior - talk about death - self harm - engaging risky behaviors - giving things away - funeral arrangements - substance abuse - making suicide threats

Phobias - biological aspects

- neuroanatomical - temperament(characteristics with which one is born that influence how she or he responds throughout life to specific situations(innate fears))

Symptoms of lithium toxicity

- notify physician if these symptoms occur - persistant n/v - severe diarrhea - ataxia - blurred vision - tinnitus - excessive output of urine - increasing tremors - mental confusion

Genuineness

- nurse's ability to be open, honest, and, "real" in interactions with the patient - To be "real" is to be aware of what one is experiencing internally and to allow the quality of this inner experiencing to be apparent in the therapeutic relationship.

Nursing interventions for risk for violence

- observe clients behavior(intervene when you see them gettting stressed) - maintain calm attitude - have suffient staff on hand

Nursing interventions for disturbed sensory perception(visual/auditory)

- observe the client for signs of hallucinations - help client understand connects between anxiety and hallucinations - distract the client from hallucinations

Vascular Neurocognitive Disorder - Predisposing factors

- occurs as a result of significant cerebrovascular disease - In vascular N C D, the syndrome of cognitive symptoms is due to significant cerebrovascular disease. - When blood flow in the brain is impaired, progressive intellectual deterioration occurs. - Vascular N C D differs from A D in that it has a more abrupt onset and runs a highly variable course. - In vascular N C D, progression of the symptoms occurs in "steps" rather than as a gradual deterioration; that is, at times the symptoms seem to clear up and the individual exhibits fairly lucid thinking.

Predisposing factors of schizophrenia - biological factors - biochemical factors

- one theory suggests that schizophrenia may be caused by an excess of dopamine activity in the brain - abnormalities in other neurotransmitterws have also been suggested

Neurocognitive disorder progression - early stages

- onset is gradual, stage is often overlooked - forgetfulness of recent events - losing track of time - becoming lost in familar places - work-finding difficulties - decision making difficulties, including managing finances and complex household tasks - behavioral changes lost interest in activities/hobbies, depression, anxiety, apathy, unusual anger/agression on occasion

Neurocognitive disorder due to alzheimers disease - predisposing factors

- onset is slow and insidious - course of the disorder is generally progressive and deteriorating - Alzheimer's disease is characterized by the syndrome of symptoms identified as Mild or Major N C D and in the seven stages described previously. Refinement of diagnostic criteria now enables clinicians to use computerized tomography (CT) scan or magnetic resonance imagery (MRI) to reveal a degenerative pathology of the brain that includes atrophy, widened cortical sulci, and enlarged cerebral ventricles.

Opioid use disorder - profile of the substance

- opioid refers to a group of compounds that includes opium, opium derivatives, and synthetic substitutes. - Opioids exert both a sedative and an analgesic effect, and their major medical uses are for the relief of pain, the treatment of diarrhea, and the relief of coughing. - Under close supervision, opioids are indispensable in the practice of medicine. - They are the most effective agents known for the relief of intense pain. - However, they also induce a pleasurable effect on the CNS that promotes their abuse.

Acquaintance rape

- or date rape if the encounter is a social engagement agreed to by the victim - term applied to situations in which the rapist is acquainted with the victim. - They may be out on a first date, may have been dating for a number of months, or merely may be acquaintances or schoolmates. - College campuses are the location for a large number of these types of rapes.

Predisposing factors - biological theories - disorders of the brain

- organic brain syndromes - brain tumors/trauma - encephalitis - temporal lobe epilepsy

Schizophrenia spectrum and psychotic disorders

- organized from least to most severe in the DSM 5 - severity determined by the level, number and duration of psychotic s/s - a spectrum is a range of linked conditions

Protective factors against suicide

- overall resilience - problem solving skills - awareness and access to physical and mental halth care - positive peer relationships - cultural or religious beliefs that discourage suicide - interpersonal and community connectedness - safe environment - positive adult relationships

Inhalant-induced disorder - behavioral intoxication

- painting fingernails with magic markers or correction fluid - sitting with a pen or marker by nose - constantly smelling clothing sleeves - showing paint or stain marks on face, fingers, or clothing - having numerous butane lighters and refills in room, backpack, or lacker - hiding rags, clothes, or empty containers of the potentially abused products in closets, under the bed, in garage

Diagnosis/Outcome Identification for anxiety, OCD, and related disorders?

- panic anxety(panic disorder and GAD) - powerlessness(panic disorder and GAD) - fears(phobias) - social isolation(agoraphobia) - Ineffective coping (OCD) - Ineffective role performance (OCD) - Disturbed body image (body dysmorphic disorder) - Ineffective impulse control (hair-pulling disorder) - Ineffective coping (OCD)

Characteristics of the child abuser

- parents who abuse their children were likely abused as children themselves •Experiencing a stressful life situation (e.g., unemployment; poverty) • Having few, if any, support systems; commonly isolated from others • Lacking understanding of child development or care needs • Lacking adaptive coping strategies; angers easily; has difficulty trusting others • Expecting the child to be perfect; may exaggerate any mild difference the child manifests from the "usual"

prediposing factors: conduct disorder - psychosocial influences

- peer relationships Poor academic performance and social maladaptation often lead to affiliations with a deviant peer group. There is some evidence that engaging in risk-taking behaviors can yield reinforcement both on a social level (acceptance within a peer group) and, as Bernstein cites, "Studies of neural processing show that risk-taking may be associated with reward-related brain activation."

dietitian

- plans nutritious meals for all patients - consults with patients with specific eating disorders

Client/Family Education - management of the illness - medication management

- possible adverse effect - length of time to take effect - what to expect from the medication

Schizoid personality disorder - predisposing factors

- possible hereditary factor - The development of schizoid personality is probably influenced by early interactional patterns that the person found to be cold and unsatisfying. The childhoods of these individuals have often been characterized as bleak, cold, and notably lacking empathy and nurturing. A child brought up with this type of parenting may develop schizoid personality traits.

Predisposing factors - biological theories - genetic influences

- possible hereditary factor - genetic karyotype XYY has been implicated

Sexual assault - the majority of rapes are?

- premeditated, and some behavioral characteristics that have been identified as associated with premeditation include the perpetrator seeking out a victim who appears to be vulnerable (capable of being overpowered or in an opportunistic position such as being alone or isolated from others); alcohol and drugs such as Rohypnol (flunitrazepam) may serve the purpose of increasing victim vulnerability. - The perpetrator may also violate or ignore others' rights in a way that gives them information about whether a potential victim is passive or tolerant of those behaviors. - But again, while these behaviors might be observed more commonly, they do not clearly define the complete profile of these perpetrators. - A feminist view suggests that rape is most common in societies that encourage aggressiveness in males, that have distinct gender roles, and in which men regard women's roles as inferior. - In 80% of the cases of rape and sexual assault, the victim knew the offender and 1 in 10 rapes involved the use of a weapon.

Informed consent

- preservation and protection of an individual's right to decide whether to accept or reject treatment - There are instances when treatment may be performed without obtaining informed consent, but in most cases, a nurse must ensure that the three major elements of informed consent are addressed

Medical treatmnet modalities - NCD for treating cognitive impairment

- primary consideration is given to etiology, with focus on identification and resolution of potentially reversible processes. - Physostigmine (Antilirium) - Donepezil (Aricept) - Rivastigmine (Exelon) - Galantamine (Razadyne) - Memantine (Namenda) For treating cognitive impairment, the cholinesterase inhibitor physostigmine (Antilirium) has been shown to enhance functioning in individuals with mild-to-moderate A D). Other cholinesterase inhibitors are also being used for treatment of mild to moderate cognitive impairment in A D and have demonstrated efficacy in treating patients with Lewy body dementia. The U.S. Food and Drug Administration (F D A) approved another medication, an N-methyl-D-aspartate (N M D A) receptor antagonist, in 2003. The medication, memantine (Namenda), was approved for the treatment of moderate to severe A D. Memantine has shown in clinical trials to be effective in improving cognitive function and the ability to perform A DLs in patients with moderate to severe A D.

Frontal Lobe

- problem solving - emotional traits - reasoning(judgement) - speaking - voluntary motor activity

Transcranial magnetic stimulation

- procedure used to treat depression by stimulating nerve cells in the brain. - TMS involves the use of very short pulses of magnetic energy to stimulate nerve cells at localized areas in the cerebral cortex, similar to the electrical activity observed with ECT - Unlike ECT, the electrical waves generated by TMS do not result in generalized seizure activity - It is noninvasive and considered generally safe.

tardive dyskinesia

- protrusion and rolling of the tongue - sucking and smacking movements of lips - chewing motion - facial dyskinesia - involuntary movements of the body and extremities

Imbalanced nutrition: less than body requirements/insomnia interventions

- provide client with high-protein, high-calorie foods - monitor sleep patterns - maintain an accurate record of intake, output, and calorie count

Psychiatric nurse function in group therapy

- provides ongoing assessment of client condition, both mentally and physically - manages the therapeutic milieu on a 24-hour basis - administers medications - assists patients with all therapeutic activities as required - focus is on one-to-one relationship development

Developmental implications: childhood and adolescence treatment strategies - family interventions

- psychoeducation about bipolar disorder - medication compliance - communication training - problem solving training

Anticonvulsants family and patient education

- refrain from discontinuing the drug abruptly - avoid using alcohol and OTC medications without approval from physician - contact provider if have suicidal ideation

Indications that the mourning process is resolved

- regaining of a sense of organization - pursuit of new interests and relationships - replacement of preoccupation with energy and resolve

Nursing diagnosis for schizophrenia - impaired home maintenance related to?

- regression - withdrawal - lack of knowledge or resources - impaired physical or cognitive functioning

Risk for violence: self-directed or other-directed interventions

- remove all dangerous objects from the environment - maintain calm attitude - if restraint is necessary, ensure that sufficient staff are available to assist

akathisia

- restlessness - trouble standing still - paces the floor - feet in constant motion, rocking back and forth

Opioid induced disorders - withdrawal signs

- restlessness, irritability, anxiety - insomnia - yawning - abdominal cramps, diarrhea, vomiting, dilated pupils, sweating, piloerection

How to destigmatize

- say mentally ill - use mental illness terms only when intending to discuss diagnosed mental illness - say sad or nervous instead of actual mental illnesses or symptoms - only use this terminology if you are truly struggling. avoid using suicide as colloquial language - regard mental health resources as positive and useful - understand and respect psychological medications as beneficial and necessary to some

Predisposing factors of trauma-related disorders - psychosocial theory

- seeks to explain why some individuals exposed to massive trauma develop PTSD while others do not - variables include characteristics that relate to the traumatic experience, the individual, and the recovery environment

Traume-related disorders treatment - pharmacology

- selective serotonin reuptake inhibitors are now considered the first-line treatment of choice for PTSD because of their efficacy, tolerability, and safety ratings. - Paroxetine and sertraline have been approved by the FDA for this purpose. - The tricyclic antidepressants amitriptyline(Elavil) and imipramine(Tofranil have been supported by several well-controlled studies. - MAO inhibitors (for example, phenelzine) and trazodone have also been effective in the treatment of P T S D. - Alprazolam has been prescribed for P T S D clients for its antidepressant and antipanic effects. - Other benzodiazepines have also been used, despite the absence of controlled studies demonstrating their efficacy in P T S D. - Buspirone, which has serotonergic properties similar to the S S R I's, may also be useful. - Further controlled trials with this drug are needed to validate its efficacy in treating P T S D. - The beta blocker propranolol and alpha2-receptor agonist clonidine have been successful in alleviating some of the symptoms associated with P T S D. - Carbamazepine, valproic acid, and lithium carbonate have been reported to alleviate symptoms of intrusive recollections, flashbacks, nightmares, impulsivity, irritability, and violent behavior in P T S D clients.

Alzheimers Disease - stage six

- severe cognitive decline - At this stage, individuals may be unable to recall the name of their spouse or may misidentify people (e.g., thinking a child is their spouse). - Disorientation to surroundings is common, and the person may be unable to recall the day, season, or year. - The person is unable to manage A D L's without assistance. - Delusions often become apparent, such as maintaining the belief that one must go to work even though they are no longer employed. - Urinary and fecal incontinence are common. - Sleeping becomes a problem. - Psychomotor symptoms include wandering, obsessiveness, agitation, and aggression. - Symptoms seem to worsen in the late afternoon and evening—a phenomenon termed sundowning. - Communication becomes more difficult with increasing loss of language skills. - Institutional care is usually required at this stage.

Rape culture

- sexist attitudes - rape jokes - locker room banter - staling - unwanted non-sexual touch - catcalling - flashing and exposuing - unsolicitied nude pocs - groping - non-consensual photo or video - revenge porn - safe word violations - threats - victim blaming and shaming - coercion/manipulation - contraceptive sabotage - stalthing - molestation - drugging - rape

Hospitalization commitment - involuntary commitments - emergency commitment

- should be sought when an individual displays behavior that is clearly dangerous to themselves or others - These commitments are time-limited, and a court hearing must be scheduled to decide if the patient should be discharged or if additional hospitalization is necessary.

CPCs

- should be used by the entire interdisciplinary team - The team decides what categories of care are to be performed, by what date, and by whom - The nurse, as case manager, is ultimately responsible for ensuring that each of the assignments is carried out. - C P C's can be standardized, as they are intended to be used with uncomplicated cases - A C P C can be viewed as protocol for various clients with problems for which a designated outcome can be predicted.

Neurocognitive disorder progression - middle stages

- signs and symptoms become clearer and more restricting. - increased forgetfulness of recent events and names, lost in familar places - difficulty with communication(speech and comprehension) - increased assistance with living safely at home(unable to cook, clean, shop) - increased assistance with personal care(dressing, washing, toileting) - behavioral changes: wandering, repeated questioning, vocalizing, disturbed sleep, hallucinations, disinhibition, aggresssion

SIGECAPS pneumonic for depression

- sleep changes - interest lost - guilt(worthlessness) - energy loss(fatigue) - cognition/concentration difficulties - appetitie loss and/or weight loss - psychomotor(agitation) - suicidal ideations

Other special concerns of elderly people

- social implications - economic implications

Functions of a group

- socialization - support - task completion - camaraderie - information sharing - normative influence - empowerment - governance

Antipsychotics client and family education - report the following symptoms to physician:

- sore throat, fever, malaise, unusual bleeding, easy bruising, skin rash, persistant n/v - severe headache, rapid HR, difficulty urinating or excessive urination, muscle twitching, tremors - darkly colored urine; pale stools - yellow skin or eyes - excessive thirst or hunger - muscular incoordination or weakness

Drugs that can cause substance and medication induced bipolar disorder

- steroids, muscle relaxants, antiparkinson agents, cardiac medications - alcohol, amphetamines, cocaine, hallucinogens, inhalants, opioids, sedatives, hypnotics, anxiolytics

pseudoparkinsonism

- stooped posture - shuffling gait - rigidity - bardykinesia - tremors at rest - pill rolling motion

11 Ways to build self-esteem and increase your confidence

- stop criticizing yourself - think positive - put yourself first - identify what you need and want - look for the good - take risks - quit focusing on your weaknesses - do not forget your right - practice saying no - do the things you enjoy - stop comparing yourself to others

Predisposing factors - separation anxiety disorder - environmental influences

- stressful life events

predisposing factors - environmenal influences

- stressful life events may be associated with exacerbation of schizophrenic symptoms and increased rates of relapse - studies of genetic vulnerability for schizophrenia have linked certain genes to increased risk for psychosis and particularly for adolescents who use cannabinoids

Adjustment disorders outcomes

- stressors(internal or external demands) - appraisals - coping resources(personal attributes, stable environment attributes) - coping responses(emotion or problem focused coping) - long term outcomes(physical health, mental health, life satisfaction) - short term outcomes(relaxation and mood)

Reversible neurocognitive disorder - can occur as a result of:

- stroke - depression - side effects of medications - nutritional deficiencies - metabolic disorders Reversible N C D can occur as a result of cerebral lesions, depression, side effects of certain medications, normal pressure hydrocephalus, vitamin or nutritional deficiencies (especially B12 or folate), central nervous system infections, thyroid disorders, and metabolic disorders. In most patients, N C D runs a progressive, irreversible course.

Risk factors for suicide - occupation

- suicide rates are higher for males employed in farming, fishing, and forestry; construction and extraction; and installation, maintenance, and repair - females, those at highest risk are employed in protective services, legal, and healthcare practice, or are technical workers

Phase 4 - residual phase

- symptoms similar to those of the prodromal phase - flat affect and impairment in role funcitoning are prominent(negative symptoms) - when positive symptoms resolve, negative symptoms can remain - more active psychotic episodes, the more impairment you will see in this phase - symptoms are either resolved or manageable

Client/family education - lithium carbonate

- take the medication reguarly - do not skimp on dietary sodium - drink 6-8 glasses of water each day(lithium can get toxic if you are dehydrated) - notify physician if vomiting or diarrhea occur - have serum lithium level checked every 1-2 months, or as advised by physician - therapeutic range is 0.6-1.2(narrow therapeutic index)

Nine ways you can reduce stigma

- talk openly about mental health - educate yourself and others about mental health - be conscious of your language - encourage equality in how people percieve physical illness and mental illness - show empathy and compassion for those living with a mental health condition - stop the criminalization of those who live with mental illness - push back against the way people who live with mental illness are portrayed in the media - see the person, not the illness - advocate for mental health reform

Client/Family Education - management of the illness - stress management

- teach ways to interrupt escalating anxiety - teach relaxation techniques

Treatment - the recovery model

- the concept of healing and transforamtion enabling a person with mental illness to live a meaningful life in the community while striving to achieve his or her full potential - research provides support for recovery as an obtainable objective for individuals with schizophrenia

Insight

- the extent to which the person recognises and appriases their experiences - do they have insight into their symptoms, disgnosis and the need for further treatment? - what is their judgement on the problem? - are they willing to work with the healthcare professional to recover? - assess the indivduals problem-solving ability - consider whether the patient is aware of any potential treatments and if they are accepting that the problem may be a reuslt of mental illness

Predisposing factors to depression - HPA axis

- the interaction between the hypothalamus, pituitary gland, and adrenal glands; it plays an important role in the stress response - responsible for the neuroendocrine adaptation component of the stress response - the major pathway of the axis results in the production and secretion of cortisol

Adapting to levels of anziety - at the mild to moderate level?

- the strength of the ego is tested. - Ego defense mechanisms are employed for protection(denial, isolation, projection)

Statutory rape

- unlawful intercourse between a person who is over the age of consent and a person who is under the age of consent. - The legal age of consent varies from state to state, ranging from age 14 to 18.

Child abuse - emotional neglect

- unmet emotional needs of the child, even if their physical needs are being met. it is the opposite of emotional abuse - emotional reglect refers to a chronic failure by the parent or caretaker to provide the child with the hope, love, and support necessary for the development of a sound, healthy personality

art therapist

- uses patients creative abilities to encourage expression of emotions and feelings through artwork - helps patients to analyze their own work in an effort to recognize and resolve underlying conflict

recreational therapist

- uses recreational activities to promote patients to redirect their thinking or to rechannel destructive energy in an appropriate manner - patients learn skills that can be used during leisure time and during times of stress following discharge from treatment

A mjaor exception to the above laws?

"duty to warn." - this is the rule that a mental health professional has a duty not only to their client, but also to individuals who are being threatened by that client. - Most states now recognize that therapists have legal obligations to prevent their clients from harming themselves or others. - Another exception to these laws is in cases of suspected child or elder abuse - Every state requires that healthcare professionals report suspicion of child abuse to legal authorities, and many have similar statutes regarding elder abuse.

Client/Family Education related to antidepressants - avoid foods and medications high in tyramine when taking MAOIs, these include:

- Aged cheese - Wine; beer - Chocolate; colas - Coffee; tea - Sour cream; yogurt - Smoked and processed meats - Beef or chicken liver - Canned figs - caviar - raisins - pickled herring - yeast products - broad beans - soy sauce - cold remedies - diet pills HYPERTENSIVE CRISIS

Psychopharmacological interventions of ASD - targeted for the following symptoms

- Aggression - Deliberate self-injury - Temper tantrums - Quickly changing moods - Dose based on child's weight and response

Physical responses to stress - Selye's general adaptation syndrome has three distincy stages:

- Alarm reaction stage - Stage of resistance - Stage of exhaustion

Classes of psychoactive substances

- Alcohol - Caffeine - Cannabis - Hallucinogens - Inhalants - Opioids - Sedatives/hypnotics - Stimulants - Tobacco

Neurocognitive disorders due to AD - predisposing factors - plaques and tangles

- An overabundance of structures called plaques and tangles appear in the brains of individuals with A D. - It is thought that the plaques and tangles contribute to the destruction and death of neurons, leading to memory failure, personality changes, inability to carry out A D L's, and other features of the disease.

projection (defense mechanism)

- Attributing feelings or impulses unacceptable to ones self to another person. EX: Sue feels a strong sexual attraction to her track coach and tells her friend, "Hes coming on to me!"

Pharmacogenomics and depression

- Between 30 and 50% of patients do not respond to first antidepressant prescription. - A study is needed to identify benefits of routine testing, cost effectiveness, and ability to provide timely results - Genotyping has also demonstrated benefits in identifying which individuals may be more prone to certain side effects

Delirium

- Characterized by a disturbance in level of awareness and a change in cognition - Develops rapidly over a short period - Delirium is a mental state characterized by an acute disturbance of cognition, which is manifested by short-term confusion, excitement, disorientation, and a clouding of consciousness. Hallucinations and illusions are common.

Borderline Personality Disorder - Psychosocial influences

- Childhood trauma and abuse - Developmental factors (Mahler's Theory of Object Relations): The child fails to achieve task of autonomy between 16- 24 months of age.

Physical conditions that influence group dynamics - membership: close-ended groups

- Closed-ended groups usually have a predetermined, fixed timeframe - All members join at the time the group is organized and terminate at the end of the designated time period - Closed-ended groups are often composed of individuals with common issues or problems they wish to address.

Attention Deficit/Hyperactivity Disorder - categorized by clinical presentation

- Combined type (meeting the criteria for both inattention and hyperactivity/impulsivity) - Predominantly inattentive presentation - Predominantly hyperactive/impulsive presentation

The impact of preexisting conditions - culture and religion

- Cultural mores, norms, ideas, and customs provide the basis for our way of thinking. Cultural values are learned and differ from society to society. - Religion also can influence communication. - Symbolic gestures, such as wearing a cross around the neck or hanging a crucifix on the wall, can communicate an individual's religious beliefs.

Nursing diagnosis for substance use disorder - deficient knowledge

- Deficient knowledge (effects of substance abuse on the body) related to denial of problems with substances evidenced by abuse of substances - Outcome: Verbalizes importance of abstaining from use of substances to maintain optimal wellness.

Planning and implementation - imbalanced nutrition/deficient fluid volume

- Determine appropriate calories to provide adequate nutrition and weight gain. - Do not focus on food and eating specifically. - Keep a strict record of intake and output. Imbalanced nutrition: less than body requirements is defined as "intake of nutrients insufficient to meet metabolic needs." Deficient fluid volume is defined as "decreased intravascular, interstitial, and/or intracellular fluid." Goals should include helping the client gain an established amount of weight per week, and eliminating signs or symptoms of malnutrition or dehydration. Interventions should include explaining the program of behavior modification, assessing vital signs and blood pressure to evaluate for bradycardia, and sitting with the client during mealtimes for support.

Dependent Personality Disorder - DARN HURT

- Disagreement is difficult to express - advice needs excessive input - responsibility for major areas delegated to others - nuturance - seeks excessive degree from others - helpless when alone - unrealistically preoccupied with being left to care for self - relationships are desperately sought(when an established one ends) - tasks(have difficulty initating projects) - Individuals with dependent personality disorder have a notable lack of self-confidence that is often apparent in their posture, voice, and mannerisms. They are typically passive and acquiescent to the desires of others.

Introduction - neurocognitive disorder

- Disorders in which a clinically significant deficit in cognition or memory exists, representing a significant change from a previous level of functioning. -

Predisposing factors: ADHD - psychosocial influences

- Disorganized or chaotic family environments - Maternal mental disorder or paternal criminality - Low socioeconomic status - Unstable foster care Disorganized or chaotic environments or a disruption in family equilibrium may contribute to A D H D. Galera et al identified several psychosocial influences associated with the development of A D H D, including non-intact family, young maternal age at birth of the target child, paternal history of antisocial behavior, and maternal depression.

Predisposing factors: ADHD - environmental influences

- Environmental lead - Dietary factors Studies continue to provide evidence of the adverse effects of elevated body levels of lead on cognitive and behavioral development. The government has placed tighter restrictions on the substance in recent years, making exposure to toxic levels less prevalent than it once was. The possible link between food dyes and additives, such as artificial flavorings and preservatives, and sugar was introduced in the mid-1970s. Studies on all of these possibilities have failed to confirm a clear link.

The role of a nurse in psychiatric and substance use disorders in nonpsychiatric settings includes the following:

- Examine one's personal beliefs and attitudes about clients with mental illness and substance use disorders. - Develop awareness of the negative impact of stigmatization. - Identify patients with potentially high-prevalence, high-risk mental health issues. - Utilize evidence-based screening tools to identify patients needing further evaluation or referral. - Provide for patient safety, up to and including continuous monitoring, while determinations are being made about referral needs. - Establish a working knowledge of available mental health services for referral and collaborate with the healthcare team to identify the most appropriate resources. - Engage the patient throughout the assessment and referral process using a patient-centered approach.

Peplaus four levels of anxiety - moderate anxiety

- Extent of the perceptual field diminishes - The individual becomes less alert to events occurring within the environment - Attention span and the ability to concentrate decrease, and assistance with problem-solving may be required - Increased muscular tension and restlessness - perceptual field begins to diminish

Postpartum depression symptoms

- Fatigue/Irritability - Loss of appetite - Sleep disturbances - Loss of libido - Concern about inability to care for infant

Warning signs that indicate that professional boundaries of the nurse-patient relationship may be in jeaopardy

- Favoring one patient's care over another's - Keeping secrets with a patient - Changing dress style when working with a particular patient - Swapping patient assignments to care for a particular patient - Giving special attention or treatment to one patient over others - Spending free time with a patient - Frequently thinking about the patient when away from work - Sharing personal information or work concerns with the patient - Receiving of gifts or continued contact and communication with the patient after discharge

Genetic Therapeutic Approaches: Separation Anxieyt Disorder - group therapy

- Group therapy provides children and adolescents with the opportunity to interact within an association of their peers. This can be both gratifying and overwhelming, depending on the child. - Group therapy provides a number of benefits. Appropriate social behavior often is learned from the positive and negative feedback of peers. Opportunity is provided to learn to tolerate and accept differences in others, to learn that it is acceptable to disagree, to learn to offer and receive support from others, and to practice these new skills in a safe environment. It is a way to learn from the experiences of others.

Psychodrama

- Group therapy that employs a dramatic approach - Clients become "actors" in life-situation scenarios.

Outcomes for eating disorders - the patient

- Has achieved and maintained at least 80% of expected body weight - Has vital signs, blood pressure, and laboratory serum studies within normal limits - Verbalizes importance of adequate nutrition - Verbalizes knowledge regarding consequences of fluid loss caused by self-induced vomiting (or laxative/diuretic abuse) and importance of adequate fluid intake - Verbalizes events that precipitate anxiety and demonstrates techniques for its reduction - Verbalizes ways in which he or she may gain more control of the environment and thereby reduce feelings of powerlessness - Expresses interest in welfare of others and less preoccupation with own appearance - Verbalizes that image of body as "fat" was misperception and demonstrates ability to take control of own life without resorting to maladaptive eating behaviors (anorexia nervosa) - Has established a healthy pattern of eating for weight control and weight loss toward a desired goal, and is progressing (B E D) - Verbalizes plans for future maintenance of weight control (B E D)

Outcomes for ADHD - the client

- Has experienced no physical harm - Interacts with others appropriately - Verbalizes positive aspects about self - Demonstrates fewer demanding behaviors - Cooperates with staff in an effort to complete assigned tasks

Legal issues in mental health nursing - confidentiality and right to privacy

- Health Insurance Portability and Accountability Act (H I P A A) - Doctrine of privileged communication - Exceptions: A duty to warn; suspected child or elder abuse

Predisposing factors associated with somatic symptom disorders - genetic

- Hereditary factors are possibly associated with somatic symptom disorder, conversion disorder, and illness anxiety disorder. - Studies have shown an increased incidence of somatic symptom disorder, conversion disorder, and illness anxiety disorder in first-degree relatives, implying a possible inheritable predisposition, and in somatic symptom disorder there is evidence of genetic overlap with some other mental disorders, including eating disorders.

How to identify an impaired nurse

- High absenteeism may be present if the person's source is outside the work area. - Or, the person may rarely miss work if the substance source is at work. - Increase in "wasting" of drugs, higher incidences of incorrect narcotic counts, and a higher record of signing out drugs for other nurses may be present. - Poor concentration, difficulty meeting deadlines, inappropriate responses, and poor memory or recall - Problems with relationships - Irritability, tendency to isolate, elaborate excuses for behavior - Unkempt appearance, impaired motor coordination, slurred speech, flushed face - Patient complaints of inadequate pain control, discrepancies in documentation

Predisposing factors associated with somatic symptom disorders - psychodynamic theory

- Illness associated with anxiety disorder is an ego defense mechanism. Physical complaints are the expression of low self-esteem and feelings of worthlessness. - Conversion disorder may represent emotions associated with a traumatic event that are too unacceptable to express and so, are acceptably "converted" into physical symptoms. - The "sick" and the "caretaker" role

Nursing diagnosis for substance use disorder - imbalanced nutrition

- Imbalanced nutrition less than body requirements. / Fluid volume deficit related to drinking or taking drugs instead of eating. - Outcome: Client will be free from signs or symptoms of malnutrition/dehydration.

Epidemiolgoical statistics related to aging

- In 1980, Americans 65 years of age or older numbered 25.5 million. - By 2016, these numbers had increased to 49.2 million, and this number is expected to double by 2060 to 98 million - In 2015, that number represented 15.2% of the population, and it is projected that by 2040 the number of - Americans over 65 will reach 21.7% of the population. - In 2016, of individuals age 65 and older, 70% of men and 46% of women were married (AoA, 2018). - Thirty-three percent of all women in this age group were widowed. - There were more than three times as many widows as widowers, which is consistent with the longer life expectancy for women.

Role of the nurse in milieu therapy - nurses are also responsible for medication administration:

- In some treatment programs, clients are expected to accept the responsibility and request their medication at the appropriate time - Although ultimate responsibility lies with the nurse, he or she must encourage clients to be self-reliant.

Predisposing factors to intellectual developmental disorder - genetic factors

- Inborn errors of metabolism - Chromosomal disorders - Single gene abnormalities Genetic factors are implicated as the cause of intellectual disability in approximately 5% of the cases. These factors include inborn errors of metabolism, such as Tay-Sachs disease, phenylketonuria, and hyperglycinemia. Also included are chromosomal disorders, such as Down syndrome and Klinefelter's syndrome, and single-gene abnormalities, such as fragile X syndrome, tuberous sclerosis, and neurofibromatosis.

Planning/Implementation - fear

- Include the client in making decisions. - Encourage the client to explore underlying feelings.

Severe depression

- Includes symptoms of major depressive disorder and bipolar depression - Affective: feelings of total despair, worthlessness, flat affect - Behavioral: psychomotor retardation, curled-up position, absence of communication - Cognitive: prevalent delusional thinking, with delusions of persecution and somatic delusions; confusion; suicidal thoughts - Physiological: a general slow-down of the entire body

Neurocognitive disorders due to AD - predisposing factors - head trauma

- Individuals who have a history of head trauma are at risk for A D. - Studies have shown that some individuals who had experienced head trauma had subsequently (after years) developed A D. - This hypothesis is being investigated as a possible cause.

binge eating disorder

- Individuals with binge eating disorders have episodes of binge eating that may be similar to those with bulimia nervosa; however, there is an absence of purging. - As a result, this client is at risk for substantial weight gain. - The episodes of eating are referred to as binges when they occur over a discreet period of time, usually defined as less than 2 hours. - usually considered obese

Clinical picture of schizotypal personality disorder

- Individuals with schizotypal personality disorder are aloof and isolated and behave in a bland and apathetic manner. - They often talk or gesture to themselves, as if "living in their own world." - Magical thinking, ideas of reference, illusions, and depersonalization are common. - Examples include superstitiousness, belief in clairvoyance, telepathy, or "sixth sense," and beliefs that "others can feel my feelings." - Speech patterns are sometimes bizarre. - People with schizotypal disorder often cannot orient their thoughts logically and become lost in personal irrelevancies and in topics that are vague, digressive, and not pertinent to the topic at hand. - Under stress, these individuals may decompensate and demonstrate psychotic symptoms, such as delusional thoughts, hallucinations, or bizarre behaviors, but they are usually of brief duration.

Nursing diagnosis for substance use disorder - ineffective coping

- Ineffective Coping related to inadequate coping skills and weak ego - Outcome: Client will be able to demonstrate more adaptive coping mechanisms that can be used in stressful situations (instead of taking substances).

Feedback is useful when it?

- Is descriptive rather than evaluative - Is specific rather than general - Is directed toward behavior that the patient has the capacity to modify - Imparts information rather than offers advice - Is well-timed

Phases of group development - phase I. Initial or orientation phase

- Leader and members work together to establish rules and goals for the group. - Leader promotes trust and ensures that rules do not interfere with fulfillment of the goals. - Members are superficial and overly polite. Trust has not yet been established

Depression - low self-esteem related to?

- Learned helplessness - Feelings of abandonment by significant others - Impaired cognition fostering negative view of self

Predisposing factors to trauma-related disorders - biological aspects

- Neurobiological changes as a result of stress - Disregulation of the opioid, glutamatergic, noradrenergic, serotonergic, and neuroendocrine pathways may also be involved in the pathophysiology of P T S D. - Like other mental disorders, most likely a combination of biological, social, and psychological factors

Functions of a group - support

- One's fellow group members are available in times of need - Individuals derive a feeling of security from group involvement.

sublimation (defense mechanism)

- Rechanneling of drives or impulses that are personally or socially unacceptable into activities that are constructive. EX: Mom of son killed by drunk driver, president of MADD.

Regression (defense mechanism)

- Responding to stress by retreating to an earlier level of development and the comfort measures associated with that level of functioning. EX: When 2 year old Jay is hospitalized for tonsillitis he will drink only from a bottle, although his mother states he has been drinking from a cup for over 6 months.

Client/Family education - support services

- Suicide hotline - Support groups - Legal/financial assistance

Undoing: Defense Mechanism

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

Alcohol use disorder - phase IV

- The Chronic Phase - This phase is characterized by emotional and physical disintegration. Emotional disintegration is evidenced by profound helplessness and self-pity. Impairment may result in psychosis. Life-threatening physical manifestations may be evident in virtually every system of the body. Unmanaged withdrawal from alcohol results in a terrifying syndrome of symptoms that include hallucinations, tremors, convulsions, severe agitation, and panic. Depression and ideas of suicide are not uncommon. For long-term, heavy drinkers, abrupt withdrawal of alcohol can be fatal.

Treating codependence - stage III

- The Core Issues Stage - In this stage, the recovering codependent must face the fact that relationships cannot be managed by force of will. - Each partner must be independent and autonomous - The goal of this stage is to detach from the struggles of life that exist because of prideful and willful efforts to control those things that are beyond the individual's power to control.

Treating codependence - stage IV

- The Reintegration Stage - This is a stage of self-acceptance and willingness to change when codependents relinquish the power over others that was not rightfully theirs, but reclaim the personal power that they do possess.

Functions of a group - socialization

- The cultural group into which we are born begins the process of teaching social norms - This is continued throughout our lives by members of other groups with which we become affiliated.

Assessment: IDD

- The degree of severity of intellectual disability may be measured by the client's IQ level. - Four levels have been delineated: mild, moderate, severe, and profound. - The levels are differentiated between the ability of the child to perform self-care, cognitive and educational abilities, social and communication capabilities, and psychomotor capabilities. - Specific behavioral manifestations and abilities associated with each of these four levels of severity

Hypothalamus and eating disorders

- The hypothalamus contains the appetite regulation center within the brain. - It regulates the body's ability to recognize when it is hungry, when it is not hungry, and when it has been sated.

Why nursing diagnosis?

- The identification and classification of nursing phenomena began in 1973 with the First National Conference on Nursing Diagnosis. - General and specialty standards are written around the six steps of the nursing process. - It is defined in most state nursing practice acts as a legal responsibility of nursing. - The use of nursing diagnosis affords a degree of autonomy that historically has been lacking in the practice of nursing. Nursing diagnosis describes the client's condition, facilitating the prescription of interventions and the establishment of parameters for outcome criteria based on what is uniquely nursing. - Promotes research in nursing.

Peplaus four levels of anxiety - panic anxiety

- The individual is unable to focus on even one detail within the environment. - Misperceptions are common, and a loss of contact with reality may occur. - Hallucinations or delusions may be present - Behavior may be characterized by wild and desperate actions or extreme withdrawal - Human functioning and communication with others are ineffective - The individual may be convinced they have a life-threatening illness or fear they are "going crazy," are losing control, or are emotionally weak - Prolonged panic anxiety can lead to physical and emotional exhaustion and can be life-threatening - the most intense state

Risk factors - marital status

- The suicide rate for single persons is twice that of married persons - The suicide rate for single, never married persons is twice that of married persons, and divorce increases risk for suicide particularly among men, who are three times more likely to take their own lives than divorced women - Widows and widowers are also at high risk

Adjustment disorders predisposing factors - transactional model of stress/adaptation

- The transactional model takes into consideration the interaction between the individual and the environment. - The type of stressor that one experiences may influence one's adaptation. - Sudden-shock stressors occur without warning, and continuous stressors are those that an individual is exposed to over an extended period. - Although many studies have been directed to individuals' responses to sudden-shock stressors, it has been found that continuous stressors were more commonly cited than sudden-shock stressors as precipitants to maladaptive functioning. - Both situational and intrapersonal factors most likely contribute to an individual's stress response. = Situational factors include personal and general economic conditions; occupational and recreational opportunities; and the availability of social supports such as family, friends, neighbors, and cultural or religious support groups. - Other intrapersonal factors that might influence one's ability to adjust to a painful life change include social skills, coping strategies, the presence of psychiatric illness, degree of flexibility, and level of intelligence.

displacement (defense mechanism)

- The transfer of feelings from one target to another that is considered less threatening or that is neutral. EX: A client is angry at his doctor, does not express it, but becomes verbally abusive with the nurse.

Leadership styles - Laissez-faire

- There is no focus in this type of leadership. - Goals are undefined, and members do as they please. - Productivity and morale are low.

Theories of aging - personality theory

- These theories address aspects of psychological growth without delineating specific tasks or expectations of older adults. - Some evidence suggests that personality characteristics in old age are highly correlated with early life characteristics. - As the population of older adults continues to grow, research has focused not only on what constitutes aging, but more specifically, what constitutes successful aging. - The research of Kern and Friedman has identified the personality trait of conscientiousness as most linked to health promoting behaviors.

Client/Family Education - nature of the illness

- What is anxiety? - To what might it be related? - What is O C D? - What is body dysmorphic disorder? - What is trichotillomania? - Symptoms of anxiety, O C D, and related disorders

Mental Health - Concepts identified by Maslow

- a "hierarchy of needs" - self-actualization as fulfillmnet of one's highest potential

Hospitalization commitment - involuntary commitments - A gravely disabled client

- a guardian, conservator, or committee will be appointed by the court to ensure the management of the person - condition in which an individual, as a result of mental illness, is in danger of serious physical harm resulting from inability to provide for basic needs.

Negative symptoms of schizophrenia

- absence of healthy behaviors - lack of emotional expression(affect) - apathy - avolition - asocial - anosognosia - anergia - anhedonia - abstract thinking lost

Types of lawsuits that occur in psychiatric nursing - assault and battery

- act that results in genuine fear that he or she will be touched without consent. - Battery is the unconsented touching of another person. - Harm or injury does not have to occur for these charges to be legitimate.

individual(personal) roles examples

- aggressor - blocker - dominator - help-seeker - monopolizer - mute or silent member - recognition seeker - seducer

Unhelpful thinking styles

- all or nothing thinking - mental filter - jumping to conclusions - emotional reasoning - labelling - over-generalizing(everything is always rubbish, nothing good ever happens) - disqualifying the positive - magnification(catastrophising) and minimisation - personalisation(this is my fault) - using words should, must, or ought

8 hours without alcohol

- anger - anxiety - fatigue - loss of appetitie - abdominal pain - vomiting - insomnia - nausea - depression - heart - palpitations - foggy brain - tremors - mood swings

Antipsychotic side effects

- anticholinergic side effects - nausea - GI upset - skin rash - sedation - orhtostatic hypotension - photosensitivity - hormonal effects - electrocardiogram changes - hypersalivation - weight gain - hyperglycemia/diabetes - increased risk of mortality in elderly clients with dementia - reduction in seizure threshold - agranulocytosis - EPS - tardive dyskinesia - neuroletpic malignant syndrome

There are two primary psycholgical response patterns to stress:

- anxiety and grief - A variety of thoughts, feelings, and behaviors are associated with each of these response patterns and may vary depending on the individual

Antianxiety agents are used in the treatment of?

- anxiety disorders - anxiety symptoms - acute alcohol withdrawal - skeletal muscle spasms - convulsive disorders - status epilepticus - preoperative sedation

Epidemiological statistics for anxiety

- anxiety disorders are the most common of all psychiatric illness - more common in women than in men- a familial predisposition probably exists - commonly seen with depression and substance abuse

Brain Stem

- breathing - body temperature - digestion - alertness/sleep - swallowing

Clinical psychologist function in group therapy

- conducts individual, group, and family therapy - administers, interprets, and evaluates psychological tests that assist in the diagnostic process

Psychiatric social worker

- conducts individual, group, and family therapy - is concerned with clients social needs, such as placement, financial support, and community requirements - conducts in-depth psychosocial history on which the needs assessment is based - works with patient and family to ensure that requirements for discharge are fulfilled and needs can be met by appropriate community resources

Client/Family education - support services

- crisis hotline - support groups - individual psychotherapy

Signs of emotional neglect

- difficulty in expressing emotions - blaming themselves for everything - wants to be independent - lack of compassion for themselves - narcissistic, perfectionists, authoritarians, permissive parents tend to emotionally neglect their children

Other positive symptoms

- disorganized thought process - associative loooseness(loose association/derailment): shjfit of ideas from one unrelated topic to another

Alchol - Profile of the substance

- ethyl alcohol(ETOH) - CNS depressant - metabolized by the liver

Anticholinergic side effects

- hot - dry - red - blind - mad

Parietal lobe

- knowing right from left - sensation - reading - body orientation

Ego-defense mechanisms

- natural and normal - When they get out of proportion (i.e., used with frequency), neuroses develop, such as anxiety states, phobias, obsessions, or hysteria.

Self-disclosure

- on the part of the nurse may be appropriate when it is judged that the information may therapeutically benefit the patient - It should never be undertaken for the purpose of meeting the nurse's needs.

Nursing diagnosis for schizophrenia - impaired veral communication related to:

- panic anxiety - regression - withdrawal - disordered unrealistic thinking

Antipsychotics - extrapyramidal symptoms

- pseudoparkinsonism - akinesia - akathisia - dystonia - oculogyric crisis

Professional boundary concerns commonly include issues such as?

- self-disclosure - gift-giving - touch - friendship or romantic association

Where does schizophrenia come from

- skhizo(split) - phren(mind)

Anticonvulsants family and patient education - report the following symptoms to the physcian immediately

- skin rash(stevens johnson syndrome) - unusual bleeding - spontaneous bruising - sore throat - fever - malaise - dark urine - yellow skin or eyes

predisposing factors - psychological factors

- these theories no longer hold credibility. Poor mother relationships, poor parent relationships do not cause it. Reseearchers now focus their studies of schizophrenia as a brain disorder - psychosocial theories probably developed early on out of a lack of information related to a biological connection

Schoizophrenia causes disturbances in:

- thought processes - perception(how we experience reality) - affect(emotion - happy affect but feel sad on the inside) - mood is internal feeling and affect is what other people see

Alzheimers Disease - stage seven

- very severe decline - In the end stages of A D, the individual is unable to recognize family members. - He or she most commonly is bedfast and aphasic. - Problems of immobility, such as decubiti and contractures, may occur.

malnutrition

20% below expected weight for height are recommended for inpatient treatment; 30% below expected weight for height are recommended for long-term intensive treatment (Sadock, et al, 2015)

The need for education of healthcare providers - clients with significant mental illness die?

25 years earlier than the general population. - 60% of those deaths are related to preventable or treatable causes.

Factors that increase your risk for developing an anxiety disorder - stress buildup

A big event or a buildup of smaller stressful life situations may trigger excessive anxiety — for example, a death in the family, work stress or ongoing worry about finances.

Define a group

A collection of individuals whose association is founded on shared commonalities of interest, values, norms, or purpose - Membership in a group is generally by chance, by choice, or by circumstance.

The standards of practice for psychiatric nursing are written around the six steps of the nursing process - Nursing Outcomes Classification(NOC)

A comprehensive, standardized classification of patient outcomes developed to evaluate the effects of nursing interventions. - outcomes lined to NANDA diagnoses and nursing interventions classification

Predisposing factors for schizophrenia - biological factors - genetics

A growing body of knowledge indicates that genetics plays an important role in the development of schizophrenia

Predisposing factors - theories of suicide - history of aggression and violence

A history of violent behavior or impulsive acts has been associated with increased risk for suicide, although recent evidence suggests that impulsive traits are higher in individuals with suicide ideation but are not necessarily associated with more attempts.

Inhalant-induced disorder - withdrawal

A mild withdrawal syndrome has been documented but does not appear to be clinically significant.

Predisposing factors to depression - physiological influences: medication side effects

A number of drugs, either alone or in combination with other medications, can produce a depressive syndrome. Most common among these drugs are those that have a direct effect on the central nervous system.

Anna Nicole Smith

A number of psychologists claim that Smith exhibited many of the symptoms of histrionic personality disorder. The public watched as she displayed excessive emotions, abused drugs, had promiscuous sex, and always had to be the center of attention.

Predisposing factors to trauma-related disorders - cognitive theory

A person is vulnerable to P T S D when fundamental beliefs are invalidated by experiencing trauma that cannot be comprehended and when a sense of helplessness and hopelessness prevail.

Values clarification

A process of self-exploration by which people identify and rank their own personal values - important process for nurses so that they may better understand why certain decisions should be made and how their own values may affect nursing outcomes

Right

A valid, legally recognized claim or entitlement, encompassing both freedom from government interference or discriminatory treatment and entitlement to a benefit or service

Treatment modalities for substance-related disorders - various support groups pattered after AA but for indivdiauls with problems with other substances

AA has been the model for various other self-help groups associated with addiction problems. Some of these groups and the memberships for which they are organized can be found in Table 14-11 in the text. Nurses need to be fully and accurately informed about available self-help groups and their importance as a treatment resource.

David Beckham

According to at least one source, the handsome and famous soccer star suffers from dependent personality disorder. While certainly not financially dependent on anyone, Beckham has shown excessive clinginess in his relationship, low self-esteem, inability to cope with certain situations by himself.

Repression (defense mechanism)

Banishes anxiety-arousing wishes and feelings from consciousness

Assessment of ASD - impairment in communication and imaginative activity

Both verbal and nonverbal skills are affected. In more severe levels of A S D, language may be totally absent or characterized by immature structure or idiosyncratic utterances whose meaning is clear only to those who are familiar with the child's past experiences. Nonverbal communication, such as facial expression or gestures, may be absent or socially inappropriate.

Child abuse

Children are vulnerable and relatively powerless, and the effects of maltreatment are infinitely deep and long-lasting. Child maltreatment typically includes physical or emotional injury, physical or emotional neglect, or sexual acts inflicted upon a child by a caregiver.

Factors that increase your risk for developing an anxiety disorder - trauma

Children who endured abuse or trauma or witnessed traumatic events are at higher risk of developing an anxiety disorder at some point in life. Adults who experience a traumatic event also can develop anxiety disorders.

Basic Assumptions of Milieu Therapy - each individual owns his or her own behavior

Each individual within the therapeutic community is expected to take responsibility for his or her own behavior.

Assessment of ASD - restricted activities interest

Even minor changes in the environment are often met with resistance or sometimes with agitated irritability. Attachment to, or extreme fascination with, objects that move or spin is common. Stereotyped body movements (hand-clapping, rocking, whole-body swaying) and verbalizations (repetition of words or phrases) are typical. Diet abnormalities may include eating only a few specific foods or consuming an excessive amount of fluids. Behaviors that are self-injurious, such as head banging or biting the hands or arms, may be evident.

Predisposing factors to dissociative disorders

Evidence points to the etiology of dissociative disorders as a response to traumatic experiences that overwhelm the individual's capacity to cope by any means other than dissociation. In DID, these experiences are most often physical, sexual, or psychological abuse by a parent or significant other in the child's life. Dissociative amnesia is frequently related to acute and extreme trauma but may also develop in the clinical presentation of DID. Dissociative amnesia is also often noted in response to combat trauma during wartimes.

Social anxiety disorder(social phobia)

Excessive fear of situations in which the affected person might do something embarrassing or be evaluated negatively by others

The standards of practice for psychiatric nursing are written around the six steps of the nursing process - Outcome Identification

Expected outcomes of care are identified. They must be measurable and estimate a time for attainment.

Nontherapeutic Communication Techniques - agreeing or disagreeing

Implies that the nurse has the right to pass judgment on whether the patient's ideas or opinions are "right" or "wrong"

Therapeutic factors of groups - altruism

Individuals provide assistance and support to each other, thereby helping to create a positive self-image and promote self-growth.

Member roles - maintenance roles

Maintaining or enhancing group processes

Orienter

Maintains direction within the group

Illusions

Misperceptions of real external stimuli - lights are brighter, colors are brigher

Role of the nurse in milieu therapy - nurses are also responsible for development of a one to one relationship:

Nurses must also establish a foundation for trust and for maintaining a therapeutic milieu in orienting the new client to the environment, to their rights and responsibilities within the unit milieu, to the structured activities designed for their personal growth, and to any limits or restrictions necessary to maintain safety.

Values

Personal beliefs about what is important and desirable

The need for education of healthcare providers - diagnostic overshadowing

Phenomenon in which a person's physical symptoms are attributed to their mental illness

Classifications within statutory and common law - criminal law

Provides protection from conduct deemed injurious to the public welfare

Physical Responses to Stress - Biological responses associated with fight or flight syndrome - sustained response

Sustained physical responses to stress occur after a prolonged period of stress and promote susceptibility to many diseases of adaptation. - Increased gluconeogenesis and retention of sodium and water (ACTH) - Decreased immune and inflammatory responses (ACTH) - Fluid retention (vasopressin) - Increased blood pressure (vasopressin) - Increased serum glucose and free fatty acids (growth hormone) - Increased basal metabolic rate (thyrotropic hormone) - Impotence and decreased libido (gonadotropins)

Mental illness - incomprehensibility

The inability of the general population to understand the motivation behind the behavior

Personality disorder

The most common symptoms occurring in personality disorders are impairment in interpersonal relationship functions (41%), dysfunctions in cognition (30%), affect (18%), and impulse control (6%). Virtually all individuals exhibit some behaviors associated with the various personality disorders from time to time, but it is only when significant functional impairment occurs in response to these characteristics that the individual is thought to have a personality disorder.

Adjustment disorder - with mixed disturbance of emotions and conduct

The predominant features of this category include emotional, as well as conduct, disturbances in which there is violation of the rights of others or of major age-appropriate societal norms and rules.

Types of groups - Supportive/therapeutic groups

The primary concern is to prevent possible future upsets by teaching the participants effective ways of dealing with emotional stress arising from situational or developmental crises

Epidemiology of depression - social class

There is an inverse relationship between social class and the report of depressive symptoms.

Nontherapeutic Communication Techniques - Making stereotyped comments, clichés, and trite expression

These are meaningless in a nurse-patient relationship

Adjustment disorders - with anxiety

This category denotes a maladaptive response to a stressor in which the predominant manifestation is anxiety. The clinician must differentiate this diagnosis from those of anxiety disorders.

Adjustment disorder - with disturbance of conduct

This category is characterized by conduct in which there is violation of the rights of others or of major age-appropriate societal norms and rules. Differential diagnosis must be made from conduct disorder or antisocial personality disorder.

Adjustment disorders - with depressed mood

This category is the most commonly diagnosed adjustment disorder. The clinical presentation is one of predominant mood disturbance, although less pronounced than that of major depressive disorder (MDD). The symptoms, such as depressed mood, tearfulness, and feelings of hopelessness, exceed what is an expected or normative response to an identified stressor.

Adjustment disorder - unspecified

This subtype is used when the maladaptive reaction is not consistent with any of the other categories. The individual may have physical complaints, withdraw from relationships, or exhibit impaired work or academic performance, but without significant disturbance in emotions or conduct.

Treatment modalities - electroconvulsive therapy MOA

Thought to increase levels of biogenic amines - induction of a grand mal seizure through the application of electrical current to the brain and is effective with clients who are acutely suicidal and in the treatment of severe depression, particularly in those clients who are also experiencing psychotic symptoms and those with psychomotor retardation and neurovegetative changes. It should be considered for treatment only after a trial of therapy with antidepressant medication has proved ineffective.

Effects of alcohol on the body - alcoholic myopathy

Thought to result from same B vitamin deficiency that contributes to peripheral neuropathy

Therapeutic factors of groups - development of socializing techniques

Through interaction with, and feedback from, other members of the group, individuals are able to correct maladaptive social behaviors and learn and develop new social skills

hypotension

a pattern of low blood pressure or orthostatic hypotension (a 20mm Hg or greater drop in systolic blood pressure with positional changes and a pulse rate increase of 20 or more beats)

Child abuse - Emotional abuse

a pattern or behavior on the part of the parent or caretaker that results in serious impairment of the child's social, emotional, or intellectual functioning

Treatment - recovery after an initial schizophrenia episode(RAISE)

a program of case management that takes a team apprach in providing comprehensive, community-based psychiatric treatment, rehabilitation, and support to persons with serious and persistent mental illness

Treatment - program of assertive community treatment

a program of case management that takes a team approach in providing comprehensive, community-based psychiatric treatment, rehabilitation, and support to persons with serious and persistent mental illness

rape

a type of sexual assault, occurs over a broad spectrum of experiences, ranging from the surprise attack by a stranger to insistence on sexual intercourse by an acquaintance or spouse. - rape is an act of aggression, not passion - it is the expression of power and dominance by means of sexual violence, most commonly by men over women, although men may also be rape victims

Adolescence - best clue that differentiates depression from normal stormy adolescent behavior

a visible manifestation of behavorial change that lasts for several weeks

Ethical principles - advocacy

acting on another's behalf, either by being a supporter or defender.

Motivational Interviewing incorporates?

active listening and therapeutic communication techniques but focuses on what the patient wants to do

Individuals who have difficulties with stress reactions to more "normal" events may be diagnosed with?

adjustment disorder - adjustment disorder are quite common and can occur at any age

Resolution of the grief response is thought to occur when?

an individual can look back on the relationship with the lost entity and accept both the pleasures and the disappointments of the association

Nursing diagnosis for bipolar disorder - disturbed thought processes related to?

biochemical alterations in the brain, evidenced by delusions of grandeur and persecution, as well as inaccurate interpretation of the environment

Generalized anxiety disorder

characterized by persistent, unrealistic, and excessive anxiety and worry, which have occurred more days than not for at least 6 months, and cannot be attributed to specific organic factors, such as caffeine intoxication or hyperthyroidism. The anxiety and worry are associated with muscle tension, restlessness, or feeling keyed up or on edge.

Positive symptoms of disorganized thought process - circumstantiality

delay in reaching the point of a communication but of unecessary and tedious details - talk in circles, excessive detail, lots of words, talking before every reaching the point

3+ days without alcohol

delerium

False imprisonment

deliberate and unauthorized confinement of a person within fixed limits by the use of verbal or physical means. - Healthcare workers may be charged with false imprisonment for restraining or secluding—against the wishes of the client—anyone having been admitted to the hospital voluntarily.

Alcohol intoxication

disinhibition of sexual or aggressive impulses, mood lability, impaired judgment, impaired social or occupational functioning, slurred speech, incoordination, unsteady gait, nystagmus, and flushed face. - occurs at blood alcohol levels between 100 and 200 milligrams per deciliter

MOA of typical antipsychotics

dopaminergic blockers with various affinity for chilinergic, a-adrenergic, and histaminic receptors

Codependency

dysfunctional behaviors that are evident among members of the family of a chemically dependent person, or among family members who harbor secrets of physical or emotional abuse, other cruelties, or pathological conditions

therapeutic nurse - patient relationships can only occur when?

each views the other as a unique human - when this occurs, both participants have needs met by the relationship

Nursing diagnosis for bipolar disorder - impaired social interaction related to?

egocentric and narcissistic behavior

Affect

emotional reaction associated with an experience - what actually comes out of the speakers - the way a patients emotional state is conveyed - related more to others perception of the patients emotional state, responsiveness

Anxiety is an?

emotional response to anticipation of danger, the soruce of which is largely unknwon or unrecognized- - Anxiety is considered a disorder (or pathological) when fears and anxieties are excessive (in a cultural context) and there are associated behavioral disturbances such as interference with social and occupational functioning- anxiety is a necessary force for survival. it is not the same as stress

Mild neurocognitive disorder

has been known in some settings as Mild Cognitive Impairment, and is particularly critical because it can be a focus of early intervention to prevent or slow progression of the disorder.

Predisposing factors to depression - genetics

hereditary factor may be invovled

Types of lawsuits that occur in psychiatric nursing - false imprisonment

holding a client against his or her wishes outside of an emergency situation

Special concerns for elderly people - financial exploitation

illegal or improper use of an older adults funds, property, or assets

Risk-prone health behavior

impaired ability to modify lifestyle/behaviors in a manner that improves health status

negative symptoms - Asocial

impaired interpersonal functioning and relationship to the external world - impaired social interaction - social isolation

negative symptoms - avolition

impairment in the ability to initiate goal-directed activity - emotional ambivalence - deterioration in appearance

Sexual assault - compounded rape reaction

in which additional symptoms such as depression and suicide, substance abuse, and even psychotic behaviors may be noted.

Sexual assault - silent rape reaction

in which the survivor tells no one about the assault. Anxiety is suppressed and the emotional burden may become overwhelming. The unresolved sexual trauma may not be revealed until the woman is forced to face another sexual crisis in her life that reactivates the previously unresolved feelings.

Positive symptoms of disorganized thought process - mutism

inability or refusal to speak

Positive symptoms of disorganized thought process - tangentiality

inability to get to the point of communication due to the introduction of many new topics - different than circumstanitality because they never get to the point

Effects of alcohol on the body - chronic alcoholic myopathy

includes a gradual wasting and weakness in skeletal muscles. Neither the pain and tenderness, nor the elevated muscle enzymes seen in acute myopathy are evident in the chronic condition.

severe electrolyte imbalance

including potassium levels below 3 mml/L, phosphate levels below 3 mg/dL, magnesium levels below 1.4 mEq/L

Avoiding liability - complying with standards of care

including those established within the profession and those identified by specific hospital policies.

Nursing diagnosis for substance use disorder

ineffective denial related to weak, underdeveloped ego

Treatment modalities for personality disorders - dialectical behavior therapy

is a type of psychotherapy that was originally developed by Marsha Linehan, PhD, specifically as a treatment for the chronic self-injurious and parasuicidal behavior of clients with borderline personality disorder. It is rooted in a belief that the primary problem for this client is emotional dysregulation. It is a complex, eclectic treatment that combines the concepts of cognitive, behavioral, and interpersonal therapies with Eastern mindfulness practices.

Objective of care for those with neurocognitive disorders

is to provide these individuals with the dignity and quality of life they deserve, while offering guidance and support to their families or primary caregivers

Role of the nurse in group interventions - guidelines set forth by the American Nurses Association specify that nurses who serve as group psychotherapists should have a minimum of a?

master's degree in psychiatric nursing - Other criteria that have been suggested are educational preparation in group theory, extended practice as a group co-leader or leader under the supervision of an experienced psychotherapist, and participation in group therapy on an experiential level. - Additional specialist training is required beyond the master's level to prepare nurses to become family therapists or psychodramatists.

harmonizer

minimizes tension within the group by intervening when disagreements produce conflict

Case management

model of care delivery that can result in improved client care - Clients are assigned a manager who negotiates with multiple providers to obtain diverse services, which leads to decreased fragmentation of care while striving to contain cost of services.

Statutues

most states have statutes that pertain to the doctrine of privileged communication, which grants certain professionals privileges under which they may refuse to reveal information about, and communications with, clients. In most states, this applies to psychiatrists and attorneys, but in some instances, psychologists, clergy, and nurses are also included.

Healthcare professionals not only share their personal lives with groups of people, but also encounter?

multiple group situations in their professional operations

Concept mapping is based on the components of the?

nursing process and is created to show each step of the nursing process. - helps students develop a holistic view of their clients

Predisposing factors - theories of suicide - interperonal therory: Durkheims three social categories - anomic suicide

occurs in response to changes that occur in an individual's life that disrupt feelings of relatedness to the group. An interruption in the customary norms of behavior instills feelings of "separateness," and fears of being without support from the formerly cohesive group.

Hospitalization commitment - voluntary admissions

occurs when an individual makes an application to the institution for services and can stay as long as treatment is deemed necessary - He or she may sign out of the hospital at any time unless it is determined that they are harmful to themselves or others.

encourager

offers recognition and acceptance of others ideas and contributions

Mood

pervasive and sustained emotion that may have a major influence on a person's perception of the world - internal amp - sustained emotional attitude

Intoxication

physical and mental state of exhilaration and emotional frenzy or lethargy and stupor

Individuals experience both ------ to stress

physical and psychological responses

Withdrawal

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

The standards of practice for psychiatric nursing are written around the six steps of the nursing process - evaluation

process of determining the healthcare consumer's progress toward attainment of expected outcomes, and the effectiveness of the registered nurse's care and interventions

Natural law theories

propose that decisions about right and wrong are self-evident and determined by human nature.

The health insurance portability and accountability act

protects client confidentiality on the federal level and gives individuals the rights to access their medical records, to have corrections made to their medical records, and to decide with whom their medical information may be shared.

The psychiatric-mental health nurse provides and maintains what?

provides structures, and maintains a safe and therapeutic environment in collaboration with patients, families, and other healthcare clinicians. - Milieu therapy is part of the conditions necessary for this therapeutic environment.

Nursing diagnosis for schizophrenia - disturbed thought processes

related to inability to trust, panic anxiety, or possible hereditary or biochemical factors

Nursing diagnosis for schizophrenia - disturbed sensory perception(auditory and visual)

related to panic anxiety, extreme loneliness, and withdrawal into self

positive symptoms - stereotypy

repetitive, abnormally frequent, non-goal-directed movements

Although strategies for milieu therapy are still used, they have been modified to conform to the current?

short-term approach to care and to outpatient treatment programs. - emphasis on acute care hospitalization lengths of stay, now averaging 2-3 days - Some programs have successfully adapted the concepts of milieu treatment to their specialty needs

The program of therapeutic community - team members of all disciplines ?

sign the plan and meet regularly to update the plan as needed - Disciplines may include psychiatry, psychology, nursing, social work, occupational therapy, recreational therapy, art therapy, music therapy, dietetics, and chaplain's service

Introduction - abuse

signitificant and frightening public health problem - abuse is the maltreatment of one person by another

Acute Stress Disorder(ASD)

similar to PTSD in terms of precipitating traumatic events and symptomatology

Hospitalization commitment - involuntary commitments - A mentally ill person in need of treatment

someone unable to make decisions regarding treatment, someone likely to harm themselves or others, or someone unable to fulfill basic personal needs

Bilateral stimulation

something(you can seee, hear or touch) that occurs in a moving side to side pattern - for example, moving your eyes back and forth - the disturbing memories are reprocessed by the brain, resulting in painful feelings being exhchanged for more resolved, peaceful feelings - people report making more progress in much less time with EMDR therapy then in traditional talk therapy

Psychodrama - nurses who work as psychodramatists require?

specialist training beyond the master's degree.

Stage 1 - hypomania

symptoms not sufficiently severe to cause marked impairment in social or occupational functioning or to require hospitalization

Substance intoxication

the development of reversible syndromes following excessive use of a substance. These symptoms are drug-specific and occur shortly after ingesting the substance. Judgment is disturbed, resulting in inappropriate and maladaptive behavior, and social and occupational functioning are impaired.

Adaptation is determined by?

the extent to which the thoughts, feelings, and behaviors interfere with an individual's functioning.

Affect

the feeling state or emotional tone

Treatment modalities for adjustment disorders - family therapy

the focus of treatment is shifted from the individual to the system of relationships in which the individual is involved. The maladaptive response of the identified client is viewed as symptomatic of a dysfunctional family system.

Sexual assault - rape can occur at any age:

the highest risk group appears to be between 16 and 34 years of age

Ethical principles - justice

the idea that individuals have the right to be treated equally regardless of race, sex, marital status, diagnosis, social standing, economic level, or religious belief.

territoriality

the innate tendency to own space

distance

the means by which various cultures use space to communicate

density

the number of people within a given environmental space - correlation exists between prolonged high-density situations and certain behaviors, such as aggression, stress, criminal activity, hostility toward others, and a deterioration of mental and physical health.

Incest

the occurrence of sexual contacts or interaction between, or sexual exploitation of, close relatives, or between participants who are related to each other by a kinship bond that is regarded as a prohibition to sexual relations.

Ethical principles - nonmaleficence

the requirement that healthcare providers do no harm to their clients. Some suggest that avoiding harm is more important than doing good.

Physical responses to stress - hans selye defined stress as?

the state manifested by a specific syndrome which consists of all the nonspecifically induced changes within a biologic system - This syndrome has come to be known as "fight-or-flight" syndrome.

Sexual assault - in the expressed response pattern?

the survivor expresses feelings of fear, anger, and anxiety through such behaviors as crying, sobbing, restlessness, and tension.

Treatment modalities for adjustment disorders - crisis intervention

the therapist, or other intervener, becomes part of the individual's life situation. Because of increased anxiety, the individual with adjustment disorder is unable to problem solve, so he or she requires guidance and support from another to help mobilize the resources needed to resolve the crisis. Crisis intervention is short term, relies heavily on orderly problem-solving techniques and structured activities that are focused on change.

Critical pathways of care(CPCs)

the tools for provision of care in a case management system - A critical pathway is a type of abbreviated plan of care that provides outcome-based guidelines for goal achievement.

cognitive therapy

therapy that teaches people new, more adaptive ways of thinking and acting; based on the assumption that thoughts intervene between events and our emotional reactions - change your throughts to change your thinking to change your behavior

Sexual assult - profile of the victimizer - anger

those who are displacing anger and rage

Treatment - social treatments - social skills training

use of role play to treach client appropriate eye contact, interpersonal skills, voice intonation, posture. - aimed at improving relationship development

Treatment - psychopharmacology - antipsychotics

used to decrease agitation and psychotic symptoms of schizophrenia and other psychotic disorders

help-seeker

uses the group to gain sympathy from others; seeks to increase self-confidence from group feedback; lacks concern for others or for the group as a whole

Sexual assault - profile of the victimizer - exploitative predators

using the victim to gratify needs such as dominance and power

Negative symptoms - associated features -posturing

voluntary assumption of inappropriate or bizzare postures

MOA of atypical antipsychotics

weak dopamine antagonists; potent 5H T2A antagonists; also exhibit antagonism for chilinergic, histaminic, and adrenergic receptors

negative symptoms - bland affect

weak emotional tone

Relationship between early childhood trauma and?

well-being problems later in life - early death - disease, disability, and social probelms - adoption of health-risk behaviors - social, emotional, and cognitive impairment - adverse childhood experiences

Treatment modalities for adjustment disorders - group experiences(self-help groups)

with or without a professional facilitator, provide an arena in which members may consider and compare their responses to individuals with similar life experiences. Members benefit from learning that they are not alone in their painful experiences.

Nursing Process: Evaluation

• Can the client recognize signs and symptoms of escalating anxiety? • Can the client intervene with adaptive coping strategies to interrupt the escalating anxiety before physical symptoms are exacerbated? • Can the client verbalize an understanding of the correlation between physical symptoms and times of escalating anxiety? • Does the client have a plan for dealing with increased stress to prevent exacerbation of physical symptoms? • Does the client demonstrate a decrease in ruminations about physical symptoms? • Have fears of serious illness diminished? • Does the client demonstrate full recovery from a previous loss or alteration of physical functioning? Evaluation of the nursing actions for the client with a dissociative disorder may be facilitated by answering the following types of questions: • Has the client's memory been restored? • Can the client connect occurrence of psychological stress to loss of memory? • Does the client discuss fears and anxieties with members of the staff in an effort toward resolution? • Can the client discuss the presence of various personalities within the self? • Can he or she verbalize why these personalities exist? • Can the client verbalize situations that precipitate transition from one personality to another? • Can the client maintain a sense of reality during stressful situations? • Can the client verbalize a correlation between stressful situations and the onset of depersonalization behaviors? • Can the client demonstrate more adaptive coping strategies for dealing with stress without resorting to dissociation?

Physical abuse is indicated if the child:

• Has unexplained burns, bites, bruises, broken bones, or black eyes. • Has fading bruises or other marks noticeable after an absence from school. • Seems frightened of the parents and protests or cries when it is time to go home. • Shrinks at the approach of adults. • Reports injury by a parent or another adult caregiver. • Abuses animals or pets. Physical abuse may be suspected when the parent or other adult caregiver: • Offers conflicting, unconvincing, or no explanation for the child's injury. • Describes the child as "evil," or in some other very negative way. • Uses harsh physical discipline with the child. • Has a history of abuse as a child. • Has a history of abusing animals or pets.

Stimulant use disorder - profile of the substance

•Amphetamines •Methamphetamine •Synthetic stimulants •Non-amphetamine stimulants •Cocaine •Caffeine •Nicotine

Outcome criteria - the patient

•Can acknowledge the traumatic event and the impact it has had on his or her life. • Is experiencing fewer flashbacks, intrusive recollections, and nightmares than he or she was upon admission (or at the beginning of therapy). • Can demonstrate adaptive coping strategies (for example, relaxation techniques, mental imagery, music, art). • Can concentrate and has made realistic goals for the future. • Includes significant others in the recovery process and willingly accepts their support. • Verbalizes no ideas or intent of self-harm. • Has worked through feelings of survivor's guilt. • Gets enough sleep to avoid risk of injury. • Verbalizes community resources from which he or she may seek assistance in times of stress. • Attends support group of individuals who have recovered or are recovering from similar traumatic experiences. • Verbalizes desire to put the trauma in the past and progress with his or her life.

Evaluation for adjustment disorders is based on accomplishment of previously established outcome criteria:

•Does the client verbalize understanding of the grief process and his or her position in the process? •Does the client recognize his or her adaptive and maladaptive behaviors associated with the grief response? •Does the client demonstrate evidence of progression along with the grief response? •Can the client accomplish activities of daily living independently? •Does the client demonstrate the ability to perform occupational and social activities adequately? •Does the client discuss the change in health status and modification of lifestyle it will affect? •Does the client demonstrate acceptance of the modification? •Can the client participate in decision making and problem solving for his or her future? •Does the client set realistic goals for the future? •Does the client demonstrate new adaptive coping strategies for dealing with the change in lifestyle? •Can the client verbalize available resources to whom he or she may go for support or assistance should it be necessary?

Child sexual abuse may be considered a possibility when the child?

•Has difficulty walking or sitting. • Suddenly refuses to change for gym or to participate in physical activities. • Reports nightmares or bedwetting. • Experiences a sudden change in appetite. • Demonstrates bizarre, sophisticated, or unusual sexual knowledge or behavior. • Becomes pregnant or contracts a venereal disease, particularly if under age 14. • Runs away. • Reports sexual abuse by a parent or another adult caregiver. • Attaches very quickly to strangers or new adults in their environment.

Evaluation of ASD

•Has the child been able to establish trust with at least one caregiver? •Have the nursing actions directed toward preventing mutilative behaviors or other injury been effective in protecting the client from self-harm? •Has the child attempted to interact with others? Has he or she received positive reinforcement for these efforts? •Has eye contact improved? •Has the child established a means of communicating his or her needs and desires to others? Have all self-care needs been met? •Does the child demonstrate an awareness of self as separate from others? Can he or she name own body parts and body parts of caregiver? •Can he or she accept touch from others? Does he or she willingly and appropriately touch others?

Evaluation for the client with binge eating disorder and associated obesity

•Has the client shown a steady weight loss since starting the new eating plan? • Does the client verbalize a relapse prevention plan to avoid triggers and abstain from bingeing? Does the client verbalize positive self-attributes not associated with body size or appearance?

Evaluation of the client with eating disorder - for the client with anorexia nervosa or bulimia nervosa

•Has the client steadily gained 2 to 3 pounds per week to at least 80% of expected body weight for age and size? • Is the client free of signs and symptoms of malnutrition and dehydration? • Does the client consume adequate calories as determined by the dietitian? • Have there been any attempts to stash food from the tray to discard later? • Have there been any attempts to self-induce vomiting? • Has the client admitted that a problem exists and that eating behaviors are maladaptive? • Have behaviors aimed at manipulating the environment been discontinued? • Is the client willing to discuss the real issues concerning family roles, sexuality, dependence/independence, and the need for achievement? • Does the client understand how he or she has used maladaptive eating behaviors in an effort to achieve a feeling of some control over life events? • Has the client acknowledged that perception of body image as "fat" is incorrect?

Common nursing diagnoses for clients with dissociative disorders include:

•Impaired memory (dissociative amnesia) •Powerlessness (dissociative amnesia) •Risk for suicide (D I D) •Disturbed personal identity (D I D) •Disturbed sensory perception [visual/kinesthetic] (depersonalization-derealization disorder)

Nursing diagnoses related to clients with abuse

•Rape-trauma syndrome related to sexual assault evidenced by verbalizations of the attack; bruises and lacerations over areas of body; severe anxiety. •Powerlessness related to the cycle of battering evidenced by verbalizations of abuse; bruises and lacerations over areas of the body; fear for her safety and that of her children; verbalizations of no way to get out of the relationship. •Risk for delayed development related to the abusive family situation.

child abuse - Physical neglect

•Refusal of or delay in seeking healthcare •Abandonment •Expulsion from the home •Refusal to allow a runaway to return home •Inadequate supervision

Planning/implementation - denial

- "conscious or unconscious attempt to disavow the knowledge or meaning of an event to reduce anxiety and/or fear, leading to the detriment of health." - Goals should include focusing on behavioral outcomes associated with substance use and helping the client to verbalize acceptance of responsibility for their own behavior. - Interventions include conveying an attitude of acceptance to the client, providing information to correct misconceptions, and encouraging participation in group activities.

Planning/implementation - ineffective coping

- "inability to form a valid appraisal of the stressors, inadequate choices of practiced responses, and/or inability to use available resources." - Goals should include helping the client express feelings about using substances as a method of coping with stress and the use of adaptive coping mechanisms. - Interventions include setting limits on manipulative behavior, explaining the effects of substance abuse, and providing positive reinforcement.

Planning/Implementation - low self-esteem/self-care deficit

- "negative self-evaluating/feelings about self or self-capabilities (either long-standing or in response to a current situation)." Self-care deficit is defined as "impaired ability to perform or complete [activities of daily living (ADLs)] for self." - Be accepting of the client. - Encourage the client to recognize areas of change. - Encourage independence in the performance of activities of daily living - Goals for treating clients with low self-esteem or self-care deficit should be to assist in ADLs, increase feelings of self-worth, and help the client satisfactorily accomplish ADLs independently. Interventions include promoting attendance in therapy groups, teaching assertiveness techniques, and showing the client how to perform activities with which he or she is having difficulty.

Planning/implementation - dysfunctional family processes

- "psychosocial, spiritual, and physiological functions of the family unit [that] are chronically disorganized, which leads to conflict, denial of problems, resistance to change, ineffective problem solving, and a series of self-perpetuating crises." - Goals should include helping family members participate in programs and support groups and take action to change self-destructive behaviors. - Interventions include exploring the roles of family members, determining the extent of enabling behaviors, and involving the family in plans for discharge.

Utilitarianism

- "the greatest-happiness principle," - holds that actions that promote happiness are right, and those actions that bring about unhappiness are wrong. - Ethical decisions should be based on the end result of the decision.

Introduction - CDC 2018 report

- 1 in 5 women experienced rape; 1 in 6 women were stalked; and 1 in 4 reported some form of intimate partner violence. - These forms of violence most often occur before the age of 25 for both men and women.

Dual diagnosis

- A client who has a coexisting substance disorder and mental illness may be assigned to a special program that targets both problems. - Traditional counseling approaches use more confrontation than that which is considered appropriate for clients with dual diagnoses. - Most dual diagnosis programs take a more supportive and less confrontational approach. - Cognitive and behavioral therapies are helpful in training clients to monitor moods and thought patterns that lead to substance abuse. - With these therapies, clients also learn to avoid substance use and to cope with cravings and the temptation to relapse - Clients with a coexisting substance disorder and mental disorder may be assigned to a special program that targets the dual diagnosis. - Program combines special therapies that target both problems.

Concept mapping

- A diagrammatic teaching and learning strategy - Shows interrelationships among medical and nursing diagnoses, assessment data, and treatments - Practical, realistic, and time-saving - It is used to plan and organize nursing care. - Enhance critical-thinking skills and clinical reasoning ability

Anxiety

- A feeling of discomfort and apprehension related to fear of impending danger. The individual may be unaware of the source of their anxiety, but it is often accompanied by feelings of uncertainty and helplessness. - Extremely common in our society - Mild anxiety is adaptive and can provide motivation for survival. - can become problematic when an individual is unable to prevent it from interfering with everyday life.

Types of somatic symptom disorders - conversion disorder

- A loss of or change in body function that cannot be explained by any known medical disorder or pathophysiological mechanism. - The most obvious and "classic" conversion symptoms are those that suggest neurological disease. - Some instances of conversion disorder may be precipitated by psychological stress. - Pseudoseizures - Conversion symptoms affect voluntary motor or sensory functioning suggestive of neurological disease. Examples include paralysis, aphonia (inability to produce voice), seizures, coordination disturbance, difficulty swallowing, urinary retention, akinesia, blindness, deafness, double vision, anosmia (inability to perceive smell), loss of pain sensation, and hallucinations. - Abnormal limb shaking with impaired or loss of consciousness that resembles epileptic seizures is another type of conversion disorder symptom that is referred to as psychogenic or nonepileptic seizures. - Pseudocyesis (false pregnancy) is a conversion symptom and may represent a strong desire to be pregnant. - "although the diagnosis requires that the symptom is not explained by neurological disease, it should not be made simply because results from investigations are normal or because the symptom is "bizarre." There must be clear evidence of incompatibility with neurological disease.

Dissociative amnesia

- A specific subtype of dissociative amnesia is with dissociative fugue, in which there is sudden, unexpected travel away from home with the inability to recall some or all of one's past. - An individual in a fugue state may not be able to recall personal identity and sometimes assumes a new identity.

Developmental implications: childhood and adolescence treatment strategies - ADHD

- ADHD is the most common comorbid condition - ADHD agents may exacerbate mania and should be administered only after bipolar symptoms have been controlled

Theories of aging - environmental theory

- According to this theory, factors in the environment (e.g., industrial carcinogens, sunlight, trauma, and infection) bring about changes in the aging process. - Although these factors are known to accelerate aging, the impact of the environment is a secondary rather than a primary factor in aging. - Science is only beginning to uncover the many environmental factors that affect aging.

Application of the nursing proces - types of dissociative disorders - dissociative amnesia

- Amnesia is partial or total, permanent or transient loss of memory. - The term is often applied to episodes during which patients forget recent evens although they may conduct themselves appropriately and after which no memory of the period persists. - Dissociative amnesia is an inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by ordinary forgetfulness, and is not due to the direct effects of substance use or a neurological or other medical condition. - onset usually follows severe psychosocial stress - types: localized, selective, generalized

Cannabis use disorder - profile of the substance

- Cannabis is the most commonly used illicit drug in the United States and the fourth most commonly used psychoactive substance after caffeine, alcohol, and nicotine. - Marijuana, the most prevalent type of cannabis preparation, is composed of the dried leaves, stems, and flowers of the plant. - Hashish is a more potent concentrate of the resin derived from the flowering tops of the plant. - Hash oil is a very concentrated form of THC made by boiling hashish in a solvent and filtering out the solid matter.

Borderline personality disorder

- Characterized by a pattern of intense and chaotic relationships with affective instability - Fluctuating and extreme attitudes regarding other people - Highly impulsive

Panic disorder

- Characterized by recurrent panic attacks, the onset of which are unpredictable and manifested by intense apprehension, fear, or terror, often associated with feelings of impending doom and accompanied by intense physical discomfort - Sudden onset, unexpected, no real apparent cause - May be accompanied by agoraphobia

Predisposing factors to OCD and related disorders - learning theory

- Conditioned response to a traumatic event or life stress - Passive avoidance - Active avoidance

Histrionic personality disorder

- Histrionic personality disorder is characterized by colorful, dramatic, and extroverted behavior in excitable, emotional people. They have difficulty maintaining long-lasting relationships, although they require constant affirmation of approval and acceptance. - Prevalence of the disorder is thought to be about 2% to 3%, and it is more common in women than in men.

Examples of anti-anxiety agents

- Hydroxyzine (Vistaril) - Alprazolam (Xanax) - Chlordiazepoxide (Librium) - Clonazepam (Klonopin) - Clorazepate (Tranxene) - Diazepam (Valium) - Lorazepam (Ativan)

Borderline Personality Disorder - I RAISED A PAIN

- Identity disturbance - relationships are unstable - abandoment frantically avoided(whether real or imagined) - impulsivity - emptiness - suicidal gestures(threats, self-mutilation) - dissociative symptoms - affective instability - paranoid ideation(stress-realted and transient) - anger is poorly controlled - idealization followed by devaluation - negavistic(undermine themselves with self-defeating behavior) - angry when things do not go their way

Types of boundaries in a nurse-patient relationship

- Material - Social - Personal - Professional

Predisposing factors - substance-induced delirium

- May be caused by intoxication or withdrawal from certain substances, such as - Anticholinergics, antihypertensives, corticosteroids, anticonvulsants, analgesics, and others - Alcohol, amphetamines, cannabis, cocaine, hallucinogens, inhalants, and others - Toxins, including organic solvents and fuels, lead, mercury, arsenic, carbon monoxide, and others

The chemically impaired nurse - state board response

- May deny, suspend, or revoke a license based on a report of chemical abuse by a nurse - Diversionary laws allow impaired nurses to avoid disciplinary action by agreeing to seek treatment. - Some of these state boards administer the treatment programs themselves, and others refer the nurse to community resources or state nurses' association assistance programs.

Postpartum depression

- May last for a few weeks to several months - Associated with hormonal changes, tryptophan metabolism, or cell alterations

Client/Family Education - management of the illness

- Medication management - Assertive techniques - Stress-management techniques - Ways to increase self-esteem - Electroconvulsive therapy

Cerebellum

- balance - coordination and control of voluntary movement - fine muscle control

5 stages of grief

1.Denial: Stage of disbelief in which the reality of the loss is not acknowledged. 2. Anger: Stage of envy and resentment. 3. Bargaining: Stage of making promises to reverse or postpone the loss. 4. Depression: Stage of desperation and disengagement. 5. Acceptance: Final stage of resignation.

Outcome criteria for suicide

1.Has experienced no physical harm to self. 2.Sets realistic goals for self. 3.Expresses some optimism and hope for the future.

Documentation of the sympatoms associated with bipolar disorder dates back to the?

2nd century in Greece

PTSD - symptoms may begin within the first?

3 months after the trauma, or there may be a delay of several months or even years - The full symptom picture must be present for more than 1 month and cause significant interference with social, occupational, and other areas of functioning. The disorder can occur at any age.

Epidemiology of depression

6.7% of persons aged 18 or older had at least one major depressive episode in the previous year.

Ethics

A branch of philosophy that deals with distinguishing right from wrong

Therapeutic use of self

Ability to use one's personality consciously and in full awareness in an attempt to establish relatedness and to structure nursing interventions

Therapeutic communication techniques - giving recognition

Acknowledging, indicating awareness

A model for making ethical decisions - implementation

Act on the decision made and communicate the decision to others

Nursing liability - malpractice

Act or continuing conduct of a professional that does not meet the standard of competence and results in provable damages to the patient

Basic Assumptions of Milieu Therapy - The health in each individual is to be realized and encouraged to grow

All individuals are considered to have strengths as well as limitations. These healthy aspects of the individual are identified and serve as a foundation for growth in the personality and in the ability to function more adaptively and productively in all aspects of life.

Therapeutic communication techniques - Giving broad openings

Allows patient to select the topic

Therapeutic communication techniques - using silence

Allows patient to take control of the discussion, if he or she so desires

Strigma - social distancing

An aspect of stigma that refers to the tendency of healthcare workers and others to avoid people with mental illness or addiction - Hallucinations, neglect of self-care, and agitation can be challenging symptoms for clinicians to manage

Predisposing factors to depression - physiological influences: neurological disorders

An individual who has suffered a cardiovascular accident (CVA), brain tumors, particularly in the area of the temporal lobe, Alzheimer's disease, Parkinson's disease, and Huntington's disease, or multiple sclerosis may display symptoms of depression.

Treatment for postpartum depression

Antidepressants and psychosocial therapies

Factors that increase your risk for developing an anxiety disorder - family

Anxiety disorders can run in families

Nontherapeutic Communication Techniques - requesting an explanation

Asking "why" implies that the patient must defend his or her behavior or feelings

Therapeutic communication techniques - encouraging comparison

Asking patient to compare similarities and differences in ideas, experiences, or interpersonal relationships

Therapeutic communication techniques - Encouraging description of perceptions

Asking patient to verbalize what is being perceived

Angelia Jolie

Beautiful and talented, Jolie voluntarily checked herself into a treatment facility in the late 1990s, claiming she had experienced both suicidal and homicidal thoughts. Although she had no intention of acting on these thoughts, she realized that she needed help. She was diagnosed with "presumptive borderline personality disorder".

Genetic Therapeutic Approaches: Separation Anxieyt Disorder - behavior therapy

Behavior therapy is based on the concepts of classical conditioning and operant conditioning. Behavior therapy is a common and effective treatment with disruptive behavior disorders such as A D H D, O D D, and conduct disorder. With this approach, rewards are given for appropriate behaviors and withheld when behaviors are disruptive or otherwise inappropriate.

Basic Assumptions of Milieu Therapy - peer pressure is useful and powerful tool

Behavioral group norms are established through peer pressure. Feedback is direct and frequent, so that behaving in a manner acceptable to the other members of the community becomes essential.

Personality Disorders - Cluster C

Behaviors described as anxious or fearful. a.Avoidant personality disorder b.Dependent personality disorder c.Obsessive-compulsive personality disorder

Personality Disorders - Cluster B

Behaviors described as dramatic, emotional, or erratic. a.Antisocial personality disorder b.Borderline personality disorder c.Histrionic personality disorder d.Narcissistic personality disorder

Personality Disorders - Cluster A

Behaviors described as odd or eccentric. a.Paranoid personality disorder b.Schizoid personality disorder c.Schizotypal personality disorder

Nontherapeutic Communication Techniques - Using denial

Blocks discussion with the patient and avoids helping the patient identify and explore areas of difficulty

Predisposing factors associated with somatic symptom disorders - neuroanatomical

Brain dysfunction has been implicated as a factor in factitious disorder. - The hypothesis is that impairment in information processing contributes to the aberrant behaviors associated with the disorder. Brain imaging studies have found hypometabolism in the dominant hemisphere, hypermetabolism in the nondominant hemisphere, and impaired hemispheric communication in conversion disorders. Other reports of brain imaging studies have identified that, in one or more of the somatic symptom disorders, there is reduced volume of the amygdala, as well as reduced connectivity between the amygdala and brain centers controlling executive and motor functions.

Therapeutic factors of groups - instillation of hope

By observing the progress of others in the group with similar problems, a group member garners hope that his or her problems can also be resolved.

Trauma-informed care

Care that assesses for, and demonstrates sensitivity to, the impact of trauma history on current behavior and relationships in every aspect of nursing intervention.

Nontherapeutic Communication Techniques - Belittling feelings expressed

Causes patient to feel insignificant or unimportant

Nontherapeutic Communication Techniques - Introducing an unrelated topic

Causes the nurse to take over the direction of the discussion

Basic Assumptions of Milieu Therapy - the individual owns his or her own environment

Clients should have the opportunity to make decisions and solve problems related to the environment (milieu) of the unit. In this way, personal needs for autonomy, as well as needs that pertain to the group as a whole, are fulfilled.

Eight core functions of EHRs - patient support

Computer-based interactive client education, self-testing, and self-monitoring have been shown to improve control of chronic illnesses

Eight core functions of EHRs - order entry/order management

Computer-based order entries improve workflow processes by eliminating lost orders and ambiguities caused by illegible handwriting, generating related orders automatically, monitoring for duplicate orders, and improving the speed with which orders are executed.

Eight core functions of EHRs - decision support

Computerized decision support systems enhance clinical performance for many aspects of healthcare. Using reminders and prompts, improvement in regular screenings and other preventive practices can be accomplished.

Eight core functions of EHRs - results management

Computerized results of all types can be accessed more easily by the provider at the time and place they are needed.

Moral behavior

Conduct that results from serious critical thinking about how individuals should treat others - This behavior reflects the way a person interprets basic respect for others, including autonomy, freedom, justice, honesty, and confidentiality

Therapeutic communication techniques - accepting

Conveys positive regard

Treatment modalities for substance-related disorders - counseling

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

Predisposing factors to depression - physiological influences: Nutritional deficiencies

Deficiencies in proteins, carbohydrates, vitamin B1 (thiamine), vitamin B2 (riboflavin), vitamin B6 (pyridoxine), B9 (folate), vitamin B12, iron, zinc, calcium, chromium, iodine, lithium, selenium, potassium, and omega-3 fatty acids have all been associated with producing symptoms of depression.

mixed type delusion

Delusions of more than one type (e.g. EROTOMANIC, GRANDIOSE, PERSECUTORY, SOMATIC) in which no one theme predominates

delusions of reference

Delusions of reference: belief that common elements in the environment are directed toward the individual - CIA is sending codes in newspaper

Basic Assumptions of Milieu Therapy - restrictions and punishment are to be avoided

Destructive behaviors can usually be controlled with group discussion. However, if an individual requires external controls, temporary isolation is preferred over lengthy restriction or other harsh consequences.

mute or silent member

Does not participate verbally; remains silent for a variety of reasons—may feel uncomfortable with self-disclosure or may be seeking attention through silence

Dysthymia

Dysthymia (also called persistent depressive disorder) is an example of moderate depression and represents a more problematic disturbance which, according to the DSM-5 is characterized by symptoms that are enduring for at least 2 years.

Therapeutic communication techniques - Encourages patient to continue

Encourages patient to continue

Nontherapeutic Communication Techniques - Indicating the existence of an external source of power

Encourages the patient to project blame for his or her thoughts or behaviors on others

Therapeutic communication techniques - Voicing doubt

Expressing uncertainty as to the reality of patient's perception

Predisposing factors - cognitive theory

Faulty, distorted, or counterproductive thinking patterns result in anxiety that is maintained by mistaken or dysfunctional appraisal of a situation

Agoraphobia

Fear of being in places or situations from which escape might be difficult or in which help might not be available in the event of panic-like symptoms or other incapacitating symptoms.

Physical responses to stress - Selye's general adaptation syndrome has three distincy stages: Alarm reaction stage

Fight-or-flight syndrome responses are initiated

Therapeutic factors of groups - imparting of information

Group members share their knowledge with each other. Leaders of teaching groups also provide information to group members.

Therapeutic factors of groups - imitative behavior

Group members who have mastered a particular psychosocial skill or developmental task serve as valuable role models for others.

Therapeutic factors of groups - interpersonal learning

Group offers varied opportunities for interacting with other people.

Trauma-related disorders treatment - group therapy/family therapy

Group therapy has been strongly advocated for clients with P T S D. It has proved especially effective with military veterans.

Treatment modalities for substance-related disorders - group therapy

Group therapy with substance abusers has long been regarded as a powerful agent of change. In groups, individuals are able to share their experiences with others who are going through similar problems. They are able to "see themselves in others," and confront their defenses about giving up the substance. Therapy groups and self-help groups such as AA are complementary to each other. Whereas the self-help group focus is on achieving and maintaining sobriety, in the therapy group the individual may learn more adaptive ways of coping, how to deal with problems that may have arisen or were exacerbated by the former substance use, and ways to improve quality of life and to function more effectively without substances.

Functions of a group - empowerment

Groups help to bring about improvement in existing conditions by providing support to individual members who seek to bring about change. Groups have power that individuals alone do not.

Positive symptoms of disorganized thought process - word salad

Groups of words put together in a random fashion

Factors that increase your risk for developing an anxiety disorder - stress due to an illness

Having a health condition or serious illness can cause significant worry about issues such as your treatment and your future.

Predisposing factors - theories of suicide - hopelessness and other symptoms of depression

Hopelessness has long been identified as a symptom of depression and as an underlying factor in the predisposition to suicide. While many of the symptoms that are identified in suicide assessment tools attempt to assess for seriousness of suicide ideation, current research is attempting to glean which symptoms might be more predictive of the move from ideation to attempts.

Nontherapeutic Communication Techniques - giving advice

Implies that the nurse knows what is best for the patient and that the patient is incapable of any self-direction

Eight core functions of EHRs - electornic communication and connectivity

Improved communication among care associates, such as medicine, nursing, laboratory, pharmacy, and radiology, can enhance client safety and quality of care.

Historical aspects of personality disorders

In the 4th century BC, Hippocrates identified four fundamental personality styles that he concluded stemmed from excesses in the four humors: the irritable and hostile choleric (yellow bile); the pessimistic melancholic (black bile); the overly optimistic and extraverted sanguine (blood); and the apathetic phlegmatic (phlegm). The medical profession first recognized that personality disorders were cause for their own special concern in 1801, with the recognition that an individual can behave irrationally even when the powers of intellect are intact. Nineteenth-century psychiatrists embraced the term moral insanity, the concept of which defines what we know today as personality disorders.

The standards of practice for psychiatric nursing are written around the six steps of the nursing process - implementation

Interventions selected during the planning stage are executed. - Documentation of interventions also occurs at this step in the nursing process.

Functions of a group - governance

Large organizations often have leadership that is provided by groups rather than by a single individual.

effects of alcohol on the body - pancreatitis - chronic

Leads to pancreatic insufficiency resulting in steatorrhea, malnutrition, weight loss, and diabetes mellitus

Active listening acronym - SOLER - L:

Lean forward toward the patient. This conveys to the patient that you are involved in the interaction, interested in what is being said, and making a sincere effort to be attentive

Therapeutic communication techniques - restating

Lets patient know whether an expressed statement has been understood

Age of depression

Lifetime prevalence of depressive disorders is higher in those aged 45 years or younger

Professional boundaries

Limit and outline expectations for appropriate professional relationships with patients

How prevalent is depression?

Major depressive disorder (MDD) is one of the leading causes of disability in the United States. The lifetime prevalence of depression is about 17%, which makes it the most prevalent psychiatric disorder.

Therapeutic communication techniques - offering self

Making oneself available

Nontherapeutic Communication Techniques - Giving reassurance

May discourage the patient from a further expression of feelings if the patient believes the feelings will only be downplayed or ridiculed

Genetic Therapeutic Approaches: Separation Anxieyt Disorder - psychopharmacology

Medication should never be the sole method of treatment. It is undeniable that medication can and does improve quality of life for families of children and adolescents with these disorders. However, research has indicated that medication alone is not as effective as a combination of medication and psychosocial therapy. It is important for families to understand that there is no way to "give him a pill and make him well." The importance of the psychosocial therapies cannot be overstressed.

Factors that increase your risk for developing an anxiety disorder - personality

People with certain personality types are more prone to anxiety disorders than others are

History of trauma

Post-trauma response has been known through history by other names such as shell shock, battle fatigue, accident neurosis, and post-traumatic neurosis. Reports of symptoms and syndromes with P T S D-like features have existed throughout history. In the early part of the 20th century, traumatic neurosis was viewed as the ego's inability to master the degree of disorganization brought about by a traumatic experience. Very little was written about post-traumatic neurosis during the years between 1950 and 1970, but this was followed in the 1970s and 1980s with an explosion in the amount of research and writing on the subject. Many of the papers written during this time were about Vietnam veterans. The diagnostic category of P T S D did not appear until the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980, after increasing numbers of problems with Vietnam veterans and victims of multiple disasters indicated a need.

Obessions

Recurrent thoughts, impulses, or images experienced as intrusive and stressful, and unable to be expunged by logic or reasoning

Therapeutic nurse-patient relationship - Working phase - countertransference

Refers to the nurse's behavioral and emotional response to the patient - These responses may be related to unresolved feelings toward significant others from the nurse's past, or they may be generated in response to transference feelings on the part of the patient

Nontherapeutic Communication Techniques - rejecting

Refusing to consider the patient's ideas or behavior

Compromiser

Relives conflict within the group by assisting members to reach a compromise agreeable to all

Sexual assault

Sexual assault is viewed as any type of sexual act in which an individual is threatened or coerced, or forced to submit against his or her will

seducer

Shares intimate details about self with group; is the least reluctant of the group to do so; may frighten others in the group and inhibit group progress with excessive premature self-disclosure

Childhood depression symptoms - up to age 3

Signs may include feeding problems, tantrums, lack of playfulness and emotional expressiveness, failure to thrive, or delays in speech and gross motor development.

Eating behaviors are influenced by?

Society and Culture - Historically, society and culture also have influenced what is considered desirable in the female body. Society and culture have a great deal of influence on eating behaviors. Society and culture also influence how people (and in particular, women) must look. History reveals a regularity of fluctuation in what society has considered desirable in the human female body. Archives and historical paintings from the 16th and 17th centuries reveal that plump, full-figured women were considered fashionable and desirable. In the Victorian era, beauty was characterized by a slender, wan appearance that continued through the flapper era of the 1920s. During the Depression era and World War II, the full-bodied woman was again admired, only to be superseded in the late 1960s by images of superthin models propagated by the media, which remain the ideal of today.

recognition seeker

Talks about personal accomplishments in an effort to gain attention for self

Electroconvulsive therapy side effects

Temporary memory loss and confusion

Bioethics

Term applied to ethics when they refer to concepts within the scope of medicine, nursing, and allied health

The impact of preexisiting conditions - the environment in which the transaction takes place

Territoriality, density, and distance are aspects of environment that communicate messages.

Treatment modalities: family therapy

The Maudsley Approach is one of the few evidence-based treatment approaches for the treatment of teens with anorexia nervosa. This approach actively involves the family in each step of the process. In some of the first controlled studies of this method, 90% of the clients showed improvement compared to 36% of those in individual therapies.

Physical responses to stress - Selye's general adaptation syndrome has three distincy stages: Stage of exhaustion

The adaptive energy is depleted, and diseases of adaptation may ensue.

Assessment of conduct disorder

The classic characteristic of conduct disorder is the use of physical aggression in the violation of the rights of others. The behavior pattern manifests itself in virtually all areas of the child's life (home, school, with peers, and in the community). Stealing, lying, and truancy are common problems. The child lacks feelings of guilt or remorse.

The impact of preexisting conditions - there are four kinds of distance in interpersonal interactions - intimate distance

The closest distance that individuals allow between themselves and others

Separation anxiety disorder

The essential feature of separation anxiety disorder is excessive anxiety concerning separation from those to whom the individual is attached. - The anxiety exceeds that which is expected for the person's developmental level and interferes with social, academic, occupational, or other areas of functioning. - Onset may occur anytime before age 18 years, but is most commonly diagnosed around age 5 or 6, when the child goes to school. Prevalence estimates for the disorder average about 4% in children and young adults, and it is more common in girls than in boys.

Physical Responses to Stress - Biological responses associated with fight or flight syndrome - immediate response

The immediate response is stimulation of the sympathetic nervous system. This can result in: - Dilation of the pupils - Dilation of the bronchioles and increased respiration rate - Increased force of cardiac contraction, which causes increased cardiac output, heart rate, and blood pressure - Decreased gastric motility and secretions - Increased secretion from the sweat glands

Informed consent elements - free will

The individual has given consent voluntarily without pressure or coercion from others.

Informed consent elements - competency

The individual's cognition is not impaired to an extent that would interfere with decision-making or, if so, that the individual has a legal representative.

Steve Jobs

The late CEO of Apple Computer Corporation suffered from obsessive-compulsive personality disorder. According to an article in Slate Magazine, Jobs' OCPD is "what made him great".

Adjustment disorders - with mixed anxiety and depressed mood

The predominant features of this category include disturbances in mood and manifestations of anxiety that are more intense than what would be expected or considered to be a normative response to an identified stressor.

Trauma informed care

Trauma-informed care generally describes a philosophical approach that values awareness and understanding of trauma when assessing, planning, and implementing care - a strength-based framework that is grounded in an understanding of, and responsiveness to, the impact of trauma that emphasizes physical, psychological, and emotional safety for both providers and survivors to rebuild a sense of control and empowerment.

Predisposing factors - biological theories - genetics

Twin studies have shown a much higher concordance rate for monozygotic twins than for dizygotic twins. Some studies with suicide attempters have focused on the genotypic variations in the gene for tryptophan hydroxylase, with results indicating significant association to suicidality. Tryptophan hydroxylase is an enzyme associated with the synthesis of serotonin, and diminished serotonin has implications for both depression and suicidal behavior. These findings suggest the potential for genetic predisposition toward suicidal behavior.

Absolute right

When there is no restriction whatsoever on the individual's entitlement

Therapeutic factors of groups - catharsis

Within the group, members are able to express both positive and negative feelings.

Basic Assumptions of Milieu Therapy - every interaction is an opportunity for therapeutic intervention

Within this structured setting, it is virtually impossible to avoid interpersonal interaction. The ideal situation exists for clients to improve communication and relationship development skills. Learning occurs from immediate feedback of personal perceptions.

Alcohol use disorder - alcohol exerts a?

a depressant effect on the CNS, resulting in behavioral and mood changes. The effects of alcohol on the CNS are proportional to the alcoholic concentration in the blood. Alcohol can be harmless and enjoyable if used in moderation, but like any other mind-altering drug, it has the potential for abuse.

Complicated grieving

a disorder that occurs after the death of a significant other (or any other loss of significance to the individual), in which the experience of distress accompanying bereavement fails to follow normative expectations and manifests in functional impairment

Substance and medication induced bipolar disorder

a disturbance of mood(depression or mania) that is considered to be the direct result of the physiological effects of a substance(for example, ingestion of or withdrawal from a drug of abuse or a medication or other treatment)

Stage 3 - delirious mania

a grave form of the disorder characterized by an intensification of th esymptoms associated with acute mania - the condition is rare because the advent of antipsychotic medication

post-trauma syndrome

a sustained maladaptive response to a traumatic, overwhelming event

Mania

alteration in mood that is expressed by feelings of elation, inflated self-esteem, grandiosity, hyperactivity, agitation, and accelerated thinking and speaking

Extended periods of repressed severe anxiety can lead to psychoneurotic responses such as:

anxiety disorders, somatic symptom disorders, or dissociative disorders

Phobias - cognitive theory

anxiety is the product of faulty cognitions or anxiety-inducing self intructions like negative self-statements and irrational beliefs

Fear

anxiety may be distinguished from fear in that anxiety is an emotional process, whereas fear is a cognitive one

Physical abuse

any nonaccidental physical injury caused by the parent or caregiver

negative symptoms - flat affect

appears to be void of emotional tone

Types of groups - therapeutic groups

are based to a lesser extent on theory. The focus is on group relations, interactions among group members, and the consideration of a selected issue - not designed to conduct psychotherapy, rather the focus is more on group relations, interactions among group members, and consideration of a selected issue. - group therapy involves psychotherapy. Therapeutic groups do not.

Secondary neurocognitive disorders

are caused by or related to another disease or condition (e.g., H I V disease or cerebral trauma).

Types of laws - common law

are derived from decisions that have been made in previous cases and evolve from court decisions resolving various issues - These laws may differ from state to state.

Kantianism

argues that the end result of an action does not make it right or wrong, but rather the motivation for an action and a sense of duty determines right and wrong.

Coordinator

clarifies ideas and suggestions that have been made within the group; brings relationship together to pursue common goals

negative symptoms - Asocial - impaired social interaction

clinging and intruding on the personal space of others, exhibiting behaviors that are not culturally and socially acceptable

Addiction

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

psychosis

condition that affects the way your brain processes information and causes you to lose touch with reality - you may beleive things that are not real - it is a symptom not an illness

When do you consider an independent bipolar disorder for medication or substance induced bipolar disorder?

consider an independent bipolar diagnosis if symptoms last about a month after cessation of acute withdrawal or severe intoxication

Antiparkinsonian agents may be prescribed to?

counteract EPS(anticholinergics, antihistamines, dopaminergic agonists)

The concepts of mental health and mental illness are?

culturally defined - cultural and religious beliefs can influence how a society views and treats mental health and mental illness - there are multiple definitions of mental health and mental illness

Legal considerations the nurse practice act

defines the legal parameters of professional and practical nursing.

Tuberhypophyseal

dopamine blockage causes increased prolactin release

negative symptoms - inappropriate affect

emotions are inconguent with the circumstances - laugh at death

Ethical principles - Autonomy

emphasizes the right of people to determine their own destinies and assumes that individuals are capable of making choices for themselves

gatekeeper

encourages acceptance of and participation by all members of the group

Nursing diagnosis for bipolar disorder - insomnia related to?

excessive hyperactivity and agitation

aggressor

expresses negativism and hostility toward other members; may use sarcasm in effort to degrade the status of others

Stressor

external pressure that is brought to bear on the individual

Family therapy

family is viewed as a system in which the members are interdependent

Predisposing factors to phobia - learning theory

fears are conditioned reponses and thus are learned by imposing reinforcements for certain behaviors

Nursing diagnoses - risk for suicide related to?

feelings of hopelessness and desperation

Trauma-related disorders treatment - cognitive therapy

for P T S D and ASD strives to help the individual recognize and modify trauma-related thoughts and beliefs. The individual learns to modify the relationships between thoughts and feelings, and to identify and challenge inaccurate or extreme automatic negative thoughts.

Premorbid behavior of the patient with schizophrenia can be viewed in?

four phases

Assessment tool used in family therapy

genogram - A family diagram that depicts each member of the family and shows connections between the generations.

Therapeutic relationships are?

goal oriented and directed at learning and growth promotion

In psychiatry, work with clients and families often takes the form of?

groups - with group work, not only can the nurse reach out to more people at one time, but those individuals also assist each other

Types of groups - group therapy

has a sound theoretical base, and leaders generally have advanced degrees in psychology, social work, nursing, or medicine - Form of psychosocial treatment in which a number of clients meet together with a therapist for purposes of sharing, gaining personal insight, and improving interpersonal coping strategies. Leaders of group therapy generally have advanced degrees in psychology, social work, nursing, or medicine.

Modern stress

has been described as a psychosocial state that is pervasive, chronic, and relentless. - This promotes susceptibility to diseases of adaptation

Rapport

implies special feelings on the part of both the patient and the nurse based on acceptance, warmth, friendliness, common interest, a sense of trust, and a nonjudgmental attitude.

Effects of alcohol on the body - esophagitis

inflammation and pain in the esophagus—occurs because of the toxic effects of alcohol on the esophageal mucosa. It also occurs because of frequent vomiting associated with alcohol abuse.

Predisposing factors of depression - the role of inflammation

inflammation is associated with stress and causes neurotransmitter dysfunction which can lead to depression

Special concerns for elderly people - psychological abuse

infliction of anguish, pain, or distress on an older adult through verbal or nonverbal acts

Therapeutic use of self

instrument for delivery of care to patients in need of psychosocial intervention

The program of therapeutic community - care is directed by an?

interdisciplinary team - An initial assessment is made by the admitting psychiatrist, nurse, or other designated admitting agent who establishes a priority of care. - A comprehensive treatment plan is formulated by the team

The need for education of healthcare providers - clients with mental illness who come to general healthcare settings are at risk for?

lack of treatment/appropriate referral. - May be related to lack of knowledge about symptom detection, stigmatization, and lack of awareness about counseling and referral services - Every nurse needs education about recognition of mental illnesses to perform competently in any nursing role.

Grief - the experience of guilt for having has a "love-hate" relationshup with the lost entity will?

lengthen the grieving process

Positive symptoms - associative looseness - concrete thinking

literal interpretations of the environment - if you tell someone they are walking on eggshells, then they will look for the eggshells - common in children

Treatment - psychological treatments - individual psychotherapy

long-term therapeutic approach; difficuly becasue of client's impairment in interperonal funcitoning

Mental illness definition

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

dominator

manipulates others to gain control; behaves in authoritarian manner

Stage 2 - acute mania

marked impairment in social and occupational functioning; usually requires hospitalization

Intimate partner violence - battering

may be defined as a pattern of coercive control founded on and supported by physical and/or sexual violence or threat of violence of an intimate partner

Whole Health begins with?

mental health

In psychiatry, therapy involving the milieu or environment, may be called?

milieu therapy, therapeutic community, or the therapeutic environment.

Sexual assault - profile of the victimizer - inadequate men

obessed with fantasies of sex that they believe cant be achieved without force

Maladaptive grief responses

occur when an individual cannot progress through the stages of grief to achieve resolution

Contracts

one party claims that the other party failed to fulfill an obligation and has breached their contract.

Negative symptoms - associated features - waxy flexibility

passive yielding of all movable parts of the body to any effort made at placing them in certain positions

Interpersonal communication - in the transactional model, both participants?

perceive each other, listen to each other, and simultaneously engage in the process of creating meaning in a relationship.

Positive symptoms of disorganized thought process - perseveration

persistent repetition of the same word or idea in response to different question - sit in corner and keeps saying hello over and over again

Adapting to levels of anxiety - anziety at the moderate to severe level that remains unresolved over an extended period can contribute to a number of?

physiological disorders - extended periods of repressed severe anxiety can result in psychoneurotic patterns of behaving

Predisposing factors - environmental influences - downward drift hypothesis

poor social condiitons seen as consequence of, rather than a cause of, schizophrenia - as they are less able to function, they will shift down socially

Predisposing factors - environmental influences - sociocultural factors

poverty has been linked with development schizophrenia - low socioeconomic class - more of schizophrenia causes you to be in lower class

Types of schizophrenia and other psychotic disorders - psychotic disorder due to another medical condition

prominent hallucinations and delusions are directly attribuable to a general medical condition

The Fourth, Fifth, and Fourteenth Amendments to the U.S Constitution

protect an individual's privacy. Most states have statues protecting confidentiality of client records.

The nurse-patient relationship is the foundation on which what is established?

psychiatric nursing - involves mutual learning - must recognize each other as unique and important

Types of schizophrenia and other psychotic disorders - schizoaffective disorder

schizophrenic symptoms accompanied by a strong element of symptomatology associated with mood disorders of either mania or depression - they have a mood component(depression/mania) in addition to psychotic symptoms(delusions, hallucinations)

Derealization

situation in which the individual loses a sense of the reality of the external world

Types of lawsuits that occur in psychiatric nursing - Invasion of privacy

stem from searching a client without probable cause

Sexual assault - in the controlled response pattern?

the feelings are masked or hidden, and a calm, composed, or subdued affect is seen.

Psychodrama - what is its purpose?

to provide the patient with a safe place in which to confront unresolved conflicts in an effort to progress toward resolution.

Interpersonal communication

transaction between the sender and the receiver. Both persons participate simultaneously.

individual psychotherapy

type of therapy specifically designed for bipolar disorder - helps regulate sleep wake cycles and daily activities

Predisposing factors to phobia - psychoanalytical theory

unconscious fears may be expressed in a symbolic manner as phobia

Ethical egoism

what is right is what is best for the individual making the decisions and that actions are based on what is advantageous to the decider.

Substance use disorder

when use of the substance interferes with their ability to fulfill role obligations, such as at work, school, or home. Often, the individual would like to cut down or control use of the substance, but attempts fail, and use of the substance continues to increase.

Avoiding liability - knowing the client

which includes helping the client become involved in his or her care, as well as understanding and responding to aspects of care in which the client is dissatisfied

Avoiding liability - practicing within the nurse's level of competence and scope of practice

which includes not only adhering to professional standards (those of the ANA and state boards of nursing) but also keeping knowledge and nursing skills current through evidence-based literature, in-services, and continuing education.

Sexual abuse may be considered a possibility when the parent or other adult caregiver:

• Is unduly protective of the child or severely limits the child's contact with other children, especially of the opposite sex. • Is secretive and isolated. • Is jealous or controlling with family members.

Other nursing concerns for clients of abuse include?

•Tending to physical injuries •Staying with the client to provide security •Assisting the client to recognize options •Promoting trust •Reporting to authorities when there is reason to suspect child abuse or neglect - Interventions should include explaining each assessment procedure, discussing options for support and assistance, stressing the importance of safety, and conducting a thorough interview with the child or adult.

ego defense mechanisms

psychological strategies that are unconsciously used to protect a person from anxiety arising from unacceptable thoughts or feelings

Developmental implications: childhood and adolescence treatment strategies

psychopharmacology - lithium - divalproex - carbamazepine - atypical antipsychotics

Extended periods of functioning at the panic level of anxiety may result in?

psychosis - Examples of psychotic disorders include schizophrenia, schizoaffective, and delusional disorders.

The length of the grief response is often extended when an individual has experienced a number of?

recent losses and when he or she is unable to complete one grieving process before another one begins

Managed care

refers to a strategy employed by purchasers of health services who make determinations about various types of services in order to maintain quality and control costs - In a managed care program, individuals receive healthcare based on need. Case management is used to achieve this goal.

Ethical principles - veracity

refers to the duty to be truthful. Clients have the right to know about their diagnosis, treatment, and prognosis.

Denial (defense mechanism)

refusing to believe or even perceive painful realities

Profound IDD

- 1% - require intensive support. May be able to communicate by verbal or other means. May have medical conditions that require ongoing nursing and therapy

Moderate IDD

- 10% - may be able to learn some basic reading and writing. Able to learn functional skills such as safety and self-help. Require some type of oversight/supervision

WATCHERS for anxiety

- Worry - Anxiety - Tension - Concentration problems - Hyperarousal/irritability - Energy loss - Restlessness - Sleep disturbance

Risk factors for suicide - religion

- Affiliation with a religious group decreases the risk of suicide. Catholics have lower rates than do Protestants or Jewish people.

Comments to avoid when comforting a friend

- "I know how you feel." We can never know how another may feel. Instead, it may be more helpful to ask your friend how he or she feels. - "Look at what you have to be thankful for." Your friend knows s/he has things to be thankful for, but part of grieving is being able to experience the feelings of sadness and loss. - "They are in a better place now." Your friend may or may not share your religious beliefs. It's best to keep your personal spiritual beliefs to yourself unless asked. - "This is behind you; it's time to get on with your life." Moving on is easier said than done. Grief has a mind of its own and works at its own pace. Giving room to grieve is important in the recovery process. - Saying, "You should..." or "You will..." Advice-giving, especially when unsolicited, is rarely helpful. Instead, you could begin your comments with: "Have you thought about..." or "You might..."

Planning/Implementation - powerlessness

- "the lived experience of lack of control over a situation, including a perception that one's actions do not significantly affect an outcome. - Encourage the client to take responsibility. - Help the client set goals. - Help the client identify areas of his or her life that they can and cannot control.

Severe IDD

- 5% - probably not able to read write, although they may learn self-help skills and routines. Require supervision in their daily activities and living environment

Planning and implementation - disturbed body image/low self-esteem

- Disturbed body image is defined as "confusion in mental picture of one's physical self." - Low self-esteem is defined as "negative self-evaluating/feelings about self or self-capabilities." - Goals should include verbally acknowledging the misperception of body image, and demonstrating an increase in self-esteem, and pursuing weight loss. Interventions include helping the client develop a realistic perception of body image. Promoting feelings of control, have the client recall coping patterns, and determining the client's motivation for developing healthier patterns.

Predisposing factors - psychodynamic theory

- Ego unable to intervene between id and superego - Overuse or ineffective use of ego defense mechanisms results in maladaptive responses to anxiety

How much anxiety is too much?

- When anxiety is out of proportion to the situation that is creating it - When anxiety interferes with social, occupational, or other important areas of functioning

Positive symptoms

- presence of problem behaviors(you do not see when someone is well) - delusions(thoughts not based in reality) - hallucinations(any sensation not based in reality) - disorganized thought process(evaluated through speech) - disorganized behavior(vatatonic, sterotypy, posturing, agitation)

Two twpes of substance-related disorders

- substance-use disorders - substance-induced disorders

Types of schizophrenia and other psychotic disorders - brief psychotic disorder

- sudden onset of symptoms - may or may not be preceded by a severe psychosocial stressor - lasts less than 1 month - return to full premorbid level of funcitoning

Planning/implementation - risk for injury

- vulnerable to physical damage due to environmental conditions interacting with the individual's adaptive and defensive resources, which may compromise health." - Goals should include stabilization of the client and avoiding physical injury. - Interventions to achieve these goals include obtaining a drug history, observe the client's behaviors and vital signs, and frequently orient the client to reality and the surroundings.

Nursing diagnosis for schizophrenia - self care deficit related to?

- withdrawal - regression - panic anxiety - perceptual or cogntive impairment - inability to trust

The Joint Commission has established specific standards regarding the use of seclusion and restraint. Some examples of current standards include:

1. Seclusion or restraint is discontinued at the earliest possible time. 2. Unless state law is more restrictive, orders for restraint or seclusion must be renewed every 4 hours for adults ages 18 and older, every 2 hours for children and adolescents ages 9 to 17, and every hour for children younger than 9 years. 3. An in-person evaluation must be conducted within 1 hour of initiating restraint or seclusion. 4. Patients who are simultaneously restrained and secluded must be continuously monitored by trained staff, either in person or through audio or video equipment. 5. Staff who are involved in restraining and secluding patients are trained to monitor the physical and psychological well-being of the patient.

The standards of practice for psychiatric nursing are written around the six steps of the nursing process - Nursing Interventions Classification(NIC)

A comprehensive, standardized language describing treatments that nurses perform in all settings and in all specialties. - N I C interventions are based on research and reflect current clinical practice.

Therapeutic communication techniques - reflecting

Directs questions or feelings back to patient so that they may be recognized and accepted

PTSD

A reaction to an extreme trauma, which is likely to cause pervasive distress to almost anyone, such as natural or man-made disasters, combat, serious accidents, witnessing the violent death of others, being the victim of torture, terrorism, rape, or other crimes - will experience it alone or in presence of others.

Legal right

A right that society has agreed upon and formalized into law

What do you need to avoid when using tricyclic antidepressants

Avoid smoking while receiving tricyclic therapy. Smoking increases the metabolism of tricyclics, requiring an adjustment in dosage to achieve the therapeutic effect.

How does EMDR work?

EMDR has a direct effect on the way the brain expereinces that are trapped in the nervous system - a trained therapist works with the individual to recall a disturbing thought, feeling or memory then bilateral stimulation

What is EMDR therapy?

EMDR stands for eye movement desensitization and reprocessing - it is a therapy proven to help reduce symptoms related to depression, trauma, PTSD, anxiety, addictions, phobias, other emotional problems

Predisposing factors - psychological factors - personality factors

Certain personality traits have been associated with an increased tendency toward addictive behavior. Some clinicians believe a low self-esteem, frequent depression, passivity, antisocial personality traits, the inability to relax or to defer gratification, and the inability to communicate effectively are common in individuals who abuse substances.

Depersonalization-Derealization Disorder

Characterized by a temporary change in the quality of self-awareness, which often takes the form of: - Feelings of unreality - Changes in body image - Feelings of detachment from the environment - A sense of observing oneself from outside the body

Bipolar disorder due to another medical condition

Characterized by an abnormally and persistently elevated, expansive, or irritable mood and excessive activity or energy that is judged to be the result of direct physiological effects of another medical condition

Persecutory type

Characterized by delusions in which the person is being persecuted or ill treated, which may trigger violent behavior

Grandiose type

Characterized by delusions of inflated self-worth, power, knowledge, or a special relationship to a deity or famous person

Genetic Therapeutic Approaches: Separation Anxieyt Disorder - family therapy

Children cannot be separated from their family. Therapy for children and adolescents must involve the entire family if problems are to be resolved. Parents should be involved in designing and implementing the treatment plan for the child and should be involved in all aspects of the treatment process.

Assessment of ASD - impairment in social interaction

Children with A S D have difficulty forming interpersonal relationships with others. They show little interest in people and often do not respond to others' attempts at interaction. As infants, they may have an aversion to affection and physical contact. As toddlers, the attachment to a significant adult may be either absent or manifested as exaggerated adherence behaviors. In childhood, there is a lack of spontaneity manifested in less cooperative play, less imaginative play, and fewer friendships.

Special concerns of elderly people - attitudinal factors

Elderly individuals in general are opposed to the use of institutions. Many view them as "places to go to die."

Factors that increase your risk for developing an anxiety disorder - drugs or alcohol

Drug or alcohol use or misuse or withdrawal can cause or worsen anxiety.

Eight core functions of EHRs - health information and data

E H R's would provide more rapid access to important patient information, thereby improving care providers' ability to make sound clinical decisions in a timely manner.

Eight core functions of EHRs - administrative processes

Electronic scheduling systems increase the efficiency of healthcare organizations and provide more timely service to patients.

Sexual abuse of a child

Employment, use, persuasion, inducement, enticement, or coercion of any child to engage in, or assist any other person to engage in, any sexually explicit conduct or simulation of such conduct for the purpose of producing any visual depiction of such conduct; or the rape, and in cases of caretaker or inter-familial relationships, statutory rape, molestation, prostitution, or other form of sexual exploitation of children, or incest with children.

Active listening acronym - SOLER - E:

Establish eye contact. Direct eye contact is another behavior that conveys the nurse's involvement and willingness to listen to what the patient has to say. The absence of eye contact, or the constant shifting of eye contact, gives the message that the nurse is not really interested in what is being said.

Motivational Interviewing

Evidence-based, patient-centered style of communication that promotes behavior change by guiding patients to explore their own motivation for change and the advantages and disadvantages of their decisions

Nursing liability - negligence

Failure to exercise the care toward others that a reasonable or prudent person would do in the circumstances

Basic Assumptions of Milieu Therapy - Inappropriate behaviors are dealt with as they occur

Individuals examine the significance of their behavior, look at how it affects other people, and discuss more appropriate ways of behaving in certain situations.

Functions of a group - camaraderie

Members of a group provide the joy and pleasure that individuals seek from interactions with significant others.

Treatment modalities - safe house or shelter

Most major cities in the United States now have safe houses or shelters where women can go to be assured of protection for them and their children. These shelters provide a variety of services, and the women receive emotional support from staff and each other. Most shelters provide individual and group counseling; help with bureaucratic institutions such as the police, legal representation, and social services; child care and children's programming; and aid for the woman in making future plans, such as employment counseling and linkages with housing authorities.

Therapeutic nurse-patient relationship - Working phase - transference

Occurs when the patient unconsciously displaces (or "transfers") to the nurse feelings formed toward a person from the past - can interfere with the therapeutic interaction when the feelings being expressed include anger and hostility. - may show anger as uncooperativeness and resistance to the therapy. Can also take the form of overwhelming affection for the nurse or excessive dependency on the nurse

Willy Wonka

Okay, so he's a fictional person, but he definitely meets almost all of the criteria for schizotypal personality disorder, including unusual perceptions and bodily illusions; suspiciousness and paranoid ideation; odd and eccentric behavior and appearance; magical thinking; lack of close friends, and more. Willy Wonka is the main character in the popular kids' movie, Willy Wonka and the Chocolate Factory.

Screening priorities

Other issues may arise, but three issues are considered prevalent, high-risk priorities for screening in all patients: - Trauma history and violence - Suicide risk - Substance use disorders

Factors that increase your risk for developing an anxiety disorder - other mental health conditions

People with other mental health disorders, such as depression, often also have an anxiety disorder.

Adolescence - most common precipitant to adolescent suicide

Perception of abandonment by parents or close peer relationship

Effects of alcohol on the body - peripheral neuropathy

Peripheral neuropathy results in pain, burning, tingling, or prickly sensations of the extremities. Researchers believe it is the direct result of deficiencies in the B vitamins, particularly thiamine. This is reversible with abstinence from alcohol and restoration of nutritional deficiencies, but permanent muscle wasting and paralysis can occur with continued use.

Treatment modalities for personality disorders - psychopharmacology

Psychopharmacology may be helpful in some instances. Although these drugs have no effect in the direct treatment of the disorder itself, some symptomatic relief can be achieved. Among the cluster A disorders, there has been some limited evidence of the benefits of antipsychotic medication in the treatment of schizotypal personality disorder, but the risk-to-benefit ratio is unclear.

Compulsions

Repetitive ritualistic behavior or thoughts, the purpose of which is to prevent or reduce distress or to prevent some dreaded event or situation

Less Primitive, More Mature Defense Mechanisms

Repression Displacement Intellectualization Rationalization Undoing

Grief

Subjective state of emotional, physical, and social responses to the loss of a valued entity - Loss may be real or perceived.

Mental health definition

Successful adaptation to stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are age-appropriate and congruent with local and cultural norms

What is depression?

alteration in mood that is expressed by feelings of sadness, despair, and pessimism. There is a loss of interest in usual activities, and somatic symptoms may be evident. Changes in appetite, sleep patterns, and cognition are common.

How was bipolar disorder defined in the past?

bestial madness characterized by rapid onset and remission, with agitation and irritability

Medication for specific disorders - Panic and GAD - antihypertensive agents

beta blockers (propranolol) and alpha2-receptor agonists (clonidine) in the amelioration of anxiety symptoms

Nursing diagnosis for bipolar disorder - disturbed sensory perception related to?

biochemical alterations in the brain and to possible sleep deprivation, evidenced by auditory and visual hallucinations

hypothermia

body temperature below 96.8

negative symptoms - avolition - deterioriation in appearance

impaired personal grooming and self-care activities

Nursing diagnosis for schizophrenia - social isolation related to?

inability to trust, panic anxiety, weak ego development, delusional thinking, regression

Predisposing factors - theories of suicide - interperonal therory: Durkheims three social categories - egoistic suicide

is the response of the individual who feels separate and apart from the mainstream of society. Integration is lacking, and the individual does not feel a part of any cohesive group (such as a family or a church).

The need for education of healthcare providers - nurses in any nonpsychiatric setting must have clear?

working knowledge of the impact of depressive disorders in treating other physical illnesses. - Depression affects 1 in 5 women and 1 in 10 men during their lifetime. - Depression is a risk factor for cardiovascular disease, metabolic syndrome, diabetes, dementia, asthma, arthritis, and hyperlipidemia.

Outcomes for the client who has been abused?

•Has received immediate attention to physical injuries. •Demonstrates trust in the primary nurse by discussing abuse through the use of play therapy. •Is demonstrating a decrease in regressive behaviors.

Outcomes for the client who has been physically battered?

•Has received immediate attention to physical injuries. •Verbalizes assurance of his or her immediate safety. •Discusses life situation with the primary nurse. •Can verbalize choices from which he or she may receive assistance.

The following manifestations may be evident in the days and weeks after the attack:

•Contusions and abrasions about various parts of the body • Headaches, fatigue, sleep pattern disturbances • Stomach pains, nausea, and vomiting • Vaginal discharge and itching, burning upon urination, rectal bleeding, and pain • Rage, humiliation, embarrassment, desire for revenge, and self-blame • Fear of physical violence and death

Outcomes for the client who has been sexually assaulted?

•Is no longer experiencing panic anxiety. •Demonstrates a degree of trust in the primary nurse. •Has received immediate attention to physical injuries. •Has initiated behaviors consistent with the grief response.