350 FINAL
What are overt statements of suicide?
"I can't take it anymore. ""Life isn't worth living anymore. ""I wish I were dead. ""Everyone would be better off if I died."
What are covert statements of suicide?
"Its ok now, soon everything will be fine "I won't be a problem much longer" "Things will never work out" "How do I give my body to science?"
What was the mindset for mental health prior to 1840?
"No treatment" for mental health illnesses - People removed from the community and institutionalized
What is a PICOT question?
(P)population, (I)intervention or issue, (C)comparison of interest, (O)outcome, and (T)time. - The essential components of a research question
Psychopharmacology in Depression: Monoamine oxidase inhibitors (MAOIs)
(first "antidepressant" drug , isoniazid, used to treat tuberculosis.
Mental Health
***
Women's Health
***
What do the different types of home health agencies do?
*****
True or false, Staff has little control over the milieu
******
What is evaluation?
- (Continued Monitoring) - Outcomes - Physical needs - Psychosocial needs - Financial needs - Client and family satisfaction
What symptoms of anorexia constitute admission into hospital?
- 30% weight loss in 6 months or rapid weight loss - Inability to gain weight (outpt tx) - Hypothermia - HR < 40 BPM - Systolic BP < 70 - Arrhythmias - Hypokalemia - Suicidal, Cutting, Out of control - Overuse of laxatives, diuretics, street drugs - Depression - Psychosis - Family dysfunction - Failure to comply with treat
Aripriprazole
- 3rd generation antipsychotic - Used for schizophrenia, bipolar, depression
What are the basic elements of a nursing malpractice lawsuit?
- A duty to the patient existed, based on the recognized standard of care. - A breach of duty occurred. - The client was injured. - Injury was directly caused by breach of a standard of care.
Family health
- A focus on the family is vital in promoting the health of the individual as well as the health of the community. - Knowledge of family structure and functioning is fundamental to implementing the nursing process with families in the community. - Nurses need to go beyond the individual and family and to understand the complex environment in which the family functions to be effective in reducing family health risks.
What is evidence-based public health?
- A public health endeavor in which there is an informed, explicit, and judicious use of evidence that has been derived from any of a variety of science and social science research and evaluation methods - Making decisions on the basis of the best available evidence, using data and information systems, applying program planning frameworks, engaging the community in decision making, conducting evaluations, and disseminating what has been learned
What are major medical complications of hallucinogens?
- AIDS - Hepatitis - Cardiac Arrest - Coma/Seizures - Respiratory Arrest - Abscess/Pulmonary Emboli
What are major medical complications of opiates?
- AIDS - Hepatitis - Cardiac Arrest - Seizures/Coma - Respiratory, Arrest/Pulmonary, Emboli - Abscess/Septicemia
What are major physical complications of crack and cocaine?
- AIDS - Hepatitis - Endocarditis/Cardiac Arrest - Seizures/Respiratory Arrest - Pulmonary Emboli - Abscess/Septicemia
Steroids?
- Abused by many athletes at all levels - Glamorized in some fitness magazines - "Allowed" by some coaches or parents in order to give the athlete an "advantage" - Side Effects: sterility, premature closure of growth plates, aggressiveness, acne, irreversible connective tissue damage, masculinization in women
What is the nurse's responsibility in nurse-client relationships?
- Accountability: for what you do as a nurse and what you don't do - Focus on the clients needs at all levels - Clinical competence like meds, skills, assessment - Delayed judgment - Supervision
What are the types of rape?
- Acquaintance rape - Marital rape - Statutory rape
General Adaptation Syndrome (GAS) 3 stage process
- Acute Stress (alarm): adrenal glands release catecholamine adrenalin. Body response: increase in heart rate, respirations and blood pressure, dilated pupils, blood increases to vital organs, production of corticosteroids, endorphins are released - Resistance: (adaptation): Sustained resistance to the stress - Exhaustion: Stress overcomes. Stress that is chronic produce psychological and physiological Responses - If the body continues to fight then it leads to resistance
Stage II of mania
- Acute mania - Marked impairment in functioning; usually requires hospitalization - Elation and euphoria; a continuous "high" - Flight of ideas; accelerated, pressured speech - Hallucinations and delusions - Excessive motor activity, little need for sleep - Social and sexual increased
How long is a crisis?
- Acute, time-limited occurrences - Usually last 4-6 weeks
What are characteristics of a resilient child?
- Adaptive temperament - Ability to form nurturing relationships with surrogate parent figures (Even though there's chaos) - Ability to distance self from chaotic parents and family - Good social intelligence and problem solving skills
What is implementation?
- Advocate for client's interests and needs - Contact health care providers - Provide referral information - Coordinate services and negotiate prices
Risk factors for suicide: Religion
- Affiliation with a religious group decreases risk. - Rates among Protestants and Jews have been higher than among Roman Catholic or Muslim populations. - Religious affiliation is associated with decreased suicide attempts, in both general population & in those with a mental illness
What is the sociocultural theory of abuse/violent behavior?
- Aggressive behavior primarily a product of one's culture and social structure. - 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; ie: prolonged unemployment, family breakdown, exposre to violence in community
What are the side effects of EPS?
- Akathisia - Acute dystonia - PseudoParkinsonism - Tardive Dyskinesia
Leadership styles: Laissez-faire
- Allows people to do as they please - There is no direction from the leader, the leaders approach is non-involvement - Goals are undefined - Members become frustrated and confused and productivity and morale are low
What are examples of primary dementia?
- Alzheimer's - Vascular dementia - Pick's disease - Lewy body disease
Stimulants
- Amphetamines: Ecstasy (MDMA) - Synthetic Stimulants: Bath Salts - Non-amphetamine Stimulants: Methylphenidate (Ritalin) - Cocaine - Caffeine - Nicotine - Induced stimulation by potentiation of norephinephrine, epinephrine or dopamine - Effects: CNS, cardiovascular/pulmonary, gastrointestinal/renal, sexual dysfunction
What does the amygdala regulate?
- Amygdala: regulates anger, judgement of events - Stimulation produces rage
What are nursing interventions for the pre-assaultive stage of violence?
- Analyze client and situation - Use verbal techniques of de-escalation - Show respect for client's personal space - Interact calmly - Spend adequate time with the client - Ensure quiet environment - Ensure your safety
What are the psychological theories on suicide?
- Anger turned inward - Hopelessness & other symptoms of depression - Desperation / guilt - History of aggression and violence - Shame/ humiliation
What are the different types of crisis?
- Anticipated Life Transitions - Dispositional Crisis - Traumatic Stress - Maturational/Developmental - Crisis Reflecting Psychopathology - Psychiatric Emergencies
How do antidepressants work for anxiety?
- Antidepressants are the first line therapy for anxiety - S/s of anxiety and depress are similar because they use the same pathways - NE and S and DA are the neurotransmitters involved
What medications are used for anxiety?
- Antidepressants: Celexa, Lexapro, Prozac, Paxil, Zoloft, Elavil, Anafranil (when used in Bipolar pts can cause manic episodes) - Anxiolytics: Xanax, Librium, Klonopin, Valium, Ativan - Antihistamines: Atarax, Vistaril Dilates the blood vessels to relax smooth muscle - Beta Blockers: Inderal Lowers blood pressure - Anticonvulsants: Tegretol, Depakote, Neurontin
What types of drugs are considered to be chemical restraints?
- Antipsychotics - Antianxiety - Minor tranquilizers - Sedatives - Hypnotics - Antidepressants
What disorders are under cluster B?
- Antisocial personality disorder - Borderline personality disorder - Histrionic personality disorder - Narcissistic personality disorder
What is an example of healthy anxiety?
- Anxiety helps motivate people to achieve goals - As long as the individual is adaptive to the anxiety and its not interfering with function it is healthy Ex: performing a solo in front of people, or speaking at a large conference for work
What are late reactions to disaster?
- Apathy and depression - Insomnia - Powerlessness - Irritable - Post-traumatic stress syndrome - Exacerbation of chronic
What are behavior indicators of neglect by the adult?
- Appears to be indifferent to the child - Seems apathetic or depressed - Behaves irrationally or in a bizarre manner - Is abusing alcohol or other drugs
Inhalants?
- Aromatic Hydrocarbons: altered consciousness, known as huffing or bagging - Inhaled through a plastic bag or inject spray down the throat - Loss of coordination, slurry speech, euphoria, hypoactive reflexes, double vision, cardiac, severe headache, brain damage or death
What is a nontheraputic communication form that minimizes the client?
- Asking why questions will minimize the client - Belittling such as telling the client you're okay or to snap out of it also minimizes what the client is feeling
What are interventions for Alzheimer's?
- Assess for safety - Maintain attitude of unconditional positive regard - Follow guidelines for communicating with clients with dementia - Teach family and clients about aspects of disease
Assessment of Personal Coping Skills
- Assess level of anxiety - Common coping mechanisms - Is there potential for suicide or homicide? Ex: "What do you usually do to feel better?" "What do you think would help your situation?" "Have you thought of killing yourself or someone else? If yes, do you have a plan?"
What are risks of suicide?
- Assess the client's thought, threats or attempts - Circumstances and motivation at the time of suicidal thoughts or behaviors - Concepts about suicide and death - Experiences around death - Feelings of depression, anger, guilt or rejection
What are interventions for delirium?
- Assess vital signs and neuro status - Maintain a hazard-free environment at all times - Orient client - Communicate with simple/direct/descriptive statements
What is the role of the nurse during a crisis?
- Assessment of patient and situation - Planned therapeutic interventions - Provide the interventions - Evaluation for crisis resolution
What is the most common comorbid condition of bipolar disorders in childhood and adolescents?
- Attention deficit/hyperactivity disorder (ADHD) is the most common comorbid condition. - ADHD agents may exacerbate mania and should be administered only after bipolar symptoms have been controlled.
What behaviors are present in avoidance personality disorder?
- Avoids interpersonal activities fearing criticism - Unwillingness to get involved with people unless certain they will be liked - Is restrained in intimate relationships for fear of being ridiculed or shamed - Preoccupied with being criticized in social situations - Feelings of inadequacy are present with new interpersonal relationships - Views self as inferior to others •Afraid of being embarrassed in new situation - Parental & Peer rejection
Sedatives/Hypnotics/Anxiolytics
- Barbiturates (ex: Phenobarbital) - Non-barbiturate Hypnotics (ex: Temazepam) - Antianxiety Agents (ex: Alprazolam)
What factors may influence schizoid personality disorder?
- Based on genetic predisposition to shyness - Raised in a cold & neglectful atmosphere - Relationships are unsatisfying & unnecessary
What is the promotion of a therapeutic community?
- Basic physiological needs are met i.e have a temp of 102, need to treat and investigate - Physical facilities are conducive to treatment - Democratic community - Responsibilities are assigned like chores - Structured program for social or work - Community and families included
What is the typical profile of the victim of IPV?
- Battered women represent all age, racial, religious, cultural, educational, & socioeconomic groups, married or single - Low self-esteem - Inadequate support systems - Some grew up in abusive homes
What are triggers to individuals with trauma?
- Bedtime - Room Checks - Large Men - Yelling - Not being listened to - Not having control - Darkness
What factors may influence histrionic personality disorder?
- Begins at 3-5 years of age - Overly attached to the opposite sex parent - Fear retaliation by the same sex parent - Emotional expressiveness & egocentricity
What are nursing interventions for ADHD?
- Behavior Modifications - Special Ed Programs - Psychotherapy - Play Therapy - Pharmaceutical Agents: Ritalin or mixed amphetamines
Individuals may provide behavioral & verbal clues about their suicidal ideas or acts, what would be examples?
- Behavioral clues include giving away prized possessions, getting financial affairs in order, writing suicide notes, or sudden lifts in mood (may indicate a decision to carry out the intent). - Verbal clues may be both direct and indirect.
Intermittent Explosive Disorder
- Behavioral outburst in adults 18 years and older Triggered by anything - Spectrum being upset to remorseful - Labile Mood
Assault stage meds?
- Benzodiazepines: Ativan, Xanax, Valium - Antipsychotics: Haldol, Thorazine - Aytpical Antipsychotics: Risperdal, Zyprexa, Geodon - Combination Injection (antipsychotic and antianxiety: Hadol, Ativan, Benadryl, Cogentin (H-ABC or ABC)
What are the 3 assessment areas in a family health risk appraisal?
- Biological and age-related risks (Genetics, Life Transitions) - Environmental risks (Neighborhood, economic) - Behavioral risks
What factors may influence borderline personality disorder?
- Biological predisposition - Possibly resulting from early abandonment - View others and self as unstable
TCAs
- Block the re-uptake of NE - Increased side effects including hypotension - Also block histamine as well causing anticholnergic effects - Drug example: amtriptyline
Distress/Eustress Theory
- Body is unable to determine negative or positive stimuli - Distress: negative input: anxiety, depression, confusion, helplessness and fatigue - Eustress: positive input: happy, hope, purpose
Maintenance roles
- Builds cohesiveness, helps people feel valued. Ex: 1. compromiser: relieves conflict within the group by assisting members to compromise 2. encourager: offers recognition and acceptance of others' ideas 3. follower: listens attentively; is a passive participant 4. gatekeeper: encourages acceptance of and participation by all members 5. harmonizer: minimizes tension during conflict
Psychosis in Anxiety
- Can be present with anxiety or grief - Presents with minimal distress - Unaware of maladaptive behaviors - Unaware of psychological problems - Flight from reality into less stressful world or attempting to adapt to stressful situation
Assault stage and restraints
- Can only be used if client is a danger to self or others - Can only be used when least restrictive methods have been tried and failed - Require a physician's order and assessment Order includes reason client has been confined, how he or she should be confined, maximum time of confinement and criteria for release - Client must be directly observed by a staff member for safety during the entire confinement - Licensing and accreditation agencies guide the times for assessment, hydration, agencies guide the times for assessment, hydration, toileting needs, nutrition, comfort and documentation
What are symptoms of re-feeding syndrome?
- Cardiac dysrhythmias - Severe bradycardia - Hypotension - Psychological problems: Depression, obsessive symptoms and social phobias
What are risk factors for dementia?
- Cardiovascular disease - Social and mental disengagement - Unhealthy diet - Head trauma - HIV - Neurological diseases - Alcohol/drug dependency
What are the 4 principles of cultural competence?
- Care is designed for the specific client - Care is based on the uniqueness of the person's culture and includes cultural norms and values - Care includes self-employment strategies to facilitate client decision making in regard to health behavior - Care is provided with sensitivity and is based on the cultural uniqueness of clients
ADHD - Hyperactivity
- Careless mistakes in homework - Not listening when spoken to - Dislikes tasks that require mental focus - Easily distracted
What are biological predisposing factors to sexual arousal disorders?
- Certain medications (decreased arousal in women): - Various medical conditions may cause erectile disorder (ED) in men: *** - Medications (ED) - Chronic alcohol use
Major depression in children
- Change in behavior form the norm - Sad or depressed mood - Lack of pleasure (anhedonia): Bad, Gloomy, Empty - Bland or "plastic smile" - Pervasive boredom nSocial withdrawal (does not want to play) - Somatic Complaints: poor sleep, appetite, stomach aches - Persistent irritability
How is dysthymic disorder characterized?
- Characteristics of persistent depressive disorder, or dysthymia, are similar and perhaps milder than MDD. - There is no evidence of psychotic symptoms. - The essential feature is a chronically depressed mood (or possibly an irritable mood in children or adolescents) for most of the day, more days than not, for at least 2 years (1 year for children and adolescents).
Bipolar II disorder
- Characterized by bouts of major depression with episodic occurrence of hypomania - Has never met criteria for full manic episode
What is the biological theory of addictions?
- Children of alcoholic parents are 3-4 more times likely to also become substance abusers - Alcohol acts on GABA receptors: Produces a morphine-like substance in the brain which leads to addictions - Cocaine and Amphetamines act on dopamine which then increases heart rate and blood pressures
Cyclothymic disorder
- Chronic mood disturbance, at least 2-year duration - Numerous episodes of hypomania & depressed mood of insufficient severity to meet bipolar I or II criteria
Bipolar I disorder
- Client experiences, or has experienced, a full syndrome of manic or mixed symptoms. - May also have experienced episodes of depression
When may informed consent not be required?
- Client is mentally incompetent to make a decision and treatment is necessary to preserve life or avoid serious harm - When refusing treatment endangers the life or health of another - During an emergency in which a client is in no condition to exercise judgement - When the client is a child (consent from parent) - If full disclosure would hinder or complicate treatment, cause severe psychological harm, or be so upsetting as to render a rational decision by the client
What are splitting behaviors in BPD?
- Client labels 1 person "all good", everyone else is "all bad" - When needs are not met "all good" person becomes "all bad" - New person becomes "all good" - Creates conflict among staff
What are the 2 basic goals of crisis interventions?
- Client safety- priority concern: Is there a need for external controls? - Anxiety Reduction: Feeling safe decreases anxiety
What are the guidelines for the use of chemical restraints?
- Client with cognitive disorder or dementia presents a danger to self or others - Psychotic symptoms cause the client "frightful distress"
What is the assessment for delirium?
- Cognitive and perceptual disturbances - Physical needs (safety) - Mood and behavior - Establish baseline by talking with family
What is Lewy body demenita?
- Combination of Alzheimer's and Parkinson's - Extra protein within the nucleus of the cells in the brain
How can we decrease conflict with staff with splitting behaviors in BPD?
- Communicate openly at staff meetings - Ongoing clinical supervision - Additional education to staff
What are the 2 victim responses to rape?
- Compounded rape reaction: includes signs of depression, anxiety, substance abuse, psychotic behavior - Silent rape reaction: tells no one about the assault, unresolved sexual trauma, overwhelming emotional burden
What are long term effects of stress?
- Compromise of the immune system - Diseases: Cancer, diabetes, ulcers, eczema, atherosclerosis, kidney and liver disease - Chronic anger and anxiety - Headaches - Obesity - Chronic muscle tension
Hoarding disorder
- Condition that makes it painful for individuals to get rid of belongings - Obsession with personal affects and collections - Person may be unaware of problem - Overtakes living space - Alienated from others - More women than men seek treatment
What are behavior manifestations of Alzheimer's?
- Confabulation - Perseveration - Aphasia - Apraxia - Agnosia
Substance-induced depressive disorder
- Considered to be the direct result of physiological effects of a substance - Depressed mood associated w/intoxication or withdrawal
What are indicators of emotional abuse by the adult?
- 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
What are the requirements for use of physical restraints?
- Consult physical/occupational therapist - Use least restrictive measures - Physician's order is required - Consent of family - Document - Must be time limited - Attempts at alternative approaches must be documented - Ongoing observation - Care interventions (food, toileting)
What is education related to antidepressants?
- Continue to take medication for 4 weeks. - Do not discontinue medication abruptly. - Report sore throat, fever, malaise, yellow skin, bleeding, bruising, persistent vomiting or headaches, rapid heart rate, seizures, stiff neck and chest pain to physician.
Seclusion of children
- Controversial - Reflects staff lack of confidence in their ability to handle the behavior - Perceived as a punishment - Terrifying experience
What are advantages of psychotherapy groups?
- Cost effective - Client is less isolated - Clients receive feedback from peers (universality) - Teaching problem-solving techniques i.e stress coping
What are the 3 stages of developing cultural competence?
- Culturally incompetent - Culturally sensitive - Culturally competent
How can culture and ethnic differences make a child vulnerable?
- Culture shock - Cultural conflicts - Lack of cultural role models - Difference in cultural expectations - Presence of stressors - Lack of support from the dominant culture
What does the temporal lobe do?
- Damage or dysfunction can cause a person to become aggressive - Can be seen after a seizure
What are biological predisposing factors to sexual desire disorders?
- Decreased level of serum testosterone in men - Elevated levels of serum prolactin in men & women - Some medications (e.g., selective serotonin reuptake inhibitors) - Alcohol, cocaine
Types of Crisis: Psychiatric Emergencies
- Deemed incompetent - Problem solving skills not intact - No responsibility for behaviors - Under the influence of substances - Suicidal - Homicidal
What is the psychological theory of addiction?
- Defense against anxious impulses - Oral regression (Anxious- smoke a cigarrete- get that oral fixation to reduce anxiety) - Self medication to alleviate depression
What is the neurochemical factor of suicide?
- Deficiency of serotonin - Only two biological factors had statistical significance: 1. Cytokines (anti-inflammatory response chemicals) 2. Low levels of fish oil nutrients (including omega-3)
What are communication disorders?
- Deficits in language - Difficulty speaking and/or understanding language
Types of Crisis: Adventitious: Traumatic Stress
- Definition: Unexpected external stressor. No control! - Not a part of every day life - Debriefing needed for all ages
What are delayed stress reactions?
- Delayed stress reactions- often exhausted - Mood swings - Often wish to return to disaster site - Deny need for rest - Do not want to leave the site - Difficulty remembering & concentrating - Need for debriefing & support
Pyromania
- Deliberate fire setting - Repeated actions - Tension or Anxiety prior to starting fire - Pleasure/relief when starting fires, witnessing a fire or when cleaning up a fire - Done to satisfy pleasure
What are examples of positive symptoms of schizophrenia?
- Delusions - Paranoia - Magical thinking - Loose associations - Neologisms - Clang associations - Word salad - Circumstantiality - Tangentiality - Perseveration - Echolalia
What are psychological changes with drug addiction?
- Denial/Minimizing - Depression - Anxiety - Dependency - Helpless and Hopelessness - Low Self Esteem
What are the Kubler Ross 5 stages of grief?
- Denial: Shock and disbelief, disassociative state - Anger: Envy and resentment toward individuals not affected by the loss - Bargaining: Agreement with God in an attempt to reverse or postpone the loss - Depression: Intense sense of loss and feelings of sadness and depression - Acceptance: Final stage brings feelings of peace regarding the loss
Cannabis
- Depressant and hallucinogenic - Desired effect: euphoria, detachment and relaxation - Other effects: talkativeness, slowed perception of time, inappropriate hilarity, heightened sensitivity - Long term effects: lethargy, anhedonia, poor concentration, loss of memory
Premenstrual dysphoric disorder (PMDD)
- Depressed mood - Anxiety - Mood swings - Irritability, increased interpersonal conflicts - Decreased interest in activities - Symptoms begin during week prior to menses, start to improve within few days after the onset of menses, become minimal or absent in the week postmenses
How is major depressive disorder (MDD) characterized?
- Depressed mood or 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
Epidemiology of Depression: Age and Gender
- Depression: more prevalent in women than in men by about 2 to 1 & more common in young women than in young men. - Gender differences: less pronounced until age 65, after age 65, women are again more likely to be depressed than are men.
What are treatment options for chemical dependency?
- Detoxification - Dual-diagnosis treatment (mental illness and substance abuse - Psychotherapy - Relapse prevention - Self-help groups for client and families - 12-step - Residential Treatment (Rehab) - Halfway Houses - Intensive outpatient - Outpatient drug free programs - Employee Assistance Program
Developmental disorders
- Developmental delays in early childhood - Regression after normal development - Impairments can be in a single area: speech, cognitive abilities, physical abilities - Problems with: ADLs, safety, and communication/socialization - Spectrum of deficits - Intellectual Developmental Disorders (IDD)
What behaviors are present with dependent personality disorder?
- Difficulty making day to day decisions - Needs others to assume responsibility for major areas of life - Difficulty disagreeing with others, fear loss of support - Difficulty initiating projects on their own - Goes to excessive lengths to receive support of others - Feels helpless when alone - Urgently seeks another relationship when one relationship ends - Preoccupied with having to care for self - Chronic illness & physical punishment
ADHD - Impulsivity
- Difficulty waiting for his/her turn - Interrupts others - Not aware of dangerous situations
What are indicators by the child of sexual abuse?
- Difficulty walking or sitting - Sudden refusal to change into gym clothes/ participate in physical activities - Reports nightmares/ bedwetting, quick attachment to strangers - Experiences a sudden change in appetite, runs away - Bizarre, sophisticated, or unusual sexual behavior - Pregnancy or contracts a STD (frequently < age 14
What are signs of abuse with crack, cocaine, and amphetamines?
- Dilated pupils - Dryness of the nasal cavity - Excessive motor activity - Euphoric State - Confusion
When assessing client's suicide ideation, what must be identified?
- Distinguish ideas (thoughts) - Plans (intentions) - Attempts (behavior)
What are the general side effects of psychotropic medications?
- Disturbance in movement: "cogwheeling" jerking movements - Depressed respiration: CNS slowed down - Slurred speech - Weight gain - EPS: m. spasms, ridgity, bradykinsia. benzotropine is the antidote
What are negative symptoms of schizophrenia?
- Disturbances in affect: feeling state or emotional tone - Anergia - Lack of abstract thinking - Apathy - Avolition - Anasognosia - Waxy flexibility - Posturing - Pacing/rocking - Regression
Dissociative Disorders
- Disturbances in the normally well-integrated continuum of consciousness, memory, identity and perception - Common for people involved in violence or PTSD
What are the positive symptoms of schizophrenia?
- Disturbances in thought content - Disturbances in thought processes manifested in speech
How do people with personality disorders see themselves?
- Do not see themselves as having a problem - Believe the problems started with other people - They are unaware that they relate to others in an unusual way
What behaviors are present with schizoid personality disorder?
- Does not enjoy close relationships, including family - Chooses solitary activities - Little interest in sexual experiences - Takes pleasure in few activities - Lacks close friends - Is indifferent to the praise or criticism of others - Shows emotional coldness, detachment or flattened affect - Detachment from social relationships - Restricted range of interpersonal emotions
Binge eating episodes are related with three or more of what?
- Eating more quickly than a normal individual - Eating until you feel painfully full - Eating substantial amounts of food when you do not feel physically hungry - Eating alone because of being self-conscious by the quantity of food the individual is eating - Feeling appalled with oneself, depressed, or very guilty after overeating
What are signs and symptoms of anorexia?
- Emaciation & Dry Skin - Dehydration - Cardiac Arrhythmias - Decreased Blood Pressure - Increased Urine Concentration - Enlarged Parotid Glands if Binge - Purging - Dental Caries if Binge Purging - Lanugo - Mottled Cool Skin
Adjustment Disorder
- Emotional response to an identifiable stressor - Decreased school performance - Temporary changes in social relationships
What is anger?
- Emotional response to perception and frustration that is a threat to one's need - The expression of anger is learned - Anger can be emotional or physical
What are medical problems associated with chemical dependency?
- Esophagitis - Gastritis - Pancreatitis - Hepatitis - Cirrhosis of the liver - Anemia - Tuberculosis
How does the nurse limit the setting during anger/aggression?
- Establish clear objectives and limits - Explain which behaviors are inappropriate - Explain why the behavior is inappropriate - Give reasonable choices and consequences. State the positive choice first - Allow time for the client to respond - Follow through with the consequences - Consistently enforce consequences - Use active listening skills - Avoid power struggles
What are predisposing factors to gender dysphoria?
- Etiology of transgender identity is unknown. - No significant evidence linking this condition to hormone or chromosome variations - Some small postmortem studies involving brain tissue - Gender roles are culturally influenced. - No clear evidence that psychological factors/ family dynamics cause gender dysphoria - Researchers have observed: - Many children who show gender-nonconforming behavior do not grow up to become transgender. - Many people who identify themselves as transgender in adulthood were not identified as gender nonconforming in childhood.
What are the 4 intoxication phases of heroin (opiate)?
- Euphoria (rush): flush face and deep voice - The High: Peaceful, may last for hours - The Nod: escape from reality: lethargic or unconsciousness - Detox: Seeking more drug (Avoid withdrawal!)
Ecstasy, MDA (love) and MDE (Eve) side effects?
- Euphoria and increased energy - Increased self confidence - Increased sociability - Feeling close to others
What are effects of opiates?
- Euphoria, followed by apathy, dysphoria, psychomotor agitation/retardation, impaired judgement - Physical Effects: CNS, gastrointestinal, cardiovascular, sexual dysfunction - Withdrawal: dysphoria, muscle aches, vomiting, rhinorrhea, pupil dilatation, sweating, diarrhea, fever, insomnia, piloerection
Separation Anxiety Disorder in children
- Excessive anxiousness when separated from parents or home - Excessive anxiety when anticipating separation - Fear of being lost or kidnapped - Refusal to sleep without a parental figure near - Refusal to attend school without a parent
What factors may influence OCD personality disorder?
- Excessive parental criticism, control & shame - Child tries to control his environment with perfection & orderliness - Heritable traits possible are compulsivity, compositionality, lack of emotional expressiveness & perfectionism
What might the recovery model for mania include?
- Exhibiting self-awareness - Becoming an expert on the disorder - Taking medications regularly - Recognizing earliest symptoms - Identifying and reducing sources of stress - Knowing when to seek help - Developing a personal support system - Managing lifestyle factors such as sleep time and exercise - Developing a plan for emergencies
What are patterns of a crisis?
- Experienced by everyone at some time - Precipitating events have occurred - Personal - The actual crisis event is acute - Resolves for better or worse - Psychological growth or deterioration
Predisposing Factors to Depression: Psychosocial theories- Object loss
- 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 - Psychomotor retardation: slowing of movements/speech/thought
What are the 2 emotional response patterns with rape trauma syndrome?
- Expressed response pattern: the survivor expresses feelings of fear, anger & anxiety aeb such behaviors as crying, sobbing, restlessness, and tension - Controlled response pattern: feelings are masked or hidden, and a calm, composed, subdued affect is seen
What is the course of hormonal therapy and surgical gender reassignment?
- Extensive psychological testing and counseling - Live in the role of the desired gender for 2 years - Hormonal therapy
What are indicators of emotional abuse by the child?
- Extremes of behavior - Inappropriately adult or infantile behavior, not age appropriate - Delays in physical or emotional development - Suicide attempts - Lack of attachment to the parent
What behaviors are present with antisocial personality disorder?
- Failure to conform to social norms - Deceitful behaviors, repeated lying - Impulsivity, failure to plan ahead - Irritability & aggressiveness - Disregard for safety of self or others - Consistent irresponsibility for work and financial obligations - Lack of remorse
What are examples of intentional civil torts?
- False Imprisonment Confining a client to a specific area, such as seclusion room if the reason for such confinement is for the convenience of staff - Assault - attempt to initiate harmful or offensive contact or a threat to do so; Act of creating apprehension of unlawful touching; threat of harm coupled with ability to cause the harm. Is a category of criminal law assault which of an attempted but unsuccessful battery. - Battery - touching without consent of another
What are symptoms of postpartum depression?
- Fatigue, Irritability - Loss of appetite - Sleep disturbances, Loss of libido - Concern about inability to care for infant - Depressed mood varying from day to day, with more bad days than good (worse in evenings)
What are possible reactions of a client that is trying to get ahold of substance abuse/dependence?
- Fear of rejection or judgment - Fear of the recovery process - Fear of failing - Denial/Minimizing - Rationalization - Avoidance - Manipulation
Medicare?
- Federally & state funded but run by federal - 65 or older or disabled - Payments- prove client is home bound and some type of skilled care is provided
Medicaid?
- Federally & state funded but run by the state - Low income
What are the stages of anger and aggression?
- Feeling vulnerable - Uneasiness - Anxiety - Anger - Violence
What are the effects of alcohol in pregnancy?
- Fetal Alcohol syndrome: problems with learning, memory, attention span, communication, vision and hearing - Alcohol related neurodevelopmental disorders - Alcohol related birth defects
What are factors to consider for providing health care for immigrants?
- Financial constraints (uninsured) - Language barriers - Differences in social, religious, and cultural backgrounds - Personal lack of knowledge about high-risk diseases in the specific immigrant groups - Traditional healing or folk health care practices that may be unfamiliar - Consider how your own background, beliefs, and knowledge may be way different from those of others
Crisis: Assessment
- First assess for need for external controls- suicidal or homicidal ideations or gestures - Then assess client's: Perceptions of the precipitating event Situational supports; support systems, available resources Personal coping skills
Tacrine hydrochloride (Cognex)
- First drug approved for Alzheimer's - Slows progression - Side effects: liver toxicity, kidney dysfunction
What are date rape drugs?
- Flunitrazepam (Roofies) - Rapidly produces disinhibition and relaxes the voluntary muscles
What is schema therapy?
- Focus on Reframing - Used in Combination w/CBT - Psychoanalysis
Leadership styles: democratic
- Focuses on the members of the group - Info is shared with members in an effort to allow them to make choices - Member participation is encouraged fully - The leader provides guidance and expertise as needed - Productivity is lower but morale is much higher
What behaviors are present with borderline personality disorder?
- Frantic efforts to avoid abandonment - Patterns of unstable & intense interpersonal relationships - Identity disturbance in self image & sense of self - Impulsive in 2 or more (Spending, sex, substance abuse, reckless driving, binge eating. Potential for self harm) - Recurrent suicidal behaviors - Affective instability due to reactivity of mood - Chronic feelings of emptiness - Inappropriate intense anger or trouble controlling anger - Transient, stress related paranoid ideations - Instability of interpersonal relationships, self-image & affects
What area of the brain is responsible for planning and judgement?
- Frontal lobe reason and emotion interact ability to problem solve, plan ahead and restrain impulses - Damage can lead to impaired judgment, personality changes and aggression
What are common characteristics of an adult survivor of incest?
- Fundamental lack of trust arising from unsatisfactory parent-child relationship - Low self esteem, poor sense of identity - Absence of pleasure with sexual activity - Promiscuity - "Family secret"
What is the etiology of anxiety?
- Genetic: Cluster in families - Neurobiological: Heightened response of amygdala alerting the presence of danger. GABA: Too little Epinephrine: Too much Norepinephrine: Too much Dopamine: Too much Serotonin: Too much
What is the etiology of anxiety/stress?
- Genetic: cluster in families - Neurobiological: heightened response of amygdala (controls flight/fight) perceiving danger - Too little GABA - Too much epinephrine - Too much NE - Too much DA - Too much SE
What factors may influence antisocial personality disorder?
- Genetically linked - Predisposition if childhood environment is inconsistent, abusive & neglectful by caregivers
What are the key components in developing a therapeutic relationship?
- Genuineness; these clients will pick up on lying and always follow through with what you say - Empathy (not sympathy) - Positive attitude - Actions; you are their for the patient - Resource development - Establish boundaries: a border that determines the extent of acceptable limits (Ex: material, social, personal or professional)
What are factors associated with positive prognosis for schizophrenia?
- Good premorbid functioning - Later in life - Female - Abrupt onset precipitated by a stressful event - Brief duration of active phase symptoms -Minimal residual symptoms - Absence of structural brain abnormalities - Normal neuro functioning - No family history of mood disorder or schizophrenia
What are symptoms of dementia?
- Gradual onset - Deterioration of: memory, judgement, abstract thinking, orientation
What behaviors are present in narcissistic personality disorder?
- Grandiose sense of self - Preoccupied with fantasies of unlimited success, power, or ideal love - Believes they are special & will only socialize with other special people - Requires excessive admiration - Sense of entitlement - Takes advantage of others for personal gain - Lacks empathy •Envious of others or believes that others are envious of them - Arrogant behaviors - Childhood neglect & criticism
What are treatments for erectile disorder?
- Group therapy, education - Yohimbine: natural remedy used to treat ED & bodybuilders. Originally used to reverse sedation in dogs - Sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra) - Penile implantation
What is the difference between therapeutic groups and group therapy?
- Group therapy: form of psychosocial treatment, clients meet together with therapist for purposes of sharing, gaining personal insight, & improving interpersonal coping strategies. - Therapeutic groups are based to a lesser extent on theory. Focus is group relations, interactions between group members, & the consideration of a selected issue. - Leaders of both types of groups must be knowledgeable about group process as well as group content.
What are side effects of pesticide exposure?
- Headache - Dizziness - Dyspnea - Abdominal cramps - Poor concentration - Eye irritation - Cancer - Behavioral issues - Reproductive problems
What is the focus of community based nursing?
- Healing/treating the patient AND family - Working within a specific zip code or agency to serve a specific community - Equal partnership with patient and nurse, patient has just as much responsibility in cares - Focus on prevention and promotion
What are the 4 dimensions of the recovery model?
- Health- Overcoming illness and live healthfully - Home-Stable, safe place to live - Purpose-Meaningful daily activities - Community- relationships/social networks provide support, friendships, hope & love
Why is community health on the rise?
- High cost of hospital stays - More treatment done in the home for acute and chronic cares - More comfortable in the home for the patient
Occupational and Environmental Health Problems in rural areas
- High risk industries found: forestry, mining, fishing, agriculture - Lack of OSHA - Common injuries - Exposure to chemicals: pesticides
What is executive function?
- Higher level of thinking. - Allows for flexibility. - Content of consciousness. - Interpret the environment, problem solve, long-term memory function, learn and retain
What is sexuality like in middle years of adulthood? (ages 40-65)
- Hormonal changes produce changes in sexual activity for both men & women. - Age of naturally-occurring menopause for the women in North America is 51 years. - With the decrease of androgen production during these years, men also experience sexual changes.
Hospice care?
- Hospice: palliative care of the very ill and dying, reducing distress from physical, emotional, and spiritual symptoms - Criteria for hospice is that disease process or condition has progressed to the extent that further treatment cannot cure.
What is the parietal lobe responsible for?
- Houses the somatosensory cortex (used for touch), navigation, and math ability - Sensory and motor (academic functioning)
What are signs of impending violence?
- Hyperactive - Pressured Speech - Tone and Volume of Voice - Intense or Starring Eyes - Silence - New Isolation - Limit setting - Increase in anxiety and tension - Verbal abuse by others - Very loud or soft voices - Intoxication with alcohol or drugs - Possession of a weapon - Recent history of violence
What are contraindications for atypical antipsychotics?
- Hypersensitivity - Severely depressed clients - Lactation - Cardiac history: QT elongation, cardiac arrhythmias - History of agranulocytosis
What are contributing factors to delirium?
- Hypoglycemia - Dehydration - Fever - UTI - Infection - Head injury - Emotional stress - Pain - Medications - Change in environment
What behaviors are present with schizotypal personality disorder?
- Ideas of reference - Magical thinking - Unusual perceptual experiences - Odd thinking and speech - Paranoid ideations - Inappropriate affect - Eccentric behavior - Lack of close friends - Excessive social anxiety - Possible Schizophrenia in family history - Pervasive pattern of social & interpersonal deficits - Acute discomfort for close relationships - Begins in early adulthood
What does each letter stand for in IS PATH WARM?
- Ideation: Has suicide ideas that are current and active, especially with an identified plan - Substance abuse: Has current and/or excessive use of alcohol or 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: Expresses dramatic mood shifts
Describe the 5 SAFE-T suicide assessment steps.
- Identify risk factors, note those that can be modified - Identify protective factors, note those to enhance - Conduct safety inquiry, evaluate suicidal thoughts, plan, behavior, intent - Determine risk level & intervention, appropriate interventions, risk reduction - Document, record assessment of risk, rationale, intervention & follow up
What is the admitting requirement for psychiatric care?
- Imminent danger of harming self or imminent danger of harming others - Unable to care for basic needs/protect self - Homicidal or suicidal
What are the symptoms of autism spectrum disorder?
- Impaired communication and imagination - Impaired social interactions - Markedly restricted stereotypical patterns of behavior and interest Ex: if angry, may bite or rock back and forth because they're not able to talk about it out loud - Soothed by repetitive motions (sounds, visual)
What reasons do we promote recovery for?
- Improve health - Self-directed life (autonomy) - Full potential
How do people recognize phobic disorders?
- In adults and adolescents most recognize this as an unreasonable response to the actual stimuli. Person sees potential for danger. - Children do not identify their fears as unrealistic. Small children the search for the boogie man at bedtime.
What are ritalin side effects?
- Inability to fall asleep - Nervousness - Loss of Appetite - Headache - Increased Blood Pressure and Heart Rate - Abnormal Cardiac Rhythm - Dizziness - Abnormal Muscle Movements - Seizures - Psychosis - Stroke
What are risk factors for ineffective coping?
- Inaccurate assessment of the stressor - Denial/avoidance of the stressor(i.e if you dont think about it then it didn't happen) - Actual/perceived lack of support -acutal/perceived lack of control over the situation - No experience or poor experiences with handling stressful situations
What are risk factors for ineffective coping?
- Inaccurate assessment of the stressor (Most people will minimize the stressors (ex: person says they ONLY drink a 6 pack) - Denial/avoidance of the stressor ("They can handle it") - Actual/Perceived lack of control over the situation - Actual/Perceived lack of support - No experience or poor experiences with handling stressful situations
What are examples of disturbed affect?
- Inappropriate affect- Emotions are incongruent with the circumstances - Bland- Weak emotional tone - Flat- Appears to be void of emotional tone
Attention Deficit Hyperactive Disorder (ADHD)
- Inattention to surrounding environment nImpulsive behaviors - Both symptoms must be present - Symptoms for 6 months
When does oppositional defiant disorder typically occur?
- Inconsistent parenting - Harsh or neglectful parenting - Depressed mother - Marital discord - Usually seen by age 8
Antidepressants action
- Increase concentration of norepinephrine, serotonin, or dopamine in the body either by blocking their reuptake by the neurons (tricyclics, tetracyclics, SSRIs, SNRIs - Inhibiting the release of monoamine oxidase inhibitors (MAOIs)
What are major medical complications of cannabis?
- Increase in birth defects - Increase in systemic infections - Memory Loss - Impaired Breathing/COPD/ARDS
What is the purpose of therapeutic milieu groups?
- Increase self esteem - Decrease social isolation - Encourage appropriate social behaviors - Education - Examples re physical activity, crafts, creative writing, community/goals group, or self care groups
What are the side effects of meth?
- Increased blood pressure, heart rate, body temperature and respirations - Violent Outbursts - Hyperactivity and Euphoria - Tremors - Nervousness or Irritability - Paranoia
What are challenges for mental health nurses with children and adolescents?
- Increases in children that need services - Decrease in the inpatient time allotted - Majority of children hospitalized have conduct disorder related to lack of adequate parenting and family support (functional orphans) - Decreased funding, but increased needs
What is symptomatology of gender dysphoria in adolescents or adults?
- Individual perceives self as being of opposite gender - Feels comfortable wearing clothing of assigned gender, often engage in cross-dressing - May find his or her own genitals unacceptable - May repeatedly submit requests to health-care system for hormonal and surgical gender reassignment - Depression and anxiety are common
Psychotherapy groups
- Individuals gather to give feedback to one another within a dynamic environment run by a trained leader. holds people together via universality - Can have specialized groups like grief loss - Members have a common purpose - Goal is to treat clients with psychiatric disorders i.e depression or anxiety
Risk factors for suicide: Socioeconomic status
- Individuals in the very highest & lowest social classes have higher suicide rates than those in the middle class. - Suicide rates are higher among physicians, artists, - Dentists, law enforcement officers, lawyers, & insurance agents. More suicide among the unemployed population
What is feeding and eating disorder?
- Infant or child does not eat adequate amounts of food - Food is available - No medical disorder or intellectual development delays - Does not gain weight - Experiences developmental delays
Electroconvulsive therapy: Pre-treatment care
- Informed consent - NPO after midnight - Hold benzodiazepines, anticonvulsants; why?
What is the process of advocacy?
- Informing - Supporting - Affirming - Systematic problem solving
What are the phases of group development?
- Inital phase: leader will orient clients to the purpose of the group and set the rules. the group gets to know eachother and build trust - Working phase: leader encourages members to cooperate and facilitates conversations and resolves conflicts. the group starts to turn to each-other for guidance and trust is created along with a group identity. - Termination: leader acknowledges the contributions of each member and the experience. the group prepares for the separation and for the future
What are the roles of the nurse in shelter management?
- Initially, physical needs the priority - Main problem is stress - Basic measures- listening, helping victims make decisions & gain needed items, referrals
What are interventions for conduct disorder?
- Inpatient hospitalization for crisis intervention - Transfer to therapeutic foster home
What are symptoms of later-life depression?
- Insomnia - Loss of appetite - Anhedonia - Anergia - Increased concern with bodily functions - Apprehension and anxiety without any cause - Low self-esteem
What are the hospice care models?
- Institutional services - Home Care
What is substance use disorder?
- Interferes with daily responsibilities - Attempts to cut down but fails - Intense cravings for the substance - Excessive amount of time trying to obtain drug - Interpersonal relationships suffer - Engages in hazardous activities while under the influence - Tolerance is built up requiring more of the substances - Withdrawal occurs - Reversible symptoms d/t substance intoxication - Disruption of physical and psychological functioning - Disturbance in judgement - Withdrawal symptoms occur with continued use over time
What are the sociological theories on suicide?
- Interpersonal Theory of Suicide - 3 step trajectory
Time out for children
- Intervening disruptive or inappropriate behavior by removing the child from the activity - Child regains self-control and reviews episode with staff
Family Play Therapy
- Involves the treatment of the whole family - As the child improves, this play should be supportive at home - Vital to educate the family
Post Traumatic Stress Disorder in Preschool Children
- Irritability, angry outbursts, temper and tantrums - Relive traumatic event in play or drawings - Nightmares or Night Terrors - Loss of previously learned skills - Somatic symptoms
What are behavior indicators of neglect by the child?
- Is frequently absent from school - Begs/ steals food or money, lacks needed medical / 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
Task roles
- Keep the group focused on getting the work done Ex: 1. coordinator clarifies, brings ideas and suggestions 2. evaluator examine the group plans and performance 3. elaborator explains and expands on ideas 4. energizer motivates the group to meet its potential 5. initiator outlines the task at hand and proposes methods for the solution 6. orienter maintains direction within the group
What are factors/barriers to implementation of EBP?
- Knowledge of research and current evidence - Ability to interpret the meaning of the evidence Individual professional's characteristics, willingness to change, personal viewpoints about quality and credibility of evidence - Commitment to time needed to implement EBP - The hierarchy of the practice environment and the level of support of managers and the ability to engage in autonomous practice - Philosophy of the practice environment - Availability of resources - Practice characteristics; leadership, colleague attitudes - Links to outside supports - Political constraints - Lack of relevant and timely public health practice research
Third generation antipsychotics
- Known as dopamine stabilizer - It stimulants dopamine in areas of the brain where there is not enough and in areas of the brain with too much, it acts a partial agonist - Drug is aripiprazole (abilify)
What are contraindications for typical antipsychotics?
- Known hypersensitivity - CNS depression - Parkinson's disease - Narrow angle glaucoma - Dementia related psychosis
Phase 2 of schizophrenia: Prodromal
- Lasts from a few weeks- few years - Deterioration in role functioning and social withdrawal - May develop sudden OCD - Substantial functional impairment - Sleep disturbance, anxiety, irritability - Depressed mood, poor concentration, fatigue - Perceptual abnormalities, ideas of reference, and suspiciousness indicate onset of psychosis - Early intervention
Child raised in an environment without "effective coping strategies" is at risk for developing: (Parent is unable to role model effective coping)
- Learned helplessness - Learn apathy - Inability to learn to cope with changes within a new or existing environment
Cognitive Impairments that result from dysfunctions in the cortex of the brain:
- Learning disabilities - Motor Skills - Communication - Children from disadvantaged socioeconomic circumstances (more prevalent in boys)
What medications are used during mania for bipolar disorder?
- Lithium carbonate - Anticonvulsants - Verapamil (calcium channel blocker) - Antipsychotics
Health providers in rural areas
- Live and practice in a particular community for decades - May provide care to people who live in several counties - Small staff to service large area
What are contributing factors to depression?
- Loneliness - Decline in health - Medical conditions - Loss - Past history of depression
What are factors that contribute to elder abuse?
- Longer life - Dependency: Due to physical needs or financial needs - Stress - Learned violence - Unresolved family conflicts/retaliation
What is the profile of the victimizer of IPV?
- Low self-esteem - Pathologically jealous - "Dual personality", public and private face - Limited coping ability - Severe stress reactions - Views spouse as a personal possession, attempts to isolate their partner
What are the 2 principles while developing cultural competence?
- Maintain a broad, objective, and open attitude toward individuals and their cultures. - Avoid seeing all individuals as alike.
What are demographic risk factors of anger/aggression?
- Male - Aged 14-24 years - Low socioeconomic status - Low support system
What are symptoms of chemical dependence in elderly?
- Malnutrition - Contusions - Self Neglect/Failure to Thrive - Depression - Increase in Falls - Incontinence/Diarrhea - Dementia
Disordered Brain Function
- Malnutrition - Lead Poisoning - HIV - Fetal Alcohol Syndrome - Drug Addiction - Traumatic Experience: Child Abuse
Types of Crisis: Situational: Dispositional Crisis
- May come from external sources- "Critical life problems" - May be unexpected - Life events/change-critical life problems
Alzheimer's stage 1
- May go unnoticed - No signs of memory lapse - No impairment - Identified by Alzheimer's disease biomarkers (such as aterm-51myloid plaques and tangles, and tau found between neurons and spinal fluid)
Predisposing Factors to Depression: Neuroendocrine disturbances
- May play a role in the pathogenesis or persistence of depressive illness - Marked disturbances in mood observed with the administration of certain hormones or in the presence of spontaneously occurring endocrine disease (Ex: cortisol, TSH)
Neuroleptic Malignant Syndrome (NMS)
- Medical Emergency!!! Potentially Fatal. Progression: 2-3 days - Severe EPS: Severe muscle rigidity, flexor/extensior posturing, cog wheeling, dysphasia - Hyperpyrexia: Temp over 103 - Autonomic Dysfunction: tachycardia, diaphoresis, incontinent, hypertension - Delirium, stupor, coma - Risk Factors: Elderly, female, pts with mood disorders, rapid dose increase
Predisposing Factors to Depression: Physiological influences
- Medication side effects - Neurological disorders - Electrolyte disturbances - Hormonal disorders - Nutritional deficiencies
Electroconvulsive therapy: during treatment
- Medications: methohexital, or Propofol (anesthetic), & succinylcholine (muscle relaxant) - BP cuff on lower extremity; why? - Maintain airway, oxygenation, ECG, observe/record type & amount of seizure activity (usu>20 seconds)
What is the temporal lobe responsible for?
- Memory and auditory processes - If there is damage can have hearing loss or memory impairment
What are signs of depression?
- Memory impairment - Aphasia - Apraxia - Agnosia - Impaired planning, organizing, abstract thinking - May mask dementia or delirium
What are symptoms of lewy body dementia?
- Mental decline - Hallucinations - Depression - Problems with ADLs - Falls - Sleep disturbances - Fluctuations iwthin the autonomic system
Alzheimer's stage 2 and 3
- Mild cognitive decline - Noticeable deterioration in daily function - Problems remembering dates and addresses - Lack of hygiene - Apathetic and loss of energy - Difficulty learning new things - Depression
Hildegard Peplau Anxiety Model
- Mild: Senses become acute, able to problem solve: irritable, restless, slight discomfort, fidgety - Moderate: Perception narrows, problem solving intact: selective inattention: racing heart, increased pulse and respirations, perspiration and somatic complaints, thought blocking - Severe: Perception distorted, scattered thoughts, problem solving limited: Increased somatic complaints, trembling, pounding heart - Panic: Medical emergency! Unable to think, loses touch with reality: Hallucinations, run, impulsive, poor communication, scared, hyperventilation and SVT possible
What are other modalities where crisis intervention is utilized?
- Mobile crisis programs - Group work-crisis intervention is used in psych hospital due to short LOS - Telephone contacts-hotlines - Disaster response - Victim outreach (rape)- useful in immediate aftermath of crime for referral & Advocacy
Alzheimer's stage 4
- Moderate cognitive decline (early stage) - Unable to identify objects - Needs simple instruction for easy tasks - Confused and frightened - Withdrawn or labile mood
Alzheimer's stage 5
- Moderately sever cognitive decline (midstage)
Opiate examples?
- Morphine - Heroin (poppy) - Codeine - Methadone - Meperidine (Demerol)
What is the epidemiology of paraphilic disorders?
- Most individuals with paraphilic disorders are men. - Most who seek treatment do so for pedophilic disorder (45%), exhibitionistic disorder (25%), or voyeuristic disorder (12%). - Behavior is usually established in adolescence, peaks in ages 15-25, & declines by age 50.
Tourette's Disorder
- Motor disorder - Characterized by motor and verbal tics - Age of onset is 2-10
What is recovery?
- Movement toward improvement in health & quality of life - Recovery is a process of change
What is the learning theory of abuse/violent behavior?
- Multigenerational transmission: children learn to behave by imitating their role models - More likely to behave in abusive manner as an adult - Individuals who were abused as children or physically punished are more likely to behave in an abusive manner as adult
What are the different factitious disorders?
- Munchausen Syndrome- Harm to self - Factitious Disorder by Proxy- Caregiver purposely harms a dependent - Malingering- Deliberately faking symptoms in order to benefit. (Ex: homeless during a blizzard. So they go to ED and say they're suicidal)
Hallucinogens
- Natural or Synthetic - Used for cultural, religious or mystical ceremonies - Episodic
Assessment of Situational Supports
- Necessary to determine client resources. - Client may need to establish new relationships with individuals or within community Ex: "With whom do you live?" "Who is available to help you?" "Where do you worship? Go to school?"
What are conflict management techniques?
- Negotiating-the plan of care, services, and payment arrangements with providers & uses effective collaboration and team members - Assertiveness - Cooperation - Communication - Detecting areas of agreement and disagreement - Collaboration - Alternatives
What is the biological theory of abuse/violent behavior?
- Neurophysiological influences: Prefrontal /frontal cortex: modulate social judgement Limbic structures alterations: emotional alterations Lower Amygdala volume: anxiety/rage - Biochemical influences (associated with impulsivity/aggression) Increased Norepinephrine Altered levels Serotonin Increased Dopamine release - Genetic influences: Possible hereditary factor - Disorders of the brain Organic brain syndromes Brain tumors/trauma, encephalitis Temporal lobe epilepsy
Post Traumatic Stress in School Aged Children
- Nightmares - Irritability - Poor Concentration - Hyper vigilance - Omen Formation
Epidemiology of Depression: Race and Culture
- No consistent relationship between race & affective disorder. - More prevalent in whites than in blacks. - More severe and disabling in blacks. - Blacks are less likely to receive treatment than are whites.
Predisposing Factors to Depression: Psychosocial theories- Transactional model
- No single theory or hypothesis exists to substantiate a clear-cut explanation for depressive disorder. - The transactional model recognizes combined effects of genetic, biochemical,& psychosocial influences on an individual's susceptibility to depression. - Increased evidence supports multiple causation.
Buspar
- Non-benzo - Elderly people - No dependent properties - Safe in substance abuse client - Slow acting 2-4 weeks to see positive side effects
Types of Crisis: Crisis of Anticipated Life Transitions
- Normal life cycle changes - Developmental events requiring role changes - Developmental Stages - Old coping skills are no longer helpful Ineffective defense mechanisms & disequilibrium (anxiety!!) occurs until new coping skills develop - May have arrested skill development - Feels out of control Ex: ***
What is in the CASE assessment?
- Normalizing communicates that the client is not the only one who experiences suicidal ideation. - Asking about behavioral events not the client's opinions ("and what did you do?") - Gentle assumptions encourage more discussion - Denial of the specific is helpful when a client generally denies suicidal ideation (ask about specific means of suicide) - Chronologically exploring the presenting suicide event, recent suicide events, past suicide events, and finally the immediate suicide events
What is the social theory of addiction?
- Normative behaviors within some subcultures - Sense of acceptance - Following modeled behaviors - Conditioning (learned response): pleasurable effects condition the individual to repeatedly seek out their use
What is a suicide contract?
- Not a legal document - Does not insure patient safety - Its used to allow client to assume personal responsibility for self - Opens dialogue between nurse and client - Should be written and client gets copy and so does facility
ADLs
- Nutrition: OCD-too busy with rituals, paranoia-suspicious of the food. Monitor intake and outputs, calorie count, patient weight - Hygiene: Monitor for over doing with ritualistic activities (OCD) i.e.: hand washing, buttons, zippers, neatness of drawers. Limit setting, simple directions, give positive feedback - Elimination: Over or under doing (obsessions and fears) - Sleep: Nightmares and Interrupted Sleep Patterns
What factors may influence paranoid personality disorder?
- Objects of excessive rage & humiliation - Feelings of inadequacy - Defense mechanism is projection & blame
What is the Nebraska elder justice act?
- Obligation to report any reasonable suspicion of crime against one receiving care from long term care facility within 24 hours. - Suspected serious bodily injury must be reported within 2 hours. - Employee consequence of $200,000 each time it is not reported. If report made in good faith, there is no retaliation against reporter
What are other symptoms of Tourette's disorder?
- Obsessions - Compulsions - Hyperactivity - Distractibility - Impulsivity - Low Self-esteem
Phase 1 of schizophrenia: Premorbid
- Occurs before evidence of illness - Social maladjustment - Antagonistic thoughts and behavior - Shy, withdrawn; poor peer relationships - Doing poorly in school - Antisocial
Symptoms of panic disorders
- Occurs suddenly and spontaneously - Palpitations - Rapid pulse - Nausea - Diarrhea - Feeling of choking or suffocation - Pupils dilated and face may be flushed
What are the Healthy People 2020 of Evidence-based practice?
- Offer a systematic approach to health improvement - Provide general direction and focus for measuring progress of improving health status within a specific amount of time - Improve clients' understanding for EBP
Therapeutic communication: offering self and offering general leading questions
- Offering self: making oneself available on an unconditional basis helps to increase the client's feelings of self-worth - Offering leading questions: general leads, or prompts, offer the client encouragement to continue. i.e "go on" or "and after that"
What are signs of physical child abuse?
- Offers conflicting, unconvincing, or no explanation for the child's injury - Fading bruises or other marks - Child is frightened of adults - Shrinks at approach of adults - Child reports injury by parent or caregiver - Adult has history of abusing animals or pets - Has a history of abuse as a child - Describes the child as "evil," or in some other very negative way - Uses harsh physical discipline with the child
What are the 5 general types of home health agencies?
- Official-agencies operated by state, county, city, or local governments - Private and voluntary-non profit organizations - Combination - Hospital based-continuity of care is enhanced - Proprietary-for profit agencies
What is the incestuous relationship?
- Often there is an impaired spousal relationship - Father: Domineering, impulsive, physically abusive - Mother : Passive, submissive, often aware of incestuous relationship uses denial/ keeps quiet due to fear of abuse by partner
Disintegrative Disorder
- Onset is between 2 and 10 - More common in males - Poor outcome - Develop normally, but regress backwards after they've learned skills
Evaluation of crisis intervention
- Outcomes - Usually done 4-8 weeks after initial interview - If successful, client anxiety and function should be at pre-crisis level
What are interventions for oppositional defiant disorder?
- Outpatient treatment with individual, group, and family therapy - Focus therapy on parenting issues
What are different boundary establishments?
- Over helping: don't do things for the clients that they can do for themselves - Controlling: Don't assume you are going to control all aspects of the nurse-patient relationship "for their own good" - Narcissism: Focusing on the negative aspects of the client in order to feel helpful - Smothering: Allow physical, emotional and time space between you and the client
What are milieu characteristics conducive to violence?
- Overcrowding - Staff inexperience - Provoking or controlling behaviors by staff - Lack of limit setting - Random taking away of privileges
What is the history of evidence based practice in the 1990's?
- Paradigm shift - Evidence-based practice term created
What disorders are under cluster A?
- Paranoid personality disorder - Schizoid personality disorder - Schizotypal personality disorder
What factors may influence avoidance personality disorder?
- Parental & peer rejection & criticism - Predisposition to anxiety & physiological arousal in social situations
What are characteristics of a child abuser?
- Parents who abuse their children were often victims of abuse while growing up & have impaired attachment with their child - Substance use disorders increase the risk of child abuse and neglect - Isolated with little support from family and friends - Expects the child should fulfill adult's emotional needs - Prone to depression, - Frequent outbursts, anger and rage - Low frustration tolerance
What is the etiology theories of Alzheimer's?
- Pathological: cerebral atrophy, neuritic plaques, neurofibrillary tangles - Genetic- chromosome 19, apolipoprotein E gene
What is stress?
- Perceived stressors from sensory inputs - Reaction to changes in environment i.e like losing a loved one or becoming homeless - Can be physical, mental or emotional - Individuals can be adaptive to stress or maladaptive when function is impaired
What are the effects of alcohol?
- Peripheral Neuropathy: Burning of extremities - Alcoholic Myopathy (alcohol induced rhabdomyolysis): Muscle pain, atrophy and weakness - Vitamin B deficiency (thiamine deficiency) - Wernicke's Encephalopathy: most serious form of thiamine deficiency - Korsakoff's Psychosis: Loss of recent memory, confusion and confabulation - Physical Effects: Cardiomyopathy, esophagitis, gastritis, pancreatitis, hepatitis, cirrhosis, leukopenia, thrombocytopenia
What is Pica?
- Persistence in eating nonnutritive substances: paint, plaster, string, pebbles, dirt and animal droppings - No aversion to eating food - Frequently associated with intellectual development disorders
What is more often to occur along side binge eating?
- Personality disorders occur more often in the eating-disordered population than the general population. - Binge eaters report a history of major depression and anxiety disorders significantly more often than non-binge eaters
What are the patterns of use with alcohol?
- Phase I: Pre-alcoholism: used to relieve stress - Phase II: Early Alcoholism: Blackouts and amnesia happening after drinking, Person requires alcohol - Phase III: Crucial Phase: Person has lost control, physiological dependence is obvious - Phase IV: Chronic Phase: Emotional and physical disintegration. Intoxicated more than sober
What are the 3 phases of battering cycle?
- Phase I: Tension-building phase- decreased frustration tolerance, minor battering - Phase II: Acute battering incident - Phase III: Calm, loving, respite (honeymoon) phase
What are treatments for genito-pelvic pain/penetration disorder?
- Physical and gynecological examination - Education of the woman and partner regarding anatomy/physiology of the disorder - Systematic desensitization with dilators of graduated sizes - Identification and treatment of any relationship problems
Factors that contribute to depression in children and adolescents?
- Physical and sexual abuse - Neglect - Homelessness - Parental marital problems - Parents' death, divorce or separation - Learning disabilities - Chronic Illness - Conflict or rejection of parents or peers
What are Robert's 7 Stages?
- Plan/Crisis Assessment - Establish Rapport - Identify Major Problems - Feeling/Emotions - Explore Alternatives - Develop Action Plan - Follow-up
What are techniques for managing disruptive behaviors?
- Planned Ignoring - Use of Signals or Gestures - Physical Distance and Touch Control - Redirect Child's Attention to an Activity - Give Additional Affection - Use of Humor as a Diversion - Appeal to child's developing self-control - Give early help to a child who is easily frustrated - Clarify situation and motivation for the behavior - Change activity to decrease stimulation or frustration - Remove child from the situation - Set Limits
Health status of rural residents
- Poorer perception of overall health - Less likely to engage in preventative behavior - Likely to have more than 1 chronic condition - Tend to have poorer health and less likely to seek medical care - Traveling time affects access to care
What are the psychological stresses of workers?
- Post-traumatic Stress " Emergency-response personnel have higher than normal risk for developing PTSD" "Nurses who work with survivors of disasters may be at risk for vicarious traumatization" - Occurs in response to listening to the survivor's stories of the event
What are three aspects of assessment that enhance understanding of the client's current suicidal crisis?
- Precipitating stressor: 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 one either by death or by divorce, problems in major relationships, changes in social or occupational roles, or serious physical illness. - Relevant history: Has the individual experienced numerous failures or rejections that would increase his or her vulnerability for a dysfunctional response to the current situation? - Life stage issues: The ability to tolerate loss and disappointment is often compromised if those losses and disappointments occur during stages of life in which the individual struggles with developmental issues (e.g., adolescence, midlife).
What behaviors are present with OCD personality disorder?
- Preoccupied with details - Perfectionism that interferes with task completion - Excessively devoted to work - Inflexible about matters of morality & ethics - Unable to throw out worthless & worn out items - Reluctant to delegate tasks unless everything is done exactly their way - Hoards money (less intense than Axis I: hoarding, perfectionism & preoccupation with details - Stubborn & rigid - Preoccupation with perfectionism - Mental & interpersonal control
What are the DSM-V criteria for anorexia?
- Preoccupied with food and rituals of eating - Voluntary refusal to eat - Morbid fear of obesity - Body weight is less than 85% of expected normal weight
What are the phases of a disaster?
- Preparedness: Plan before the event occurs (disaster plan) - Mitigation: Limit impact of a disaster - Response: Implementation of the disaster plan - Recovery: Stabilization of the community - Evaluation: Looking at outcomes to prepare for future events
What are the goals of psychiatric hospitalization?
- Prevention of self harm - Stabilization of crisis situation - Initiation or adjustment of meds - Support and problem solving allowing the individual to regain control - Client plan of care and transition to partial care
How do we assess suicide risk in elderly?
- Previous suicidal behavior - Current thoughts: plan, lethality of method chosen
How do the different personalities in DID interact with each other?
- Primary personality (host) not usually aware of the others - Each personality at some time takes full control of the person's behavior - The alters are aware of each other - Each alter behaves as a separate individual
What are the primary and secondary prevention roles of the nurse in paraphilic disorders?
- Primary prevention process: Intervene in home life/other facets of childhood in an effort to prevent problems from developing - Secondary prevention: Diagnose/treat early to decrease difficulties: conduct sexual history to ID paraphilic disorders
What does the limbic system do?
- Primitive emotions and basic drive - Dysfunction can lead to an increase or decrease in aggression
What are examples of inpatient milieu therapies?
- Programs of therapy aimed at social rehabilitation, purposeful activities, general therapies, specialty therapies - Staff and patients have a voice in what will happen throughout the day/group but it is still structured. patient can have some control of environment
Post Traumatic Stress Interventions in children?
- Protect child from panic levels of anxiety - Provide emotional support to help child progress developmentally nIncrease child's self-esteem and feelings of competence - Help child accept and work through traumatic event - Focus on underlying fears and concerns - Behavior Modification
What are the types of elder abuse?
- Psychological - Physical - Financial (Exploitation)
What are signs of elder abuse?
- Psychological abuse: change in behavior r/t depression, anxiety, sleep disorders - Physical abuse: bruises, fractures, etc - Neglect: hunger, poor hygiene, consistent lack of supervision, - Sexual abuse: pain/itching in genital area, bleeding, bruising in genital/anal area - Financial abuse: lack of sufficient funds for daily living expenses
What are treatment strategies for childhood and adolescents with bipolar disorders?
- Psychopharmacology: Lithium, Divalproex, Carbamazepine, Atypical antipsychotics - Family interventions: Psychoeducation about bipolar disorder, Communication training, Problem-solving skills training
What is treatment for postpartum depression?
- Psychotic depression may be treated with antidepressant medication, along with supportive psychotherapy, group therapy, and possibly family therapy. - Moderate depression may be relieved with supportive psychotherapy and continuing assistance with home management until the symptoms subside
What are the 2 types of bulimia nervosa?
- Purging Type: The individual participates in self-induced vomiting or the misuse of laxatives, diuretics or enemas. - Nonpurging Type: The individual participates in excessive fasting or excessive exercise but does not participate in the self-induced vomiting.
What are the 3 types of anorexia?
- Purging type- using self-induced vomiting, laxatives, and enemas to lose weight - Binge-eating- Engages in binge eating or purging behaviors - Restricting Type: Person is severely under weight
The evidence is assigned a "grade" based on what?
- Quality of the evidence - Number of well-designed studies - Presence of similar findings in all of the studies
What are the 3 domains for evaluation systems?
- Quality: Extent to which bias is minimized - Quantity: number of studies, the magnitude of the effect, and the sample size - Consistency: studies that have similar findings, using similar and different study designs
Hierarchy of evidence
- Randomized controlled trials ranked as the highest level of evidence - Some argue that hierarchy ignores evidence gained from clinical experience - Incorporate evidence & clinical experience, i.e., professional guidelines
What is the profile of a rape victim?
- Rape can occur at any age - Highest-risk age group: females younger than age 34, with lower income, & those living in rural areas - Most victims are single women, and the attack often occurs near their own neighborhoods
What are the suicide categories?
- Rational: to escape pain - Reactive: following a loss - Vengeful: to punish someone else or make them feel what your feeling (associated with BPD) - Manipulative: to stop someone elses plans (Ex: husband going on business trip and say your going to kill yourself to get him to stay) - Psychotic: to fulfill a delusion - Accidental: reconsider too late
Oppositional Defiant Disorder
- Recurrent/Hostile pattern of behavior toward authority figures - Argumentative and Tests Limits - Refuses to Accept Blame - Does not involve the destruction of property
Anticonvulsants
- Reduce the firing rates of high frequency neurons in the brain - Reduce mood swings Examples: valprorate, carbamazepine, lamotrigine, gabapentin, topiramate, oxcarbazepine
Anticonvulsants
- Refrain from discontinuing the drug abruptly. - Report the following symptoms immediately: skin rash, unusual bleeding, spontaneous bruising, sore throat, fever, malaise, dark urine, and yellow skin or eyes. - Do not drive or operate dangerous machinery. - Carry identification noting taking lithium. - Avoid using alcohol and over-the-counter medications without approval from physician.
What are stress reactions in children?
- Regressive behaviors - May have heightened sensitivity to sounds, smells, sights - Influenced by parents reaction to disaster - Suffer from post traumatic stress syndrome more frequently than adults
What does the hippocampus do?
- Regulates the recall of recent experiences and new information - Damage or impairment can cause impulsive behaviors
Individual roles
- Relate to personalities and personal agendas of people within the group Ex: 1. aggressor: expresses negativism and hostility, often uses sarcasm to degrade others 2. blocker: resists group effords 3. dominator: manipulates others to gain control 4. help-seeker: uses the group to gain sympathy from others; seeks to increase self confidence but lacks concerns for others 5. monopolizer: maintain control by dominating conversation 6. recognition seeker: talks about personal accomplishments in effort to gain attention 7. seducer: shares intimate details about self; may frighten others in group with excessive premature self disclosure 8. Playboy appears disinterested in group, makes jokes about group, peers
Implementation/Intervention of crisis intervention
- Remember first steps-assess for suicidal or homicidal thoughts/plans - Then..perceptions, situational supports, coping skills - Remember basic assumptions (ex: Client solves the problem-not nurse, The person is in charge of his or her own life- a crisis is a state of disequilibrium)
What is rumination disorder?
- Repeated regurgitation and rechewing of food - Lack of nausea, retching or gastrointestinal problems - May occur with developmental delays
Kleptomania
- Repeated stealing - Tension build up before stealing - Relief after stealing
Stereotypic Movement Disorder
- Repetitive, purposeless movements rocking, waving, teeth grinding - Impairs ADLS and daily functioning
What are major medical complications of inhalants?
- Respiratory Arrest - Tachycardia - Arrhythmias - Brain Damage/CNS
Types of Crisis: Maturational/Developmental
- Response to failed life transitioning - Developmental milestones not achieved - Struggle in transitional roles
What are early warning signs of trauma informed care?
- Restlessness - Agitation - Pacing - Clenching teeth - Heart Pounding - Swearing - Sweating
What are the stipulations associated with restraints and seclusions?
- Restraint order must not exceed 24 hours - Release from the restraints for 60 minutes or more requires a new order - All restraint use must be documented - Assessment will take place every 15 minutes - Patient becomes a 1 to 1 client - Debriefing required after restraint use
What factors may influence narcissistic personality disorder?
- Resulting from childhood neglect & criticism - Does not learn that others can comfort & support - Hide feelings with invulnerability & self-sufficiency
What are the building blocks that are used by case managers?
- Risk analysis - Data mapping - Data monitoring for health processes, indicators, and unexpected illnesses - Epidemiologic investigation of unexpected illnesses Multidisciplinary development of action plans and programs - Identifying case management triggers or events that promote earlier referrals of high-risk clients when prevention can have dramatic results
Risk factors for suicide: Age
- Risk of suicide increases with age, especially w/ men - Highest rate of suicide in the 45- to 64-year-old age group or those > 85 years
Electroconvulsive therapy: Post-treatment care
- Routine post-op checks, treat BP alterations as needed - Reorient upon arousal
What medications are used in binge eating?
- SSRI's - Antiepileptics agents - Tricyclic Antidepressants - Appetite Suppressants - Belviq (Lorcaserin) - "diet" pill and exercise. Prescribed in adults with BMI 30 or > or BMI of 27 with 1 health condition S/E: dizziness, fatigue, dry mouth, hypoglycemia Osymia (combined topiramate/phentermine) considered a Schedule IV controlled substance Contraindications: glaucoma, MAOIs, hyperthyroid, pregnancy and lactation S/E: tingling in hands/feet, altered taste, insomnia, constipation, dry mouth antiseizure med topiramate phentermine - calorie burner
What medications can help mood with anorexia?
- SSRI's- Fluoxetine (Prozac) Reduces obsessive-compulsive behavior in maintenance phase - 2nd Generation antipsychotic Olanzapine (Zyprexa) Improves mood and decreases obsessive behaviors Reluctant to take this because of the weight gain
What are long term use meds for aggression?
- SSRI: Stabilizes mood - Lithium: Used in Antisocial, MR and Brain Injury - Anticonvulsants: Decreases impulsive behaviors - Gabapentin: Reduces anxiety - Benzodiazepines: Reduces anxiety - Atypical antipsychotics: Schizophrenia - Beta-Blockers: Dementia, MR, Schizophrenia, Brain Injury
Phase 3 of schizophrenia: Active psychotic (Acute schizophrenic episode)
- Schizophrenia is a chronic illness but characterized by acute episodes in which symptoms are more pronounced - Delusions, hallucinations, impairment in work, relationships/self-care
What factors may influence schizotypal personality disorder?
- Schizophrenia spectrum disorder - Genetically linked - more likely if family member has schizophrenia
Complications of Depression
- School Failures - Drug and Alcohol Use - Sexual Promiscuity - Running Away - Illegal and Antisocial Behaviors - Suicide
What were challenges for African American nurses
- Segregated nursing education in the South until 1960s - Lower salaries in the South than for White nurses
What are Robert's 7 Stage Model Based on?
- Sense of Safety - Calming - Self-efficacy & Collective-efficacy - Connectedness - Hope
What are common initial reactions to a disaster?
- Sense of urgency - Obsessed with loss - Panic and fear - Anger/blaming
What are some anxiety disorders in children?
- Separation Anxiety - Social Phobias - Obsessive Compulsive Disorder - Generalized Anxiety Disorder - Post Traumatic Stress Disorder
What neurotransmitters are involved with aggression? Levels?
- Serotonin: higher levels of serotonin are related to impulse, anxiety and aggression - Dopamine: lower levels in depressed pts may produce anger d/t SI thought
What are psychoeducational groups?
- Set up to teach about a variety of illnesses or a specific illness like bipolar - Health teachings - Med education - Clients can have a voice about their concerns about the topic - APRN has a role in psychotherapy groups that are used to explore feelings and give feedback on actions
What are the biological factors of paraphilia disorders?
- Several organic conditions, including abnormalities in limbic system /temporal lobe - Abnormal levels of androgens
What are side effects of meth withdrawal?
- Severe Depression - Drug Induced Schizophrenia - Picking at Skin and Clothes - Self Absorption - Violent and Erratic Behaviors - Hallucinations - Tweaking: Binging, no sleep 3-15 days, craving intensifies, unable to satisfy, possible death
Alzheimer's stage 6
- Severe cognitive decline - Agraphia - Hyperorality - Hypermetamorphosis - Loses ability to care for self or walk - Unaware of recent experiences - Changes in sleep patterns - Incontinence - Paranoia and delusions - Wandering
What is the SAD PERSONS scale tool for suicide?
- Sex - Age - Depressed mood - Previous attempt - Ethanol use-Rational thinking-Social supports - Organized plan - No spouse - Severe or chronic * Each one gets certain amount of points and the more points the greater the risk
What are psychosocial predisposing factors to sexual dysfunctions?
- Sexual desire disorders: fear, hx of abuse, relationship issues - Sexual arousal disorders: chronic stress, etc - Orgasmic disorders
What are the 4 groups of underlying motives of a rapist?
- Sexual sadists: aroused by inflicting pain - Exploitative predators: gratify need for power/dominance - Inadequate men: obsessed with sexual fantasies - Displacing anger/rage
Diagnosing conduct disorder
- Shows at least 1 symptom before age 10 - The earlier the diagnoses the greater chance of seeing an antisocial personality in adulthood
Why is a depressed parent significant to a child?
- Significant b/c the child is not getting the nurturing affection that they need** - Not available emotionally - Child unable to develop emotional attachment
What are effects of Sedatives/Hypnotics/Anxiolytics on the body?
- Sleep/dreams - Respiratory Depression - Cardiovascular Arrhythmias - Impaired hepatic and renal function - Body temperature dysregulation - Sexual dysfunction
Rivastigmine (Exelon)
- Slows memory loss in only 1/2 of patients - Side effects: loss of appetite, weight loss, nausea
Galantamine (Reminyl)
- Slows progression of disease only in stages 1 and 2 - Less side effects: drowsiness, nausea
What is the symptomatology of gender dysphoria in children?
- Some children may resist wearing clothing or playing with toys that are typical for their assigned genders. - Often part of normal childhood behavior unless the behaviors persist into later childhood/adolescence, they may indicate a stable gender identity.
What are biological predisposing factors to orgasmic disorders?
- Some medications (e.g., selective serotonin reuptake inhibitors) - Medical conditions (e.g., depression, diabetes) - In men, delayed orgasm may be related to: Surgery of the genitourinary tract, neurological disorders, diabetes
What symptoms of antipsychotics are required to report immediately?
- Sore throat; fever; malaise - Unusual bleeding; easy bruising; skin rash - Persistent nausea and vomiting - Severe headache; rapid heart rate - 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
What services are needed for mental health?
- Special Education: Behavior Disorders School, School Aide for 1 to 1 care, Special Ed classes/mainstream classes - Psychologists - Psychiatrists - Counselors specializing in behavior disorders - Parenting Classes - Respite Cares - Case Management - Social Worker - Group Home Placement
Paraphilia is considered to be a paraphilic disorder when...?
- Specific types of sexual fantasies/behaviors are recurrent over a period of at least 6 months - Paraphilia causes the individual clinically significant distress or impairment in social, occupational, or other important areas of functioning
Methamphetamine (Stimulant)?
- Speed, ice, crystal (looks like rock candy) - Stimulant - Fastest growing drug - Smoked, snorted, injected or taken orally - White, odorless and tasteless. Dissolves in water - Main ingredient: ephedrine
Methylphenidate (Ritalin)?
- Stimulant - Appetite Suppressant - Increased Attention Span and Awareness - Euphoria - Street Names: Vitamin - "R" or Smart Drug - Weight Reduction
Psychopharmacology for children
- Stimulants: Ritalin, Cylert, Adderall - Antidepressants: Prozac, Paxil and Wellbutrin and Effexor - Antipsychotics: Risperdal, Abilify, Geodon, Haldol and Stelazine - Mood Stabilizers: Tegretol, Depakote and Neurontin - Anxiolytics: Ativan, Trazadone and Buspar
Immune Stress Response
- Stress stimuli: increases corticosteroids - Increase in cytokines to fight of stress to the immune system - More steroid production - Inhibits Immune System - Increase in Illness
Neurotransmitter Stress Response
- Stressful situation produces more serotonin - Increase in steroidal activity - Increase in depression - Increase in sleep - Decreased mood - Increases irritability - Decrease in pleasure
What is the overall goal of mental health patients?
- Successful performance of daily activities - Fulfilling relationships - Balance emotions - Able to change or cope with change
What behaviors are present with paranoid personality disorder?
- Suspects that others are out to harm them - Preoccupied with the trustworthiness of friends and peers - Reluctant to confide in people for fear the person will turn on them - Finds hidden meaning or threat in normal conversation - Persistent grudges against others - Questions the fidelity of their partner - Rage and Humiliation
Phase 4 of schizophrenia: Residual
- Symptoms are similar to those of prodromal phase - Flat affect and impairment in role functioning are prominent - Remission - Negative symptoms may remain
Cannabis use disorder?
- Symptoms can occur within a week of last use - Post use symptoms: irritability, anxious, insomnia, decreased weight loss, depression, tremors, sweats, fever, headache
What is the pharmacology in Alzheimer's?
- Tacrine hydrochloride (Cognex) - Rivastigmine (Exelon) - Galantamine (Reminyl) - Memantine (Namenda) - Donepezil (Aricept)
Lithium
- Take the medication regularly. - Do not drive or operate dangerous machinery. - Do not skimp on dietary sodium and maintain appropriate diet. - Know pregnancy risks. - Carry identification noting taking lithium. - Be aware of side effects and symptoms of toxicity. - Notify physician if vomiting or diarrhea occur. - Have serum lithium level checked every 1 to 2 months.
What are the different types of groups?
- Task: The function of a task group is to accomplish a specific outcome or task. The focus is on solving problems and making decisions to achieve this outcome. - Teaching: convey knowledge on topics like medication, diet, exercise - Supportive/theraputic: concerned with preventing future upsets by teaching participants effective ways to deal with emotional stress arising from situational or developmental crises. They focus instead on group relations, interactions among group members, and the consideration of selected issue - Self help: They allow clients to talk about their fears and relieve feelings of isolation while receiving comfort and advice from others undergoing similar experiences. i.e AA
Disruptive Mood Dysregulation Disorder
- Temper outbursts, verbal rage, physical aggression, - Occur 3 or more times/week (on average) - Temper outbursts inconsistent with developmental level - Persistent irritability between temper outbursts - Occur in at least 2 of 3 settings: home, school, with peers - Age of onset before age 10, - Diagnosis should not be made before age 6 or after age 18
What is temperament, diathesis, and stress in the diathesis-stress model?
- Temperament- how someone responds to challenges in predictable ways (ex: laid back) - Diathesis- genetic and biological vulnerabilities (ex: personality traits) - Stress- immediate influences on personality
What are treatments for hypoactive sexual desire disorders?
- Testosterone - Cognitive therapy, Behavioral therapy - Relationship therapy
Sedative-hypnotics
- The "Z" drugs - No anti anxiety, anticonvulsant or muscle relaxant effects - Quick onset Examples: zolpidem (Ambien), zaleplon, and eszopiclone (Lunesta)
What were the 3 divisions of nursing projects that received the most attention and shaped nursing's view of using research to guide practice?
- The Nursing Child Assessment Satellite Training Project (NCAST) - The Western Interstate Commission for Higher Education (WICHE) - The Conduct and Utilization of Research in Nursing Project (CURN)
Negligence
- The failure to exercise the standard of care that a reasonably prudent person would have exercised in a similar situation. - Any conduct that falls below the legal standard established to protect others against unreasonable risk of harm, except for conduct that is intentionally, wantonly, or willfully disregards others' rights.
Cognitive Behavioral Therapy
- The goal is to change the process - Reduce the frequency of the maladaptive response - Replace the maladaptive behaviors with a new positive response
When is the situation a crisis?
- The individual's perception of the event - The availability of a support system - Adequate support system
What are treatment issues with gender dysphoria in adolescents or adults?
- The longer people live with gender dysphoria before seeking treatment, the greater likelihood of suicide attempts/completions. - Some seek therapy to learn how to cope with altered sexual identity. - Some desire hormonal therapy and surgical gender reassignment.
Advocacy
- The nurse advocate makes the client's rights the priority. - Aim to promote self-determination in a client group
What are client rights?
- The right to treatment - The right to refuse treatment (including medication) - The right to the least restrictive treatment alternative - The right to confidentiality and the right to privacy
Fight or flight theory
- Threat to the body - Increase in blood pressure, heart rate and cardiac output - Men: alteration in the prefrontal area of the brain and increase in salivary cortisol - Women: Increase in limbic activity (emotions) - Reaction is dependent whether the signals to the brain interpret a threat to the body - Dilated pupils, dilated blood vessels
What are disadvantages of psychotherapy groups?
- Time constraints - Privacy; need to use blanket statements opposed to being specific - Disruptive members
Management of Disruptive Behaviors
- Time-out, redirection and limit setting - Quiet Room - Play Therapy and use of humor - Bibliotherapy - Therapeutic Drawing - Journaling - Music Therapy - B-mods - Counseling - Role Modeling and showing affection - Planned Ignoring - Sign Language and Signals - Physical Distance
What are psychotherapy treatment options for chemical dependency?
- Trexan and Revia (naltrexone): Block opiate receptors and reduces alcohol cravings. Used for alcohol and opiod addictions - Suboxone and Methadone: Block opiate receptors, decrease/stop opiate cravings. Methadone safe in pregnancy - Campral (acamprosate): abstinence. Used in alcohol addiction - Antabuse (disulfiram): Used in maintenance. Causes vomiting and/or diarrhea within 30 minutes of drinking alcohol - Clonidine (Catapres): Suppresses cravings for opiods - Benzodiazepines (Librium): Used to manage symptoms of withdrawal - Anticonvulsants Dilantin and Phenobarb used in the event of a seizure - Carbamzepine (Atretol): Withdrawal of alcohol. Taper off - Chlordiazepoxide (Librium): Alcohol detox. Reduces agitation and increases seizure threshold.
Types of Crisis: Crisis Reflecting Psychopathology
- Triggered by underlying psychiatric issues - Trigger Examples: Personality disorders, Anxiety, Mood Disorders, Thought Disorders
Alcohol abuse in elderly?
- Triggers: widow, retirement, loneliness - Michigan Alcoholism Screening Test: Geriatric Version 3 or < = no problem 4 = possibly alcoholism 5 or > = alcoholism Treatment: socializing, one on one therapy, facility therapy, grief/loss groups, AA
What behaviors are present with histrionic personality disorder?
- Uncomfortable if they are not the center of attention - Inappropriate sexual or provocative behaviors with others - Shallow expression of emotions - Uses physical appearance to draw attention to self - Speech is lacking in detail - Exaggerated expression of emotion - Easily influenced by others - Considers relationships to be more intimate than they actually are - As early as age 3-5, overly attached to parent of opposite sex
What are common characteristics of caregivers who are likely to be abusers of the elderly?
- Under economic stress, substance abuse, - Have been victims of previous family violence, - Exhausted / frustrated by the caregiver role
What are indicators by the adult of sexual abuse?
- Unduly protective of 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
Assessment of Possible Maltreatment
- Unexplained or unusual history of physical injury - Unexplained developmental delays - Malnutrition and dehydration - Medical problems
What is the psychological theory of abuse/violent behavior?
- Unmet needs for satisfaction and security result in an underdeveloped ego with a poor self-concept, & weak superego - Aggression and violence supply the individual with a dose of power and prestige that increases self-esteem
Health of children
- Urban children more likely to see a pediatrician when they are ill - Rural adults and children more likely to have a general practitioner as regular caregiver - Children who work on farms (exposure to injuries)
Bibliotherapy
- Use of children's literature to help the child express feelings in a supportive environment - Book should reflect the situation or feelings the child is experiencing
Suboxone?
- Used for opioid addiction - Taken at home with one on one therapy - Produces limited Euphoria - Step down approach Only compliant patients - They need to come in for drug test and need to go to support groups - If suboxone is altered, it won't work and they will have severe withdrawal effects
Trauma informed care
- Used in all settings - Trying to reduce the effects of trauma - Provider aware of traumatic events and triggers - Used to not retraumatize patients
Memantine (Namenda)
- Used in moderate to sever Alzheimer's
When are seclusions and restraints used?
- Used only in an emergency when there is imminent risk of the client hurting him/herself or others - An order for the restraint or seclusion must be obtained within an hour of the process - 4 hours adults - 2 hours for children 9-17 and 1 hour for children under 9
Antipsychotics
- Used to bring manic symptoms under control quickly (ex: Olanzapine) - Do not discontinue drug abruptly. - Use sunblock when outdoors. - Rise slowly from a sitting or lying position. - Avoid alcohol and over-the-counter medications. - Continue to take the medication, even if feeling well and as though it is not needed; symptoms may return if medication is discontinued.
Therapeutic holding for children
- Used to control destructive behaviors - Prompt, firm, nonretaliatory protective restraint - Used to reduce the child's distress - Produces relaxation and returns self-control and trust in staff
Mood stabilizers: Lithium
- Used to treat bipolar disorder - It works by balancing potassium and sodium by altering electrical currents - Need a lithium level of 0.4-1.3 - Side effects: sinus brady, convulsions, tremors, polyuria, edema, hypothyroidism - Need to monitor blood levels
When is methadone used?
- Used to treat opioid addiction - Synthetic opiate - Blocks cravings - Taken daily - Given in a clinic - Safe in pregnancy
Alzheimer's stage 7
- Very severe cognitive decline (late stage) - Inability to respond or control movement - Abnormal reflexes - Needs continual care - Muscle rigidity - Impaired swallowing - Able to say words or phrases
Predisposing Factors to Depression: Psychosocial theories- Cognitive theory
- Views primary disturbance in depression as cognitive rather than affective - Cognitive Triad: Negative expectations of the environment Negative expectations of the self Negative expectations of the future
What is a nurse self assessment with substance dependent patients?
- What are your attitudes, feelings or beliefs about addiction - Develop understanding and empathy to manage the manipulative behaviors - Avoid judgmental or condemnation statements
Crack and cocaine effects on the body?
- When smoked takes effect in 4-6 seconds, followed by a 5-7 minute high and then a deep depression - Effects on body: anesthetic and stimulant - Produces an imbalance of dopamine and norepinephrine - Withdrawal symptoms: depression, paranoia, lethargy, anxiety, insomnia, nausea, vomiting, sweating and chills
What are common characteristics of victims of the elderly?
- White female age 70 or older, - Mental or physical impairment, Inability to meet daily self-care needs - Care needs that exceeded the caretaker's ability
Risk factors for suicide: Gender
- Women attempt suicide more often, but more men succeed. - Women tend to overdose; men use firearms ( lethal)
Second generation antipsychotics
- Work on DA and S - Decrease EPS - Target negative and positive symptoms - Can cause metabolic syndrome - Side effects are hyperglycemia, weight gain, gyncomastia, amenorrhea, low libido - Drugs are clozapine, risperidone, olanxapine
First generation antipsychotics
- Work on DA, NE, and histamine - Treat positive symptoms - Side effects include EPS, amenorrhea, glactorrhea, gynecomastia, hypotension, weight gain and sexual dysfucntion Ex: haloperidol, aliphatic, piperazine, piperdine (phenothiazines/nonphenothiazines)
Anxiolytics: Benzodiazepines
- Work on GABA, to increase it and cause more inhibitory effect, it increases the receptor responsiveness thus decrease anxiety - If used with alcohol, opiates or TCAs can be life threatening - Examples are diazepam, clonazepam, alprazolam - Alprazolam is the most overused (Xanax)
What is the different elderly classifications?
- Young-old: 65-74 - Middle-old: 75-84 - Old-old: 85-100 - Elite-old (centenarians) 100+
What are treatment issues with gender dysphoria in children?
-Evaluation/management of concurrent mental health problems, social support systems; in later childhood, non-judgmental exploration of the individual's desires with regard to sexual reassignment. - Behavior modification to assist the child in accepting a culturally appropriate self-image without mental health concerns from discomfort associated with the assigned gender - Treatment must be personal choice. - Address issues of depression, anxiety, social isolation, anger, self-esteem, and parental conflict. Children who demonstrate gender nonconforming behaviors are often targets of bullying and violence.
How do you determine the lethality of a suicide plan?
-I f they have the means to carry it out (Ex: if they say they will kill themselves with a gun but don't have a gun then not as lethal) - If they say im going to jump in front of a car that is lethal because it can be easily carried out
What is the effect of stress on the immune system?
-stress contributes to lower immunity and increase disease and illness -stress increases the risk for depression -positive thinking and social supports increase optimum functioning
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What are the 7 steps in the evidence-based practice process?
0. Cultivating a spirit of inquiry 1. Asking compelling, clinical questions (PICOT) 2. Searching for the best evidence (Literature search) 3. Critically appraising the evidence 4. Integrating the evidence with clinical expertise and client preferences and values 5. Evaluating the outcomes of the practice decisions or changes based on evidence 6. Disseminating EBP results
What are the different BALs?
0.05 0.20 0.40- comatose 0.50- death
What are normal lithium levels?
0.6-1.2 mEq/L
What are substance abuse criteria? How many?
1 or more - Unable to fulfill responsibilities - Engage in dangerous behaviors under the influence (ex:driving) - Recurring legal or interpersonal problems - Continued substance use regardless of social or interpersonal problems
What are the Kubler-Ross stages of grief?
1. Denial: shock or disbelief 2. Anger: envy and resentment toward individuals not affected by the loss (Ex: everyone around you is happy and you cant understand why no one cares) 3. Bargaining: agreement with God in an attempt to reverse or postpone loss 4. Depression: intense sense of loss and feelings of sadness and depression (situational depression not clinical) 5. Acceptance: final stage brings feelings of peace regarding the loss
What are personal factors that effect communication?
1. Emotional: mood, stress, and personal bias 2. Social: previous experience, cultural differences, language differences 3. Cognitive: problem-solving, ability, knowledge and language use
Therapeutic communication: encouraging the patient perception, restating, and reflecting
1. Encouraging the patient perception: Asking the client to verbalize what is being perceived is often used with clients experiencing hallucinations. (Ex: "tell me what the voices are saying now") 2. Restating: repeating the main idea of what the patient says i.e if he says "my mind is wondering" the nurse says so your having problems concentrating? 3. Reflecting: Questions and feelings are referred back to the client so that they may be recognized and accepted and so that the client may recognize that his or her point of view has value—a good technique to use when the client asks the nurse for advice.
Group dynamics?
1. Group process: interaction among the members. this includes nonverbals, emotional reactions, how members process their thoughts, interactions between members and leaders, and power struggles. 2. Group content: what is said in the group 3. Group norms: common themes/feelings within the group
What are skinner's 7 basics of therapeutic milieu?
1. Health of each patient is recognized and encouraged to grow i.e physical or mental 2. Every interaction is a chance for therapeutic intervention 3. Each client owns his/her environment 4. Each client owns own behavior i.e consequences for bad behavior 5. Peer pressure is useful and powerful 6. Inappropriate behaviors are dealt with as they occur 7. Restrictions and punishments are to be avoided
What are examples of problematic patterns in a group?
1. Monopolizer: dominates the conversation and make the group about them-self 2. Complaining member who continues to reject help 3. Demoralizes others 4. Silent person 5. Paralingustics, so the tone of how people speak
What are 3 trends happening with sexuality during adolescence?
1. More adolescents are engaging in premarital intercourse. 2. The incidence of premarital intercourse for girls has increased. 3. The average age of first intercourse has decreased.
Sociological theories: 3 step trajectory elevates suicide ideation to an active risk for attempts
1. Pain combined with hopelessness significantly increases suicide ideation. 2. Connectedness prevents suicide ideation from escalating in those at risk; when pain / hopelessness exceed sense of connectedness to others, suicide ideation becomes active (as opposed to passive) 3. Strong, active suicide ideation leads to an attempt only if one has capacity to make an attempt.
Nontheraputic communication: examples of premature, denial and interpreting
1. Premature advice giving: implying how the client should behave i.e "why dont you..." 2. Denial: Denying that a problem exists blocks discussion with the client and precludes helping the client identify and explore areas of difficulty. 3. Interpreting: With this technique, the therapist seeks to make conscious that which is unconscious, to tell the client the meaning of his or her experience. the nurse needs to leave this behavior interpretation to the psychiatrist
What are the 4 phases of schizophrenia?
1. Premorbid 2. Prodromal 3. Active psychotic (Acute schizophrenic episode) 4. Residual
What are the phases of a nurse-client therapeutic relationship?
1. Preorientation: explore self perceptions and concerns about the patient, unit. not sure what to expect could have fear/anxiety 2. Orientation: first meeting, initial interview, establish rapport, patient problems discussed 3. Working phase: maintaining relationship, info sharing, data gathering, problem solving, behavioral change, adaptive behaviors 4. Termination: final phase, summarizing goals, new coping strategies, reviewing situations within nurse/client relationship and exchange of memories
How do you start a client interview?
1. Setting: secure, private and quiet 2. Seating: comfortable, good eye contact, normal tone of voice, good angle with your stance 3. Intro: ask the patient what brought you here opposed to why are you here 4. Start with open ended questions
Liability concerns of case managers exist when what conditions are met?
1. The provider had a duty to provide reasonable care. 2. A breach occurred through an act or omission to act. 3. The act or omission caused injury or damage to the client.
What are goals of case management?
1. To manage resource use and control expenses 2. To emphasize evidence-based clinical decision making 3. To ensure that care coordination occurs across the continuum
Group leadership communication
1. clarification: asks members to clarify or re-state info 2. confrontation: spots inconsistency with statements and behaviors within group 3. give information: provide resources 4. reflection: encourage exploration of feelings rather than thoughts or events 5. summarization: wraps up main points and key issues 6. support: acknowledge member thoughts and feelings and gives positive feedback *act on facts and feel your feelings. dont want to act on our feelings
Yalom's Curative Factors (1-5)
1. instillation of hope: by observing progress of others, it gives other members hope 2. universality: realize they are not alone, people share the same problems 3. imparting of information: knowledge is gained through instruction as well as sharing 4. altruism: mutual sharing and concern for each other. 5. corrective recapitulation of the primary family group: group members are able to reexperience early family conflicts that remain unresolved. resolution is promoted through feedback and exploration
When does antisocial personality disorder start?
15 to at least 18 years old
Henry Street Settlement
1st public health nursing practice
What is rape trauma syndrome?
2 emotional response patterns, may occur within hours after a rape; healthcare workers may see in emergency department or rape crisis center.
What is criteria for substance dependent? How many?
3 or more - Tolerance to the drug - Withdrawal symptoms - Increasing need more drug - Unsuccessful attempts to stop use - More time spent obtaining, using and recovering from the substance - Reduction in social, occupational and recreational activities - Continued use despite physical or mental issues
How long does it take for psychotropic medications to work?
3-6 weeks
What should sleep patterns be like for people with anxiety?
6-8 hours of un-interupted sleep, give antidepressant-trazadone to help with sleep + resperidone (antipsychotic) to help with slowing things down to allow for longer amount of sleep
Yalom's Curative Factors (6-8)
6. development of socializing techniques: interaction with and feedback from other members within the group, people are able to correct and develop new social skills 7. imitative behavior: if have a developed skill, can be a valuable role model for others. 8. interpersonal learning: group offers many opportunities for interacting with other people. insight is gained regarding how one perceives and is being perceived by others
How many stages does Alzheimer's have?
7
What is the disease duration of lewy body dementia?
8 years
What is the disease duration of Alzheimer's?
8-10 years
Yaloms curative factors (9-11)
9. group cohesiveness: members develop a sense of belonging that separates the individual from the group. 10. catharsis: word vomit, sharing of intense emotions to feel better 11. existential factors: group is able to help individual members take direction of their own lives and accept responsibility for the quality of their existence
Abilify (aripiprazole)
A 3rd class antipsychotic, adjunctive medication, very expensive
Autism Spectrum Disorder
A behavioral syndrome resulting from abnormal brain activity of unknown etiology
What is race?
A biological designation whereby group members share features (e.g., skin color, bone structure, genetic traits such as blood groupings)
What is metabolic syndrome?
A cluster of conditions that increase the risk of heart disease, stroke, and diabetes.
What is dialectical behavior therapy?
A combination of CBT and mindfulness to treat personality disorders or those with comorbid personality disorders. - Individual Awareness of thoughts and behaviors - Increase ability to handle stress - Improve interpersonal skills
What is cultural competence?
A combination of culturally congruent behaviors, practice attitudes, and polices that allow nurses to work effectively in cross-cultural situations
Body Dysmorphic Disorder
A disorder characterized by the unrealistic perception of physical flaws
What is brief psychotic disorder?
A disorder is identified by the sudden onset of psychotic symptoms that may or may not be preceded by a severe psychosocial stressor.
What is anxiety?
A feeling of discomfort, apprehension, or dread related to anticipation of danger, the source of which is often nonspecific or unknown. 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 function *anxiety attacks the emotions deeper than a fear response *normal anxiety, which is a healthy survival reaction that gives us motivation to achieve goals
What is integrative review?
A form of a systematic review that does not have the summary statistics found in the meta-analysis because of the limitations of the studies that are reviewed (e.g., small sample size of the population)
Fragile X Syndrome
A genetic disorder involving an abnormality in the X chromosome - Delays in ability to learn - Delays in functioning - Increase in anxiety - Hyperactive behaviors - At risk for seizures
What is continuum?
A gradual progression through many stages between one extreme and another
What is word salad?
A group of words that are put together randomly, without any logical connection Ex: "Most forward action grows life double plays circle uniform."
What is aggression?
A harsh physical or verbal action that reflects anger, rage, hostility and potential for physical or verbal destructiveness
Normal anxiety
A healthy survival reaction. Gives energy to achieve goals, motivates
Psychological theories: 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 not necessarily associated with more attempts.
Statutory laws
A law that has been enacted by a legislative body
Predisposing Factors to Depression: Psychoanalytical theory
A loss is internalized and becomes directed against the ego
Conversion Disorder
A loss of or change in body function that cannot be explained by any known medical disorder or pathophysiological mechanism Ex: Ex: being terrified to give a speech, that when they speech comes- has laryngitis. Once everyone else gives speeches and I don't have to, laryngitis goes away
What is delirium?
A mental status characterized by an acute disturbance of cognition manifested by short term confusion, excitement, disorientation, and clouded consciousness.
Prejudice
A negative attitude toward an entire category of people, often an ethnic or racial minority.
What is anxiety?
A noticeable change in behavior. A state of feeling of uneasiness, agitation, uncertainty and fear resulting from the anticipation of some threat, danger, change or fear of the unknown.
What is a paradignm shift?
A paradigm shift simply means a change from old ways of knowing to new ways of knowing and practicing.
What is battering?
A pattern of coercive control founded on & supported by physical and/or sexual violence or threat of violence toward an intimate partner
What is borderline personality disorder?
A pattern of intense and chaotic relationships, with affective instability and fluctuating attitudes towards other people.
What is a phobic disorder?
A persistent and irrational fear of a specific object, activity or situation that results in a compelling desire to avoid the dreaded object or situation.
Conduct Disorder
A persistent pattern of deviant behavior involving aggression to people or animals, destruction of property, theft, or serious rule violations - More often in boys - One of the most frequent dx for children
What is affect?
A person's outward expression of their inner mood. Example: smiling
What is sexual dysfunction?
A problem that consistently impairs sexual arousal or functioning
What is Alzheimer's?
A progressive disease that destroys memory and other important mental functions.
Post Traumatic Stress Disorder (PTSD)
A reaction to an extreme trauma (Ex: combat, natural disasters, accidents, rape)
Reactive depression
A response to a stressful event such as hospitalization or separation from parent
What is a narrative review?
A review done on published papers that support the reviewer's particular point of view or opinion and is used to provide a general discussion of the topic reviewed. This review does not often include an explicit or systematic review process.
What is culture?
A set of beliefs, values, and assumptions about life that are widely held among a group of people and that are transmitted across generations
What is psychosis?
A severe mental condition characterized by disorganization of personality, deterioration in social functioning, and loss of contact with, or distortion of reaility
Hypochondirasis
A somatoform disorder in which a person misinterprets normal physical sensations as symptoms of a disease - Chronic with relapse - History of Childhood Trauma
What is hypomania?
A somewhat milder form of mania
What is a meta-analysis?
A specific method of statistical synthesis used in some systematic reviews, where the "results from several studies are quantitatively combined and summarized"
Cultural conflict
A struggle that arises because of differing values, customs, or circumstances between groups of people.
What is duel diagnosis?
A substance abuse or dependence ALONG WITH a mental issue
What is a crisis?
A sudden event in one's life, during which usual coping mechanisms cannot resolve the problem - State of disequilibrium occurs and problems seem unsolvable - Associated with events that are experienced by helplessness, disorganization, tension - Opportunity for potential growth
What is systematic review?
A summary of the research evidence that relates to a specific question and to the effects of an intervention.
Somatoform Disorders
A syndrome multiple somatic symptoms that cannot be explained medically and are associated with psychosocial distress
Aggregate
A targeted segment of the population or a group
What is the diathesis-stress model?
A theory that attempts to explain how a personality disorder is a result of an interaction between diathesis, temperament, and stress.
What is Electroconvulsive therapy (ECT)?
A treatment that involves inducing a brief seizure by delivering an electrical shock to the brain
Tort
A violation of a civil law in which the individual has been wronged
What is the best clue to identify depression vs normal stormy adolescent behavior?
A visible manifestation of behavioral change that lasts for several weeks
During the termination phase of nurse/client relationship the nurse should do which one of the follwing? (select all) a. recap what has been accomplished within the nurse/client relationship b. have the client discuss how he/she is feeling c. clarify the roles within the nurse/client relationship d. share learned experiences
A,B,D
After an examination and treatment for rape, the nurse prepares to discharge a client from the emergency department (ED). Which discharge teaching should the nurse provide? A- Information on available community resources B- The names and phone numbers of local attorneys who defend rape victims C- When to return to the ED for follow-up care D- The phone number of the battered women's shelter or safe house
A- Information on available community resources B/c they can know where to go
A nurse is preparing an educational program on cultural perspectives in nursing. The nurse should include which factors as influenced by an individual's culture? (select all that apply) A- Nutritional practices B- Family structure C- Health care interactions D- Biological variations E- Views about illness
A- Nutritional practices B- Family structure C- Health care interactions E- Views about illness
A 12-year-old girl suddenly refuses to change for gym, participate in physical activities, has difficulty walking and sitting, and will not eat her food at lunchtime. What should the school nurse consider when assessing this child's symptoms? A- Sexual abuse B- Emotional neglect C- Physical neglect D- Emotional abuse
A- Sexual abuse
A client who is prescribed lithium carbonate is being discharged from inpatient care. Which medication information should the nurse teach this client? A. Do not decrease dietary sodium intake. B. Have serum lithium levels checked every 6 months. C. Limit fluid intake to 1,000 mL of fluid per day. D. Adjust the dose if you feel out of control.
A. Do not decrease dietary sodium intake. B/c Clients taking lithium should consume a diet adequate in sodium and drink 2,500 to 3,000 ml of fluid per day. Lithium is a salt and competes in the body with sodium. If sodium is lost, the body will retain lithium with resulting toxicity. Maintaining normal sodium and fluid levels is critical to maintaining therapeutic levels of lithium and preventing toxicity.
A client, diagnosed with paranoid schizophrenia, states, "My roommate is plotting to have others kill me". Which is the appropriate nursing response? A. I find that hard to believe B. What would make you think such a thing C. I know your roommate. He would do no such thing D. I can see why you feel that way
A. I find that hard to believe
A client diagnosed with schizophrenia experiences identity confusion and communicates with the nurse using echolalia. What is the client attempting to do by using this form of speech? A. Identify with the person speaking B. Imitate the nurse's movements C. Alleviate alogia D. Alleviate avolition
A. Identify with the person speaking
In the initial stages of caring for a client experiencing an acute manic episode, what should the nurse consider to be the priority nursing diagnosis? A. Risk for injury related to excessive hyperactivity B. Disturbed sleep pattern related to manic hyperactivity C. Imbalanced nutrition, less than body requirements, related to inadequate intake D. Situational low self-esteem related to embarrassment secondary to high-risk behaviors
A. Risk for injury related to excessive hyperactivity
As a last resort, an agitated, physically aggressive client is placed in four-point restraints. The client yells, "I'll sue you for assault and battery." The unit manager determines that the nurses are protected under which condition? A. The client is voluntarily committed and poses a danger to others on the unit. B. The client is voluntarily committed and has a history of being a danger to others. C. The client is involuntarily committed because of a history of violent behavior. D. The client is involuntarily committed and is refusing treatment.
A. The client is voluntarily committed and poses a danger to others on the unit. As threat to others, the client can be restrained despite objections and voluntary commitment
What tool is used to monitor for tardive dyskinesia?
AMES
What are the symptoms of metabolic syndrome?
Abdominal obesity, high triglycerides, low HDL, hypertension, insulin resistance, prothrombotic or proinflammatory states
What is resilience?
Ability to adapt/secure resources. Characterized by optimism, sense of mastery, competence and is essential to recovery. This is the ability to bounce back
Who does abuse affect?
Abuse affects all populations, races, religions, economic classes, ages, and educational backgrounds equally The phenomenon is cyclical as many abusers were themselves victims of abuse as children.
Who is usually the victimizer of elder abuse?
Abuser is often a relative who lives with the elderly person and may be the assigned caregiver.
Therapeutic communication: accepting and giving recognition
Accepting: convey an attitude of reception and regard Giving recognition: acknowledging and giving compliment (Ex: I see you made your bed today, good job)
Acculturation
Acculturation is the process of merging with or adopting the traits of a different culture. Adapting to a new culture requires changes in daily living practices. Ex: changes in: language, education, work, recreation, social experiences, and the health care system
Utilitarianism
Actions are right to the degree that they tend to promote happiness and are wrong as they tend to produce the reverse of happiness
What is indirect care?
Activities are those that a nurse does on behalf of clients to improve or coordinate care Ex: Supervising home health aides, Obtaining results of diagnostic tests, Documenting care.
What is advocacy?
Activities for the purpose of protecting the rights of others while supporting the client's responsibility for self-determination; involves informing, supporting, and affirming a client's self-determination in health care decisions. Ex: Assuring a client
Client advocate
Acts as an advocate, provides information, and supports benefit changes that assist member, family, primary care provider, and capitated systems
Broker
Acts as an agent for provider services that are needed by clients to stay with coverage is what case manager role
What are stress reactions in people with illnesses?
Acute and chronic illnesses may become worse by the prolonged effects of a disaster-exacerbation!
Refugees
Admitted outside the usual quota restrictions based on fear of persecution due to their race, religion, nationality, social group, or political views
Nonimmigrants
Admitted to the U.S. for a limited duration and specific purpose (i.e., students, tourists)
How does sexuality change in adolescence?
Adolescence represents an acceleration in biological changes, psychosocial and sexual development.
What type of crisis is hurricane katrina?
Adventitious (traumatic stress)
What type of crisis is rape?
Adventitious (traumatic stress)
Cultural brokering
Advocating, mediating, negotiating, and intervening between the client's culture and the biomedical health care culture on behalf of clients.
What are the 4 spheres of human functioning?
Affective Behavioral Cognitive Physiological - Alterations within these spheres differ according to degree of severity of symptomatology.
Epidemiology of Depression: Seasonality
Affective disorders are more prevalent in the spring and in the fall.
When is Asperger's usually first observed?
After the age of 2
What is the psychosocial theory of anger & aggression?
Aggression can be viewed as a direct result of unmet basic needs, childhood abuse and neglect, dysfunctional families, poor parenting, separation from parents physical and sexual abuse
What does reminiscence therapy do for elderly?
Alleviates depression and enhances positive self-concept
What is mania?
Alteration in mood may be expressed by feelings of elation, inflated self-esteem, grandiosity, hyperactivity, agitation, racing thoughts, & accelerated speech.
Tricyclic antidepressants examples
Amitriptyline, Imipramine, Nortriptyline, Clomipramine, Doxepin
Obsessive Compulsive Disorder (OCD)
An anxiety disorder characterized by unwanted repetitive thoughts (obsessions) and/or actions (compulsions)
Cultural awareness
An in-depth self-examination of one's own background, recognizing biases, prejudices, and assumptions about other people
What is cultural awareness?
An in-depth self-examination of one's own background, recognizing biases, prejudices, and assumptions about other people
Collaboration
An individual attempts to work with others toward solutions that satisfy the needs of both parties
What is transgender?
An individual experiences incongruence between his or her biological/assigned gender and gender identity.
Malpractice
An instance of negligence or incompetence on the part of a professional.
What is evidence-based nursing?
An integration of the best evidence available, nursing expertise, and the values and preferences of the individuals, families, and communities who are served
What are common behaviors after a crisis?
Anger Forgetfulness Headaches Overeating, undereating Shock, disbelief Social withdrawal Poor concentration Many, many more
Adolescence symptoms of depression
Anger, aggressiveness Running away Delinquency Social withdrawal Sexual acting out Substance abuse Restlessness, apathy
What are some common, but manageable, side effects of antidepressants?
Anticholinergic effects dry mouth, sedation, and nausea.
What are side effects of antipsychotics?
Anticholinergic effects, nuasea, rash, sedation, orthostatic hypotension, photosensitivity, hormonal effects, electrocardogram changes, weight gain, hyperglycema, reduction in seizure threshold, agranulocytosis, NMS, EPS
What is treatment for depression in elderly?
Antidepressant medication Electroconvulsive therapy Psychosocial therapies
What medications are used in bulimia?
Antidepressants, SSRIs with Cognitive Behavioral Therapy (CBT) Prozac, Wellbutrin
What are medications commonly used to treat extrapyramidal side effects?
Antiparkinsonian agents such as: benztropine, amantadine, trihexyphenidyl, diphenhydramine
What is the pharmacological treatment for schizophrenia?
Antipsychotics- to decrease agitation and psychotic symptoms of schizophrenia and other psychotic disorders
How are stress and anxiety different?
Anxiety is subjective and caused by stressors, so stress and anxiety are different
Children raised by a depressed parent are at risk for what?
Anxiety, conduct disorder, alcohol dependence
Adult Disorders That May Begin in Childhood?
Anxiety, mood disorder, schizophrenia
Cluster C is described as?
Anxious or fearful
Restraints are any device or method of prevented voluntary/monitor
Any device or method of preventing voluntary movement
What is a disaster?
Any human-made or man-made event that causes destruction and devastation that cannot be relived without assistance. - Does not need to cause death or injury
Personal Health Information (PHI)
Any info that IDs the person for which reasonable basis to believe it can be used to ID the person
What is sexual assault?
Any type of sexual act in which an individual is threatened or coerced, or forced to submit against his/her will
What are behaviors to avoid while interviewing clients?
Arguing with the client, minimizing the situation, speculate about what the real problem is, attacking the client, criticism of other peers/staff/unit
Coordinator
Arranges, regulates, and coordinates needed health care services for clients at all necessary points of services
How early can schizophrenia be seen in children?
As early as 5-6
In a client crisis, the nurse will first determine client safety to see if there is a need for external controls. What is the next priority assessment for the nurse? - Assess coping skills - Assess situational supports - Assess the client's perception of the precipitating event
Assess the client's perception of the precipitating event
Nursing process with case management?
Assessment - Clarify Problem by evaluating physical needs, psychosocial issues, functional ability, and financial constraints Diagnosis - Problem Identification - Determine cause and precipitating factors. - Identify nursing diagnoses based on assessment findings Planning - Prioritize problems - Outcomes: advantages and disadvantages, roles of interdisciplinary team & family effect of plan on client
Identification
Assumption of thoughts in order to decrease anxiety
Who was the system of care during America's colonial period and the new republic?
At first it was a family/friend system of care
What do personality disorders cause a disruption in?
At least 2 - Cognition - Affect - Interpersonal relationships - Impulse control
Who do community based nurses work with?
At risk populations like teen moms, older adults, ethnic differences in a VARIETY of settings
Depressive disorder associated with another medical condition
Attributable to the direct physiological effects of a general medical condition (Ex: Cancer, Parkinson's)
What are barriers to rural health care delivery?
Available, affordable, accessible, or acceptable services and professionals, providers' attitudes, insights, and knowledge
What is the aversion therapy for paraphilic disorders?
Aversion therapy methods in the treatment of paraphilic disorders involve pairing noxious stimuli, such as electric shocks and bad odors, with the impulse, which then diminishes.
What is the primary emphasis for antidepressant therapy?
Avoidance of possible side effects rather than on efficacy - Low doses, slowly and gradually increase as necessary
A client expresses a desire to begin attending the self-help group Alcoholics Anonymous (AA). Which nursing response gives the client pertinent information about this type of group? A "In this type of group, membership is always within a fixed time frame." B "Group members receive comfort and advice from others undergoing similar experiences." C "The purpose of this type of group is to convey information to a number of individuals." D "The function of this type of group is to accomplish a specific outcome."
B "Group members receive comfort and advice from others undergoing similar experiences."
QUESTIONS: What does a nurse need to do first, before providing care for a client with variations in sexual orientation? A. Learn vocabulary B. Assess own values/judgements C. Recognize medications used D. Recognize variations in sexual orientation as a mental illness
B. Assess own values/judgements
A nurse gave a client 5 mg of haloperidol (Haldol) for agitation. The client's chart was clearly stamped "Allergic HALDOL." The client suffered anaphylactic shock and died. How would the nurse's actions be labeled? A. Intentional tort B. Negligence C. Battery D Assault
B. Negligence
QUESTION: Which of the following medications is appropriate in the treatment of male erectile disorder? A. Rivastigmine (Exelon) B. Tadalafil (Cialis) C. Somatropin (Zorbtive) D. Phenelzine (Nardil)
B. Tadalafil (Cialis)
The nurse is assessing a client or side effects following ECT. Which side effect is to be expected? A. Enduring memory loss B. Temporary disorientation C. Residual seizure disorders D. Cardiovascular complications
B. Temporary disorientation
A suicidal client with a history of manic behavior is admitted to the emergency department. The client's diagnosis is documented as bipolar I disorder: current episode depressed. What is the rationale for this diagnosis instead of a diagnosis of major depressive disorder? A. The physician does not believe that the client is suffering from major depression. B. The client has experienced a manic episode in the past. C. The client does not exhibit psychotic symptoms. D. There is no history of major depression in the client's family.
B. The client has experienced a manic episode in the past
When teaching about the tricyclic group of antidepressant medications, which information should the nurse include? A. Strong or aged cheese should not be eaten while taking this group of medications. B. The full therapeutic potential of tricyclics may not be reached for 4 weeks. C. Long-term use may result in physical dependence. D. Tricyclics should not be given with anti-anxiety agents
B. The full therapeutic potential of tricyclics may not be reached for 4 weeks.
A client has been diagnosed with major depression. The psychiatrist prescribes Paroxetine . Which of the following medication information should the nurse include in discharge teaching? Select all that apply. A. Do not eat chocolate while taking this medication. B. The medication may cause priapism. C. The medication should not be discontinued abruptly. D.The medication may cause photosensitivity. E. Report increased n/v, diarrhea, muscle rigidity
B. The medication may cause priapism. C. The medication should not be discontinued abruptly. E. Report increased n/v, diarrhea, muscle rigidity
A nurse is caring for a client in a mental health setting who becomes more and more aggressive to staff and clients. the client has not responded well to redirection. which action should the nurse demonstrate in regards to the milieu? a. escort the client to his or her room b. direct all clients to their rooms c. continue with group and ignore behavior d. redirect client back to the group
B; not A because trying to get the client back to the room could increase aggression and we want to promote safety of others
What are the verbal tics of Tourette's disorder?
Barks, grunts, yelps, clicks, snorts, sniffs, coughs
Suicide risk may increase early in treatment with antidepressants. Why?
Because antidepressants give those with depression clear thoughts and energy to possibly carry it out
Why can a panic disorder become an emergency?
Because it can turn into a myocardial infarction
Why are patients with somatoform disorders at risk for suicide?
Because of rejection and they are often irritated by an implication that stress or psychosocial factors play a role in their conditions
Why could Phase 3 of caplan's phases be a medical emergency?
Because the anxiety can increase so badly that it could cause a heart attack
Why is a child more vulnerable if the mother is suffering from mental disorders?
Because the mother is typically the head nurturer and has stronger bond
What is schizotypal personality disorder?
Behavior that is odd and eccentric but does not decompensated to the level of schizophrenia
Asperger's Syndrome
Behavioral syndrome characterized by varying degrees of difficulty in social and conversational skills but normal-to-above-average intelligence and language development
What is the behavioral therapy for paraphilic disorders?
Behavioral therapy also includes skills training and cognitive restructuring in an effort to change the individual's maladaptive beliefs.
Ethnocentrism
Belief in the superiority of one's nation or ethnic group
Racism
Belief that race is the primary determinant of human traits and capacities and that racial differences produce an inherent superiority of a particular race.
What is the biological treatment of paraphilic disorders?
Biological treatment of individuals with paraphilic disorders has focused on blocking or decreasing the level of circulating androgens. - Meant to be used only as congjunctive therapy
What are the mood disorders in children?
Bipolar disorder, major depression, dysthymia
Development of Human Sexuality Birth- Age 12
Birth- age 12: masculinity & femininity plus gender roles are culturally-defined By age 2- 2 1/2, children know their gender By age 4-5, they engage in heterosexual play Late childhood and preadolescence may be characterized by heterosexual or homosexual play Children ages 10 to 12 years: preoccupied with pubertal changes & beginnings of romantic interest in the opposite gender
Projection
Blaming
How do typical antipsychotics work?
Block postsynaptic dopamine receptor blockers
Dissociation
Blocking of extreme anxiety or event
What is BAL?
Blood Alcohol Levels (BAL) - Used to assess the level of intoxication and the level of tolerance
Does the body always respond to a threat?
Body responds the same whether the threat is real or perceived
Conduct Disorder by Gender
Boys: fight, steal, vandalize, school problems Girls: runaway, taunt, drug use, prostitution, less confrontational
Affect assessment
Bright Euthymic Blunted Bland Flat
What is case manager?
Builds on the basic functions of the traditional role and adapts new competencies for managing transition from one part of the system to another or to home.
Atypical antidepressant examples
Bupropion, Mirtazapine, Trazodone
Question: The nurse understand the concept of therapeutic relationships when the nurse responds to the patient in which one of the following ways: A "I know what it is to feel as lonely as you. You should just try to rest" B "Are you feeling lonely?" C " Please explain how you are feeling" D " When I feel lonely, I like to sleep"
C " Please explain how you are feeling" Because it keeps it open
Jose Aguilar is a 48-year-old male who works in the grape fields for 12-13 hours per day. He is responsible for picking fruit and packing and moving crates to be picked up for delivery. What are the primary health concerns for this client? (Select all that apply) A Tractor fall B Green tobacco sickness C Chronic neck and back pain D Eye problems related to dust and chemicals E Skin cancer
C Chronic neck and back pain D Eye problems related to dust and chemicals E Skin cancer
As a public health nurse working in rural practice, what are some of the professional challenges Ms. Garcia may encounter? A Diversity in clinical experiences B Close relationships with clients and coworkers C Lack of resources with other health professionals to interact with D Greater autonomy of practice
C Lack of resources with other health professionals to interact with
After a supportive-therapeutic group, a nurse hears one client say to another, "I never thought that other people had the same problems that I have." Which curative factor would the nurse identify in this statement? A Catharsis B Group cohesiveness C Universality D Imitative behavior
C Universality
From a biological theory perspective, which of the following predisposes individuals to be abusive? A- Unmet needs for security resulting in an underdeveloped ego and a weak super ego B- Imitation of individuals who have a predisposition toward aggressive behavior C- Various levels of norepinephrine, dopamine, and serotonin D- The influence of culture and social structure
C- Various levels of norepinephrine, dopamine, and serotonin B/C C is part of the biological theory
A client who has been taking chlorpromazine (Thorazine) for several months presents in the emergency department with EPS of restlessness, drooling, and tremors. What medication will the nurse expect the physician to order? A. Paroxetine (Paxil) B. Carbamazepine (Tegretol) C. Benztropine (Cogentin) D. Lorazepam (Ativan)
C. Benztropine (Cogentin)
The client hears the word "match." The client replies, "A match. I like matches. They are the light of the world. God will light the world. Let your light so shine." Which communication pattern does the nurse identify? A. Word salad B. Clang association C. Loose association D. Ideas of reference
C. Loose association
QUESTION: A nursing instructor is teaching a class about normal human sexuality. Which information should be included? A. Gender identity develops during adolescence. B.Sexual drives remain consistent throughout the life span. C. Many medications can impact sexual functioning. D. The elderly have little interest in sexual activity.
C. Many medications can impact sexual functioning.
A client is admitted with a diagnosis of brief psychotic disorder, with catatonic features. Which symptoms are associated with the catatonic specifier? A. Strong ego boundaries and abstract thinking B. Ataxia and akinesia C. Stupor, muscle rigidity, and negativism D. Substance abuse and cachexia
C. Stupor, muscle rigidity, and negativism
The nurse is preparing the activities and groups for the week. the nurse understands the concept of a therapeutic milieu groups when the nurse includes which one of the following in the weeks activities? a. alcoholic annonymous group b. a game of monopoly c. art therapy d. session with a licensed therapist
C; A would exclude people, a game of monopoly is just fun not therapeutic, and session with a therapist is one on one
What is the CAGE tool?
CAGE (AID) TOOL (1 + answer = possible problem, 2 + = probable problem) C= Have you ever felt like cutting down on your drinking? A= Have people annoyed you by criticizing your drinking? G= Have you ever felt guilty about your drinking? E= Have you ever had to take a drink in the morning to get going (eye opener)? A= Adapt to Include Drugs
Brain imaging: CT vs MRI
CT: 3-D x-ray. can find lesions, abrasions, bleeds, aneurysms, atrophy, schizophrenia and cognitive disorders. MRI: 3-D imaging via radio waves. it can show edema, ischemia, neoplasm, trauma, schizophrenia, reduction of temporal and prefrontal lobes. this is the most accurate and definitive test but a CT is quicker and cheaper
How can mania occur?
Can occur as part of bipolar disorder, as part of some other medical conditions, or in response to some substances.
What may a person with a panic disorder first present with?
Can present to the ED as a MI and mitral valve prolapsed. After a work up will then be dx as a panic attack.
What foods are foods to avoid with MAOIs?
Can't eat food with tyramine Ex: cheese, smoked meat, wine, chocolate
What is vulnerability?
Cannot have their needs met on their own
Electroconvulsive therapy: Contraindications
Cardiac, CVA, severe osteoporosis
Mentor
Case manager who counsels and guides the development of the practice of new case managers
Researcher
Case manager who uses and applies evidence-based practices for programmatic and individual interventions with clients and communities, participates in the protection of clients in research studies, and initiates and collaborates in research programs and studies
Consultant
Case manager who works with providers, suppliers, the community, and other case managers to provide case management expertise in programmatic and individual applications
What are examples of secondary dementia?
Caused by other pathological processes, or pseudomentia
What are examples of SSRIs?
Celexa, Prozac, Paxil, Zoloft
What is the function of the cerebellum versus the cerebrum?
Cerebellum: The cerebellum is associated with involuntary aspects of movement such as coordination, muscle tone, and the maintenance of posture and equilibrium. sits at the base of the brain Cerebrum: divided into left and right; the left hemisphere appears to deal with logic and solving problems. The right hemisphere may be called the "creative" brain and is associated with affect, behavior, and spatial-perceptual functions. Each hemisphere is divided into four lobes
What is the function of the cerebellum and hypothalamus?
Cerebellum: regulate skeletal muscles and balance Hypothalamus: basic drives and thought/emotions. primitive functions
What are personality traits?
Characteristics with which an individual is born or develops early in life.
What is female sexual/interest/arousal disorder?
Characterized by a reduced or absent interest or pleasure in sexual activity. The individual typically does not initiate sexual activity and is commonly unreceptive to partner's attempts to initiate. There is an absence of sexual thoughts or fantasies and absent or reduced arousal in response to sexual or erotic cues.
What is delayed ejaculation?
Characterized by marked delay in ejaculation or marked infrequency or absence of ejaculation during partnered sexual activity. With this disorder, the man is unable to ejaculate, even though he has a firm erection and has had more than adequate stimulation. - The severity of the problem may range from only occasional problems ejaculating (secondary disorder) to a history of never having experienced an orgasm (primary disorder).
What is erectile disorder?
Characterized by marked difficulty in obtaining or maintaining an erection during sexual activity, or a decrease in erectile rigidity that interferes with sexual activity. - Primary erectile disorder refers to cases in which the man has never been able to have intercourse - Secondary erectile disorder refers to cases in which the man has difficulty getting or maintaining an erection but has been able to have vaginal or anal intercourse at least once.
What is bipolar disorder?
Characterized by mood swings from profound depression to extreme euphoria (mania), with intervening periods of normalcy - May include delusions or hallucinations - Onset of symptoms may reflect seasonal pattern.
What is child abuse?
Child maltreatment typically includes physical/ emotional injury, physical or emotional neglect, or sexual acts inflicted upon a child by a caregiver.
What is the behavioral theory of anger & aggression?
Children learn through imitation and people repeat behaviors they are rewarded for. Aggression is linked to domestic abuse, suicide, chemical dependency and sexual assaults - Aggression is linked to domestic abuse, suicide, chemical
What is clang associations?
Choice of words governed by sounds; usually rhyming
What is marital sex?
Choosing a marital partner/developing a sexual relationship with another person
What is addiction?
Chronic disease of the brain reward, motivation, memory and related circuitry where a dysfunction in these circuits is connected to an individual pathophysiology pursuing reward and/or relief by substance use and behavior - Dysregulation of the pleasure center - Loss of behavioral control, unable to abstain - Cravings - Loss of emotional regulation - Cant identify problems in relationships and behaviors
What is emotional neglect of a child?
Chronic failure by parent/ caretaker to provide child with hope, love, & support necessary for the development of a sound, healthy personality
SSRI
Class of drugs used to relieve anxiety by limiting reuptake of a neurotransmitter serotonin, so more in circulation - Less anticholinergic effects and less sedation - First line treatment - Drugs: fluoxetine, fluvoxamine, sertaline, paroxetine, citalopram, escitalopram - Can cause sexual dysfunction - Effects can take 1-4 weeks to see - Weight gain is a major side effect
How do you gain perception of the precipitating event before a crisis?
Clear definition of the problem Ex: "What leads you to seek help now?" "Describe how you are feeling now" "Has anything upsetting happened to you within the past few days or weeks?"
The highest priority goal for crisis intervention is? - Client safety - Anxiety reduction - Identification of situational supports - Teaching coping skills
Client safety
Pain disorder
Clients experience pain in the absence of physiological findings and the presence of possible psychological factors - Diagnostic Tests do not find an underlying reason - Discomfort leads to impairment - Serious risk for suicide
Affect is to mood as weather is to ...?
Climate
What is CIWA?
Clinical Institute Withdrawal Assessment for Alcohol (CIWA) Used to Direct Benzodiazepine Protocol 0-7 score
Which antipsychotic causes agranulocytosis?
Clozapine
What are the genetics to anxiety theory?
Clusters in families
What is sexual exploitation of a child?
Coercing a child to engage in sexually explicit conduct for the purpose of promoting any visual sexual performance, and child sexual abuse, being used for the sexual pleasure of an adult
What are the 3 dimensions of each stage of developing cultural competence?
Cognitive (thinking), Affective (feeling), Psychomotor (doing)
What is histrionic personality disorder?
Colorful, dramatic, extroverted behavior in excitable, emotional people
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 lack of interest in playing with friends.
Childhood depression symptoms: Ages 3-5
Common symptoms may include accident proneness, phobias, aggressiveness, and excessive self-reproach for minor infractions.
What are the comorbidities associated with childhood depression?
Conduct or oppositional disorders, Anxiety disorder, ADHD
Caplan's 4 phases of a crisis: Phase 1
Conflict or problem ↓ Self concept is threatened ↓ Increased anxiety ↓ Use of problem solving techniques and defense mechanisms to reduce anxiety
What is coordinating?
Conscious activity of assembling and directing the work efforts of a group of health providers so that they can function harmoniously in the attainment of the objective of client care.
Suppression
Conscious removal of awareness - Also procrastination
Factitious Disorders
Conscious, intentional feigning of physical or psychological symptoms - Under conscious control - Attention seeking - Get emotional needs met - Intentional - External Incentives (monetary gain, avoidance of consequences or responsibilities)
Telehealth
Contemporary intervention approach used by case managers
What are bentos contraindicated in?
Contraindicated in substance abuse, pregnant or breast feeding clients
When can tardive dyskinesia occur?
Could be late onset (months-years)
Dorothea Dix
Crusade to help individuals who were institutionalized for mental health illnesses
What is cultural accommodation?
Cultural accommodation means that the nurse supports and facilitates clients in their use of cultural practices when such cultural practices are not harmful to clients. Ex: consider the practice of home burial of the placenta.
What is recognized as the fundamental aspect of quality health care (including mental health)?
Cultural and linguistic competence b/c it acts as an essential strategy for reducing disparities by improving access, utilization and quality of care
What is cultural brokering?
Cultural brokering is advocating, mediating, negotiating, and intervening between the client's culture and the biomedical health care culture on behalf of clients. Ex: migrant workers tend to have high occupational mobility; many are poor and have limited formal education. They may seek health care only when they are ill and cannot work. Whenever a nurse interacts with them, it is important to teach them about prevention, health maintenance, environmental sanitation and pesticides, and nutrition because it may be the only opportunity that the nurse will have to treat a particular migrant worker.
What are cultural encounters?
Cultural encounter is the process that permits nurses to seek opportunities to engage in cross-cultural interactions with clients of diverse cultures to modify existing beliefs about a specific cultural group and possibly avoid stereotyping. this is part of interpersonal nursing
What is cultural preservation?
Cultural preservation means that the nurse supports and facilitates the use of scientifically supported cultural practices from a person's culture along with those from the biomedical health care system. Ex: acupressure and acupuncture.
What is cultural repatterning/restructuring?
Cultural repatterning/restructuring means that the nurse works with clients to help them reorder, change, or modify their cultural practices when these practices are harmful to them. Ex: a culturally competent nurse knows of the high incidence of obesity among Mexican American women 20 years of age and older. A school nurse was invited to develop a health education program for Mexican teenagers in the local high school
What are some skills culturally skillful nurses use?
Culturally skillful nurses use appropriate touch during conversation, modify the physical distance between themselves and others, and use strategies to avoid cultural misunderstandings while meeting mutually agreed-upon goals.
What are examples of SSNRIs?
Cymbalta, Effexor
Janelle Garcia is working primarily with Mexican immigrants. What cultural health beliefs and practices is Ms. Garcia expected to encounter when dealing with this population? A Mexican immigrants prefer not to be touched in encounters. B The female in the household is considered the health care decision maker. C The Mexican client is more likely to listen to the health care provider for information. D The Mexican client may appear to understand information by nodding.
D The Mexican client may appear to understand information by nodding.
A young mother in a severely abusive relationship is admitted to the psychiatric unit after an attempted suicide. The client states," I'm sure things will be better between us once I go home." What is the nurse's most appropriate response? A- "Research shows that men who batter get worse rather than improve." B- "Aren't you concerned about your children?" C- "You really should not return home to that violent situation." D- "Let's develop a safety plan in case he becomes violent in the future."
D- "Let's develop a safety plan in case he becomes violent in the future." B/c safety is #1, and preparing for the next steps
When a client is beginning to escalate the best thing to do is which one of the following: A- Ignore the behavior B- Direct the client to take a time out C- Encourage the client to keep it all inside D- Ask the client what is going on with him/her
D- Ask the client what is going on with him/her
All of these are examples of signs that may precede violence except which one of the following: A- Verbal abuse by others B- Limit setting by staff C- Hyperactivity D- Waking up from a nap
D- Waking up from a nap
To deal with a client's hallucinations therapeutically, which nursing intervention should be implemented? A. Reinforce the perceptual distortions until the client develops new defenses B. Provide an unstructured environement C. Avoid making connections between anxiety producing situations and hallucinations D. Distract the client's attention
D. Distract the client's attention
An individual experienced the death of a parent 2 years ago. This individual has not been able to work since the death, cannot look at any of the parent's belongings, and cries daily for hours at a time. Which nursing diagnosis most accurately describes this individual's problem? A. Posttrauma syndrome related to parent's death B. Anxiety (severe) related to parent's death C. Coping, ineffective related to parent's death D. Grieving, complicated related to parent's death
D. Grieving, complicated related to parent's death
What is the difference between DSM IV and DSM V?
DMS-5 has clumped together axis that are in paragraph form but also have coding for billing purposes. In DSM IV all the axis are separate
Why would someone be involuntarily committed?
Danger to self, others, or you have an overall inability to provide for basic needs
Intervention- Counseling Strategies
Deals with present problem only-"Here and Now"
Common laws
Decisions based on prior cases of a similar nature
What is circumstantiality?
Delay in reaching the point of a communication because of unnecessary and tedious details - The goal is usually met by multiple interruptions by the interviewer
Stage III of mania
Delirious mania - Serious form of the disorder characterized by intensification of symptoms associated with acute mania - Labile mood; panic anxiety - Clouding of consciousness; disorientation - Frenzied psychomotor activity - Exhaustion and possibly death without intervention
What are the 3 main types of cognitive disorders?
Delirium, dementia, amnestic disorder
When diagnosing older adults, what is depression confused with?
Dementia and delirium
Demerol is usually not used, but under what circumstance is it?
Demerol is used when someone is allergic to morphine
What are long-term effects of rape?
Depend largely on individual's ego strength, social support system, & the way he/she was treated as a victim.
Dysthymia in children
Depressed affect interspersed with periods of normal mood - Irritability - Negative or shy reaction to praise - Low energy - Low self-esteem - Chaotic, rejecting, inadequate home life
What is the mood disorder continuum?
Depression --> dysthymia --> euthymia --> cyclothymia --> mania
What if someone has depression and uses crack and cocaine?
Depression can be even lower after withdrawing from crack/cocaine
What are anticonvulsants used for?
Depression, seasonal affective disorder and panic disorder (ex: Depakote, Neurontin and Tenormin)
Bioecological Systems Theory
Describes how environments and systems outside of the family influence development of a child over time. This theory helps identify the stresses and potential resources that can affect family development and adaptation
What is transitional care in the home?
Designed for populations who have complex or high-risk health problems and are making a transition from one level of care to another
What are interventions with metabolic syndrome?
Diet and exercise early on
What is substance/medication-induced sexual dysfunction?
Difficulties with sexual desire, arousal, and/or orgasm due to a side effect of certain medications (legal or illicit)
What is dyslexia?
Difficulty reading
What is dyscalculia?
Difficulty with math
What is dysgraphia?
Difficulty writing
What do negative symptoms of schizophrenia reflect?
Diminution or loss of normal function
What is population focused home care?
Directed toward the needs of specific groups of people, including those with high-risk health needs such as mental health problems, cardiovascular disease, or diabetes; families with infants or young children; or older adults.
What is apathy?
Disinterest in environment
Cultural shock
Disorientation when you move to a new culture
What are the different types of dissociative disorders?
Dissociative Amnesia Dissociative Fugue Dissociative Identity Disorder (DID)- used to be called multiple personalities disorder Depersonalization Disorder
DIGFAST for mania
Distractability Insomnia Grandiosity Flight of Ideas Activity increased Speech pressured Talkative (Labile)
Systems allocator
Distributes limited health care resources according to a plan or rationale
Nonmaleficence
Do no harm
Beneficence
Doing good
Beneficience
Doing good
Non-maleficence
Doing no harm
What neurotransmitter is responsible for pleasure?
Dopamine
Doctrine of privilege communication
Dr's have the right to refuse care, and share/disclose confident information
Cluster B is described as?
Dramatic, emotional, or erratic
What is pseudomentia?
Drug toxicity, nutrition/hydration status, metabolic imbalances
What may cause borderline personality disorder?
Early abandonment
When does paranoid personality disorder present?
Early adulthood
At what age do most eating disorders start?
Early teens, but as early as 7-8
What are functions of the family?
Economic, reproductive, socialization, affective, healthcare
Educator
Educates the client, family, and providers about the case management process, delivery, resources, and benefit coverage
Cultural skill
Effective integration of cultural knowledge and awareness to meet the needs of clients
Can milieu have positive or negative effects?
Either
What are examples of TCAs?
Elavil, Anafranil, Tofranil and Pamelor
What is emotional abuse?
Emotional abuse: a pattern of behavior by the parent or caretaker that results in serious impairment of the child's social, emotional, or intellectual functioning.
What is home based primary care?
Emphasis in these programs is delivering primary care in the homes of people for whom it is difficult to come into a primary care clinic, community center, or physician's office due to functional or other health problems
When would ECT be used for mania?
Episodes of acute mania are occasionally treated with ECT. - Particularly when the client does not tolerate or fails to respond to lithium or other drug treatment or when life is threatened by dangerous behavior or exhaustion
What is parity?
Equal treatment of mental health conditions and substance use disorders in insurance plans
Denial
Escaping unpleasant realities
Mary Breckinridge
Established the Frontier Nursing Service for rural areas, also introduced midwifery
How often should a suicide contract be revised?
Every 24 hours
What is narcissistic personality disorder?
Exaggerated sense of self worth
What neurotransmitter is disrupted in schizophrenia?
Excess dopamine, NE, and serotonin, too little GABA and neurotension
Intellectualization
Excessive use of reasoning
Repression
Exclusion of unwanted experiences or emotions
Anticipatory grief
Experiencing the grief process before the actual loss occurs
What is extramarital sex?
Extramarital sex occurs when a married person engages in sexual activity with someone other than his or her spouse
What is extrapyramidal syndrome?
Extrapyramidal syndrome is a neurological side effect of anti-psychotic medication
What is paranoia?
Extreme suspiciousness of others
What is avoidance personality disorder?
Extremely sensitive to rejection and may lead a vary socially withdrawn life
What are the motor tics of Tourette's disorder?
Eye blinking, tongue protrusion, touching, squatting, skipping
True or false, anxiety attacks the emotions less deep than a fear response?
FALSE- Anxiety attacks the emotions deeper than a fear response
True or false, the cause of amnestic disorder could be delirium or dementia?
False
What is stigma?
False beliefs
What are hallucinations?
False sensory stimuli, there is no external stimulus. Can be visual, auditory, olfactory, gustatory, tactile. Ex: seeing bugs crawling on floor, walls, or person
True or false, anorexia occurs later than bulimia?
False, Bulimia occurs later than anorexia \
What are delusions?
False, fixed beliefs. Complex thoughts focused on ideas of reference, prosecution, grandiose thought patterns, somatic sensations, and control Ex: nurses talking about medications may be construed as "people out to get me"
True or false, there are levels of depression, but not different levels of mania?
False, there are levels of depression, and levels of mania
True or false, it is easy to profile a rapist?
False, there is no exclusive type
Elder abuse is what type of violence?
Family
Family as the client
Family first, individuals second - Focus is on how the family is responding to the sick individual
Family as a component of society
Family is seen as one of many institutions in society along with health, education, religious, and financial institutions
Who is most likely to identify symptoms of PMDD?
Family members, coworkers
How does a phobia develop?
Fear arises through a process of displacing an unconscious conflict onto an external object symbolically relating to the conflict.
Claustrophobia
Fear of closed spaces
Mysophobia
Fear of dirt or germs
Acrophobia
Fear of heights
Agoraphobia
Fear of open spaces, becomes reclusive to home
Glossophobia
Fear of public speaking
Hydrophobia
Fear of water
What is the duration of postpartum depression?
Few weeks to several months
Jessie Sleet (Scales)
First African-American public health nurse
Shattuck Report
First attempt to describe a model approach to the organization of public health - This report called for broad changes to improve the public's health: the establishment of a state health department and local health boards in every town; sanitary surveys and collection of vital statistics; environmental sanitation; food, drug, and communicable disease control; well-child care; health education; tobacco and alcohol control; town planning; and the teaching of preventive medicine in medical schools
Lillian Wald
First public health nurse
Lina Rogers
First school nurse
Psychopharmacology in Depression: Tricyclics
First-line treatment for many years, but effective for only about 70% of those treated.
What are the first generation vs second generation antipsychotics?
First: also called traditional, typical. block just D2 receptors. They only work on positive symptoms and can cause EPS Second: also called atypical or nontraditioanl. block D4 and serotonin. Works on negative and positive s/s with fewer EPS symptoms.
What are delusions?
Fixed false beliefs
What is a delusion
Fixed false idea that a person holds onto, and you cannot argue them away from it
Neuroleptic malignant syndrome
Fluctuation in BP, severe muscle rigidity, high fever, tachycardia, deterioration of mental status (stupor, coma)
What is the antidote to anxiolytics?
Flumazenil
Which benzos are approved for sleep?
Flurazepam, temazapam, triazolam, estazolam, and quazepam
Family as a system
Focus on family as a client and the family - is viewed as an interacting system - Interactions between family members become target of nursing interventions
Therapeutic communication: focusing and exploring
Focusing: Taking notice of a single idea or even a single word works especially well with a client who is moving rapidly from one thought to another. This technique is not therapeutic, however, with the client who is very anxious. Focusing should not be pursued until the anxiety level has subsided. Exploring: diving further into a topic such as "tell me more about that"
What foods should be avoided when on MAOIs?
Foods such as aged cheese, pickled meats, wines, chocolate, yogurt, bananas
Standardization monitor
Formulates and monitors specific public health nursing and disease management protocols that guide the type and timing of care to comply with predicted treatment outcomes for the specific client and conditions; attempts to reduce variation in resource use; targets deviations from standards so adjustments can occur in a timely manner. These protocols are usually found in agency policy books or in public health reference guides within governmental agencies
Family Development and Life Cycle Theory
Framework for understanding normal predicted stresses that families experience as they change and transition over time. - Achievement of family development tasks helps individual family members accomplish their tasks
Psychological theories: 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.
What is the biological aspect of the anxiety theory?
GABA/Benzodiazepine (abnormalities in the benzo receptors lead to increased anxiety levels. Sodium lactate theory (sodium lactate and carbon dioxide warn the brain of impending suffocation), Stress response alters the anatomy of the brain
How is gender dysphoria diagnosed in children?
Gender dysphoria is not diagnosed unless symptoms of distress emerge.
What is the most common mental disorder?
Generalized anxiety disorder
What factors influence vulnerability?
Genetics, coping behaviors, environment
Predisposing Factors to Depression: Biological theories
Genetics: - Hereditary factor may be involved, first degree relatives Biochemical influences: - Deficiency of norepinephrine, serotonin, and dopamine has been implicated - Excessive cholinergic transmission may also be a factor
What is required before starting psychotropic medications?
Get good head to toe assessment prior to starting a med in order to find side effects
Who does Rett's disorder affect? What age is it seen?
Girls, onset is before 4 years
Which gender are eating disorders more common in?
Girls/women
Serotonin norepeniphrine disinhibitors
Give both antidepressant and anxiolytic effects by increasing norepinephrine and serotonin transmission
Why is metabolic syndrome important to those with schizophrenia?
Greater risks with atypical antipsychotics
Mentor
Guides the development of the practice of new case managers is what case management role
What are hard methods of suicide?
Gun, jumping off high place, jumping in front of car, hanging, poisoning, staging car crash, carbon monoxide
What is the difference between a hallucination and delusion
Hallucination involves false sensations of any of the 5 senses, while delusions are a fixed false belief
What is psychotic disorder associated with medical condition?
Hallucinations/delusions due to medical condition such as CNS infections, hypo/hyperthyroid, renal disease
How is ADHD diagnosed?
Have to have hyperactivity, inattention to detail and surroundings to diagnose
What is dual diagnosis?
Having a mental illness and substance abuse
What diseases can be caused by stressed?
Heart Attack Stroke Diabetes Cancers Ulcers & GI Problems Allergies Autoimmune Diseases: MS/Lupus Arthritis Kidney and Liver Disease Reduction in Immunity
What is conflict management?
Helping clients manage conflicting needs and scarce resources
What does group therapy do for elderly?
Helps decrease sense of disorientation and isolation
What are examples of high risk groups and high risk factors?
High risk groups: homeless, children of family with jail/foster/drugs High risk factors: drugs, traits/genes, environmental exposure, abuse/trauma
What does the imbalance of histamine and glutamine cause?
Histamine: too little sedation and weight gain Glutamate: too much is neurodegeneration in alzheimers and too little is psychosis
What is the CAGE tool used for?
History of substance abuse
Psychological theories: Hopelessness & 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.
What is postpartum caused by?
Hormonal changes, tryptophan metabolism, or cell alterations
Types of admission
Hospitalization, involuntary commitment,
What are stage 2 and 3 dependent upon?
How severe ADLs are disrupted
How do we assess psychological state?
How suicidal 0-5 scale (0=nothing), anything more than 0 needs to be talked about - Cravings, homicidal, anxiety, depression, suicidal all assessed
What are life threatening side effects of MAOIs?
Hypertensive Crisis if non compliant w/diet
Stage 1 of mania
Hypomania - Symptoms not sufficiently severe to cause marked impairment in social or occupational functioning or to require hospitalization. - Cheerful mood - Rapid flow of ideas; heightened perception - Increased motor activity
What is the DSM-5 axis format?
I: diagnosis of mental illness and is something we can treat II: personality disorders/intellectual delay we cant treat these but can help become functional III: medical diagnosis prevalent to patient like diabetes or HTN IV: psychosocial i.e poverty, jobs, family, DUI V: GAF score, 100 is highest extremely functional and looks at stressors - The DSM-5 indicates that in order to be diagnosed with a mental disorder, there must be significant disturbance in cognition, emotion, regulation, or behavior that reflects a dysfunction in the psychological, biological or developmental processes underlying mental functioning
What is the mnemonic for presenting symptoms of suicidal patients?
IS PATH WARM?
What is magical thinking?
Ideas that one's thoughts/behaviors control specific situations
Abused and neglected children usually identify with what emotions?
Identification with aggressor and development of bullying behavior
What is voyeuristic disorder?
Identified by recurrent and intense sexual arousal involving the act of observing an unsuspecting individual who is naked, in the process of disrobing, or engaging in sexual activity. Sexual excitement is achieved through the act of looking, and no contact with the person is attempted. Masturbation usually accompanies the "window peeping" but may occur later as the individual fantasizes about the voyeuristic act. (aka peeping tom)
What is treatment of delirium?
Identify the cause, then intervene so that permanent damage to neurons does not result
What is cisgender?
Identity that is the same as the gender assigned at birth
When a client has attempted self-injury, it is important to distinguish what?
If it was suicidal self-injury or nonsuicidal self-injury
Caplan's 4 phases of a crisis: Phase 4
If problem remains unsolved and coping skills are ineffective ↓ Overwhelming anxiety-severe or panic level ↓ Poor communication, Possible serious personality disorganization, depression, confusion, suicidal behavior, violence against others
Caplan's 4 phases of a crisis: Phase 3
If trial and error attempts fail, anxiety can escalate to severe and panic levels ↓ Autonomic relief /maladaptive behaviors used ↓ Some form of resolution may be made (compromising or redefining situation- use of a defense mechanism)
What is expressive language disorder?
Impairment in communicating through language or speech
What is the frontal lobe responsible for?
Important for planning, decision making, etc. Contains important speech structures, such as Broca's, primary motor cortex (aka motor strip. controls voluntary movements) and the supplementary motor cortex (helps with motor planning of speech)
When does borderline personality disorder usually start?
Impulsive behavior by early adulthood
How are personality disorders characterized?
In clusters A, B, C
Persecutory type of delusional disorder
In persecutory delusions, which are the most common type, individuals believe they are being persecuted or malevolently treated in some way. Frequent themes include being plotted against, cheated or defrauded, followed and spied on, poisoned, or drugged. Repeated complaints may be directed at legal authorities, lack of satisfaction from which may result in violence toward the object of the delusion.
What is the psychoanalytic therapy for paraphilic disorders?
In this type of therapy, the therapist helps the client to identify unresolved conflicts and traumas from early childhood. The therapy focuses on helping the individual resolve these early conflicts, thus relieving the anxiety that prevents him or her from forming appropriate sexual relationships. In turn the individual has no further need for paraphilic fantasies.
What are predisposing factors to sexual pain disorders?
In women: - Intact hymen - Episiotomy scar - Vaginal or urinary tract infection - Ligament injuries - Endometriosis - Ovarian cysts or tumors In men: - Infections - Phimosis - Prostate problems
What is anasognosia?
Inability of the individual to recognize they are ill
What is social communication disorder?
Inability to effectively use verbal and nonverbal means of communication.
What is tangentiality?
Inability to get to the point of communication due to introduction of many new topics
What is avolition?
Inability to initiate goal directed activity
What is physical neglect of a child?
Includes refusal or delay in seeking health care, abandonment, expulsion from the home or refusal to allow a runaway to return home, and inadequate supervision
What is case management?
Includes the activities implemented with individual clients in the system
What is evidence-based practice?
Includes the best available evidence from a variety of sources, including research studies, evidence from nursing experience and expertise, and evidence from community leaders.
What is gender dysphoria?
Incongruence between assigned gender & expressed gender; Adopted to minimize stigma connected to previous label and emphasize emotional component of condition
What does the imbalance of somatostatin (peptide) cause?
Increase causes Huntington and decreased causes Alzheimer and depression
Healthy People 2020
Increase the portion of persons who are referred for follow-up for substance abuse problems is an initiative of?
Light therapy
Increased melatonin production during darkness, seasonal serotonin transport affect mood.
Family as the context, or structure
Individual first, family second - Is the family helping the individual that is sick? - Nurse is more interested in individual but the family influences the health of the individual
What populations are at greatest risk for disaster?
Individual variables that cause people to react differently include age, culture, health status, social support - High Risk: Persons with disabilities, Institutionalized people; chronic mentally il, Homeless
What happens with weight while binge eating?
Individuals who start binge eating may be of normal weight, repeated bingeing inevitably causes obesity.
Grandiose type of delusional disorder
Individuals with grandiose delusions have irrational ideas regarding their own worth, talent, knowledge, or power. They may believe that they have a special relationship with a famous person, or even assume the identity of a famous person. Grandiose delusions of a religious nature may lead to assumption of the identity of a deity or religious leader.
Which mood disorder will be affected by light therapy/ exposure to light?
Individuals with seasonal effective disorder
Somatic type of delusional disorder
Individuals with somatic delusions believe they have some type of general medical condition.
What is cultural knowledge?
Information, skills, attitudes, conceptions, beliefs, values, and other mental components of culture that people socially learn during enculturation. so it is the information we know about a group. there is a emphasis on learning
Civil tort
Intentional or unintentional malpractice
What is a therapeutic relationship?
Interaction between 2 people where input from both parties contributes to healing, growth promotion, illness prevention - Setting boundaries
Cultural encounter
Interaction with a client related to all aspects of his or her life
What is perception?
Interpretation of environment. Dependent on sensory input
What is trauma informed care?
Intervention strategies to prevent trauma to the patient/client
What is the difference between client interview and client intake?
Interview: more specific in details regarding psychiatric illness or diagnosis. client leads the interview Intake: gathering general facts. may include a mini status exam and psychosoical history. nurse leads conversation.
Sociological theories: Interpersonal Theory of Suicide
Introduces concept that suicide ideation/suicide attempts need to be understood as distinct processes (Ex: low connectedness, high sense of burden)
What is seclusion?
Involuntary confinement
What is acute dystonia?
Involuntary muscle contraction or spasm (torticollis, oculogyric crisi)
Case management
Involves activities implemented with individual clients in the system
Vagal nerve stimulation and deep brain stimulation
Involves implanting an electronic device in the skin to stimulate the vagus nerve
What does suppression of feelings by workers lead to?
Irritability, powerlessness, anger, fatigue, mood swings
Depersonalization Disorder
Is one or more episodes of feeling detached from one's self so that the usual sense of personal reality is temporarily lost or changed. - Disturbing experiences: Deadness of body, Seeing oneself from a distance, Perceiving distorted limbs
Dissociative Identity Disorder (DID)
Is the presence of two or more distinct personalities within one person
MAOI examples
Isocarboxazid, Phenelzine, Tranylcypromine, Selegiline (transdermal)
Autonomy
It is an individuals right to determine their destinies
One model for enhancing communication in suicide assessment is the CASE (Chronological Assessment of Suicide Events) approach, describe it.
It is described as flexible guide for interviewing that includes communication techniques designed to elicit and enhance detailed, valid feedback from clients about sensitive topics like suicide.
What happens to the residual phase between episodes?
It often increases between episodes of active psychosis.
What is cultural desire?
It refers to the nurse's intrinsic motivation to provide culturally competent care. Nurses who desire to become culturally competent do so because they want to rather than because they are directed to do so.
Jealous type of delusional disorder
Jealous delusions center on the idea that the person's sexual partner is unfaithful. The idea is irrational and without cause, but the individual with the delusion searches for evidence to justify the belief. The sexual partner is confronted regarding the imagined infidelity.
What tool is used for self appraisal and what are the 4 quadrants?
Johari window tool is used to observe recognition of self and increase self awareness. there are 4 quads. 1. Public self: individual and public are aware of this self 2. Unknowing self: known to others but hidden from self 3. Private self: known to self but is hidden from others 4. Unknown self: unknown to both individual and others
Stereotyping
Judging someone on the basis of one's perception of the group to which that person belongs
Rationalization
Justification
What are the comorbidities associated with ADHD?
Juvenile onset bipolar disorder, Oppositional defiant disorder, Conduct disorder
What is LGBTQIA?
LGBTQIA acronym describes range of sexual preferences
What is anergia?
Lack of energy
What type of impact does an interpersonal support system have?
Lack of meaningful network of satisfactory relationships may implicate high risk for suicide during an emotional crisis.
What is dependent personality disorder?
Lack of self-confidence and extreme reliance on others to take responsibilities for them
What is male hypoactive sexual desire disorder?
Lack or absence of sexual fantasies and desire for sexual activity
How long does adjustment disorder last?
Lasts no longer than 6 months after the stress ceased
When do symptoms of schizophrenia typically appear?
Late adolescence or early adulthood
Leadership styles: autocratic
Leaders have personal goals for group. the message of the group is "we will do it my way". this approach uses persuasion. productivity is high but morale is low because of lack of member input
Predisposing Factors to Depression: Learning theory
Learned helplessness, the individual who experiences numerous failures learns to give up trying.
What is the recovery model for mania?
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
Resolution
Length of the grief process is entirely individual. Influenced by many factors.
What does LGBTQIA stand for?
Lesbian Gay Bisexual Transgender Queer- people who are either uncertain or uncomfortable with conventional, binary labels Intersex- individuals who describe themselves as sexually ambiguous Asexual- those who have no sexual orientation or preference.
Rape survivors feel what upon arrival to ED?
Likely experiencing overwhelming sense of violation, helplessness that began with the powerlessness and intimidation experienced in the assault.
What is aphasia?
Loss of language
What is agnosia?
Loss of sensory ability to recognize objects
What can trigger grief?
Loss or anticipated loss
What is amnestic disorder?
Losses in both short term and long term memory which impairs the person's functioning. - Unable to learn new things or recall previous information
Fidelity
Loyalty
What are comorbidities to anxiety?
Major depression, substance abuse
Compensation
Make up for deficiencies to protect the mind
Undoing
Making up for an act performed
What is abuse?
Maltreatment of one person by another
What is dementia?
Many cognitive deficits, impairment in memory, but not in consciousness.
What is the most widely used illicit drug?
Marijuana
What is female orgasmic disorder: anorgasmia?
Marked delay in, infrequency, or absence of orgasm during sexual activity. It may also be characterized by a reduced intensity of orgasmic sensation. The condition, which is sometimes referred to as anorgasmia, has lasted at least 6 months, and causes the individual significant distress. - A woman is considered to have primary orgasmic disorder when she has never experienced orgasm by any kind of stimulation. - Secondary orgasmic disorder exists if the woman has experienced at least one orgasm, regardless of the means of stimulation, but no longer does so.
What is persona?
Mask like, what others see
What type of crisis is birth of a child?
Maturational
What type of crisis is death of a parent?
Maturational
What type of crisis is retirement?
Maturational
Unauthorized immigrant
May have crossed the border illegally or legal permission expired; eligible only for emergency medical services
Who allowed the first home visits by nurses
Metropolitan Life Insurance Company
What are examples of the biological systems theory?
Microsystem: schools, daycares Mesosystem- family members or people you don't see everyday but still have some effect Exosystem- polictics Macrosystem- broad terms like culture, attitudes, values, beliefs Chronosystem- time related things, births, deaths
What is the tone of the unit?
Milieu
How can milieu be portrayed?
Milieu It might be internal environment (feelings and thoughts) external - hospital room or home. It could be psychosocial- whether the patient feels accepted physical- whether the room is comfortable.
What are TCAs used for?
Moderate depression or when SSRI's are not effective
What is sex trafficking?
Modern-day slavery involving the use of force, fraud, or coercion to obtain some type of commercial sex
What is care management?
Monitors the health status, resources, and outcomes for a targeted segment of the population
What antidepressant is a last resort?
Monoamine Oxidase Inhibitors (MAOIs) Used in treatment resistant patients
Substance-induced bipolar disorder
Mood disturbance (depression or mania) considered to be direct result of physiological effects of a substance (e.g., ingestion /withdrawal from drug of abuse or medication)
Electroconvulsive therapy: Bilateral electrode placement
More effective, more cognitive side effects
Electroconvulsive therapy: Risks
Mortality; permanent memory loss; brain damage
Extrapyramidal symptoms (EPS)
Motor disorders involving rigid muscles, tremors, shuffling movement, restlessness, and muscle spasms affecting their posture caused by dopamine blockage (Pseudoparkinsonism, Akinesia, Akathisia, Dystonia, Oculogyric crisis)
What is akathisia?
Motor restlessness
How can someone be diagnosed with acute stress disorder?
Must have three of the following: Numb Detachment Reduction in Awareness Derealization Dissociative Amnesia - RESOLVES in 4 weeks
What are examples of MAOIs?
Nardil, Parnate
What is NAMI?
National Alliance on Mental Illness
What would happen if the frontal lobe was damaged?
Needed for reasoning. If there is damage the individual will act out or have impulsive behavior
What are examples of positive and negative effects of milieu?
Negative: too many people, hot, inexperienced staff all impact negatively Positive: good attitude, productive, sleep, good eating and compliant with program
Negotiator
Negotiates the pain of care, services, and payment arrangements with providers
Negotiator
Negotiates the plan of care, services, and payment arrangements with providers; uses effective collaboration and team strategies
Neurosis
Nerve condition characterized by excessive anxiety and phobias
What is the etiology of dementia?
Neuronal degeneration of the hippocampus and cerebral cortex
What is neologisms?
Newly invented words that are meaningless to others but have symbolic meaning to the individual
Is Asperger's considered autism?
No
Is depression part of normal aging process?
No
Anhadonia
No longer finding pleasure in things one usually does
If someone already has an addiction, will they receive a Xanax prescription?
No, because their risk of addiction and dependency is high
Is suicide a diagnosis?
No, it is a behavior
Is there a cure for lewy body dementia?
No, just symptom management
What is NSSI?
Non-suicidal self-injury, A method of releasing emotion, and communicates severity of distress
Antihistamines
Nonaddictive (Benadryl & Vistaril)
Legal immigrant
Not a citizen but allowed to both live and work in the U.S. Also known as lawful permanent residents
Hypertensive crisis
Nuchal rigidity, severe headache, N/V, extreme elevation of BP.
Clara Barton
Nurse during the Civil War; founder of the American Red Cross
Family systems theory
Nurses use this theory to understand how a family is organized. - Purpose is to maintain stability through adaptation of internal and external stresses that are created by change as the family is viewed as a whole rather than composed as individuals
What are some disorders SSNRIs are used with?
OCD and Posttraumatic Stress Disorder
What is affect?
Observable response or emotional reaction associated with an experience.
Cultural knowledge
Obtaining sufficient knowledge of diverse groups, including their values, health beliefs, care practices
Ada Mayo Stewart
Occupational/industrial traveling nurse- she began working with employees and families free of service, providing obstetrical care, sickness care and post surgical care in workers homes
What is incest?
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
What is re-feeding syndrome?
Occurs when malnourished patient begins to receive nourishment again. Severe change in intake and electrolyte increases cause heart to work harder
Cluster A is described as?
Odd or eccentric
What is the focus of public health during the 1990s and early 2000s?
On cost, quality, and access to services
What does the ability to preserve health and treat illness depend on?
On the civilization's knowledge of science, use and availability of technologies, and degree of social organization.
What is the focus on during crisis intervention?
On the person's present problem and resolution of the immediate crisis only
How long does delusional disorder last?
One month or more
Contract
One party asserts that the other party, in failing to fulfill an obligation, has breached the contract - Either compensation, or performance of of obligation will be remedy Ex: Physician having a contract to a hospital
Veracity
One's duty to always be truthful
What are the differences between depression and the other types of cognitive disorders?
Onset of mental changes, level of consciousness, attention span
What is catharsis?
Open expression of feelings is beneficial for the individual within the group. similar to word vomit or an intense sharing of feelings
How fast do benzos work?
Oral- within 30 minutes IV/IM- within 15 minutes
Florence Nightingale
Organized nursing practice and nursing education in hospitals
Deontology
Our actions are bound by a sense of duty
Reaction formation
Over-compensation
What is pacing/rocking?
Pacing back and forth and rocking the body
What are the most frequent symptoms of somatoform disorders?
Pain, dysphasia, nausea, bloating, constipation, palpitations, dizziness, shortness of breath
What are beta-blockers used for?
Panic attacks and social anxiety (ex: Tenormin and Inderal)
What does remotivation therapy do for elderly?
Participants share similar experiences, and visual aids are used to stimulate the discussions
What is waxy flexibility?
Passive yielding of all movable body parts to any effort made at placing them in certain positions Ex: when nurse takes blood pressure, they leave their arm sticking out for hours in position she placed it
What is POEM?
Patient Oriented Evidence that Matters
What is schizoaffective disorder?
Patient has schizophrenic symptoms along with a strong mania or depressive symptoms. Hallucinations/delusions occur for at least 2 weeks without major mood episode. Generally a better prognosis than other schizophrenia spectrum conditions
What is antisocial personality disorder?
Pattern of socially irresponsible, exploitative, and guiltless behavior that reflects a general disregard for the rights of others.
What is the cognitive theory of anger & aggression?
Perceived assault on areas of personal domain, values, moral codes and protective rules can lead to anger
What is stress?
Perceived stressors from sensory inputs - Can be physical, mental or emotional
What are learning disorders based on?
Performance is well below that of peers
Mourning
Period of Characteristic emotions and behaviors
What is binge eating?
Persistent episodes of binge eating. An episode of binge eating is distinguished by the following: - Eating in a separate period an amount of food that is substantially larger than what most people would consume during the same time period and under comparable circumstances - A feeling of lack of control over eating during the episode
What is bulimia nervosa?
Persistent episodes of binge eating. Both of the following must be present: - Eating in a separate period an amount of food that is substantially larger than what most people would consume during the same time period and under comparable circumstances - A feeling of lack of control over eating during the episode
Social phobia
Persistent fear and avoidance of situations in which the person may be exposed to scrutiny by others.
What is early ejaculation?
Persistent or recurrent ejaculation occurring within one minute of beginning partnered sexual activity and before the person wishes it. The diagnosis should take into account factors that affect the duration of the excitement phase, such as the person's age, the novelty of the sexual partner, and frequency of sexual activity. - Could be related to infections, or neurological disorders
What is perseveration?
Persistent repetition of the same word/idea in response to different questions
Generalized Anxiety Disorder (GAD)
Persistent, unrealistic, and excessive anxiety and worry that have occurred more days than not for at least 6 months and cannot be attributed to specific organic factors
What is the goal of crisis intervention?
Person may emerge at a higher level, same level, or lower level of functioning but our goal is to return to pre-crisis level of functioning (or higher)
What are the different crisis resolutions?
Person may emerge at: - A higher level of functioning - The pre-crisis level of functioning - A lower level of functioning
What are characteristics of mental illness?
Personality development has been hindered by many biophysical factors resulting in impairments in physical and cognitive capabilities
What is mood?
Pervasive and sustained emotion that may have a major influence on a person's perception of the world.
What is paranoid personality disorder?
Pervasive mistrust and suspiciousness of others, and misinterpretation of others' motives as malevolent
What are the phases of crisis development?
Phase 1: Stressor occurs Phase 2: Increased anxiety as problem solving skills are ineffective Phase 3: Utilizing internal and external resources in problem solving Phase 4: Disorganization in the individuals and/or environment
What are ethical issues?
Philosophical ideas regarding right and wrong
What is IPV?
Physical abuse between domestic partners may be known as spousal abuse, domestic or family violence, wife or husband battering, or IPV.
Dermotillomania
Picking of one's skin. Mainly the face. Means of dealing with stress. May use biting, nail cutters or tweezers as well as fingernails
Do positive effects of TCAs take a long or short time?
Positive effects take longer
What is the behavioral theory of addiction?
Positive reinforcement effects on drug seeking behavior
What are positive and negative responses to stress?
Positive: Solve problems, redefine issue, social supports Negative: avoid problems, wishing away, self blame
What is secondary dementia?
Possibley reversible
What are symptoms of catatonic state?
Posturing, muscle rigidity, mutism, waxy flexibility r/t metabolic d/o, diabetic ketoacidosis
What are the difference stages of violence?
Pre-assaultive- tension builds Assaultive- abuse takes place Post-assaultive- apologies, excuses
Electroconvulsive therapy: Medications
Pretreatment medication; muscle relaxant; short-acting anesthetic
Intellectual Developmental Disorders
Previously called --> Mental Retardation: Changed with DSM-V May 2013 - Deficit in reasoning, problem solving, planning, academics, judgement, abstract thinking
Conversion disorder- primary gain, secondary gain
Primary gain- keep the conflict out of conscious awareness Secondary gain-person is able to avoid a distressing or uncomfortable or repugnant activity
Why do victims of IPV 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 for their lives or lives of their children(Family) - Fear of retaliation by the partner (Fear) - Fear of losing custody of their children - Lack of financial resources (Finances) - Lack of a support network (Friends) - Cultural/religious reasons (Faith) - Hopefulness - Lack of attention to the danger
Caplan's 4 phases of a crisis: Phase 2
Problem solving techniques and defense mechanisms fail →Threat persists ↓ Anxiety increases ↓ Feelings of extreme discomfort Functioning disorganized ↓ Trial and error attempt to solve problem to restore balance
Transcranial magnetic stimulation
Procedure that is used to treat depression by stimulating nerve cells in the brain (noninvasive, 40" 3/wk for 4-6 wks)
Health risk appraisal
Process for assessing for the presence of specific factors in each of the categories that have been identified as being associated with the likelihood of an illness (unhealthy behaviors/activities)
What is schizoid personality disorder?
Profound defect in the ability to form personal relationships
What is primary dementia?
Progressive and irreversible
Civil law
Protects the private and property rights of individuals and businesses.
What is the goal of nursing interventions for victims of abuse?
Provide shelter and promote reassurance of his or her safety
Liaison
Provides a formal communication link among all parties concerning the plan of care management
Monitor and reporter
Provides information to parties on the status of members and situations affecting patient safety, care quality, and patient outcome and on factors that alter costs and liability
Criminal law
Provides protection from conduct deemed injurious to the public welfare.
What does group psychotherapy do for elderly?
Provides support for effecting change
What type of provider will prescribe Xanax? Which will not?
Psychiatrist will not typically prescribe Xanax unlike family practice physicians
What are nursing interventions for binge eating?
Psychotherapy - Cognitive Behavior Therapy (CBT) - Dialectal behavior therapy - Interpersonal Therapy Health teaching/ Promotion - learning new coping strategies (Not Binge), education, healthy exercise, meal plans Team Work/ Safety - identify emotional and physical triggers to episodes Surgical - bariatric surgery
Trichotillomania
Pulling out one's hair. For some decreases anxiety (similar to cutting behaviors)
What is hyperorality?
Put everything in mouth
Introjection
Qualities of another person adopted into your personality
What is sexual violence?
Rape, and any act of sexual coercion, i.e., penetration, unwanted sexual contact, & noncontact unwanted sexual experiences, (verbal harassment, unwanted exposure to pornography)
What is the onset of SSRIs?
Rapid onset and few side effects - Initial effects shown within 24 hours- not full effect
What is loose associations?
Rapid shifting from one idea to another with no connection of logic.
Symptoms of PTSD
Re-experiencing the trauma through flashbacks, nightmares, and intrusive thoughts can cause high levels of anxiety, depression, numbness
What is fear?
Reaction to a specific danger
What is transvestic disorder?
Recurrent and intense sexual arousal from dressing in the clothes of the opposite gender. The individual is commonly a heterosexual man who keeps a collection of women's clothing that he intermittently uses to dress in when alone. (cross dressing)
What is sexual masochism disorder?
Recurrent and intense sexual arousal from the act of being humiliated, beaten, bound, or otherwise made to suffer. These masochistic activities may be fantasized and may be performed alone or with a partner.
What is exhibitionistic disorder?
Recurrent and intense sexual arousal from the exposure of one's genitals to an unsuspecting individual. Masturbation may occur during the exhibitionism.
What is sexual sadism disorder?
Recurrent and intense sexual arousal from the physical or psychological suffering of another individual. The sadistic activities may be fantasized or acted on with a consenting or nonconsenting partner. In all instances, sexual excitation occurs in response to the suffering of the victim. Examples of sadistic acts include restraint, beating, burning, rape, cutting, torture, and even killing.
What is fetishistic disorder?
Recurrent and intense sexual arousal from the use of either inanimate objects or specific non-genital body parts. A common sexual focus is on objects intimately associated with the human body. The fetish object is usually used during masturbation or incorporated into sexual activity with another person in order to produce sexual excitation.
What is frotteuristic disorder?
Recurrent and intense sexual arousal involving touching or rubbing against a nonconsenting person. Sexual excitement is derived from the actual touching or rubbing, not from the coercive nature of the act. Almost without exception, the gender of the frotteur is male.
What is a panic disorder
Recurrent attacks of severe anxiety lasting a few moments to an hour. Also induces by chemicals or medical conditions - Not associated with any stimulus
Obsession
Recurring thought that cannot be dismissed from consciousness (thought).
What is the goal of cognitive therapy?
Reduce Self-harming Behaviors
What is direct care?
Refers to the actual physical aspects of nursing care—anything requiring physical contact and face-to-face interactions Ex: Performing a physical assessment on the client, Changing a dressing on a wound, Giving medication by injection
What is perseveration?
Repetition of phrase or behaviors
What is paraphilia?
Repetitive or preferred sexual fantasies or behaviors that involve nonhuman objects, suffering or humiliation of oneself or one's partner, or nonconsenting persons
Dissociative Disorder Not Specified
Residual category used for disorders in which the predominant feature is a dissociative reaction that does not meet the criteria of any specific dissociative disorder
Restraints
Restraints are never to be used as punishment or for the convenience of staff, but when there is immediate risk to self or others (physical or medication)
What does vulnerability result from?
Results from a complex multilayered interaction among the characteristics of the child
What is memory?
Retention and recall of past experiences
What is regression?
Retreat to an earlier level of development
Rett's disorder
Rett syndrome is a rare genetic neurological and developmental disorder that affects the way the brain develops, causing a progressive loss of motor skills and speech
Regression
Reverting to a child-like pattern
Where is case management more complex?
Rural settings
What is the difference between rural and urban?
Rural- farm residency Urban- Nonfarm residence
What is the priority in a Therapeutic Milieu?
SAFETY
Psychopharmacology in Depression: Selective serotonin reuptake inhibitors
SSRIs and SNRIs became the preferred first-line treatment for depression
What is the MAIN goal of psychiatric hospitalization?
Safety
What is the main nursing intervention with anger/aggression?
Safety
What are different ways to evaluate evidence?
Sample selection Randomization Blinding Sample size Description of intervention Outcomes Length of follow-up Attrition Confounding variables Statistical analysis
What is satiation?
Satiation is a technique in which the postorgasmic individual repeatedly fantasizes deviant behaviors to the point of saturation with the deviant stimuli, consequently making the fantasies and behavior unexciting. - Leads to less impulsivity
What typically causes death in Alzheimer's
Secondary to choking or pneumonia
What are side effects for benzos?
Sedation, ataxia, lower cognition
What are used if SSRIs aren't working?
Selective Serotonin Norepinephrine Reuptake Inhibitors (SSNRIs)
What is the first drug used with individuals with anxiety?
Selective serotonin reuptake inhibitors (SSRIs)
Since selegilin is an MAOI, does the individual have to follow a strict diet?
Seligiline does not have dietary restrictions due to being given as patch, transdermally.
What is gender identity?
Sense of knowing whether one is male or female
What neurotransmitters are dysregulated in personality disorders?
Serotonin, and norepinephrine
SSRI examples
Sertraline, Fluoxetine, Citalopram, Escitalopram, Fluvoxamine
What is pedophilic disorder?
Sexual arousal from prepubescent or early pubescent children equal to or greater than that derived from physically mature persons. DSM-5 criteria specify that the behavior has lasted at least 6 months and is manifested by fantasies or sexual urges on which the individual has acted or which cause significant distress or impairment in social, occupational, or other important areas of functioning. The age of the molester is at least 16 years, and he or she is at least 5 years older than the child.
What is ethnicity?
Shared feeling of peoplehood among a group of individuals
Defamation of character
Sharing information to hurting someone's character Libel- written Slander- Orally
What is attention?
Short-term memory, focus without distraction
What is crisis intervention?
Short-term, therapeutic process that focuses on rapid resolution - "Function of the basic-level nurse"
Childhood depression symptoms: Below 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.
Epidemiology of Depression: Marital Status
Single & divorced people more likely to experience depression than married persons or those with a close interpersonal relationship (differences occur in various age groups).
What type of crisis is divorce?
Situational (disposition)
Ms.ABC is a married mother of 2 and has come to the crisis center severely battered. She has just left her husband and is without a home or personal belongings. - The nurse would assess this crisis as? - What would you assess?
Situational crisis; physicality, safety
What are ethical dilemmas?
Situations that require individuals to make a choice between two equally unfavorable alternatives.
What are soft methods of suicide?
Slashing wrist, inhaling natural gas, ingesting pills
What is the assessment tool to use with your client with depression?
Sleep disturbance Interest decreased (anhedonia) Guilt (M)ood Energy Concentration decreased Appetite Psychomotor retardation/agitation Suicide SIGMECAPS
Vegetative symptoms (s,s,e,e)
Sleeping, eating, sex, elimination
Donepezil (Aricept)
Slows progression of memory loss palliative treatment
Why is smoking cessation important in schizophrenia?
Smoking cigarettes identified as a particular health risk for clients with schizophrenia b/c cigarettes help decrease anxiety
What is a substitutional activity for cutters?
Snapping a rubber band
What is cognitive behavioral therapy?
Social skills training and assertiveness training to teach alternative ways to deal with frustration by focusing on intra/interpersonal relationships, thoughts, and actions
What are the general functions of group therapy?
Socialzation, support, task completion, camaraderie, information sharing, normative influence, empowerment, goverance
What is senescence?
Societal attitude toward aging
Psychological theories: Shame/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.
Serotonin syndrome
Some patients taking SSRIs or SNRIs complain of sexual dysfunction, potential for serotonin syndrome. Excess level of serotonin. N/V, diarrhea, restless, high fever, irregular heart beat, seizures, death
What is a flash back?
Something triggers a memory of substance use
When is the highest incidence of suicide?
Springtime because more energy to carry out plan opposed to the winter where levels of depression are the highest
Are state laws all the same for nurses?
State laws can vary greatly. The nurse is responsible for knowing specific laws regarding client care within the state or states in which the nurse practices
What are the 6 steps in WRAP?
Step 1: Developing wellness toolbox Step 2: Daily maintenance list, divided into 3 parts: Description of feelings in wellness, daily wellness maintenance, list of daily reminders Step 3: Triggers Step 4: Early warning signs Step 5: Things are getting worse Step 6: Crisis planning
How does stress relate to immunity
Stress contributes to lower immunity, disease and illness
How does stress relate to depression
Stress increases the risk for depression
What is family demographics?
Study of the structure of families and households and the family-related events, such as marriage and divorce, that alter the structure through their number, timing, and sequencing - Used to forecast stress
What are signs of a hypertensive crisis?
Stupor, elevated temp, high blood pressure, high heart rate, confused
Grief
Subjective State: Emotional, Physical and Social Responses to a loss
What is grief?
Subjective state of emotional, physical, and social responses to the loss of a valued entity - A loss or anticipated loss can trigger grief - S/s can be sadness, guilt anger, helplessness, despair. - There is no time frame or specific why to grief - Mourning is the period of characteristic emotions and behaviors (the actual s/s objective)
What does the imbalance of substance P peptides and neurotension (peptide) cause?
Substance P: is a mood and pain regulator Neurotension: decreased levels found in schizophrenia
Dissociative Fugue
Sudden, unexpected travel away from customary laces or by bewildered wandering with the inability to recall some or all of one's past. May assume a new identity
Dissociative Amnesia
Suddenly become aware they have a total loss of memory for events that occurred during a period that may range from a few hours to a whole lifetime - Have one or more episodes of memory loss of important personal information
What is the 3rd leading cause of death among individuals 15-24?
Suicide
What is SAFE-T?
Suicide Assessment Five Step Evaluation & Triage
What is a literature review?
Summarizes a topic that is broad in scope (ex: cancer treatment)
What are warning signs of suicide?
Superficial cuts, giving away possessions, evasive statements such as just wait until tomorrow, isolation, high energy with intense feelings, gathering of friends and relatives, taking a trip alone
Cultural accommodation
Supporting and facilitating the client's use of cultural practices that are beneficial to the client's health
What is treatment for depression in adolescents?
Supportive psychosocial intervention Antidepressant medication
Facilitator
Supports all parties in work toward mutual goals
Cultural preservation
Supports and integrates the use of practices as much as possible
Trichophagia
Swallowing pulled hair
Symptoms of depression in elderly is often confused with what?
Symptoms of depression often confused with symptoms of neurocognitive disorder
Why are patient's with Personality Disorders admitted?
Symptoms that admit someone: suicidal, homicidal, medical. NOT because they have a personality disorder
Moderate depression
Symptoms: associated with dysthymic disorder - Affective: Helpless, powerless - Behavioral: Slowed physical movements, slumped posture, limited verbalization - Cognitive: Slowed thinking processes, difficulty with concentration - Physiological: Anorexia or overeating, sleep disturbance, headaches
Mild depression
Symptoms: associated with normal grieving - Affective: Anger, anxiety - Behavioral: Tearful, regression - Cognitive: Preoccupied with loss - Physiological: anorexia, insomnia
Severe depression
Symptoms: includes symptoms of major depressive disorder and bipolar depression - Affective: Total despair/worthlessness, flat affect - Behavioral: Psychomotor retardation, curled-up position, absence of communication - Cognitive: Prevalent delusional thinking, delusions of persecution and somatic delusions; confusion; suicidal thoughts - Physiological: a general slow-down of the entire body, vegetative symptoms: S,S,E,E, sleep disturbances
Transient depression
Symptoms: this level of continuum not usually dysfunctional - Affective: The "blues" - Behavioral: Some crying - Cognitive: Some difficulty getting mind off disappointment - Physiological: Tired/listless
What is social cognition?
Taking in consideration other's feelings, what is appropriate behaviors
What is tardive dyskinesia?
Tardive dyskinesia is characterized by repetitive involuntary purposeless movements. S/S: Grimacing, tongue protrusion, lip smacking puckering and pursing, and rapid eye blinking, involuntary movements of the fingers
What are the 3 major types of member roles in a group?
Task roles, maintenance roles, individual roles
Teach back
Teach back- ask questions to assure that they understand the medication and its use
What areas of the brain are involved with aggressiveness?
Temporal lob and amygdala
Electroconvulsive therapy: Side effects
Temporary memory loss and confusion, HA
La Belle Indifference
Term used to describe the lack of concern over physical illness; seen in conversion reactions
What level of prevention/intervention is debriefing?
Tertiary
What is stress adaption?
The Concept of Stress Adaptation, describes how an individual's response to stressful situations is influenced by physiological factors, his or her personal perception of the event, and a variety of predisposing factors such as heredity, temperament, learned response patterns, developmental maturity, existing coping strategies, and support systems of caring others. - Theory of GAS, neuortransmitters
What are traits of mental health?
The ability to think rationally and understand that our way may not be the only way, communication appropriately, learn and grow emotional, healthy self esteem and to be resilient.
How often does the binge eating behavior occur?
The binge eating behavior and unsuitable occurs on average at least twice a week for 3 months
What is family structure?
The characteristics and demographics (gender, age, and number) of individual members, along with roles and positions of family members
What is phobic avoidance reaction?
The client worries about it happening again at work while driving at school, etc. If a person has a repeated attacks or worries about it they may avoid situations that induce fear. And develop another anxiety disorder called phobic avoidance reaction
What is codependency?
The codependent person disowns his or her own needs and wants in order to respond to external demands and the demands of others
What is evidence-based medicine?
The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual clients
Acute Stress Disorder
The development of anxiety and dissociative symptoms within 1 month of an extremely traumatic event.
Why would someone who was diagnosed with schizophreniform be then diagnosed with schizophrenia?
The diagnosis is changed to schizophrenia if the clinical picture persists beyond 6 months.
What is tolerance?
The diminishing effect with regular use of the same dose of a drug, requiring the user to take larger and larger doses before experiencing the drug's effect
What is genito-pelvic pain/penetration disorder?
The disorder involves difficulty having intercourse and feeling significant pain upon penetration. The severity can range from a total inability to experience vaginal penetration to the ability to experience penetration in one situation but not another.
What is cultural skill?
The effective integration of cultural awareness and knowledge IN ORDER to obtain relevant cultural data and meet the needs of culturally diverse clients
MAOIs
The enzyme MAO is responsible for destruction of excess NE. tyramine foods increase the release of NE. So when MAOIs are taken they inhibit MAO from this breakdown and it can cause a hypertensive crisis.
What is delusional disorder?
The existence of prominent, nonbizarre delusions for one month or more (Erotomanic type, grandiose type, jealous type, persecutory type, somatic type, mixed type)
What is rape?
The expression of power/dominance by means of sexual violence, most commonly by men over women; men may also be rape victims.
Five "rights" of case management
The five "rights" of case management are right care, right time, right provider, right setting, and right price.
What is the main focus of a person with paraphilic disorders?
The focus should be to diagnose and treat the problem as early as possible to minimize difficulties
What are treatments for female sexual interest/arousal disorder?
The goal of treatment for female sexual interest/arousal disorder is to reduce the anxiety associated with sexual activity. There is reported successful results using behaviorally oriented sensate focus exercises to treat this disorder. The objective is to reduce the goal-oriented demands of intercourse on both the man and the woman, thus reducing performance pressures and anxiety associated with possible failure.
Define splitting?
The inability to view both positive and negative aspects of others as part of a whole; either a wonderful or horrible person
Erotomanic type of delusional disorder
The individual believes that someone, usually of a higher status, is in love with him or her. Famous persons are often the subjects of erotomanicdelusions
What is medication can be used with sexual desire disorders?
The medication, flibanserin (Addyi), is a serotonin receptor agonist but the how it works to improve sexual desire is unknown.
Cultural desire
The motivation and commitment to caring that moves an individual to learn from others, accept the role as learner, be open and accepting of cultural differences, and build on cultural similarities
What is schizophreniform disorder?
The patient has manifestations similar to those of schizophrenia but the duration is from 1 to 6 months
What is medical comorbidity?
The presence of one or more additional conditions co-occurring with (that is, concomitant or concurrent with) a primary condition
What is substance-induced psychotic disorder?
The presence of prominent hallucinations and delusions that are judged to be directly attributable to substance intoxication or withdrawal
Kantianism
The principle or motivation on which the action is based is the morally decisive factor
Cultural Blindness
The process of ignoring differences in people's culture and proceeding as though the differences do not exist
What is research utilization?
The process of transforming research knowledge into practice, and the use of research to guide clinical practice
Justice
The right of individuals to be treated equally and fairly - All resources are allocated equally
Psychoneuroimmunology
The study of how psychological, neural, and endocrine processes together affect the immune system and resulting health
What is mental health?
The successful adaptation to stressors from internal or external environment, evidenced by thoughts, feelings, and behaviors that are age-appropriate and congruent with local and cultural norms This includes: recognizing own potential (maslow), coping with normal stress, work productively, ability to control behavior, positive relationships and contribution to society.
What is personality?
The totality of emotional and behavioral characteristics that are particular to a specific person and that remain somewhat stable and predictable over time
Seclusion
The use of seclusion and restraint as a therapeutic intervention for psychiatric patients has long been controversial
What do therapeutic relationships help to do?
Therapeutic relationships help facilitate expression of feeling, assisting wit problem solving, helping examine self defeating behaviors i.e cutting themselves/scratching, and promoting Independence and self care (take away negative behavior and give a positive one)
What medications can be used in anorexia?
There are no drugs approved by the FDA and research does not support the use of pharmacological agents to support the core symptoms
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.
What is the history of evidence based practice in the mid to late 1970's?
There was a growing consensus among nursing leaders that scientific knowledge should be used as a basis for nursing practice. So the division of Nursing began funding research utilization projects
What do hair pulling and skin picking disorders cause?
These disorders cause social stigma, disability and altered appearance. Linked to OCD symptoms. Occurs more often in children.
How long does brief psychotic disorder last?
These symptoms last at least 1 day but less than 1 month, and there is an eventual full return to a normal level of functioning.
What are the problems with transference and countertransference?
They can't be therapeutic
How do somatoform disorders run their course?
They fluctuate through periods of remission and exacerbation
What lengths will someone go to avoid triggers with PTSD?
They go as far as to becoming dysfunctional
What are antagonistic effects?
They take something to even the other out, uppers and downers used together
What is the Milieu?
This includes the physical, social, and emotional aspects of the patient's environment. To be therapeutic, the client should feel safe and comfortable in every aspect
What is SOLER? What does it stand for?
This is active listening S: sit squarely facing the client O: observe an open posture L: lean forward toward the client E: establish eye contact R: relax
Brain imaging: electroencephalograph
This is an EEG, NOT and EKG. EEG looks at brain waves while the EKG looks at heart waves. this records electrical impulses and is used for first line diagnostics (least invasive/expensive).
Elizabethan Poor Law
This law governed health care for the poor, establishing coherent, consistent public support for needy people through local taxes
What does NAMI do?
This service is trying to fight the stigma of mental illness and improve the quality of life for individuals with mental illness.
What does schizophrenia cause a disturbance in?
Thought process, perception affect
Electroconvulsive therapy: Mechanism of action
Thought to increase levels of biogenic amines; affects neurotransmitters: - Increase in gray matter following ECT
What are sources of anxiety?
Threats to biologic integrity: - Actual or impending threats to basic needs - Food, drink, or warmth Threats to security of the self: - Unmet expectations - Unmet needs for status and prestige - Anticipated disapproval by significant others - Inability to gain or reinforce self-respect - Guilt
What is found during a nurse's case management activities?
Through a nurse's case management activities, general community weaknesses in quality and quantity of health services are often discovered.
How are the goals of mental health patients ultimately met?
Through therapeutic communication and milieu
What is the benefit of motivational interviewing?
To allow the patient to explore why they act the way they do. This is patient centered and promotes behavioral change. Exploring patients reasons for change and pros and cons of change
What is the priority goal with home health?
To maximize the client's ability to manage their own health
What is the collaboration goal?
To promote respect, understanding, and accuracy of communication of all team members' points of view
What does the imbalance of norepinephrine cause?
Too high: mania, anxiety and schizophrenia Too little: depression
What does the imbalance of serotonin cause?
Too much: anxiety Too little: depression
What does the imbalance of Ach cause?
Too much: depression Too little: Alzheimer, Huntington, Parkinsons
What does the imbalance of GABA mean?
Too much: reduction in anxiety Too little: anxiety, schizophreniam, mania and huntingtons disease *GABA is inhibitory transmitter so when we increase GABA we have a CNS depressed effect. Benzos increase GABA
What does the imbalance of dopamine cause?
Too much: schizophrenia and manic Too little: parkinsons and depression
What is hypermetamorphosis?
Touching everything
Displacement
Transfer of emotions onto another person or object
What is the difference between transference and countertransference?
Transference: The nurse reminds the patient of someone in his/her past- POSTIVE- not therapeutic Countertransference: Patient reminds the staff of someone in his/her past- NEGATIVE- not therapeutic
What 3 purposes are we able to share PHI?
Treatment, payment, health care operations
What is pseudoparkinsonism?
Tremor, shuffling gait, drooling, rigidity
True or false, A nurse can give an IM medication to a client on a board of mental health hold or committal?
True
True or false, All antidepressants carry FDA black-box warning for increased risk of suicidality in children and adolescents?
True
True or false, Binge eating is not associated with the behaviors of bulimia or anorexia?
True
True or false, Children exposed to high levels of stress have a greater incidence of mental illness as adults?
True
True or false, Hospitalizations are often stressful for patients and families and are precipitating causes of crisis
True
True or false, No "typical family" model exits?
True
True or false, One goal of "trauma informed care" is to prevent or decrease the incidence of re-traumatizing the client?
True
True or false, Taking no action is considered an action taken?
True
True or false, anxiolytics can be considered a medical restraint if used in high dosage?
True
True or false, developing cultural competence is one of the core competencies for public health nurses?
True
True or false, if the diagnosis is made while the individual is still symptomatic but has been so for less than 6 months, it is qualified as "provisional."?
True
True or false, the greater the number of stressors, the greater the incidence of mental disorders?
True
True or false, case management is complex?
True, Because of the coordinating activities of multiple providers, payers, and settings throughout a client's continuum of care.
True or false, Sedatives/Hypnotics/Anxiolytics are addictive?
True, Highly Addictive!!! Psychological and Physical Addiction Cross tolerance and addiction
True or false, An individualized crisis plan could include aroma therapy?
True, Incorporates sensory interventions
What is the biological theory on suicide?
Twin studies have shown much higher concordance rate for monozygotic twins than for dizygotic twins.
What are synergistic effects?
Two drugs or drugs and alcohol that work together to give a better high
What is poly drug use?
Two or more forms of drugs
Splitting
Unable to integrate positive and negative aspects of self or others- Personality disorders
What is agraphia?
Unable to read or write
What is confabulation?
Unconscious attempt to maintain self-esteem
Sublimation
Unconsciously substituting positive activities for negative activities
Conversion
Unconsciously transformed anxiety into physiological response
Compulsion
Uncontrollable, persistent urge to perform certain acts or behaviors to relieve unbearable tension (behavior).
What is amnestic disorder secondary to?
Underlying cause such as substance abuse
Fantasy
Unrestrained imagery regarding reality
Supporting
Upholding a client's right to make a choice and act on that choice
What medications are used during depressive phase for bipolar disorder?
Use antidepressants with care (may trigger mania)
Length of use for anxiolytic medications?
Used for short amount of time
Quiet room for children
Used to remove child from a situation fro self-control or control by the staff
What are anxiolytic medications used for?
Used to treat high level anxiety and panic to insomnia - Benzodiazepine class
Caboxone
Used with chronic pain
Benzos
Used with somatic and psychological symptoms - Fast acting and most common - Addictive property and used on short term
When is autism spectrum disorder observed?
Usually observed before age 3
When does sexual dysfunction occur?
Usually occur as a problem in one of the following phases of the sexual response cycle: Phase I: Desire Phase II: Excitement Phase III: Orgasm Phase IV: Resolution
What is the #1 drug to treat tardive dyskinesia?
Valbenazine
What is the humanistic theory of anger & aggression?
Value and self worth affect one's self esteem. If a person feels undervalued or unneeded self esteem becomes threatened. The response is then aggression or violence
What is the occipital lobe responsible for?
Vision
What is posturing?
Voluntary assumption of inappropriate or bizarre postures
What assessment is important while on clozapine?
WBC, needs to be 3500 or greater
How do we use Pharmacological Interventions with personality disorders?
We can't treat personality disorders with medications, but we can treat symptoms
How do atypical antipsychotics work?
Weak dopamine antagonists
What is WRAP?
Wellness Recovery Action Plan; Process to monitor& manage symptoms occurring in daily life
Cultural imposition
When one person imposes his or her beliefs, values, and practices on another because he or she believe his or her ideals are superior
What are personality disorders?
When personality traits deviate markedly from expectations of the individual's culture, become rigid and inflexible, contribute to maladaptive patterns of behavior or impairment in functioning
Will someone remember their period of fugue?
When returned to their former consciousness they do not remember their period of fugue
What is catatonic disorder due to another medical condition?
When symptoms of catanoia are caused by a medical condition such as neoplasms, metabolic conditions , encephalitis
Mixed type of delusional disorder
When the disorder is mixed,delusions are prominent, but no single theme is predominant.
Who has high prevalence of suicide?
While elderly men
What happens if you have a transference or countertransference occur?
Will have to give up the patient if this occurs because you are no longer therapeutic
How do we document abuse?
With direct client statements/quotes - Body map to locate injuries
What is imaginal desensitization?
With imaginal desensitization the client learns how to achieve a state of relaxation while recalling situations that triggered paraphilic behavior with the idea that relaxation will lead to less impulsivity in one's behavior.
What are symptoms of alcohol withdrawal vs. alcohol delirium?
Withdrawal: - Hyper alertness - Jerky motions - Irritability - Easily startled - "Shaky" Delirium: - Tachycardia and/or elevated blood pressure - Disorientation - Diaphoresis - Visual or tactile hallucinations - Hyperexcitability or lethargy - Paranoia, delusions or agitation - Fever of 100-103
What is alcohol withdrawal vs. alcohol delirium?
Withdrawal: may appear 6-8 hours after decreasing the alcohol intake. Signs peak after 24-48 hours then rapidly disappear. Delirium: Alcohol delirium Medical emergency!!! Can result in death Delirium peaks at 2-3 days after stopping alcohol use. Can last 2-3 days
When does adjustment disorder begin?
Within 3 months of the stressors
When is a crisis usually resolved?
Within 4-6 weeks
What are the expectations of the client during therapeutic milieu?
Within this therapeutic community setting, the client is expected to learn adaptive coping, interaction, and relationship skills that can be adapted to other aspects of his or her life.
Who is at risk in rural areas for being underinsured and uninsured? Why?
Working poor - Employed but can't afford health insurance - Income just high enough to disqualify for assistance - Self-employed - Part time employee or seasonal occupation - "Fall through the cracks"- language barriers, agency placements, lack of transportation, undocumented
Cultural repatterning
Working with clients to make changes in health practices when the client's cultural behaviors are harmful or decrease their well-being
When did the influenza pandemic take place?
World war 1
What are illusions?
Wrong perception of a sensory stimuli Ex: crease in a sheet is perceived as a wave of water or wallpaper is seen as clouds
What are examples of benzos?
Xanax, Librium, Klonopin, Valium and Ativan
Is delirium an emergency?
Yes
Is it possible for a person to experience two or three types of crises simultaneously?
Yes
Are individuals in the biological theory of addiction at more risk for other addictions?
Yes Ex: gambling, sex addiction - Having one addiction predisposes them to being addicted to something else
Is tardive dyskinesia reversible?
Yes if treated as early as possible, may not cause symptoms to completely go away. But they will improved
Do people experience grief and anxiety at the same time?
Yes, people are anxious when they're grieving
Bipolar disorder associated with another medical condition
abnormally/persistently elevated, or irritable mood/ excessive activity judged to be result of physiological effects of another medical condition
A nurse wishes to develop cultural competence. Which of the following actions should the nurse take first? a. Complete a survey of all the various ethnicities represented in the nurse's community. b. Consider how the nurse's own personal beliefs and decisions are reflective of his or her culture. c. Invite a family from another culture to join the nurse for an event. d. Study the beliefs and traditions of persons living in other cultures.
b. Consider how the nurse's own personal beliefs and decisions are reflective of his or her culture.
Which of the following is a potential advantage of hospital-based home health agencies over other types of home care agencies? a. Administration and management benefits are gained from the expertise of two boards of experts. b. Continuity of care is enhanced. c. Health promotion and illness prevention concerns take precedence over acute care and rehabilitation. d. They are eligible for tax exemptions through affiliated agencies.
b. Continuity of care is enhanced.
A nurse is caring for a client who is from a different culture than himself. When the beginning the cultural assessment, which actions should the nurse take first? a. Determine the client's perception of this current health status b. Gather data about the client's cultural beliefs c. Determine how the client's culture can affect the effectiveness of nursing actions d. Gather information about previous client interactions with the health care system
b. Gather data about the client's cultural beliefs
Which of the following statements best describes the most essential difference between home health care and acute client care? a. Acute client care is individualized for the client and family. b. Home health care is provided in the client's environment. c. Reimbursement for home health care varies from that of care provided in institutions. d. The focus of acute client care is on community health.
b. Home health care is provided in the client's environment.
In the agency, one of the nurses spent all available time visiting a group of persons with mental health problems who were trying to remain functional in the community. Which of the following types of assignments did the nurse most likely have? a. Home-based primary care b. Population-focused home care c. Proprietary home care d. Transitional care
b. Population-focused home care
Which is a misconception about suicide? a)Eight out of ten individuals who commit suicide give warnings about their intentions. b)Most suicidal individuals are ambivalent about their feelings regarding suicide. c)Most individuals commit suicide by taking an overdose of drugs. d)Initial mood improvement can precipitate suicide.
c) Most individuals commit suicide by taking an overdose of drugs.
A client with a history of a suicide attempt has been discharged and is being followed in an outpatient clinic. At this time, which is the most appropriate nursing intervention for this client? a)Provide the client with a safe and structured environment. b)Isolate the client from all stressful situations that may precipitate a suicide attempt. c)Observe the client continuously to prevent self-harm. d)Assist the client to develop more effective coping mechanisms.
c)Observe the client continuously to prevent self-harm.
The nurse is caring for an actively suicidal client on the psychiatric unit. What is the nurse's priority intervention? a)Discuss strategies for the management of anxiety, anger, and frustration. b)Provide opportunities for increasing the client's self-worth, morale, and control. c)Place client on suicide precautions with one-to-one observation. d)Explore experiences that affirm self-worth and self-efficacy.
c)Place client on suicide precautions with one-to-one observation.
Which of the following types of home health agencies emphasizes health promotion and illness prevention? a. Combination agencies b. Hospital-based agencies c. Official agencies d. Proprietary agencies
c. Official agencies
A client is crying softly and saying, "What did I do to deserve this punishment, Lord?" Which of the following responses by the nurse would be the most appropriate? a. God doesn't punish people. You're just sick because of bad luck b. I can call the hospital chaplain to help you talk about these feelings c. What can I do to be helpful to you right now? d. Would you like to confess your sins and repent so this illness will go away?
c. What can I do to be helpful to you right now?
An elderly person is in the last stages of dying. Which type of care would be the best for him? a. Home Health b. Assisted living c. Nursing home d. Hospice
d. Hospice
What are the 4 approaches to family nursing?
family as context, family as client, family as system, family as a component of society
What is apraxia?
loss of purposeful movement in the absence of motor or sensory impairment
What is the goal of therapeutic milieu?
the goal of milieu therapy is to manipulate the environment so that all aspects of the client's hospital experience are considered therapeutic.
Hallucinations can involve any of the 5 senses, what are examples?
•Auditory hallucinations are false perceptions of sound. Most commonly they are of voices, but the individual may report clicks, rushing noises, music, and other noises. "Voices" that issue commands for violence to self or others may or may not be heeded by the psychotic person. Auditory hallucinations are the most common type. •Visualhallucinations may consist of formed images, such as of people, or of unformed images, such as flashes of light. •Tactile hallucinations are false perceptions of the sense of touch, often of something on or under the skin. One specific tactile hallucination is formication, the sensation that something is crawling on or under the skin. •Gustatoryhallucinations are false perceptions of taste. Most commonly, gustatory hallucinations are described as unpleasant tastes. •Olfactory hallucinations are false perceptions of the sense of smell. Illusions differ from hallucinations in that they are are misperceptions or misinterpretations of real external stimuli.
