Pysch 2

Interventions for rape trauma syndrome

The nurse plays a crucial role in giving support and minimizing the trauma of the examination Provide a support person to stay with the patient Explain the legal process to the patient Document whether the patient has showered or bathed Explain the rape protocol Document mental state, physical state, history of incident, evidence of violence, and prior gynecological history Note all signs of physical injury such as cuts, bruises etc. Implement rape protocol(collect samples of hair, secretions, clothing) Secure samples for legal evidence Let the victim be involved in decision making of care when possible. Implement crisis intervention counseling- 24 hour hotlines for counseling and resources Provide nonjudgmental care, emotional support, assure confidentiality, and allow survivor to express feelings Promotion of self care activities and provide written materials for outpatient resources Follow-up with patient 24-48 hours after discharge. Then schedule F/U visits at 2, 4, and 6 weeks

Assessment of rape victim

The nurse should assess the: Psychological trauma Physical trauma Level of anxiety Coping ability Available support resources Community support Allow the victim to talk about the experience . Pose questions in a gentle manner using nonjudgmental terminology. Document verbatim statements made by the patient.

Personal assessment for sex assault

The nurse's feelings about sexual assault can directly affect the quality of physical and psychological care she provides to the victim. The nurse should get in touch with how she/he feels about rape before initiating patient care.

Marital rape

The spouse may be held liable for sexual abuse directed at a marital partner against that person's will. In 1993, marital rape became a crime in all 50 states

Bulimia genetics

There may be genes that make some people more vulnerable to developing eating disorders. People with first-degree relatives — siblings or parents — with an eating disorder may be more likely to develop an eating disorder too, suggesting a possible genetic link. It's also possible that a deficiency in the brain chemical serotonin may play a role in the development of bulimia.

Wernicke's encephalopathy

Thiamine deficiency. Paralysis of ocular muscles, diplopia, ataxia, somnolence, stupor, possibly death

Neglect

This includes physical, emotional, and educational neglect.

Diagnosing PTSD

To be diagnosed with PRSD, a person must have all of the following for at least 1 month: At least one re-experiencing symptom At least two hyperarousal symptoms At least three avoidance symptoms Symptoms that make it hard to go about daily life, go to school or work, be with family and friends and take care of important tasks

CIWA-AR

Tool to assess risk/severity from alcohol withdrawal initially and ongoing. 0 means none

Topiramate

Topamax) This works to decrease alcohol cravings by inhibiting the release of mesocorticolimbic dopamine, which has been associated with alcohol craving (

Psychoanalytic psychotherapy

Treatment of choice for histrionic that focuses on unconscious motivation for seeking total satisfaction from others and for being unable to commit to a stable meaningful relationship

Benzo withdrawal

Tremor, n/v, dilated pupils, sweating, delirium tremens, seizure, coma, DEATH

Alcohol withdrawal s/s

Tremors, nausea/vomiting dilated pupils, sweating, delirium tremors, seizure, coma, DEATH few hours after last drink. Peak 24-48 hours Increased alertness, irritability, feelings of "shaking inside," presence of illusions, seizures can occur within 7-48 hours

Naltrexone

Trexan, Revia For recovering alcoholics to reduce cravings. Also a narcotic antagonistic that blocks the euphoric effects of opioids for up to 72 hours. It has low toxicity with few side effects and is nonaddicting.

PTSD symptom management for trigger reactions? Anger?

Trigger reactions: teach anger expected/normal, reassure that they can learn to manage anger Anger: teach anger management

Ineffective denial interventions

Trusting relationship via keeping promises/positive regard, acknowledge feelings, avoid arguing/bargaining, state which behaviors are unacceptable and how privileges will be restricted, encourage to verbalize feelings

Drug general assessment

Two important questions In the last year, have you ever drank or used drugs more than you meant to? Have you felt you wanted or needed to cut down on your drinking or drug use in the last year? Details needed Drugs used Route Quantity Time of last use Usual pattern of use

Substance abuse criteria

Two or more of the following during a 12 month period: 1. An inability to manage obligations at work or at home (e.g., unable to care for children and other dependents, showing up late to work or school, repeatedly missing work or school, etc.) 2. Repeated use of drugs or alcohol in circumstances where it becomes physically dangerous (e.g., driving while under the influence) 3. Ongoing interpersonal issue caused by the effects of chronic drug and alcohol use (e.g., fights with a significant other due to behaviors under the influence) 4. Tolerance for the drug of choice defined by either the need for higher and higher doses in order to feel the desired effects of the drug or decreased effects with the same dose 5. Withdrawal symptoms when without the drug of choice or a substance that is similar in effect 6. Taking more of the drug than is intended either in a single use session or in a certain period of time 7. An inability to stop using the substance of choice or to cut down on use 8. Spending a large amount of time seeking the drug of choice, being high or drunk, or recovering from use of the drug or drugs 9. Avoiding family activities, social events, or former hobbies due to substance use 10. Continued use of drugs and alcohol despite the realization that the behavior is causing psychological, physical, and/or social problems 11. Cravings for the drug of choice

Statutory rape

Unlawful intercourse between a person who is over the age of consent. Legal age of consent vary from 14 to 18 across states

Labs of alcoholic

Urine Drug Screen Serum ethyl alcohol or breathalyzer Chem 14 - Electrolyte disturbances (low NA, K, Mg) Dehydration - BUN & Creatinine elevated CBC - Low WBC might suggest HIV; low platelets support alcoholism (ETOH suppresses bone marrow); low Hb with MCV suggest ETOH; UTI is frequent

Considered to have substance abuse disorder when

Use of substance interferes with ability to fulfill role obligations like work, school, home

Threats of physical/sex violence

Use words, gestures, or weapons to communicate the intent to cause death, disability, injury, or physical harm.

Contact burns

Usually involve hot metal objects Prolonged steady contact Cigarette burns are common source of contact burns Assess body part that was burned or "branded"

Profile of rape victimizer

Usually males Typically between ages 25-44 years of age Under the influence of alcohol and/or drugs 61% of the time the victim is acquainted with the perpetrator History of abuse

Vulnerability to drug abuse and addiction

Vulnerability is a product of the interaction of a person's biology (including their genes), environment, and age. These interactions are complex and difficult to tease apart.

Violence co-morbidity

We know that anger and aggression often co-exist with people who are diagnosed as Depressed Anxious Psychotic Having a Personality Disorder Having an addiction

Interventions for anorexia

Weigh patient in minimal clothing, at same time of day, after voiding and before drinking or eating Monitor patient during meals to prevent throwing food away/purging Recognize patient's distorted body image without minimizing or challenging patient's perception Educate patient about ill effects of low weight Work with patient to identify strengths

Withdrawal, initial/active drug treatment, health maintenance outcomes

Withdrawal Fluid balance Neurological status: consciousness Distorted thought self-control Initial and active drug treatment Risk control - alcohol use Risk control - drug use Substance addiction consequences Health maintenance Knowledge: substance abuse control Family coping

Elder abuse neglect

Withholding food and water Inadequate heating Unclean clothes and bedding Lack of needed eyeglasses, hearing aids, dentures Sexual Abuse Sexual molestation; rape Sexual intimacy against the will of the elderly person

Economic abuse

Withholding of financial support or the illegal or improper exploitation of funds or other resources

Caffeine withdrawal

Within 24 hours. Headache, fatigue, drowsiness, dysphoric, irritability, difficulty concentrating, flu like, n/v, muscle pain

Stimulant. Withdrawal

Within few hours to several days after. Fatigue, depression, nightmares, headache, sweating, cramps, hunger.

Environmental factors of eating disorders

Women's magazines: 10 times more ads promoting weight loss than men's magazines Miss America: Weight has declined 12% since 1920s

Ineffective coping interventions

Work to determine situations that increase anxiety/rituals, allow plenty of time for rituals at first, don't be judgmental, support exploring meaning/purpose, structured schedule of activities including time for rituals, gradually begin to limit time allotted for rituals, give positive reinforcement, help learn ways of interrupting OCD/rituals via thought stopping/relaxation/exercise

Psychological elder abuse

Yelling Insulting-name calling Harsh commands Threats Ignoring, social isolation withholding affection

Patient says he doesn't have problem with alcohol and his boss is a jerk. Best response is? What defense mechanism is he using?

You are here because your drinking was interfering with work. Denial

Indicators of physical abuse

Younger than age 4 Perceived as being different Unexplained injuries Fading bruises or other marks noticeable after an absence from school Child appears frightened of parents Child shrinks at the approach of adults Reports injury by a parent or another adult caregiver Parent or caregiver offers conflicting or no explanation for the child's injury History of child abuse Use of harsh physical discipline with the child Special needs that may increase caregiver burden(e.g., disabilities, autism, mental retardation, mental health issues, and chronic physical illnesses).

Decades of research have revealed addition to be

a disease that alters the brain. We now know that while the initial decision to use drugs is voluntary, drug addiction is a disease of the brain that compels a person to become singularly obsessed with obtaining and abusing drugs despite their many adverse health and life consequences

Wenicke's encephalopathy

a syndrome characterized by ataxia (loss of coordination), ophthalmoplegia (eye paralysis), confusion, and impairment of short term memory. often resulting from inadequate intake or absorption of thiamine ( Vit B1)

dsm 5 borderline PD

a syndrome rather than disorder on axis I possible new name emotional dysregulation disorder

Outcomes for anxiety disorders

able to recognize signs of escalating anxiety and intervene before reaching panic level (panic and GAD) Is able to maintain anxiety at manageable level and make independent decisions about life situation (panic and GAD) Functions adaptively in the presence of the phobic object or situation without experiencing panic anxiety (phobic disorder) Verbalizes a future plan of action for responding in the presence of the phobic object or situation without developing panic anxiety (phobic disorder)

Addiction requires treatment that

addresses its complexity. Substance abuse treatment should address the whole person and can include medications, behavioral therapies, and ancillary support services.

Intimate partner violence

affects individuals in every community and background. IPV occurs between two people in a close relationship. The term "intimate partner" includes current and former spouses and dating partners. Used to gain control over other partner can be physical, sexual, emotional, economic, psychological actions/threats that influence the other IPV exists along a continuum from a single episode to ongoing battering. IPV includes four types of violence(physical, sexual, emotional and threats of physical and sexual violence).

Alcohol can affect

all organ systems, but problems often seen involve the CNS (Wernicke's encephalopathy and Korsakoff's psychosis

Child maltreatment includes

all types of abuse and neglect in children up to age 17 years.

PTSD marked symptoms of

anxiety or increased arousal (e.g., difficulty sleeping, irritability, poor concentration, hypervigilance, exaggerated startle response, motor restlessness).

Excessive anxiety

anxious apprehension in the literature. This term was coined because anxiety is viewed as an emotion, focused on the future, where a person is preparing to deal with some anticipated negative circumstance. Excessive worry is referred to as apprehensive expectation because a person is always expecting some sort of terrible event will happen at any moment and that they are not safe. The feeling would be similar to walking around in a minefield while blindfolded.

Research has identifies a number of brain circuits that are affected by addiction

areas depicted contain the circuits that underlie feelings of reward, learning and memory, motivation and drive, and inhibitory control. Each of these brain areas and the behaviors they control must be considered when developing strategies to treat drug addiction

Focus of fam therapy for violence

asset families who use violence to solve problems to help them identify alternative ways to problem resolution in the family. Use of democratic ways for conflict resolution. Referral to agencies for parenting classes. Support groups for abusive parents is also helpful

Kosakoff psychosis

brain disorder caused by the lack of thiamine (Vit B1) in the brain and the GI system (esophagitis, gastritis, pancreatitis, hepatitis, cirrhosis)

Physical indicators of elderly abuse

bruises, welts, lacerations, burns, punctures, skeletal dislocations and fractures

Use of alcohol during pregnancy

can result in fetal alcohol spectrum disorders (FASDs) (1) Fetal alcohol syndrome (FAS). Effects of alcohol on the fetus can result in problems with learning, memory, attention span, communication, vision, and hearing. (2) Alcohol-related neurodevelopmental disorder (3) Alcohol-related birth defects

Alcohol withdrawal

cessation or deduction after prolonged use after 4-12 hours. Exhibits nausea, vomiting, anxiety, increased pulse and blood pressure, seizures, tremors, malaise, weakness, tachycardia, sweating, elevated BP, anxiety, depression, hallucinations/illusions, headache, insomnia within a few hours after use to 48 hours. Can lead to alcohol withdrawal delirium on 2nd or 3rd day of cessation

Early indications for chemically impaired nurse

changing lifestyle to focus on activities that encourage substance use, showing inconsistency between statements and actions, displaying increasing irritability, projecting blame, isolating self from social contacts, deteriorating physical appearance, episodes of vaguely described illness, frequent tardiness or absences, manipulating possession of keys to narcotics, and deepening depression. When the impaired nurse is on duty, patients may complain that their pain is unrelieved by their narcotic analgesic, and increases in inaccurate drug counts and vial breakage may occur.

Panic disorder

characterized by uncued (unexpected) panic attacks (see previous section). This diagnosis is not made if the panic attacks are cued or expected. repeated, unexpected (uncued) panic attacks. The attacks are followed by constant concerns about having more attacks; worrying about the consequences of the attacks; or significantly changing behavior to avoid the attacks. These worries and concerns about experiencing another attack must continue for a month or longer. The frequency and severity of panic attacks varies considerably. Some people report moderately frequent attacks that occur regularly (such as once per week) every month, for many months. Others report a cluster of very frequent attacks (perhaps one per day) that occur for a several weeks, followed by a dormant period of several months, without any attacks.

Uncued panic attack path

chemicals remain active in the body with no quick or easy way of getting rid of them. This thereby produces the unpleasant physical sensations that are associated with panic attacks. These sensations include all the physical symptoms that occur when the fight-or-flight response is activated (racing heart, accelerated respiration, perspiration, digestive upset, dizziness, etc.). Subsequently, the fight-or-flight response is not helpful at this point because there is no real threat. Instead, the person is just left feeling physically and emotionally fearful, highly uncomfortable, and ultimately exhausted.

Alcohol and liver

chief site of alcohol damage, person cannot convert glycogen into glucose, thus lowering blood sugar and producing hypoglycemia, it inefficiently detoxifies substances in the blood and inadequately eliminates drugs, alcohol, and dead red blood cells. A diseased liver also cannot manufacture bile (for fat digestion), prothrombin (for blood clotting), and albumin (for preventing plasma loss from capillaries) causing bruising/skin discolor/blood shot eyes

Drug addiction resembles other

chronic diseases in more ways than relapse rates. These include both biological and behavioral components that need to be addressed during treatment, an expectation of long-term recovery requiring repeated episodes of treatment and the added value of support programs in sustaining it

When a client receiving lorazepam (Ativan) returns for a clinic visit, he is noted to stagger. His speech is slurred and he seems somewhat confused. The nurse should

consider the possibility that the recommended dose is being exceeded and notify the physician

Obsessive compulsive personality OCPD disorder is

diagnosed to describe pervasive and life-long perfectionist, puritanical and rigidly controlling personality traits that some people demonstrate. The diagnosis of OCPD doesn't require the presence of obsessions and compulsions

Financial abuse elderly indicators

disparities between assets and satisfactory living conditions or the elderly person complains of a sudden lack of sufficient funds for daily living expenses

PTSD disturbance causes clinically significant

distress or impairment in social, occupational, or other important areas of functioning or impairs the individual's ability to pursue some necessary task, such as obtaining necessary assistance or mobilizing personal resources by telling family members about the traumatic experience.

Opiate intoxication

euphoria, apathy, drowsiness, slurred speech, pinpoint pupils

Define trauma

event involving being a victim of or witness to atrocity, violence, true horror and/or the death of another or near death of ones self. Examples might include rape, murder, torture, accidents, terrorism, etc.

S/s of anorexia

excessive exercise hypothermia lanugo amenorrhea bradycardia hypotension many metabolic changes. compulsively obsessed with food. feelings of depression and anxiety often accompany need for control (which manifests in eating behavior)

Cocaine abusers may

experience malnutrition, myocardial infarction, and stroke.

True OC is

extreme condition diagnosed only when obsessions and compulsions cause significant impairment in a person's ability to work or meet other important responsibilities (such as when a person is unable to get to work on time because she is spending over an hour checking to see that her door is locked).

Genetic vulnerability for PD

genetics loads the gun, environment pulls the trigger Limbic - emotional center of the brain. Child abuse changes in size of limbic center

IV drug users

have a higher incidence of HIV, TB, STDs, abscesses, and bacterial endocarditis

Cued panic attack

if a woman experiences a panic attack in a grocery store, she may come to believe the grocery store "caused" the panic attack. As a result, they will avoid the grocery store at all cost. Because they believe the grocery store caused the attack, merely thinking about the need to shop for groceries may prompt another panic attack. anxiety has been learned through a behavioral learning process called classical conditioning

Not all trauma victims experience PTSD

immediately after exposure to trauma. Some persons react quickly to traumatic exposure, while others appear to emerge from traumatic exposure unscathed, only to experience the sudden emergence of PTSD-type symptoms months or years later.

Drug chief complaint

in their own words SA: substance use, how much, how often, last use, consequences, withdrawal, tolerance MH: medical problems, meds, allergies Past Psychiatric: depression, mania, anxiety, trauma Past SA: when started, when out of control, previous treatments, sober periods, h.o IVDU, HIV, Hep C SH/DH: childhood, current support systems, education level, employment, housing, income, access to healthcare, Legal HX: past and current MSE: appearance , behavior, cooperation, speech, mood, affect, thought process, thought content, perception, insight, judgment

Child physical neglect

includes refusal of or delay in seeking health care, abandonment, expulsion from the home or refusal to allow a runaway to return home, and inadequate supervision

Smoking a substance

increases the incidence of respiratory problems, and intranasal use predisposes to sinusitis and perforated nasal septum.

Child emotional abuse

involves a pattern of behavior on the part of the parent or caregiver that results in serious impairment of the child's emotional or intellectual functioning. Examples of emotional abuse include: belittling or rejecting the child; ignoring the child; blaming the child for things over which he has no control; isolating the child from normal social experiences, and using harsh and inconsistent discipline.

Cannabis withdrawal

lethargy, inability to eat, increased anxiety, irritability, sleep difficulty

Elderly neglect indicators

manifested by consistent hunger, poor hygiene, inappropriate dress, consistent fatigue or listlessness, consistent lack of supervision, and abandonment

PTSD the disturbance lasts for

minimum of 2 days and a maximum of 4 weeks and occurs within 4 weeks of the traumatic event.

All physiological changes of alcoholic

neuropathy leads to falling, liver changes lead to increased bleeding, gastritis and pancreatitis contributes to poor nutrition...poor nutrition leads to further physical illness

Obsessive thoughts/compulsive behaviors that worsen during times of stress are

normally experienced by many people, and are not necessarily a sign of OCD. The tendency to become obsessed with ideas or to compulsively pursue organization and ordering tasks are valued personality features in a variety of detail-oriented fields, including accounting, computer programming and scientific research

Once documentation for chemically impaired rn

nurse manager must be informed. Intervention is the responsibility of the nurse manager. If the situation persists without intervention by the nurse manager, the information needs to be taken to the next level in the chain of command. Although reporting a colleague is difficult, not reporting is an enabling behavior. Referral to a treatment program should be an option. Reports to the state board for nursing by nursing administration must contain factual documentation

Violence define

objectionable act that involves intentional use of force that results in, or has the potential to result in, injury to another person.

Acute stress disorder vs. posttraumatic stress

occurs in the time frame between just after exposure to a traumatic event to six months later, and posttraumatic stress beginning at the six month point and extending thereafter

Drug assessment complex bc

of poly drug use, dual diagnosis, and comorbid physical illness

Drug assessment is complex because

of poly drug use, dual diagnosis, and comorbid physical illness.

Inhalant intoxication

paint thinner, nail polish, glues, nitrous oxide) Euphoria, belligerence, violence, apathy, dizziness, incoordination, slurred speech, tremor, coma

Treatment of nicotine addiction

patch provides transdermal doses of nicotine and has been shown to double long-term abstinence rates.

Substance induced delirium

peaks 2-3 days after last use. Severely impaired level of consciousness, autonomic hyperactivity, hallucinations, medical emergency

OCD people have?

persistent, upsetting thoughts (obsessions) and use rituals to control the anxiety these thoughts produce. Most of the time, the rituals end up controlling them

It is considered psychological/emotional violence when there has been

prior physical or sexual violence or prior threat of physical or sexual violence. In addition, stalking is often included among the types of IPV. Stalking generally refers to "harassing or threatening behavior that an individual engages in repeatedly, such as following a person, appearing at a person's home or place of business, making harassing phone calls, leaving written messages or objects, or vandalizing a person's property"

When a patient is showing increased signs and symptoms of anxiety and agitation, it is appropriate to offeR

prn medications to alleviate symptoms. You would use these medications in combination with psychosocial interventions and descalation techniques which could prevent an aggressive violent incident

Anxiety is

psychological and physiological state characterized by somatic, emotional, cognitive and behavioral components. Anxiety is considered to be a normal reaction to a stressor. Anxiety may help a person to deal with a difficult situation by prompting one to cope with it.

Regardless of type of rape it is

psychological emergency and should receive immediate attention.

Substance abusers experience higher

rates of other co morbid mental illnesses than the general population. Although comorbidity is common, causality is more difficult to demonstrate.

Alcohol intoxication

recent intake, significant change in sexual, aggressive, mood and judgment. May exhibit slurred speech, unsteady gait, stupor, disinhibition, flushed face, nystagmus

PTSD traumatic even is persistently

reexperienced in at least one of the following ways: recurrent images, thoughts, dreams, illusions, flashback episodes, or a sense of reliving the experience; or distress on exposure to reminders of the traumatic event.

Child emotional neglect

refers to chronic failure by the parent or caregiver to provide the child with hope, love, and support necessary for the development of a sound, healthy personality

Feelings are kept in control and anxiety may be

released in the form of stress-related illnesses, or compulsive behaviors such as eating, spending, working, or use of substances

DSM anxiety

require that symptoms must cause a person significant distress or impairment. Therefore, just because someone is experiencing some symptoms of anxiety, it does not mean they meet the requirements for a mental disorder unless their symptoms are highly distressing to them, and/or cause significant problems in their functioning

It is the human to human personal boundary violations of violence that

results in individuals developing greater psychological symptoms than something like a natural disaster, a flood, earthquake or some God-given trauma.

Chronic amphetamine use

results in neurotoxicity possibly from glutamate and axonal degeneration Can see permanent amphetamine psychosis with continued use

Setting limits for PD

set limits only in areas in which there is a clear need to protect the client or others establish realistic and enforceable consequences of exceeding limits make client aware of limits and consequences & allow discussion of feelings about them all limits should be supported by all staff staff may discontinue limits based on actions, not promises staff should formulate a plan to address their own difficulty in maintaining limits

Alcohol intoxication s/s? OD?

slurred speech, incoordination, unsteady gait, nystagmus, impaired attention, and memory , Decreased BP, stupor, coma OD: n/v, shallow respiration, cold/clammy skin, weak rapid pulse

Research has shown for uncued panic attacks

some form of underlying life stressor often triggers these unexpected or uncued panic attacks. Examples of life stressors may include: separation and loss; relationship problems; new responsibilities; a family member's illness, drug reactions; pregnancy; and/or school and work issues (Bourne, 2000). Interestingly, life stressors do not necessarily need to be "negative" in content. Indeed, "positive" stressors such as a job promotion, planning a marriage, and having children may also contribute to the level of stress that may precipitate an initial, uncued panic attack

PTSD marked avoidance of

stimuli that arouse recollections of the trauma (e.g., thoughts, feelings, conversations, activities, places, people

Social

stressors make all diseases worse. Support makes all diseases better.

Indicators of elderly sex abuse

suspect when the older adult presents with pain or itching in the genital areas; bruising or bleeding in the external genitalia; unexplained sexually transmitted diseases, and bleeding in the anal or vaginal areas.

Psychological indicators of elderly abuse

symptoms associated with depression, anxiety, withdrawal, sleep disorders, and increased confusion and agitation

Children with GAD

tend to worry about their performance, even when it is not being evaluated. As such, they may develop perfectionistic tendencies. They can become highly concerned about being on time, or worry that some unlikely event will cause them to be late. They may seek constant reassurances and approval.

PTSD the disturbance is not due to

the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition, is not better accounted for by Brief Psychotic Disorder, and is not merely an exacerbation of a preexisting mental disorder.

PTSD person has been exposed to traumatic event in which

the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others the person's response involved intense fear, helplessness, or horror

PTSD either while experiencing or after experiencing distressing even individual has

three (or more) of the following dissociative symptoms: a subjective sense of numbing, detachment, or absence of emotional responsiveness a reduction in awareness of his or her surroundings (e.g., "being in a daze") derealization depersonalization dissociative amnesia (i.e., inability to recall an important aspect of the trauma)

Obsessions define

unwanted ideas or impulses that repeatedly well up in the mind of a person with OCD. Common ideas include persistent fears that harm may come to self or a loved one, an unreasonable concern with becoming contaminated, or an excessive need to do things correctly or perfectly. Again and again, the individual experiences a disturbing thought, such as, "My hands may be contaminated -- I must wash them" or "I may have left the gas on" or "I am going to injure my child." These thoughts tend to be intrusive, unpleasant, and produce a high degree of anxiety. Sometimes the obsessions are of a violent or a sexual nature, or concern illness.

Manipulative behaviors in personality disorder

uses bargains, threats, demands or intimidation to get own way able to use other's weaknesses for own benefit makes continuous, unrealistic demands pits one person against another pretends to be helpless and sorry for behavior lies to gain sympathy of others keeps all relationships at a superficial level uses flattery, charm and excessive compliments uses fear of physical violence to control others exploits generosity of others appears unconcerned or detached when confronted with maladaptive behavior finds a way around the rules

When anxiety loses its link

with precipitating circumstances, or becomes excessive or maladaptive, a person is said to have an anxiety disorder.

Safe houses/shelters are places

women can go to be assured protection from the batterer. Most shelters provide counseling, social services, legal support, child care, employment counseling and linkage to housing services.

Genetics for eating disorders

"We think genes load the gun by creating behavioral susceptibility such as perfectionism or the drive for thinness. Environment then pulls the trigger."

Possible reasons mental illnesses and substance abuse ten to co-occur

(1) the propensity for people to self-medicate in order to relieve mental distress or illness; (2) the increased risk for mental illness brought on by drug abuse, especially in those with genetic or other vulnerabilities; and (3) the overlap of risk factors for both conditions.

Body burns alcohol at rate of

.5 ounces per hour

Cage questionnaire

1. Have you ever felt like you should CUT down on your drinking? 2. Have people ANNOYED you by criticizing your drinking? 3. Have you ever felt bad or GUILTY about your drinking? 4. Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (EYE OPENER)?

Clinical institute withdrawal assessment for alcohol scale revised CIWA-AR

1. Nausea and vomiting 2. Tremor 0-3 3. Paroxysmal sweating 0-4 4. Anxiety 0-4 5. Agitation 0-4 6. Tactile/visual/auditory disturbances 0-4 7. Facial flushing 0-2 8. Seizures 0 -10 9. Headache or fullness 0-3 10. Orientation (0-4 points)

Alcohol intoxication blood alcohol level

100-200mg/dL, death at 400-700mg/dL

Barbiturate/benzo withdrawal can occur when

12 hours to 3 days

Valium withdrawal can occur when

7-10 days to appear

Panice define

A discrete period of intense fear or discomfort, in which at least 4 of the following symptoms developed abruptly and reached a peak within 10 minutes:

Tolerance

A need for higher and higher dosages of a substance to achieve the desired effect.

Personality trait vs. personality disorder

A personality disorder exists when these traits become inflexible and maladaptive and cause either significant functional impairment or subjective distress. A personality trait is an enduring pattern of perceiving, relating to, and thinking about the environment and oneself.

Bulimic binge

A variant of compulsive overeating Reported in 20% to 30% of obese clients No compensatory behaviors Major depression a significant co morbidity Most effective treatment is cognitive behavioral therapy Selective serotonin reuptake inhibitors may be used in treatment.

Rape trauma syndrome

A variant of post traumatic stress disorder. Acute Phase Occurs immediately after the assault; lasts 2-3 weeks Patient seen by ER personnel are most involved in dealing with patient initial reactions to the trauma During this phase there is a great deal of disorganization of the patient's lifestyle Common reactions are shock, disbelief, numbness Confusion, difficulty concentrating May appear calm outwardly but the patient may have some cognitive impairment. Long Term Reorganization Phase Occurs 2 or more weeks after the rape Intrusive thoughts about the rape(anger, violence, flashbacks) Increased activity such as moving, taking trips, visiting friends ,changing telephone numbers Increased emotional lability such as mood swings, depression, intense anxiety, crying spells Fears and phobias develop as a defensive reaction to the rape

DSM V Alcohol withdrawal criteria

A. Cessation of (or reduction in) alcohol use that has been heavy and prolonged. B. Two (or more) of the following: 1. Autonomic hyperactivity (e.g., diaphoresis or HR>100) 2. Increased hand tremor 3. Insomnia 4. Nausea and vomiting 5. Transient visual, tactile, or auditory hallucinations or illusions 6. Psychomotor agitation 7. Anxiety 8. Grand mal seizures

Fetal alcohol syndrom

Abnormal face, short nose, thin lip, small midface, small head, short heigh, low weight, poor coordination, hyperactive, difficulty paying attention, poor memory, difficulty in school, learning disabilities, speech/language delays, intellectual disability/low IQ, poor reasoning/judgement, sleep/sucking issues, vision/hearing problems, heart/kidney/bones issue, psychiatric disorders, ADHD

Abuse head trauma/shaken baby syndrome

Abusive head injury is the most common cause of death as the result of child abuse. Infants frequently present with nonspecific clinical features without a history of trauma. As a result, as many as 30 percent of children with abusive head injury may be misdiagnosed at the initial evaluation

Denial actions

Accept unconditionally, identify ways in which use has contributed to maladaptive behaviors, don't allow client to blame others

Complicated grieving interventions

Accepting attitude, be honest/keep promises, identify function that anger serves, encourage to discharge anger through exercis, explore true anger source, explain behaviors, ways to express anger, positive reinforcement, role model, set limits/consequences and be consistent

Risk fo other directed violence antisocial interventions

Accepting, trusting, be honest/keep promises, low stimuli, observe behavior frequently, remove dangerous objects, help identify objecct of hostility, encourage to verbalize, alternative ways of handling anger, calm, sufficient staff, tranq, possible restraints, one person to watch restrained

Rape

According to the FBI(2008) rape is the most commonly reported sexual assault. The expression of power and dominance by means of sexual violence, most commonly by men over women although men may also be rape victims. Rape is an act of aggression, not one of passion. Rape is a type of sexual assault that occurs over a broad spectrum of experiences ranging from the surprise attack by a stranger to insistence on sexual intercourse by an acquaintance or spouse.

Alcoholic cardiomyopathy

Accumulation of lipids causing enlargement and weakening. Similar to congestive heart failure/arrhythmia. S/S: decreased exercise tolerance, tachycardia, dyspnea, edema, palpitations, nonproductive cough, elevated CPK/AST/ALT/LDH. Treatment: rest, O2, digitalization, Na restriction, diuretics

Phase 2

Acute battering incident: most violent and shortest, beating

Alcohol pancreatitis

Acute: 1-2 days after binge with constant severe epigastric pain, n/v, distention. Chronic: pancreatic insufficiency resulting in steatorrhea, malnutrition, weight loss, DM

Alcoholic myopathy

Acute: muscle pain, swelling, weakness, reddish urine from myoglobin, high muscle enzymes in blood, elevated creatinine phosphokinase CPK/lactase dehydrogenase LDH/aldolase/aspartate aminotransferase AST. Chronic: gradual wasting/weakness in skeletal muscles no pain/tenderness/elevated enzymes. Both from vitamin B deficiency

Compound rape reaction

Additional symptoms like depression suicide, substance abuse, psychotic behaviors

Delirium tremens

Alcohol Delirium Tremens: Medical emergency S/S- body tremors, mental status changes, agitation, irritability, confusion, disorientation, decreased attention span, deep sleep that persists for a day or longer, stupor, lethargy, diaphoresis, increased BP, seizures, hallucinations, delusions, high sensitivity to light, sound, and touch Death secondary to sepsis, MI, electrolyte imbalance, suicide

Alcohol on blood

Alcohol disrupts metabolism and increases triglycerides and cholesterol in the blood, increasing the buildup of plaque deposits in the arteries - think what this predisposes patients for developing: increases the risk for hypertension, heart attacks, and stroke.

Withdrawal from short-acting sedative hypnotics? Long acting hypnotics?

Alprazolam/lorazepam: 12-14 hours after last does, peak at 34-72 hours and subside in 5-10 days. Diazepam/phenobarbital/chlordiazepoxide 2-7 days after, peak 5-8 day, subside 10-16 days

Antianxiety generic/trade names, common street names

Alprazolam/xanax, chlordiazepoxide/librium, clonazepam/klonopin, clorazepate/tranxene, diazepam/valium, lorazepam/ativan, oxazepam/serax, meprobamate/midtown. Green and whites, roaches, candy, downers, VS, dolls, dollies

Barbiturate generic/trade names, street names

Amobarbital/amytal, pentobarbital/nembutal, secobarbital/seconal, butabarbital/butisol, phenobarbital. Blue birds, blue angels, yellow jackets, mellow birds, GBs, red birth, red devils.

Amphetamine neuroadaptation

Amphetamines inhibit the reuptake of DA, NE, SE and greatest effect by increased release of DA

Aggression define

An action or behavior that results in verbal or physical attack.

Acetylmethadol

An alternative to methadone; patients need to come to an outpatient facility for their medication only three times per week.

Post traumatic stress disorder

An anxiety disorder as a result of an exposure to a traumatic event in which the person has responded with intense fear, helplessness, or horror. Re-experiencing of the traumatic event in recurrent, intrusive, and distressing images, thoughts, or perceptions.

Anger define

An emotional response to frustration of desires, a threat to one's emotional or physical needs, or a challenge.

Red flags of potential victim

An inconsistent injury Frequent medical visits with new complaints Injuries in pregnant women Delays in seeking treatment Depression/suicidal thoughts Anxiety and severe crying spells

Common responses of health care pros to violence

Anger Confusion Fear Anguish Helplessness Discouragement Embarrassment Blame the victim mentality

Family violence

Anger and Aggression Intimate Partner Violence Child Maltreatment Older Adult Violence/Abuse Sexual Abuse and Sexual Assault

Anorexic vs. bulimic

Anorectic- more denial- do not see a problem. The bulimic is aware of a problem and is upset about it.

Consequences of eating disorders

Anorexia can lead to osteoporosis in later as a result of amenorrhea. Mortality 5.9%-23.8% malnutrition and electrolyte disturbances. Bulimia-electrolyte imbalances such as hypokalemia leading to cardiac dysrhythmias and death. Can be fatal

Evaluation of anorexia

Anorexia nervosa is a chronic illness: relapse common Evaluation criteria Percentage of weight restored Extent to which self-worth no longer dependent on weight and shape Decreased disruption in patient's life

Disulfiram

Antabuse Taken daily after abstaining from alcohol for >12 hrs, preventing drinking because w/ alcohol makes a severe reaction. Avoid hidden sources of alcohol in: cough syrup, vanilla extract, aftershave, cologne, mouthwash, nail polish remover Lasts 5 days -2 weeks in the body after stopping Adverse Reactions: facial flushing, sweating, throbbing headache, tachycardia, neck pain, respiratory distress, n/v, and decreased BP

Meds for panic disorder

Antidepressants. It takes several weeks before they begin to work, so you have to take them continuously, not just during a panic attack. Benzodiazepines.These areanti-anxiety drugs that act very quickly (usually within 30 minutes to an hour). Taking them during a panic attack provides rapid relief of symptoms. However, benzodiazepines are highly addictive and have serious withdrawal symptoms, so they should be used with caution.

PTSD meds

Antidepressants: setraline/zoloft, paroxetine/paxil. SSRIs TCAs Benzodaizapines SNRI's MAOIs Beta blockers Tegretol

PTSD and acute stress disorder are classified in DSM as member of

Anxiety disorders, unlike other anxiety disorders, trauma disorders also frequently may involve Dissociative symptomology. In its mildest form, dissociation involves 'spacing out' so that events that are occurring appear to be unreal. In more severe forms of dissociation, memory for events may be misplaced (as in amnesia), or a person may be so unnerved by what they have experienced that they take on another persona

PTSD management for anxiety/panic attacks? Self-mutilation?

Anxiety/panic attacks:Daily relaxation techniques, training in assertiveness, problem solving, prioritizing, positive self-talk, etc Self-mutilation:Assist the patient to reframe negative self-appraisals. Use positive imagery

Physical abuse

Any non-accidental physical injury caused by the parent or caregiver. Include any physical injury as a result of punching, beating, kicking, stabbing, choking, shaking, throwing, hitting.

PTSD: anytime a trauma occurs? In severe trauma? Ordinary coping is>

Anytime a trauma occurs, the potential to develop PTSD exists In severe trauma, the patient confronts extreme helplessness and terror and the possibility of annihilation Ordinary coping are ineffective, and person can not resist or escape

Symptoms of anorexia nervosa

Appears emaciated (less than 85% of expected weight) Refuses to eat, Gross distortion of body image to the point of delusional. (denial) Preoccupation with food. Cook for others. Perceives themselves as being fat even though they are emaciated.

Risk for injury substance related interventions

Assess LOC, obtain drug history, urine sample, quiet environment, observe frequently, assist when ambulating/wheelchair for long distance, pad headboard/side rails, no smoking materials/harmful objects near, give meds

Nursing interventions for DTS

Assess V/S and level of consciousness Administer medications as ordered Ensure patient safety Monitor serum electrolytes Assess for suicidal thoughts or feelings Develop therapeutic nurse/client relationship Maintain optimal cardiac output Acknowledge delusions/hallucinations without agreeing to the content

Disturbed body image interventions

Assess client's perception, help to see body image distorted, encourage verbalization of fears/anxieties and discuss alternative coping, involve in activities that reinforce positive sense of self, make referrals to support like adult children of alcoholics, victims of incest, survivors of suicide and adults abused as children

Assessment guidlines for drugs

Assess for withdrawal syndrome Assess for overdose that warrants medical attention Assess for suicidal thoughts or other self-destructive behaviors Evaluate for physical complications related to drug abuse Explore interests in doing something about drug or alcohol problem Assess patient and family for knowledge of community resources

Deficient knowledge interventions

Assess level of knowledge and readiness to learn, include significant others in teaching, provide info about physical effects on body, teach about disulfiram

DSM panic attack

At least 4: palpitations/accelerated HR, sweating, trembling, SOB, choking, chest pain, nausea, dizzy/lightheaded, chills/heat, paresthesias, derealization or depersonalization, fever of loosing control/going crazy, fear of dying

Anxiety ranges

At the low end of the intensity range, anxiety is normal and adaptive whereas the high end of the intensity range, anxiety can become pathological and maladaptive. While everyone experiences anxiety, not everyone experiences the emotion of anxiety with the same intensity, frequency, or duration as someone who has an anxiety disorder.

Cluster B histrionic personality disorder

Attention grabbing, self-dramatizing expression of emotions Cannot make long lasting relationships Easily influenced by others Sexually provocative clothing/behaviors Excessive concern with appearance Extreme sensitivity to others approval False sense of intimacy with others Constant sudden emotional shifts Impressionistic speech lacking detail

Therapeutic interventions for PD

Authenticity - match words with actions & act on words expressed, recognize own feelings Trustworthiness - be predictable and constant, but not rigid & inflexible Setting limits - know when & how to say no dealing with manipulation - Confront client with manipulative behavior, setting clear and realistic limits on behavior Use established interventions for: Manipulative behaviors Impulsive behaviors Aggressive behaviors

Dedative/hypnotic/anxiolytic withdrawal s/s

Autonomic hyperactivity, sweating, pulse rate >100, increased hand tremors, insomnia, n/v, hallucinations, illusions, psychomotor agitation, anxiety, grand mal seizures

Communicating with anorexia

Avoid authoritarianism and assumptions of parental role Build therapeutic alliance Frequently acknowledge patient difficulty with goal of gaining weight Address underlying emotions of anxiety, depression, low self-esteem, and feelings of lack of control

Depressants

Barbiturates Benzodiazepines Chloral hydrate Glutethimide Meprobamate Alcohol

Sedative, hypnotic, anxiolytic compounds causing depression categories? Similar to?

Barbiturates, nonbarbiturate hypnotics, antianxiety. Similar s/s as alcohol except OD: anxiety, hallucinations, tremors

Hamilton anxiety rating scale

Based on anxiety, tensions, fears, insomnia,, intellect, depression, somatic, CV s/s, respiratory s/s, GI s/s, GU s/s, autonomic symptoms, behavior at interview. 25-30 sever, 18-24 moderate, 14-17 mild

Evaluation for PD

Based on assessment of behavioral, affective, cognitive and sociocultural manifestations, identify realistic, specific and measurable short-term goals for nursing interventions Be aware that realistic goals must reflect small steps to improving function and decreasing subjective distress; personality traits are too ingrained to expect immediate, radical, long-term change Evaluate the effectiveness of the nursing interventions in relationship to the stated outcomes.

Basic principles of intervention for PD

Basic principles of nursing intervention 1. Recognize that clients have the right to change or not to change; if patterns of behavior are connected to self image, clients may lack the motivation required to effect change 2. Help clients to see how behavior affects their lives to motivate them to develop a more adaptive lifestyle 3. Remember that personality trait are too ingrained to expect radical, long-term behavioral change; interventions should be based on short-term goals and focus on small steps designed to improve role functioning and decrease distress 4. Maintain hope for each client's improvement; all clients have the potential for change 5. Identify your own emotional responses when caring for client's with PD as power struggles between related to the best treatment approach create staff divisiveness and a chaotic rather than a structured milieu

Why can't addicts just quit

Because addiction changes brain circuits making it hard to "apply the brakes" to detrimental behaviors. In the non-addicted brain, control mechanisms constantly assess the value of stimuli and the appropriateness of the planned response. Inhibitory control is then applied as needed. In the addicted brain, this control circuit becomes impaired because of drug use and loses much of its inhibitory power over the circuits that drive responses to stimuli deemed salient.

Eating disorder treatment

Behavior modification best via contract with rewards for milestones and removal of privledges if not met(weight restoration only). Cognitive behavioral therapy for binging. Individual therapy for psych issues. Family therapy, meds via fluoxetine/prozac and clomipramine/anafranil for anorexia/OCD, periactin/cyproheptadine for appetite stimulant

Cluster A schizotypal personality disorder

Behavior or appearance is odd, eccentric, or peculiar Odd, elaborate style of dressing, speaking, interacting Magical thinking, ideas of reference, illusions, depersonalization, superstitious, clairvoyance belief, telepathy, 6th sens Under stress delusion, hallucinations for brief time Unusual perceptual experiences Lacks close friends, isolated, suspicious, paranoid Excessive and unrelieved social anxiety

Cluster A paranoid personality disorder

Believe others are lying, cheating, or exploiting them, mistrust Perceive hidden malicious meaning in benign comments Inability to work collaboratively with others Emotionally detached Hostile to others Believe they arent as successful because they are treated unfairly Doesn't occur exclusively during schizo, bipolar, or other psychotic disorder and not from meds

Panic disorder and generalized anxiety disorder drugs

Benzo S, buspirone/buspar, tricyclics, SSRIs, SNRIs, propranolol, clonidine

Drugs used for alcohol withdrawal delirium

Benzo's: Chlordiazepoxide (Librium) Diazepam (Valium) clorazepate (Tranxene) Anticonvulsive: Phenobarbital Vitamins: Thiamine (B1) Folic Acid Multi-vitamins Benzodiazepines- Librium, Valium, Serax or Ativan Beta-adrenergic blockers -Inderal or Atenolol Alpha-adrenergic blockers- Clonidine Antiepileptics-Tegretol

Sedative hypnotic intoxication

Benzodiazepines) Slurred speech, incoordination, unsteady gait, nystagmus, impaired attention, and memory, stupor, coma

Alcohol substitution therapy

Benzodiazepines: Chlordiazepoxide/Librium, oxazepam/Serax, lorazepam/ativan, diazepam/valium. Starts high and reduces each day. If liver issue chlordiazepoxide/diazepam not used and instead lorazepam/oxazepam. Possible anticonvulsant like carbamazepine, valproic acid, gabapentin. Multivitamins including thiamine to prevent neuropathy, confusion, encephalopathy

Addiction involves

Biology/genes, environment, brain

What is addiction

Brain disease characterized by Compulsive Behavior Continued abuse of drugs despite negative consequences Persistent changes in the brain's structure and function

Recognizing bulimia: bulimia rarely?

Bulimia rarely shows up in the doctor's office or in lab tests for blood and urine.

A nonbenzodiazepine anxiolytic that doesn't cause dependence but must be taken for 2 to 6 weeks for full effects to become apparent is

Buspirone/buspar

Drug screening

Cage, 25 question michigan alcoholism screening test MAST, 10 question alcohol use disorders identification test AUDIT

Phase 3

Calm, loving, respite/honeymoon phase. Batterer becomes loving, kind, asks for foregiveness

Acamprosate

Campral This is used by people who have quit drinking and wish to remain abstinent. It probably works to reduce intake of alcohol by suppressing excitatory neurotransmission and enhancing inhibitory transmission

Fear

Can easily state feared object

Evaluation for anxiety/panic disorders

Can the client recognize signs and symptoms of escalating anxiety, and interrupt before it reaches panic level? Can the client discuss the phobic object or situation without becoming anxious? Can the OCD client refrain from performing rituals when anxiety level rises, and demonstrate substitute behaviors to maintain anxiety at a manageable level? Can the PTSD client discuss the traumatic event without experiencing panic anxiety?

Clonidine

Catapres) This drug is a nonopioid suppressor of opioid withdrawal symptoms and when combined with naltrexone is an effective nonaddicting treatment for opioid addiction.

Symptoms of PTSD

Category 1: Re-experiencing symptoms Category 2: Avoidance symptoms Category 3: Hyperarousal symptoms

Stress

Caused by existing stressor. Sleeplessness, poor concentration, worry, feeling pressured

Bulimia behaviors

Certain behaviors, such as dieting or over exercising, can contribute to the development of bulimia. For example, dieting is a primary factor in triggering binge eating. In addition, dieting helps encourage rigid rules about food, which when broken can lead to loss of control and overeating.

Sex dysfunction alcohol

Changes in period, loss/decreased ability to become pregnant, decreased libido/sex performance/impaired fertility

After abstinence

Changes in the # and functioning of dopamine receptors and transporters in the brain persist for many months after abstinence

Physical abuse of kids s/s

Child is frightened of adults/parents Conflicting or unconvincing explanation for injuries Unexplained injury, cries when time to go home. Parent gives conflicting info for injury, describes child as evil/negative way, uses harsh physical discipline, history of abuse as child

Who suffers from bulimia

Children Adolescents Young Adults

Nonbarbiturate hypnotics generic/trade names, common street names

Chloral hydrate, estazolam, flurazepam, temazepam/restoril, triazolam/halcion, quazepam/doral, eszoplicone/lunesta, ramelteon/rozerem, zaleplon/sonata, zolpidem/ambien. Peter, mickey, sleepers

Which med is most likely to order for a client experiencing alcohol withdrawal syndrome

Chlordiazepoxide/Librium

Cluster B antisocial personality disorder

Chronic irresponsibility and unreliability Lack of regard for law and rights of others for personal gain Persistent lying and stealing for personal gain Conning others for personal gain Lack of remorse for hurting others Reckless disregard for others' safety/aggressive/fights Easily bored, take chances No relationships

Phase 4

Chronic phase. Emotional/physical disintegration. Intoxicated more than sober. Helplessness, self-pity, psychosis. Withdrawal symptons

Isolation

Client removes themselves from the company of friends and family to maintain their habit. "I am busy so I can not go with you tonight"

Patient teaching for anxiety

Clinical symptoms I may experience include: The reasons I may experience anxiety include: Interventions I have learned to reduce anxiety: Support persons I may contact: The name of the medication I am taking is: Instructions regarding medication

DSM 5 for sedative hypnotic or anxiolytic intoxication

Clinically significant maladaptive behavioral or psychological changes that develop during or after use like inappropriate sex/aggressive behavior, mood liability, impaired judgement, impaired social/occupational function, slurred speech, incoordination, unsteady gait, nystagmus, impaired memory

Understanding DSM IV clusters of personality disorders

Cluster A: odd or eccentric behaviors Related to schizophrenia Cluster B: dramatic, emotional, or erratic behaviors Manipulation is common defense mechanism Tendency to blame others for one's problems Cluster C: anxious or fearful behaviors Related to Axis I anxiety disorders Internalize blame for problems in life

Treatment for anorexia: psychotherapy

Cognitive-behavioral Diminish errors in patient thinking/perceiving related to eating disordered behaviors Psychodynamic Address underpinnings of disorder Group Provide support Family Does family dysfunction contribute to problem?

Treating OCD

Cognitive-behavioral therapy Antidepressants Family Therapy Group Therapy Consultation with a psychiatrist and a psychologist or social worker with expertise in CBT are recommended first steps

Cocaine street names

Coke, blow, toot, snow, lady, flake, crack

Diagnosis/outcomes for PD

Common nursing diagnosis Ineffective coping Risk for other-directed violence Risk for suicide Risk for self-mutilation Outcomes Identification Recognize that change may be slow, occur with trial and error Establish modest, obtainable goals

Rape trauma syndrome interventions

Communicate they are safe, you are sorry, you are glad they survived, it's not their fault, they did the best they could, explain assessment procedure, ensure adequate privacy, as few people as possible providing care/evidence, encourage to give account of assault with nonjudgmental listening, discuss who to call for support/assistance

Community risk factors for kid violence

Community violence

Personality disorder comorbidity: often? Axis 1?

Comorbidity Often more than one personality disorder diagnosed Axis I disorders common: substance abuse, somatization, eating disorders, PTSD, depression, and anxiety disorders

Early warning signs of anorexia

Complains of feeling fat when weight is normal Preoccupation with food and weight Excessive exercising Social withdrawal Extreme concern of appearance Inability to concentrate Unusual concern for school or work performance Over-sensitivity to criticism

Risk for delayed development interventions

Complete physical assessment, note of injuries, assess for nonverbal signs of abuse, in depth interview with parent, use games/play therapy to gain child's trust and assist in describing story, determine if it should be reported

Addiction

Compulsive/chronic need so strong as to generate physical/psychological distress if left unfulfilled

Korsakoff's psychosis

Confusion, loss of memory, confabulation in alcoholics seen usually wth wernicke's encephalopathy. Treatment: parental/oral thiamine replacement

Common obsessions/compulsions

Contamination Violent Images Fear of harming others/self Perverse/forbidden sexual thoughts Symmetry/Exactness Somatic Religious Checking Cleaning/washing Counting Hoarding/Collecting Ordering/Arranging Repeating

How we protect from anxiety

Coping mechanisms and Defense Mechanisms Coping mechanisms are conscious Coping mechanisms may be either effective or ineffective

Stage 3

Core issues stage: recovering codependent must face fact relationships cannot be managed by force of will and each should be independent and detach from struggles of life that exist

Stimulants

Crack, cocaine Amphetamines Dextroamphetamine Methamphetamine

Kid violence treatment modalities

Crisis Intervention Provide a safe & secure environment Address immediate health care needs Make referral as indicated to child protective services Family Therapy Individual Therapy Case Management

Phase 3

Crucial phase. Lost control, phsyiological addiction. Inability to not stop. Sickness, LOC, extremely ill. Anger aggression. Drinking total focus causing loss of job, marriage, family, friends, self-respect

Acquaintance rape

Date Rape)-Applied to the situation in which the rapist is acquainted in some way with the victim.

Biologic interventions of panic/anxiety disorders

Decreased intake of stimulants Exercise Nutrition Relaxation Techniques Medication use and misuse

Barbiturate effects on sleep

Decreases dreaming, and when withdrawn dreaming vivid w/ rebound insomnia

Codependency

Defined as an emotional, psychological, and behavioral condition that develops as a result of an individual's prolonged exposure to, and practice of, a set of oppressive rules—rules that prevent the open expression of feelings and the direct discussion of personal and interpersonal problems. Derives self-worth from others Feels responsible for the happiness of others Denial that problems exist is common Codependence is a cluster of behaviors that prevents one individual from taking care of his or her own needs because of preoccupation with another who is addicted to a substance.

Bulimia s/s

Dehydration from the vomiting Electrolyte imbalance Erosion of tooth enamel from gastric acid Tears in the esophagus or gastric mucosa. Salivary gland enlargement May also have depression (71%) anxiety disorders, substance abuse, suicide abuse of laxatives, diuretics, enemas, and/or diet pills, compulsive and excessive exercising Feeling that you can't control your eating behavior Eating until the point of discomfort or pain Eating much more food in a binge episode than in a normal meal or snack Forcing yourself to vomit after eating Being preoccupied with your body shape and weight Having a distorted, excessively negative body image Going to the bathroom after eating or during meals Abnormal bowel functioning Damaged teeth and gums Sores in the throat and mouth Irregular heartbeat Sores, scars or calluses on the knuckles or hands Menstrual irregularities or loss of menstruation (amenorrhea) Depression and Anxiety

Barbiturates and respiratory

Depression

Assessment guidelines for anorexia

Determine if medical/psychiatric condition warrants hospitalization (appropriate testing important) Severe hypothermia, bradycardia, hypotension, hypokalemia, cardiac abnormalities Weight loss more than 30% over 6 months Suicidal or self-mutilating behaviors Severe depression or psychosis Out of control use of laxatives, diuretics, street drugs

Process of withdrawal treatment

Detoxification with safe/supportive environment and substitution therapy, intermediate care with education/understanding, rehab with outpatient/alternative sources of satisfaction

Interventions for IPV

Develop a safety plan for a fast escape when violence occurs Identify signs of escalation of violence and designate this as the time to leave Include in escape plan a destination and a way to get there Have the hotline referral telephone number of a shelter or safe house and a contact person Provide a listing of community resources so the victim can access

Screening for abuse

Develop trust and rapport with the patient Be understanding and attentive Interview the patient in private Create a nonjudgmental and non-threatening environment Avoid using words such as abuse or violence Use open-ended questions Reassure patient that they did nothing wrong Areas to include in an abuse assessment-violence indicators; level of anxiety and coping responses; family coping patterns; support systems; suicide potential; homicide potential and drug and alcohol use.

Ineffective denial interventions for substance abuse

Develop trusting client relationship, be honest, keep promises, attitude of acceptance(it's not you but behavior is unacceptable), give info to correct misconceptions via facts, identify maladaptive behaviors/situations and show how drug contributed, use confrontation with caring via not allowing to fantasize, don't accept rationalization/projection, encourage group activities, offer positive recognition

Therapeutic communication

Develop trusting r/t with the client Use culturally appropriate techniques to communicate with the client. Encourage client to share painful feelings Validating and empathizing Reflecting and empathizing. Encourage the expression of feelings while feelings are close to the surface. Beginning to explore the drug dependence in a gentle, nonthreatening manner.

Amphetamine generic/trade name and common street names

Dextroamphetamine/dexedrine, methamphetamine/desoxyn, methylenedioxyamphetamine MDMA, amphetamine+dextroamphetamine/Adderall. Denies, uppers, truck drivers, meth, speed, crystal, ice, adam, ecstasy, EVE, XTC, beanies, pep pills, speed, uppers

Imbalanced nutrition

Dietitcian consult, i/o, daily weight, monitor protein intake, restrict sodium intake for fluid retention, small frequent feedings of noniritant foods

Cluster B borderline personality disorder BPD

Difficulty controlling emotions Stormy relationships with anger and fighting Persistent unstable self-image Use of splitting (idealizing and devaluing same person) Frantic efforts to avoid real/perceived abandonment Dramatic mood shifts, changes in opinions and plans Affective instability Impulsive, self-damaging behaviors Recurrent suicide attempts or self-mutilation Depression, inability to be alone, clinging/distancing, manipulating, self destructive, impulsive

Indicators of child sex abuse

Difficulty walking/sitting, suddenly refuses too change in gym/physical activities, reports nightmares/bedwetting, change in appetite, unusually sex knowledge/behavior, runs away

Sex abuse

Divided into three categories: 1) use of physical force to compel a person to engage in a sexual act against his or her will, whether or not the act is completed; 2) attempted or completed sex act involving a person who is unable to understand the nature or condition of the act, to decline participation, or to communicate unwillingness to engage in the sexual act, e.g., because of illness, disability, or the influence of alcohol or other drugs, or because of intimidation or pressure; and 3) abusive sexual contact.

Inhalant intoxication s/s

Dizziness, ataxia, euphoria, nystagmus, blurred vision, slurred speech, hypoactive reflexes, lethargy, pyshomotor retardation, muscle weakness, coma

Panic

Dizzy, heart palpitations, trembling, faint feeling, breathing difficulty

Violence assessment guidelines

Do you have a history of violence? Clients who are delusional, hyperactive, impulsive, or predisposed to irritability Is the client at risk for harm? Does the client have an intent to harm? Does the client have a plan in place to harm? Assess for personal triggers and personal sense of competence in situations related to conflict Is there demographic risk factors Male 14-24 years Low SES Inadequate support system Previously incarcerated Limited coping skills

Methadone

Dolophine) This drug is a synthetic opiate. In a sufficient dosage taken daily, it blocks craving for and effects of heroin. Methadone maintenance helps keep the patient out of the illegal drug culture while counseling is undertaken. Methadone is highly addicting and, when stopped, produces withdrawal. Because it is an oral drug, it reduces risk of HIV infection from needles. rigorously well-tested medication that is safe and efficacious for the treatment of narcotic withdrawal and dependence. For more than 30 years this synthetic narcotic has been used to treat opioid addiction. Heroin releases an excess of dopamine in the body and causes users to need an opiate continuously occupying the opioid receptor in the brain. Methadone occupies this receptor and is the stabilizing factor that permits addicts on methadone to change their behavior and to discontinue heroin use.

Incidence of intimate parter violence

Domestic violence leading cause of injury to women in this country.

Comorbidity

Drug users have higher risk of developing mental disorders like psychosis, depression, anxiety, panic attacks

Uncued panic attack

During a false alarm, our bodies kick into the flight-or-fight mode. This prepares us for action, just as it would during a true alarm. However, unlike the circumstances that trigger a true alarm, there is nothing in the immediate environment that represents an actual threat. In other words, there is no clear and present danger. So, the "DANGER-DANGER" alarm is going off but for no apparent reason. When this alarm is triggered, without an immediate threat or environmental "cue, Because there is no discernable reason for the panic attack, people often describe these panic attacks as "coming out of the blue."

Amphetamine withdrawal

Dysphonic mood, depression, fatigue, vivid nightmares, abnormal sleep pattern, increased appetite, suicide risk, confusion. Treatment similar as for cocaine but no known substances to reduce cravings. 2-4 days after to peak but depression/irritability for motnhs

Cocaine withdrawal

Dysphonic mood, fatigue, vivid nightmares, abnormal sleep pattern, increased appetite, potential for suicide

Opiate withdrawal

Dysphoria, sweating, n/v, muscle /bone pain, runny nose, teary eyes, diarrhea, yawning, insomnia Every orifice in the body oozes; bone pain

Opioid withdrawal

Dysphoric mood, n/v, muscle aches, lacrimation/rhinorrhea, pupillary dilation, piloerection, sweating, dirrahea, yawning, fever, insomnia. Short acting like heroin 6-8 hours after, peaks 1-3 days, subsides 5-10 days Longer acting like methadone 1-3 days after, peak 4-6 days and complete in 14-21 days Ultra-short acting meperidine 8-12 hours, complete in 4-5 days

Nicotine withdrawal

Dysphoric/depressed, insomnia, irritability, frustration, anger, anxiety, restlessness, decreased HR, increased appetite, weight gain

Phase 2

Early alcoholic phase. Blackouts and required. Sneaking drinks, secret drinking, preoccupation with drinking and maintaining supply. Feels guilt, defensive, denial, rationalization

Secondary prevent

Early intervention in abusive situation to minimize their disabling or long term effect by Nurses establishing screening programs for individuals at risk for abuse Coordinating community resources to provide continuity of care Providing access to supportive psychotherapy and to support groups

Principles that apply to all CNS depressants

Effects are additive with one another, are capable to make physiological addiction, are capable of making psychological addiction, cross tolerance/dependence can exist between various depressants

Education of substance use

Effects of drug on body/life, management via substitution activities, relaxation techniques, problem solving skills, good nutrition, support services

Sex abuse minors

Employment, use, persuasion, inducement, enticement, or coercion of any child to engage in, or assist any other person to engage in, any sexually explicit conduct or any stimulation of such conduct for the purpose of producing any visual depiction of such conduct; or rape, and in cases of a caretaker or interfamilial relationship, statutory rape; molestation, prostitution, or other forms of sexual exploitation of children, or incest with children(Townsend, 2009).

Impaired social interaction borderline interventions

Encourage to examin behaviors/feelings, help realize you will be available, rotate staff to avoid developing dependence, recognize when splitting staff against each other and suggest client discuss directly with the staff member,

Powerlessness interventions

Ensure all physical wounds have immediate attention, take photos if patient permits, take to private area to interview, assure of safety, encourage to discuss battering incident, ask if has happened before/whether abuser takes drugs/whether abused has safe place to go/whether interested in pressing charges, ensure rescue not attempted by rn but offer support, stress importance of safety and make aware of resources

Gastritis alcohol

Epigastric distress, n/v, distention, possible hemorrhage

Bulimia

Episodic, uncontrolled rapid ingestion of food over a short period of time followed by purging. Compensatory measure to rid the body of the excessive calories. The food has a sweet taste, high calorie count. The binging is done in secret and alone. induced purging Use of laxatives, diuretics, or enemas Weight fluctuations- but patient is usual of normal weight.

Nursing interventions basic level

Establish a therapeutic relationship primary nursing focus Give explanations of what is expected and be consistent Provide safety and Security high anxiety & crisis often occur may need close observation and suicide precautions monitor and assist with sleep

Effects of opioids on body

Euphoria followed by dysphoric, apathy, impaired judgement, mood changes, mental cloudiness, sedation, drowsiness, pupil constriction unless severe OD then anoxia/dilation, respiratory depression, constipation, possible hypotension, decreased sex function, can be used to relieve pulmonary edema/pain from MI

Amphetamine intoxication

Euphoria, confusion, paranoia, compulsive behavior, dilated pupils, sweating and chills, n/v, agitation, chest pain, seizure, abnormal movement, coma longer s/s than cocaine. Route: oral, IV, nasally, smoked. No vasoconstrictive effect

Cocaine intoxication

Euphoria, paranoia, agitation, dilated pupils, chest pain, confusion, seizure, coma

Restraint care

Evaluation by physician within 1 hour of putting restraints on, new order q 4 hours, observed q 15 minutes, remove one at a time

Evaluating for bulimia

Evaluation process is ongoing Short-term and intermediate goals revised as necessary Specific outcomes identified reviewed for level of achievement

Psychotherapy of addiction

Evidence-based practice indicates that cognitive-behavioral therapy, psychodynamic and interpersonal therapies, group and family therapies, and participation in self-help groups are all effective treatment modalities. Critical issues that arise within the first 6 months of therapy include physical changes as the body adapts to functioning without the substance, needing to learn new responses to former cues to drink or use drugs, experiencing full-strength emotions instead of drug-mediated emotions, need to address family and co-worker responses to a patient's new behavior, and need to develop coping skills to prevent relapse and ensure prolonged sobriety

Social anxiety disorder

Excess fear of situation where a person might do something embarrassing or by viewed negatively by others like fear of speaking/eating in public/using public restroom causing panic anxiety, sweating, tachycardia, dyspnea

Cluster C dependent personality disorder

Excess need to be taken care of/excess of relying on others for emotional support Difficulty with decision making Others assume responsibility for person's life Fear of disagreeing with others and being unable to care for self Preoccupied with fear of being left alone, urgently seeks another relationship when one end

Symptoms of GAD

Excessive, ongoing worry and tension Unrealistic view of problems Restlessness or a feeling of being "edgy" Irritability Muscle tension Headaches Sweating Difficulty concentrating Nausea The need to go to the bathroom frequently Tiredness Trouble falling or staying asleep Trembling Being easily startled

S/s of child emotional abuse

Extremes in behavior, inappropriately adult/infantile, delayed physical/emotional development, attempted suicide, reports a lack of attachment to parent.

Tertiary prevention

Facilitation of the healing and rehabilitative processes through Counseling Providing support groups for survivors Legal advocacy programs Stress reduction programs Individual and Family Therapy Helping survivors achieve their optimal level of safety, health, and well being

Violence historical perspectives and prevalence

Family violence is not a new problem, it is probably as old as humankind. In 1968 Child abuse became a mandated reportable occurrence. In 1987 Congress passed amendments to the Older American's Act of 1965 to assess the need for elder abuse prevention. Elder abuse in now a mandated reportable occurrence.

Stages of cirrhosis in alcoholism

Fatty liver causing enlargement that can reverse from stopping, liver bibrosis recovery possible but scar tissue remains, cirrhosis from connective tissue that destroys liver and irreversible

Why victim will stay in relationship

Fear for their life Fear for the lives of their children Fear of losing custody of children Financial reasons Fear of retaliation Lack of a support network Religious reasons Hopefulness

Social phobias

Fear in response to one or more social of performance situations where person is exposed to unfamiliar persons or possible scrutiny Fear of acting in an embarrassing or humiliating way or showing symptoms of anxiety

Specific phobias

Fear in response to presence or anticipation of specific object or event Heights Acrophobia Open spaces/source of security Agoraphobia Closed spaces Claustrophobia Animals Zoophobia Germs Microphobia Strangers Xenophobia Spiders Arachnophobia

Anxiety vs. fear

Fear is generally considered a primary emotion. In contrast, anxiety is considered a secondary emotion that represents the avoidance of fear (including the avoidance of fear-producing stimuli. Fear is the response to a danger that is currently detected in the immediate, present moment of time. In contrast, anxiety refers to the anticipation of some potential threat that may, or may not, happen in the future. In other words, fear is a response to an immediate danger in the present moment of time, while anxiety is associated with a threat that is anticipated in a future moment of time

DSM for social anxiety disorder

Fear/anxiety about 1 or + social situations with possible scrutiny by others for 6+months

DSM for agoraphobia

Fear/anxiety about 2 or+: using public transportation, being in open spaces, being in enclosed spaces, standing in line, being in cloud, being outside home alone. Lasting 6+months

Controlled response rape pattern

Feelings masked/hidden

Ineffective coping examples

Fighting Withdrawing Using substances that have the potential for addiction Excessive use of defense mechanisms

3 classes of symptoms for PTSD

First, the post-trauma victim typically experiences intrusive memories of the traumatic event. Intrusive recollections may occur during waking hours or sleep (in the form of repetitive vivid recreation nightmares involving the trauma). Second, the post-trauma victim makes efforts to avoid exposure to anything that might cause them to recall the trauma they experienced. Third, the post-trauma victim typically shows an exaggerated startle response and heightened anxiety levels

Club drug generic/trade names, street names

Flunitrazepam/rohypnol, gamma hydroxybutyric acid GHB. Date rape, R-2, rope, liquid X, grevious bodily harm, easy lay

Bulimia med

Fluoxetine aka SSRI, imipramine/tofranil, norpramine, Nardil, Elavil, aventyl. Anticonvulsant:topiramate/topamax

Meds for weight gain

Fluoxetine/prozac, clompiramine/anafranil(also for OCD/depression), cyproheptadine/periactin and chlorpromazine/thorazine

Natural rewards that increase dopamine

Food, water, sex, nurturing

CAGE questionnaire

For Screening for issue, not diagnostic. 4 yes/no questions. 2-3 yes suggest problem with alcohol. Have you felt you should cut down on drinking, have people annoyed you by criticizing drinking, have you felt guilty about drinking, have you ever had a drink first thing in morning to steady nerves/hangover

MICHICAN ALCOHOlism screening test MAST

For diagnosis of alcoholism. 25 yes/no questions. 0-3 points no issue, 4 points possible issue, 5+ problem with alcohol

Indicators of child neglect

Frequently absent from school Begs or steals money or food Lacks medical or dental care Consistently dirty and has severe body odor Lacks sufficient clothing for the weather Abuses alcohol or other drugs Seems apathetic or depressed Behavior change Indifferent to other children

Alcohol esophagitis

From frequent vomiting

Neurochemically anxiety disorders

GABA is the amino acid neurotransmitter which is believed to be dysfunctional in anxiety disorders. GABA is the body's natural antianxiety agent which reduces excitability and decreases neuronal firing. On the other hand, Norephinephrine does the complete opposite. According to Research an excess of norepinephrine is suspected in OCD, PTSD, and GAD which makes sense because we know norepinephrine to cause excitability.

Types of anxiety disorders

Generalized Anxiety Disorder (GAD) Obsessive Compulsive Disorder (OCD) Panic Disorder Post Traumatic Stress Disorder (PTSD) Social Phobia

Anxiety disorders to nothing identifiable

Generalized anxiety persistent/chronic, panic attacks/disorder transient and intense

Causes of generalized anxiety/panic disorders

Genetics Brain Chemistry - associated with an abnormal level of certain neurotransmitters in the brain. Environmental - trauma, stressful events, abuse, death, major life changes, substance abuse withdrawal

Predisposing factors to substance related disorders

Genetics, biochemical ie acetaldehyde, developmental influences, personality factors like low self esteem/depression/antisocial, social learning, conditioning, cultural/ethnic influences

Anxiety disorders causative theories

Genetics, learned response to stress, neurochemical issues

Rationalization

Giving explanations to hide problem

Cluster B narcissistic personality disorder

Grandiosity, Inflated sense of self-importance Constant attention-grabbing behavior Manipulation of others No regard for feelings of others Arrogant manner toward others Unreasonable expectation for special treatment Often envious of others with belief that others are envious of him/her

Trichotillomania

Hair pulling disorder

Hallucinogen intoxication

Hallucinations, depression, delusions, fear of losing one's mind, dilated pupils, blurred vision, increased pulse/BP/temp

Indicators of sex abuse

Has difficulty walking or sitting Reports nightmares or bedwetting Shrinks away or seems threatened by physical contact Behavior change such as suddenly refusing to change for gym class or participate in physical activities Sudden change in appetite Frequent urinary or yeast infections Reports sexual abuse by a parent or another adult Demonstrates unusual or sophisticated sexual knowledge Overly protective or concerned for siblings

Disturbed body image/low self esteem interventions

Help develop realistic perceptions of body and relationship w/ food via comparing measurements with perceived calculations, promote feelings of control through independent decision making and positive feedback, help realize perfection unrealistic

Opioid derivatives generic/trade name and street names

Heroin, hydromorphone/dilaudid, oxycodone/percodan/OxyContin, hydrocodone/vicodin. H, horse, junk, brown sugar, smack, slag, TNT, harry, 4s, lords, little D, Perkins, oxy, OC, vike

Substance abuse nurse s/s

High absenteeism, rarely will miss work, increased wasting of drugs, incorrect narcotic counts, higher record than others for signing out drugs, poor concentration, difficulty meeting deadlines, inappropriate responses, poor memory, mood swings, unkempt appearance, frequent restroom use, patient complaints of inadequate pain control

Stress/anxiety sufferers have what than general population

Higher rate of ailments like acid reflux, allergies, backache, asthma, fatigue, migraines

Assessment of aggression and violence

History of aggression or violence-single best predictor of future violence Hyperactivity - most important predictor of imminent violence(pacing or restlessness) Irritability Speech pattern changes-excessively loud or barely audible Verbal abuse, profanity, argumentative Intense eye contact or avoidance Recent acts of violence Possession of a weapon

Planning/implementing for anorexia

Hospitalization may be necessary for short time (either medical or psychiatric) Long-term treatment with individual, group and family therapy Focus interventions on establishing trust and monitoring eating patterns Weight restoration and monitoring create opportunities to counter disturbed thought processes (cognitive distortions)

Cluster C avoidant personality disorder

Hypersensitive to criticism/rejection Self-imposed social isolation because they gave fear of rejection/criticism Preoccupied with being criticized/rejected Strongly wants relationship but shies away Avoids occupation involving interpersonal contact Views self as socially inept, inferior

Sedative/hypnotic/anxiolytics CV effects

Hypotension , decreased CO

Measures taken to prevent elder abuse

Identify individuals and families at high risk(e.g., caretaker with history of mental illness, substance abuse) Provide health education Coordinate support services to prevent crisis

Dual diagnosis

If patient has coexisting substance disorder and mental illness. Treatment: peer support groups psychodynamic therapy, cognitive/hebahvioral therapy, 12 step, individual case management

Rn diagnoses for anorexia

Imbalanced nutrition: less than body requirements Disturbed body image Chronic low self-esteem Hopelessness/Powerlessness

Rn diagnoses for drugs

Imbalanced nutrition: less than body requirements Disturbed thought processes Disturbed sleep patterns Ineffective health maintenance Hopelessness Risk for suicide Risk for other-directed violence Ineffective airway clearance Ineffective breathing pattern

Diagnosis/outcomes for bulimia

Imbalanced nutrition: less than body requirements. Disturbed body image. Chronic low self-esteem. Social isolation Ineffective health maintenance. Decreased cardiac output Powerlessness

Cannabis intoxication

Impaired coordination, euphoria, anxiety, sensation of slowed time, impaired judgment, increased appetite, tachycardia, hypotension, decreased sperm

Alcohol thrombocytopenia

Impaired platelet production increasing hemorrhage risk

Goals of therapy for violence

Impulse and aggression control Abusive behavior self-restraint Successful coping

Compulsions define

In response to their obsessions, most people with OCD resort to repetitive behaviors called compulsions. The most common of these are washing and checking (e.g., making sure the gas from the oven has been turned off). Other compulsive behaviors include counting (often while performing another compulsive action such as hand washing), repeating, hoarding, and endlessly rearranging objects in an effort to keep them in precise alignment with each other. Cognitive problems, such as mentally repeating phrases, list making, or checking, are also common. These behaviors generally are intended to ward off harm to the person with OCD or others. Some people with OCD have regimented rituals while others have rituals that are complex and changing. Performing rituals may give the person with OCD some relief from anxiety, but it is only temporary.

Upon reading the child's report card, the caregiver/parent slaps the child across the face, withholds food, and berates the child's ability until "better marks" are made.

In this example physical abuse occurred as a result of the caregiver slapping the child's face. Failure to provide occurred as a result of the caregiver withholding food. Psychological abuse occurred as a result of the caregiver berating the child

Paramedics find a two and a half year old. The child was undressed with only underwear on walking outside in the winter. The paramedics noted belt-patterned bruises on the child's legs and trunk. The child also had ethyl alcohol in his blood system.

In this instance there is physical abuse as noted by belt marks and ethyl alcohol There is failure to provide as noted by inadequate clothing. There is failure to protect as noted by the young child being unaccompanied.

Risk factors for IPV

Individual Factors Relationship Factors Community Factors Societal Factors

Alcoholic hepatitis

Inflammation of liver. S/s: enlarged/tender liver, n/v, lethargy, anorexia, elevated WBC, fever, jaundice, ascites, weight loss, possible cirrhosis, hepatic encephalopathy.

General characteristics of personality disorder

Inflexible, maladaptive responses to stress Disability in working and loving Avoidance and fear of rejection Blurred boundaries between self and other Insensitivity to needs of others Demanding and fault finding Lack of accountability Evoke intense interpersonal conflict

Risk for suicide interventions

Inquire about suicidal thoughts/plan, make environment safe, short written/verbal contract, close observation, frequent irregular rounds, encourage open/honest feelings

Elder abuse assessment

Interview the older adult person in private Build rapport and trust Ask open-ended questions Use language the older adult person understands Document findings Take photographs if necessary of the abuse Inform the person if you must make a referral to Adult Protection Services Report to authorities any findings documented Maintain accurate records which could be used in any legal proceedings

CNS stimulant withdrawal therapy

Intoxication: tranquilizers like chlordiazepoxide or haloperidol/haldol Not medical emergency like depressants. Quiet atmosphere with rest/food, suicide precautions, possible antidepressants, desipramine for cocaine withdrawal/abstinence

Opioid substitution therapy

Intoxication:Naloxone/narcan, naltrexone/Revia, nalmefene/revex Withdrawal: methadone then after tapered off clonidine/catapres Possible buprenorphine instead of methadone since safer

Psychological/emotional abuse

Involves trauma to the victim caused by acts, threats of acts, or coercive tactics. Psychological/ emotional abuse can include, but is not limited to humiliating the victim, controlling what the victim can and cannot do withholding information from the victim, deliberately doing something to make the victim feel diminished or embarrassed, isolating the victim from friends and family, and denying the victim access to money or other basic resources.

Psychological factors of eating disorders

Issues of coping, self esteem, and perfectionism. The primary problem is not with food, but with issues of control, self esteem, depression, difficulty with intimate relationships, and developmental expectations Food is merely an expression of the problems. Appetite comes to be driven by external or psychological causes. Food or the refusal there of becomes a vehicle for dealing with anger, hurt and fear. Failure to nurture self.

Addiction is similar to other chronic illnesses because

It has biological and behavioral components, both of which must be addressed during treatment. Recovery from it--protracted abstinence and restored functioning--is often a long-term process requiring repeated episodes of treatment. Relapses can occur during or after treatment, and signal a need for treatment adjustment or reinstatement. Participation in support programs during and following treatment can be helpful in sustaining long-term recovery

Munchausen by proxy

It is the act of one person fabricating or inducing an illness in another to meet his/her own emotional needs through the treatment process. The illness can be physical or mental. Usually with children under 6 years old. Most commonly exhibited in mothers but fathers may exhibit it too.

If you think there is a substance abused nurse

Keep objective records, confrontation should occur in presence of supervisor/other nurse and include offer of assistance in treatment, report to state board

Hallucinogens

LSD Mescaline Psilocybin Phencyclidine piperidine (PCP) Marijuana (Cannabis sativa): active ingredient is THC has mixed depressant and hallucinogen properties.

An indecisive client cannot decide what to wear, a reasonable intervention is

Limit choices to 2 outfits

Interventions for aggression

Listen and be attentive to patient's expressed concerns Provide reassurance De-escalation of the anger Nurse should model being calm, controlled, open, and non-threatening Respect the patient's physical space (Be more than arms length away) Encourage patient to go to a quiet room with music Seclusion (where staff can observe) Restraint Pharmacological intervention Staff debriefing Observation Verbalize to client the limits of his/her behavior and inform of expected behavior Documentation Assist client to express anger and aggression in appropriate ways(remember to always use the least restrictive measures first to control patient aggression)

Risk factors for PTSD

Living through dangerous events and traumas Having a history of mental illness Getting hurt Seeing people hurt or killed Feeling horror, helplessness or extreme fear Having little or no social support after a traumatic event Dealing with extra stress after the event, such as loss of a loved one, pain and injury or loss of a home or job

CNS depressant particularly barbiturates withdrawal therapy

Long acting barbiturate phenobarbital/Luminal dosage then gradually decreased

Factors that contribute to elder abuse

Longer Life Dependency Stress Learned Violence

Acute management of violent behaviors

Lorazepam (Ativan) Alprazolam (Xanax) Diazepam (Valium) Haloperidol (Haldol) Chlorpromazine (Thorazine) Risperidone (Risperidol) Olanzapine (Zyprexa) Ziprasidone (Geodon)

Alcohol leukopenia

Low number/function of WBCs increasing risk for disease

Psychological characteristics of anorexia

Low self esteem Suppression of feelings especially anger (good girl syndrome), Perfectionism Rigid lacking in spontaneity Obsessed with body size and food Sexual and relationship problems Identity crises Feeling a lack of autonomy Black or white thinking Depression Worry about growing up Fear of taking risks Difficulty being honest Strong need to please others Compliant Anger used to push others away A need for control Struggle with conflict

Individual factors for IPV

Low self-esteem Low income Low academic achievement Young age Aggressive or delinquent behavior as a youth Heavy alcohol and drug use Depression Anger and hostility Antisocial personality traits Borderline personality traits Prior history of being physically abusive Having few friends and being isolated from other people Unemployment Emotional dependence and insecurity Belief in strict gender roles Desire for power and control in relationships Perpetrating psychological aggression Being a victim of physical or psychological abuse History of experiencing poor parenting as a child History of experiencing physical discipline as a child

Perfectionism

Low self-esteem and fear of failure drive codependent nurses to strive for an unrealistic level of achievement.

Sedative/hypnotic/anxiolytic temp./sex effects

Lower but usually not altered Initial increase in libido but then decreased

Synthetic hallucinogens

Lysergic acid diethylamide/LSD, dimethyltryptamine/DMT and dietheyltryptamine DET, pnehcyclidine PCP, ketamine/ketalar, methylene-dioxyamphetamine MDMA, methoxy-amphetamine MDA, methylenedioxypyrovalerone MDPV or MMC bath salts

Defensive coping for antisocial interventions

Made aware if acceptable behaviors, limits/consequence with something of value, consisten, either/or approach, positive feedback/reward, increase time requirement for acceptable behavior for reward, milieu unit, help gain insite, talk about past behaviors and encourage to think how they would feel if circumstance reversed, its not you but your behavior

De-escaltation techniques

Maintain the client's self-esteem and dignity Maintain calmness for yourself and the client Assess the client and the situation Identify stressors and stress indicators Respond as early as possible Use calm, clear tone of voice Maintain a large personal space Use a non-aggressive posture Use verbal and nonverbal communication skills Assess your personal safety Be goal oriented Establish what the client feels to be his/her needs Remain honest Give the client options with clarity Be assertive not aggressive

Interventions for individuals experiencing anxiety disorders are aimed at

Maintaining anxiety at manageable level Problem-solving to increase client's level of personal control Helping the client learn to function in the presence of the phobic object without experiencing panic anxiety Assisting the client to overcome fear of leaving home alone Helping the client learn new, more adaptive coping strategies without resorting to obsessive-compulsive behaviors Helping the client gain independence and greater control over life situations

Demographic risk factors for violence

Male 14-24 years Low SES Inadequate support system Previously incarcerated Limited coping skills

Relationship factors for IPV

Marital conflict-fights, tension, and other struggles Marital instability- divorces or separation Dominance and control of the relationship by one partner over the other Economic stress Unhealthy family relationships and interactions Violence during pregnancy

Family dynamics anorexia

Marital couple may be avoiding their issues and conflictual areas and focusing on the child Behavior serves a purpose in maintaining family homeostasis. Enmeshed families- family maintains an appearance of being OK but there is pain that is not being looked at and focus is diverted to the child. In the bulimic family - more chaos and sexual acting out and/or substance abuse. Spiritual factors - good person if I can discipline myself - can help with feelings of low self worth.

Diagnostic characteristics of phobias

Marked, persistent, excessive, or unreasonable fear response from anticipation of object/situation/exposure which promotes anxiety or panic attack Exposure causes immediate anxiety Recognition by person that fear is excessive or unreasonable Situation avoided or endured with extreme anxiety and distress Duration of at least 6 months in persons under 18 years Impairment of normal routine, functioning, social activities, or relations resulting from avoidance, anxious anticipation, or distress in feared situations; marked distress with having phobia Fear not a direct physiologic effect of substance or general medical condition; not better accounted for by another mental disorder

Planning/implementing for bulimia

May require hospitalization in either medical or psychiatric facility for short time Long-term outpatient treatment expected Implementations directed toward examining underlying conflicts and distorted perceptions of shape and weight

Panic disorder treatment

Medication can be used to temporarily control or reduce some of the symptoms of panic disorder. However, it doesn't treat or resolve the problem. Medication can be useful in severe cases, but it should not be the only treatment pursued. Medication is most effective when combined with other treatments, such as therapy and lifestyle changes, that address the underlying causes of panic disorder.

Meds for anorexia

Medications not recommended until weight has been restored SSRI antidepressants Fluoxetine (Prozac): to reduce relapse Atypical antipsychotics Olanzapine (Zyprexa): helpful in improving mood and decreasing obsessional behaviors

Codependent nurse

Meeting the needs of others to the point of neglecting their own. Caretaking(meeting others to point of neglecting own needs), perfectionism, denial, poor communication

Synthetic opiate like drugs generic/trade names and street names

Meperidine/demerol, methadone/dolophine, pentazocine/talwin, fentanyl/fentora. Doctors, dollies, done, TS, apache, china girl, chinatown, dance fever, goodfella, jackpot

Pharmacological treatment of opioids

Methadone (Dolophine) Synthetic opiate blocks craving for and effects of heroin LAAM (l-α-acetylmethadol) An alternative to methadone Naltrexone (ReVia) Antagonist that blocks euphoric effects of opioids Clonidine (Catapres) Effective somatic treatment when combined with naltrexone Buprenorphine (Subutex) Blocks signs and symptoms of opioid withdrawal

Synthetic stimulants generic/trade names? Street names?

Methylenedioxypyrovalerone MDPV, methylmethcathinone Mephedrone MMC, methylone. Bath salts, blue silk, cloud 9, ivory wave, vanilla sky, white knight

Treatment with bulimia

Milieu therapy: Highly structured inpatient unit has goal of interrupting binge/purge cycle Close observations during and after meals (similar to patient with anorexia) Teaching focused on: Healthy diet Coping skills Physical and emotional effects of bingeing and purging

Treatment for anorexia

Milieu therapy: Relies on interdisciplinary team approach Work for normalization of eating patterns Work toward addressing psychological issues Use of highly structured setting with close monitoring to prevent throwing food away, falsely increasing weight, purging During meals During weighing During bathroom visits

Elder financial abuse/exploitation

Misuse of older adult's income by caregiver Forcing the older adult person to sign over financial affairs to another person against his or her will

12 step programs

Most effective treatment modality for relapse prevention Alcoholics Anonymous - Behavioral, cognitive, and dynamic structure needed in recovery. 1st Step: admit to powerlessness over addiction & unmanageable live. For family members : Al-Anon and Alateen

Causes of eating disorders

Mutifactorial causes involving genetics and heredity, psychological, sociocultural and spiritual factors. Neurochemical Factors- (role of neurotransmitters and brain hormones) decreased level of serotonin and norepinepherine as well as increased levels of brain cortisol (same as in chronic stress response and/or depression. Which comes first?) These points to a problem in the hypothalamus which regulates appetite control. Serotonin is involved in feelings of fullness. In animals they are investigating Cholecystokinin, related to satiety. Night binging might be related to a phase delay in the circadian rhythm.

Patient addicted to heroin likely to experience which symptoms from withdraw

N/v dirrahea and diaphoresis

Pharmacological intervention treatment of alcoholism

Naltrexone (ReVia) Reduces or eliminates alcohol craving Acamprosate (Campral) Helps client abstain from alcohol Topiramate (Topamax) Works to decrease alcohol cravings Disulfiram (Antabuse) Alcohol-disulfiram reaction causes unpleasant physical effects

3 events that can precipitate PTSD

Natural disaster, violence, military combat, accident, crime related evens

Client/fam education for anxiety /panic disorders

Nature of the illness What is anxiety? What might it be related to? What is OCD? What is PTSD? Symptoms of anxiety disorders Management of the illness Medication management Possible adverse effect Length of time to take effect What to expect from the medication Management of the illness Stress management Teach ways to interrupt escalating anxiety. Teach relaxation techniques Support services Crisis hotline Support groups Individual psychotherapy

Cluster a schizoid personality disorder

Neither desires nor enjoys human relationships Fixated on personal thought/fantasies Demonstrates emotional coldness, detachment, and flat affect, inappropriately serious, no pleasure Indifferent to praise or criticism Chooses solitary activities Doesn't occur exclusively with other medical dx

Inhalant effects

Neuro damage, ataxia, neuropathy, speech issues, tremors, wheezing/dyspnea, ab pain, n/v, usual breath odor, rash around mouth, renal issues

Violence biological theories

Neurophysiological Influences Biochemical Influences Genetic Influences Disorders of the Brain

Personality disorder cure

No cure just goal is to lessen and make as productive as possible

Sedative/hypnotic/anxiolytic renal/hepatic effects

No effect. Jaundice

Inhalant withdrawal

No withdrawal symptoms. Irreversible brain damage

Hallucinogen withdrawal

No withdrawal symptoms. Suicidal (serotonin crash

Common outcomes for anorexia

Normalize eating patterns Demonstrate improved self-acceptance Address maladaptive beliefs related to eating

Reporting elder abuse

Nurses are mandated reporters for abuse in the elderly All reports are investigated by Adult Protective Services The goal is safety of the older adult person If the competent elderly person chooses to stay in the abused environment the nurse must provide the elder with names and telephone numbers to call for assistance. An initial follow-up visit is conducted by Adult Protective Services with subsequent visits as needed

Mandated reporting

Nurses have a legal responsibility and are mandated to report suspected or actual cases of child and elder abuse. Each state has specific guidelines for reporting. It is important to review the guidelines for the state in which you practice in to ensure that they are followed.

Powerless actions

Nursing Actions Attention to injuries Take photographs Provide privacy Allow patient to verbalize the incident Encourage use of community resources Stress importance of personal safety

Rn diagnosis for violence

Nursing Diagnosis for inappropriate expression of anger or aggressive behavior include: Risk for self-directed violence Risk for other-directed violence Ineffective coping related to psychopathology Poor impulse control History of violence

Psychoeducational checklist for anxiety disorders

Nutrition and diet restriction Routine exercise Use of Support groups Positive coping strategies Assertiveness training Anger management Breathing Control: Deep Breathing exercises Progressive muscle relaxation Guided Imagery OTHER: massage spiritual herbal acupuncture Priority training Relationship workshops Sleep Medication education Cognitive/Behavioral Therapy Desensitization Flooding, Response Prevention Psychotherapy

Ocd cause?

OCD is likely the cause of a number of intertwined and complex factors which include genetics, biology, personality development, and how a person learns to react to the environment around them

Personality disorders which is most common

OCPD

Risk for mutilation/violence interventions

Observe frequently, verbal contract they will seek help, wound care with no sympathy, encourage to talk about feelings, act as role model for appropriate expression of anger, remove dangerous objects, redirect violence with physical outlets, sufficient staff, tranqs, possible restraints, possibly 1 staff member watching at all times,

DSM for OCD

Obsessions, compulsions, or both: recurrent persistent thoughts/urgetns, repetitive behaviors

Older adult abuse/neglect

Older Americans now compose the fastest growing segment of the U.S. population. An elder is considered to be an adult 65 years of age or older. Abuse of the elderly is a serious form of family violence. According to Sadock and Sadock (2007) it is estimated that 10 percent of individuals older than 65 are victims of abuse and neglect Abuser is often a relative that lives with the older adult.

COWS

Opiate withdrawal scale. Resting pulse rate 0-4, swearing 0-4, restlessness 0-5, pupil size 0-5, bone/joint aches 0-4, runny nose/tearing 0-4, GI upset 0-5, tremors 0-4, yawning 0-4, anxiety/irritability 0-4, gooseflesh skin 0-5. 0= none 5-12=mild, 13-24 moderate, 25-36 moderately severe, >36 severe withdrawal

Opiates

Opium Heroin Demerol Morphine Codeine Methadone Dilaudid Fentanyl

Opioids of natural origin generic/trade names and street names

Opium, morphine/astramorph, codeine. Black, poppy, tar, big O M, white stuff, miss emma term, schoolboy, syrup, cody

Inhalants

Organic Solvents: gasoline, paint thinner, acetone Volatile nitrites: room deodorizers Anesthetics: gas- nitrous oxide

Powerless outcomes

Outcomes Physical wounds have been attended to Client verbalizes assurance of immediate safety Client discusses situation with the nurse Client verbalizes available choices

Anxiety disorders to specific traumatic event

PTSD, acute stress disorders

Alcohol peripheral neuropathy

Pain, burning, tingling, prickly sensations from vitamin B/thiamine deficiency. Reversible but if not stopped permanent muscle wasting/paralysis can occur

S/s of panic attack

Palpitations, pounding heart, or accelerated heart rate Sweating Trembling or shaking Feeling of choking Sensations of shortness of breath or smothering Paresthesias (numbing or tingling sensations) Chest pain Fear of dying nausea or abdominal distress feeling dizzy, unsteady, faint derealization/deper-sonalization fear of losing control or going crazy

Panic anxiety behaviors

Palpitations, trembling, sweating, chest pain, SOB, fear of going crazy, fear of dying(panic disorder). Excess worry, difficulty concentrating, sleep issue(generalized anxiety).

Rn diagnoses associated with anxiety disorders

Panic anxiety (panic disorder and GAD) Powerlessness (panic disorder and GAD) Fear (phobic disorder) Social isolation (phobic disorder) Ineffective coping (OCD) Ineffective role performance (OCD) Post-trauma syndrome (PTSD) Complicated grieving (PTSD)

Cluster A vs. B vs. C

Paranoid, schizo, schitotypical. Histrionic, narcissistic, boarderline, antisocial Avoidant, dependent, OCD

Imbalanced nutrition less than required substance inteventions

Parenteral support, encourage sensation of smoking, consult dietitian, document I/O, weigh daily, ensure adequate protein but if liver issue low protein, sodium restriction possible, nonirritating food if varicies, small frequent feedings of fave foods, supplement with vitamin/minerals

Individual risk factors for perpetration

Parents' lack of understanding of children's needs and child development and parenting skills Parents' history of child abuse in the family of origin Substance and/or mental health issues including depression in the family Parental characteristics such as young age, low education, single parenthood, large number of dependent children, and low income Non-biological, transient caregivers in the home (e.g. mother's male partner) Parental thoughts and emotions that tend to support maltreatment behavior

Which behavior indicates that a patient diagnosed with borderline personality disorder is improving

Patient informs staff she feels unsafe and is having thoughts of harming herself

Assessment for builimia

Patient may be at or slightly above or below ideal weight Typical signs: enlarged parotid glands, dental caries, enamel loss, Russell's sign Review patient history for impulsive behaviors (stealing) or compulsions Vital signs Weigh and check for hidden things to make weight more. How much has gained or lost Ask how do they feel about their body Ask about eating habits. Do they take amphetamines to suppress appetite, laxatives, ipecac What are the lab values. Anorectics have dry yellowish skin with lanugo, no menses, cyanosis of extremities, and peripheral edema. Bulimic patients often have hoarseness,parotid gland enlargement (Chipmunk) tooth enamel erosion, scarred fingers.

Communicating with bulimic

Patient may readily form therapeutic alliance with nurse Eating behaviors are ego-dystonic (alien, unwanted, and inconsistent with self-image). Nurse needs to understand patient's sensitivity toward perceptions of others May feel shame and out of control Accepting, nonjudgmental approach guides communication

Battering

Pattern of coercive control founded on and supported by physical and/or sex violence of threat of violence of intimate partner

Psychological causes of bulimia

People with eating disorders may have psychological and emotional problems that contribute to the disorder. They may have low self-esteem, perfectionism, impulsive behavior, anger management difficulties, family conflicts and troubled relationships, for instance.

DSM for body dysmorphic disorder

Perceived defects/flaws in physical appearance, repetitive behaviors like excess groosming/skin picking or mental acts comparing themselves to others leading to distress/impairment in functioning

Kid violence assessment

Perform physical assessment of the child/youth Note and document types of injuries. Be sure to write exactly what caregiver said happened at the initial assessment Are they consistent with explanation by caregivers. Determine whether injuries should be reported to authorities.

Effects of alcohol on body

Peripheral neuropathy (2) Alcoholic myopathy (3) Wernicke's encephalopathy -a syndrome characterised by ataxia (loss of coordination), ophthalmoplegia (eye paralysis), confusion, and impairment of short term memory. often resulting from inadequate intake or absorption of thiamine ( Vit B1) (4) Korsakoff's psychosis is a brain disorder caused by the lack of thiamine ( Vit B1) in the brain (5) Alcoholic cardiomyopathy (6) Esophagitis (7) Gastritis (8) Pancreatitis (9) Alcoholic hepatitis (10) Cirrhosis of the liver (a) Portal hypertension (b) Ascites (c) Esophageal varices (d) Hepatic encephalopathy (11) Leukopenia (12) Thrombocytopenia (13) Sexual dysfunction

General anxiety disorder GAD

Persistent anxiety without phobias or panic attacks. uncontrollable, excessive anxiety and excessive worry across several situations. This worry and anxiety happens on more days than not, and persists for six months or more. A person with GAD finds it very difficult to control or discontinue the worry, or anxiety, despite their best efforts to do so Worry excessively about everyday concerns May become preoccupied with catastrophic thoughts Immune system suppression leading to illness can result physical symptoms must also be present on most days. These include; restlessness; becoming easily fatigued; problems concentrating or "zoning out;' irritability; muscle tension; and sleep disturbances. tend to worry about everyday things such as finances, job responsibilities, and tending to one's home and family. Children are apt to worry about their abilities, future events, past behaviors, making mistakes, and school performance. This chronic worrying and anxiety causes people with GAD feel "keyed up" or "on edge" much of the time.

Bulimia red flags

Persistent worry or complaining about being fat Repeatedly eating unusually large quantities of food in one sitting, especially high-fat or sweet foods Not wanting to eat in public or in front of others Use of dietary supplements or herbal products for weight loss Excessive exercising The use of laxatives or diuretic medications

4 phases of alcoholics pattern of drinking

Phase 1 prealcoholic phase, 2:early alcoholic phase, 3:crucial phase, 4:chronic phase

Cycle of battering/IPV

Phase 1 tension-building phase, 2: acute battering incident, 3: calm, loving, respite/honeymoon phase

Nonamphetamine stimulants generic/trade names and street names

Phendametrazine/bontril, benzphetamine/didrex, diethrylpropion/tenuate, phentermine/adipex/lonamin, sibutramine/meridia, methylphenidate/ritalin, dexmethylphenidate/focalin, modafinil/provigil. Diet pills, speed, uppers

Anxiety disorders to something identifiable

Phobias simple/social/complex that are disruptive/exaggerated/irrational, OCD obsessive idea generates anxiety relieved by compulsive acts

Effective coping examples

Physical activity Reviewing strength and limitations establishing goals Making a plan Talking about how we feel Expressing how we feel by crying, laughing Seeking support Stress reduction techniques

Connection between eating and emotion

Physical connections related to the brain Social connections- dating, reward or punishment with food, celebrate Cultural connections Emotional- too nervous to eat, anger and not eating (won't eat), power, mad at yourself and can't eat. Comfort foods, meets needs for love or can keep people at a distance.

Intoxication

Physical/mental state of exhilaration and emotional frenzy, lethargy, and stupor. Reversible symptoms

Planning/implementing for PD

Planning People with personality disorder seen in health care setting for other reasons Implementation Nurse needs to understand difficulty with creating therapeutic relationship with patient Give choices Orient patient to reality Teach behaviors that build on existing skills

Imbalanced nutrition < body requirements/deficient fluid volume interventions

Possible liquid diet via NG tube, dietitian consult for calories privileges/restrictions based on compliance with weight gain, weight daily when arising/after 1st voids yes sane scale, strict I/O, skin turgor/mucous membranes, stay for 30min-1 hours following meals and during, if weight loss occurs restrictions, educate on tube feedings if status deteriorates, explore try feelings/fears

Panic disorder s/s

Pounding heart beat Chest pain Smothering sensation Sweatiness Weakness Faintness Dizziness Chills Tingling hands Nausea

Community factors for IPV

Poverty and associated factors Low social capital-lack of institutions, relationships, and norms that shape a community's social interactions Weak community sanctions against IPV(unwillingness of neighbors to intervene) Impact on children

Staff behavior contributing to anger in clients

Power disputes over medications Blocked access to phones, televisions, or rooms Denials of requests in general Physical restraint Ignoring clients Ordering clients to do or not do something

Phase 1

Prealcoholic phase. Use to relieve stress, tolerance develops

Cluster C obsessive compulsive personality disorder

Preoccupied with details, rules, lists Perfectionist that interferes with task completion Unable to share responsibility with others Devoted to work, exclusion of pleasurable activities Financial stinginess Inability to discard useless objects Discomfort with emotions and relationships person can't control Reaction formation where they withhold true feelings that opposite feelings come forth Isolation, intellectualization, rationalization, undoing

Primary prevention

Primary prevention - health teaching FRAMES Feedback of personal risk Responsibility of the patient Advice to change Menu of ways to reduce substance use Empathetic counseling Self-efficacy or optimism of the patient

Education for client/fam for elder abuse

Provide a supportive, empathetic, and nonjudgmental atmosphere Interview both parties separately Emphasize the importance of remaining socially active with family and friends Remind the elder that one does not have to live with a violent person Assess whether abuse is intentional or related to knowledge deficit Include the elderly person in the treatment plan

Violence most frequent in

Psych units, ER, geriatric units

Predisposing factors to phobias

Psychoanalytic via unconscious fears from another event. Learning theory via stressful stimulus with harmless object. Cognitive theory via negative/irrational thinking causing anxiety. Biological aspects via innate fears that turn to phobia. Life experience

Psychological interventions for panic/anxiety disorders

Psychoeducation on panic/anxiety Deflate the danger by teaching the facts Stay with patient during acute panic attacks Help re-frame the situation as survivable Breathe into paper bag!

Violence psychological theories

Psychological Theorist Focus on Personality Traits and mental characteristics of the offender. Personality Traits Include Poor Impulse Control Sudden Bursts of Anger Poor Self Esteem Psychological Theorist believe that individuals engage in violence and aggression because of unmet needs for satisfaction and security that result in an underdeveloped ego and poor self-concept.

Withdrawal

Psychological and physiological reactions occur when blood and tissue concentrations of a drug decrease after heavy prolonged use of the substance

Other treatment for bulimia

Psychotherapy Cognitive-behavioral approach recommended Medications SSRI antidepressant, fluoxetine (Prozac) Reduces binge eating and vomiting episodes Treats comorbid depression

Other interventions for PD

Psychotherapy Pharmacological management benzodiazapines for acute anxiety atypical antipsychotics for acute agitation and poor impulse control SSRI's for depression, anxiety and OC behaviors mood stabilizers for emotional lability and poor impulse control Social skill building Cognitive restructuring Anxiety management training Coping skills

GAD treatment

Psychotherapy (Cognitive Behavioral Therapy) Cognitive part helps change thinking patterns that support the fears and behavioral part helps change the way the person reacts to the anxiety provoking situation Medication SSRIs - (Prozac, Zoloft, Lexapro, Paxil, Celexa Tricyclics - (Tofranil, Anafranil) MAOIs - Nardil, Parnate, Marplan) Anti-anxiety - (Klonopin, Ativan, Xanax, Buspar)

Fear interventions

Reassure safe, explore client's perception, discuss reality of situation, include in making decisions r/t to selection of alternate coping, if client wants to eliminate use desensitization/implosion, face feats

Panic disorder: recurrent? Usually affects? Produces?

Recurrent panic attacks Usually affects young adults Produces a sense of unreality, a fear of impending doom or a fear of losing control

PTSD management for reexperiencing phenomena? Intrusive thoughts?

Reexperiencing phenomena: journal writing, music, art, dance in therapeutic sessions Intrusive thoughts: cognitive/behavioral use of stop, snapping rubber band

Stage 2

Reidentification stage: able to glimpse true selves through a break in denial system and accept label of codependent and take responsibility for behavior

Stage 4

Reintegration stage: self-acceptance and willingness to change and reclaim personal power, integrity achieved, self-discipline/confidence

Intervention strategies

Relapse prevention Self-help groups for patient and family 12-Step programs Residential programs Intensive outpatient programs Outpatient drug-free programs and employee assistance programs

Sedative/hypnotic/anxiolytic continuum as dose is heightened

Relief from anxiety, disinhibition, sedation, hypnosis/sleep, general anesthesia, coma, death

Help for chemically impaired nurse

Report observations to nurse manager Intervention by nurse administrators Clear documentation important (specific dates, times, events, consequences) Job performance and patient safety State Board programs for impaired nurses

Cognitive/behavioral interventions for panic/anxiety disorders

Retreat Talk to another person Move around or engage in physical activity Engage in simple repetitive activity Do something that requires focused concentration Express anxiety Practice thought stopping Repeat positive coping statements Do relaxation exercises

Diagnosis for IPV

Risk for injury Risk for self-directed violence Powerlessness Ineffective Coping

Clients withdrawaling for CNS depressant diagnosis? Clients withdrawaing from CNS stimulants?

Risk for injury vs. risk for suicide

Elder abuse diagnoses

Risk of Trauma related to caregiver role strain Powerlessness related to lifestyle of helplessness and dependency on others

Ineffective coping behaviors

Rituals, obsessive thoughts, inability to meet basic needs, severe level of anxiety aka OCD

Cirrhosis of liver

S/s: n/v, anorexia, weight loss, ab pain, jaundice, edema, anemia, coagulation abnormalities, portal hypertension, ascites, esophageal varices, hepatic encephalopathy leading to inability to convert ammonia to urea

Panic meds

SSRIs

Phobic disorder meds

SSRIs Benzodiazapines BuSpar Beta blockers Neurontin Tricyclics Propranolol

Long term management of chronic aggression

SSRIs Lithium Anticonvulsants Gabapentin Benzodiazepines

GAD meds

SSRIs TCAs BuSpar SNRIs Valproic acid

OCD meds

SSRIs, TCA/clomipramine/anafranil

Treatment modalities for violence

Safe House or Shelter Family Therapy Individual Therapy Case Management

Elder abuse treatment modalities

Safety Plan- all persons experiencing abuse should be counseled about developing a safety plan Safe Houses for the older adult Individual Counseling/Family Counseling Community Resources

Projection

Saying problem belongs to someone else. attributing one's own unacknowledged unacceptable/unwanted thoughts and emotions to another.

Co-occurrence of abuse/neglect of kids

Scenario 1 Police find a 20 month old child with bruises on extremities, cigarette burns to the forehead and upper chest, and signs of dehydration. The child was at home with the male caregiver who was high on opium. In this instance there is physical abuse as noted by the bruises and cigarette burns. There is failure to provide as noted by the child's dehydration. There is failure to protect as noted by the caregiver being under the influence of drugs and unable to care for the child.

CIWA-AR withdrawal scale scores

Score < 5 = Mild Withdrawal Severity Score 5 - 14 = Moderate Withdrawal Severity Score > 15 = Severe Withdrawal Severity

Assessment for PD

Self-assessment essential Dealing with people with personality disorder is often difficult, challenging, frustrating Take full medical history, check for past abuse issues, substance use Determine suicidal/homicidal thoughts Relate personality functions to individual's ethnic/cultural background Determine recent important loss

Why do mental illnesses and substance abuse co-occur

Self-medication substance abuse begins as a means to alleviate symptoms of mental illness Causal effects Substance abuse may increase vulnerability to mental illness Common or correlated causes the risk factors that give rise to mental illness and substance abuse may be related or overlap

Patient in rehab and drinking buddies come for visit and when they leave patient has alcohol on his breath what is best intervention at time

Send urine specimen

Ineffective coping

Set limits on manipulating behavior, practice alternative/more adaptive coping strategies, give positive feedback for delaying gratification and using adaptive coping

Ineffective coping interventions for substance abuse

Set limits on manipulative behavior, give consequences for violating limits, ensure staff maintains consistent limits, encourage to verbalize feelings, answer questions, explain effects on body, explore options to assist stress like AA/exercise/relaxation/meditation, give positive reinforcement/feedback, encourage to be independent, practice alternative adaptive coping

Chemically impaired rn s/s

Signs and Symptoms: 32% to 50% higher rate than general population Work additional shifts Spend lots of time in the bathroom More patients complain that their pain is unrelieved in spite of receiving sedatives Increases in the inaccurate drug counts Increase in absences from work Lack of attention to personal grooming Makes bad decisions or shows poor judgment 1. High absenteeism (if substance source is outside the work area) 2. Rarely misses work (if substance source is at work) 3. Problems with relationships 4. Irritability 5. Tendency to isolate 6. Elaborate excuses for behavior 7. Unkempt appearance 8. Impaired motor coordination; slurred speech 9. Frequent trips to the bathroom 10. Patient complaints of inadequate pain control 11. Discrepancies in documentation D. Peer Assistance Program developed by the American Nurses' Association in 1982. 1. To assist impaired nurses to recognize their impairment 2. To obtain necessary treatment 3. To regain accountability within their profession 4. Contract is drawn up: To detail method of treatment To establish guidelines for monitoring course of treatment

Diagnostic criteria for personality disorder

Simply put: an extreme variant of normal personality traits ENDURING pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture, is INFLEXIBLE and PERVASIVE across a broad range of personal and social situations, leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning, is stable and of long duration (traced back to early adolescence or early adulthood) and not better accounted for by another mental, substance abuse d/o or medical condition (e.g. head trauma)

Misinterpreted uncued panic attack

Since there is no obvious explanation for the symptoms that occur during a "false alarm" (uncued panic attack), people understandably misinterpret them as a sign, or "cue" that something is terribly wrong. "I'm having a heart attack." "I must be going crazy." In other words, these symptoms are misinterpreted to mean, "I must be in danger." By now we know when the mind believes there is a real and present danger; it prepares the body for fight-or-flight. So, a vicious cycle gets set up. The symptoms of a panic attack are alarming and suggest danger. The body responds as it ordinarily does to a perceived threat, and the symptoms continue or worsen. As this cycle continues, exhaustion will eventually occur. Just like a car, the body does not have an unlimited supply of fuel.

PTSD management for sleeping issues? Numbing and dissociation?

Sleeping: avoid caffeine, daily exercise, relaxation techniques at bedtime Numbing/dissociation: Journal about feelings of being "dead inside" or in "faraway place". Change clothes, touch safe object, exercise, clean, talk to friend.

Characteristics of FAS

Small size for gestational age or small stature in relation to peers (2) Facial abnormalities (3) Poor coordination or delays in psychomotor development (4) Hyperactive behavior (5) Learning disabilities (6) Mental retardation or low IQ (7) Problems with daily living (8) Vision or hearing problems (9) Poor reasoning and judgment skills (10) Sleep and sucking disturbances in infancy (11) Heart and kidney defects (12) Abnormalities in size and shape of brain (13) Risk for psychiatric disorders (e.g., ADHD, mood and anxiety disorders, eating disorders, and drug and alcohol dependence)

Cued panic attacks common with

Social Anxiety Disorder, Agoraphobia, and Specific Anxiety Disorder

Social learning theorists

Social Learning Theorists believe that human beings are obviously not born with a large amount of aggressive impulses. These must be learned in the same way that other behaviors are acquired. Important sources for learning and modeling come from the family, the subculture and the media. The Social Scientist purports that aggressive behavior is solely a product of ones culture.

Family risk factors for kid violence

Social isolation

Behavioral characteristics of personality disorder

Solves problems in an immature way unable to implement change cannot tolerate frustration exhibits patterns of learned helplessness & hopelessness difficulty identifying feelings and needs evokes interpersonal conflict & reactions rarely seeks psychiatric help

Codependency stages of recovery

Stage 1: survival, 2:reidnetification stagee, 3: core issues, 4: reintegration

Panic anxiety interventions

Stay w/ client for safety/security, don't leave alone, maintain calm approach, use simple words/brief messages, speak calmly/clearly, if hyperventilation breath in paper bag, keep surroundings low in stimuli, admin tranquilizers, when LOC lowered look for reasons, teach s/s of escalating anxiety and ways to interrupt via relaxation/deep breathing/meditation/exercise

Psychomotor stimulants vs. general cellular stimulants

Stimulation by norepinephrine, epinephrine, dopamine vs. action on cells like caffeine/nicotine and different than stimulant related disorders

Anxiety s/s

Stress continues after stressor gone. Diffuse, vague, dread, excess worry, hypervigilance, apprehension, fear, breathlessness, choking sensation, heart palpitations, restlessness, increased muscle tension

Physical elder abuse

Striking Hitting Bruising Cutting Restraining

Substance related disorders composed of 2 groups:

Substance use disorders aka addiction and substance induced disorders aka intoxication/withdrawal/delirium/neurocognitive disorder/psychosis/bipolar/depression/OCD/anxiety/ sex dysfunction/sleep disorders

Buprenorphine

Subutex) This drug is a partial opioid agonist. At low doses, it blocks signs and symptoms of opioid withdrawal. Early studies suggest it suppresses heroin use.

Ineffective impulse control interventions

Support in effort to stop pulling hair, help to understand it's possible to stop, nonjudgmental attitude, habit reversal training cia awareness/competing response/social support, suggest holding something when hair pulling anticipated, stress management techniques, support/encouragement

Stage 1 of condependency recovery

Survival stage: let go of denial that problems exist

Expressed response rape pattern

Survivor expresses feelings of fear, anger, anxiety, crying, sobbing, restlessness, tension

Silent rape reaction

Survivor tells no one

Social interventions for panic/anxiety disorders

Teach Coping Skills Time management Assertiveness training Problem solving/conflict Resolution Use of support groups Stress reduction (job, activities, etc.)

Phase 1

Tension building: tolerance for frustration declining, lashes out, in desperate effort to avoid more serious confrontation woman accepts the abuse, may rationalize behavior, jealousy, possessiveness increases

Cycle of vilence

Tension via walking on eggshells, threats, intimidation, fear, guild, unpredictable behavior. Violence when abuse occurs. Honeymoon when abuser will apologize, try to make up, blane behavior on victim, ignore/deny abuse

Drug abuse linked to

The effects of drug abuse are wide ranging and affect people of all ages. Besides addiction, drug abuse is linked to a variety of health problems, including HIV/AIDS, cancer, heart disease, and many more. It is also linked to homelessness, crime, and violence. Thus, addiction is costly to both individuals and society

Bulimia causes

The exact cause of bulimia is unknown. As with other mental illnesses, there are many possible factors that could play a role in the development of eating disorders, such as genes, certain behaviors, psychological disorders, and family and societal influences.

Kid violence interventions

The goal for the victim of abuse or neglect is to provide shelter and promote reassurance of his/her safety. The role of the nurse is support and encouragement. Other Nursing Concerns Include Attending to the child's physical injuries Staying with the client to provide security Promoting trust Help the client to see and recognize other options Reporting to authorities when there is "reason to suspect" that child abuse is going on

Define panic attack

The highest level of anxiety, characterized by disorganized thinking, feelings of terror and helplessness, and non purposeful behavior Intense- feel like they are about to die, lose control, or go crazy.

Hormone causes of eating disorders

The hypothalamus is a highly complex structure in the brain that regulates many important brain chemicals. Malfunction of this area of the brain may produce endocrine disorders, impaired temperature regulation, headaches, and other problems.

Physical abuse

The intentional use of physical force with the potential for causing death, disability, injury, or harm. Physical violence includes, but is not limited to scratching; pushing; shoving; throwing; grabbing; biting; choking; shaking; slapping; punching; burning; use of a weapon; and use of restraints or one's body, size , or strength against another person.