Unit 1

What is the primary risk factor for developing a NCD?

- advanced age

_______ dementia is preventable

vascular

5 types of elder abuse:

1. Physical 2. Emotional/Psychological 3. Sexual 3. Neglect 5. Financial

What is the single best predictor of future violence?

A history of violence

It is a legal process involving a physician, an officer of the law, and a third party who has knowledge of circumstances; this is often a nurse who has also assessed the patient. It is how to process of involuntary commitment begins

EOD, Emergency order of detainment

Dementia with Lewy bodies: - abnormal deposits of a protein called alpha-synuclein that form inside the brain's nerve cells - features: spontaneous Parkinsonism or extrapyramidal signs, persistent visual hallucinations, and fluctuating cognition - may have the best response to cholinesterade inhibitors - antipsychotic meds should not be used

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Which drugs are used for date rape? which is the most common?

- Ketamine, GHB, Rohypnol, Alcohol **ALCOHOL

What are characteristics of therapeutic communication?

- client centered: no social or reciprocal - purposeful, planned, and goal oriented

What are the 4 main categories of abuse?

- emotional - physical - sexual - neglect

What are some predicitve factors for violence?

- paranoid ideation and frank psychosis - angry, irritble - hyperactivity: most important predictor of imminent violence

The social learning theory or Intergenerational Violence Theory of family violence purports that behaviors are developed through: - - - A child who witnesses abuse learns that violence is an acceptable reaction to stress and it becomes the behavioral norm.

- role modeling - identification - human interaction

What are 2 of the most important concepts applicable to civil commitment cases?

- writ of habeas corpus and the least restrictive alternative doctrine

- Depression is often misdiagnosed as Dementia. Must do thorough assessment - There is no standard single physiologic test for Dementia. - Beta-amyloid proteins can now be detected through brain scans or spinal fluid but can be costly. CT, MRI, and PET scans are used to rule out other conditions that may cause symptoms similar to AD.

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ALL your patients with history before May 2013 will at least have an Axis I, IV, and V diagnosis! Some will have all.

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Erickson's 8 stages of growth and development: - Erickson postulated that each stage constitues a developmental crisis. When a person arrives at a new stage, previous coping styles are no longer appropriate and new coping mechanisms have yet to be developed. This often leads to increased anxiety until he/she establishes equilibrium

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Intimate Partner Violence is defined as a pattern of assault and course of behaviors that may include physical injury, psychological abuse, sexual assault, progressive social isolation, stalking, deprivation, intimidation, and threats between current OR former partners in an intimate relationship, regardless of gender or marital status

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Levels of Anxiety: PANIC-LEVEL: - characterized by markedly disturbing behavior - the client is not able to process what is occuring in the environment and can lose touch reality - client experiences extreme fear and horror - client experiences severe hyperactivity, flight, or immobility - dysfunction in speech, dilated pupils, severe shakiness, severe withdrawal, inability to sleep, delusions, and hallucinations

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Levels of Anxiety: SEVERE: - perceptual field is greatly reduces with distorted perceptions - learning and problem solving do not occur - functioning is effective; behaviors are automatic - confusion, feeling of impending doom, hyperventilation, tachycardia, withdrawal, loud and rapid speech, and aimless activity - This client is usually not able to take directions from others

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dementia vs delirium

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5 A's process of implementing best evidence into clinical practice includes:

1. Ask a question 2. Acquire literature 3. Appraise the literature 4. Apply the evidence 5. Assess the performance

4 defense mechanisms seen in patients with AD?

1. Denial 2. Confabulation: making up of stories or answers to maintain self-esteem 3. Perservation: repetition of phrases or behaviors, intensified under stress 4. Avoidance of questions

4 elements required to prove negligence:

1. Duty 2. Breech 3. Causation 4. Damages

Community Based Mental Health Programs: - For the patient to be treated using the Home Care program, what are the 4 criteria that must be met?

1. Homebound 2. Have psychiatric diagnosis 3. Need the skills of the mental health nurse and 4. A plan of care developed by the healthcare provider

What are the 4 major groups of neurotransmitters in the brain?

1. Monoamines (dopamine, norepinephrine, serotonin) 2. amino acids (GABA, glutamate) 3. peptides (hypothalmic CRH) 4. cholinergic (acetylcholine)

What are the 3 phases of Therapeutic Relationships?

1. Orientation 2. Working 3. Termination

What are the 3 Phases of Group Development and characteristics within each phase?

1. Orientation: - define purpose and goals of the group - group leader sets tone and is active - group leader provides the purpose of the group - discussion about termination - members get to know each other 2. Working: - problem-solving skills - power and control issues can dominate this phase - group leader uses therapeutic communication to encourage group work toward meeting goals - members take informal roles within the group 3. Termination: - discuss termination issues - summarize work - give feedback

Theories of Psychiatric Care: (Behavioral) - Humanistic Theory: - Maslows hierachy of needs: 1. 2. 3. 4. 5. 6.

1. Physiological Needs: 2. Safety Needs: 3. Belonging and Love needs: affiliation, relationships 4. Esteem needs: 5. Self-actualization: 5. Self transcendence: drive to go beyond personal self

Alternatives to Seclusion and Restraints: Trauma-Informed Approach - This approach uses interventions that address reducing the trauma's consequences and facilitates healing - A trauma-informed approach reflects adherence to 6 key principles rather than a prescribed set of practices and procedures, including: - - - - - -

1. Safety 2. Trustworthiness and transparency 3. Peer support 4. Collaboration and mutuality 5. Empowerment, voice, and choice 6. Cultural, historical, and gender issues

What are the 3 basic types of crises?

1. Situational (arise from an external source: loss of loved one, loss of a job) 2. Developmental (role changes:marriage, birth of a child, retirement) 3. Existential (inner conflicts such as midlife crisis)

Erickson's stages of psychosocial development 1- 2- 3- 4- 5- 6- 7- 8- 9-

1: Trust vs Mistrust (birth to 1.5): Hope 2. Autonomy vs Shame (1.5 to 3): Will 3. Initiative vs Guilt (3 to 6): Purpose 4. Industry vs Inferiority (6 to 12): Competency 5. Identity vs Role confusion (12 to 20): Fidelity 6. Intimacy vs isolation (20 to 40): Love 7. Generatively vs Stagnation (40 to 65): Care 8. Integrity vs Despair (65 to death): Wisdom

Levels of Anxiety: MODERATE: - slightly reduced perception and processing of information occurs, and selective inattention can occur - ability to think clearly is hampered, but learning and problem-solving can still occur - Concentration difficulties, tiredness, pacing, changes in voice pitch, voice tremors, shakiness, increase HR and RR - client may report somatic manifestations including headache, backache, urinary urgency and frequency, and insomnia - the client who has this type of anxiety usually benefits from the direction of others

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This type of mental health care setting provides intensive treatment and supervision in locked units for clients who have severe mental illness, who present a danger to self or others

Acute Care

The perpetrator of sexual assault: causes can be related to - Biological factors such as alterations in the function of neurotransmitters - Psychosocial factors: the ________ personality disorder is one of the most prevalent in which people are viewed as objects

Antisocial Personality Disorder

DSM-4 axes categories: - Axis I: - Axis II: - Axis III: - Axis IV: - Axis V: What changes were made in DSM-5?

Axis I: lists the psychiatric diagnosis: such as major depressive disorder, schizophrenia, etc Axis II: lists personality disorders and mental retardation to ensure long-standing issues that may co-occur with the Axis I disorders are considered Axis III: lists any medical condition that patients may have, which may or may not influence the mental health diagnosis such as: coronary heart disease Axis IV: lists psychococial stressers in a brief narrative form such as: hiomelessness, going through divorce Axis V: contains the Global Assessment of Functioning (GAF). The GAF is rated on a scale of 1 to 100 and indicates the patient;s level of functioning. The higher the score, the higher the level of functioning - Changes include: 1. deletion of the five-axis system of diagnosis 2. the coding system now mirrors, International Statistical Classification of Diseases and Related Health Problems, Clinical Modification:(ICD-10) which are often part of the billing and tracking process

The introduction of ________, the first antipsychotic medication, in the early 1950s contributed to hospital discharges

Chlorpromazine (Thorazine)

Use of Cognitive Therapy: - ________ assists clients to identify negativce thoughts that produce anxiety, examine the cause, and develop supportive ideas that replace the negative self-talk

Cognitive Reframing

With this neurocognitive disorder the patient may experience hallucinations or illusions

Delirium

______ is a type of NCD that tends to be short-term and reversible

Delirium

______ is always secondary to another condition

Delirium

Defense Mechanisms: (Immature) - _______: involves escaping unpleasant realities by ignoring their existence

Denial

An abusive relationship is all about instilling ____ and wanting to have power and control in the relationship. ANGER is one way that the abuser tries to gain authority ______ abuse may include threats to harm a child, pet, or loved one, or displaying weapons

Fear Psychological

This neurotransmitter modulates neuronal excitability and is associated with the regulation of anxiety. Most anti anxiety drugs act by increasing the effectiveness of this neurotransmitter.

GABA

What is the HEADSSS assessment tool for adolescents?

H: Home environment E: Education/.Employment A: Activities D: Drug and substance abuse S: Sexuality S: suicide/depression S: safety

The Biological Model is currently the dominant model and focuses on physical causation for personality problems and psychiatric disorders. _______ is the primary biological therapy

Medication

Intervention for family and friends of a person who has completed suicide, called _____, should be initiated within 24 to 72 hours after the death

Postvention

Defense Mechanisms: ______: taking the opposite belief because the true belief causes anxiety. EX: having a bias against a particular race or culture and then embracing that race or culture to the extreme ______: integrating the beliefs and values of another individual into one's own ego structure (helps a person avoid social retaliation and punishment; particularly important for the child's development of superego)

Reaction Formation Introjection

Medications for Suicide: __________: - observe for CNS depression, avoid use of other CNS depressants - caffeine interferes with desired effects - do not abruptly discontinue

Sedative hypnotic anxiolytics (Benzodiazepines) Lorazepam, Diazepan

Low central _____ function has been correlated with impulsive aggression as well as an impulsive history of suicide ______ is thought to act as a modulator in the central nervous system to lessen impulsive and violent behaviors

Serotonin Serotonin

Alternatives to Seclusion and Restraints: What involves the use of comfort rooms, where the psychiatric facility sets aside a special room to which a person can go to voluntarily to self-manage anxiety and distress

The Recovery Model

______ are more likely to attempt suicide ______ are more likely to complete suicide

Women Males

Electroconvulsive Therapy (ECT) is effective in decreasing suicide ideation in clients who have a _____ or _____ disorder

depressive or psychotic disorder

The earliest cognitive symptom most often observed in the development of AD is impairment in ________ and _______

memory and learning

The autonomic nervous system is divided into: - - ________ are first-line drugs for treating ADHD. In low doses, stimulants improve focus and thinking by ncreasing synaptic levels of the neurotransmitters ______ and _______

sympathetic and parasympathetic - Sympathomimetics - Dopamine and Norepinephrine

**** Suicide: patients that attempt suicide generally have a SEROTONIN deficiency

test question

Compound Rape Reaction: Some survivors of rape can experience additional disorders as a result of the sexual assault such as: - depression - substance abuse - physical disorders (manifestations of a prior physical illness) Silent Rape Reaction: The survivor does not report or tell anyone of the sexual assault, including family, friends, or the authorities. - Client will have: * abrupt changes in relationship with partners * nightmares * increased anxiety during interview * marked changes in sexual behavior * sudden onset of phobic reactions * no verbalization of the occurence of sexual assault

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GAF Scale (Global Assessment of Functioning) - this is Axis 5 of the multiaxis system - the GAF score is used to rate how serious a mental illness is - it measures how much a person's symptoms affect their day-to-day life on a scale of ___ to ____ - who assigns the score and when do they assign it?

- 0 to 100 - the doctor, usually on admission and again on discharge **We expect to see a higher GAF score on discharge**

Mini Mental Status Exam MMSE: -It is an ___ question measure that tests 5 areas of cognitive function including: __________ - The max score is _____. A score of ___ or lower is indicative of cognitive impairment.

- 11-question ORAC-RL - Orientation - Registration - Attention and Calculation - Recall - Language 30 23

Seclusion and Restrains: - The provider must write a new perscription how often? - Complete documentation of the client every __ to ___ minutes - If placement of seclusion or restrains must occur due to an emergency and there is no order, you must obtain the order within a specified period of time, usually ___ to ___ min

- 24 hours - 15 to 30 min - 15 to 30 min

Acute Stress Disorder: - occurs after a traumatic event (sexual assault) and manifestations are similar to PTSD. In acute stress disorder manifestations appear and persist at least ___ days and can extend to ______ - _______ occurs beyond 1-month of the attack and has long-term psychological effects - What are some physiological effects seen after sexual assault (PTSD) ?

- 3 days to 1 month - PTSD - reliving the event (flashbacks, nightmares) - increased activity due to fear that the assault will reoccur - hyperarousal and increased emotional response - avoidance, fears, and phobias - difficulties with daily functioning, low self-esteem, depression, sexual dysfunction

Emergency order of detainment: - requires how many people?

- 3: physician, law enforcement officer, and a person with information on the person, usually a nurse

Child Abuse: - a risk factor for child abuse is if the child is under ___ years of age - Shaken Baby Syndrome: - assess for respiratory distress, bulging fontanels, increase in head circumference, and retinal hemorrhage - any bruising on an infant before the age of ___ is suspicious Preschoolers to Adolescents: --- bruising is normal if found where on these kids? --- bruising is unusual if found where? - numerous bruises at different stages of healing of indicative of possible abuse - be suspicious of bruises that resemble the shape of an object such as a belt buckle - BURNS covering "glove" or "stocking" areas of the hands or feet can indicate forced immersion into boiling water --- Assess for head injuries which includes the following signs and symptoms: __________

- 4 - 6 months - arms and legs - abdomen, back, buttocks - altered LOC, unequal or nonreactive pupils, N/V

Laws regarding restraints: - orders for restraints may only be renewed in accordance with the following limits for a total of 24 hours: - ____ hours for adults 18 years of age and older - ____ hours for children 9 to 17 years of age - ___ hour for children under 9 years of age - In an emergency, a properly trained staff member may place the patient in restraints and must obtain an order within _____

- 4 hours - 2 hours - 1 hour - 1 hour

A crisis is self limiting and is usually resolved in ____ to ___ weeks During a crisis people are often more open to outside interventions than times when they are stable functioning Crisis intervention deals with the person's present problem and resolution of the immediate crisis only "here and now". Addressing issues not directly related to the crisis can take place at a later time

- 4 to 6 weeks

Dopamine is balanced by which neurotransmitter?

- Acetylcholine

Alzheimer's disease: Pharmacology: Treatment of AD focuses on: - increasing the amount of _____ in the brain -or- - blocking the receptors for _______

- Acetylcholine - NMDA (N-methyl-D-aspartate)

- A client's mood provides information about the emotion the client is feeling - A clients _____ is an objective expression of mood (lack of facial expression or a flat affect)

- Affect

Major Neurocognitive Disorders (Alzheimers Disease) - ____ are twice as likely to develop AD than whites - _____ are 1 1/2 times as likely to develop AD than whites - ____ have a lower incidence of AD than whites - what sex is more prone to develop AD?

- African Americans - Hispanics - Asian Americans - FEMALES (2/3)

Stress and Defense Mechanisms: - Defense mechanisms are reversible and the client can use them in adaptive or maladaptive manner. - Which 2 defense mechanisms are always healthy?

- Altriusm: delaing with anxiety by reaching out to others or helping others - Sublimation: dealing with unacceptable feelings or impulses by unconsciously substituting acceptable forms of expressions, EX: working out vigourously at the gym to sublimate feelings of anger and hostility

Defense Mechanisms: (Healthy) - ______: emotional stressors and conflicts are addressed by meeting the needs of others. The person receives gratification either vicariously or from response of others. (volunteering to help others) - ________: unconscious process of substituting constructive and socially acceptable activity for strong impulses that are not considered acceptable. (become a butcher, play contact sports) - _______: the conscious denial of a disturbing situation or feeling. - ______: emphasing amusing or ironic aspects of the conflict

- Altruism - Sublimation - Suppression - Humor

________ is neurodegenerative, resulting in the gradual impairment of cognitive function. It is the MOST COMMON type of Major NCD

- Alzheimer's

Minor and Major NCD subtypes of further classed: - NCD due to _______ - NCD due to ______ - NCD due to ______

- Alzheimer's - Parkinson's Disease - Huntington's Disease

Cognitive Impairment: 4 A's": - - - -

- Amnesia or memory impairment - Aphasia: loss of language ability - Apraxia: loss of purposeful movement - Agnosia: inability to recognize objects

_____ is a human emotion, an unplanned reaction to a stressor _____ is a forceful goal directed action that may be verbal or physical. It can be adaptive or maladaptive _____ has the underlying intention of doing harm to a specific person or group. Bullying is an example

- Anger - Aggression - Violence

There is no specific lab or diagnostic testing to diagnose NCDs. Definitive diagnosis cannot be made until _______

- Autopsy

________: pairing of a maladaptive behavior with a punishment or unpleasant stimuli (bitter taste, electric shock) to promote a change in the behavior

- Aversion therapy

What are often the first medication of choice for acute aggressive episodes?

- Benzodiazepines * 2nd gen antipsychotics, ziprasidone or zyprexa, can be useful in emergency situations

Piagets Stages of Cognitive Development: -

- Birth to 2 years: Sensorimotor: experiences world through senses and actions - 2 to 6 years: Perioperational: uses words and images to represent things. Lacks logical thinking. - 7 to 11 years: Concrete Operational: thinking logically about concrete events - 12 through Adulthood: Formal Operational: abstract reasoning

Brain Structures: - The _____ contributes to both motor control and cognitive processing. Alterations in cerebello-thalmo-corticol circuits are associated with the development of positive symptoms (hallucinations, delusions, and altered perception)

- Cerebellum

Brain Structures: - The ___ is also called the human brain or higher brain. It is responsible for higher cognitive skills, self-awareness, and executive functions. - It has 4 Lobes: - The ___ lobe is responsible for conscious movement, problem-solving skills, and speech production - The _____ is the most anterior part of the frontal cortex and is involved in moderating social behaviors, goal setting and planning, and personality - The ___ lobes are involved in tactile sensation and spatial awareness - The ____ lobe is primarily responsible for vision and visual processing - The ____ lobe is responsible for hearing, language reception, and language comprehension

- Cerebrum - Frontal lobe - prefrontal cortex (PFC) - parietal lobe - occipital lobe - temporal lobe

What is the strongest pedictor of adult violence?

- Childhood aggression (setting fires, performing crual acts on animals, etc)

- This type of behavior therapy is used to assist client's with anxiety management. It takes into account what clients think influences their feelings and behaviors

- Cognitive Behavior Therapy

Types of Psychotherapy: - _____: this type is based on the cognitive model, which focuses on individual thoughts and behaviors to solve current problems. The belief is that thoughts come before feelings and actions. It treats depression, anxiety, eating disorders

- Cognitive Therapy

Theories of Psychiatric Care: (Cognitive Theory: Beck) - ________ Therapy is based on both cognitive and behavioral theoryand seeks to modify negative thoughts that led to dysfunctional emotions and actions - ______ are unique assumptions about ourselves, others, and the world around us - Sometimes called the ABCs of irrational beliefs, a useful technique in CBT is to use a 4 column format to record the: - precipitating event - resulting automatic thought - ensuing feelings and behaviors - a challenge to the nefative thoughts based on rational evidence

- Cognitive-Behavioral Therapy - Schemata

This therapetuic strategy consists of: - using therapeutic commmunication skills - assisting with problem solving - crisis intervention - stress management

- Counseling

Comments or signals of suicide can be Overt (obvious) or Covert: - Everything is looking pretty grim to me = ______ - There is just no reason for me to go on living = ______

- Covert - Overt

Do not use judgemental language when documenting the sexual assault victims words, Use words such as : - - -

- Declined (not rejected) - Reported (not alleged) - Penetration (not intercourse)

What are the 3 major type of Neurocognitive Disorders (NCD)?

- Delirium - Minor neurocognitive disorder - Major neurocognitive disorder (Dementia, Alzheimers)

- With _____ the clients level of consciousness is usually altered, in clients with ____ their level of consciousness is usually unchanged

- Delirium - NCDs

Group and Family Therapy: Leadership Styles: - ______: the leader supports group interaction and decision making to solve problems - ______: the leader doesnt make any attempt to control direction - ______: the leader completely controls the direction and structure

- Democratic - Laissez-faire - Autocratic

Defense mechanisms used by clients with NCDs: -________: refuse to believe that changes are taking place - _______: client makes up stories when questioned about events they do not remember. It is an unconscious attempt to save self-esteem and prevent admitting the inability to remember - _______: Client avoids answering questions by repeating phrases or behavior. Unscious attmept to maintain self-esteem when memory has failed

- Denial - Confabulation - Preservation

_______ in the older adult can mimic the early stages of Alzheimer's disease

- Depression

- This type of behavior therapy is a cognitive-behavioral therapy for clients who have a personality disorder and exhibit self-injurious behavior. This therapy focuses on gradual behavior changes and provides acceptance and validation for these clients

- Dialectical Behavior Therapy

Defense Mechanisms: (Intermediate) - _______: transfer of emotions associated with a specific person, object, or situation to another person, object, or situation that is nonthreatening EX: boss yells at the man, the man yells at his wife, wife yells at child, etc. - _______: unacceptable feelings or behaviors are kept out of awareness by developing the opposite behavior or emotion EX: person who harbors hostility toward children becomes a boy scout leader

- Displacement - Reaction Formation

Defense Mechanisms: (Immature) - ________: a disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment - _______: occurs when emotional conflicts or stressors are handled by attributing negative qualities to self or others. - ______: emotional conflicts or stressors are addressed by attributing exagerrated positive qualities to others - ________: the inability to integrate positive and negative qualities of oneself or others into a cohesive image. This defense mechanism is prevalent in personality disorders.

- Distortion - Devaluation - Idealization - Splitting

In DSM-5, mental disorders are associated with: - ______ (a painful symptom) - ______ (impairment in 1 or more important areas of functioning) - increased risk of suffering death, pain, disability, or a loss of freedom or independence

- Distress - Disability

Cholinesterase Inhibitors: - these medications are : - The main adverse reactions involve the ____ system due to increased amounts of acetylcholine in all parts of the body - Other adverse reactions include ______ and ______ due to a temporary decrease in the flow of blood to the brain ** give these meds with FOOD to ease side effects and suggest that the client takes them at BEDTIME * monitor for weight loss due to inadequate nutritional intake * NSAIDS are not recommended due to risk of GI bleeding * observe for signs of CNS stimulation such as insomnia and dizziness * anticholinergic drugs such as antihistamines decrease the effects of donepezil

- Donepezil, rivastigmine (exelon), galantamine - GI system (n/v, diarrhea) - bradycardia and syncope

______ is an important neurotransmitter involved in cognition, movement, and motivation. it controls emotional responses and the brains reward and pleasure centers

- Dopamine

In delirium, disorientation and confusion often worse at what times? Personaltiy change is rapid in _____ and gradual in _____ Aphasia (speech impairment) agnosia (ability to recognize faniliar objects), and apraxia (movement) impairments are present in _______

- Early in the morning and at night Delirium, NCDs NCDs

________ is a term that refers to the unnecessary use of simple, childlike phrases; slow speech; high volume; and collective pronouns Such as "Do we want to take a bath". This kind of language can be percieved as insulting to older adults

- Elderspeak

Rape-Trauma Syndrome: - a ______ reaction is overt and consist of emotional outbursts, including crying, laughing, hysteria, and anger - a _______ reaction is ambiguous. The survivor can appear calm and have blunted affest, but can also be confused, have difficulty making decisions, and feel numb - a ______ reaction can occur later in which the client can have a variety of physical manifestations such as: muscle tension, headache, sleep disturbances, GI issues, GU issues

- Expressed Reaction - Controlled Reaction - Somatic Reaction

Therapeutic Communication: - Attending behaviors or active listening are nonverbal means of conveying interest in another - ___ typically converys interest and respect - ____ and _____ can demonstrate level of comfort and ease - _____ enhances rapport and emphasizes particular topics/issues - _____ provides feedback by restating or summarizing the clients statements

- Eye contact - Body language and Posture - Vocal quality - Verbal tracking

Intentional Torts are willful actions that damage a client's property or violate client rights. What are some examples of Intentional Torts? Unintentional Torts are actions or inactions that cause unintended harm as a result of failing to meet one's duty of care in either a personal or professional situation. What are some examples of unintentional Torts?

- False Imprisonment, Assault, Battery - Negligence, Malpractice

Screening and Assessment tools for Delirium and NCDs: - Confusion Assessment Method: for delirium - MMSE - Functional Assessment Screening Tool - Neelson-Champagne Confusion Scale: for delirium - ________: will give the nurse information regarding clients ability to perform self-care, extent of memory loss, mood changes, and degree of danger to self and others - ______: used for clients in long-term care settings - _______: provides the nurse with client behavioral information based on an interview with a secondary source

- Functional Dementia Scale - Brief Interview for Mental Status - Blessed Dementia Scale

NMDA Receptor Antagonist: Namenda (memantine) - This medication works by blocking excess _____ from stimulating NMDA receptors, decreasing the influx of _______ into neurons in the brain. * Adverse reactions include CNS effects such as dizziness, headache, and increased confusion. PT may also experience constipation. Provide ________ as needed * Memantine is better tolerated than cholinesterase inhibitors * Contraindications include _____ failure. * Memantine can interact with _______ and other drugs that increase the pH of urine. This can increase levels of memantine and lead to possible toxicity

- Glutamate, CALCIUM - fiber supplements, stool softeners, and laxatives - Renal failure - over the counter antacids such as sodium bicarb

Group Therapy: - ______: the verbal and nonverbal communication that occurs during group sessions - ______: the way the group behaves during sessions; it provides structure for the group EX: raise hand for recognition, sit in the same seat - ________: a group in which all members share a certain chosen characteristic

- Group Process - Group Norm - Homogenous Group

3 main categories of risk factors for suicide include: - - -

- Health:health issues - Environmental: access to mean to commit suicide, prolonged stress in relationship, bullying, loss of employment - Historical: previous attempts or family hx of suicide, adverse childhood events

Sullivan: Stages of Interpersonal Development: ICJPA -

- Infancy: birth to 1 1/2 years: mother relieves tension. Anxiety in mother yields anxiety in child. learn to count on others for satisfaction - Childhood: 1 1/2 to 6 years: beginning to develop self-esteem. Learn to delay satisfaction of wishes with relative comfort - Juvenile: 6 to 9 years: develop satisfying interpersonal relationships with peers that involve competition and compromise - Preadolescence 9 to 12 years: develop intimate relationships with person of same sex. Learn to care for others of the same sex - Adolescence: 12 to 20 years: establish satisfying relationships with opposite sex, intimate and long-lasting relationships Erickson: Sullivan: Piaget: 1. birth-1 1/2 birth-1 1/2 birth- 2 2. 1 1/2 - 3 1 1/2 - 6 2 - 6 3. 3 - 6 6 - 9 7 - 11 4. 7 - 11 9 - 12 12 - adulthood 5. 12 - 18 12 - 20 6. 18 - 35 7. 35 - 65 8. 65 - death

Erickson personality development theory: - Task: develop a basic sense of trust that leads to hope - Task: integrate all the tasks previously mastered into a secure sense of self - Task: derive meaning from one's whole life

- Infancy: birth to 1.5 years (trust vs mistrust) - Adolescence: 12 to 20 years (identity vs role confusion) - Senescence: 65 years to death (integrity vs despair)

Types of Admission to Mental Helth Facility: - This type of admission is the least restrictive and the client is free to leave the hospital at any time, even against medical advice - In this type of admission the patient is considered competent and has the right to refuse medication and treatment. Before release, the patient may be evaluated and if deemed necessary the care provider can initiate an involuntary admission - Temporary Emergency Admission: client is admitted due to inability to make decisions regarding care. The medical health care provider can initiate the admission which is then evaluated by a mental health care provider. The length varies by client's needs and state laws but often is not to exceed ____ days

- Informal Admission - Voluntary Admission - 15 days

Theories of Psychiatric Care: - _____ theory focuses what occurs between people as opposed to psychoanalytical theory which is rooted in what occurs in the mind - _____ therapy is a hands-on system in which therapists actively guide and challenge maladaptive behaviors and distorted views. The premise for this work is that people are aware of their dysfunctional patterns and unrealistic expectations

- Interpersonal Theory (Sullivan) - Interpersonal Therapy

Cognitive and Intellectual Assessment: - Assess the clients ______ based on the client;s answer to a hypothetical question. EX: what would you do if the room was on fire - Assess the clients ability to _______ by asking the client to interpret a cliche.

- Judgement - think abstractly

Mental Status Exam: (Levels of Consciousness:) - Alert - _____: client is able to open their eyes and respond but is drowsy and falls asleep readily - _______: the client requires vigorous or painful stimuli to elicit a brief response. Might not be able to respond verbally - ______: the client is unconscious and does not respond to painful stimuli

- Lethargic - Stuporous - Comatose

What are the roles group members can take during group therapy?

- Maintenance Role: help maintain the purpose and process of the group - Task role: such as recorder who takes notes - Individual Role: these roles tend to prevent teamwork. These individuals take on roles to promote their own agenda

These types of NCD's are progressive and irreversible

- Major Neurocognitive disorders

Dysfunctional Family Characteristics: - ______: members use dishonesty to support their own agenda - _____: one member takes responsibility for problems to keep peace at all costs - ______: members use overall descriptions (Always, Never) in describing family encounters Others include: Blaming and Distracting

- Manipulating - Placating - Generalizing

What are some Techniques to control pain, tension, and anxiety? Other techniques include: - _______: exposing a client, while in the company of a therapist, to a great deal of undeisrable stimulus in an attempt to turn off the anxiety response - _______: preventing a client from performing a compulsive behavior with the intent that anxiety will diminish - _______: teaching a client when negative thought or compulsive behaviors arise, to say or shout, "STOP" and substitute a positive thought - ________: useful for clients with neurocognitive disorders. It is a process of communication with a disoriented older adult client by respecting and validating their feelings in a time or place that is real to them, even though it does not relate to reality

- Meditation - guided imagery - diaphragmatic breathing - muscle relaxation - biofeedback - Flooding - Response Prevention - Thought Stopping - Validation Therapy

Levels of Anxiety: _________: - occurs in normal experienc of everyday living - it increases one's ability to perceive reality - has an identifiable cause - client may exhibit tension-relieving behaviors such as foot-tapping, fidgeting, lip biting

- Mild Anxiety

- _______: a therapist or others serve as role models for a client who imitates them to improve behavior. This method can be used in the acute therapeutic milieu to help clients improve interpersonal skills

- Modeling

In ____ culture, avoiding eye contact is a sign of respect

- Native American

A _______ is a chemical messenger between neurons by which one neuron triggers another

- Neurotransmitter

Anxiety: - _______: This type of anxiety is a healthy life force that is necessary for survival, it motivates people to take action - ______: This type of anxiety is precipitated by an imminent loss or change that threatens one's sense of security - ______: This type of anxiety is one that usually develops over time, often starting in childhood. Client may display their anxiety in physical manifestations (fatigue, frequent headaches)

- Normal Anxiety - Acute (immediate state) - Chronic (sustained trait)

Types of Families: - _______: include children who reside with parents - _______: include children who live with a single adult that can be related or nonrelated to the children - ______: include children who live with 1 biological or adoptive parent and a nonrelated step parent who are married - ______: include children who live with 1 biological or adoptive parent and related adult who is not their parent (aunt, uncle) - ______: include children who live with 1 biological parent and a NONRELATED adult who are cohabitating - ______: include children living with nonrelated adults who are not their parents

- Nuclear Family - Single-Parent Families - Blended Families - Extended Families - Cohabitating Families - Other Families

- ________: with this the client receives positive rewards for positive behavior

- Operant conditioning

Community Based Mental Health Programs: - This program provides intense short-term treatment for clients who are well enough to go home each night and who have a responsible person at home to provide support and safe environment. Certain DETOXification Programs may use this program - This program includes nontraditional case management and treatment by an interprofessional team for clients who have severe mental illness and are noncompliant with traditional treatment. It helps reduce recurrences of hospitalizations and provides crisis intervention, assistnace with independent living, and information regarding resources for support services

- Partial Hospitalization Program - Assertive Community Treatment (ACT)

Defense Mechanisms: (Immature) - _______: seen when an individual deals with emotional conflict or stressors by indirectly and unassertively expressing aggression toward others - ________: an individual addresses emotional conflicts or stressors by actions rather than by reflections or feelings. Person may lash out in anger verbally or physically to distract the self from threatening thoughts or feelings. Destructive coping style

- Passive Aggression - Acting-Out Behaviors

With both Mild neurocognitive and Major neurocognitive disorders there is evidence of cognitive decline from the previous level of performance in one or more of the cognitive domains - What are the cognitive domains? P CELLS

- Perceptual/Motor ability - Complex attention - Executive Function - Language - Leaning and Memory - Social cognition

Theories of Psychiatric Care: (Behavioral) _________ Therapy: - emphasis is on self-awareness and the present because the past has already happened and the future has not yet occures. - The role of the therapist is that of a non directive facilitator who seeks clarification and provides encouragement in the process - 3 essential qualities in the therapist are _____, _____ and _____

- Person-Centered Therapy (Humanistic Model) - congruence (genuineness), empathy, and respect

______ is the process of adapting and changing as gray matter shrinks and thickens and connections are pruned or forged

- Plasticity

Erickson personality development theory: - Task= achieve a sense of purpose and develop a sense of mastery over task - Task: gain self control (potty training) of and independence within the environment - Task: gain a sense of self-confidence and recognition through learning, competing, and performing successfully

- Play age: 3 to 6 years (initiative vs guilt) - Early childhood: 1.5 to 3 years (autonomy vs shame) - School age: 6-12 years (industry vs inferiority)

What are some things the client be able to state/perform to show that are successfully adapting to role and life changes?

- Positive coping behaviors - maladaptive coping behaviors - participate in community resources - list stress reduction techniques - maintain housing and employment

Piagets Stages of Cognitive Decelopment: - Which stage: * representing things with words and images but lacking logical reasoning * pretend play, egocentrism - Which stage: * abstract reasoning, potential for moral reasoning - Which stage: * thinking logically, grasping analogies, performingh arithmetical operations * conservation - Which stage: * experiences world through senses and actions, object permanence, stranger anxiety

- Preoperational: age 2-6 - Formal Operational: age 12 - adulthood - Concrete Operational: age 7-11 - Sensorimotor: age birth - 1 1/2

There are 3 levels of prevention used by nurses when implementing community care interventions: - _________: promotes health and emphasizes efforts on preventing mental health problems from occuring EX: teach stress reduction techniques - _______: focuses on early detection of mental illness EX: screen older adults for depression - _______: focuses on rehab and prevention of further problems in clients who have previous diagnoses. Mental illness is present and the goal is to prevent further deterioration or complications EX: lead support froup for clients who have completed a substance use program

- Primary - Secondary - Tertiary

Major Neurocognitive Disorders: - Primary vs Secondary:

- Primary= 80%, it is irreversible, progressive and there is no known cure - Secondary: may have a reversible component, treatment of cause may show improvements in dementia

Cognitive Restructuring - ______: assists clients to identify what requires priority (devoting energy to pleasurable activities) - _______: helps clients write down stressful thoughts and has a positive effect on well-being - ______: teaches clients to express feelings, and solve problems in a nonaggressive manner - _______: helps clients to be aware of negative thinking

- Priority Restructuring - Journal Keeping - Assertiveness Training - Monitoring Thoughts

Defense Mechanisms: (Immature) - ________: a person unconsciously rejects emotionally unacceptable personal features in one's self and attributes those unacceptable traits to other people, objects, or situations. This is the HALLMARK of BLAMING, scapegoating, prejudicial thinking, and stigmatization. The pain/anxiety is projected to someone else. These people project onto others those characteristics in themselves that they find distasteful and cannot consciously accept

- Projection

Effective communication skills and techniques: - _____ these type of questions use "what if" or similar to assist clients in exploring feelings and to gain greater understanding of problems and possible solutions - _____: these type of questions explore the client's life goals or motivations by presenting a hypothetical situation in which the client no longer has the mental health disorder - What are some clarifying techniques? - What are some barriers to effective communication?

- Projective Questions - Presupposition Questions - Restating - Reflecting (direct the focus back to the client in order for the client to examine his feelings) - Paraphrasing - Exploring (allows the nurse to gather more information) - giving advice, giving false reassurance, asking "why" questions, minimizing feelings

Models of Psychiatric Care: - _____ Model: based on unconscious motivations and the interplay between the primitive brain (ID), the sense of self (ego), and the conscience (superego) - ____ model: maintains that health disorders are created by social forces and interpersonal experiences - ____ model: suggest behavior is learned and that behavior therapy should improve behavior through rewards and reinforcement - _____ model: based on human potential and therapy is aimed at maximizing that potential. Maslow's hierarchy - ____ model: disorders are the result of faulty thinking and this kind of therapy focuses on the recognition of distorted thinking

- Psychanalytical Model - Interpersonal Model - Behavior Model - Humanist Model - Cognitive Model

Types of Psychotherapy: - ________: employs the same tools as psychoanalysis, but focuses more on the client's present state, rather than their early life. This therapy tends to last longer than other treatment approaches - _______: assists clients in addressing specific problems. Can improve interpersonal relationships, communication, role-relationships, and bereavement. The premise of this type of therapy is that many mental health disorders are influenced by interpersonal interactions and the social context. The goal is to improve interpersonal and social functioning

- Psychodynamic Psychotherapy - Interpersonal Psychotherapy

This type of therapy involves more verbal therapist-to-client interaction than classical Psychoanalysis. The client and the therapist develop a trusting relationship to explore the client's problems

- Psychotherapy

Interventions for patients with neurocognitive deficits: - _____ consist of providing the correct information to the patient about place, date, and current life circumstances - If a patient says she needs to return home to care for her children, do not tell that patient that her children are all grown up and that she no longer has a home. Instead, ask the patient "tell me more about your children"

- Reailty Orientation

Defense Mechanisms: (Intermediate) - _______: the exclusion of unpleasant or unwanted experiences, emotion, or ideas from conscious awareness. This is considered the CORNERSTONE of the defense mechnanism and it is the first line of psychological defense against Anxiety EX: forgetting the name of a former girlfriend, forgetting an appt to discuss poor grades

- Repression

Medications for Suicide: ___________: - have decreased risk of lethal toxicity - can take 1 to 3 weeks for therapetuic effect and up to 2 months for maximal response - do not abruptly stop taking these meds - adverse effects include N/V, headache. and CNS stimulation - sexual dysfunction can occur - follow healthy diet, weight gain can occur

- SSRI's (citalopram, fluoxetine, sertraline)

Concepts related to Dysfunctional Families: - ________: a member of the family with little power is blamed for problems within the family - _______: a 3rd party is drawn into the relationship with two members whose relationship is unstable. - ________: emotional issues or themes within a family that continue for at least 3 GENERATIONS

- Scapegoating - Triangulation - Multigenerational Issues

What are the 2 main brain lesions present in Alzheimers Disease?

- Senile Plaques and Neurofibrillary Tangles

Which neurotransmitter is important as it pertains to suicide?

- Serotonin

_____ refers to a client's internal values, sense or morality, and how the client views the purpose of life ______ refers to a client's beliefs according to an organized set of patterns of worship and rituals

- Spirituality - Religion

- _________: planned, progressive exposure to anxiety-producing stimuli in real life situations, or by imagining events that cause anxiety. The client will use relaxation techniques to suppress anxiety response

- Systematic Desensitization

Brain Structures: - The ____ filters sensory information before it reaches the cerebral cortex. Disrupted sensory filtering in schizophrenia is associated with altered connections between the thalamus and prefrrontal cortex - The _____ maintains homeostasis. It regulates temperature, blood pressure, perspiration, libido, hunger, thirst, and circadian rhythms

- Thalmus - Hypothalmus

What are 2 methods that have been impemented to reduce the use of seclusion and restraints?

- The recovery model - Trauma-informed approach

A _____ provides a healthy social structure within an inpatient setting or structured outpatient clinic. Groups aim to help increase patient's self-esteem, decrease social anxiety, encourage appropriate social behaviors and educate patients in basic living skills such as good hand washing.

- Therapetuic milieu (Examples of therapeutic milieu groups include recreational groups, physical activity groups, creative art groups, and storytelling groups)

Theapeutic Relationship: (psychoanalysis) - ______ occurs when the client views a member of the health care team as having characteristics of another person who has been significant to the client's personal life. This is more likely to occur with a person in authority * EX: client may demonstrate jealousy of the nurses time/attention, client expects exclusive services from the nurse - ________ occurs when a healthcare team member displaces characteristics of people in their past onto a client. EX: nurse overly identifies with a client, nurse argues with a client

- Transference - Countertransference

Erickson's Psychosocial Development Theory: - 8 predetermined life stages 1. Infancy: birth to 1 1/2 years: 2. Early childhood: 1 1/2 to 3 years: 3. Play Age: 3 to 6 years: 4. School Age: 6-12 years 5. Adolescence: 12 to 20 years: 6. Young Adulthood: 20-30 years: 7. Adulthood: 30 to 65 years: 8. Senescence: 65 years to Death:

- Trust vs Mistrust: develop basic sense of trust that leads to hope - Autonomy vs Shame/doubt: develop confidence in physical and mental abilities - Initiative vs Guilt: interest in socially appropriate goals leads to a sense of purpose - Industry vs inferiority: develop healthy competitive drive that leads to confidence - Identity vs Role Confusion: develop sense of self - Intimacy vs Solidarity: Love and be loved - Generativity vs Self-absorption: interest in nurturing subsequent generations creates a sense of caring, contributing and generativity - Integrity vs Despair: acceptance of mortality

Defense Mechanisms: (Intermediate) - _______: performing an action to make up for a previous behavior EX: giving a gift to someone after an argument - _______: justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations for the behavior. It is a form of self-deception

- Undoing - Rationalization

Stages of Violence: - Preassaultive Stage: - the patient becomes increasingly agitated - _______ are frequently sufficient during the stage - The use of empathetic statements can aid in reducing anxiety and anger. " it sounds like you are in pain and confused. You're here to get help and we're going to figure outs what going on. Let us help you, dont be afraid."

- Verbal interventions

Erickson personality development theory: - Task: form intense long-term relationships and commit to another person, cause, institution - Task: achieve life goals and obtain concern and awareness of future generations

- Young adulthood: 20 to 30 (intimacy vs isolation) - Adulthood: 30 to 65 (generatively vs self-absorption

Voluntary nor Involuntary admission to a mental facility does not determine whether a patient is capable of making informed decisions about their health care The determination of legal competency is made by the courts. If the courts rule to the patient to be legally incompetent then a guardian may be appointed. - What is the difference between a guardian and a power of attorney?

- a POA may make decisions on behalf of an individual but generally does not override that individual's decisions - A guardian has control over all medical, financial, and personal decision making

Alzheimers Disease medications: (mild to moderate) - It is hypothesized that symptoms of AD are associated with low levels of ______ - The current FDA approved cholinesterase inhibitors are: * Galantamine * Rivastigmine (exelon) * Donepezil (Aricept) - These medications are effective in slowing down the progression of AD for a limited period of __ to ___ months - What are the common side effects? (moderate to severe) - _______ is an antagonist at the NMDA-glutamatergic receptor, which is associated with memory and learning. This drug works by regulating glutamate and inhibiting the toxic effects of the excess influx of ______ that causes neurodegeneration - _____ is composed of both donepezxil and memantine and is targeted to treat moderate to severe stages of AD.

- acetylcholine - 3 to 6 months - GI: n/v, diarrhea, loss of appetite - Memantine (Namenda) - calcium - Namzaric

- after attaching to a receptor and exerting its influence on the postsynaptic cell, the transmitter separates from the receptor and is destroyed. Some transmitters are destroyed by specific enzymes EX: acetylcholine is destroyed by the enzyme __________ EX: monoamine transmitters (norepinephrine, dopamine, serotonin are destroyed by the enzyme _______ - Other transmitters are taken back into the cell from which they were originally released by a process called ________

- acetylcholinesterase - monamine oxidase - cellular reuptake

Risk factors for neurocognitive disorders and Alzheimer's:

- advanced age - prior head trauma - cardiovascular disease - diabetes - depression - lifestyle factors - family hx of alzheimers : STRONG genetic link

Neurotransmitters: (Histamine) - Functions= - Decrease in levels causes=

- alertness, inflammatory response, stimulates gastric secretion - sedation, weight gain

Spirituality and Religion role in mental health: -

- altered state of consciousness such as those achieved through mysticism, meditation, and mindfulness can be spiritualluy enriching and bring peace and serenity but should not be confused with dissociateve states caused by trauma - prayer - storytelling: can use a metaphor to offer a social message, create a narrative to help a child understand and cope with trauma, or help older adults reconnect with positive memories from the past

Stress: - Stress is the body's nonspecific response to any demand made upon it - Stress is the brain's natural response to any demand - What kind of stressors produce a biological response? - What are 2 damaging stressors that cause distress?

- any kind: good or bad - anxiety and anger

What are expected findings with Acute Stress (fight/flight)? What are expected findings with prolonged stress (maladaptive)?

- apprehension, unhappiness or sorrow, decreased appetite, increased RR HR BP and cardiac output, increased metabolism and glucose use, depressed immune system - chronic anxiety or panic attacks, depression, chronic pain, sleep disturbances, weight gain/loss, increased risk for MI/stroke, poor diabetes control, HTN, fatigue, irritability, decreased ability to concentrate, increased risk for infection

Cognitive and intelluctual assessment: - Assess the clients memory: - Immediate memory assessment would be _______ - Recent memory assessment would be _______ - Remote memory assessment would be _____

- ask cient to repeat a series of numbers or list of objects - ask client to recall events from earlier in the day or ask if they know the purpose of the current health appointment - ask the client their birthdate or mothers maiden name

When talking with a patient with escalating anger, how should the nurse and the patient be seated while talking?

- at a 45-degree angle. This puts the nurse on the same level but allows for frequent breaks in eye contact

NCD Medications: Cholinesterase inhibitors (Donepezil, rivastigmine, galantamine) * these meds improve the ability to perform self-care and slow cognitive deterioration of Alzheimer's in mild-to-moderate stages * increases the amount of acetylcholine at cholinergic synapses by inhibiting its breakdown by acetylcholinesterase. - Administer this medication at what time in the day? - Adverse effects include: - Contraindications: - What medications can reduce therapeutic effects of Donepezil?

- at night - nausea, vomiting, diarrhea, bradycardia, syncope - asthma, or COPD. Avoid NSAIDS (bleeding) - antihistamines, tricyclics, antipsychotics

Types of Psychotherapy: (Behavior Therapy) - this type is based on the theory that behavior is learned and has consequences - Abnormal behavior results from an attempt to _________ - Behavior therapies teach clients ways to decrease anxiety or avoidant behavior and gives clients an opportunity to practice techniques - Involves relaxation training and modeling - Behavior therapy has been used to successfully treat phobias, substance use or addictive disorders

- avoid painful feelings

Suicide: - Indirect Self-destructive Behavior = _______ - Direct self-destructive behavior= _______

- biting nails, pulling hair, scratching/cutting, alcohol, drug use. Self injury is an undesired effect. These acts are done as a coping mechanism for low self-esteem - Suicide

Healthy Families have what type of boundaries? Dysfunctional Families have what type of boundaries?

- clear and distinguishable. They define the roles of each member and are understood by all - Enmeshed: thoughts, roles, and feelings blend so much that individual roles are unclear - Rigid: rules and roles are completely inflexible. Members tend to isolate and not share thoughts or feelings

This therapetuic strategy consists of: - modeling - systemic desensitization - operant conditioning

- cognitive and behavioral therapies

Tools for determining Suicide Risk: - Modified SAD Persons Scale - Suicidal Assessment Five Step Eval and Triage SAFE-T:

- commonly used in ED and helps staff quickly evaluate the urgency of referral to mental health. A score greater than 8 needs immediate inpatient treatment - 5 steps include: 1. Identify risk factors 2. identify protective factors 3. conduct suicide inquiry 4. determine risk level/intervention 5. document

De-escalation technique for violent patient: - Direct Approach: describe the consequences (medications, restraints, seclusion). Best for which type of patients? - Indirect Approach: give the patient a choice. "you have a choice. You can take this medication and go into the interview room and talk, or you can sit in the seclusion room until you feel less anxious." This approach is best for which type of patients?

- confused or psychotic patients - patients that are NOT confused

Anatomical changes in the brain seen with AD include:

- cortical atrophy in areas involved in higher-level functioning such as thinking, planning, speech, remembering - damage to the hippocampus, an area of the cortex that plays a key role in the formation of new memories - increase in size of ventricles due to loss of brain tissue

To be eligible for APS (adult protective services) help in most states requires an older adult who has been deemed unable to care for himself Elder abuse is most often diagnosed in older adults who have: ______ which compounds an older adult's vulnerability and draws attention to the person's situation

- depression - alcohol/drug abuse - dementia - psychiatric illness

What are some describing characteristics of a "Serious Mental Illness"?

- disorders that are severe and persistent - clients often habe difficulty with ADL's - lifelong disorders that can have remissions and exacerbations

Reducing the patient's anxiety: - Provide comfort items such as decaffeinated coffee, deck of cards before they are requested. This can build rapport and act symbolically to reassure the patient. - Interventions for patient with anxiety might include the use of distractions such as magazines, comic books, and video games. Generally what kind of distractions work best? - Anxiety can also be minimized by reducing ______. This strategy includes clear and concrete communication.

- distractions that are colorful and do not require sustained attention - Ambiguity

NCD Medications: memantine (Namenda) * blocks the entry of calcium into nerve cells, thus slowing down brain-cell death * approved for moderate-to-severe stages of Alzheimers * can be used concurrently with a cholinesterase inhibitor - Common side effects include:

- dizzy, headache, confusion, constipation

Most psychtropic drugs produce effects by altering synaptic concentrations of: - - - - -

- dopamine - norepinephrine - serotonin - histamine - acetylcholine - GABA - Glutamate

Specific mental health issues where health care professionals can break confidentiality include: - -

- duty to warn and protect third parties - reporting of child and vulnerable adult abuse

Interventions for patients with neurocognitive deficits: - Steps to dealing with a patient having a Catastrophic Reaction: -

- face the patient from within 2 feet, remain calm and unhurried - say the patients name - gain eye contact - smile - repeat these steps if needed - use gentle touch and keep voice soft - ask patient if they need to use the bathroom - help patient regain a sense of control- ask what is needed - validate the patients feelings: "You look upset. This can be a confusing place" - use short simple sentences - decrease sensory stimulation - get the patient to use rhythmic sources of self-stimulation such as humming, a rocking chair

Neurotransmitters: (DOPAMINE) - Functions= - Increase in levels causes= - Decrease in levels causes=

- fine muscle movement, integration of emotions and thoughts, decision making, stimnulates hypothalmus to release hormones - psychosis, mania - parkinsons disease, depression

Levels of Anxiety: MILD: - occurs in the normal experience of everyday living - increases one's ability to perceive reality - there is an identifiable cause - vague feeling of mild discomfort, restlessness, irritability, impatience, and apprehension - The patient can exhibit mild tension-relieving behaviors such as __________

- finger or foot-tapping, fidgeting, lip-chewing

This therapetuic strategy consists of: - assisting client with cessation of smoking - monitoring other health conditions

- health promotion and health maintenance

Brain Structures: - Limbic System ("emotional brain") consists of what structures?

- hippocampus, amygdala, hypothalmus, thalamus

Identify the 4 M's when caring for the elderly: - - - -

- identify what MATTERS - consider MENTATION and provide approproate supports - encourage MOBILITY - MEDICATION should be optimized to reduce poly pharmacy and overmedication

No-Suicide Contract: - it is a verbal or written agreement made to not harm themselves, but to instead seek help - not legally binding - can be beneficial but it should not replace other prevention methods - can be used as a tool to maintain trust between the nurse and client - it is DISCOURAGED for clients who are: _____________

- in crisis under the influence of substances psychotic very impulsive very angry/agitated

What is the main difference in the criteria to diagnose Mild vs Major Neurocognitive Disorder?

- in mild there is no interference with performing ADL whereas in Major there is

DSM-5 includes information related to culture in the discussion of each individual disorder how?

- in the glossary of cultural concepts of distress - by providing the CFI (Cultural Formulation Interview)

Mechanical Restraints are avoided in which type of patients? After seclusion or restrained, the patient must be evaluated within ___ by a physician or licensed independent practitioner

- individuals with a history of sexual abuse and trauma - individuals at risk for positional asphyxia, sudden cardiac collapse - 1 hour

Psychoanalysis: - a therapeutic process of assessing unconscious thoughts and feelings - clients attend many sessions over the course of MONTHS to YEARS - Due to the __________ and ________, classical psychoanalysis is unlikely to be the sole therapy of choice - Freud contended that internal conflicts always occured due to what? Therapeutic Tools used in Psychoanalysis: - Use of Defense Mechanisms - ______ are a common focus for therapy and to uncover unconscious conflicts - ______ is the spontaneous, uncensored verbalization of whatever comes to a client's mind - Freud believed that __________ to be urges and impulses of the unconscious mind that played out throught the dreams of clients

- length of the therapy and insurance constraints - early childhood experiences - Past relationships - free association - Dream analysis and interpretation

What are some stress standardized screening tools?

- life-changing events questionnaire (Holmes and Rahe stress scale) to measure life change units - Perceived Stress Scale - Lazarus's Cognitive Appraisal

Brain Structures: Linking the frontal cortex, basal ganglia, and upper brainstem, the _______ system mediates thought and feeling through complex bidirectional connections. - Antianxiety drugs slow the ____ system

- limbic - limbic

Milieu characteristics that are conducive to violence include: -

- loud - overcrowding - staff inexperience - provocative or controlling staff - poor limit setting - staff inconsistencies

Psychological theories focus on the abuser having personality traits that cause abusive behavior. Psychological Factors that correlate with domestic violence include: -

- low self-esteem - poor problem solving skills - history of impulsive behavior - hypersensitivity (sees self as victim) - narcissism

What are some relaxation techniques used for stress?

- meditation/prayer - guided imagery - breathing exercises - progressive muscle relaxation: a person trained in this method can help client attain complete relaxation within a few minutes - physical exercise: causes release of endorphins that lower anxiety, promote relaxation, and have antidepressant effects

Brain Structures: - Brainstem: - basic life functions occur through the brainstem, composed of what 3 parts? - through projections called ______, the brainstem sets the level of consciousness and regulates the cycle of sleep and wakefulness

- midbrain, pons, and medulla - reticular activating system (RAS)

_______ is a syndrome in which there is a decline in the previous level of cognitive function but no significant impairment of functioning. These people are at greater risk for developing dementia

- mild cognitive impairment (MCI)

What are the 2 most frequent factors contributing to the escalation of violence?

- minimization of angry behaviors - ineffective limit setting

What are some cognitive/behavioral therapies used in mental health?

- modeling - operant conditioning - systemic desensitization

Neurotransmitters: (Norepinephrine) - Functions= - Increase in levels causes= - Decrease in levels causes=

- mood, attention and arousal, stimulates sympathetic branch of autonomic nervous system - psychosis, mania, anxiety - depression

Neurotransmitters: (Serotonin) - Functions= - Increase in levels causes= - Decrease in levels causes=

- mood, sleep regulation, hunger, pain perception, aggression and libido, hormonal activity - anxiety states - depression

Therapies to lessen behavioral symptoms in patients with AD: - Sensory interventions include: - Active therapy/structured activities: -

- music therapy - Dementia mapping: observation of a person with dementia over a period of time for the purpose of determining patient-centered care - massage - therapeutic touch - multisensory stimulation - music therapy - light therapy - pet therapy - hearing aids - dancing, exercising, social interaction, art therapy, walks

Rape/ Sexual Assault Documentation: - document physical injuries in _____ and _____ form, using body maps or photographs - document subjective data using the clients __________

- narrative and pictorial - Verbatim statements

Is there laws requiring mandatory reporting for crimes of sexual assault?

- no, unless they involve abuse of a minor or elder

What are some risk factors for Alzheimers Disease?

- older age - female - cardiovascular disease - depression - diabetes - low socioecominc status - genetics

Milieu Therapy consists of: -

- orienting the client to the physical setting - identifying rules and boundaries of the setting - ensuring a safe environment for the client - assist the client to participate in activities

The elder ABUSER: - most often to abuser is a middle-aged adult child or other family member and is often financially dependent on the older adult - The abuser's personality may be similar to abuser in other categories OR it could be a caregiver who is under extreme stress: (caregiver stress, caregiver anxiety) - In nursing facilties, who is often the ABUSER?

- other residents (but could also be a staff member)

Patients concerned that they may be subject to involuntary psychiatric commitment can prepare an Advance Psychiatric Directive This document can include things such as:

- patients choice of a surrogate decision maker - hospital choices - medications and treatment options - emergency interventions - individuals to be notified when they are hospitalized and who are allowed to visit

Crisis Assessment: - after determining whether there is a need for safety interventions because of suicidal or homicidal ideation or gestures, the nurse should assess what 3 main areas?

- patients perception of the event - patients available supports - patients usual coping skills

SANE (sexual assault nurse examiner) are forensic nurses who have been certified to work with victims of sexual assault. Some of their functions include: - ** Most rural communities dont have a trained SANE nurse and this would require the patient to be transferred to the inner city to be evaluated

- perform physical exam of the survivor - collect forensic evidence - provide expert testimony - support psychobiological needs of the survivor - be part of the SART - work closely with law enforcement agencies

What are some protective factors that increase a client's resiliency, or ability to resist the effects of stress?

- physical health - strong sense of self - optimism - religious/spiritual beliefs - hobbies or other outside interests - satisfying interpersonal relationships - strong social support systems - humor

Risk factors for Delirium:

- physiological changes (parkinsons or huntingtons disease) - metabolic disease (hepatic or renal failure, fluid and electrolyte imbalances, nutritional deficiencies) - cardiovascular disease - infections (HIV/AIDS) - substance use or withdrawal - older age - multiple co-morbidities = polypharmacy - ICU's, surgery, aphasia, restraint use, environment change

The Recovery Model:

- places emphasis on rehabilitation and recovery. It is focused on helping individuals develop the knowledge, attitudes, and skills they need to make good choices or change harmfull behaviors - The concept of recovery refers primarily to managing symptoms, reducing psychosocial disability, and improving role performance - Madates include: 1. mental health care is to be consumer and family driven, with patients being partners in all aspects of care 2. care must focus on increasing consumer success in coping with lifes challenges and building resilience, not just managing symptoms 3. an individualized care plan is to be at the core of consumer centered recovery

Neurotransmitters: (Glutamate) excitatory neurotransmitter - Functions= - Increase in levels causes= - Decrease in levels causes=

- plays a role in learning and memory - prolonged increase can kill neurons, neurodegeneration in Alzheimers disease - psychosis

Neurotransmitters: (Acetylcholine) - Functions= - Low levels of acetylcholine are found in what diseases?

- plays role in learning, memory. Regulates mood: mania, sexual aggression. Affects sexual and aggressive behavior. Stimulates parasympathetic nervous system - alzheimers, huntingtons, and parkinsons disease

Societal and Cultural Risk factors for abuse include: - The classic frustration-aggression theory proposes that when frustration is high in response to negative societal situations, frustration leads to aggression The patriarchal theory (feminist theory) holds the view that male dominance in our political and economic structure exists to enforce the differential status of men over women.

- poverty/unemployment, inadequate resources or overcrowding, social isolation, substance abuse, early parenthood, inadequate coping skills, family members with chronic health conditions

Types of Admission to Mental Helth Facility: INVOLUNTARY ADMISSION: - the criteria for an involuntary admission include: - The number of physicians required to certify that the client's condition requires commitment varies from state to state but is usually ____. This can be imposed by a family member, legal guardian, PCP, or mental health provider - The client can request a legal review of the admission at any time - An involuntary admission is limited to ___ days at which time a psychiatric and legal review of the admission is required

- presence of medical illness - poses danger to self or others - demonstrates severe disability or inability to meet basic necessities including food, clothing, and shelter - requries treatment but unable to seek it voluntarily related to the impact of the mental illness - 2 - 60 days

Depression in later life responds well to: - - - -

- psychosocial treatments: group exercises - talk therapies - establishment of social support systems - ECT : used for intractable depression. it is extrememly effective however it is time-consuming, and carries unwanted side effects of memory impairment and exposure to strong IV meds - antidepressants

Indicators for domestic violence include:

- recurrent ED visits for physical injuries attributed to being caused by accidents - somatic symptoms reflecting anxiety such as hyperventilation, GI distress, hypertension, insomnia, nightmares, and eczema or hair loss - signs of depression

Neurotransmitters: (GABA) Inhibitory neurotransmitter - Functions= - Increase in levels causes= - Decrease in levels causes=

- reduces anxiety, excitation, aggression. May play role in pain perception. Anticonvulsant and muscle relaxing - reduction in anxiety - psychosis, mania, anxiety

What is the focus of a group in an acute mental health setting? What is the focus of a group in the outpatient setting?

- relief - growth

Home safety measures for clients with NCDs: -

- remove rugs - install door locks that cant be easiily opened - lock water heater temperature and turn down to a safe level - provide good lighting, especially on stairs - install a handrail on stairs and mark sharp edges with colored tape - remoive clutter - secure electrical cords to baseboards - install cleaning supplies in locked cupboards

An involuntary commited patient still has the right to: - What rights may be revoked from a patient?

- retain freedom from unreasonable bodily restraints - right to treatment - right to refuse treatment - right to informed consent - right to refuse medication - right to use telephone if making threats on the phone - right for freedom to move around within the facility if neeed for safety reasons - right for privacy if needed for safety reasons

The nurse should be positioned between the patient and the door but NOT directly in front of the patient of in front of the doorway. This can be interpreted as confrontational and the patient may feel trapped. Having enough staff is essential for _________ and is often enough to avert confrontation

- show of strength

Reasons alcohol is more dangerous in older adults: -

- slowed metabolism - decreased tolerance for effects of alcohol - increased sensitivity to alcohol in the brain - decline in lean muscle mass and increase in fatty tissue can contribute to higher blood alcohol levels - decreased dexterity, balance, and flexibility can increase likelihood of falls, burns, or other accidents - injuries heal more slowly

child abuse: - a suspicion and not confirmation of child abuse is all that is necessary to file a report - Who are considered mandatory reporters and must report abuse to child protective services?

- teachers, clergy, nurses, and other healthcare providers

Current drug treatments for Alzheimers Disease are based on which hypothesis?

- the Cholinergic Hypothesis: altered functioning of cholinergic receptors in multiple areas of the brain is the cause of cognitive inpariement

Antidepressant Therapy: - In choosing a drug to treat depression in the older adult, the primary emphasis is placed on ________ - start with about half the normal adult dose for older patients - ____ are typically the first-line medication used but can cause increase in fractures - _______ have more cardiac and anticholinergic effects. This class has a higher rate of stopping treatment due to their side-effect profile

- the avoidance of side effects - SSRI's - Tricyclic antidepressants

Seclusion and Restrains: - How must the provider perscribe the order for seclusion or restrains? - Time limit for seclusion/restrains: - Age 18 and older = - Age 9 to 17= - Age 8 and younger=

- the order must be in writing - 4 hours - 2 hours - 1 hour

Post Assualtive Stage: - During this stage, who should review the incident?

- the staff members should review the incident mong themselves as well as with the patient * Reviewing the incident with the patient allows them to learn from the situation, identify stressors that precipitated the out of control behavior and plan alternative ways of responding

Neurocognitive Disorders are a group of conditions characterized by the disruption of: - - -

- thinking - memory - processing - problem-solving

mental illness is defined as changes in a person's _____, _____, and ____ Symptoms of a mental illness will be shown by the patient's: - - - -

- thinking, behavior, and mood - thoughts, mood, behavior, speech

Trauma-Informed Care:

- trauma informed care recognizes that trauma is almost universally found in the histories of mental health patients and is a contributor to mental health issues, substance abuse, chronic health conditions, and contact with the criminal justice system - main concept is asking the question "What has happened to you?" Key principles include: 1. avoiding retraumatizing through constraints or coercive practices 2. an open and collaborative relationship between patient and provider 3. empowerment 4. cultural respect

Most ED protocols for sexual assault will include: -

- treatment of physical injuries - STI prophylaxis - pregnancy prevention: emergency contraception - Tetanus: if open wounds present - hep b if not previously vaccinated - forensic evidence collection - counseling

Domestic violence is normally thought of as occuring between more powerful (perpetrator) and less powerful (victim) family members. However, this type of abuse can also be perpetrated by a ____________

- trusted authority figure such as a religious leader, caregiver, helth care provider, teacher, or coach

Communication with children: Communication with Adolescents: Communication with older clients:

- use simple straightforward language, children are sensitive to nonverbal communication, position yourself at the childs level, incorporate play in interactions, be aware of the child's development - determine how to adolescent perceives the mental health diagnosis. Are they at risk for refusal of treatment due to a desire to be "normal"? Identify if the mental health diagnosis affects the client;s relationship with their peers - Client might require amplification. Allow adequate time, minimize distractions, face the client when speaking

Seclusion and Restraints: - Less restrictive measures include: - - The nurse should never use seclusion or restraints for the following: -

- verbal interventions - diversion or redirection - providing a calm, quiet environment - offering a PRN medication - convienance of the staff - punishment of the client - clients who are extremely physically or mentally unstable - clients who cannot tolerate the decreased stimulation of a seclusion room

MMSE Questions and Scores: (Orientation) - (5) What is the (year) (season) (date) (day) (month) - (5) Where are we (state) (country) (town) (hospital) (floor) (Registration) - (3) Name 3 objects. 1 second to name each. Then ask the patient all 3 after you have said them. Give 1 point for each correct answer. Then repeat them until he/she learns all 3. Count Trials and record TRIALS = ____ (Attention and Calculation) - (5) Serial 7's. 1 point for each correct answer. Stop after 5 answers. Alternatively spell "word" backward (Recall) - (3) Ask for the 3 onjects repeated above. 1 point for each correct (Language) (2) Name a pencil and watch (1) repeat the following: "No ifs, ands, or buts" (3) Follow a 3-stage command: "take a paper in your hand, fold it in half, and put it on the floor" (1) read and obey the following: CLOSE YOUR EYES (1) write a sentence (1) copy the design shown

.

If attempts to teach the patient alternatives to manage their anger are unsuccessful, what 3 interventions can be used?

1. leave the room as soon as the abuse begins; the patient can be informed that the nurse will return in a specified amount of time (20-min) when the situation is calmer 2. attend positively to, and thus reinforcing, nonabusive communication by the patient. Interventions can include discussing non-illness related topics, responding to requests, and providing emotional support 3. Develop a predictable routine, such as scheduled contacts with the nurse( every 30-min, every 60-min). This contract is negotiable with the patient and addresses the patients anxiety about getting their needs heard

Specialized mental status exams are the most common screening tests used as part of the assessment process for client with suspected neurocognitive disorder. - The MINI-COG test: a person is asked to complete 2 tasks: 1. 2.

1. remeber the names of 3 common objects and repeat them a few minutes later 2. draw the face of a clock showing all 12 numbers in the right places and a time specified by the examiner

Cycle of Violence: 3 Phases: - - -

1. tension-building phase 2. acute battering phase 3. honeymoon phase

Stage 1: Mild Alheimers Disease (Forgetfullness) Stage 2: Moderate Alzheimers Disease (Confusion) Stage 3: Mod to Severe (Ambulatory Dementia) Stage 4: Late Alzheimers Disease (End stage)

1: Apathy is the most common behvioral problem in this stage. Depression also common. Client loses energy and drive . Word-finding difficulties. Memory aids compensate for memory loss and forgetfulness (lists, routine, organization) 2. decline in ADLs. cant remember phone number or address. ability to dress is affected, may have bursts of paranoia, anger, jealousy and loss of interest. need care and supervision full-time. Person will have strong denial that they are losing control and memory 3. person often unable to identify familiar objects or people, even a spouse. (AGNOSIA) person needs repeated instructions to complete simple task. Total patient care is necessary. depression resolves because person forgets they have lost control. Incontinence Agraphia (inability to read/write) is evident. Tendency to wonder. Disinhibition (such as urinating in public, sexually inapproproate behaviors) 4. Hyperorality (need to taste, chew, put everything in one's mouth) hypermetamorphosis (touching everything in sight) ability to talk and walk is lost dysphasia, stupor, coma

4 Phases of a Crisis: 1 2 3 4

1: person is confronted by a conflict that threatens the self-concept responds with increased feelings of anxiety. This stimulates the use of problem-solving techniques and defense mechanisms in effort to solve the problem and lower anxiety 2. if threat persists and the usualy defense mechanisms fail, anxiety and discomfort continue to rise. Individual functioning becomes disorganized. Trial and error attempts at solving the problem and restoring a normal balance begin 3. If trial and error attempts fail, anxiety can escalate to severe and panic levels, and the person mobilizes automatic relief behaviors such as withdrawl and flight. Some form of compromise, such as redefining the situation or reevaluating needs, may occur in this stage. 4. Anxiety can overwhelm the person. In this final phase of crisis, serious personality disorganization, depression, confusion, violence against others, or suicidal behavior can develop.

Agression and violence Setting Limits for the client: - Tell the client calmly and directly what they must do in a particular situation such as : " I need you to stop yelling and walk with me to the day room" use physical activity such as walking to deescalate anger and behaviors Inform the client of the consequences of their behavior such as the loss of privileges Plan for ___ to ___ staff members to be available and in sight of the client as a "show of force"

4 to 6

Involuntary commitment is a legal process that begins with an Emergency Order of Detention (ED or EOD); in OK this allows for up to ____ days of assessment and observation

5

Stages of Violence: - Assaultive Stage: - One person will be chosen as the spokesperson - Generally a team of ___ staff members is advisable to restrain a resistant patient although teams may be larger if needed - This stage involves the use of seclusion, medications, and physical restraints - A patient may not be held in seclusion or restraint without a physicians order - Use seclusion or restraints in the following circumstances: -

5 - patient presents a clear and present danger to self or others - patient has been legally detained for involuntary treatment and is though to pose an escape risk - the patient requests to be secluded or restrained

Types of Admission to Mental Helth Facility: LONG-TERM INVOLUNTARY ADMISSION - This type of commitment is similar to temporary commitment but must be IMPOSED BY THE COURTS - Time of commitment varies but it usually ___ to ___ days

60 to 180 days

The neurotransmitter _____ plays a role in skeletal and muscle movement, arousal, memory, and sleep-wake cycle - Decreased levels of this neurotransmitter are present in patients with Alzheimer's disease so therefor drugs are given to these patients that inhibit the enzyme that degrades this neurotransmitter

Acetylcholine

Rape Trauma Syndrome: a variant of PTSD and is common sequela of psychological trauma. 2 Phases include: - ________: begins immediately after the crisis. Cognitive, affective, and behavioral disruptions. Most common responses are shock, numbness and disbelief, generalized pain, eating and sleeping disturbances, anger, fear, anxiety, guilt, humiliation, self-blame, and mood swings. - _______: may not occur for months or even years after the event. Characterized by: - flashbacks, nightmares, and phobias - somatic and gynecological symptoms. - Depression, panic disorder, suicidal ideation, and substance abuse are the most prevalent. - PTSD is the long-term consequence of sexual assault

Acute Phase (Disorganization Phase) Long-Term Phase (Delayed, Organization Phase_

a ______ crisis is similar to a situational criss but is a much larger in scale and impacts a community. Examples include a terrorist attack, natural disasters, etc.

Adventitious crisis

__________: deeply rooted negative attitudes or bias toward people because of their age

Ageism

Dementia is a general term for a decline in mental ability severe enough to interfere with daily life. DSM-5 has incorporated dementia within the broader category of Major Neurocognitive Disorder. _______ is one of the subtypes of Major Neurocognitive Disorders and is the most common cause of Dementia

Alzheimers Disease

________ is the most common cause of Dementia (major neurocognitive disorders)

Alzheimers Disease

Anticholinergic drugs can cause an increase in brain atrophy thus explaining the increased risk for cognitive decline, poor memory, and diminished executive function. _______ and _____ are commonly prescribed medications with anticholinergic effects

Antihistamines and antidepressants

Theories of Psychiatric Care: (Behavioral) - Behavioral Theory (Pavlov) * ______ conditioning in which involuntary behavior or reflexes can be conditioned to respond to neutral stimuli * ____ conditioning in which voluntary behaviors are learned through consequences of positive reinforcement (study hard get good test score) or negative reinforcement (drive fast get ticket) - _____ is based on classical conditioning. The premise is that learned responses can be reversed by first promoting relaxation and then gradually facing a particular anxiety - ____ therapy is based on both classical and operant conditioning. It is used to eradicate unwanted habits by associating unpleasant consequences with them - ______ is a technique in which individuals learn to control physiological responses such as breathing rates, heart rates, blood pressure, and skin temperature. This control is achieved through providing visual or auditory biofeedback of the physiological response and then using relaxation techniques.

Classical conditioning Operant conditioning - Systematic Desensitization - Aversion Therapy - Biofeedback

Defense Mechanisms: - _______: covering up a real or perceived weakness by emphasizing a trait one considers more desirable. a high school student too small to play football becomes the star long-distance runner for the track team - ________: not acknowledging the significance of one's behavior. a person says, "Don't believe everything my wife tells you. I wasn't so drunk I couldn't drive."

Compensation Minimization

______ is the most common, most debilitating, and also most treatable psychiatric disorder in the older adult

Depression

Nurses working in which department experienced the highest rate of on-the-job violence?

Emergency Department

Commitment for specified period, 1-10 days, to prevent dangerous behaviors to self or others

Emergency Involuntary Hospitalization

Theories of Psychiatric Care: Psychoanalytical Theory: - Freud: claims most psychological disturbances are the result of early trauma or incidents that are often not remembered or recognized The 3 interactive agents of the brain: 1. ______: primitive, pleasure seeking and impulsive part, lurks in unconcscious mind 2. ______: the problem solver and reality tester that navigates in the outisde world. Acts as an intermediary between the ID and reality 3. ______: represents the moral component of the personality, sense of what is right and what is wrong. It is greatly influenced by parents or caregivers moral and ethical stances

ID EGO SUPEREGO

Defense Mechanisms: - _____: conscious or unconscious assumption of the characteristics of another individual or group that they admire. EX: child with chronic illness pretends to be a nurse for their dolls-OR- child who sees abusive parent at home and then he becomes a bully at school - _______: seperation of emotions and logical facts when analyzing or coping with a situation or event. Avoiding unacceptable emotions by focusing on the intellectual aspects. Instead of focusing on your sadness of losing a loved one you focus on paying for the funeral - ______: responding to stress through the unconscious developmnent of physical symptoms not caused by a physical illness

Identification Intellectualization Conversion

__________: personal statement of how and when one wishes to die. It can be changed at any time by the individual. It is activated only when the person is terminally ill and incapacitated _______: a physician is appointed by the individual to serve as a proxy. Particularly useful in cases of terminal illness when an individual has no family. Can be revoked orally at any time, without regard to patient competency ________: a person is appointed to act as the patient's agent. Patient does not have to be terminally ill or incompetent

Living Will Directive to Physician Durable power of attorney

Levels of Anxiety: _________: - slightly reduced perception and processing of information - selective inattention - ability to think clearly is hampered, but learning and problem solving still occur - client may report somatic manifestations such as headaches, backache, urinary urgency, insomnia - increase in heart rate and respiratory rate

Moderate Anxiety

Medications for Suicide: ________ - maintain fluid intake of 2 to 3 liters per day - maintain adequate sodium intake - minimize GI effects by taking with food or milk

Mood Stabilizers: Lithium

A problem in industrialized countries, where financial resources have increased and family size has decreased is _______ of children. This can be considered a type of neglect that can result in: - social and emotional impairment - lack of empathy - physical problems related to inactivity or obesity

Overindulgement

Levels of Anxiety: - _______: - markedly disturbed behavior - client not able to process what is occuring in the environment and can lose touch with reality - extreme fright and horror - severe hyperactivity, flight or immobility - dysfunction in speech, dilated pupils, shakiness, inability to sleep, delusions, hallucinations

Panic-Level Anxiety

the ________ Act passed in 1990 requires that health care facilities provide clear, written information to every patient regarding his or her legal right to make healthcare decisions

Patient Self-Determination Act

4 Phases of a crisis: - This phase involves escalating anxiety from a threat that activates increased defense responses

Phase 1

4 Phases of a crisis: - In this phase anxiety continues escalating as defense responses fail, functioning becomes disorganized and the client resorts to trial-and-error attempts to resolve anxiety

Phase 2

4 Phases of a crisis: - In this phase trial-and-error methods of resolution fail, and the clients anxiety escalates to severe or panic levels, leading to flight-or-withdrawn behavior

Phase 3

4 Phases of a crisis: - In which phase does the client experience overwhelming anxiety that can lead to anguish and apprehension, feelings of powerlessness and being overwhelmed. Depression, dissociative findings, confusion

Phase 4

Suicide: - ______ interventions focus on suicide prevention through the use of community education and screenings to identify individuals at risk - ______ interventions focus on suicide prevention for an individual client who is having an acute suicidal crisis. Suicide precautions include this level of intervention - _____ interventions focus on providing support and assistance to survivors of a client who completed suicide

Primary Secondary Tertiary

3 levels of nursing care in Crisis Intervention include: - - -

Primary: promotes mental health and reduces mental illness to decrease the incidence of crisis. (teach coping skills, stress mitigation) Secondary: establishes intervention during an acute crisis to prevent prolonged anxiety from dimishing personal effectiveness and personality organization (primary focus is to ensure patient safety) Tertiary: provides support for those who have experienced a severe crisis and are now recovering from a disabled mental state. (rehab centers, workshops)

Levels of Anxiety: - _______: - perceptual field is greatly reduced with distorted perceptions. - learning/problem solving do not occur - functioning is ineffective, behaviors are automatic - confusion, feeling of impending doom, hyperventilation, tachy - not able to take directions from others

Severe Anxiety

Types of Crises: - ______: Often unanticipated loss or change experienced in everyday, often unanticipated, life events (divorce, job change) - _______: achieving new development stages which requires learning additional coping mechanisms (getting married, retiring) - _______: occurence of natural disasters, crimes. People in communities with large-scale psychological trauma caused by disasters or crime such as active shooter

Situational/External Maturational/Internal Adventitious

Suicide precautions: Milieu: - There is an increased risk for suicide during ______ times

Staff rotation

The ____ of mental illness interfers with the person's ability to establish and maintain friendships, employment, and housing

Stigma

Suicide _____ is one-on-one monitoring at arm's length away Suicide ____ os 15-minute visual check of mood, behavior

Suicide Precaution Suicide Observation

According to Freud, the _____ has a moral/ethical component and if often learning from your parents

Superego

Primary, Secondary, Tertiary Care for Crisis: - Which type involves collaborating with the client to provde support during recovery from a severe crisis. Includes outpatient clinics, rehab centers, crisis centers, workshops - Which type involves collaborating with the client to identify potential problems, instruct on coping mechanisms, and assist in lifestyle changes. (Preventing a crisis from happening) - Which type involves collaborating with a client to identify interventions to use while in an acute crisis that promotes safety

Tertiary Care Primary Care Secondary Care

Most victims of sexual assault will go to the Emergency Dept to be seen.The physical exam and collection of evidence are often done by the attending ER physician, gynecologist, or SANE. The person who collects the evidence should be forensically trained. If a date rape drug is suspected, ______ should also be collected Survivors needs to know that they have the right to refuse police assistance but can still choose to have forensic evidence collected. The PT must sign a CONSENT FORM for the collection of evidence

Urine sample

Sullivan Stages of Interpersonal Development: - Sullivan's interpersonal theory focuses on what occurs between people, as opposed to psychoanalytical theory - He believed that social forces and interpersonal problems were the cause of psychiatric alterations - he believed all behavior is aimed at avoiding ______

anxiety

Neurons and Synaptic Transmission: - an essential feature of neurons is the ability to initiate signals and conduct electrical impulses from one end of the cell to the other, this is called Neurotransmission - Electrical signals within the neurons are then converted at synapses into chemical signals through the release of molecules called Neurotransmitters, which then eleicit electrical signals on the other side of the synapse 1. Electrical impulse reaches the end of the neuron 2. neurotransmitter is released from axon terminal at the presynaptic neuron and diffuses across a synapse to a postsynaptic neuron 3. neurotransmitter then attaches to specialized recepters on the cells surface to either inhibit or excite the postsynaptic neuron ***** It is the interaction between the neurotransmitter and receptor that is a major target of psychotropic drugs

continued on next slide

Will the patient experieice a change in level of consciousness with Major Neurocognitive Disorders?

no, it will remain the same. * Delirum will cause a change in LOC

***Crisis intervention******* - Our most important outcome goal is that the individual is able to return to the same level of functioning -or- HIGHER, as they had prior to the crisis

test question

Who are at the greatest risk for Delirium? What are the specific criteria for the diagnosis of Delirium?

the ederly that the symptoms develop rapidly over hours to days and fluctuate in severity over the course of the day (sundowners). There must also be evidence that the disturbance develops as a direct physiological consequence of another medical condition

How do nurses typically provide information/resources to women in need of help in leaving their abuser?

verbally. this is becuase printed brochures can be found by the partner and can increase the risk of violence