Mental health/ community health final review

Anorexia nervosa

Anorexia refers to a prolonged loss of appetite. Anorexia nervosa is characterized by a morbid fear of obesity. Symptoms include gross distortion of body image, preoccupation with food, and refusal to eat. Body image is a subjective concept of one's physical appearance based on personal perceptions of self and the reaction of others. The distortion in body image is manifested by the individual's perception of being fat when he or she is obviously underweight or even excessively thin. Weight loss is extreme, usually more than 15% of expected weight. Other symptoms include hypothermia, bradycardia, hypotension, edema, lanugo, and a variety of metabolic changes. Amenorrhea (absence of menstruation) usually follows weight loss, but sometimes happens early on in the disorder, even before severe weight loss has occurred. Individuals with anorexia nervosa may be obsessed with food. For example, they may hoard or conceal food, talk about food and recipes at great length, or prepare elaborate meals for others, only to restrict themselves to a limited amount of low-calorie food intake. Compulsive behaviors, such as hand washing, may also be present. Age at onset is usually early to late adolescence, and psychosexual development is often delayed. Feelings of depression and anxiety often accompany the disorder. Weight loss in clients with anorexia nervosa is usually accomplished by reduction in food intake and often extensive exercising. Self-induced vomiting and the abuse of laxatives or diuretics also may occur

Activities of school nurses

Data or access to: immunization record, screenings (vision, hearing, mental health, neglect - are mandatory reporters - screenings) may be conducted in that facility. Health educated is an important task Want to monitor the health of the community, act as case managers (take individual case, look at the issues, coordinate services and care), Advances well-being, academic success, lifelong achievements, and health Provide individual and population-based care through: assessment, diagnosis, outcome identification, planning, implementation, and evaluation. School nurses promote health and safety, provide case management, intervene when actual and potential health problems arise, serve as advocates, and promote self-management. School nurses function in two worlds Health Education Know both education and health Priorities Goals Policies Legal requirements Implementation of school health services Have a role as coordinators and connectors in the school setting Code of ethics for school nurses focuses on: Client care Professional advocacy Professional responsibilities Sexuality and sex education: Primary prevention of high-risk behaviors related to sexuality is a priority for the school population. Sex education = school nurses take into consideration cultural and enviornmental issues specific to their schools and students. School nurses have a role in prevention and treatment related to bullying, cyberbullying, and violence. Show warmth and positive interest in their students Set firm limits on unacceptable behavior Use consistent nonphysical, non hostile negative consequences when rules are broken Function as positive role models Dating violence: A need to screen adolescents for teen dating violence Outreach to immigrant populations: Outreach can include developing: Welcoming orientation, student support teams, methods for facilitating the integration of the students into after-school activities, and overall advocacy program for the families School nurses regularly conduct health screening including: Vision Audiometric Obesity Episodic care in the school setting: Asthma, cancer, diabetes, allergies School nurses also provide care to those who have disabilities or mental health disorders. Mental health disorders: Require coordination among: Family School Healthcare Individualized Health care Plan School nurses most importantly advocate for students: Advocates for the student population and their families through efforts to influence policy at the local, state, and/or national levels* A direct advocate for health-care consumers, in this case students, families, and school communities

Causes of delirium in the elderly

Delirium is one of the most common and critical forms of psychopathology in later life. A number of factors have been identified that predispose elderly people to delirium, including structural brain disease, reduced capacity for homeostatic regulation, and impaired vision and hearing, among others.

Bulimia nervosa interventions

Efforts to change the maladaptive eating behaviors of clients with anorexia nervosa and bulimia nervosa have become the widely accepted treatment. The importance of instituting a behavior modification program with these clients is to ensure that the program does not "control" them. Issues of control are central in these disorders. Fluoxetine (Prozac) has been found to be useful in the treatment of bulimia nervosa. A dosage of 60 mg/day (triple the usual antidepressant dosage) was found to be most effective. It is possible that fluoxetine, a selective serotonin reuptake inhibitor, may decrease the craving for carbohydrates. Other antidepressants, such as imipramine (Tofranil), desipramine (Norpramine), amitriptyline (Elavil), nortriptyline (Aventyl), and phenelzine (Nardil), also have been shown to be effective in controlled treatment studies.

Suicide - priority interventions to keep client safe

ask patient directly, create a safe environment for the patient, convey an attitude of unconditional acceptance of the patient as a worthwhile individual, maintain close observation of the patient, maintain special care with meds, make rounds at frequent, irregular intervals, encourage patient to express honest feelings, ID community resources

Epidemic Curves

○ Plotted graph ○ Shows time elapsed from exposure to clinical symptoms ○ Helps determine if you have: ■ Point source = exposure at one point in time ■ Intermittent source = exposure comes and goes ■ Continuous sources = exposure is ongoing

Rural vs Urban health concerns for adults and children

○ Urban: socioemotional, crime, more communicable diseases because of the close physical proximity, and more exposure to pollution or pesticides (decreased air quality). Providers are more available ○ Rural: access to healthcare and dental care (lack of fluoride) = tooth loss, morbidity, mortality. Providers are more scaris in rural places (lack of education), lack of internet

Prevalence Pots

A prevalence pot is a way of depicting the total number of cases of the disease in the population that takes into account issues related to duration of the disease and the incidence of the disease.

Primary prevention

Activities that focus on improving the ability of individuals and populations to practice healthy living Protecting individuals and populations from disease - vaccinations Health education Public health announcements and alerts Purpose: to keep a person free from disease Routine checkups Support of positive health practices Assistance with changing behavioral risks

Ethical principles

Autonomy: presumes that individuals are always capable of making independent choices for themselves Beneficence: one's duty to benefit or promote the good of others Non-maleficence: requirement that HCPs do no harm to their clients, either intentionally or unintentionally Justice: basic premise lies with the right of individuals to be treated equally and fairly regardless of race, sex, marital status, medical diagnosis, social standing, economic level, or religious beliefs Veracity: one's duty to always be truthful

Goal of treatment for personality disorders

Biggest issue: relationship with others Goal: help them have a more functional, working, and healthy relationship with others

Psychosocial theories of aging and implications for program planning (485-486)

Biological = aging causes a decrease in health or can worsen conditions. May not impact program planning in the same way the psychosocial ways can. Psychosocial theories = increased risk for social isolation, depression, and suicide. We will need to create more accessible programs or activities for the younger population - low impact activities for those who are older - make sure the seniors have the opportunity to be involved. More likely to do better when they are engaged in activities Psychosocial theories of aging revolve around three major and somewhat conflicting ideas: disengagement, activity, and continuity. Early theorists offered the observation that older adults tend to disengage from pursuits and roles that they enjoyed in earlier life and suggested that this process was a mutual withdrawal of the individual from society. Cumming proposed that this process of disengagement was accepted and actually desired by older adults, and that it was a natural and universal feature of a long life. From their perspective, disengagement was the "correct" way to age. However, a clearly opposing theory was at work. Older adults who resisted withdrawal and remained active and engaged in life were observed to age more optimally. In fact, the more active they were, the greater satisfaction they expressed with the quality of their lives. They were more likely to be able to substitute new roles for those lost through changing function or social circumstances. Many community-based programs for older adults are based on the activity theory and offer many activities that help older adults to keep busy and socially engaged. For many older adults, activity is a vital coping strategy, as they face inevitable losses and changes in their lives. Perhaps strongest of all is the theory that people are basically consistent throughout their lives, and their personalities remain constant through the passing years. This is described as continuity and can be an important consideration for nurses as we assist individuals in managing health issues or dealing with new challenges associated with aging. We can help older adults use their past experiences to frame new situations and work from the strengths within their perspectives and personalities.

Most likely personality disorder to exhibit self-destructive behaviors

Borderline personality disorder

bulimia nervosa

Bulimia refers to an excessive, insatiable appetite. Bulimia nervosa is an episodic, uncontrolled, compulsive, rapid ingestion of large quantities of food over a short period of time (bingeing), followed by inappropriate compensatory behaviors to rid the body of the excess calories. The food consumed during a binge often has a high-caloric content, a sweet taste, and a soft or smooth texture that can be eaten rapidly, sometimes even without being chewed. The bingeing episodes often occur in secret and are usually only terminated by abdominal discomfort, sleep, social interruption, or self-induced vomiting. Gastric acid in the vomitus also contributes to the erosion of tooth enamel. In rare instances, the individual may experience tears in the gastric or esophageal mucosa. Some individuals develop calluses on the dorsal surface of their hands, typically on knuckles. This feature is called Russell's Sign, after the British psychiatrist who first described it. Onset of bulimia nervosa occurs in late adolescence or early adulthood. Among college women, about 20% experience transient bulimic symptoms during their college years. Cross-cultural research suggests that bulimia nervosa occurs primarily in societies that place emphasis on thinness as the model of attractiveness for women and where an abundance of food is available.

ED medication considerations

Cannot take nitroglycerin with viagra because it can cause a hypertensive crisis (within the 24-48 hr window). Types = sildenafil (viagra), tadalafil (cialis) Has a stigma with it, some people can react a certain way to them, and nurses must ask specifically about the use of these medications.

Be able to determine the case fatality rate

Case fatality rate determines the severity of the outbreak and the number of fatal cases divided by the number of cases (fatal cases divided by total cases). ○ Dividing the number of deaths from a specified disease over a defined period by the number of individuals diagnosed with the disease during that time; the resulting ratio is then multiplied by 100 to yield a percentage. ■ Ex: One population consists of 1,000 people; 300 of these people have the specified disease, 100 of whom die from the disease. In this case, the mortality rate for the disease is 100 ÷ 1,000 = 0.1, or 10 percent. The case fatality rate is 100 ÷ 300 = 0.33, or 33 percent.

Personality disorder clusters

Cluster A: Behaviors described as odd or eccentric. a.Paranoid personality disorder b.Schizoid personality disorder c.Schizotypal personality disorder Cluster B: Behaviors described as dramatic, emotional, or erratic. a.Antisocial personality disorder b.Borderline personality disorder c.Histrionic personality disorder d.Narcissistic personality disorder Cluster C: Behaviors described as anxious or fearful. a.Avoidant personality disorder b.Dependent personality disorder c.Obsessive-compulsive personality disorder

Cohort study

Cohort studies are studies that follow a specific population, subset of the population, or group of people over a specified period of time. Cohort studies can be effective in generating a wealth of data relating to the population of interest. Two types of cohort studies are found in application: Prospective Retrospective (also called historical)

Common modes of transmission for communicable diseases.

Communicable disease transmission: Infectious agents and transmission = public health departments (protect the population from spread of infection). Three key components needed in the transmission cycle are agent, host, and environment.

Communicable diseases

Communicable diseases is top 10 causes of death Lower respiratory infections Most common C D cause of death Diarrheal diseases Tuberculosis Leading causes of death in low-income countries versus all others 7 of the 10 leading C O D's in low-income countries are C D's 1 of the 10 leading C O D's in high-income countries is a C D

Types of public health assessment (when appropriate and what each would involve)

Comprehensive community assessment: assets, unmet need, and opportunities for improvement done every 3 years Population-focused assessment- focused on a specific population for purposes of planning and developing intervention programs Setting-specific assessment- identifying strength and weaknesses of an organization or policies and programs within an organization (policies, health indicators, building, etc) Problem or issue-based assessment- can help a community identify physical activity and nutrition policies, practices, and environmental conditions within the local community Health impact assessment- a means of assessing the health impacts of policies, plans, and projects in diverse economic sectors using quantitative, qualitative, and participatory techniques Rapid needs assessment- the present and potential public health impact, determining existing response capacity, identifying any additional immediate needs

Methods for controlling the spread of communicable diseases.

Controlling communicable disease: Changing the environment: altering and eliminating the reservoir, controlling the vector, applying personal measures of hygiene, and using aseptic technique. Deactivating the agent: use of physical and chemical agent Increasing host resistance: active (occurs when our own immune system is responsible for protecting use from a pathogen; vaccine acquired immunity or exposure to illness) or passive (occurs when we are protected from a pathogen by immunity gained from someone else; mother to child = natural, immunoglobulin treatment = artificial passive).

cross-sectional study

Cross-sectional studies or surveys examine risk factors and disease using data collected at the same point in time. It is easy to remember that a cross-sectional study provides an estimate of the disease status or frequency at one point in time; thus, it is truly a cross section of the disease or illness within the population of interest at a given moment in time.

Dependency ratios; implication of higher ratios

Dependence ratio = proportion of dependents (those aged 0 to 14 years plus those 65 years of age and older) per every 100 members of the population aged 15 to 64. Factors that may improve the aged dependency ratio include the increased age of full retirement for Social Security benefits for baby boomers rising from 65 to 67 and the graying of the U.S. workforce. As the number of those who live past the age of 65 increases, any possible benefits from the increased number of those over 65 who work may be wiped out by the increasing number of persons aged 75 and older. Total Dependency Ratio: Aged Dependency Ratio: those who are over 65 Implication of higher ratios: increase the age of full retirement, looking at available resources to make sure we are targeting the right groups - cost effective - or reaching the most number of people.

Non-communicable diseases: common causes, barriers to treatment and rate reduction

Diseases that are not passed from one person to the next (directly or indirectly) and are not caused by an infectious agent. Long duration, usually slow progression, require medical attention over time, and tend to limit ability to perform ADLs. Prevention: Global priority, reduced individual risk factors, behavioral changes, and populations at highest risk are those with the fewest resources. Cannot be prevented or cured through vaccination or medication They require: maintaining a healthy lifestyle, early diagnosis and treatment, and long-term management. The four common risk factors that account for most noncommunicable diseases are modifiable: nutrition, physical activity, tobacco use, obesity, and alcohol use. Socioeconomic Risk for Noncommunicable Disease Income and social status Higher income and social status are linked to better health. The greater the gap between the richest and poorest people, the greater the differences in health. Education Low education levels are linked with poor health, higher stress levels, and lower self-confidence. Physical environment Safe water, clean air, healthy workplaces, safe houses, communities and roads all contribute to good health. Employment and working conditions People in employment are healthier, particularly those who have more control over their working conditions. Social support networks Greater support from families, friends and communities is linked to better health. Culture Customs, traditions, and the beliefs of the family and community all affect health. Genetics Inheritance plays a part in determining life span, health, and the likelihood of developing certain illnesses. Personal behavior and coping skills Balanced eating, keeping active, smoking, drinking, and dealing with life's stresses and challenges all affect health. Health services Access to, and use of, services that prevent and treat disease influence health. Gender Men and women suffer from different types of diseases at different ages. Central risk factor for NCDs: Lack of access to health care including preventive screening, early and ongoing treatment, and resources needed to manage care For those who are unable to obtain adequate insurance or who do not have adequate transportation to services, care is often delayed until the disease has become advanced.

The Emergency Preparedness Theoretical Framework and the disaster continuum.

Emergency Preparedness Theoretical Framework: To effectively prepare for emergencies and manage disasters when they occur, EPDM plans are needed at the community, state, national, and global levels. Is dynamic because everything is different when it comes to disaster awareness Mitigation = trying to lessen the burden; stop the spread and lessen the effect Disaster plans must be developed so that timely interventions can be rapidly disseminated when a threat surfaces or an emergency happens. The four key concepts of the preparedness framework include preparedness, mitigation, response, and recovery, and a fifth component, evaluation. Disaster continuum = is characterized by three major phases: preimpact (before), impact (during), and post impact (after). The purpose of disaster planning is to prevent or reduce the risk for adverse consequences posed by a natural or manmade disaster. When working in a practice setting, it is important that nurses review the organization's emergency preparedness and disaster management plan. Things to identify prior to the occurrence of a disaster: Where is a copy of the plan located for the organization? What is the plan for the specific unit or area of the organization? Example of items to review in the plan: Location of the command center Plan for back up emergency power Exit routes Roles for each person in the unit/area Specific instructions for different types of disasters Communication and coordination plan Triage plan and report to work plan Emergency alarm systems What is the link between the organization and community/governmental agencies? What are the priorities in relation to vulnerable populations?

Epidemiology Triangle

Expanded to help disease researchers understand the cycle of transmission

PTSD treatment

Eye Movement Desensitization Reprocessing Trauma therapy specifically for PTSD

Behaviors that put individuals are greater risk during disasters

Failure to evacuate affected areas Failure to take shelter Failure to secure property Failure to follow guidelines for food/water safety Injury protection guidelines not followed

Secondary prevention:

Focuses on: Identifying individuals with subclinical disease Initiating early treatment Screening

General principles of life expectancy by race, income, and education

For life expectancy r/t race, I know in the documentary she had us watch it talked about how the Black community and other people of color are more likely to experience chronic health conditions, therefore shortening their life expectancy

Noncommunicable disease

Four main categories: Cardiovascular diseases, cancer, chronic respiratory disease, and diabetes. Nurses can reduce the burden of noncommunicable disease by primary, secondary, and tertiary prevention. Noncommunicable disease often leads to premature death; calculated by subtracting the age at which a person dies from his or her life expectancy. Risk factors: behavioral, genetic, and environmental factors. Disparities: income and social status, education, physical environment, social support networks, personal behavior and coping skills, employment and working conditions, health services, and gender.

Tertiary prevention:

Goal is to... Minimize complications or sequelae of noncommunicable diseases and communicable diseases. Diabetes, CVD, hypertension, HIV/AIDs Involves good case management: Assessment Planning Advocacy Essence of case management Incorporation of the client, the family, and the community Meeting the needs of the patient

Herd Immunity: how it is achieved and what it means for communities

Greater population protected (vaccine) Protects those who cannot be vaccinated or choose not to be Community immunity: most of the population gets immunized and the spread of contagious disease is contained. The immunity of a population to an agent: Having a large enough portion of the population immune (by vaccine or past infection) prevents spread of the disease to persons in the population who do not have immunity. The threshold of immunity: The percentage of the population that must be immune to achieve herd immunity to a specific agent Even if a few members of the community become infected, the population as a whole is protected from an outbreak

Health disparities in maternal-infant rates and care

Health disparities: populations most affected are black women are more likely to die in childbirth or after (4x more likely to die compared to caucasian women), black women are more likely to give birth to low birth weight babies. These can be caused by a lack of access to prenatal care, resources, and healthcare bias. Infant mortality rate: number of infant death for every 1,000 live births An indicator of access to medical care, socioeconomic conditions, and public health practices. Top five leading causes of infant death: Birth defects, preterm birth and low birth weight, sudden infant death syndrome, maternal pregnancy complications, and injuries. Health disparities in infants: Preterm birth (occurring less than 37 weeks of gestation), low birth weight (less than 5 pounds and 8 ounces), sudden unexpected infant death (SUID - american indian/alaskan native and non-hispanic black infants are more than twice as likely to die from this), obesity can cause infant death, tobacco use, alcohol use, or second hand smoke. Maternal mortality rate: number of maternal deaths per 100,000 births Death of a woman while pregnant or within 42 days of the end of a pregnancy. Health disparities: African american women are more likely than caucasians (inequities in social determinants of health, systemic racism, geographic differences).

Health equity; how can nurses contribute to health equity

Health inequity: describes avoidable gaps in health outcomes Promote to have more services for those who have noncommunicable chronic diseases and are on a fixed income Be an advocate for your patient (ex: nurses on the front lines with patients who have difficulty affording their prescriptions advocate for those patients by identifying pharmacies that provide assistance as well as other sources of help to pay for medications)

Why is it important to know the developmental stage of children?

Help us identify normal vs abnormal behavior Help identify developmental delays or regression Chronological age doesn't always match developmental stage

Population Pyramids; understand how to interpret and current U.S. trends

If the pyramid has a broad base and a small top it is an example of an expansive pyramid which there is most likely a rapid rate of population growth A pyramid with indentations that even out from top to bottom indicates slow growth A stationary pyramid has a narrow base with equal numbers over the rest of the age groups and tapering off in the oldest age groups A declining pyramid is one that has a high proportion of people in the higher age groups

Signs of elder abuse/neglect

Inappropriate dress, expired meds, high stage pressure sores

Physical effects of purging

Individuals with binge eating disorders have episodes of binge eating that may be similar to those with bulimia nervosa; however, there is an absence of purging. As a result, this client is at risk for substantial weight gain. The episodes of eating are referred to as binges when they occur over a discrete period of time, usually defined as less than 2 hours. Gastric acid in the vomitus also contributes to the erosion of tooth enamel. In rare instances, the individual may experience tears in the gastric or esophageal mucosa. Some individuals develop calluses on the dorsal surface of their hands, typically on knuckles. This feature is called Russell's Sign, after the British psychiatrist who first described it.

Yalom's curative group factors

Instillation of hope: By observing the progress of others in the group with similar problems, a group member garners hope that his or her problems can also be resolved. Universality: Individuals come to realize that they are not alone in the problems, thoughts, and feelings they are experiencing. Imparting of information: Group members share their knowledge with each other. Leaders of teaching groups also provide information to group members. Altruism: Individuals provide assistance and support to each other, thereby helping to create a positive self-image and promote self-growth. Corrective recapitulation of the primary family group: Group members are able to re-experience early family conflicts that remain unresolved. Development of socializing techniques: Through interaction with, and feedback from, other members of the group, individuals are able to correct maladaptive social behaviors and learn and develop new social skills. Imitative behavior: Group members who have mastered a particular psychosocial skill or developmental task serve as valuable role models for others. Interpersonal learning: Group offers varied opportunities for interacting with other people. Group cohesiveness: Members develop a sense of belonging rather than separating the individual ("I am") from the group ("we are"). Catharsis: Within the group, members are able to express both positive and negative feelings. Existential factors: The group is able to assist individual members to take direction of their own lives and to accept responsibility for the quality of their existence.

Functions of Strategic National Stockpile

Large amounts of pharmaceutical and medical supplies The SNS Program is committed to have 12-hour Push Packages delivered anywhere in the U.S. or its territories within 12 hours of a federal decision to deploy. The 12-hour Push Packages have been configured to be immediately loaded onto either trucks or commercial cargo aircraft for the most rapid transportation.

Goals of post-impact Epidemiological Surveillance

Look at data based on one instance, evaluate that, and determine how you can go about that the next time - to be more proactive. Monitor for lingering effects of an intervention (ex: cancer) Observing what happened, what went good or bad, what needs to happen the next time. Oversing the effectiveness of an intervention

Global trends in life expectancy and reasons for the trends

Low and middle income countries: lower life expectancy due to more difficulty with control and eradication of communicable diseases and illnesses r/t maternal/child/women's health Higher income counties: higher life expectancy, more death from heart disease or cancer bc we are living longer so more chance of our bodies to give out

What is mental illness?

Maladaptive responses to stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are incongruent with the local and cultural norms and interfere with the individual's social, occupational, or physical functioning

Symptoms of mania in bipolar disorder

No sleep, pressured speech, irritable, racing thoughts, reckless behavior, impulsive

How prioritization changes during disasters

Normal health-care priorities → crisis standards The objective for health-care providers responding to the scene shifts from providing high-quality, individualized care to providing population-based care with the goal of saving as many lives as possible.

Role of nurses during a disaster

Nurses are often key members of teams that intervene to prevent deaths. PHNs are involved in developing emergency preparedness and disaster management plans, and can help add to the plans' outreach to those most vulnerable such as older adults or the homeless. Such plans include the establishment of warning systems and emergency cooling centers, monitoring of older adults and isolated persons during an extreme heat or cold event, and improving communication and awareness among city officials and emergency medical services. Outreach by PHNs to tenant organizations in buildings is a means of informing community members about available public health services, fostering better networking and communication among residents, and helping to strategize about safety concerns. PHNs have key roles to play in disaster planning and preparedness efforts. A key preparedness function uses a basic public health nursing skill, community assessment. By knowing the aspects of the community, plans can be written to meet the unique needs of that community during an emergency or disaster. During the disaster, the PHN's role may center on staffing emergency shelters for persons with special health and medical needs or providing tetanus immunizations in the community for persons engaged in clean-up activities. During the recovery phase of a disaster, the PHN may be assigned to go into the community to assess the current and long-term needs of the area. Identification of these needs is essential to ensure the delivery of services to the community so that normal functioning may return.

Goals of nursing care with older adults and barriers

Nurses provide needed care for older adults and are educated to view aging as a lifelong process, not simply a particular chronological age or an end stage of life. Understanding the specific needs of the older adult from a population perspective provides nurses with an opportunity to actively participate in the public health initiative reflected in HP: improve the quality of life for older adults. For nurses providing care to older adults, there is an opportunity to reduce risk and enhance function at the individual level, even in the face of age-related changes. When this is expanded to include groups of individuals, communities, and populations, the impact of nursing interventions is more significant. Regardless of clinical practice settings, most nurses are likely to provide care to older family members, friends, or members of their communities. Providing care to older adults requires examining the phenomenon of aging from a population perspective that includes: The demographic, social, and health trends associated with aging Public health issues Impact on individual care delivery systems Resources for health prevention and promotion Implications for policy and research

Dissociative Identity Disorder - priority nursing interventions

Nursing care for the client with a dissociative disorder is aimed at restoring normal thought processes. Assistance is provided to the client in an effort to determine strategies for coping with stress by means other than dissociation from the environment.

Relationship between sexual health and other conditions

Other conditions may make some people more susceptible to STDs and vice versa?

Positive and negative symptoms of schizophrenia

Positive symptoms: delusions (disturbances in thought content), disturbances in thought processes manifested in speech (loose associations, neologisms, loose associations, word salad, circumstantiality, tangentiality, perseveration, echolalia), disturbances in perception (hallucinations, illusions, echopraxia) Negative Symptoms: disturbances in affect (inappropriate affect, bland or flat affect), apathy, avolition, lack of interest or skills in interpersonal interaction, lack of insight, anergia, anhedonia, lack of abstract thinking ability

Neuro cognitive disorders (NCD) vs. pseudodementia (depression)

Pseudodementia: depression in the elderly, is commonly confused with dementia NCD: disoriented to time and place where as ^ is not disoriented

Principles of triage during mass casualty event; colors associated with types of conditions

Red, yellow, green, black, orange, etc. Black = expectant: victim unlikely to survive Red = immediate: victim can be helped by immediate intervention and transport Yellow = delayed: victim's transport can be delayed Green = minor: victim with relatively minor injuries We use this system to make it easier to prioritize the resources, quickly and effectively prioritize the care and determine what care is needed.

Benefits of group activity in the elderly

Reduces isolation

Common health characteristics and risk factors in a rural patient population

Rural communities top 10 priorities: Access to quality health services, nutrition and weight status, diabetes, mental health and mental disorders, substance abuse, heart disease and stroke, physical activity and health, older adults, maternal/infant/child health, tobacco use. Rural Communities: increased health disparities that reflect the economic opportunities, educational systems, social and cultural factors, and geographic isolation in rural areas; ⅓ of rural dwellers lose all thor teeth by age 65, 2,000 rural communities have one one pharmacist, experience greater rates of chronic disease, racial and ethnic minorities compromise 15% of the total rural population and 30% of the rural poor population; major barrier is access to obtaining health care → have to travel long distances to access care and tertiary facilities are even farther away

Reportable communicable diseases

STIs: most are reportable, someone will identify or notify the person who might be affected or caused the infection, nurse or patient will notify. Can or cannot be deadly but have to take into consideration if the disease can spread to others. Malaria, HIV, TB, Flu, chicken pox, mumps, rubella, gonorrhea, pertussis, leprosy, Hep C, anthrax, plague, diarrheal diseases. Making sure people are treated appropriately, making sure the disease does not spread or get out of control = nurses major roles.

Risk of using SSRIs in client with undiagnosed bipolar disorder

Serotonin can fuel a hypomanic episode

Social determinants of health

Social determinants of health (SDOH) are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. SDOH can be grouped into 5 domains: Economic Stability Education Access and Quality Health Care Access and Quality Neighborhood and Built Environment Social and community context

SMART objectives

Specific Measurable Attainable Realistic Time-bound What to ensure... Action oriented Specify the desired results in a concrete, well-defined, detail-focused statement Include the measurement criteria to determine when you have succeeded in meeting the objective Can attain the desired outcome in the prescribed time frame

Definition of recovery

Stage I: The Survival Stage. In this stage, codependent persons must begin to let go of the denial that problems exist. This initiation of abstinence from blanket denial may be a very emotional and painful period. Stage II: The Re Identification Stage. Re Identification occurs when the individuals are able to glimpse their true selves through a break in the denial system. They accept the label of codependent and take responsibility for their own dysfunctional behavior. They accept their limitations and are ready to face the issues of codependence. Stage III: The Core Issues Stage. In this stage, the recovering codependent must face the fact that relationships cannot be managed by force of will. Each partner must be independent and autonomous. The goal of this stage is to detach from the struggles of life that exist because of prideful and willful efforts to control those things that are beyond the individual's power to control. Stage IV: The Reintegration Stage. This is a stage of self-acceptance and willingness to change when codependents relinquish the power over others that was not rightfully theirs, but reclaim the personal power that they do possess.

Most common mental disorders in the elderly

THE most common: depression Others: cognitive disorders, depressive disorders, phobias, and alcohol use disorders are among the most common psychiatric illnesses in later life.

Therapeutic milieu

The 7 basic assumptions of a therapeutic community: The health in each individual is to be realized and encouraged to grow: All individuals are considered to have strengths as well as limitations. These healthy aspects of the individual are identified and serve as a foundation for personality growth and the ability to function more adaptively and productively in all aspects of life. Every interaction is an opportunity for therapeutic intervention: Within the structured setting of a therapeutic community, it is virtually impossible to avoid interpersonal interaction. The ideal situation promotes the opportunity to improve communication and relationship development skills. Learning occurs from immediate feedback of personal perceptions. Each individual owns his or her own environment: Patients should have the opportunity to make decisions and solve problems related to the environment (milieu) of the unit. In this way, personal needs for autonomy as well as needs that pertain to the group as a whole are fulfilled. Each individual owns his or her behavior: Each individual in the therapeutic community is expected to take responsibility for his or her own behavior. Peer pressure is a useful and powerful tool: Behavioral group norms are established through peer pressure. Feedback is direct and frequent, so that behaving in a manner acceptable toward the other members of the community becomes essential. Inappropriate behaviors are dealt with as they occur: Individuals examine the significance of their behavior, look at how it affects other people, and discuss more appropriate ways of behaving in certain situations. Restrictions and punishment are to be avoided: Destructive behaviors can usually be controlled with group discussion. However, if an individual requires external controls, temporary isolation is preferred over lengthy restriction or other harsh consequences.

case-control study

The case-control study design allows the epidemiologist to compare the ratio of disease in those exposed to a risk factor with those who were not exposed to the same risk factor. Using the case-control method, the epidemiologist has a specified number of people with a disease or illness. These individuals who are defined as diseased or ill are the "cases."

Health Literacy guidelines for the general public.

The degree to which individuals have the capacity to obtain, process, and understand basic health information and service needed to make appropriate health decisions. In addition to health literacy, culture and language should also be included. Using pictures or images, using smaller words or less syllables, short sentence lengths, short clear statements, and jargon free - easily understood. Literacy publications = 8th grade reading level

outbreak investigation

The outbreak investigation is in response to elevated levels of a disease or illness within the defined population. Examples of commonly recognized outbreak investigations include foodborne illness investigations resulting from salmonella; gastroenteritis illness investigations at community daycare centers resulting from Shigella; communities with elevated numbers of pediatric asthma emergency room visits and subsequent hospitalization; health-care providers with unusually high numbers of patients with uncontrolled type 2 diabetes; employees with elevated levels of asbestosis; communities with unexpectedly high numbers of infants with elevated blood lead level; and, on a global level, the Ebola outbreaks in Africa.

What is cross tolerance?

The patient is tolerant to another medication with a similar pharmacological makeup Ex: alcohol withdrawal treated with benzos, valium Might need higher dose of benzos if the patient has built up a tolerance to alcohol

Definition of trauma

The traumatic event is described as one that is "outside the range of usual human experience."

What medications are used to treat extrapyramidal symptoms (EPS)? What medications are most likely to cause EPS? What are the symptoms of EPS?

Treat it: Cogentin aka Benztropine; Anticholinergics Cause it: 1st generation antipsychotics Bc of dopamine inhibition (not on test) Symptoms: parkinsonism, tardive dyskinesia, akathisia (continuous restlessness and fidgeting), akinesia (absence or impairment in voluntary movement)

Therapeutic relationship for client with borderline personality disorder

Very straightforward, matter of fact, honest and open Consistency: same page on rules and expectations (helps prevent splitting) Cut off any personal talk about other staff

Lithium - side effects and interventions for the side effects

Weight gain: exercise, diet change Hypothyroidism: Tremors: propranolol Neurogenic bladder AE = Lack of spontaneity, Memory problems and problems concentrating, WEIGHT GAIN, N/V/D, Hand tremors, Hypothyroidism Patient education and regular monitoring is essential Serum lithium levels should be monitored once or twice a week after initial dosage and serum levels are stable, then monthly during maintenance therapy

Conduct disorder (CD) - childhood vs. adolescent onset and symptoms of CD

With conduct disorder (CD), there is a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated. Physical aggression is common, and peer relationships are disturbed. This is one of the most frequent reasons that children and adolescents are referred for psychiatric intervention. Prevalence estimates range from 2% to more than 10%, the prevalence rises from childhood to adolescence, and it is more common in males than females. There is a higher male predominance among those with the child-onset subtype. A number of comorbidities are common with conduct disorder, including A D H D, mood disorders, learning disorders, and substance use disorders. Childhood : before the age of 10 Worse prognosis Tend to go on to have antisocial personality disorder; the longer they have these behaviors the worse they'll be (most likely) Violent, destructive, destruction of property Adolescent: over 10 Equates to antisocial personality disorder in adults

What mood stabilizing medications require serum level monitoring?

lithium