441 Psych Final

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Name some TCAs.

-ipramine (anafranil, Norpramin, Tofranil), Sinequan, Elavil, Aventyl

Describe the stages of alcohol level.

0.02 - mellow 0.08 - impaired judgement and coordination (drunk driving limit) 0.15 - obviously drunk 0.30 - may lose consciousness 0.40 - most lose consciousness (some die), coma 0.50 - stop breathing, many die For an alcoholic, at 0.08 they function fine and dont even know they are drinking because of tolerance

What is SC legal intoxicated blood level?

0.08 grams/deciliter

What is the therapeutic index of lithium?

0.6-1.4

What does planning and implementation include for a pt with severe and panic levels of anxiety?

1. Establish a trusting relationship (pt participate in plan of care, safety #1, listen to feelings, unconditional positive regard, give room to pace, know yourself) 2. Nurses self-awareness (give pt space, protect from harm, use calm voice and open stance, use direct and short sentences, dont use why, dont argue, dont interrupt repetitive acts) 3. Protecting the pt (allow pt to go to room, decrease stimuli in unit, set limits in calm manner) 4. Modifying the environment (educate, recognition, insite, coping, promote relaxation) 5. Encouraging activity 6. Meds

Name and describe the levels of intervention for dissociative dissorders.

1. Expanded self-awareness - establish an open, trusting relationship (work with whatever ego strength the pt has, max the pts participation in the therapeutic relationship (mutuality) 2. Self exploration - help the pt accept his own feelings and thoughts, help the pt clarify his concept of self and his relationship to others through self-disclosure, be aware and have control of ones own feelings, repond empathically emphasizing that the power to change lies with the pt 3. Self evaluation - help the pt define the problem clearly, explore the pts adaptive and maladaptive coping responses to the problem 4. Realistic planning - help the pt ID alternative solutions, help the pt develop realistic goals 5. Commitment of action - both nurse and pt must allow sufficient time for change

What are the 5 stages of the sleep cycle?

1. Falling sleep 2. Sleep 3&4. Deep sleep (Delta) 5. (brief return to 2 then) Rapid eye movement (REM)

When the significant other no longer adequately nourishes the persons fragile self-esteem, the relationship moves from what stages?

1. Idealization and overevaluation 2. Disappointment when unrealistic needs for maintaining self-esteem are not met 3. Rationalization and devaluation 4. Rejection of other person based on narcissistic injury

What level does lithium become toxic?

1.5

How many deaths occur each day from suicide?

1000 per day

Never ive other antidepressants within _ days of stopping MAOIs

If someone begins using drugs or alcohol before the age of _, they are more likely to abuse substances by the time they are an adult

What space constitutes personal space?

18 inches to 4 feet.

What age does physical differenctiation begin?

18 months

What age do you develop constancy?

18 months (with peek-a-boo)

Delirium Facts

2 million patients in the US are affected The behavioral response to widespread disturbances in cerebral metabolism A sudden decline from a previous level of functioning Usually considered a medical emergency that can lead to death or permanent cognitive decline in some cases if not treated. Can occur at any age but advanced Age: greatest risk factor Should be considered if there is an acute change in mental status Want them to do MRI to diagnose if there is something causing it (i.e. hydrocephalus) Occurs in hospitalized pts often

When does lithium reach its peak effect?

2-3 hours

How long does it take MAOIs to work?

2-4 weeks (lag time)

What is the time frame it would take for SSRIs to work?

2-6 weeks (lag time)

What happens to alcohol when it is ingested?

20% is directly absorbed into blood stream (goes to brain and organs), 80% is slightly processed by the upper intestine and absorbed directly into the blood stream

What age in infancy is a symbolic stage of development?

3-18 months

How long does the continuation treatment phase usually take?

4-9 months

What is the therapeutic level of Depakote or V.A.?

50-100 mg/ml

At what age does the internal development of morality and empathic feelings occur?

6-10 yo

How long does the acute treatment phase usually take?

6-12 weeks

A patient with a personality disorder told the nurse during the interview that he believes that people in general do not like him, and may even wish to harm him. This thinking can be assessed as showing evidence of the use of A. projection. B. conversion. C. intellectualization. D. introjection.

During the admission interview, a patient mentions to the nurse that he had increased the amount of oxycodone because the smaller dose "just wasn't doing it for me anymore." The nurse assesses this phenomenon as resulting from: A. tolerance. B. withdrawal. C. relapse. D. intoxication.

Milieu management for a patient who has ingested a hallucinogen should create an environment that is: A. simple and safe. B. active and noisy. C. stimulating and colorful. D. confrontive and challenging.

Patient: "I dont know where to start." Nurse: "Tell me about what has been on your mind recently." A. Broad opening B. Reflecting C. Sharing perception D. Suggesting

Patient: "When my son went to live with his father at fourteen, my life went downhill." Nurse: "You say your life is gonig downhill since your son went to live wth his father?" A. Restating B. Sharing perception C. Broad opening D. Focusing

Pt: "My drinking isnt hurting anyone." Nurse: "Lets looks at what your drinking does." A. Confrontation B. Giving false hope C. Broad opening D. Belittling feelings

The nurse is working with a 40-year-old male patient diagnosed with chronic alcoholism and his wife. The wife describes how she has cut off all outside relationships over the past 20 years while focusing her life on trying to help her husband remain sober. Based on this, the nurse assesses the wife's behavior as an indication of: A. enmeshment. B. concern. C. martyrdom. D. introversion.

The optimal time in the continuum of care to begin group therapy for a patient with dual diagnosis is: A. during inpatient treatment. B. at the point of transfer to outpatient treatment. C. never, as group therapy is not effective for patients with dual diagnosis. D. when the patient has successfully completed withdrawal from the substance of choice.

The problem that is most likely to occur when a nurse sets unrealistically high goals for an antisocial patient is A. the nurse becomes frustrated and angry with the patient when goals are not met. B. the nurse adopts various acting out behaviors used by the patient. C. the patient's acting out behaviors intensify in response to frustration over inability to meet the expectations of others. D. the patient experiences anger and directs it inward.

When a patient demonstrates behaviors and verbalizations indicating a lack of guilt feelings, desired outcomes will be facilitated by interventions that: A. provide external limits on patient behavior. B. foster discussion of rationales for behavior. C. encourage interactions with vulnerable patients. D. require participation in activities therapies.

When caring for a patient with dependent personality disorder, the behavior the nurse would positively reinforce would be: A. choosing which outfit to wear. B. asking another patient for advice. C. sitting next to the nurse at community meeting. D. concealing anger with a member of the family.

Which of the following behaviors would the nurse expect to observe while interacting with a 43-year-old woman diagnosed with narcissistic personality disorder? A. Attention seeking B. Empathy towards others C. Lack of trust in others D. Labile affect

Which of the following is a broad opening? a. What shall we talk about today? b. Do you want to talk right now? c. Why don't you just go tell him exactly how you feel?

Choose whether the communication technique is therapeutic or non-therapeutic and select the best technique to correspond with the interaction. A. Giving recognition E. Verbalizing implied feelings I. Giving advice B. Focusing F. Voicing Doubt J. Belittling feelings C. Giving false reassurance G. Exploring K. Reflection D. Giving Broad openings H. Restating L. Rejecting M. Defending Nurse: "Good moring, Sue. I see that you are weariing the bow that you made in occupational therapy."

A - giving recognition

What is a delusion?

A false belief that is firmly maintained even though it is not shared by others and is contradicted by social reality.

Intimate partner violence

A pattern of assaultive and coercive behaviors (physical, sexual, and psychological abuse and violence) that adults or teens use against their intimate partners Intimate partnership includes current or former dating, married, or co-habiting relationships of heterosexuals, lesbian women, or gay men The violence is coercive control Abuse of female partners is the most widespread form of family violence One of the most frightening realities of intimate partner violence is the potentional for homicide of the abused partner or the abuser or for homicide-suicide A women is in most danger of homicide when she leaves her abusive partner or makes it clear to him that she is ending the relationship Risk factors for this degree of danger include having a handgun in the house, a hx of suicide treats or attempts in either partner, battering during pregnancy, sexual abuse, substance abuse, and extreme jealousy and controlling behaviors

What is personality fusion?

A persons attempt to establish a sense by fusing with, or attaching to, or belonging to someone else. It leads to further loss of identity. May occcur in formal relationships, intense relationships, or brief affairs because each can be seen as a desperate attempt to outline ones identity

What is personality fusion?

A persons attempt to establish a sense of self by fusing with, or attaching to, or belonging to someone else; leading to further loss of identity

What is dissociative fugure?

A sudden, unexpected travel away from home or customary place of daily activities, with an inability to recall some or all of ones past, have complete amnesia

What are the tasks of the Termination phase?

A time to exchange feelings and memories and to evaluate mutually the patient's progress and goal attainment. Patients may become angry or hostile at the thought of termination. They may regress when they know it is imminent. Nurse and patient must deal with separation anxiety.

Teen/Child ADHD vs Bipolar Disorder

ADHD Property destruction accidental Tantrums last 20-30 minutes Kids wake up alert Difficulty falling asleep Usual have learning disabilities May have difficulty sitting still for an interview, but are not antagonistic toward staff May stumble into a fight Symptoms may improve over time No psychotic symptoms (unless associated thought disorder diagnosis) Lithium has no effect Bipolar Property destruction purposeful Tantrums last up to 4 hours (may include regression) Slow to arouse, fuzzy, somatic complaints Highly violent dream content: reluctant to go to sleep Learning issues are related to motivation (can concentrate when they want to) Often intellectually gifted Interview intolerant: openly hostile toward interviewer

What is genetic mapping?

AKA linkage mapping, is the first step in isolating a gene, confirming that disease transmitted from parent to child is linked to one or more genes, and it provides clues to which chromosome contains the gene and where the gene is on the chromosome

What is dissociative identity disorder?

AKA multiple personality disorder - distinct and separate personalities within the same person, each of whom dominates the persons attitudes, behaviors, and self-view was thouh no other personality exist

Name some atypical or 2nd generation antipsychotic medications.

Abilify, Clozaril, Geodon, Invega, Resiperdal, Seroquel, Zyprexa

What is flat affect?

Absence of emotional expression

What does inhalants do in the body?

Absorbed through lungs, reaches the CNS rapidly and can cause peripheral and CNS damage and brain (can be permanent)

What type of learning does the ability to interpret common proverbs test?

Abstract reasoning

Frontotemporal Dementia (Pick's Disease)

Accumulation of cytoplasmic collections in the brain Leads to: Progressive loss of judgment Disinhibition Social misconduct Apathy Loss of expressive language and comprehension AKA Picks disease Accumulation of cytoplasmic collections in the brain, leading to a progressive loss of judgement, disinhibitation, social misconduct, apathy, and loss of expressive language and comprehension 3rd most common cause of dementia

SSRIs

Action is selective serotonin reuptake inhibitors Effective in treatment of pts with depression and anxiety Block reuptake of serotonin (serotonin savers) These are Celeva, Cymbalta, Lexapro, Luvox, Paxil, Prozac, Zoloft CCLLPPZ Note that they may take 2-6 weeks to effect change (lag time) Side effects are dwecreased libido; some cause insomnia, HA, anxiety, nervousness Fewer SE than TCAs Can cause serotonin syndrome Potential fatal side effect of antidepressants Mania, disorientation, agitation, HA, ataxia, excessive sweating, nausea, tremor Low overdose potential Observe pt for suicidal ideation (esp teens) May cause a pt with Bipolar disorder to become manic

What type of therapeutic communication technique is: being attentive to what the client is saying, verbally and non-verbally?

Active listening

What are the tasks of the working phase?

Actual behavioral change is the focus of this task. The nurse and the client work toward the client developing insight with insight being translated into actions and a change in behavior. Problem solving takes place.

Mental Confusion Disorders Nursing Diagnoses

Acute confusion r/t severe dehydration AEB hypervigilance, distractibility, visual hallucinations, and disorientation to time, place and person Disturbed thought processes r/t brain disorder AEB inaccurate interpretation of environment, deficit in recent memory, impaired ability to reason and confabulation

Is uncompliant grief adaptive or maladaptive?

Adaptive

Define which defense mechanism the patient is using and identify it as adaptive or maladaptive. A young man who is physically unable to participate in sports becomes a Rhode's scholar _________________________

Adaptive - compensation

Define which defense mechanism the patient is using and identify it as adaptive or maladaptive: Mrs. D.'s husband tells her she will have to go back to work as a secretary to support herself because he is leaving her. The woman develops paralysis in her arm. ____________________________________________

Adaptive - conversion/somatation

Define which defense mechanism the patient is using and identify it as adaptive or maladaptive. I was so upset about having surgery that I don't remember what the doctor said. _______________

Adaptive - denial/repression

Define which defense mechanism the patient is using and identify it as adaptive or maladaptive: After a bad day at the office Mr. Jackson yells at the dog and slams the door. ________________________________

Adaptive - displacement

Define which defense mechanism the patient is using and identify it as adaptive or maladaptive: A child says to her friend, "Do not tear that book. Books are our friends." ____________________________________

Adaptive - introjection/identification/symbolization

Define which defense mechanism the patient is using and identify it as adaptive or maladaptive: A businessman who values punctuality is late for a meeting and states, "My assistant forgot to remind me of my meeting. It is so hard to find good help these days." ___________________________________

Adaptive - projecting

Define which defense mechanism the patient is using and identify it as adaptive or maladaptive: A man who is unconsciously attracted to other women teases his wife about flirting with men _____

Adaptive - projection

Define which defense mechanism the patient is using and identify it as adaptive or maladaptive: A man who abused substances in his younger years preaches against the dangers of alcohol and marijuana. ___________________________

Adaptive - reaction formation

Define which defense mechanism the patient is using and identify it as adaptive or maladaptive: A secretary who is sexually attracted to her boss and intensely dislikes his wife, is aloof and detached to the boss and is overly courteous and polite to the wife. __________________________________________

Adaptive - reaction formation

Define which defense mechanism the patient is using and identify it as adaptive or maladaptive: An aggressive, hostile man becomes a butcher. _____________________

Adaptive - sublimation

Define which defense mechanism the patient is using and identify it as adaptive or maladaptive: A boy who is extremely aggressive with pent up anger becomes a football player and then a coach. _____________

Adaptive - sublimation

Define which defense mechanism the patient is using and identify it as adaptive or maladaptive: I am not going to think about the test until Monday night._______________

Adaptive - suppression

Define which defense mechanism the patient is using and identify it as adaptive or maladaptive: After flirting with her male secretary a woman brings her husband tickets to a play he has talked about attending. _________________________

Adaptive - undoing

Define which defense mechanism the patient is using and identify it as adaptive or maladaptive: Everyone fails Mrs. Clary's first test so she gives everyone 50 points. She finds it intolerable that NO ONE would pass her test! ________________

Adaptive - undoing

What should pts with PD discuss in journaling?

Adaptive coping mechanisms and positive interpersonal relationships

Eating Adaptive vs Maladaptive Responses

Adaptive eating responses are characterized by balanced eating patterns, appropriate caloric intake, and body weight that is appropriate for height Maladaptive eating regulation responses include anorexia nervosa, bulimia nervosa, binge eating disorder, and night eating syndrome

What is the difference between adaptive and maladaptive responses?

Adaptive is an emotional response while maladaptive is the suppression of emotions

Memory Adaptive vs Maladaptive Responses

Adaptive responses - decisiveness, intact memory, complete orientation, accurate perception, focused attention, coherent logical thought Maladaptive - inability to make decisions, impaired memory and judgement, disorientation, misperceptions, decreased attention span, and difficulties with logical reasoning In childhood, called developmental disabilities or mental retardation

Adaptive vs Maladaptive Sexual Response

Adaptive sexual response Between two consenting adults (16 yo) Mutually satisfying to both Not psychologically or physically harmful to either party Lacking in force or coercion Conducted in private Maladaptive sexual response Behaviors that do not meet one or more of the criteria for adaptive responses

Adaptive vs Maladaptive Sexual Coping Mechanisms

Adaptive- Fantasy creates increased sexual excitement and enjoyment and do not usually indicate dissatisfaction with a current partner Excess fantasy can be maladaptive when used as a replacement for actual sexual expression or the development of intimate relationships with others Maladaptive- They use projection for blaming the spouse for the problem or used when a persons thoughts and feelings are unacceptable and anxiety producing Denial example - I don't have a problem with sex or I never feel sexual Rationalization - I don't need sex; Im fine without it. Besides, a good marriage is a lot more than just sex

_ is psychosocial behaviors related to substance dependence

Addiction

Teen Group Therapy

Addresses teens need for peer support Conflicts can be detected by peers rather than adults, making group therapy particular helpful for teens Group therapy helps fulfill the adolescents need for a positive, meaningful peer group for ego ID formation Beginning with a planned activity provides a stabilizing factor for young teens

What is the nursing interventions for neuroleptic malignant syndrome?

Admin Dantroline and Bromocrptine; monitor temp, ventilation, tachycardia, hydration

At what age is a childs self-estem most threatened?

Adolescence

Teen Depression

Adolescent depressive disorders are common and potentially fatal Often don't complain about the way they feel and instead act moody and irritable Have negative perceptions of their current lives and their future Teens at greatest risk are those with family hx of depression Between 11-15 yo, rate of depression rises rapidly in girls Slightly in boys Girls have feelings they have less control over their environment and what is happening in their lives Boys tend to focus more externally on their actions and activities Youth who develop depression between 14-16 are at greatest risk for major depressive disorder in adulthood Interventions are similar to adults with some changes Cognitive behavioral therapy (CBT) is effective Teens respond differently to meds because they don't show evidence of hypercortisolemia (excessive production of cortisol) Only SSRI approved for teens is fluoxetine Watch for suicidal ideation

What happens in development at the young adulthood age?

Adolscence ends when person is self-sufficient and maintains interdependent relationships with parents and peers, decision making is independent, may marry and begin family, career begins, self-aware of dependence and independence balance, sensitive to and accepting the feelings and needs of others are critical to this level of mature functioning

What are behaviors (affective, perceptions, cognitive, and behavioral) associated with depersonalizaiton?

Affective - feelings (loss of ID, insecurity, fear, shame, alientation of self, unreality), isolation, inability to derive pleasure, lack of sense of inner continuity Perceptions - hallucinations, confusuon, disturbed body image, difficulty distinguishing self from others Cognitive - confusion, distorted thinking, memory disturbance, time disorientation, presence of separate personalities in one person Behavioral - blunt affect, emotional passivity, incongruent or idiosyncratic communication, lack of spontaneity, loss of impulse control, loss of initiative and decision making ability, social withdrawal

Describe the affective, cognitive, physiological, and behavior associated with depression.

Affective: anger, apathy, anxiety, hopelessness, loneliness Cognitive: confusion, pessimism, ruminating on negative thoughts Physiological: insomnia, fatigue, anorexia, dizziness Behavioral: pschomotor agitation or retardation, irritability, tearfulness

Eating disorder outcomes

After hospitalization, the patient will: Restore healthy eating patterns Normalize physiological parameters related to body weight and nutrition

Elderly risk for drug toxicity

Age: monitor medications carefully Polypharmacy: observe OTC meds, alcohol intake, as well as other meds Adherence: can be noncompliant Comorbidity: acute and chronic illnesses can alter the body's response

Dementia Precipitating Factors

Aging There were 30 million people over age 65 in 1990. Loss of mental abilities is NOT automatically associated with aging. A cumulative degeneration of brain tissue is associated with aging Advanced age is one of the risk factors for Alzheimier's Disease Neurologic Alterations occur in the: Neuritic Plaques Neurofibrillary Tangles Limbic system Neurotransmitter systems Characteristic alterations occur in brain tissue are neuritic plaques ( contains a starch protein called amyloid-beta and remains of dying nerve cells) and neurofibrillary tangles (twisted clumps of protein fibers) They often have a deficiency of the neurotransmitter acetylcholine Genetic The risk for development of AD is greater for relatives with the disease. The greatest risk is for relatives of patients who developed the disease before age 55 (early onset). Strong family history with mutation of a specific gene: genetic testing may be available Offspring who does not inherit early-onset AD does not pass it on to their children Early onset AD occurs more often in pts with Downs syndrome Underlying psych/medical diagnosis Cognitive impairment may be found in other psychiatric and medical disorders. The underlying primary problem must be identified.

_ is fear of being alone in an open place where escape is hindered

Agoraphobia

Describe the DSM-IV-TR of panic disorder with agoraphobia.

Agoraphobia is the fear of being alone in open or public place or situation from which escape might be difficult, embarrasing, or help is not available if panic attack should occur

What is a major side effect of carbamazepine - Tegretol?

Agranulocytosis or aplastic anemia

AIDS Dementia

Aids Dementia Complex: Organic Brain Syndrome developed by 1/3 of people infected with HIV Symptoms include: Very slowed thinking Severe forgetfulness Difficulty performing multistage complex tasks Muscle control problems Social withdrawal, apathy, and depression

What are extrapyramidal reactions to first generation antipsychotics?

Akathisia, dystonia, tardive dyskinesia, parkinsonis, oculogyric crisis (give anticholinergics)

What does the general adaption sydrome include?

Alarm, stage of resistance, stage of exhaustion

What is the drug of choice for nurses?

Alcohol (the narcotic drug of choice is meperidine (Demoral))

Name some CNS depressants.

Alcohol, barbiturates, benzodiazipines (aka sedative-hypnotics)

CNS Depressant Abuse

Alcohol, benzos, barbiturates Primarily they reduce anxiety, induce sleep, or both Interact with antidepressants, aspirin, narcotics

_ is difficulty naming and describing emotions

Alexithymia

What are two requirements for therapeutic communication techniques?

All communication must preserve the self-respect of both individuals and one should communicate understanding before giving any suggestions or advice

What are goals for a pt with depression?

Allow expression of feelings, to analyze stressors, strengthen pts self-esteem, increase control and awareness of choices, and responsibility for behavior; sleep 6-8 hrs

Mood Stabilizing Drugs: Anticonvulsants

Also used either alone or with Lithium Thought to decrease kindling and to potentiate GABA Depakote, Depakene, Valproate Valproic acid or divalproex (therapeutic serum level is 50-100) Baseline liver function tests performed May be lethal in overdose Do not use in pregnancy or while nursing Common side effects are tremors, GI upset, ataxia, dizziness, weight gain, thrombocytopenia may occur (decrease dose) Tegretol (carbamazepine) Blood work and renal function tests performed Side effects are agrenulocytosis or aplastic anemia, sedation Don't used in pregnancy Lamictal (lamotrigine) Life threatening rash may occur (increases in children) (Stevens-Johnson Syndrome) Side effects are ataxia, HA, dizziness Overdose can be serious Don't use in pregnancy Neurontin (gabapentin) More effective in treating anxiety and agitation Don't use during pregnancy Klonopin (clonazepam) Many uses like antianxiety, anticonvulsants, sedative Topamaz (topiramate) May use calcium channel blockers during pregnancy Verapamil, Nifedolomd, nimodipine

What are nursing interventions for a pt on hallucinogens?

Always take VS first to see physical condition, give Ativan or Hadol, gastric lavage may be needed if symptoms dont subside, may be able to talk pt down, provide safe environment with little stimuli, avoid rapid movements, dont touch pt without permission

Most common type of Dementia

Alzheimer's Disease Accounts for 65% of cases of dementia 4.8 million people in US have AD Prevalence of AD doubles every year Annual Cost: $80 Billion

What is the cluster of symptoms from marijuana called?

Amotivational syndrome

Describe psychostimulants.

Amphetamines, methamphetamines, cocaine (euphoric, energetic, alert), use increases norepinephrine and dopamine but eventually destroys pleasure center in brain); tolerance and withdrawal can occur and can lead to psychosis

Ethic

An ethic is a standard of behavior or a belief values by an individual or a group It is what ought to be (not what is)

Ethic Dilemma

An ethical dilemma exists when moral claims conflict with one another Defined as a difficult problem that seems to have no satisfactory solution or a choice between equally unsatisfactory alternatives

What is dissociative amnesia?

An inability to recall important personal insormation, usually due to a traumatic or stressful event; types are localized, selective, continuous, generalized

What does the mood describe?

An individuals sustained emotional tone, which significantly influences behavior, personality, and perception

What is anxiety?

An uncomfortable and unpleasant feeling. It is contagious and is a subjective feeling that every person experiences differently. May be diffuse apprehension

_ is inability or decreased ability to experience joy, pleasure, intimacy, or closeness

Anhedonia

_ is inability or decreased ability to experience pleasure, joy, intimacy, closeness

Anhedonia

_ is a condition in which the pt doesnt recognize there is anything wrong or that there are deficits of any kind

Anosognosia

Choose whether the communication technique is therapeutic or non-therapeutic and select the best technique to correspond with the interaction. A. Giving recognition E. Verbalizing implied feelings I. Giving advice B. Focusing F. Voicing Doubt J. Belittling feelings C. Giving false reassurance G. Exploring K. Reflection D. Giving Broad openings H. Restating L. Rejecting M. Defending Pt: "My daddy always tucked me in at night." Nurse: "Lets talk more about your relationship with your father."

B - Focusing

What are some screening tools for substance abuse?

B-Dast, breathalyzer, blood and urine screens

What tests are done with anticonvulsants?

Baseline liver tests

Why would we possibly give narcan 4 hours later?

Because 1/2 life is less than morphine

Nursing Assessment for Abuse

Begin with thorough hx and physical exam In general, child and adults should be separate in interview Depending on child's age and other factors Honestly state purpose of interview Approach is calm and supportive The initial interview is not the time to confront a suspected abuser directly because measures must be taken to doc and report the abuse in a way that will ensure the child's safety

Nurses are less judgmental about the pt if they understand sources of _ and _

Behavior and feelings

Delirium Coping Mechanisms

Behavioral disruption is altered awareness, therefore, defense mechanisms are not generally used. Protect patient from harm Constantly reorient and reinforce reality during the treatment process

What is treatment of schizophrenia?

Behavioral therapy and social-learning-token-economy programs help structure, support, and reinforce prosocial behaviors in persons with schizophrenia; structured, educational family interventions help pt with schizophrenia maintain gains achived with med and case management; social skills training has enabled persons with schizophrenia to acquire instrumental and affiliative skills to improve functioning in their communities; atypical antipsychotics is promising becuse they reduce side effects and enhanced efficacy in some pts

What is magical thinking?

Belief that thinking equates with doing, characterized by lack of relationship between cause and effect

Benzodiazepines/Nonbenzodiazepines

Benzodiazepines - Ativan, Centrax, Klonopin, Paxipam, Serax, Valium, Librium, Equanil, Tranxene, Xanax Used for anxiety, sedation, alcohol withdrawal, seizure disorders, skeletal muscle, relaxation Nonbenzodiazepines - BuSpar, Catapres, Inderal They depress the CNS and RAS They must incoming stimuli GABA is potentiated, reducing anxiety and relaxing the muscles They target physical and psychological symptoms of anxiety Use short term Inhibiting effect makes them useful as anticonvulsants Pt teaching includes do not use for minor stressors of life (instead use alternative methods of reducing anxiety), it potentiates drugs like OTCs and alcohol, and avoid driving until tolerance develops Side effects Drowsiness, fatigue, decreased coordination, decreased reflexes, decreased alertness Problems with dependence, withdrawal, and tolerance HIGH ABUSE POTENTIAL ABRUPT WITHDRAWAL causes serious side effects (seizures, agitation, irritability, hyperactivity, HA, blurred vision, dizziness, hallucinations, NV, insomnia) Must be gradually withdrawn They interact additively with other CNS depressants (like alcohol) TREAT OVERDOSE with flumazenil (Mazicon, Romazicon)

What are antianxiety meds?

Benzodiazepines and non-benzodiazepines

What are two classifications of meds for anxiety?

Benzodiazepines and non-benzodiazepines

What is treatment for sleep disorders?

Benzos (zolpidem and zaleplon) reduce sleep onset by 15-30 mins, decrease number of awakenin to 1-3, increase total sleep by 15-45 mins Over the long term, use behavior interventions (stimulus control, sleep restriction, relaxation strategies)

Bulimia

Binging Purging Use of diuretics, laxatives, or enemas Can eat 10,000 calories at one time Esophagus can rupture or stomach can get really distended Lose enamel on teeth Potassium depletion Arrhythmia, muscle weakness/cramps Fluid and electrolyte problems After they eat they con just vomit as a reflex instead of putting finger down throat Can still gain weight because body absorbs some calories and nutrients Need 2000+ calories/day

What are predisposing factors of schizophrenia?

Biological; genetics; imaging can show atrophy of the frontal lobe, cerebellum, limpic; dopamine in high levels when first appears along with serotonin and glutamine

When a person has experienced one or more manic episodes, with or without a major depressive episode, the category of _ is used

Bipolar disorder

A depressive disorder with previous or current manic episodes would be classified as _

Bipolar disorder or manic-depresive illness

How do atypical antipsychotics help bipolar disorders?

Block dopamine and serotonin postsynaptic receptors

TCAs

Block reuptake of norepinephrine and serotonin at receptor sites, increasing concentration in the body These are Tofranil, Elavil, Anafranil, Ludiomil, Sinequan, Aventyl, Norpramin TEAL SAN TCA Withdrawal Syndrome - taper off slowly Can cause cardiotoxic effective over 40 yo ECG LETHAL OVERDOSE Assess for suicide risk Anticholinergic effects (blurred vision, glaucoma aggravated, dry mouth, sedative, dizziness, ortho hypo, tachycardia, urinary retention, constipation, lowered libido, impotence, weight gain, cognitive dysfunction) Can cause serotonin syndrome Potential fatal side effect of antidepressants Mania, disorientation, agitation, HA, ataxia, excessive sweating, nausea, tremor HIGH POTENTIAL FOR OVERDOSE

What do TCAs do?

Blocks reuptake of neurotransmitters norepinephrine and serotonin at receptor sites, thus increasing their concentration in the body

What does cocaine do in the brain?

Blocks reuptake of norepinephrine and dopamine

What tests are performed with the anticonvulsant carbamazepine - Tegretol?

Blood and renal function

Describe carbamazepine (Tegretol).

Blood work and renal function tests performed and monitored during first admin; side effects - agranulocytosis or aplastic anemia, sedation

What are anticholinergic effects of first generation antipsychotics?

Blurred vision, dry mouth, constipation, urinary retention

Name the personality disorder for: Instability; impulsivity; hypersensitivity; self-destructive behavior; profound mood shifts; unstabl and intense interpersonal relationships

Borderline

What PD has the highest suicidal rate?

Borderline PD

_ PD is a pervasive pattern of instability of interpersonal relationships, self-imaging, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts

Borderline PD

What 2 PD are more likely to attempt suicide?

Borderline PD and Antisocial PD

Borderline PD

Borderline is pervasive pattern of instability of interpersonal relationships, self-imaging, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts Instability, impulsivity, hypersensitivity Self-destructive behavior, profound mood shifts, unstable and intense interpersonal relationships, all good or all bad Treat with dialectical behavior therapy (DBT) which is a type of cognitive behavior therapy that uses psychological education, problem solving, training in social skills, exercise in monitoring moods, modeling by therapists, homework assignments, and meditation, partial hospitalization with group and individual therapy for 18 months, and noradrenergic agents tend to improve mood but not irritability or dyscontol so serotenergic agents may act to reduce impulsivity HIGHEST suicidal rate HALLMARK is impulsive aggression Interventions are avoid manipulation, clear boundaries, maintain nonreactivity, avoid rejection or rescue, assess for suicide, behavior therapy, SSRIs, assess for self mutulation

Describe how BEAM works, what it images, and the advantages/disadvantages.

Brain electrical activity mapping (BEAM) How it works: Uses computed tomographyic techniques to display data derived from EEG recordings of brain electrical activity that can be sensory evoked by specific stimuli, such as a flasg of light or a sudden sound, or cognitive evoked by specific mental tasks What it images: Brain activity/function Advantages/disadvantages: Reflects the cumulative activity of broad areas of the brain, usually near the surface, making it difficult to locate areas of possible pathological states

If a pt is anxious for a long time, give what?

BuSpar (not PRN because it has to build to a therapeutic level)

What a hypochondriac pt, who want to do what before asking them to see a doctor?

Build trust with pt and help them see that anxiety is coming out in ways

Describe the antisocial PD pt.

Bully, harm animals, person has to be at least 18 to be diagnosed but since 15 of behavior, impulsive and decietful, think your alive for their own pleasure, irresponsible, lack of remorse/empathy, no insight to know they have hurt or stole from someone, hard to change them, aka sociopath or psychopathic

What meds are used to decrease cravings of nicotine?

Buproprion (Wellbutrin) and chantix (people are having psychotic breaks with it

Other Antianxiety meds

Buspar Not sedating, acts as serotonin agonist, causes no cross-tolerance, no addictive potential, not effect with drug or alcohol withdrawal Some sedative/hypnotic meds can also be used for anxiety disorders Ambien and Sonata Other SSRIs may be prescribed for panic attacks, phobias, and OCD Prozac and Luvox Some TCAs are used to treat panic attacks, phobias, and PTSD Clomipramine (Anafranil) is a TCA used to treat OCD Desyrel is an antidepressant used for insomnia Barbiturates are old antianxiety and sedative meds used but dangerous in overdose, CNS depressants, very addictive, and serious withdrawal Secobartbital, Phenobarbital, sodium amytal, mnembutal Very rarely used but are big street drug Potentiates alcohol and benzos

A patient admitted for psychiatric examination ordered by the court following arrest for embezzlement from his workplace has a history of blaming others for his problems and becoming defensive and angry when criticized. He expresses no remorse for his actions, but claims his actions were justified because his company did not pay him what he is worth. The nurse would correctly determine that this patient displays symptoms most closely associated with: A. avoidant personality disorder. B. schizotypal personality disorder. C. antisocial personality disorder. D. borderline personality disorder.

A patient asks the nurse, "How would I know if I were dependent on alcohol?" The nurse should respond by telling her that dependence is defined by: A. a compulsion to use the drug. B. a loss of control over use of the drug. C. a physiological need to use the drug. D. continued use despite adverse consequences.

A patient who has been clinically depressed for the past year has responded poorly to antidepressants. The statement that would be of greatest concern relative to the development of dual diagnosis is: A. "My life has lost all its color and pleasure." B. "I can't take it anymore. I'm going to end it." C. "When I drink things look better, and I feel almost human." D. "I can't seem to get any work done. I'm always so tired."

A patient with severe and persistent paranoid schizophrenia and crack abuse tells the nurse, "I don't think I'll ever get straight. Maybe I don't even want to. Being schizophrenic is such a drag. The voices are such downers, always insulting and berating me, but when I use crack, I like the good feeling I get." The nursing diagnosis the nurse should consider is: A. spiritual distress related to separation from religious ties. B. risk for violence related to poor impulse control. C. impaired adjustment related to failure to intend to change behavior. D. disturbed thought process related to use of mind-altering drugs.

Indicators that would support the nurse's suspicion that a patient has been using inhalants are: A. perforated nasal septum and hypertension. B. drowsiness, euphoria, and constipation. C. confusion, mouth ulcers, and ataxia. D. pinpoint pupils and respiratory rate 12.

Patient: "The head man expects some cash today" Nurse: "I am not sure what you mean. Who is the head man?" A. Informing B. Theme identification C. Clarification D. Sharing perception

The distinguishing characteristic the nurse is likely to assess in a patient with antisocial personality disorder that is absent in most other personality disorders is: A. exhibiting guilt and remorse. B. responding well to neuroleptics. C. disregarding the rights of others. D. responding to kindly, gentle suggestions.

The nurse working with a patient who has borderline personality disorder must consider in advance strategies for intervening in: A. grief and social isolation. B. withdrawal and social avoidance. C. mood shifts, impulsivity, and manipulation. D. thought disorder, grandiosity, and overreaction.

Which assessment would a nurse be most likely to make when working with a patient with a personality disorder? A. Patient behavior demonstrates similarity to cultural norms for behavior. B. Patient behavior causes little distress to self or others. C. Patient behavior is inflexibly dysfunctional. D. Patient seeks an intense relationship with nurse.

Which goal for treatment of alcoholism is primary? A. Develop alternate coping strategies. B. Learn about dependence and recovery. C. Achieve physiological stability. D. Develop a peer support system.

Which of the following would the nurse expect to observe in a patient diagnosed with schizotypal personality disorder? A. Brief psychotic episodes in response to stress B. Intense, stormy relationships C. Incorrect interpretation of external events D. Lack of tender feelings toward others

Patient: "I just want scream when ,y husband spends all his time at the computer." Nurse: "You are feeling very frustrated about your husband spending time at the computer." A. Focusing B. Restating C. Reflection D. Broad opening

C - because talking about a feeling

Choose whether the communication technique is therapeutic or non-therapeutic and select the best technique to correspond with the interaction. A. Giving recognition E. Verbalizing implied feelings I. Giving advice B. Focusing F. Voicing Doubt J. Belittling feelings C. Giving false reassurance G. Exploring K. Reflection D. Giving Broad openings H. Restating L. Rejecting M. Defending Pt: "I dont think my life will ever be the same again." Nurse: "Cheer up, Everyting is going to be ok."

C - giving false reassurance

Choose whether the communication technique is therapeutic or non-therapeutic and select the best technique to correspond with the interaction. A. Giving recognition E. Verbalizing implied feelings I. Giving advice B. Focusing F. Voicing Doubt J. Belittling feelings C. Giving false reassurance G. Exploring K. Reflection D. Giving Broad openings H. Restating L. Rejecting M. Defending Pt: "Whenever I ask for a different therapy, my doctor ignores me." Nurse: "Oh Im sure that your doctor knows whats best for you."

C - giving false reassurance

How do you assess for alcoholism?

CAGE - cut down, annoyed, guily, eye opener (drink in morning) 2 yeses need further assessment

What is the mechanism of action for hypnotics?

CNS depressant

What are 5 neuroimaging techniques used?

CT, MRI, BEAM, PET, SPECT

What medications or substances may be related to anxiety disorders?

Caffeine, aspirin, steroids, alcohol, narcotics, sedative hypnotics, PCP, anticholinergic drugs

Creutzfeldt-Jakob disease

Can be transmitted through: Infections Food or Inherited Symptoms include: Rapidly progressing motor and behavioral disturbances, Dementia, Abnormal EEG Rare in humans Can be transmitted by means of infections (organ transplants or growth hormone injections from contaminated sources), food (kura, transmitted during cannibalism when contaminated human brains are consumed), or inherited (DMA mutation) Normal protein cell prion is mutated causing spongy appearance of the brain postmortem Symptoms are rapidly progressing motor and behavioral disturbances, dementia, and abnormal EEG activity

What are problems with Wellbutrin?

Can cause agitation, seizures (lowers seizure threshold), HA, dryness, urinary hesitancy, blurred vision

What is a major problem associated with TCAs?

Can cause cardiac problems and more dangerous in overdose

Give an example of focusing.

Can you give me an example of how that typically happens for you? What is it about your family that bothers you? It concentrates on a single issue and allows the client to focus on one issue.

How do you treat personality disorders?

Cannot treat (change) someones personality but can help improve their quality of life

What does overdose of psychostimulants cause?

Cardiac arrhythmias, seizures, increase in BP, shock, and death

_ is stuporous state in which the pt may require complete nursing care

Catatonia

What can SSRIs do to a pt with bipolar?

Cause manic state

What are nursing challanges when dealing with a pt with PD?

Challenges of nurse caring for these pts is maintaining pt safety, facilitates pts participation in care, select least restrictive interventions, facilitate behavioral change, and help pt assume responsibility for behaviors

What is a key sign of major depressive disorder?

Change in behavior over 2 weeks

What is the key element of depression?

Change in persons behavior and response (mostly by family but usually dont associate with depression)

Anorexia

Characterized by a morbid fear of obesity Onset: Early to late adolescense Gross distortion of body image Preoccupation with food and refusal to eat Key feature - see bones, amenorrhea, probably not sexually active (probably isolated), sometimes they cook a lot of food and invite people over and only eat one bite Do this for control of their environment and body

What is paranoid schizophrenia?

Characterized by feelings of persecution, grandiose delusions and auditory hallucinations; tense; guarding; voices may be hostile and aggressive; must introduce self before touching them because they may strike at you

Describe the DSM-IV-TR of hypochondriasis.

Characterized by preoccupation with fear of having or the idea that one has a serious disease, preoccupation presists despite appropriate medical tests and reassurance, somatic delusions are ruled out, causes impairment in social or occupational functioning or cause marked distress

Describe the DSM-IV-TR of PTSD.

Characterized by repeated re-experiencing of a highly traumatic event that involved actual or threatened death or serious injury to self or others, to which the individual responded with intense fear, helplessness, or horror; rarely own psych diagnosis

Teen Bipolar Disorder

Characterized with mood fluctuations and instability, poor impulse control, and aggression with irritability and agitated behavior Interventions need to consider the level of development to make sure its age appropriate Teens have more frequent mood fluctuations that are less episodic in nature than adults Same meds (mood stabilizers - lithium, divalproex, lamotrigine as well as atypical antipsychs - olanzapine, risperidone)

What age is there conflict between setting limits and boundaries?

Childhood (6-10)

Dementia Meds

Cholinesterase Inhibitors Aricept, Reminyl, Exelon Cognex: liver toxicity may occur Target symptoms - apathy, psychosis (delusions, hallucinations), agitation, anxiety, nighttime behavior Positive effects have been shown on cognition, activities of daily living, and global functioning Inhibit enzyme acetylcholinesterase (AChE) Antipsychotics Risperidone (Risperdal) Olanzapine (Zyprexa) Quetiapine (Seroquel) Haloperidol (Haldol)+ Hadol is given PRN (given with Ativan and sometimes benadryl) Other 3 are atypical - watch for metabolic syndrome like weight gain (causing high lipids, high cholesterol, diabetes, etc) EPS symptoms - oculogeric crisis, tardic a (weird movements) - give anticholingeric Benzos Must be used with caution in the elderly and in patients with dementia Can interfere with learning May decrease anxiety and agitation Should be avoided (as well as anticholinergic agents) because it interferes with learning Target anxiety and agitation Antidepressants Beta Blockers Estrogen Anticonvulsants Serotonergic Agents NMDA antagonist Targets severe dementia mentaine (Namenda) May be combines with cholinesterase inhibitors Skin patch Only skin patch is exelon patch for mild to moderate AD Apply to back, upper arm, or chest Improves tolerability and allowing higher proportion of pts to receive therapeutic dosages

Eating disorder appraiser of stressers

Client Does not possess: Resiliency when stress occurs An integrated self concept A realistic body image Ability to describe their feelings

What is bizzare affect?

Client is unable to relate logically to the environment

CBT for eating disorders

Client must understand: Cues that trigger problematic eating Thoughts, feelings and assumptions associated with specific cues Connection between thoughts, feelings and assumptions and eating responses Consequences resulting from eating responses

What are the hoped for outcomes for a suicidal pt?

Client will: not harm self, verbalize a measure of hope and acceptance, maintain self control without supervision, uphold suicide contract, seek help when suicidal ideas occur, set realistic goals, seek treatment for depression and drug abuse

Give an example of paraphrasing.

Client: "I cant focus. My mind keep wondering." Nurse: "Youre having difficulty concentrating?"

How do you assess for a pt with opiate withdrawal?

Clinical Institute Narcotic Assessment Rating Scale (CINA) for monitoring symptoms: substitute opiate with tapering doses of Methadone or Buprenorphine; use clonidine to manage withdrawal symptoms; check BP q45mins

What type of personality disorders use manipulation?

Cluster B

What are the effects of nicotine similar to?

Cocaine, opiates, and amphetamines

Psychostimulants

Cocaine-Affects neurotransmitter Dopamine; In brain its blocks reuptake of norepinephrine and dopamine; reaction in body is euphoria for 10-20 secs then 15-20 min less intense euphoria; biggest problem with withdrawal is depression; Methamphetamines is when people think they have bugs on skin and skin picking Amphetamines cam treat ADHD Use increases nopinephrine and dopamine but eventually destroys pleasure center in brain; tolerance and withdrawal can occur and can lead to psychosis Overdose causes cardiac arrhythmias, seizures, increase in BP, shock, and death Symptoms of withdrawal are depression, fatigue, anxiety, psychomotor, retardation, suicidal ideation

What are meds used to treat extrapyramidal side effects (EPS)?

Cogentin, Artane, Kemadrin, Akineton, Benedryl; benzos (ativan, inderal, klonopin, valium)

What are some cognitive and mood symptoms of schizophrenia?

Cognitive - attention, memory, executive functions (abstraction, concept formation, problem solving, decision making) Mood - dysphoria, suicidal, hopelessness

Therapeutic Milieu for elderly

Cognitive Stimulation Promote a Sense of Calm and Quiet Consistent Physical Layout Structured Routine Focus on Strengths and Abilities Minimize Challenging Behavior Minimal Demands for Compliant Behavior Provide Safety

What is treatment for avoidant PD?

Cognitive behavioral desensitization, MAOIs, SSRIs, benzos for pain, friendly and gentle approach, antidepressnats

What is the treatment for body dysmorphic disorder?

Cognitive-behavior therapy can help pts ID and challange body perceptions and interrupt self-critical thoughts

What is treatment for hypocondriasis?

Cognitive-behavioral therapy is helpful in reducing attention to the distress bodily sensationgs, correcting misinformation and exaggerating beliefs, and addressing the cognitive processes that maintain disease fears

What does LCD look like?

Colorless, tasteless, and swallowed (slipped in drinks)

What are common characteristics of PD?

Common characteristics are continuous, inflexible and maladaptive response to stress, disability in working and loving, ability to evoke interpersonal conflict, capacity to get under the skin, little insight into behavior and don't feel they need to change, unconscious behavior

What are some ego-defense mechanisms?

Compensation, denial, displacement, dissociation, identification, and intellectualization

What is Wernicke's encephalopathy and Wernicke-Korsakoff syndrome?

Complications of alcohol abuse where severe deficit in cognitive functioning, related to deficiency of Vit B, esp thiamine; may be irreversible

What type of therapeutic communication technique is: helping the client become more aware of inconsistancies in his or her feelins, attitudes, beliefs, and behaviors?

Confrontation

When is confrontation used in a relationship?

Confrontation is used when there are discrepancies between: a. the patient's expression of what he or she is (self concept) and what he or she wants to be (self-ideal) b. between the patient's verbal self expression and nonverbal behavior c. between the patient's expressed experience of himself or herself and the nurse's experiences of him or her

What is the difference between congruent and incongruent communication?

Congruent is verbal and nonverbal communication is the same Incongruent is both are opposite

Cognitive Disturbance Areas

Consciousness - reduced clarity or awareness of the environment Attention - impaired ability to direct and maintain mental focus, resulting in problems with processing stimuli into information Cognition - recent memory impairment, disorientation to time and person, or language disturbance Perception - misinterpretations, illusions, or hallucinations Motor ability - poor balance, ambulation, or coordination

Binge eating disorder

Consuming large amounts of food within a two hour time period and with a sense of total lack of control during this period

What is substance abuse?

Continues use despite problems related to use of drugs or alcohol

Describe personality disordes.

Continuous rather than episodic, appearance and severity of symptoms can vary over time, includes a wide range of persons lifes, individual has few strategies for relating, inflexible/maladaptive approach to relationships and environment, needs/perceptions/behavior foster viscious cycle (promote unhelpful patterns and provoke negative reactions from others), unstable and fragile coping skills, and lack of resilence in stressful situations

Name eight assessment criteria you would use to determine the pts ability to harm themselves.

Contract for safety, suicide plan, elopement risk, suicidal ideation, hx of attempts, symptoms (hopelessness, ect), current morbid thoughts

What is the function of the basal ganglia?

Coordinate involuntary movements and muscle tone

What are symptoms of lithium toxicity?

Course hand tremors, n/v, diarrhea, muscular weakness, oliguria, ataxia, slurred speech, confusion, coma, anuria, seizures, death

What is compensation?

Covering up a lack or weakness by overemphasisof another area (ex: I may be short but I know basketball)

What is the cerebral cortex's function?

Critical in decision making and higher-order thinking, such as abstract reasoning

For which of the following behaviors would it be most essential for the nurse to use limit setting? A. Dependence B. Avoidance C. Suspicion D. Manipulation

Patient: "Since my wife left me nothing matters." Nurse: "You have spoken so often of feeling deserted by your wife. It seems this change has left you feeling empty." A. Clarification B. Focusing C. Informing D. Theme identification

The community mental health nurse is conducting a community health education series on substance abuse. Which of the following descriptions of abuse or addiction should the nurse plan to include? A. Abuse and addiction are interchangeable terms. B. Abuse is characterized by physical dependence, whereas addiction is characterized by psychologic dependence. C. Both abuse and addiction are disease entities with severe withdrawal symptoms. D. Addiction is characterized by both psychological and physiological withdrawal symptoms.

The nurse caring for an individual with schizoid personality disorder would expect to assess: A. impulsive, restless, aggressive behavior. B. magical thinking and suspicious, odd behavior. C. distrustful, cold, often angry behaviors. D. few interactions with others and little verbalization.

When asked to contrast social superficially with therapeutic intimacy, an experienced nurse mentor explains to a new nurse that the termination component in therapeutic intimacy is A. Closed to negotiation or agreement B. Unknown C. Open ended D. Specific and agreed on

When planning limit setting for a manipulative patient, which of the following steps would be omitted? A. Establishing realistic limits B. Making sure limits are enforceable C. Making patient aware of limits and consequences of violating limits D. Allowing staff to use own judgment in event the patient exceeds limits

Choose whether the communication technique is therapeutic or non-therapeutic and select the best technique to correspond with the interaction. A. Giving recognition E. Verbalizing implied feelings I. Giving advice B. Focusing F. Voicing Doubt J. Belittling feelings C. Giving false reassurance G. Exploring K. Reflection D. Giving Broad openings H. Restating L. Rejecting M. Defending Pt: "Good moring nurse." Nurse: "Good morning Brittney, what would you like to talk about today?"

D - giving broad opening

Choose whether the communication technique is therapeutic or non-therapeutic and select the best technique to correspond with the interaction. A. Giving recognition E. Verbalizing implied feelings I. Giving advice B. Focusing F. Voicing Doubt J. Belittling feelings C. Giving false reassurance G. Exploring K. Reflection D. Giving Broad openings H. Restating L. Rejecting M. Defending Pt: "We always has such fun durin the holidays when I was growing up." Nurse: "Tell me more about what it was like when you were a little girl."

D - giving broad openings

What can atypical second generation antipsychotics cause?

What is narcolepsy?

Daily irresistible attacks of refreshing sleep, reduction in number of neurons containing hypocretin, inflammatory process (gliosis - linked to neuronal degeneration)

What are problems with TCAs?

Dangerious cardiac side effects, lethal in overdose (suicide risk), tapper off slowly

How does typical or first generation antipsychotics meds help treat schizophrenia?

Decrease dopamine to lessen hallucinations and delusions

What are some neurotransmitters associated with depression?

Decrease uptake in serotonin and nerepinephrine

When do you usually see repeated pinking of lint or dirt off clothing?

Delirium or toxic conditions

_ is false belief that is firmly maintained even though is not shared by others and is contradicted by social reality; false fixed belief

Delusions

In the mental status assessment, what is included in the thouh content?

Delusions type (religious, somatic, grandiose, or paranoid), other thought descriptors (thought broadcasting, thought insertion, depolarization, hypochondriasis, ideas of reference, magical thinking, nihilistic thinking, obsession, phobias, ruminations, and religiousity), and assessment of suicide/homicid ideas

What defense mechanism is the following person using? "I do not need to go out of the house. I don't need people at all. I have my books who are my greatest friends. I read of beautiful places far away and meet such interesting people through my books. I have plenty of stimulation, listening to Mozart, Beethoven, and Bach."

Denial and Intellectualization

Define which defense mechanism the patient is using and identify it as adaptive or maladaptive: Smoking is not harming me. I can quit any time I want. ______________ and ___________________________________.

Denial and rationalization

What are four defense mechanisms that people use to decrease the threat of suicide thoughts?

Denial, rationalization, regression, magical thinking (suicide behavior indicates the immiment failure of coping mechanisms)

What is the difference between denotative meaning and connotative meaning of words?

Denotative meaning of a word is the actual and concrete Connotative meaning of a word is the implied or suggested word

Name some anticonvulsants for mood disorders?

Depakote, Neuronfin, Klonopin, Topamax, Tegretol, Lamictal

What happens in development at the adolescence age?

Dependence on a close friend of same gender usually yields to dependent heterosexual relationship, asserting interdependence from their parents, parents can help the adolescent grow by providing consistent limits and a caring tolerance of rebellious outburts, person learns to balance demands and peer group pressure

What are problems with antianxiety meds?

Dependence, withdrawal, and tolerance

Name the personality disorder for: Submissive bhavior; low-esteem; dependency in relationships; extreme self-consciousness; urgently and indiscriminately seeks another relationship when close relationship ends; inadequate; helpless

Dependent

_ PD is a pervasive pattern and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts

Dependent PD

Dependent is pervasive pattern and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts Treatment is psychotherapy, supportive therapy, cognitive behavior therapy, med for social anxiety (SSRI so watch for dependency)

_ is a temporary change in the quality of self-awareness, which often takes the form of feelins of unreality, changes in body image, feelings of detachment from the environment or a sense of observing oneself outside the body

Depersonalization

What is the mechanism of action of antianxiety drugs?

Depress CNS, Depress RAS, Mute incoming stimuli, GABA is potentiated so anxiety is reduced and muscles relax, Target physical/psychological symptoms of anxiety, used short-term, Inhibiting effects makes them useful as Anticonvulsants

What are non-benzodiazepams used for?

Depress CNS, depress reticular activating system, mute incoming stimuli, anxiety (physical and psychological), muscle relaxant, anticonvulsants

Describe barbituates.

Depressants that cause initial response of euphoria; popular street drugs: once widely prescribed for sedative-hypnoticc effects but have been major cause of overdose death from accidental poisionings, suicide; produce excessive drowsiness, even at therapeutic doses; tolerance develops rapidly

Barbituate Abuse

Depressants that cause initial response to euphoria Popular street drugs Once widely prescribed for sedative-hypnotic effects but have been major cause of overdose death from accidental poisioning or suicide Produce excessive drowsiness even at therapeutic dose; tolerance develops rapidly AKA black beauty, reds, sleepers

What does decreased serotonin cause?

Depression

What is the biggest problem with cocaine withdrawal?

Depression

What is the number 1 psychiatric cause of diability?

Depression

When do you usually see stooped posture?

Depression

What is beck assessment for?

Depression (1-10 normal)

What are SSRIs used to treat?

Depression and anxiety

4 Ds of geropsych assessment

Depression, dementia, delirium, delusions

What are symptoms of withdrawal from psychostimulants?

Depression, fatigue, anxiety, psychomotor retardation, and suicidal ideation

When do you usually see little body movement?

Depression, organic mental disorders, catatonic schizophrenia, drug-induced stupor

Name the personality disorder for: Depressive conditions: gloomy, brooding, pessimistic, guilt-prone, hihly critical of self and others, cheerless

Depressive

A depressive episode with no manic episodes should be classified as what?

Depressive disorder

What is the most common and central behavior of a depressed patient?

Depressive mood

Sexual Response Cycle

Desire - sexual fantasies and the desire for sexual activity Excitement - subjective sense of sexual pleasure along with physiological changes, including penile erection in the male and vaginal lubrication in the female Orgasm - peaking of sexual pleasure and the release of sexual tension accompanied by rhythmical contractions of the perineal muscles and pelvic reproductive organs Resolution - sense of general relaxation, muscular relaxation, and well-being; females may be able to respond to additional stimulation almost immediately during this stage but most males need some time before they can be restimulated to orgasm

What do you monitor for with atypical or 2nd generation antipsychotic medications?

Diabetes

Name the personality disorder for: Use behavioral and cognitive techniques including psychological education, problemsolving, training in social skills, exercise in monitoring moods, modeling by the therapist, homework assignments, and meditation

Dialectical behavior therapy

_ Thinking in extreme or absolute terms such as that events can only be black or white, right or wrong, good or bad

Dichotomous or all-or-none thinking

What is the difference between direct and indirect self-destructive behavior?

Direct - any form of suicidal activity (suicidal ideation, threats, attempts, completed suicides) with intent of behavior is death and person is aware of desired outcome Indirect - any activity detrimental to persons physical well-bein that potentially may result in death however the person may be unaware of this potential and deny it if confronted

What are behaviors associated with low self-esteem?

Direct: self criticism, guilt/worry manifestations, postponing decisions, denying oneself pleasure, disturbed relationships, withdrawal from reality, self and ther destructiveness Indirect: illusions and unrealistic goals, exaggerated sense of self, boredom, polarizing view of life

What are 7 sociocultural sressors?

Disadvantagement - lack of scioeconomic resources that are basic to adaptation Discrimination - Differential treatment of individuals or groups that is not based on actual merit Intolerance - unwillin to accept different opinions or beliefs from people of different backgrounds Prejudice - a preconceived, unfavorable belief about individuals or groups that disregars knowledge, thought, or reason Racism - the belief that inherent differences among races determine individual achievement and that one race is superior Stereotype - a depersonalized conception of individuals within a group Stigma - an attribute or trait deemed by the persons social environment as unfavorable

What is pharmocogenetics?

Discipline that blends pharmocology with genomic capabilities, will eventually allow researchers to match DNA variants with individual responses to medical treatments

What are the 3 cateogories of confrontation?

Discrepancies between pts expression of what he is (self-concept) and what he wants to be (self-ideal) Discrepancies between pts verbal expression and nonverbal expression Discrepancies between pts expressed experience of himself and the nurses experience of him

What are the cluster B personality disorders?

Disorders of erratic, dramatic, or emotional nature (antisocial, borderline, histrionic, narcissistic PD)

Memory Loss Behaviors Associated with Dementia

Disorientation to time, place and person Sensory Memory (visual orauditory) Primary Memory (immediate or short term) Secondary Memory (storage of info tat one intends to retain) Tertiary Memory (long term) Working Memory (operates with primary memory and includes the stimulaneous storage and processing of info over a short period of time)

What are behaviors associated with identity diffusion?

Disruption in relationships (withdrawn or distancing, pt may ignore or destroy the people who threaten him), problems with intimacy (reflection in isolation, denial, and withdrawal from others), gender confusion, high degree of anxiety, inability to emphasize with others, contradictory personality traits

What are the essential features the DSM-IV-TR describes for dissociative disorders?

Disruption in the usually integrated functions of consciousness, memory, identity, or perception. Dissociative responses occur when anxiety becomes overwhelming and the personality becomes disorganized. Consciousness, memory, identity, and perception must be integrated. If not the person starts dissociating and splitting. There may be a sudden disruption of memory, identity, and perception. Anxiety may occur in these pts and their self becomes fragmented.

What are behaviors that a pt with identity diffusion show?

Disruptions in relationships: withdrawal or distancing; the pt may ignore or destroy the people who threaten him Problems with intimacy: reflected in isolation, denial, and withdrawal from others Feelings of emptiness Explosive interpersonal relationships Gender confusion High degree of anxiety Inability to empathize with others Contradictory personality traits

_ is the disruption in the usually integrated functions of consciousness, memory, ID, or perceptions of the environment (experiences blocked off from consciousness)

Dissociation

What is depersonalization disorder?

Disturbance in the perception of self, perceiving the self as not real. It serves as a defense mechanism and offers protection from overwhelming anxiety. ITs a subjective experience of the partial or total disruption of ones ego and the disintegration and disorganization of ones self concept. It serves as a defense, but is destructive because it masks and immobilizes anxiety without diminishing its intensity.

Low self-esteem is a major element in what problem?

Disturbed body image

What are s/s of inhalant use?

Dizziness, slurred speech, unsteady gait, depressed reflexes, tremor, euphoria, blurred vision, stupor, coma, rash may be present around the mouth

What is some patient teaching you should give with antianxiety meds?

Do not use for minor stressors of life Potentiates drugs (OTC, alcohol) Avoid driving until tolerance develops (should not operate hazardous machinery)

What is chronic pain?

Doesnt follow normal anatomical nerves, usually lasts 6+ months, meds dont help, relationship between anxiety and pain

Describe a pt in a fugue state?

Dont appear to behavin out of the ordinary. Minimal contact with people. Life may be simple and incomplete. Usually get picked up by police for wandering. Duration is hours to months.

What are interventions for PCP (phencycline)?

Dont attempt to talk pt down (pt may be agitated and may harm self or others), decreased environmental stimuli

What neurotransmitter increased is affected with schizo causing the positive symptoms?

Dopamine

Which neurotransmitter is affected by cocaine?

Dopamine

What are the neurotransmitters effected by schizophrenia?

Dopamine (increases with hallucinations and delusions) and serotonin

What are some neurotransmitters associated with schizophrenia?

Dopamine (said to be increased when demonstrating symptoms, like hallucinations and delusions) and serotonin

For the mental status assessment, what are included in the general appearance?

Dress (appropriateness, bizarre, unkempt, hygiene, impaired, inappropriate), posture (erect, slumped, tense/rigid, unusual, bizarre, elated), facial expression (sad, angry, suspicious, anxious, warm/friendly, makes eye contact, other), and motor behavior (tremors, tics, restless, slow, hyperactivem agitated, grimacing, posturing, repetitive movements, abnormal gait, compulsions)

What are side effects of hypnotics?

Drowsiness, dizziness, ataxia, irritability, tolerance

What are the side effects of antianxiety meds?

Drowsiness, fatigue, decreased coordination, decreased reflexes, decreased alertness

What are the side effects of typical or 1 generation antipsychotic medications?

Drowsiness, ortho hypo, wt gain, edema, menstrual disorders, photosensitivity, lowered seizure threshold, agranulocytosis, jaundice, galactorrhea, gynecomastia, impaired ejaculation Anticholinergic effects - blurred vision, dry mouth, constipation, urinary retention Extrapyramidal reactions - akathisia, dystonia, tardive duskinesia, parkisonism, oculogyric crisis (Give anti-cholinergics)

Delirium Precipitating Factors

Drug or Substance Abuse (Polypharmacy) - Most common Delirium r/t alcohol or sedative hypnotic withdrawal is recognized by agitation hyperactive/hyperalert motoric state Delirium r/t alcohol or sedative hypnotic withdrawal Underlying Medical conditions: CNS disorders, cardiopulmonary disorders, systemic illnesses, sensory deprivation or stimulation Central Nervous Disorder (head trauma, brain diseases and infections) Metabolic Disorder (endocrine malfunction, hypoxia) People with hypothyroidism feel sluggish and dysfunctional in thinking Severe hypothyroidism (myxedema) may develop psychotic behavior characterized by delusional thinking Other causes are hypoglycemia, hypopituitarism, adrenal disease Nutrition (malnutrition, anorexia and bulimia nervosa) Vit B deficiency can lead to Wernicke-Korsakoff synddrome leading to severe deficit in cognitive functioning Cardiopulmonary disorder Systemic illnesses Sensory deprivation or stimulation ICU psychosis is with constant lighting and activity in ICU can lead to confusion, delusions, and hallucinations

What are side effects of TCAs?

Dry mouth, tachycardia, sedation, dizziness, blurred vision, constipation, urinary retention, glaucoma aggravated, decreased libido, priapism, orthostatic hypo, weight gain, cognitive dysfunction, serotonin syndrome

Describe how intimacy changes through life.

During childhood the parents are the significant ones. As the child ages, they develop internal merality between 6-10. Preadolescence they pull from parents and peers become more important. They develop autonomy but struggle between dependent and independent needs. Parents need to set limits and boundaries. Young adults become sulf-sufficient and independent

What neurotransmitters are associated with bipolar?

Dysregulation in serotonin, norepinephrine, dopamine, acetylcholine

Choose whether the communication technique is therapeutic or non-therapeutic and select the best technique to correspond with the interaction. A. Giving recognition E. Verbalizing implied feelings I. Giving advice B. Focusing F. Voicing Doubt J. Belittling feelings C. Giving false reassurance G. Exploring K. Reflection D. Giving Broad openings H. Restating L. Rejecting M. Defending Pt: "He is such a scumbag that I think I need to get a divorce." Nurse: "You seem very angry with your husband."

E - verbalizing implied feelings/ K - reflection

What do you determine if someone has overdosed of alcohol and other CNS depressant?

EMERGENCY SITUATION - unconscious, cant be awakened by pinching, prodding or shouting, skin is cold, clammy, pale, bluish or purplish color (signs of oxygen depreviation), slow or labored breathing, fewer than eight breaths per min, vomiting without waking up

_ is the pathological repeating of anothers word by imitating and is often seen with people with catatonia like "Mary come for your meds...Mary come for your meds"

Echolalia

_ is purposeless imitation of movements made by another person

Echopraxia

_ is purposeless imitation of movements made by other people

Echopraxia

Name seven protective factors against suicide.

Effective clinical care, easy access to clinical interventions, restricted access to lethal methods, support, medical and mental health care support, problem solving skills and nonviolent handling of disputes, cultural and religious beliefs that discourage suicide

What are withdrawal symptoms?

Effects resulting from biological need when body adapts to drug

Name some MAOIs.

Eldepryl, Nardil, Parnate, Marplan

What is the goal of acute treatment phase for mood disorders?

Eliminate symptoms

Emergency, short term, and long term hospitalization

Emergency hospitalization is for acute ill pts Most states limit this to 48-72 hours Short term hospitalization or observational hospitalization commitment is used primarily for diagnosis and short-term therapy and doesn't require an emergency situation Long term hospitalization or formal commitment is for indefinite time or until the pt is ready for discharge

_ is when you get the person to talk about their emotions

Emotional catharsis

Name some recurring themes in anxiety.

Emotional pain, danger or threat, fight or flight syndrome

What are the biological factors of narcolepsy?

Emotions-arousal-corticosteroid release from HPA axis, genetically inherited tendency, prolonged stress can cause physiological changes to vulnerability to stress, learning ways of communicating helplessness

What is the term for the time when someone can perceive the feelings of someone else and communicate these feelings to the other person?

Empathy

For confrontation to work, need high levels of _ and _

Empathy and respect

What is teaching with Lithium?

Encourage fluid intake 2000-3000 mL/day, dont restrict salt in diet, CV/renal/thryoid functions evaluated, alert pt - diuretics/fever/exercise all increase lithium levels

How does benzos help bipolar?

Enhance GABA and decrease anxiety

State of Relatedness

Enmeshment - people who are so enmeshed in other peoples lives that they don't know themselves; don't know where other person stops and they begin Connectedness - actively involved in relationships, mutuality, interdependence, comfortable and exceptable of others, not totally dependent on significant other for development and behavior Disconnectedness - lack of involvement that is not satisfactory to the person Parallelism - lack of involvement that is comfortable and acceptable to the individual

Describe the states of relatedness.

Enmeshment - people who are so enmeshed in other peoples lives that they dont know themselves; dont know where other person stops and they begin Connectedness - actively involved in relationships; mutuality; interdependence; confortable and exceptable of others; not totally dependent on significant other for development and behavior Disconnectedness - lack of involvement that is not satisfactory to the person Parallelism - lack of involvement that is comfortable and acceptable to the individual

Developmental Tasks of Kids

Erickson: Industry vs. Inferiority Piaget: Concrete operations (logical reasoning, learning through trial and error, understanding rules and other people's point of view) Kohlberg: 4-7 yrs old (rules obeyed to gain rewards); 7-12 yrs old (conformity to family, group, society)

What are developmental influences?

Erikson: concept of ego identity Adolescence: Identity versus Identity diffusion

How will a pt with depression encourage behavioral changes?

Establish small and measurable goals, focus on positive activities, must be relavent to their need, focus on task at hand, give positive reinforcement

How does cocaine react in the body?

Euphoria short acting starting with 10-20 sec rush then 15-20 mins of less intense euphoria

What do biological rhythm affect?

Every aspect of health and well-being, including lifestyle, sleep, mood, eating, drinking, fertility, body temp, and menses

What are the symptoms of PTSD?

Exaggerated startle response, recurrent and distressing thoughts about the event, nightmares, flashbacks, Inability to remember parts of the event, survivors guilt, difficulty concentrating, irritability or anger, emotional withdrawal, decreased interest in activities

Describe the DSM-IV-TR of generalized stress disorder.

Excessive anxiety and worry for 6 months or longer while experiencing at least 3 of the following: restlessness or feeling on edge, fatigue and sleep disturbance, poor concentration or mind going blank, or irritability and muscle tension

What is the DSM-IV-TR definition of anxiety?

Excessive anxiety and worry, occuring more days than not for at least 6 months, about a number of events or activites. The person finds it difficult to control the worry and experiences at least three of the following symptoms: restlessness or feeling keyed up or on edge, fatigue, difficulty concentrating or mind going blank, irritability, muscle tension, sleep disturbance.

Describe the histrionic PD pt.

Excessive emotionality, attention seeking, sexually seductive, theatrical, suggestible, gets hurt in relationships, physical sx, rapid shifts of emotions, wants physical appearance to attract others

Outcomes and goals for elderly

Expected outcomes must be based on the person's ability to change behaviors. If the patient cannot change, then the outcomes are focused on adaptation of the situation. The goals may also focus on the caregiver.

How will a pt with depression utilize cognitive behavioral strategies?

Exploration of feelings and defense mechanisms, elicit their view of the problem, modify the pts thinking, involve the pt in productive tasks and activities as tolerated, increase the level of socialization

What is delayed grief reactions?

Expressed by hostility and gried, prolonged feelings of emptiness and numbness, an inability to weep or express emotions, low self esteem, use of present tense when speaking of the decreased, persistent dreams about loss, and keeping clothing

What is labile affect?

Expressions shift from one affect to another (laughing to crying)

Choose whether the communication technique is therapeutic or non-therapeutic and select the best technique to correspond with the interaction. A. Giving recognition E. Verbalizing implied feelings I. Giving advice B. Focusing F. Voicing Doubt J. Belittling feelings C. Giving false reassurance G. Exploring K. Reflection D. Giving Broad openings H. Restating L. Rejecting M. Defending Pt.: "The FBI wants to kill me." Nurse: "I really find that hard to believe."

F - voicing doubt (cant voice doubt without trust)

How should you sit when you are talking with a patient?

Face to face confrontation is more threatening than sitting sideways toward the patient. Sit on the same level with the patient and communicate caring.

What is identity diffusion?

Failure to integrate various childhood identifications into a harmonious adult psychosocial identity

What is malingering?

Faking an illness to avoid responsibilities the person feels is a burden, person may exaggerate symptoms, is evasive and tells contradictory stories

What are hallucinations?

False sensory perceptions

What occurs in the preinteraction phase of the nurse patient relationship?

Familiarize yourself with pt before meeting them (reading the chart to learn about the pt)

Violence Facts

Family violence is a range of harmful behaviors that occur among family and other household members Includes physical and emotional abuse of children, child neglect, abuse between adult intimate partners, marital rape, and elder abuse Violence may be a family secret and often continues through generations Violence and abuse are caused by an interaction of personality, demographic, biological, situational, and sociocultural factors Male batterers often see themselves as law-abiding citizens

_ is a retreat from reality and an attempt to solve problems in a private world

Fantasy

What are side effects of lithium?

Fatigue, lethargy, HA, mental dullness, fine hand tremors, thirst, dry mouth, weigh gain, edema, polydipsia, polyuria, metallic taste, DM, n/v, gastric irritation (Give with food)

Sexual Nursing Responsiblities

Feel comfortable with discussing sexual issues Be able to assess for sexual dissatisfaction Understand physiologic responses as related to reproduction, chronic illness and sexual dysfunctions Understand relationship of normal sexual response cycle to reproduction Education is the most common method of primary prevention of sexual problems Sex education is a lifelong process with the primary goal of promoting sexual health Comprehensive sexuality programs have been found to the effective in delaying both sexual intercourse and teen pregnancy For sex education programs to be effective, it must promote behavior change Most successful are comprehensive and skilled based (teaching how to say no)

What occurs in the cortisol reaction?

Fiht or flight syndrome

Sexual Dysfunction Nursing Diagnoses

First is ineffective sexuality pattern, which includes difficulties, limitations, or changes in sexual behaviors or activities Second is sexual dysfunction, which includes lack of sexual satisfaction, alternations in perceived sex role, and conflicts involving values

How do you overcome resistance and transference?

First you listen and clarify the focus areas, sometimes resistance comes from not arriving at mutually set goals so clarify the goals

Describe residual schizophrenia.

Flat affect, impaired hygiene, flat affect, illological thinking, atrophy

Name three descriptions of affect.

Flat, labile, incongruent, blunted.

What is the following speech pattern that is characterized by rapid shift from one topic to the other with fragmented ideas? I went to the hospital saw the chair it was raining outside when I got up but I couldn't see the airplane in the distance or the teacher

Flight of ideas

In the mental status assessmen, what is included in the thought process?

Flow/form (logical, retarded, speeded, thought blocking, loose associations, concrete thinking, circumstantiality, povery of speech, tangentiality, neologism, perservation, clang association, flight of ideas, echolalia, attention span, word salad)

Pts with bipolar I disorder are at risk for what problem?

Fluid and electrolyte imbalance (check hydration - give juice or water as client ambulates, check nutrition - give finger foods, check elimination - take pt to bathroom)

What is treatment for antianxiety med overdose?

Flumazenil (Mazicon) (Romazicon)

What is the focus of therapy with PD?

Focus of therapy is to help pts change maladaptive thinking and behavior that results from personality treats, treat any co-morbid conditions (i.e. anxiety, depression, alcoholism) Focus on pts strengths

What type of therapeutic communication technique is: taking notice of a single idea expressed or even a single word?

Focusing

What is immediacy?

Focusing on current interaction of nurse and pt in relationship, which involves sensitivity to pts feelings and willingness to deal with these feelings rather than ignore them

Describe dialectical behavior therapy (DBT).

For borderline PD, reduces rates of suicide attempts, hospitalization for suicidal ideation, overal medical risk. Evidence supports effectiveness of atypical antipsychotic med olanzapine in reducing anger, impulsivity-aggression, possibly depression, interpersonal sensitivity. May have dependency needs. Utilize behavioral strategies to increase social skills training, decrease impulsivity, and anger management

Complications of anorexia and bulimia

For both bulimia and anorexia Musculoskeletal - osteoporosis Esp damaging young teens Cardiac - can die suddenly with arrhythmias Usually sexually inactive Renal - dehydrated, UTIs May have ventricular enlargement

Substance Abuse

For substance abuse outcomes with withdrawals is will withdraw safely with minimal discomfort (also oriented x3, will report symptoms of withdrawal, will correctly interpret environmental stimuli) Teens go from nicotine to alcohol to marijuana to more serious drugs Outcome for dependence of substance is will abstain from all mood-altering chemicals Prevention: primary-aims to prevent drug use in children (family strengthening strategies are key); secondary-aimed at people with mild to moderate drinking problems; tertiary-decreasing complications of addiction with psych and medical treatment

Key features of Bulimia

Frequent vomiting or diuretic/laxative abuse Less weight loss Slightly older More extroverted Hunger experienced Eating behavior considered foreign and source of distress More sexually active Avoidant, dependent, or borderline features as well as obsessional features Death from hypokalemia or suicide Menses irregular or absent Drug and alcohol abuse, self-mutilation, and other behavior problems

Choose whether the communication technique is therapeutic or non-therapeutic and select the best technique to correspond with the interaction. A. Giving recognition E. Verbalizing implied feelings I. Giving advice B. Focusing F. Voicing Doubt J. Belittling feelings C. Giving false reassurance G. Exploring K. Reflection D. Giving Broad openings H. Restating L. Rejecting M. Defending Pt: (mute) Nurse: "It must have been a horrible experience for you being the only survivo of the automobile accident."

G - explorin

What neurotransmitters are thought to control the activity or firing rates of the neurons in the parts of the brain responsible for producing anxiety?

GABA

What are the neurotransmitters assocaited with anxiety?

GABA, nerepinephrine, and serotonin

What neurotransmitters are involved with OCD?

GABA, serotonine, ad repinephrine

What are side effects of anticonvulsants?

GI upset, tremors, ataxiam dizziness, weight gain, thrombocytopnia

Inhalants

Gasoline, glue, aerosol spray, paint thinner Look for residual on nose area Use causes dizziness, slurred speech, unsteady gait, depressed reflexes, tremor, euphoria, blurred vision, stupor, coma, rash may present around mouth

Name some inhalants.

Gasoline, glue, aerosol sprays, paint thinner

_ persons perception of ones own maleness or femalenss

Gender Identity

_ cultural role attributes of ones gender, such as expectations regarding behavior, cognitions, occupations, values, and emotional responses

Gender Role

What do you give if a pt has a extrapyramidal reaction?

Give anticholinergics

How do you treat symptoms of detoxification for alcohol?

Give fluids if dehydrated, encourage eating, antidiarrheal or analesic meds as needed, seizure precautions, cool cloth on forehead

Informed Consent

Goal of informed consent is to help pts make better decisions It means that a clinical must give the pt a certain amount of info about the proposed treatment and must obtain the pts consent, which must be informed, competent, and voluntary Should be obtained for all psychiatric treatments (including meds - particularly antipsychs, somatic therapies - ECT, and experimental treatments)

What are characteristics of manipulators?

Goal oriented or self oriented, not other oriented; skilled at giving impression that they care

Describe narcissistic PD.

Gradiosity, arrogance, needs excessive admiration, lacks empathy, unrealistic expectations, entitlement yet feels shame and inferiority, very self-absorbed, wants success and power, believe they are unique and special and should only associate with high status people, exploid others, show too much skin

_ delusions are beliefs that one possesses greatness or special powers (I am Jesus Christ and I can heal you)

Grandiose delusions

What are illnesses r/t depression?

HTN, DM, RA

Habeas corpus

Habeas corpus is a constitutional right that provides for the speedy release of any person who claims to be detained illegally

Name some typical or 1 generation antipsychotic medications.

Hadol, Loxitane, Navane, Prolixin, Stelaxine, Taractan, Trilafon, Thorazine

Name some typical first generation antipsychotics.

Hadol, Loxitane, Prolixin, Taractan, Trilafon

In the mental status assessment, what is included in the perceptions?

Hallucinations (type and uses of auditory, visual, tactile-touch, gustatory-taste, olfactory-smell) and illusions

Describe benzodiazipines.

Have replaced barbituates as perferred treatment for anxiety, related disordess; as effective as barbituates but safer; can be addictive, causing physical and psychological dependence, can lead to withdrawal symptoms when discontinued

How do you determine if the pt who is suicidal needs to be hospitalized?

Have they attempted suicide before? Assess the risk of suicide Ask the pt if they are suicidal Ask if they have a plan Will they make a no-suicide contract?

What is postvention?

Help after an attempt or action

What occurs in the termination phase of the nurse patient relationship?

Helping pt end relationship without regression; most difficult and more important; feelings of rejection, loss, sadness, and anger are expressed; pts reactions vary to seperation (some may deny it causing the inexperienced nurse to feel rejected by the pt, some may be anger, some may regress)

What is the difference between helplessness and hopelessness?

Helplessness - no one will do anything to aid you Hopelessness - you nor anyone else can do anything

How does atypical or second generation antipsychotic meds help treat schizophrenia?

Helps with hallucinations, delusions, and other symptoms (apathy, flat affectm lack of pleasure, ext)

Why is marijuana used with chemotherapy?

Helps with n/v

Name some opiates.

Heroin, morphine, meperidine (Demerol), codeine, opium, methadone

The most suicidal pt is one with what items?

Highly lethal method, specific plan, means readily available

Who is the mother of psychiatric nursing?

Hildegard Peplau

Name the personality disorder for: Excessive emotionality; attention seeking; superficial and stormy relationships; lively; uncomfortable when not the center of attention

Histrionic

_ PD is a pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts

Histrionic PD

Histrionic is pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts Superficial and stormy relationships, lively, uncomfortable when not the center of attention Treatment teach assertiveness and what is appropriate in relationships, be aware of seductive behaviors, teach assertiveness and socially appropriate behaviors

What do you do if a pt is taking MAOIs and gets hypertensive crisis?

Hold MAOI dose, dont lie client down, give IM chlorpromazine 100 mg, give IV phentolamine in 5 mg doses (slowly), manage fever and evaluate and stress compliance with diet

What is gene therapy?

Holds potential for treating or even curing genetic and acquired diseases such as cancer and acquired immunodeficiency syndrome (AIDS) by using nromal genes to supplement or replace defective genes or bolster a normal function, such as immunity

What is a good indicator of the quality and depth of the pt pains?

Hopelessness, despair, anger, anxiety

Describe how CT works, what it images, and the advantages/disadvantages.

How it works: Its a series of radiographs that are computer constructed into slices of the brain that can be stacked by the computer, giving a 3D image What it images: Brain structure Advantages/Disadvantages: Provides clear pictures of the brain than radiographs alone

What does the thought process look at?

How the pt self-expresses

When do you usually see mumblind pts?

Hungington chorea

What is cyclothymic disorder?

Hx of 2 years of hypomanic and depression without a diagnosis of mania or bipolar I disorder

Describe the somatization disorder overview.

Hx of physical symptoms, onset before 30, complaints occur over a period of years, tx seeking and/or significant impairment in social and occupational functioning, pts symptoms cannot be explained by medical condition

What is treatment of neuroleptic malignant syndrome?

Hydration, renal dialysis, ventilation, fever reduction, give dantroline or bomocriptine

What are symptoms of mania?

Hyperactivity, undertaking too many activities, lack of judgement, irritability, pressured speech, loose associations, flight of ideas, distractibility, inflated self-esteem, hypersexuality, hallucinations, ideas of reference, delusions

What is the problem with MAOIs?

Hypertensive crisis can occur when foods or meds with tyramine or norepinephrine agonists are ingested; dont take with aged cheese, wine, beer, bananas, coffee, chocolate, chicken liver, preserved meats; no cough syrup; no hypoglycemics or insulin, no narcotic analgesics

What medical conditions or substances may cause anxiety disorders?

Hyperthyroidism, Hypothyroidism, menopause, hypertension, cardiac arrhythmias, CHF, epilepsy

What physical illnesses must be ruled out before making a diagnosis of bipolar I?

Hyperthyroidism, cocaine, substance abuse

What illness must be ruled out before the diagnosis of depression?

Hypothyroidism

Choose whether the communication technique is therapeutic or non-therapeutic and select the best technique to correspond with the interaction. A. Giving recognition E. Verbalizing implied feelings I. Giving advice B. Focusing F. Voicing Doubt J. Belittling feelings C. Giving false reassurance G. Exploring K. Reflection D. Giving Broad openings H. Restating L. Rejecting M. Defending Pt: "Do you think I should leave home and get an apartment of my own?" Nurse: "Yes, I think you would be much better off away from your parents."

I - Giving advice

How do you involve the pt in planning of care for a pt with PD?

ID cues and triggers to behavior problems that allows pt to be more active in therapeutic process

What is hostile transference?

If pt internalizes anger and hostility, resistance may be expressed as depression and discouragement (pts attempt to compete with nurse)

What is the correlation with sodium intake and lithium levels?

If sodium intake is increased, lithium levels decrease because more is excreted so makes it non-therapeutic levels If sodium intake decreases, lithium levels increase (or if profuse sweating or diarrhea) may reach toxicity

Why is MAOI a dangerous drug?

If someone eats cheese or drinks beer or takes cough syrup the patient can go into HTN crisis

What is the difference between illusions and hallucinations?

Illusions are false perceptions that are responses to a real stimulus. Hallucinations are false sensory impressions or perceptions.

What is the difference between illusions and hallucinations?

Illusions: misinterpretations and misperceptions of real events (man saw his coat on a rack and thought it was a bear about to attack him) Hallucinations: a false sensory perception for which no external stimulus

What is the hallmark of borderline PD?

Impulsive aggression

When is personality acquired?

In early childhood and is genetic and predisposition and becomes lifelong pattern of behavior

What is the physiological response to anxiety?

Increased BP, HR, and Respiration. Restlessness, tremors, startle reaction, rapid speech. GI upset, impaired attention, poor concentration, loss of objectivity, nervousness, fear, fright, alarm, helplessness, frustration

What does dopamine do?

Increased amount of dopamine causes psychosis, schizophrenia, mania, and positive symptoms so give antipsychotic to help these. 1st generation helps with just hallucinations and delusions while 2nd generation helps with all problems

What behavior is on the middle of the self protective continuum?

Indiret self destructive behavior

What is treatment for pain disorders?

Individual and group cognitive-behavioral therapy reduce pain-related distress and disability, anitdepressants decrease pain intensity

_ is the evolution of the childs internal psychological structure and growing sense of separateness, wholeness, and capability

Individualization

Nursing Assessment for sexual assault

Initial assessment is most important All nursing assessments must include questions to determine current or past sexual abuse Ask "Has anyone ever forced you into sex that you did not wish to participate in? If yes, ask them to tell more about it

What are symptoms of use of opiates?

Initial euphoria, relaxation, relief from pain, apathy, drowsiness, detachment, constricted pupils, nausea, constipation, slurred speech, resp depression

What are phobias?

Inordinate amount of fear where a person may act inappropriately to that fear. May use systematic desensitization and implosion therapy (flooding) to treat phobias.

What is the DSM-IV-TR for sleep disorders?

Insomnia is the most prevalent, hypersomnia is excessive sleepiness, parasomnia is sleep walking/night terrors/restless leg syndrome/enuresis; take meds like aderol

What is the main sociocultural stressor of PD?

Instability in families (i.e. divorce)

Describe disulfiram (Anatabuse).

Interrupts metabolism of alcohol, causes buildup of toxins if the client uses alcohol (causing HA, n/v, flushing, hypotension, chest pain, confusion), must have written permission of pt, no preparations with alcohol, avoid alcohol for 14 days

_ is a positive and healthy interpersonal relationship; that ability to experience closeness with others while keeping own separate identity

Intimacy

When do you usually see slurred speech pts?

Intoxicated pts

What are the defense mechanisms of major depressive disorder?

Introjection, isolation, repression, suppression, denial, dissociating

What are defense mechanisms of depression?

Introjection, repression, suppression, denial, dissociation

What is perseveration of thought process?

Involuntary, excessive continuation or repetition of a single response, idea, or activity; may apply to speech or movement, but most often verbal

What are psychological symptoms of anxiety?

Irritabiliy, uneasiness, fear, sense of impending doom, insomnia

_ is the seperation of a thought or memory from the feeling tone or emotions associated with it

Isolation (aka emotional isolation)

Child Depression

It seriously affects social, emotional, and educational development and is the most important predictor of suicidal behavior in young people aged 15-24 Symptoms of depression in children are similar to adults, children also usually have irritable mood, may fail to make expected weight gain, and tend to keep secret their depressive thoughts and crying Can precede the diagnosis of bipolar disorder in children and can occur in combo with another disorder, such as anxiety, conduct disorder, or ADHD Suicide is difficult to predict, but it does occur in children as young as 8 Assessment for suicide ideation, plans, or attempts is paramount Risk factors include depression, sexual abuse, prior suicide ideation or plan, substance abuse, impulsive or aggressive behavior, and access to firearms Suicidal children are not likely to self-refer or seek help; therefore early ID of at-risk is critical

What is PD?

It's a set of patterns or traits that hinder a person's ability to maintain meaningful relationships, feel fulfilled, enjoy

What is the DSM-IV-TR for depersonalization?

Its a persistent or recurrence of a feeling of detachment or estrangement from ones self. May be a mechanical or dreamlike feeling or a belief that the body characteristics have changed. Altered perceptions followed by anxiety, depression, fear of going insane, obsessive thoughts, somatic complaints, and disturbance in subjective sense of time

Describe ego-orientation coping defense.

Its the first line of psychic defense, protects the person from feelings of inadequacy and worthlessness and prevents awareness of anxiety, can distort reality/interfere with relationships/limit abiliy to work if used to an extreme (denial of dug use)

Choose whether the communication technique is therapeutic or non-therapeutic and select the best technique to correspond with the interaction. A. Giving recognition E. Verbalizing implied feelings I. Giving advice B. Focusing F. Voicing Doubt J. Belittling feelings C. Giving false reassurance G. Exploring K. Reflection D. Giving Broad openings H. Restating L. Rejecting M. Defending Nsg Assistant: "Mr. J. always calls me sweetie pie. I get so angry when he does that." Nurse: "Perhaps you should consider how he feels."

J - Belittling feelings

Choose whether the communication technique is therapeutic or non-therapeutic and select the best technique to correspond with the interaction. A. Giving recognition E. Verbalizing implied feelings I. Giving advice B. Focusing F. Voicing Doubt J. Belittling feelings C. Giving false reassurance G. Exploring K. Reflection D. Giving Broad openings H. Restating L. Rejecting M. Defending Pt: "I feel like such a failure in the eyes of my family." Nurse: "You fel as though you let your family down."

K - reflection

Lithium is excreted by the _ and adversely affects the _

Kidneys; thyroid

_ sensation of movement while standing motionless

Kinesthetic

Choose whether the communication technique is therapeutic or non-therapeutic and select the best technique to correspond with the interaction. A. Giving recognition E. Verbalizing implied feelings I. Giving advice B. Focusing F. Voicing Doubt J. Belittling feelings C. Giving false reassurance G. Exploring K. Reflection D. Giving Broad openings H. Restating L. Rejecting M. Defending Pt: "I want to call my husband." Nurse: "Why do you want to talk to him after the way he treated you?"

L - rejecting/J - belittling feelings

Choose whether the communication technique is therapeutic or non-therapeutic and select the best technique to correspond with the interaction. A. Giving recognition E. Verbalizing implied feelings I. Giving advice B. Focusing F. Voicing Doubt J. Belittling feelings C. Giving false reassurance G. Exploring K. Reflection D. Giving Broad openings H. Restating L. Rejecting M. Defending Pt: "Id like to talk about my relationship with my boyfriend Jack." Nurse: "Oh lets not talk about that. You talk about that entirely too much."

L - rejecting/J - belittling feelings

Name some hallucinogens.

LSD, Mescaline, MSMA, PCP (phencyclidine)

Describe conversion disorders.

La belle indifference - lack of concern or distress in face of the symptoms, symptoms arent due to malingering (faking), secondary gains

What is loose associations thought process?

Lack of logical relationship between thoughts and ideas that renders the speech and thought inexact, vague, diffuse, and unfocused

Memory vs Learning

Learning is defined as any relatively permanent change in behavior that results from experince Memory is defined as the storage and retrieval of past experience and, like learning, is a neurochemical process mediated by the brain (key to cognitive ability) Some people with brain dysfunction, cognitive responses either do not develop fully or deteriorate once they have developed Deficit responses on continuum - periodic indecisiveness, forgetfulness, mild transiet confusion, occasional misperceptions, distractability, occasional unclear thinking Learning: any relative permanent change in behavior that results from experience. Human beings are affected by the ability to learn from experience, to remember what is learned, and to modify behavior in response. Memory: The storage and retrieval of past experience and, like learning, is a neurochemical process mediated by the brain. Memory is a key cognitive ability; to exercise judgemnt, make decisions, or even be oriented to time and place, a person must remember past experiences. Memory loss is a particularly frightening experience.

The process of recovery for schizophrenia beins with what?

Learning to ID symptom triggers and early symptoms

What is the function of the frontal lobe?

Learning, abstracting, reasoning, inhibiting

Mental Confusion Planning

Life threatening problems always receive the highest priority for nursing intervention. Family caregiver education is a top priority. Development of a formal protocol may be necessary. Goals are directed toward an improved ability to process information (realistic) or toward optimum use of the abilities the patient retains (if impairment is irreversible) Ex: Pt disoriented by drug/substances abuse goal is oriented by day 3 to person, place, and time Ex: Goal for a pt who is disoriented because of chronic alcoholism and who is not withdrawal might be that the pt finds ones own bed every night without assistance after 1 month

Who is the first American psychiatric nurse?

Linda Richards

What two mood stabilizers cannot be taken during pregnancy or while nursing?

Lithium and Depakote

Mood Stablilizing Drugs: Lithium

Lithium carbonate (Cibalith-S, Eskalith, Lithane) A natural occurring salt Excreted by kidneys and adversely affects the thyroid Don't use during pregnancy or nursing Side effects are fatigue, lethargy, HA, mental dullness, hand tremors, thirst, dry mouth, weight gain, bloated feeling, edema, polydipsia, polyuria, metallic taste, DM, NV, anorexia, gastric irritation (take with food) Toxicity causes course hand tremors, NV, diarrhea, ataxia, muscular weakness, oliguria, slurred speech, decreased BP, confusion, coma, anuria, seizures, death Medical Emergency NO ANTIDOTE for lithium poisoning Do gastric lavage, IVs, Mannitol (decreases swelling in brain), hemodialysis may be needed Lag time is 7-10 days Antipsych meds can be used during this time Monitor serum lithium levels Therapeutic range is 0.6-1.4 (lower for elderly) Toxicity is over 2.0 Teach signs of toxicity Teachings Encourage 2-3L of fluid per day Don't restrict salt in diet Reaches peak effect 203 hours so given several times daily Take with food to avoid GI discomfort Evaluate cardiovascular, renal, thyroid function before starting Lithium Sodium levels If sodium intake is up, lithium levels are down because more is excreted so it reaches a non-therapeutic level If sodium intake is down, lithium levels are up (or if profuse sweating or diarrhea), thus may reach toxic level Lithium and sodium act like a see saw

When someone passes out from drinking, when do you know its an emergency?

Look at breathing and HR, cyanosis, if they cant wake up

How does a function MRI work?

Looks at glucose uptake

_ islack of logical relationship between thoughts and ideas that render speech and thought inexactm vaguem diffused, and unfocused

Loose associations

What are some precipitating stressors of depression and anxiety?

Loss of attachment (loss of loved one, job, self esteem, etc), life events, role strain, and physiological changes

What happens in development at the late adulthood age?

Losses occur, such as physical change of aging, death of parents, loss of occupation through retirement, and later the deaths of friends and ones spouse

What does high self-esteem correlate with?

Low anxiety, effective group functioning, and acceptance of others.

What are symptoms of PCP (Phencyclidine)?

Low dose (less than 5 mg) is euphoric, floating, heightened emotionally and incoordination, distorted preceptions (objects floating or growing), inability to judge distance, or out-of-body experience High dose (more than 5 mg) is intense psych experience with extreme agitation (may be violent toward self or others) Feel little to no pain

What neurotransmitter is associated with suicide?

Low levels of serotonin (5-HT)

Which med do you never give other antidepressants within 14 days of stopping?

MAOI

_ Overestimation of the significance of undesirable events

Magnification

What are the challanges of nurses caring for a pt with PD?

Maintain pts safety, facilitate pts participation in care, select least restrictive intervention, facilitate behavioral change, help pt assume responsibliy for behaviors

What are the nursing interventions for post hospitalization after being suicidal?

Make a contract with client to call for help, ive support person name and contact info of counselor, ask pt about means to commit suicide, assess support network, encorage socialization, enlist friends and family to check on pt, encourage pt to keep appointments at mental health center, be direct and talk openly about suicide, and assess pts use of coping skills

What is the function of rephe nuclei?

Make serotonin, a neurotransmitter involved in regulation of sleep, behavior, and mood

What is the function of substantia nigra?

Makes dopamine; neurotransmitter involved in complex movements, thinking, and emotions

What is the function of the locus ceruleus?

Makes norepinephrine

What does increased GABA cause?

Makes you feel relaxed and relaxes skeletal muscles

What is confabulation?

Making up stories to recount situations that cannot be remembered.

Define which defense mechanism the patient is using and identify it as adaptive or maladaptive: Woman whose husband died three years ago still keeps his clothes in his closet and talks about him in the present tense.

Maladaptive - denial

Define which defense mechanism the patient is using and identify it as adaptive or maladaptive. A man who cannot tell his professor he is angry at him, yells at a fellow student after class___________________

Maladaptive - displacement

Define which defense mechanism the patient is using and identify it as adaptive or maladaptive: A young boy thinks a neighborhood pimp with great car, money, and drugs is someone to emulate. ____________________________

Maladaptive - identification

Define which defense mechanism the patient is using and identify it as adaptive or maladaptive: A young woman who was belittled and criticized as a child believes she is "no good" to anyone as an adult. ______________________________

Maladaptive - introjection

Define which defense mechanism the patient is using and identify it as adaptive or maladaptive: Mother who has an unconscious hospitility toward her daughter hovers over her to protect her from harm. She is overprotective and controlling which interferes with her normal growth and development. __________

Maladaptive - reaction formation

Define which defense mechanism the patient is using and identify it as adaptive or maladaptive: Mr. Smith has rigid and moralistic beliefs about sex and is driven to wash his hands to gain composure when he sees an attractive woman. _______________________________

Maladaptive - undoing

Is OCD adaptive or maladaptive and what is the defence mechanism?

Maladaptive and the defence mechanism is undoing

What disorders occur more often in men? Women? Equal?

Male: substance abuse and antisocial personality Female: Mood disorders and anxiety disorders Equal: Schizophrenia

Malpractice

Malpractice is the failure of professional to provide the proper and competent care that is warranted by members of their profession, a failure that results in harm to patients All nurses are held to national standards of care Filed under the law of neglect tort A tort is a civil wrong for which the injured party is entitled Plaintiff must provide one of the following Legal duty of care existed The nurse performed the duty negligently Damages were suffered by the plaintiff as a result The damages were substantial

What is the difference between mania and hypomania?

Mania is characterized by elevated, expansive, or irritable mood Hypomania is clinical syndrome that is similar to but not as severe as mania

What are the s/s of serotonin syndrome?

Mania, confusion, disorientation, muscle rigidity, ataxia, hyprreflexia, myoclonic jerking, tachycardia, diaphoresis

Where do you commonly see circumstantial thought process?

Manic disorder and some organic brain disorders

What is the DSM-IV-TR for diagnosis for Bipolar I Disorder?

Manic episode lasting 1 week. Mood is abnormally and persistently elevated, expansive or irritable. Severe enough to cause extreme impairmnt in social or occupational functioning. Must have previous features with one of the following diagnosis (manic - limited to manic episodes, depressed - hx of manic episodes with a current depressive episode, mixed - presentation of both manic and depressive episodes)

When do you usually see a pt with colorful or unusual attire?

Manic pts

When do you usually see liable affect?

Manic pts

When do you usually see pressured speech?

Manic pts

What is schizoaffective disorder?

Manifested by schizo behaviors but also mood disorders like depression or mania

Name the personality disorder for: A behavior in which people treat others as objects, and form relationships that center around control issues. Behavior is easily misunderstood

Manipulation

_ is the behavior in which people treat others as objects, form relationships centered around control issues

Manipulation

_ is when people treat others as objects and form relationships that center around control issues

Manipulation

What are the risk factors that would predispose a client to commit suicide?

Marital status, gender, age, religion, socioeconomic status, ethnicity, other risk factors

Depression associated with Dementia

May be most common mood disorder among older adults Pseudodementia is a cognitive impairment secondary to a functioning psych disorder (i.e. depression) characterized by lapses in memory and judgment, poor concentration, and seemingly diminished intellectual capacity which is reversible with treatment of depression Aggression in pts with dementia is strongly linked to the presence of depressive symptoms so need treatment for depression They tend to confabulate not because they want to lie but because they are embarrassed they cannot remember

What type of meds are used for cluster C PD?

May benefit from serotonergic antidepressants

What are things that can occur after taking LCD?

May experience paranoid, grandiose, or somatic delusions accompanies by vivid hallucinations and may go away but can have flashbacks for several months after stopping; can lead to self-destruction because of impaired judgement

What type of medication is used for cluster A PD?

May need antipsychotics for subtyle psychotic symptoms

Give an example of splitting.

May see nurse in morning and think she is wonderful and all good but nurse tries to set limits and is all bad now

Review precipitating stressors, appraisal of stressors, coping resources, and coping mechanisms. What are the defense mechanisms?

Mechanisms which help us "fool" ourselves into thinking everything is A-Okay! They can be overused so they interfere with our lives.

How do you treat lithium toxicity?

Medical emergency, no antidote for lithium, gastric lavage, IVs, mannitol, hemodialysis may be necessary

What occurs in the introductory phase of the nurse patient relationship?

Meeting the pt and introducing self, geting to her level, giving space, beginning trusting relationship, determining reason for coming (what is your reason for coming today instead of why are you here), form pt contract

In the mental status assessment, what is included in the sensorium and cognition?

Memory (recall recent, remote, and immedate memory along with exhibiting confabulation (makes up stories)), level of concentration and calculation, information and intelligence, judgement, and insight (recognizes illness, effects of illness of life, accepts responsibility for own actions, and demos adaptive coping strategies)

Impaired memory in geriatrics

Memory loss is one of the most distressing and frustrating aspects of aging With age, loss of short-term memory (recall of recent events) is more likely to occur than loss of long-term memory (recall of events that occurred in the distant past) Speed of access to memories appears to slow with increasing age Factors of altered memory - stress of crisis, depression, a sense of worelessness, loss of interest in present events, cerebrovascular changes that affect cerebral functions, loss of neural cells because of disease or trauma, and sensory deprivation or social isolation Impaired memory for recent events may be a result of decreased vision or hearing (may lead to elder looking to old memories for comfort)

What is the maladaptive response for dissociation?

Mental decompensation of thought, emotions, and memories

Mental illness is considered to be caused by?

Mental illness is considered to be multi-causal (genetics, environment, etc. )

What medication is used to treat addiction to other opiates, aid withdrawal or provide maintenance at stable dose and doesnt interfere with functioning ability?

Methadone

What are interventions to obtain abstinence of opiates?

Methadone (also addictive), suboxone (Buprenorphine and naloxone), naltraxone (Vivitrol: injectable), L-alpha acetylmethadol or LAAM is a long acting opiate agonist

Opioid Abuse

Methadone is used to treat addiction to other opiates, aid withdrawal or provide maintenance at stable dose and doesn't interfere with ability to function Opiates-heroin, morphine, meperidine (Demerol), codeine, opium, methadone To obtain abstinence use methadone, suboxone (Buprenorphine and naloxone), naltraxone (Vivitrol: injectable), L-alpha acetylmethadol or LAAM If overdose occurs, give Narcan (naloxone: opioid antagonist) and maintain airway; narcan has half life less than opiates so may need to give again in 4 hours Opiates cause initial euphoria, relaxation, relief from pain, apathy, drowsiness, detachment, constricted pupils, nausea, constipation, slurred speech, resp depression If withdrawal occurs, assess for withdrawal with CINA and substitute opiate with tapering dose of Methadone or Buprenorphine, use clondine to manage withdrawal symptoms; check BP q 45 mins Symptoms of overdose are resp and circulation depression, unconsciousness, coma, resp and cardiac arrest, death, anoxia can lead to brain abcess if pt lives Tramadol used to help during detox Symptoms of withdrawal are usually non-life threatening but comfortable-anxiety, restlessness, insomnia, irritability, impaired attention, often physical illness with NV, diarrhea, chills, fever, muscle spasms, HTN, HA, muscle pain, tension

What are the 4 levels of anxiety?

Mild anxiety- alert and perceptual field is increased (day-to-day tension) Moderate anxiety- focus on immediate concerns, involve the narrowing or perceptual fields Severe anxiety- perceptual field narrows markedly, person less able to concentrate on surroundings, "all behavior is aimed at relieving anxiety." Panic- awe, dread, terror. Person unable to do things even with direction. Total disorganization of the personality. Can be life threatening. Increased motor activity, decreased ability to relate to others. Distorted perceptions and loss of rational thought. Panic is a frightening and paralyzing experience.

What is blunt affect?

Minimal emotional response

What is mixed PD and treatment for it?

Mixed between cluster B and C PD (exclusing cluster A PD) Treatment is an avg of 40 weeks of brief dynamic therapy yields substantial symptomatic improvement at both the end of treatment and after 1.5 years; meds may help for several of these disorders, although may methodological problems remain to be worked out

What physiological responses are associated with anxiety?

Modulated by brain through the ANS

What is nursing interventions for neuroleptic malignant syndrome?

Monitor temp -> ventilation -> tachycardia -> hydration Teach to avoid direct sunlight Use antidepressants and benzos cautiously Change positions slowly Use sugarless gum and candy High fiber diet

What can antipsych meds be caused with?

Mood stabilizers Lithium and Valproic Acid

What are some classifications of drugs used for bipolar disorder?

Mood stabilizing drugs - antimania-lithium, anticonvulsants, atypical antipsychotics, benzodiazepines, calcium channel blockers

What type of medications is used for cluster B PD?

Mood-stabilizing meds or atypical antipsych meds for subtle signs of bipolar disorder; meds are usually not helpful for this cluster of PD

Child Autism

More common in boys Basic element is the association cortex and of connectivity in the brain Children have normal head circumference at birth but may develop macroencephaly in childhood Found abnormal neuronal migration and a decrease in size of the cerebellum as early as the first trimester The three areas of impairment for the child are communication, social skills, and overregulated or repetitive behavior patterns Most children have avg intelligence and function in mainstream society but need individualization educational and health services Mental health needs are often related to co-occurring depression or anxiety disorders

Child Anxiety

Most common sign of anxiety in children is fear of being separated from parents and home and refusal to attend school Prevalence of anxiety is higher at times of transition (moving from preschool to primary school and from primary to secondary school

Abduction of Children

Mostly a parent taking a child in violation of custody Key characteristics of parents at risk for abducting their children include parents who have made a prior treat of or actual abduction, suspect that the other parent is abusing/molesting/neglecting the child and feel that authorities have not investigated adequately, are paranoid and markedly irrational believing that they have been betrayed by their former partner and they therefore must protect themselves and the child, are sociopathic and use the child as an instrument of revenge or punishment or as a trophy in their fight with the former partner, or are from another country and want the child to be raise in the home country of origin

Child ADHD

Mostly boys Likely that is has a neurobiological basis that is complicated by social interactions and the progressive consequences of related learning problems The comprehensive treatment of children with ADHD is a long-term process because they typically present with a variety of social deficits, learning disabilities, behavior problems, and depression Goal is assisting the child to cope with ADHD and the difficulties it brings to family, school, and social functioning

Substance abuse can increase the risk of what problems?

Motor vehicle accidents, suicide, sexual assault, high-risk sexual behavior

How do teenagers venture through drugs?

Move from nicotine to alcohol to marijuana, and then to more dangerous drugs

What are some predisposing factors of mood disturbances?

Multicausal - genetics, bioloical (neurotransmitters and limpic system, learned helplessness and dependence, aggression turned inward theory)

What is the s/s of neuroleptic malignant syndrome from first generation antipsychotics?

Muscular rigidity, sweating, tachycardia, fever, stupor, tremors, autonomic hyperactivity, fever 101-103 (up to 108)

What is dysthymic disorder?

Must have at least 2 years of depressed mood and one symptom of major depressive disorder. Sad or down in the dump.

What are the effects of hallucinogens on the body?

N/V, chills and sweating, pupil dilation, increased BP, increased pulse, increased temp, decreased resps, dizziness, loss of appetite, insomnia, elevated BS

What are symptoms of alcohol withdrawal?

N/V, tremors, profuse sweating, anxiety, agitation, tactile, auditory, and visual disturbances (hallucinations), extreme HA, fullness in head, disorientation with clouding of the sensorium

Name the personality disorder for: Arrogance; need for admiration; lack of empathy; seductive; socially exploitative; manipulative; grandiose sense of importance

Narcissistic

_ PD is a pervasive pattern of grandiosy (fantasy or behavior), need for admiration, and lack of empathy beginning by early adulthood and present in a variety of context

Narcissistic PD

Narcissistic

Narcissistic is pervasive pattern of grandiose (fantasy or behavior), need for admiration, and lack of empathy beginning by early adulthood and present in a variety of contexts They are grandiosity, arrogant, needs excessive admiration, lacks empathy, unrealistic expectations, self-absorbed, wants success and power, believe they are unique and special and should only associate with high status people, exploit others, show too much skin Avoid power struggles, they usually don't seek treatment

When do you usually see pupil constriction?

Narcotic addiction

Describe lithium.

Natural occuring salt, excreted by kidneys and adversely affects the thyroid, therapeutic range of 0.6-1.4, lag time of 7-10 days

What are new words that a patient makes up?

Neologisms

What are circadian rhythms?

Network of internal clocks that coordinate everts in the body accordng to a 24 hour cycle

What is a potentially fatal side effect of typical or 1 generation antipsychotic medication?

Neuroleptic malignant syndrome Occurs more with high potency neuroleptics with s/s of muscular rigidity, sweating, tachycardia, fever (101-103 but may reach 108), stupor, tremors, autonomic hyperactivity

What is the difference between neuroses and psychoses?

Neuroses is when your reality is intact but symptoms are there (dont violate the socia norms, no apparent organic cause like truama, when it interferes with like then it becomes a mental illness) Psychoses is when reality is not intact (hallucinate, delusions, not usually danger to society, can be organic cause, very impaired, no self-perception, personality disintegration)

What is neologisms thought process?

New word or words created by the patient, often a blend of words

_ delusions belief that self or part of self doesnt exist (I can put my hand on the stove because it doesnt exist)

Nihilistic delusions

What is treatment for narcissistic PD?

No effective treatment and they usually dont seek treatment, avoid power struggles with them

What is treatment for histrionic PD?

No effective treatment but need to be tauht assertiveness and what is appropriate in relationships, be aware of seductive behaviors, teach assertiveness and socially appropriate behaviors

What is treatment for antisocial PD?

No known effective tx but treat aggression, dont usually seeks treatment voluntarily, safety, avoid manipulation, set limits

What is treatment for borderline PD?

No treatment is completely effective but can help improve quality of life; dialectical behavior therapy (DBT) which is a type of cognitive behavior therapy which uses psychological education, problem solving, training in social skills, exercises in monitoring moods, modeling by therapists, homework assignments, and meditation (very structured and may spend 8hr a day training on insight in behavior and how to monitor moods)(produces lower attrition, fewer severe episodes of suicide, and fewer hospital days); partial hospitalization with group and individual therapy for 18 months (reduces the number of suicidal attempts, acts of self harm, psych symptoms, and inpt days, and increases the quality of social and interpersonal functioning); noradrenergic agents tend to improve mood but not irritability or dyscontrol; serotenergic agents may act to reduce impulsivity

Name five elements that can distort communication.

Noise, environmental factors, too close to patient or too far away, table or desk that blocks communication, too much light, too dark, other patients talking at the same time, television or radio going

What is some teaching for antianxiety meds?

Non-benzodiazepams used for short term, dont use for minor stressors in life, potentiates drugs (OTC, alcohol), avoid driving until toleration develops

What is the most important type of communication?

Nonverbal

HTN can result in an increase of what neurotransmitter?

Norepinephrine

Name the neurotransmitters.

Norepinephrine, serotonin, dopamine, melatonin, acetylcholine, glutamate, GABA

Why is busprione (BuSpar) used as a anxiey med?

Not as sedating, act as serotonin agonist, causes no cross-tolerance, no addictive potential, not effective with drug or alcohol withdrawal

Angry, punitive limit setting confirms pts expectations. Limit setting should be used how?

Not to control but to work together toward process of change

Night eating disorder

Not yet identified in DSM-IV-TR Clients average two awakenings per night which are associated with food intake May not remember eating during night

Who is liable for patients safety?

Nurse

Teen Therapeutic Alliance

Nurses align themselves with the healthy, reality-oriented part of teens ego and move toward an honest and critical understanding of teens thoughts and behaviors Ways to establish and maintain this alliance Point out the behavior is motivated by thoughts and feelings Limit acting out by pointing out how it interferes with the therapeutic process Establish that the teens behavior is the result of automatic thoughts and inner feelings that are interfering with the teens happiness Point out the teens tendency to see things in extremes Distinguish among thoughts, feelings, and actions, discouraging impulsiveness Encourage emotional catharsis in sessions Be alert to the defenses of denial and reaction and formation Accepting any healthy and adaptive responses of the teen strengths the sense of ego mastery

Hallucinogens

Nursing intervention-always take VS first to see physical condition, give Ativan or Hadol, gastric lavage may be needed if symptoms don't subside, may be able to talk pt down, provide safe environment with little stimuli, avoid rapid movements, don't touch pt without permission LSD, Mescaline, MSMA, PCP (Phencyclidine) For PCP interventions, don't attempt to talk pt down (pt may be agitated and may harm self or others), decrease environmental stimuli After taking LCD, may experience paranoid, grandiose, or somatic delusions accompanied by vivid hallucinations and may go away but can have flashbacks for several months after stopping; can lead to self-destruction because of impaired judgment LSD is colorless, tasteless, and swallowed (people slip in drinks) Causes NV, chills, sweating, pupil dilation, increased BP, increased pulse, increased temp, decreased resps, dizziness, loss of appetite, insomnia, elevated BS PCP in low dose (less than 5mg) causes euphoric, floating, heightened emotionally and incoordination, distorted perceptions (objects floating or growing), inability to judge distance, out-of-body experience; high dose causes intense psych experience with extreme agitation (may be violent with self or others); feel little to no pain

Describe how you make a safet plan with a depressed pt.

Nursing staff will help you manage your safety. Has the patient attempted suicide previously? What are the reasons you are attempting to harm yourself? Help us recognize when you are trying to harm yourself. What helps you to calm down and feel safe? How can the staff help keep you safe? 1 to 1 supervision if pt is actively attempting to commit suicide. After a contract is made, patient will contact nurse if feeling suicidal, allow pt to re-enter population with 15 min checks, and assess suicide every shift or more if needed.

What is teaching for atypical or 2nd generation antipsychotic medications?

Nutrition, exercisem and diabetes mellitus symptoms, may cause sedation

What is clomipramine (Anafranil) used for in anxiety pts?

OCD

When do you usually see repeated motor movements or compulsions?

OCD

What does assessment of a pt with dissociative disorder include?

Observe pts appearance, inquire about eating and sleeping and hygiene, what does the pt think about self as a person, ask pt to describe self along with weakenesses and prorities and strengths, does the person feel unified or self directed or diffuse and other-directed, the nurse must be aware of own affective response toward the pt

Name the personality disorder for: Unable to express affection; overly cold and rigid; crippling preoccupation with trivial detail, orderliness, perfectionism, and control (i.e. attends to rules, lists, organization, schedules, to the extent that the major point of the activity is lost); superior attitude

Obsessive-compulsive

_ PD is a pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts

Obsessive-compulsive PD

Obsessive-compulsive is a pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expose of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts Unable to express affection, overly cold and rigid, attends to rules, superior attitude Treat with support, insight psychotherapy, cognitive-behavioral therapy, avoid power struggles and buying into defense mechanisms

What is treatment for the obsessive-compulsive PD?

Obsessive-compulsive support, insight psychotherapy, cognitive-behavioral therapy, avoid power struggles and buying into defense mechanisms with them

Dementia Coping Mechanisms

Often mirrors the person's personality Denial: make light of memory lapses Regression: in advanced dementia

What is the DSM-IV-TR for diagnosis for Bipolar II Disorder?

One or more depressive episodes and at least one hypomanic episode. No manic episode has developed.

Name some benzodiazepines.

Ones that end in -azepam (lorazepam - Ativan, clonazepam - Klonopin, diazepam - Valium), xanax - alprazolam

When should confrontation be used?

Only when there is trust and used sensitively

When do you usually see tactile hallucinations?

Organic mental disorders, cocaine abuse, and delirium tremors

In the mental status assessment, what is included in the LOC?

Orientation (time, place, person) and if they are confused

What is the DSM-IV-TR diagnosis of Depression?

Over 2 week period, the pt must have a depressed mood and/or loss of interest or pleasure (anhedonia) WITH four of the following: eating problems (weight loss or gain), insomnia or hypersomnia, sad or emptying feelings, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness, hopelessness, powerlessness, guilt, difficulty concentrating or making decisions, diminished ability to think, and recurrent thoughts of death or suicide

What age group has the highest suicide rate?

Over 65 (esp men over 85)

What is the stages of relapse?

Overextension, restricted consciousness, disinhibition, psychotic disorganization, psychotic resolution

_ Extracting a rule on the basis of one event and applying it to other dissimilar situations

Overgeneralization

What is flight of ideas thought process?

Overproductive speech characterized by rapid shifting from one topic to another and fragmenting idea

Dementia Brain Imaging

PET: Positive Emission Tomography Patients with early onset may show: Cortical atrophy Ventricular enlargement Loss of temporal lobe volume Late AD who developed the disease after 75 show age-related changes PET shows pts with AD typical pattern of frontal, association, and temporal hypometabolism

What are some anxiety responses?

Pacing, increased HR, increased VS, shallow breathing, restlessness, nausea, confusion, tension, helplessness, alarm, terror

Describe pain disorder.

Pain is the primary symptom in this disorder with the absence of physical disease and may be associated with psychological factors, pain doesnt respond to pain meds and causes impairmen in social or occupational functioning or marked distress, stress/conflict = anxiety = pain

What are manifestations of panic attacks?

Palpitations, sweating, trembling, shaking, sensation of SOB, chest pain, feeling of choking, dizziness, derealization or depersonalization, fear, sobbing

What are tyicyclics used to treat in anxiety?

Panic attacks, OCD, or phobias

What are other medical diagnoses related to anxiety on axis 1?

Panic disorder with/without agoraphobia, agoraphobia without hx of panic disorder, specific phobia disorders, social phobia, OCD, PTSD, acute stress disorder, generalized anxiety disorder

Name the personality disorder for: Distrust: persistent suspiciousness, secretive, withholding, hypervigilant, jealous, envious; suspects without sufficient basis that others are exploitin, harming, or deceiving them

Paranoid

Name and describe the cluster A PD.

Paranoid - suspicious without justification, sees people as malevolent towards the individual, reads hidden meaning and bears grudges Schizoid - solitary, doesnt like being in close relationships, asexual, cold, detached, very serious, shy, uneasy, work in isolation Schizotypal - ideas of reference, magical thinking, odd beliefs, inappropriate affect, odd appearance or behavior, social anxiety, lack of close friends, flat affectm bland manner, illusions are part of their world, think ilogically

_ PD is a pervasive distrust and supiciousness of others such that their motives are interpreted as maevolent, beginning in early adulthood and present in a variety of contents

Paranoid PD

_ delusion is excessive or irrational suspicion and distrust of others, characterized by systematized delusions that others are out to get them

Paranoid delusions

Paranoid PD

Paranoid is pervasive pattern of distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning in early adulthood and present in a variety of contents Suspicious without justification, sees people as malevolent towards the individual, reads hidden meaning and bears grudges, secretive, jealous

What type of therapeutic communication technique is: restating anothers message more briefly using ones own words?

Paraphrasing

What is the difference between parasympathetic and sympathetic?

Parasympathetc responses conserve body responses (flight or fight) Sympathetic responses activate body processes

What happens in development at the middle adulthood age?

Parenting and adult friendships test the persons ability to foster independence in others, mature person must be self-reliant and find new supports, freedom that can be used for new activities from decreased dependent needs from children

Who are the strongest influence over children, adolescence, and young adulthood and can shape a childs self image through positive and negative reinforcement?

Parents

Name the personality disorder for: Negativistic attitudes: Sullen and arumentative, resents others, resists fulfilling obliations, complains of being unappreciated

Passive-aggressive

What is passive-aggressive?

Passive-aggressive is negativistic attitudes, sullen and argumentive, resents others, resists fulfilling obligations, complains of being unappreciated

What is one of the differences between a nurse client relationship and a social one?

Patient growth is the primary goal of the nurse client relationship. Self realization, self acceptance, and an increased genuine self respect are the characteristics of a nurse client relationship. A social relationship is based on reciprocal truat and congruent (Like) expectations. The relationship between a professional and a patient is based on clear role expectations. Each phase builds on the one before it and is characterized by specific tasks.

What is the outcome for dissociative disorder?

Patient with obtain max level of self actualization to realize his or her potential

Give one example of restating?

Patient: I feel so badly that I yelled at my child. Nurse: You feel badly about yelling at your child.

Give one example of reflection. (Reflects the emotion underlying the message.)

Patient: I just don't know what I will do when I get home. Nurse: You are feeling anxious about going home? It sounds like you are feeling hopeless and powerless about going home.

What is the critical element of stressors for depersonalization?

Patients perceptions of the treat

Name some SSRIs.

Paxil, Prozac, Zoloftm Lexapro

When do panic attacks usually peak and how long do they usually last?

Peak in 10 mins and last 15-30

Dementia Coping Resources

People who have attained higher levels of education and remain active deteriorate less rapidly Interpersonal resources are important Caregivers need coping resources: Alzheimer's Disease and Related Disorders Association AD Support Groups

What are some consequences of alcohol abuse?

Peripheral neuropathy, alcohol amnestic syndrome and brain damage, gastritis/esophagitis/pancreatitis, anemia, cirrhosis/hepatitis of liver

What happens in development at the preadolescence age?

Person become involved in an intimate relationship with a friend of the same gender (best friend), relationships involve sharing, clarify values and recognize difference in people, very dependent relationship with active efforts to exclude others

Coping Resources for Sexual Dysfunction

Person's knowledge about sexuality Positive sexual experiences Supportive people in the patient's environment Social and cultural norms that encourage healthy sexual expression

_ is a set of deeply ingrained, enduring patterns of thinking, feeling, behaving

Personality

_ is a set of deeply ingrained, enduring patterns of thinking, feelings, behaving

Personality

_ is enduring and consistent attitudes, beliefs, desires, values, and patterns of behavior

Personality

What is fixation?

Personality development is arrested at a level short of maturity

Name the personality disorder for: A set of patterns or traits that hinder a persons ability to maintain meaningful relationships, feel fulfilled, and enjoy life

Personality disorder

_ disorder is a set of patterns or traits that hinder a persons ability to maintain meaningful relationships, feel fulfilled, enjoy

Personality disorder

What are the cluster C personality disorders?

Personality disorders of anxious or fearful nature (avoidant, dependent, obsessive-compulsive PD)

What are the cluster A personality disorders?

Personality disordesr of odd or eccentric nature (paranoid, schizoid, schizotypal PD)

_ Egocentric interpretations of impersonal events or overinterpretation of events related to the self

Personalization and self-reference

What are side effects of typical antipsychotics?

Photosensitivity, agranulocytosis (emergency), drowsiness, ortho hypo, weight gain, edema, anticholinergic effects, EPS, extrapyramidal effects (slow posture changes, drink more fluids, chew sugarless gum, high fiber diet, check bp frequently), neuroleptic malignant syndrome

Interventions for Delirium

Physiological Needs: Nutrition and fluid balance Sleep deprivation Hallucinations Protection Orientation of patient Communication: Simple, direct statements Patient Education May need to be repeated Give written materials Without treatment, it can become chronic and irreversible

Developmental Tasks of Teens

Piaget: Formal operations Learning to deal with abstract concepts Erickson: Identity vs. Role Confusion Kohlberg: Postconventional Stage Believes laws and rules should further human values

What is the high prority of depression patients?

Potential for suicide, especially when their energy returns and their feelings seem to lift

What is a major risk factor for getting help?

Poverty

What are the phases of the nurse patient relationship?

Preinteraction phase, introductory (orientation) phase, working phase, and termination phase

What is the DSM-IV-TR for body dysmorphic disorder (BDD)?

Preoccupation with an imaging defect in appearance, causing significant distress and impairment in social or occupational functioning, causes impairment in social or occupational functioning or marked distress

What are some things to consider when planning care for a personality disorder pt?

Prepare guide for intervention that promotes consistency among treatment staff who provide patient care. Particularly important when working with pts with maladaptive social responses. Attend to educational needs. Help pts and families to understand disorders that cause maladaptive social responses.

What is the DSM-IV-TR for conversion disorders?

Presence of 1 or more symptoms that suggest the presence of a neurological disorder (i.e. blindness or paralysis), absence of medical or neurological findings to explain cause of symptoms, causes impairment in social or occupational functioning or causes marked distress, psychological factors: stress and conflicts associated withh exacerbation of symptoms

What do MAOIs do?

Prevent destruction of monoamines, increasing level of neurotransmitters

What is the goal of continuation treatment?

Prevent relapse

How does sharing humor promotes positive communication?

Prevention, Perception, and perspective

What is the best indicator for possible suicide?

Previous attempts

What are the effects of CNS depressants?

Primarily they reduce anxiety (calming, antianxiety, or sedative effects), induce sleep (hypnotic effect), or both

Describe prevention of substance abuse.

Primary - aims to prevent drug use in children; family-strenthening strategies are key to preventing problems Secondary - aimed at people with mild or moderate drinking problems Tertiary - decreasing complications of addiction; psych and medical treatments

Prevention for Violence

Primary prevention Activity that stops the problem before it occurs Changing society's acceptance of violence and abuse is an important first step in prevention Effective primary preventions are eliminating cultural norms and values that accept and glamorize violence Also want to eliminate porn (esp aggressive) Primary prevention of abuse also includes strengthening individuals, families, and communities so they can cope more effectively with stress and resolve conflict nonviolently Nurses can teach family life and sex education Family violence prevention includes anticipatory guidance while working with families A society must develop programs and policies that support families and reduce stress and inequities Secondary prevention Secondary prevention efforts involve ID of families at risk for abuse, neglect, or exploitation of family members, as well as early detection of those who are beginning to use violence Early indicators of families at risk include violence in the family of origin of either partner, communication problems, and excessive family stress, such as an unplanned pregnancy, unemployment, or inadequate family resources When nurses become aware of risk factors, immediate nursing intervention is required Tertiary prevention Tertiary prevention efforts refer to those nursing activities that address the immediate and long-term needs of survivors as they recover from their experiences in order to ameliorate negative effects Focus on stopping the current abuse and preventing the recurrence for abuse Legal recourse against the perpetrator may be mandated in the case of abuse of a child or older adult and may be voluntary pursed by an adult of intimate partner violence

What is the primary role of meds with PD?

Primary role of meds is to relieve symptoms of anxiety, mood swings, impulsive aggression

The way the nurse approaches limit setting can make a difference between _ and _

Productive hospital experience and nonproductive or counterproductive one

_ is blaming mom or others for behavior

Projection

_ is the attribution of feelings or impulses unacceptable to ones self to another person (passes the blame)

Projection

_ is when pt acts positive toward nurse and nurse acts positive toward pt and vice versa

Projective Identification

_ is pt acts positive toward nurse so nurse acts positive towarm them and vice versa

Projective identification

What are some interventions for a pt with bipolar I disorder?

Protect from harm, decrease stimulation, assess I&O, give simple and concise explanations (turn door knob, push door open), point out positive behavior, teach relaxation techniques,

What is a big intervention with PD?

Protect from self harm and suicidal ideation

Protection and Advocacy Act, Americans with Disabilities act, and Advanced directives

Protection and Advocacy Act stats all states must designate an agency that is responsible for protecting the rights of the mentally ill Americans with Disabilities Act prohibits discrimination against people with physical and mental disabilities in hiring, firing, training, compensation, and advancement in employment Advanced Directives are documents, written while a person is competent, that specify how decisions about treatment should be made if the person becomes incompetent

What are the 4 best ways to promote a childs self esteem?

Provide opportunities for success, instilling ideals, encouraging aspirations, helping the child build defenses against attacks to his or her self-perceptions

What type of therapeutic communication technique is: relevant info is important to make decisions, experience less anxiety, and feel safe and secure?

Providing information

When are SSRIs used for anxiety and what are some examples of meds?

Prozac or Luvox Used for panic attacks, phobias, or OCD

Name five predisposing factors that can lead a person to use suicide as a coping mechanism.

Psychiatric diagnosis, personality traits, psychosocial millieu, family hx, biochemical factors (serotonin)

Nursing care for eating disorders

Psychoeducational material Identify advantages and disadvantages of behaviors Use focus strategies Exploration of personal values Discuss maladaptive coping skills and teach adaptive coping skills

What are the four components of awareness of self?

Psychological, physical, Environmental, philosophical

What is addiction?

Psychosocial behaviors related to substance dependence

What is treatment for the dependent PD pt?

Psychotherapy, supportive therapy, cognitive behavioral, medication for social anxiety (SSRI), watch for dependency

What is dependent transference?

Pt demands more of the nurse and when needs arent met the pt hilled with hostility and contempt

What is the main cause of dissociative identity disorder?

Pt is sexual abused as a child so pt has an out of body experience to not have feelings of sexual abused

What is introjection?

Putting thoughts into someones head (ex:when someone dies and only think about the positive things)

What is the expected outcome for a pt with schizophrenia?

Reach their optimal level of functioning

What will happen if SSRIs are discontinued too quickly?

Rebound depression

A nurse asks a pt to remember a certian object, color, and address, what is she assessing?

Recent memory

Describe the DSM-IV-TR for panic disorder without agoraphobia.

Recurrent episodes of panic attacks, followed by one month of concern about having additional attacks; worry about consequences (going crazy, having heart attacks, losing control); significant change in behavior; dosent have agoraphobia

_ is going back in age

Regression

What is the function of the hypothalamus?

Regulates pituitary hormones, temp, and behaviors like eating, drinking, and sex

What is relapse in schizophrenia?

Relapse of symptoms that affect well being

What is the sleep cycle related to?

Related to the timing of circadian rhythms, changes in light and darkness, and temperature changes

Name some cognitive behavioral treatment strategies that the patient can use to effectively cope with anxiety. Relaxation therapy, guided imagery, deep breathing, cognitive restructuring, monitoring thoughts and feelings, reframing, role modeling, role playing, decatastrophizing, thought stopping, reframing, etc.

Relaxation therapy, guided imagery, deep breathing, cognitive restructuring, monitoring thoughts and feelings, reframing, role modeling, role playing, decatastrophizing, thought stopping, reframing, etc.

_ delusions are beliefs that one is favored by a higher being or is an instrument of that being (God has me as his messanger to tell the world that they are going to hell)

Religious delusions

Name the types of delusion.

Religious, somatic, grandiose, paranoid delusion

What is substitution?

Replacement of ones attitude or emotion by another

_ is the unconscious forgetting of something

Repression

What is the difference of repression and suppression?

Repression - unconscious supression of thought Supression - conscious suppression of thought

What is included in the psychodynamic of PD?

Repression or suppression, regression, undoing, development tasks unmet, projection, splitting, and projective identification

What are coping mechanisms of somatization?

Repression, compensation, regression

What is the human genome project?

Research program that has characterized the complete set of genetic instructions of the human

Sexual Response Theories

Research was limited until the 1960s Masters and Johnson (1966)- Four phases: Excitement, Plateau, Orgasm, Resolution Conducted research on college students, prostitutes and voluntary sample Studied partners and how they built up the climax What they thought was important was closeness and touch If someone was having problems, they would have the couple lay together, touch each other, and lead to sex but has to lead to it All about touch Helen Kaplan (1974)- Three Stages: Desire, Excitement, Orgasm Current theory combines the two

What are key words regarding "good mental health"?

Resilience and self esteem

What are 4 therapeutic impasses?

Resistance (pts reluctance or avoidance of verbalizing or experiencing troublings aspects of oneself) Transference (unconscious response in which pt experiences feelings and attitudes toward nurse that are originally associated with other aignificant figures in their lifes) Countertransference (transference by nurse) Boundary violations (occurs when nurse goes outside the boundaries of therapeutic relationship and establishes social, economic, or personal relationship with pt)

What are symptoms of opiate overdose?

Resp and circulation depression, unconsciousness, coma, resp and cardiac arrest, death, anoxia can lead to brain abcess if pt lives

What is incongruent affect?

Response that is inappropriate to the situation

What is the difference between fear and anxiety?

Response to a identifiable, specific response (We have a fear) Anxiety is an emotion triggered by fear. We become anxious.

What is the expected outcome for a pt with depression?

Return to pre-crisis level of functioning

Name four nursing diagnosis that would apply to a client with suicidal ideations.

Risk for suicide, hopelessness, self mutilation, risk for self directed violence

Alcohol Facts

Risky drinking for women is 7/wk or 3/occasion and men is 14/wk or 7/occasion When ingested 20% absorbed directly into blood stream (goes to brain and organs) then 80% slightly processes by upper intestine and absorbed directly into blood stream When someone passes out, emergency when breathing less than 8, bradycardia, cyanosis, cannot wake up Monitor withdrawal with CIWA-AR by monitoring symptoms q1-2h and decreasing to 4-8h until score below for 24h Most likely nutritional deficit

Name some boundary violations.

Role boundaries, time boundaries, money boundaries, physical contact boundaries

What is the protocol for detoxification from alcohol?

SEIZURE PRECAUTIONS - long-acting benzodiazipines are the drugs of choice (usually chlordiazepoxide (Librium), diazepam (Valium, or lorazepam (Ativan)); monitor for toxicity of benzos (ataxia: difficulty walking, nystagmus: involuntary eyeball movement); thiamine and vit B12 may help prevent Wernicke encephalopathy and Korsakoff psychosis (give clondine or catapres for increased BP); Structure Milieu: Inpatient medical or psych unit, crisis stabilization unit, or outpt setting with close monitoring (seizure precaution); need quiet, calm environment to decrease nervous system irritability; promote relaxation; provide reassurance in calm, quiet voice and do not leave pt alone and treat with respect and dignity; place clock within sight of pt to provide reality orientation; give fluids if dehydrated; encourage eating; antidiarheal or analgesic meds as needed; cool cloth on forehead if pt diaphoretic

Alcohol Detox

SEIZURE precaution, long-acting benzo (Lithium, Ativan), monitor for toxicity of benzo (ataxia, nystagmus), thiamine and B12 may prevent Wernicke encephalopathy and Korsakoff psychosis (give clondine or catapres for increased BP) Structure Milieu-inpatient medical or psych unit, crisis stabilization, or outpt setting with close monitoring then quiet and calm space to decrease nervous system irritability, promote relaxation, provide reassureance in calm and quiet voice, don't leave pt alone, place clock within sight for reality orientation, give fluids, encourage eating, antidiarrheal or analgesics PRN, cool cloth on forehead for diaphoretic

Which med classes can cause serotonin syndrome?

SSRI, TCAs

What is the drug of choice for moderate anxiety?

SSRIs

What type of meds are used for depression?

SSRIs

What meds are used when serotonin and norepinephrine are affected?

SSRIs (Zoloft, Paxil, Lexapro, Celexa, Prozac), TCAs (Amitripyline, Elavil), MAOI, and mood stabilizers (Lithium, Anticonvulsives like Lamictal or GABA or V.A. Depekote)

What meds to people with OCD take?

SSRIs for long term use (Paxil, Prozac, Lexapro)

What are some classification of drugs used for depression?

SSRIs, TCAs, and MAOI

Other Antidepressants

SWERD Serzone Wellbutrin (motor restlessness, insomnia, HA) Precaution: decreases seizure threshold Effexor (restlessness, increased anxiety, nausea) Remeron (sedation, wt gain) Deseryl (sedation, sleep aid)

What is the biggest concern with major depression disorder?

Safety

What is the nurses action in panic attacks?

Safety (tell them to breath, concentrate on me, simple demands)

Do not restrict _ in the diet with lithium

Salt

What is withdrawal like for benzodiazepines?

Same as alcohol

What are the side effects of atypical or 2nd generation antipsychotic medications?

Same extrapyramidal effects of 1st generation antipsychotics and agranulocytosis; wt gain (may predispose client to metabolic disturbances)

What do SSRIs do?

Save serotonin

Schizotypal PD

Schizotypal is pervasive pattern of social and interpersonal deficit marked by acute discomfort with disorder and reduce capacity for close relationships and by cognitive and perceptual distortions and eccentricities of behavior, beginning in early adulthood and present in a variety of contexts Ideas of reference, magical thinking, odd beliefs, inappropriate affect, odd appearance or behavior, social anxiety, lack of close friends, illusions are part of world

What is the difference between self injury and suicide attempt?

Self injury: injury causes tissue damage but the lethality is very low; the pt may feel a relief from tension or may inflict pain in order to feel Suicide: active thoughts or plans of causin ones death; a self-directed action taken by a person that will lead to death if not stopped

What are the 6 personal qualities a nurse needs to be an effective helper?

Self-awareness, exploration of feelings, role modeling, altruism, ethics and responsibility, and judgement

What type of therapeutic communication technique is: subjectively true personal experiences about self, are intentionally revealed to another person for the purpose of emphasizin both the similarities and the differences in experiences?

Self-disclosure

_ is the degree of regard or respect that individuals have for themselves

Self-esteem

Child Conduct Disorder

Serious persistent patterns of disturbed conduct and antisocial predominantly affect boys and make up the largest group of childhood psych disorders Conduct disturbance may begin early in childhood as oppositional, aggressive, and defiant behavior, becoming established during the primary school years and increasing after puberty Occurs in more boys Sources of etiology are family, biological, and psychsocial factors Many have ADHD, learning problems, and depression as well Affective aggression (impulsive, uncontrolled, unplanned, or overt) or predatory aggression (goal oriented, controlled, planned, or hidden) is observed in children with conduct disorder The latter type of aggression has a strong basis in bullying behaviors Consequences of growing up a bully or victim can be severe, with resulting anxiety, depression, self-esteem problems, and deficits in concentration and school achievement Requires vigorous early intervention, assessment, and management 1/3 will continue to get worse and have personality disorders, criminality, and alcoholism 40% can grow into antisocial PD

Sexual abuse of a child or teen

Sexual abuse is the involvement of children and adolescents in sexual activities they do not fully comprehend and to which they don't or cannot freely consent because of physical, cognitive, and psych immaturity Observable signs of sexual abuse include sexual acting out, physical aggression, excessive masturbation, social withdrawal, expressions of low self-esteem, impaired school performance, and disturbed sleep

Sexual Response Changes with Age

Sexual activity is stable over middle and late adulthood with small decline in later life. Women Decreased vaginal lubrication and elasticity Men Erections less firm and takes longer Less strength with orgasm Increased refractory period Women have decreased lubrication, lack of interest in sex, and difficulty reaching orgasm Men report erectile dysfunctions and need more direct penile stimulation for ejaculation to occur and the orgasm is less intense One important variable affecting sexuality in older adults is the lack of knowledge about the normal changes that occur with the aging process

Rape and sexual assault

Sexual assault (mostly women and children) results in physical trauma, psychic and spiritual disruptions, and deterioration of social relationships Definition of sexual assault The forced perpetration of an act of sexual contract with another person without consent It is not a sexual act but is instead motivated by a desire to humiliate, defile, and dominate the survivor Marital rape Is legally recognized in most states and is often reported along with physical abuse Often the women report forced sex and insertion of objects in vagina, anus, mouth

Sexual Dysfunction in Men and Women

Sexual dysfunction can occur when any phase is disrupted, resolution phase inhibition is rarely responsible for specific sexual dysfunction Men or more likely to report problems with sexual performance and erectile dysfunction Women are motivated to seek help for concerns about sexual feelings, including lack of desire or sexual pleasure Takes more stimulation for women to have an orgasm Sexual dysfunction in women Lack of orgasm When a woman orgasm - all the muscles around the vagina contract With men all the muscles contract in penis but cum Vaginismus - involuntary spasms that hurt and it just clamps down and gets tight and interferes with sexual intercourse Sexual dysfunction in men Erectile dysfunction Ejaculatory disorders Premature is early Inhibited is doesn't happen Retrograde is when it goes into bladder

What type of therapeutic communication technique is: the ability to understand and accept another persons reality, to accurately perceive feelings, and to communicate understanding?

Sharing Empathy

What type of therapeutic communication technique is: nurses can help clients express emotions by making observations, acknowledging feelings, and encouraging communication, giving permission to express negative feelings and modeling healthy anger?

Sharing Feelings

What type of therapeutic communication technique is: contributes to feelings of togetherness, closeness and friendliness?

Sharing Humor

What type of therapeutic communication technique is: communicating a sense of possibility to others; encouragement when appropriate and positive feedback?

Sharing hope

What type of therapeutic communication technique is: observations by commenting on how the other person looks, sounds, or acts?

Sharing observations

When do you usually see tics and grimaces?

Side effects of meds

What type of therapeutic communication technique is: time for the nurse and client to observe one another, sort out feelings, think of how to say things, and consider what has been verbally communicated?

Silence

What is the tangential thought process?

Similar to circumstantial but the person never returns to the central point and never answers the original question

Describe how SPECT works, what it images, and the advantages/disadvantages.

Single-photon emission computed tomography (SPECT) How it works: Similar to PET but uses more stable substances and different detectors to visualize blood flow problems What it images: Brain activity/function Advantages/disadvantages: Useful in diagnosin, cerebrovascular accidents and brain tumors

How do you show you are an active listener?

Sit facing the client, open posture, lean toward the client, eye contact, and relax

What does serotonin affect?

Sleep, hunger, mood states, aggression

_ is fear provoked by exposure to a social situation or a performance situation

Social phobias

_ delusions are beliefs that ones body or parts of ones body are diseased or distorted (Joe thought his brain wasrotting away)

Somatic delusions

What is hypochondriasis?

Somatic overconcern with and morbig attention to details of body functioning (always think your sick)

_ is fear provoked by specific object or situation

Specific phobias

_ is all good or all bad (nurse can be good in morning but once she sets rules is all bad)

Spliting

_ arises from the lack of achievement of object constancy and is manifested by an inability to integrated and accept both positive and negative feelings

Splitting

_ is the inability to realize people have good and bad so they are either all good or all bad

Splitting

Stages of Dementia

Stage I - Mild (changes occur slowly) Impaired Memory Insidious loses in ADL's Subtle changes in personality Socially normal Stage II - Moderate (changes occur rapidly) Obvious Memory Impairment Overt ADL impairment Prominent behavioral difficulties Variable social skills Supervision needed Stage III - Severe (changes occur slowly) Fragmented memory No recognition of familiar people Assistance needed with basic ADL Fewer troublesome behaviors (Usually) Reduced mobility

Dementia Interventions

Stressors do not involve immediate threat to life Help patient maintain optimal level of functioning Nursing approaches should address the patient's need for social interaction. (Group interaction) Highest priority is optimal level of functioning Snoezelen multisensory environment to relax and enhance trust using senses Orientation Mark patient's rooms with large letters Encourage personal possessions Hang calendars and clocks Adequate lighting decreases nighttime agitation Provide newspapers Use systematic reality orientation Communication Nurses attitude must reflect unconditional positive regard. Exhibit empathy, warmth, and caring Patients may enjoy discussing past experiences Use "yes" and "no" questions Do not use pronouns Verbal and nonverbal communications should be congruent Use of distraction may be utilized

_ is severe condition or disease with physical problems and serious disruptions in work, family, social life

Substance Dependence

_ is continued use despite problems related to use of drugs or alcohol

Substance abuse

Name several forms of indirect self destructive behaviors.

Substance abuse (alcohol or drugs), eating and other addictions, smoking, poor nutrition, noncompliant people are struggling for control (denial, guilt, and control are key words)

Teen Substance Abuse

Substance abuse carries serious consequences, causing 50% of the deaths in teens Due to interaction of environment and inherited constitutionally vulnerable traits Genetic variables affect variations in absorption of drugs, neuron response, metabolism, and excretion Teens are particularly vulnerable because although the reward system in their brains are developed, the areas involving judgment and critical decision making and the ability to delay reward and gratification are not All drugs with dependency capacity activate the brain reward centers shown by elevated dopamine Alcohol is the most commonly used and abused substance by youth Alcohol is a sedative that is accessible because its legal after age 21 yo Early regular drinking is associated with later alcohol dependence and use, abuse, and dependence on drugs Marijuana is the illegal drug most commonly abused by teens Main ingredient is THC Can take 30 days to get out of system Onset of drug use before age 20 predicts more sustained use overtime Chemical dependence is gradual process Repeated and regular use of drugs for recreational purposes can lead to problems with depression and anxiety Teens often report a wish for closeness that is satisfied by sharing a drug experience with friends Adolescents account for 85-90% of first time smokers that usually occurs at 6-9th grade

What is thought blocking in thought process?

Sudden halt in the train of thought or in the middle of a sentence

When a pt is on SSRIs, its important to observe for what?

Suicidal ideation (esp adolescents)

Name four forms of direct self destructive behavior.

Suicidal ideation, treats, attempts, completed suicide

Confusion in geriatrics

Sundowning or sunrising syndrome, disoriented or confused Is a constellation of behaviors (inattention and memory deficits), challanging behaviors (aggressiveness, combativeness, delusions), inability or failure to perform ADLs Institutionalized elders are more at risk for confusion Sunrise syndrome (early morning confusion) is usually from effects of sedative-hypnotics or other night meds Sundowning syndrome (increasing disorientation or confusion at night) from loss of visual accommodation and other factors Most logic cause is deteriotation of the suprachiasmatic nucleus in hypothalamus Major pacemaker of circadian rhythms regulates the sleep-wake cycle and found to be deteriorated in demented people

_ Believing in the cause-effect relationship of noncontingent events

Superstitious thinking

What are some interventions for abstinence from alcohol?

Support groups: AA, Alateen, Alanon, ACOA (adult children of alcoholics) Meds: naltrexone (Vivitrol) which is injectable and the nalmefene is an opiate receptor anatgonist to diminish cravings acamprosate (Campral), citalopram, or ondansetron can decrease alcohol desire disulfiram (Antabuse) interrupts alcohol metabolism cauing physiological responses

_ is conscious forgetting of something (repression is the unconscious forgetting of something)

Suppression

_ is the conscious forgetting of something until tomorrow

Suppression

What is the difference between suppression and repression?

Suppression - conscious Repression - repress anxiety and coming out in symptoms

What are symptoms of alcohol withdrawal?

Symptoms of withdrawal are NV, tremors (DT), profuse sweating, anxiety, agitation, hallucinations (tactile, auditory, and visual), extreme HA, fullness of head, disorientation with clouding of sensorium

T/F: US has one of highest substance abuse rates in world

What is the active ingredient in marijuana?

THC

What symptoms would you observe in the ER that would lead you to believe the pt has overdosed on stimulants?

Tachycardia, agitation

What are nursing interventions for typical or 1 generation antipsychotic medication?

Teach to change positions slowly, rinse mouth, drink more, sugarlass gum and candy, no driving, high fiber diet; avoid direct sunlight and wear sunglasses; observe for fever, sore throat, extrapyramidal effects, check BP; use antidepressants and benzos cautiously with antipsych meds

Teen Conduct Disorder

Teens with conduct disorders display behavior that violates the basic rights of others or societal norms and rules Ex: fighting, crulty, lying, truancy, aggression toward people/animals, bullying Have poor relationships with parents Antisocial acts allow the teens to express anger toward parents Learn not only from parents but others Many factors that may lead to teen delinquency, including lying, stealing, and other social offenses Conflict between dependence and independence may be expressed in poor school adjustment Teens may drop out of school for a variety of reasons Parents may overtly or covertly discourage education

What do studies show about depressed persons sleep cycle?

That REM sleep is excessive, the deeper stages of sleep are decreased and dreams may be unusually intense. Although the depressed person sleeps for extended periods of time they do not feel rested and have poor concentration, irritability and fatigue.

What does value mean?

That something has worth. It is important to you

When we speak of a philosophical component, what are we speaking of?

That we have a sense of life having meaning.

You read a patient's chart to prepare for your first day with the patient. What part of the nurse client relationship are you developing?

The Preinteraction phase. The initial task of the preineraction phase is self exploration. The tasks are gathering data and planning for the first interaction.

What is the term for bringing fears, feelings and experiences out in to the open in order for them to be examined and discussed?

The expression of feelings can be very therapeutic.

What is Somatization?

The expression of psychological stress throuh physical symptoms, characterized by physical complaints, no organic basis for physical symptoms, significant impairmnt in social or occupational functioning, symptoms are not intentionally produced (as in malingering)

What is the definition of identity diffusion?

The failure to integrate various childhood identifications into a harmonious adult psychosocial identity

Communication with children

The first goal of the nurse is to establish a therapeutic alliance with the child and parents Often a child will not respond to a problem-centered line of communication. In this case the nurse should start discussing more general aspects of the child's life, such as family members, school, or friends Children with internalizing disorders, such as depression or anxiety, are often the best informants about their affective states Children with externalizing disorders, such as ADHD or coduct disorder, are typically poor informants and generally less cooperative in an interview Tend to blame

Teen FamilyTherapy

The nurse needs to assess the level of family functioning and determine how to best interact with and help the family of the teen Mostly useful when interaction between teen and parents is interfering with development

Nursing Intervention for sexual assault

The nurses initial response of nonjudgmental listening and psych support is essential Is assault is suspected, physical evidence will be needed to take legal action Use a sexual assault nurse examiner (SANE) Later interventions may include referrals to survivor groups, shelters for battered women, or legal services The acute stage, immediately after the attack, is characterized by extreme confusion, fear, disorganization, and restlessness The second phase involves long-term process of reorganization

What is the expected outcome for patients with maladaptive anxiety responses?

The patient will demonstrate adaptive ways of coping with stress. Moderate level of anxiety: Patients need to identify when they are becoming anxious, gain insight into the anxiety, and learn adaptive coping skills in order to tolerate mild levels of anxiety.

Eating disorder short term goals

The patient will: Identify cognitive distortions about food, weight and body shape Exercise after gaining ___________ percentage of weight and when she is medically and nutritionally stable Accurately describe body dimensions Will demonstrate + family interaction Will describe the complications and medical sequelae of the eating disorder

Teen Social Role

The peer group is very important because within the security of the peer group, adolescents can attempt to resolve conflicts Test out thoughts and ideas Help explore other ways of dealing with problems and offer its members companionship, protection, and security Can accept dependency, not as a child but as one of the gang, testing out ideas and trying new values Within the safety of the peer group, they can observe, comment on, and evaluate the activities of others Close relationships with the opposite gender provide adolescents with security and a person with whom to discuss problems and evaluate solutions

Children Legal and Ethical Issues

The right to privacy and confidentiality is rarely granted to a child apart from the parents In mental health care the provider is sometimes required to balance the child's wishes and interests against the parents request for information Clear exceptions are when a child reports a plan for self-harm or harm to others or relates information about child sexual or physical abuse, which must be reported to authorities as required by the court Minors are considered to me emancipated or free from parental authority if they are married, serving in the military, parenting a child, living separate from parents, or self-supporting

Dementia with Lewy Bodies

The second most common form of degenerative dementia Lewy bodies: neurofilament material found in the brainstem, thalamus, and basal ganglia of patients with dementia associated with atypical Parkinson's disease and in the cerebral cortex of patients with dementia with Lewy bodies. Lewy bodies are found in brainstem, thalamus, and basal ganglia of pts with dementia associated with atypical Parkisons disease and in cerebral cortex of pts with dementia with Lewy bodies

What is the key therapeutic tool of the psychiatric nurse?

The therapeutic use of Self.

Teen Pharmacology

The treatment strategy is more complex for this age-group because of the following: Need for comprehensive family involvement (often optional in adults) Developmental differences that affect assessment, treatment alliance, management, compliance, and pharmacokinetics Difficulty in diagnosing emerging first episodes versus adjustment disorders in this age-group Lack of controlled clinical drug trials in teens Dosing is usually closer to adult range Guidelines SSRI is generally preferred over TCAs in treatment of teens Benzos for anxiety is not recommended because of increase drug experimentation in teens Lithium is usually well-tolerated in this age group and effective in treatment of mania, aggression, and conduct disorder Antipsych are standard treatment for psych symptoms in teens Teens have a positive reponse to psychostimulants for ADHD

Describe valproic acid (Depakote).

Therapeutic blood level: 50-100 mcg/ml; may be lethal overdose; metabolized in liver; baseline liver function tests must be performed; common side effects - tremors, GI upset, ataxia, dizziness, weight gain, thrombocytopenia may occur (decreased dose); dont use with pregnancy

Intimate partner violence nursing intervention

There is treatment programs for abusive men Work better if made mandatory by court with punishment for noncompliance To empower an abused woman, one must first make sure she has accurate info on which to base her difficult decisions Includes knowledge of the related state and local laws and ordinances Be aware of community resources Mutual goal setting is particularly important when working with abused women Effective interventions are those that reduce isolation, empower through accurate knowledge about abuse and about community resources, and attend to safety needs

Antianxiety meds

These are antiolyxics and minor tranquilizers Anxiety symptoms - psychological (irritability, uneasiness, dear, sense of impending doom, insomnia) and physical (restlessness, sweating, dilated pupils, dry mouth, tachycardia, SOB) These are benzodiazepines, nonbenzodiazepienes, and others

Cognitive Disorders

These responses are classified as cognitive disorders, because they feature as a cardinal symptom an impairment in important functions, such as, Memory, Language, Attention Cognitive activity depends on intelligence, education, life experience, and culture Cognitive activity Is dependent on: Intelligence, Education, Life Experiences, Culture

Hypnotics

They are CNS depressants These are Ambien, Vistaril, Benadryl, Desyrel, Lunesta, Halcion, Noctec, Prozam, Rozerem, Sonata, Doral, Dalmane, Restoril Side effects are drowsiness, dizziness, ataxia, irritability, tolerance Special notes Use caution when driving and using machinery Use cautiously with elderly Can cause nightmares and confusion Some reports of memory loss, night eating, and sleep walking on new Especially Ambien, Lunesta, and Sonata

Why are barbiturates used rarely in anxiety pts and give some examples of meds?

They are dangerous in OD, CNS depressant, very addictive, potentiates alcohol and benzodiazepines, and serious withdrawal Ex: -bartbital (secobartbital, phenobarbital), sodium amytal, or mnembutal

Cluster C PD

They are disorders of anxious or fearful nature (avoidant, dependent, obsessive-compulsive) Meds used that may benefit are from serotonergic antidepressants

Cluster B PD

They are disorders of erratic, dramatic, or emotional nature (antisocial, borderline, histrionic, narcissistic) Meds used are mood-stabilizers and atypical antipsych meds for subtle signs of bipolar disorders, meds are usually not helpful for this cluster of PD Used manipulation

What are the illicit drug names for barbituates?

They are downers called names like black beauties, reds, sleepers

What is the biggest reason manipulative people dont want to change?

They are getting rewards, they get what they want but dont see the lack of intimacy in satisying relationships

Cluster A PD

They are odd or eccentric nature (paranoid, schizoid, schizotypal) Treatment-meds used are antipsych for substyle psych symptoms, cognitive therapy (insight to behavioral traits), supportive psychotherapy, social skills instructions

Elderly Abuse Assessment

They are vulnerable to abuse and it usually is from a primary caregiver (child, spouse, ect) Nursing assessment Family interviews should be not only about the pt but also assess the interactions among family members for indications of verbal and physical control and aggression Its difficult for abused elders to admit being physically hurt by an adult child, spouse, or caregiver Elder may not say anything for fear of being alone Bruises on the upper arms from shaking is the most common in elder Signs of neglect are poor hygiene, breakdown of the skin, malnutrition, dehydration, or underdosing or overdosing of prescriptive meds Nursing interventions When the nurse must report elder abuse, its usually less damaging to the therapeutic relationship to inform the family first Deciding whether to discuss reporting beforehand is influenced by the likelihood of the abusing family member disappearing and the severity of the abuse

How do you detoxify from alcohol?

They can have alcohol withdrawal syndrome or delirium tremens (DTs), its removal of toxic substance from the body naturally through physiological processes (hepatic or renal functions) or medically by intruducing alternative substances, gradual withdrawal (use benzos to decrease anxiety and prevent seizures, thiamine (B1 and 12), and clonidine (check VS))

Why do people with depression who sleep all the time still feel exhausted?

They dont go through REM sleep to allow a restful sleep

What does the developmental theory say about borderline PD?

They fail to achieve object constancy during the separation-individuation related to another as series of disconnected parts instead of a whole

Cognitive Disturbance Facts

They have misinterpretations and disordered thought with illusions and hallucinations Worsens at night Disoriented in time, place, and person Poor judgment Labile affect Can be misinterpreted with depression

Why is it a high priority to assess a pt with depression when they are impulsive, angry, and hurt?

They may not think about the consequences of their suicide, so they may be more prone to commit it very hurriedly and successfully. Develop a safety plan with the pt.

what are command hallucinations?

They tell the patient to do something

What is circumstantial thought process?

Thought and speech associated with excessive and unnecessary detail that is usually relevant to a question and an answer is eventually provided (telling long story to get to point)

What is the belief that my thoughts are being aired to the outside world?

Thought broadcasting

_ is the belief that ones thoughts can be heard by others (I can control all heads of state through my thoughts)

Thought broadcasting

_ is the belief that thoughts of others are being inserted into ones mind (They made me think bad thoughts)

Thought insertion

What can anticonvulsants mood stabilizers?

Thought to decrease "kindling" and to potentiate GABA

What is nihilistic thinking?

Thoughts of nonexistence and hopelessness

Parenting Styles influencing Teens

Traditional parents Tend to value a sense of continuity and order Adolescents tend to be more attached to their parents, conforming, and achievement oriented Authoritarian parents Oriented toward shaping, controlling, and restricting the adolescent to fixed standards Obedience is seen as a virtue Power and responsibility is not shared with the adolescent Results in problems with the adolescents development of autonomy Democratic parents Tend to be supportive and respond to the specific situation with solutions that promote the adolescents autonomy Foster stimulation and challenge Combines limit setting with negotiation Shown to predict greater independence functioning in adolescents

What medication is used to help with detox of opiate abuse?

Tramadol and tappered off with light substance

What is the difference between transference and countertransference?

Transference is an unconscious response where the nurse reminds the patient of someone in their past. This gives the patient an inaccurate view because the perceptions of the patient about the nurse are not correct. Countertransference is the nurse's emotional response to the client. The nurses perceptions are not accurate about a certain patient because he or she unconsciously identifies the patient with someone from her past. Countertransference reactions are usually three types: 1. reactions of intense love or caring 2. reactions of intense disgust or hostility 2. reactions of intense anxiety, often in response to resistance by the patient

What are some precipitating stressors of DID?

Trauma: physical, sexual, and psychological abuse has been reported by most pts with dissociative symptoms, depersonalization disorder, and DID Role strain: frustration felt when a person is torn in opposite directions or feels inadequate or unsuited to enact certain roles Physiological stressors: O2 deprived, hyperventilation, biochemical imbalances, severe fatiguem and sensory and emotional isolation Alcohol, drugs, and other substances

What conditions are antipsychotic medications used for?

Treat schizophrenia, schizoaffective disorder, organic brain syndrome with psychosis, delusional disorder, and bipolar disorder

What is the evidence-based treatment for cluster A PD?

Treat with antipsychotic meds to reduce some symptoms of the disorder, cognitive therapy (insight to behavioral traits), supportive psychotherapy, social skills instructions

What is the DSM-IV-TR for schizophrenia?

Two of the following for a period of at least 1 month: delusions and/or hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms, work and interpersonal relations or self care disturbances

What drug classifications are used to treat schizophrenia?

Typical or first generation antipsychotic meds (Hadol) and atypical or second generation antipsychotic meds (quetiapine - Seroquel)

What are some classification of drugs used for schizophrenia?

Typical or first generation antipsychotic meds and atypical or second generation antipsychotic meds

What is repression?

Unconscious suppression of thoughts (ex:child was sexually abused and unconsciously suppressed it until it comes out later in life)

Sexual Assessment

Use composure and professionalism Use techniques of interviewing Open ended questions Privacy Be aware of level of patient' understanding and communication Only assess for information that you need Open-ended questions are one of the most effective ways for promoting a discussion on sexual issues Have you noticed any changes in sexual function with your medicaton? How has it been going for you with you and your partner?

Child Bibliotherapy

Use of literature to help children ID and express feelings within structure and safety of the nurse-pt relationship

How do you monitor a pt with alcohol withdrawal?

Use the clinical institute withdrawal assessment- alcohol revised (CIWA-AR) or a similar tool to score symptoms, monitor q1-2h, decreasing to 4-8h until score below for 24 hours

What role does medication use have for PD?

Used primarily to relieve symptoms such as anxiety, mood swings, impulsive aggression

Antidepressants

Used to treat major depression and anxiety disorders These are SSRIs, TCAs, MAOIs, and others

Antipsychotics

Used to treat schizophrenia, schizoaffective disorder, organic brain syndrome with psychosis, delusional disorder, and bipolar disorder Typical or 1st generation: Affect neurotransmission that blocks dopamine from the receptor site and calms excitable behaviors and reduces psychotic symptoms Hadol, Loxitane, Navane, Prolixin, Stelexine, Taractan, Trilafon, Thoraxine Side effects-drowsy, ortho hypo Anticholingeric effects-blurred vision, dry mouth, constipation, urinary retention, wt gain, edema, menstrual disorders, photosens, lowered seizure thres, agranulocytosis, jaundice, galactorrhea, gynecomia, impaired ejaculation Extrapyramidal reactions-akathisia, dystonia, tardive dyskinesia, parkinsonism, oculogyric crisis (Give anti-cholinergics) Target is positive symptoms (hallucinations, delusions) of schizophrenia Nursing interventions are teach pt to change positions slowly, rinse mouth, drink more water, use sugarless gum and candy, no driving, high fiber diet, avoid direct sunlight, observe for fever and sore throat and EPS, check BP Neuroleptic malignant syndrome-muscular rigity, sweating, tachycardia, fever (101-103 but can reach 108), stupor, tremors, autonomic hypersensitivity; If neuroleptic malignant syndrome occurs, admin Dantroline and Bromcrptine, monitor temp, ventilation, tachycardia, and hydration Use antidepressants and benzos cautiously with antipsych meds; used for schizophrenia, schizoaffective disorder, organic brain syndrome with psychosis, delusional disorder, and bipolar disorder Atypical or 2nd generation: Inhibit reception of neurotransmitters Dopamine and Serotonin at Postsynaptic sites Less EPS or Tardice Dyskinesia (TD) Abilify, Clozaril, Geodon, Invega, Respirdal, Seroquel, Zyprexa Side effects-same EPS (akathisia, dystonia, tardive dyskinesia, parkinsonism, oculogyric crisis), agranuclocytosis, wt gain (may predispose to metabolic problems) Monitor for diabetes Target positive (delusions, hallucinations) and negative (loss of affect, speech, pleasure, attention) symptoms of schzio Teaching is nutrition, exercise, and diabetes symptoms, may cause sedation Antipsych meds can be used with mood stabilizers Lithium and Valproic Acid

Marijuana

Used with chemo for n/v reduction Can precipitate psychosis in schizophrenic pts Active ingredient is THC Cluster of symptoms called amotivational syndrome

What is the most potent form on communication?

Using Touch

What is symbolizing?

Using an object or idea as a substitute or to represent another object or idea

Dementia Facts

Usually a gradual onset May be a progressive deterioration or may stabilize May involve a continual and irreversible decline in mental function and behavior. Some can be reversed (subdural hematoma, tumor, cerebral vasculitis, hydrocephalus) Occurs at any age but mostly elderly Results from structural and neurochemical changes in the brain as a result of trauma, infection, cerebralvascular disruptions, substance use, or an unknown cure Cognitive changes are related to the actions of stressors that interfere with functioning of the cerebral cortex and the hipocampus

MAOIs

Usually last choice Prevent destruction of monoamies, increasing level of neurotransmitters (serotonin and norepinephrine) Marplan, Eldepryl/Emsam, Nardil, Parnate MEENP NEVER GIVE other antidepressants within 14 days of stopping MAOIs Overdosing as suicide attempt always a risk Avoid driving Takes 2-4 weeks to be effective (lag time) Can cause HTN crisis with Tyramine foods/meds Aged cheese, beer, wine, bananas, coffee, chocolate, chicken livers, preserved meats No SSRIs, TCAs, other MAOIs, stimulants, OTC cold or cough meds, hypoglycemic, insulin, narcotic analgesics Treatment Hold MAOI dose, don't lie doen, IM Chlorpromazine 100 mg, IV Phentolamine 5 mg (slowly), manage fever, evaluate and stress compliance with diet Patient observation for suicide potential

Child Planning

Usually multimodal and may involve medications, psychosical supports (after-school program, big brother mentoring), psychoeducational interventions (coping skills, problem solving), and individual or group therapy Helping children take full advantage of their resilient coping ability is a primary intervention for child psych nurses Child's effective coping behaviors may include the following Withdrawal from the stressful situations Postponing an immediate response Finding a more manageable situation Restructuring (manipulating or shaping) the environment Accepting both good and bad as part of everyday life Working toward maintaining optimal conditions of adjustment, security, and comfort Nurses task is to find ways to enhance resilience and promote healthy development In order to ensure that the mental health needs of children are met, increased focus must be placed on the multisystemic, wraparound, seamless continuum of care

What are symptoms of opiate withdrawal?

Usually not life-threatening but uncomfortable - anxiety, restlessness, insomnia, irritability, impaired attention, often physical illness with n/v, diarrhea, chills, fever, muscle spasms, HTN, HA, muscle pain, tension

When do you usually see dilated pupils?

Usually with drug intoxication

What are 5 types on nonverbal communication?

Vocal cues are nonverbal quality of speech (tone, pitch, loudness, ect) Action cues are body movements aka kinetics (automatic reflexes, posture, facial expression) Object cues are speakers intentional and unintentional use of all objects (dress, furnishing, possession) Space between people (intimate space is up to 18 in used for max interpersonal sensory stimulation, personal space is 18 in to 4 ft used for close relationships and when touching distance may be desired, social-consultative space is 9-12 ft for less personal and requires louder speech, and public space is 12+ ft for speech giving and other language gatherings) Touch is personal space and action (most personal of nonverbal)

What are some of the nonverbal cues that the nurse must observe?

Voice inflections, body movements. gestures, facial expressions, posture, and physical energy levels.

What is dissociation?

Walling off certain areas of the personality from consciousness

Alcohol complications

Wernickes and Wernicke-Korsakoff syndrome is complications of alcohol abuse where severe deficit in cognitive function, related to deficiency of Vit B (esp thiamine), may be irreversible Consequences of abuse are peripheral neuropathy, alcohol amnestic syndrome and brain damage, gastritis/esophagitis/pancreatitis, anemia, cirrhosis/hepatitis of liver Abstinence-support group (AA, alateen, alanon, ACOA)

When communication is congruent, what does it mean?

What I feel, what I believe, what I do, what I think all match.

What does thought content look at?

What the pts thinking

Nursing Interventions for Abuse

When child abuse is suspected, the nurse must report it to protective services Nurse should be honest with family and state the purpose of the investigation and length of time it takes Nurse should stay in contact with protective service to ensure safety and consistency of investigation

When does a condition become pathological?

When it interferes with one's life-work, relationships, family, ADL's, etc.

When is it a good time to use immediacy in the nurse patient relationship?

When it is stalled or isnt progressing

What is short time goals for PD?

When setting short time goals you want to develop with pts active participation, consider pts ability to tolerate anxiety before setting goals

What is kinley?

When something in early life causes anxiety in later life (Ex: When a child is abused so when adult have anxiety problems)

When is diagnosis made for depersonalization?

When symptoms cause distress or impairment in functioning

Voluntary vs Involuntary Admission

When voluntarily admitted, the pt retains all civil rights, including the right to vote, hold a drivers license, buy and sell property, manage personal affairs, hold office, practice a profession, and engage in a business Involuntary is when the patient is committed because he or she is mentally ill and one of the following: dangerous to self or others, mentally ill and in need of treatment, unable to provide for own basic needs This begins with a sworn petition by a relative, friend, public official, physician, or any interested citizen stating that the person is mentally ill and in need of treatment They have lost the right to leave the hospital as desired If they leave before discharge, the staff has the legal obligation to notify the police and committing courts

What is undoing?

When you do something and try to make up for it after (ex: eat ice cream then workout afterwards)

What is reaction formation?

When you dont ike something but play the role like you do (ex: a baby sitter who hates kids)

What is regression?

When you go back to an earlier level of emotional development (ex: when a sibling is born the older one will sometimes start wetting the bed again)

What is identification?

When you identify with someone (Ex: a child is playing with teddy bears and goes to give a shot and says "this is only going to hurt a little")

What is projection?

When you project your feeling on someone else (ex: when a child hits someone and blames the other person) (ex: when someone is cheating and blames the other for an affair)

What is sublimation?

When you take a situation and substitute it with a bad behavior

What is displacement?

When you transfer unacceptable feelings aroused by one object to a safe substitute object (ex: dad is mad at boss but comes home and spanks child)

What is rationalization?

When you try to rationalize your actions (ex: robber says bank had plenty of money and didnt need it)

When do you have withdrawal symptoms?

When your body adapts to having addictive drugs or substances in its system

What is somatization (conversion)?

Where someone takes anxiety and puts into physical symptoms (ex: someone sees something they dont like and go blind)

What is waxy flexibility?

Where they stay in one position for a long time, if you move them they will stay in that position

What is an outcome for dependence of substance abuse?

Will abtain from all mood-altering chemicals

What is a outcome for substance abuse with withdrawals?

Will withdraw safely, with minimum discomfort; also oriented x3, will report symptoms of withdrawal, will correctly interpret environmental stimuli

What is tolerance?

With continues use, more of substance needed to produce same effect

What are symptoms of caffeine withdrawal?

Withdrawal symptoms are HA, sleepiness, fatigue, problems with attention, and decreased vigor; want to tapper off

Paranoia in geriatrics

Withdrawal, fearfulness, secretiveness Classic paranoia is rare in elderly They may feel threatened by certain people or at certain times Relocation can induce it Personality of aging paranoid pts is characterized by withdrawal, aloofness, fearfulness, oversensitivity, and often secretiveness Older people who have transient or chronic paranoia are at high risk for victimization by others as well as self-neglect and self-abuse

Who do you see borderline PD more in?

Women

What is considered risky behavior (number of drinks) for men and women?

Women - no more than 7 drinks per week or more than 3 on any one occasion (absorbed immediately into every tissue and cell) Men - no more than 14 drinks per week or 7 on any one occasion (higher metabolism and enzyme that breaks it down)

Which phase of the nurse patient relationship would you use confrontation?

Working phase

What occurs in the working phase of the nurse patient relationship?

Working with pt to teach pt to deal with mental illness (if person has suicidal thought, tell them to come to get you and you can help work through it with them; tell them ok you have these thoughts, what are you going to do about them), explore stressors and promote the development of insight in the pt by linking perceptions, thoughts, feelings, and actions; see change in behavior; master anxieties, increase independence, and self responsibility

Can anticonvulsants be used with lithium?

Yes

Do you want to directly question the pt about suicidal thoughts and plans?

Yes because will not cause pt to take suicidal action

Can you have more than 1 PD?

Yes or traits of several of them

Sexuality

_ All aspects of being sexual and is one dimension of the personality It is evident in the person's appearance and in belief's, behaviors, and relationships with others.

Genetic Identity

_ persons chromosomal gender

What are the three kinds of responses that a nurse can make to a patient?

a. questions or statements intended to increase the patient's awareness "Your face is smiling but your voice sounds angry." Tell me what you are feeling. b. Statements that reflect content - You were talking about your parents Separation c. Statements suggesting the nurse's responsiveness. I can sense that you are anxious.

Define which defense mechanism the patient is using and identify it as adaptive or maladaptive. A teenage girl emulates the mannerisms and dress of Hannah Montana __________________________________________

adaptive - identification

Define which defense mechanism the patient is using and identify it as adaptive or maladaptive: A person who is crying and upset withdraws to their room, curls up in a fetal position and sleeps for 12 hours. ______________

adaptive - isolation/suppression/regression

Name the five hallucinations.

auditory (hearing), visual (seeing), tactile (touch) Gustatory (taste), Olfactory (Smell)

Being psychologically self aware means being what?

being sensitive to the feelings of others.

What are other antidepressants used?

buproprion (Wellbutril) - lowers seizure threshold, weight loss, smoking cessation mitrazapine (Remeon) trazodone (Desyrel) - hypnotic venlafazine (Effexor)

Biological factors of anxiety are what?

decreased GABA = increased anxiety, norepinephrine is thought to deal with the fight or flight syndrome, hypersensitive 5-HT receptors.(serotonin)

What is treatment for narcolepsy?

dexedrine - dextroamphetamine, mixed amphetamine salts - Adderall, methylphenidate (Ritalin), Modafinil (Provigil)

What are memory problems associated with schizophrenia?

forgetfulness, disinterest, difficulty learning, and lack of compliance

Describe the borderline PD pt.

instability in relationships, self image, affects and impulsivity; abandonment issues, recurrent suicidal behavior, self mutilation, anger management issues, job instability, emptiness, fail to form autonomy or independence, needy, attachment and withdrawal but needy, see all good and all bad

Define which defense mechanism the patient is using and identify it as adaptive or maladaptive: A psychiatric patient claims to be the Son of God, drapes himself in a sheet and blanket, performs miracles on other clients and refuses to respond unless addressed as Jesus Christ. ___________________

maladaptive - identification/introjection

Define which defense mechanism the patient is using and identify it as adaptive or maladaptive: A young man who is extremely fearful of going to camp tells his counselor that all the other boys are such cowards here. _______________

maladaptive - projection

A bipolar pt on SSRI may cause _

manic

What medical diagnosis must be ruled out before diagnosing bipolar 1 and 2?

must rule out hyperthyroidism

Alcohol Meds

naltrexone (Vivitrol) which is injected and the nalmefene is an opiate receptor antagonist to diminish cravings acamprosate (Campral) and citalopram and ondansetron can decrease alcohol desire disulfiram (Antabuse) interrupts alcohol metabolism causing physical responses (severe HA, NV, flushing, hypotension, tachycardia, dyspnea, diaphoresis, chest pain, palpitations, dizziness, confusion, effects last 14 days after discontinuing) so need consent to use and cannot drink 12 after initiating it and avoid alcohol 14 days after stop taking

When do you usually see visual hallucination?

organic mental disorders

_ is a field that explores the interactions between the CNS, endocrine system, and the immune system; the impact of behavior/stress on these interactions; and how psychological and pharmacological interventions may modulate these interactions

psychoneuroimmunology

What is treatment for restless leg syndrome?

ropinirole (Requip), pramipexole dihydrochloride (Mirapex)

What are side effects if you abruptly stop taking antianxiety meds?

seizures, agitation, irritability, hyperactivity, HA, blurred vision, dizzy, hallucinate, n/v, insomnia

What are some physiological responses of Antabuse?

severe HA, n/v, flushing, hypotension, tachycardia, dyspnea, diaphoresis, chest pain, palpitations, dizziness, confusion; effects last 14 days after discontinuing

Positive and negative countertransference by staff members can lead to _

splitting, staff conflict

What are some sedative/hypnotic meds used for anxiety?

zolpidem (Ambien), zaleplon (Sonata), diphenhydramine (Benadryl), trazodone (Desyrel), eszopiclone (Lunesta), quazepam (Doral), flurazepam (Dalmane), temazepam (Restoril)

Name five DSM-IV-TR diagnosis that are more prone to use suicide as a coping mechanism.

Anxiety, bipolar, major depression, schizophrenia, substance use, noncompliance with treatment also predisposes client to suicidal ideations

What is co morbidity to PD?

Anxiety, depression, and impulse disorders

When do you usually see excessive body movements?

Anxiety, mania, stimulant abuse

What are benzodiazepines used for?

Anxiety, sedation, alcohol withdrawal, seizure disorders, skeletal muscle relaxation

_ is lack of feelings, emotions, interests, concern

Apathy

_ is lack of feelings, emotions, interests, or concern

Apathy

Define aphasia, apraxia, agnosia, and amnesia

Aphasia - difficulty finding the right words Apraxia - an inability to perform familiar skilled activities Agnosia - difficulty in recognizing well-known objects, including people Amnesia - significant memory impairment in the absence of clouded consciousness or other cognitive symptoms

_ is the inability to carry out motor functions or tasks

Apraxia

What are drugs used to treat extrapyramidal side effects?

Artane (triexphemidyl), Akineton (biperiden), Cogentin (benzotropine), Kemadrin (procyclidine)

What should the nurse do if they suspect the patient is suicidal?

Ask them about it and then follow with questions of lethality, and previous attempts, etc.

What are some non-therapeutic communication techniques?

Asking person questions, givin personal opinions, changing the subject, automatic responses, false reassurance, sympathy, asking for explanations, approval or disappoval, defensive responses, assertive communication, and arguing

How do you assess a patient's mood?

Asking them to rate their mood on a scale of 1 to 10

What are things you want to assess for in depressed patients?

Assess for suicidal ideation, plan (lethality), elopement risk Assess for impulsivity, shame, helplessness, hopelessness, angedonia, guilt and anger or rage

Primary care for elderly

Assess patient's cognitive, affective, functional, physical, and behavioral status Have a knowledge of the community resources & how to access them Plan nursing interventions with collaboration of patient, family, and other caregivers Coordinate Services Review legal options Role of the nurse in geriatric and any unit is advocacy (esp when they cant advocate for themselves) If you find patient at home not taken care of by wife have to call DSS They must know the effects of psychotropic meds on elderly people As a consultant, the geropsych nurse helps other providers address the behavior, social, and cognitive aspects of the pts care The role of the pt advocate is a critical one for the nurse caring for elders with mental illnesses because of cognitive changes or symptoms of acute or chronic health problems, elders may not be able to effectively voice their wishes or concerns

Child Assessment

Assessment of the child requires a biopsycosocial approach with attention given to the contribution of biological development; medical illness; cognitive and personality characteristics; cultural context; and child's family, school, and social environment Goals of assessment are to determine the child's emotional, cognitive, social, and linguistic development and to ID the nature of relationships with family, school, and social milieu An understanding of the child's competencies related to the child's stage of development is critical to forming a well-grounded diagnosis Establishing a therapeutic alliance with the child begins during assessment and should move toward a working partnership Playing with or watching the child play with age-appropriate toys or games in an effective way to observe interactions with parents, caregivers, or others Several key areas of assessment merit further discussion Development hx Family hx Stress and trauma hx Strengths of the child Mental status exam Want to observe child from developmental perspective (depression may be confused by shyness) along with social relatedness (observation of personal boundaries and the child's view of the emotional state of others

Name some characteristics of manipulative behavior.

Assume interpersonal relationships are formed to take advantage of others, unaware of lack of relatedness, cannot imagine intimate or sharing relationship, believes in always maintaining control to avoid being controlled

Once a suicidal pt is hospitalized, what nursing interventions would be appropriate for the client?

Assure the client that they will be safe, never leave the client alone if they are actively suicidal, remove dangerous objects from room and pt, make contract with client: will not harm self and will contact staff if thoughts occur

What is the function of the limpic system?

Attention, emotions, flight or fight, memory

What is the most common hallucination?

Auditory

What are interventions used with borderline PD pts?

Avoid manipulation, clear boundaries, maintain nonreactivity, avoid rejection or rescue, assess for suicide, behavioral therapy, SSRIs may help, assess for cutting and self mutulation

Name the personality disorder for: Social inhibitation; withdraw from social and occupational situations that involve significant interpersonal contact; longs for relationships; inadequacy; hypersensitivity to negative criticism, rejection, or shame

Avoidant

Avoidant PD

Avoidant is a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of context Treat with cognitive behavioral desensitization, MAOIs, SSRIs, benzos for pain, friendly and gently approach, antidepressants

Which DSM-IV-TR axis is anxiety on?

Axis 1

What are the DSM-IV-TR 5 axises?

Axis I: clinical disorders, including major mental disorders, as well as developmental and learning disorders Axis II: underlying pervasive or personality conditions, as well as mental retardation Axis III: acute medical conditions and physical disorders Axis IV: psychosocial and environmental factors contributing to the disorder Axis V: global assessment of functioning or childrens global assessment scale for children under 18 (on scale 100 to 0)

A nurse wishing to assess a patient's interpersonal relationships would obtain most data by asking: A. "How would you describe yourself?" B. "Describe your relationship with friends." C. "Do you have any persistent worries?" D. "Tell me about any strange or unusual things that have ever happened to you."

A nursing diagnosis appropriate to consider for a patient with any of the personality disorders is: A. noncompliance. B. impaired social interaction. C. disturbed personal identity. D. disturbed sensory perception.

A patient admitted for treatment of pneumonia has a history of substance abuse. Twenty-four hours after admission he exhibits tremulousness, anorexia, hypertension, and confusion. The nurse analyzes these symptoms as being indicative of: A. acute intoxication. B. delirium tremens. C. alcoholic hallucinations. D. Wernicke-Korsakoff syndrome.

At a meeting for family members of alcoholic individuals, one woman describes trying her best to help her husband keep his job by calling the employer and lying when her husband was too intoxicated to go to work. The nurse assesses this behavior as: A. assertive. B. codependent. C. role reversal. D. homeostasis.

Patient: "I am going to a resturant on my pass." Nurse: "Lets review the special diet required while you are taking this antidepressant." A. Theme identification B. Informing C. Clarification D. Suggesting

Patient: "I dont know what to do. My cat is home and no one is there to feed it." Nurse: "Have you thought about asking a friend to feed your cat?" A. Restating B. Suggesting C. Informing D. Reflecting

Patient: "I need to change my appoitment time again" (said with an expression of dread) Nurse: "I am wondering from your expression if it is difficult for you to do." A. Clarification B. Sharing perception C. Theme identification D. Reflection

Patient: "My mother hates me." Nurse: "Tell me about a time when you thouht your mother hated you." A. Focusing B. Braod opening C. Reflection D. Suggesting

The probable occurrence of withdrawal symptoms in a patient with a history of long-term alcohol abuse is most accurately assessed by determining: A. the blood alcohol level at the time of admission. B. drinking history, quantity consumed, and time of last drink. C. experiences following previous cessation of drinking. D. the kind of alcoholic beverage last consumed.

How should the nurse inquire about hallucinations?

"Do you ever see or hear things?" Do you have strange experiences as you fall asleep or awaken?

What is the definition of depression?

A clinical illness that is severe, maladaptive and incapacitating. It may range from mild to moderate to severe with or without psychotic features. Its characterized by a depressed mood or loss of interest or pleasure in usual activities.

Describe the DSM-IV-TR of OCD.

It is a preoccupation with persistent intrusive thoughts, impulses, or images (obsession), repeative behaviors or mental acts (compulsion) to decrease a dreaded situation, repeated ritualistic behaviors that are based on unrealistic fears, interferes with life activities

Describe the DSM-IV-TR of phobias.

It is an illogical, irrational, intense, persistent fear of a specific object or a social situation, that causes extreme distress and interferes with normal life functioning and a dx is made when the fear alters life

When should you use self disclosure?

It is used for the patient's benefit to model and educate, to foster the therapeutic alliance, to validate reality, to encourage the patient's autonomy.

What does norepinephrine affect?

Mood

What is the difference between mood and affect?

Mood is the pts self-report of the prevailing emotional state and reflects the pts life and situation Affect is the pts apparent emotional tone

What drug classifications are used to treat biopolar disorders?

Mood stabilizers (antimania - lithium, anticonvulsants - VA Depakote, atypical antipsychotics - quetiapine or seroquel, benzos - ativan or valium, and calcium channel blockers - verapamil or calan)

What is the protocol for opiate overdose?

Narcan (Naloxone: opioid antagonist) and maintain airway

What is the DSM-IV-TR for somatization disorder?

Pt must c/o pain in at least 4 different sites or functions, hx of at least 2 GI symptoms other than pain, hx of at least one sexual or reproductice problem, hx of at least one symptom defined as or suggesting a neuological disorder

What is the long-term goal of a pt with somatization?

Pt will express feelings verbally rather han through the development of physical symptoms

What do you focus on with personality disorder pts?

Pts strengths

What is suppression?

Putting memories in the back of the mind (ex: taking a vacation from my problems)

Name some typical antipsychotic 1st generations drugs and what they do.

Block dopamine from receptor sites and work at positive symptoms Hadol (haloperidol) Thorazine (chlorpromazide) Prolixin (fluphenazin) Stealazine (trfluoperzaine) Hadol D and PRolixin D (Decanoate) are long-acting injections

How do typical or 1 generation antipsychotic medications affect neurotransmitters?

Block dopamine from the receptor sites to calm excited behavior and reduce psychotic symptoms

What is psychoneuimmunology?

It explores the interactions between the CNS the endocrine system, and the immune system.

What is genetic testing used for?

To diagnose disease, confirm a diagnosis, provide prognostic info about the course of a disease, confirm the existence of a disease in asymptomatic people, and detect predispositions to the disease in healthy people and their offspring

Why do people cut?

To feel a sense of relief (helps with anxiety relief)

What are the tasks of the introductory or orientation phase?

To find out the reason the patient is in the hospital. Formulate a contract and explore feelings, perceptions, thoughts and actions. Also , define specific goals with the patient

Nicotine

To help cravings, use buproprion (Wellbutrin) or chantix (people are having psychotic breaks on this) Effects similar to cocaine, opiates, and amphetamines

What is the focus of therapy for PD?

To help pts change maladaptive thinking and behavior that result from personality traits, treat any co-morbid conditions, such as depression, anxiety, alcoholism, difficulties in work or personal relationships

What is the highest priority for a suicidal pt?

To protect them from harm

Drugs for EPS

To reduce abnormal involuntary movements For extrapyramidal effects of psychotropics (tremors, rigidity, bradykinesia) These are Cogentin, Artane, Kemadrin, Akineton, Benadryl CAKAB IM Cogentin relives EPS quickly IM Benadryl also used for quick intervention Can used some benzodiazepines Ativan, Inderal, Klonopin, Valium Side effects are anticholinergic effects of dry mouth, constipation, nausea, GI upset, sedation, dizziness, memory impairment, exacerbation of psychosis Can pee, poop, spit

_ is with continued use, more of the substance needed to produce same effect

Tolerance

What is included in insight-oriented therapy?

Underlying feelings must be recognized, expression of feelins occurs, nurse provides feedback, ID and explore pts defenses, teach pt alternative coping skills, be alert to signs of anxiety, self help groups

_ is trying to make up for what is done

Undoing

What space constitutes intimate space?

Up to 18 inches between people

What is patient teaching for hypnotics?

Use caution when driving and using machinery Use cautiously in elderly Can cause nightmares and confusion Some reports of memory loss, night eating, sleep walking

What is the difference between circumstantial and Tangential?

circumstantial (eventually gets back to the subject) and Tangential (never gets back to the subject)

What are opiates used for?

To decrease pain

Name some non-benzodiazepams.

Buspar, Catapres, Inderal (beta-blocker), buspirone, clondine, propronolol

Ego Defense Mechanisms for Eating Disorders

Denial Isolation of affect Intellectualization

Give an example of sharing hope.

"I believe you will find a way to face your situation, because I have seen your courage in the past"

Give an example of sharing empathy.

"It must be very frustrating to know what you want and not be able to do it"

Give an example of focusing.

"On a scale of 0 to 10 tell me the level of pain you are experiencing in your great toe right now."

Give an example of providing information.

"Susie is getting an ECG riht now wish is a test that uses painless sound waves to create a moving picture of her heart structures and valves and should tell us what is causing her murmur."

Give some examples of sharing observations.

"You look tired today" or "I havent seen you eating anything today"

Which of the following would the nurse analyze as indicating improvement in a patient with a diagnosis of high risk for self-mutilation related to feelings of abandonment and impulsivity? A. Patient controls self-destructive impulses when feeling empty or upset. B. Patient vows never to get involved in a close relationship again. C. Patient expresses deep rage at the ending of a relationship. D. Patient suppresses feelings of abandonment.

_ low WBC

Agranulocytosis

_ PD is a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of context

Avoidant PD

What is treatment for sleep disorders?

Benzos like Lorazepam or klonopam; nonbenzos like antihistamine (Benedryl); antidepressant like Desryl;

In the mental status assessment, what is included in the speech assessment?

Flow (normal, rapid, pressured, retarded, mutism), volume (normal, loud, soft, monotone, hostile tone), amount (quantity - reduced or excessive)

Antisocial PD

Antisocial is pervasive pattern of disregard for and violation of the rights of others occurring since age 15 They are a bully, harm animals, person has to be at least 18 to be diagnosed but since 15 of behavior, impulsive and deceitful, think your alive for their own pleasure, irresponsible, lack of remorse/empathy, no insight to know they have hurt or stole from someone, hard to change, AKA sociopath or psychopathic

What does decreased GABA cause?

Anxiety

What is the most common mental illness?

Anxiety disorders

What does increased serotonin cause?

Anxiety or mania

The TCA clomipramine (Anafranil) was _ affect

Anti-obsessional (OCD)

When do you use trazadone (Desyrel) for anxiety pts?

Antianxiety med For insomnia

What are some benzodiazepine meds given for anxiety?

Antianxiety or anxiolytic drugs (theory is GABA is an inhibitory neurotransmitter so when its increased, it decreases tension in muscles and decreases anxiety; its potentiated with alcohol, ect) and sedative hypnotic drugs (work same as antianxiety drugs)

Name some non-benzodiazepines for anxiety.

Antianxiety or anxolytic drugs, sedative hypnotic agents, antihistamines, antidepressants

What med class is thought to decrease kindling and to potentiate GABA?

Anticonvulsants

What type of meds are used with lithium?

Anticonvulsants

What do CNS depressants interact with?

Antidepressants, aspirin, narcotics

Meds Causing Sexual Dysfunction

Antihypertensives Anticholenergics Antihistamines Chemotherapeutic Antidepressants- SSRIs, neuroleptics, benzodiazepines Benzodiazepines - problem is they make your fall asleep Affect GABA (increases to make then feel better) and decreases skeletal tension Antihistamines - drying Beta-blockers and diabetes can contribute to impotence in men and testosterone deficiency can create anorgasmy in women

How do you treat narcolepsy?

Antipsychotics

Name the personality disorder for: Disregard for rights of others, lies; manipulates; exploitative; seductive; repeatedly performs acts that are grounds for arrest

Antisocial

_ PD is a pervasive pattern of disregard for and violation of the rights of thers occuring since age 15

Antisocial

Name four nursing diagnosis.

Anxiety, Ineffective coping, readiness for enhanced coping, fear

Vascular Dementia

Caused by disruptions in the cerebral blood supply, which include: hemorrhage, hypoperfusion (cardiac arrest and hypotension), ischemic stroke, postsurgical complications, vasculitis from autoimmune (lupus) and infectious (neurosyphilis, Lyme) diseases, hypertensive vascular disease, and atherosclerosis. AKA multi-infarct dementia

_ is feeling body functions, such as blood pulsing through the body or food digesting in the stomach

Cenesthetic

Teen Body Image

Chronologic age is not a true guide for physical maturation because growth often occurs in spurts and individual differences exist The greater ones difference from the rest of the group, the greater is the adolescents anxiety The physical changes of puberty cause adolescents to be self-conscious about their changing bodies Exams may intensify masturbatory conflicts, sexual fantasies, and guilt feelings Early and middle phases of puberty also may give to increased conflict, distance, and dissatisfaction in parental relationships

Name some lithiums.

Cibalith-S, Eskalith, lithotab/bid/nate/ane

_ is meaningless rhyming of words "on the right track...have a bi mac...or get in the sack"

Clanging

What type of therapeutic communication technique is: to check whether understanding is accurate, or o better understand, the nurse restates an unclear or ambiguous message to clarify the senders meaning?

Clarifying

Which antipsychotic do you do CBC with WBC check for?

Clorazil

Benzodiazepine Abuse

Detox by tapering off the same classification drug (called detox if drug abused), consider therapeutic discontinuation if treating physical dependence from drug taken as prescribed, may treat high-dose withdrawal by gradually reduction of same classification of drug, may substitute Phenobarbital (IM initially with decreasing dose), monitor for toxicity of benzos (ataxia:difficulty walking, nystagmus:involuntary eyeball movement) Antidote is Ramaxicon (maxicon, mucinone) Withdrawal is same as alcohol (NV, tremors (DT), profuse sweating, anxiety, agitation, hallucinations (tactile, auditory, and visual), extreme HA, fullness of head, disorientation with clouding of sensorium)

What are some things to consider when setting short-term goals for personality disorders?

Develop goals with pts active participation, consider pts ability to tolerate anxiety before setting goals

Choose whether the communication technique is therapeutic or non-therapeutic and select the best technique to correspond with the interaction. A. Giving recognition E. Verbalizing implied feelings I. Giving advice B. Focusing F. Voicing Doubt J. Belittling feelings C. Giving false reassurance G. Exploring K. Reflection D. Giving Broad openings H. Restating L. Rejecting M. Defending Pt: "I feel like such a failure in the eyes of my family." Nurse: "You feel like a failure."

H - restating

What are somatic complaints of depression and anxiety?

HA, GI problems, and pain

What are side effects of SSRIs?

HA, nausea, lethargy, fatigue, insomnia, sexual dysfunction, weight gain, serotonin syndrome; DONT take with MAOIs or St Johns Warts or abruptly stop taking

What are withdrawal symptoms of caffeine?

HA, sleepiness, fatigue, problems with attention, and decreased vigor

Imcompetence

Incompetence is proven in court by all of the following (must be all): person has a mental disorder, disorder causes a defect in judgment, defect makes the person incapable of handling personal affairs If ruled incompetent, this person cannot vote, marry, drive, or make contracts

What is ideas of reference?

Incorrect interpretation of casual incidents and external events as having direct personal references (hear someone laughing and think they are laughing at them)

Social phobia, give what?

Inderal (decreases HR and anxiety right away)

What are common characteristics of PD?

Inflexible and maladaptive response to stress, disability in working and loving, ability to evoke interpersonal conflict, capacity to get under the skins of others, little insight into behavior and dont feel they need to change, unconscious behavior

How do anticonvulsants help with bipolar?

Inhance GABA effect and desensitize the kindling effect of bipolar

Name some atypical antipsychotics second generation and what do they do?

Inhibit dopamine and serotonine so target positive symptoms and negative symptoms Abilify (aripiprazole), clozaril (clozapine) - agranulocytosis, geoson (ziprasidone), invega (palpiteridone), risperdal (risperidone), seroquel (quetiapine), risperdal consta is a long acting injectable

What neurotransmitters does atypical or 2nd generation antipsychotic medications affect?

Inhibits reception of dopamine and serotonin at postsynaptic sites

_ is the belief that thinking something will make it happen like "step on a crack and break your mamas back"

Magical thinking

Describe how MRI works, what it images, and the advantages/disadvantages.

Magnetic resonance imaging (MRI) How it works: A magnetic field surrounding the head induces brain tissues to emit radio waves that are computerized to provide clea and detailed construction of sectional images of the brain What it images: Brain structure; newer functional MRI (fMRI) shows brain activity Advantages/disadvantages: Avoids the use of harmful radiation although MRI can be adapted to use radioactive materials also

Brain Patho with Dementia

Occipital lobe - visual processing changes Frontal lobe - organization of words into fluent speech Parietal lobe - association area for integrating sensory input Temporal lobe - recognition and comprehensive of sensory input; hearing; memory consolidation; association of memory, thought, perception, and emotion Limbic system - emotions, storage of short-term memory, mood

Describe the seasonal affective disorder (SAD).

Occurs in winter and fall. Hypersomnia, lethargy, fatigue, irritability, food carvings with weight gain

Describe the DSM-IV-TR of acute stress disorder.

Occurs one month after exposure to a highly traumatic event with at least 3 of the following: sense of detechment, derealization, depersonalization, dissociateed amnesia, reduced awareness of surroundings

_ eyes fixed in a certain position

Oculogyric crisis

What type of symptoms does first generation antipsychotics meds target?

Positive

What is the target of atypical or 2nd generation antipsychotic medications?

Positive (delusions, hallunications) and negative (loss of affect, speech, pleasure, attention) symptoms of schizophrenia

What are the positive and negative symptoms of schizophrenia?

Positive - exaggerated - delusions, hallucinations, thought disorder, disorganized speech, bizarre behavior, inappropriate affect Negative - flat affect - affective flattenin, alogia, avalition/apathy, angedonia/asociality, attentional deficit

What is the target of typical or 1 generation antipsychotic medications?

Positive symptoms of schizophrenia

Describe how PET works, what it images, and the advantages/disadvantages.

Positron emission tomography (PET) How it works: An injected radioacctive substance travels to the brain and shows up as briht spot on the scan; different substances are taken up by the brain in different amounts, depending on the type of tissue and the level of activity What it images: Brain activity/function Advantages/disadvantages: Allows the injection of labeled drugs for the study of neurotransmiter receptor activity or concentration in the brain

Name and describe the postpartum mood symptom categories.

Postpartum blue: 1-4 days, labile mood and tearfulness with treatment of reassureness and time to resolve this normal response Postpartum depression: 2-12 weeks, treatment with meds and psychotherapy Postpartum psychosis: begins 2-3 days after delivery and lasts a while; pts usually develop bipolar disorder

What are side effects of neuroleptic malignant syndrome?

Potential fata side effect (emergency situation), occurs more with high potency neuroleptics, muscular rigidity, tremors, autonomic hyperactivitym confusion, sweating, tachycardia, renal failure, temp (101-103 but may reach 108)

Dysfunctional grieving and hopelessness in elderly

Prolonged grief and mourning over a real or imagined loss should be recognized and treated as depression Common symptoms are wt loss, appetite loss, fatigue, apathy, loss of interest in friends, family, and usual acitivies and psychomotor retardation All can be treated and are not related to age Coping strategies of elderly widowers include faith, flexibility, participation in activities, and support of family or friends Symptoms of grief can be diagnosed as dementia (falsely) Persons attitude toward aging, dying, and death influences whether the depression can be treated successfully How the elder differ from young - elder integrate attitudes toward death with their religious beliefs, have experiences the death of significant others, by more accepting of death, and approach problems primarily from an internal focus

Describe the CAGE questionaire.

Questions: 1. Have you felt you out to Cut down on your drinking? 2. Have people Annoyed you by criticizing your drinking? 3. Have you felt Guilty about your drinking? 4. (Eye opener) Have you had a drink first thing in the morning to steady your nerves? If you answer Yes to 2, warrants further assessment

What is the antidote for benzodiazepine?

Ramazicon, maxicon, mucinone

In the mental status assessment, what is included in the affect?

Range, duration, intensity, and appropriateness of being sad, angry, fearful, elated, flat/blunted, labile, congruent with speech/behavior, or other

What are some precautions for pts with bipolar I disorder?

Rapid cycling, must protect the pt, POTENTIAL FOR SUICIDE

Key features of anorexia

Rare vomiting or diuretic/laxative abuse More severe weight loss Slightly youngera More introverted Hunger denied Eating behavior may be considered normal and source of esteem Sexually inactive Obsessional and perfectionist features predominate Death from starvation (or suicide, in chronically ill) Amenorrhea Fewer behavioral problems (these increase with level of severity)

Name the four terms that describes speech.

Rate, Volume, amount, characteristics

Name two defense mechanisms used in the following. Statement. "Smoking is not hurting me. I can quit any time I want?" ______________

Rationalization and denial

In the mental status assessment, what is included in the mood?

Scale 0 (sad, fearful) to 10 (elation)

Marijuana can precipitate psychosis with what type of pts?

Schizo pts only

Name the personality disorder for: Social detachment; self-absorbed; restricted emotionality; cold and indifferent; neither desires nor enjoys close relationships; anhedonic, indifferent to others; less distubed than schizotypal

Schizoid

_ PD is a pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning in early adulthood and present in a variety of contects

Schizoid

Schizoid PD

Schizoid is pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning in early adulthood and present in a variety of context Solitary, doesn't like being in close relationships, asexual, cold, detached, very serious, shy, uneasy, work in isolation

When do you usually see auditory hallucinations?

Schizophrenia

When do you usually see flat affect?

Schizophrenia

Name the personality disorder for: Interpersonal deficits; cognitive distortions; eccentricities; paranoid; difficulty feeling understood and accepted; odd beliefs, magical thinking, unusual perceptual experiences; social isolations

Schizotypal

_ PD is a pervasive pattern of social and interpersonal deficits marked by acute discomfort with disorder and reduced capacity for close relationships and by cognitive and perceptual distortions and eccentricities of behavior, beginning in early adulthood and present in a variety of contexts

Schizotypal PD

_ Basing a conclusion on isolated details while ignoring contradictory and more important evidence

Selective abstraction

Name two behaviors that are on the maladaptive end of the continuum?

Self injury and suicide

What is intimacy characterized by?

Sensitivity to the other persons needs

What type of personality development occurs at 18 months to 3 years of age?

Separation-individuation stage of development (seperation includes all experiences, events, and development achievements that promote self-differentiation and a sense of being separate and unique

What are some neurotransmitters associated with bipolar disorders?

Serotonin, norepinephrine, dopamine, and acetylocholine

What is substance dependence?

Severe condition or disease with physical problems and serious disruptions in work, family, social life

_ gender to which one is romantically attracted

Sexual orientation

What do you give a narcolepsy pt?

Stimulants (amphetamines)

How do you treat neuroleptic malignant syndrome?

Stop neuroleptic med and treat with Dantroline and Bromocriptine

How do you treat neuroleptic malignant syndrome from typical or 1 generation antipsychotic medications?

Stop neuroleptic medication and treat with Dantroline and Bromocriptine

How do you promote self-esteem?

Stop poor self-judgements

_ is speaker goes off the subject, can destroy interpersonal communication and never gets back to the points

Tangentiality

How do you detox for benzodiazipines?

Taper off using same classification drug; called detox if drug was abused; consider therapeutic discontinuation if treating physical dependence from drug taken as prescribed; may treat high-dose withdrawal by gradually reducting of same classification of drug, may substitute phenobarbital (IM initially with decreasing dosage); monitor for toxicity of benzos (ataxia; difficulty walking, nystagmus: involuntary eyeball movement)

How do you help with withdrawal of caffeine?

Tapper off of it

What are some coping mechanisms for anxiety?

Task-focused reaction and ego-orientation

What is the seed of personality?

Temperament

Sexual Dysfunction Outcome

The client will obtain the maximum level of adaptive sexual responses to enhance or maintain health

Intimate partner violence nursing assessment

The most prevalent cause of trauma in women treated in ER is abuse by an intimate partner Also common cause of psych pt women Assessment for intimate partner violence should be mandatory in all health care settings, particularly ER, prenatal settings, primary care facilities, and mental health settings If no injuries, best to look for abuse through hx of relationship Can ask how they resolve conflicts Ask if arguments lead to pushing and shoving If abuse is revealed, the nurses first response is critical You can give a statement about the frequency of abuse in the US Can also say their persons very survival is suggestive of strength in the face of adversity Signs of depression, anxiety, low self-esteem, or substance abuse must be evaluated

Who attempts suicide more, women or men?

Women

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