Mental Health Test 2 Mon. 2/27/17
*Mild intellectual development disorder (IDD) <20*
Is capable of developing social skills and independent living, w/ assistance. IQ 50-70.
Autism spectrum disorder (ASD)
Withdrawal of the child into the self and into a fantasy world of his or her own creation.
Theresa is hospitalized following a suicide attempt after breaking up with her boyfriend. Theresa says to the nurse, "When I get out of here, I'm going to try this again, and next time I'll choose a no-fail method." Which is the best response by the nurse? a. "You are safe here. We will make sure nothing happens to you." b. "You're just lucky your roommate came home when she did." c. "What exactly do you plan to do?" d. "I don't understand. You have so much to live for."
c. "What exactly do you plan to do?"
• Anxiety disorders
separation anxiety disorder
• Posttrauma response
was historically know as shell shock, battle fatigue, accident neurosis, or posttraumatic neurosis. A renewed interest about the disorder begin in the 1970's, in response to problems encountered by the Vietnam veterans. The diagnostic category of posttraumnatic stress disorder (PTSD) first appeared in 1980 in the DSM-III.
*values clarification!*
A process of self-discovery by which people identify their personal values and their value rankings. This process increases awareness about why individuals behave in certain ways. - is a process of self-exploration - important in nursing to increase understanding about why certain choices and decisions are made over others and how values affect nursing outcomes
• Amphetamines
A racemic sympathomimetic amine that acts as a central nervous system stimulant. It (and its derivatives, such as methamphetamine and dextroamphetamine) is a commonly abused substance, but has therapeutic use in the treatment of narcolepsy and attention deficit/hyperactivity disorder.
collectivist culture
A type of culture that highly values interdependence among its members.
Improvement after severe depression means the suicide risk is over
FALSE
Once a person is suicidal, he or she is suicidal forever
FALSE
People who talk about suicide don't commit suicide
FALSE
Suicide is an inherited trait
FALSE
Suicide is the act of a psychotic person
FALSE
• *Fetal Alcohol Syndrome*
Prenatal exposure to alcohol can result in a broad range of disorders to the fetus, known as fetal alcohol spectrum disorders (FASDs), the most common of which is fetal alcohol syndrome (FAS). Fetal alcohol syndrome includes physical, mental, behavioral, and/or learning disabilities with lifelong implications. There may be problems with learning, memory, attention span, communication, vision, hearing, or a combination of these (Centers for Disease Control and Prevention [CDC], 2015a). Other FASDs include alcohol-related neurodevelopmental disorder (ARND) and alcohol-related birth defects (ARBD). o *No amount of alcohol during pregnancy is considered safe, and alcohol can damage a fetus at any stage of pregnancy* therefore, drinking alcohol should be avoided by women who are pregnant and by women who could become pregnant. Estimates of the prevalence of FAS range from 0.2 to 1.5 per 1,000 live births (CDC, 2015b). The rate is higher among African Americans and Native Americans (possibly as high as 9 per 1,000 in the latter group) (Dannaway & Mulvihill, 2009). Maier and West (2013) stated: The number of women who engage in heavy alcohol consumption during pregnancy surpasses the total number of children diagnosed with either FAS or ARND, meaning that not every child whose mother drank alcohol during pregnancy develops FAS or ARND. Moreover, the degree to which people with FAS or ARND are impaired differs from person to person. Several factors may contribute to this variation in the consequences of maternal drinking. These factors include, but are not limited to, the following: Maternal drinking pattern Differences in maternal metabolism Differences in genetic susceptibility Timing of the alcohol consumption during pregnancy Variation in the vulnerability of different brain regions o Sadock and colleagues (2015) report that women with alcohol-related disorders have a 35 percent risk of having a child with defects. Children with FAS may have the following characteristics or exhibit the following behaviors (CDC, 2015a): Abnormal facial features: tin upper lip, short nose, skin folds at the corner of the eye, small eye opening, small head circumference, low nasal bridge, small midface, indistinct philtrum (groove b/w nose & upper lip) Small head size Shorter-than-average height Low body weight Poor coordination *Hyperactive behavior* Difficulty paying attention Poor memory Difficulty in school Learning disabilities Speech and language delays Intellectual disability or low IQ Poor reasoning and judgment skills Sleep and sucking problems as a baby Vision or hearing problems Problems with the heart, kidneys, or bones o Neuroimaging of children with FAS shows abnormalities in the size and shape of their brains. The frontal lobes and cerebellum are often smaller than normal, and the corpus callosum and basal ganglia are commonly affected (Dannaway & Mulvihill, 2009). Studies show that children with FAS are often at risk for psychiatric disorders, commonly attention deficit/hyperactivity disorder, mood disorders, anxiety disorders, eating disorders, reactive attachment disorder, and conduct disorder (Coles, 2011; Hoffman, 2006). o Children with FAS require lifelong care and treatment. There is no cure for FAS, but it can be prevented. The Surgeon General's Advisory on Alcohol Use in Pregnancy states: Health professionals should inquire routinely about alcohol consumption by women of childbearing age, inform them of the risks of alcohol consumption during pregnancy, and advise them not to drink alcoholic beverages during pregnancy.
Tourette's disorder
Presence of multiple motor tics and 1 or more vocal tics.
Oppositional defiant disorder (ODD)
Negativism and defiant behavior, including obstinacy, procrastination, disobedience, resistance to change and authority.
*Psychological dependence*
Overwhelming desire to repeat the use of a particular drug to produce pleasure or avoid discomfort.
Most people give clues and warning about their suicidal intentions
TRUE
*free will* (major element of informed consent)
The individual has given consent voluntarily w/o pressure or coercion from others.
Psychiatric, Medical, and Family History (assessment NP for suicidal client)
The individual should be assessed with regard to previous psychiatric treatment for depression, alcoholism, or previous suicide attempts. Medical history should be obtained to determine the presence of chronic, debilitating, or terminal illness. Is there a history of depressive disorder in the family, and has a close relative committed suicide in the past?
*competency* (major element of informed consent)
The individual's cognition is not impaired to an extent that would interfere with decision-making, but if cognition is so impaired, the individual has a legal representative.
territoriality
The innate tendency of individuals to own space. Individuals lay claim to areas around them as their own. This phenomenon can have an influence on interpersonal communication.
*withdrawal*
Withdrawal is the physiological and mental readjustment that accompanies the discontinuation of an addictive substance. The substance-specific syndrome includes clinically-significant physical signs and symptoms as well as psychological changes such as disturbances in thinking, feeling, and behavior.
• esophageal varices
Veins in the esophagus become distended because of excessive pressure from defective blood flow through a cirrhotic liver.
Conduct disorder
Violates the rights of others and societal norms and rules. Displays physical aggression and inability to control anger.
• Adaptive functioning:
refers to the person's ability to adapt to requirements of activities of daily living and the expectations of his or her age and cultural group
Which of the following medications is used to treat Tourette's disorder? a. Methylphenidate (Ritalin) b. Haloperidol (Haldol) c. Imipramine (Tofranil) d. Phenytoin (Dilantin)
b. Haloperidol (Haldol)
other medications
d. There is little positive evidence concerning the use of *antipsychotics* for PTSD. (1) For severe aggression and agitation (2) PTSD pts are NOT psychotic
*symptoms of opioid withdrawal!*
Opioid withdrawal produces a syndrome of symptoms that develops after cessation of or reduction in heavy and prolonged use of an opiate or related substance. Symptoms include dysphoric mood, nausea or vomiting, muscle aches, lacrimation or rhinorrhea, pupillary dilation, piloerection, sweating, *diarrhea*, yawning, fever, and insomnia (APA, 2013). With short-acting drugs such as heroin, withdrawal symptoms occur within 6 to 8 hours after the last dose, peak within 1 to 3 days, and gradually subside over a period of 5 to 10 days (Walton-Moss et al., 2010). With longer-acting drugs such as methadone, withdrawal symptoms begin within 1 to 3 days after the last dose, peak between days 4 and 6, and are complete in 14 to 21 days (Leamon et al., 2008). Withdrawal from the ultra-short-acting meperidine begins quickly, reaches a peak in 8 to 12 hours, and is complete in 4 to 5 day i. Withdrawal symptoms: Craving for the drug, nausea/vomiting, muscle aches, lacrimation or rhinorrhea, pupillary dilation, piloerection or sweating, diarrhea, yawning, fever, insomnia 1. Withdrawal symptoms appear within 6-8 hours after last dose, reach a peak in the 2nd or 3rd day, and subside in 5-10 days. Times are shorter with meperidine and longer with methadone.
Outcome Criteria (NP for suicidal client)
Outcome criteria include short- and long-term goals. Timelines are individually determined. The criteria that follow may be used for measurement of outcomes in the care of the suicidal client. The Client Has experienced no physical harm to self. Sets realistic goals for self. Expresses some optimism and hope for the future.
*Stress*
Perceptions, emotions, anxieties, interpersonal, social, or economic events that are considered threatening to one's physical health, personal safety, or well-being
alcohol effects on the body
Peripheral neuropathy, characterized by: Peripheral nerve damage (usually the *feet*) Pain Burning Tingling Prickly sensations of the extremities Researches believe it is the direct result of deficiencies in the B vitamins, particularly *thiamine*. At low doses, alcohol produces relaxation, loss of inhibitions, lack of concentration, drowsiness, slurred speech, and sleep. Chronic abuse results in multisystem physiological impairments. Describe the effects of alcohol abuse on the body. Peripheral neuropathy results in pain, burning, tingling, or prickly sensations of the extremities. Researchers believe it is the direct result of deficiencies in the B vitamins, particularly thiamine. This is reversible with abstinence from alcohol and restoration of nutritional deficiencies, but permanent muscle wasting and paralysis can occur with continued use.
assimilation
Adopting the behaviors, beliefs, and values of the majority culture by incorporating practices and values of the dominant culture
The following demographics are assessed when evaluating a client for suicide risk:
Age: Adolescents and the elderly have been generally identified as high-risk groups, but recent statistics demonstrating the highest incidence in the 45- to 64-years age group suggests that nurses should pay close attention to assessing for suicide risk in all of these age groups. Gender: Males are at higher risk for successful suicide than females, but females attempt suicide more frequently. Ethnicity/race: The CDC reports highest rates of suicide among Caucasians followed by American Indians Marital status: Single, divorced, and widowed individuals are at higher risk for suicide than are married people. Socioeconomic status: Individuals in the highest and lowest socioeconomic classes are at higher risk than those in the middle classes. *Occupation: Health-care professionals (especially physicians), law enforcement officers, dentists, artists, mechanics, lawyers, and insurance agents have all been identified as occupational groups incurring greater risks for suicide* Method: The lethality of the method identified by an individual with suicide ideation or by one who has already made an attempt provides meaningful information about the client's intent to die. Use of firearms, for example, is considered a highly lethal method. Religion: People with a close religious affiliation may be at less risk for attempting suicide if they believe, for example, that suicide is an unforgivable sin or that within their religious affiliation suicide is strictly forbidden. Conversely, people without close affiliations that impose restrictions about suicide may be at greater risk. Family history: A family history of suicide increases an individual's risk for suicide. Military history: Suicide rates among military personnel now exceed those of the general population
sexual dysfunction
Alcohol can interfere with the normal production and maintenance of female and male hormones. For women, this can mean changes in the menstrual cycles and a decreased or loss of ability to become pregnant. For men, the altered hormone levels result in a diminished libido, decreased sexual performance, impaired fertility, and gynecomastia may develop secondary to testicular atrophy. - In the short term, enhanced libido and failure of erection are common. Long-term effects include gynecomastia, sterility, impotence, and decreased libido.
*Why is it important to have a class on culture in every course of nursing?*
All verbal and nonverbal behavior in connection with another individual is communication. - *Therapeutic communication has always been considered an essential part of the nursing process and represents a critical element in the curricula of most schools of nursing.* - Communication has its roots in culture. Cultural mores, norms, ideas, and customs provide the basis for our way of thinking. - Cultural values are learned and differ from society to society. - Communication is expressed through language (the spoken and written word), paralanguage (the voice quality, intonation, rhythm, and speed of the spoken word), and gestures (touch, facial expression, eye movements, body posture, and physical appearance). - The nurse who is planning care must have an understanding of the client's needs and expectations as they are being communicated. As a third party, an interpreter often complicates matters, but one may be necessary when the client does not speak the same language as the nurse. Interpreting is a very complex process, however, that requires a keen sensitivity to cultural nuances and not just the translating of words into another language. - The nursing process is applied to the delivery of psychiatric mental health nursing care for individuals from the following cultural groups: Northern European Americans, African Americans, American Indian and Alaska Natives, Asian/Pacific Islander Americans, Latino Americans, Arab Americans, and Jewish Americans.
*Name the 3 criteria for committing someone into a mental health facility against their will (Involuntary Commitment)*
Although the term involuntary hospitalization is preferred by some rather than the term involuntary commitment, it must be understood that this process needs to be conducted with respect to state and federal law - bc involuntary hospitalization results in substantial restrictions of the rights of an individual, the admission process is subject to the guarantee of the 14th Amendment to the U.S. Constitution that provides citizens protection against loss of liberty and ensures due process rights - Involuntary hospitalizations are made for various reasons - Most states commonly cite the following criteria: 1. *The person is imminently dangerous to himself or herself (i.e., suicidal intent).* 2. *The person is a danger to others (i.e., aggressive, violent, or homicidal).* 3. *The person is unable to take care of basic personal needs (the "gravely disabled").* - Under the 4th Amendment, individuals are protected from unlawful searches and seizures without probable cause, therefore, the individual recommending involuntary hospitalization must show probable cause for hospitalizing the client against his or her wishes; that is, the person must show that there is cause to believe that the client would be dangerous to self or others, is mentally ill and in need of treatment, or is gravely disabled
*libel* Differentiate b/w malpractice and negligence
An action w/ which an individual may be charged for sharing with another individual, in writing, info that is detrimental to someone's reputation. *writing false & malicious information about a person* - nursing: mental health practitioners—psychiatrists, psychologists, psychiatric nurses, and social workers—have a DUTY to provide appropriate care based on the standards of their professions and the standards set by law - *malpractice & negligence often used interchangeably* - in absence of any state statutes, *common law* is the basis of liability for injuries to clients caused by acts of malpractice and negligence of individual practitioners; MOST decisions of negligence in the professional setting are based on legal PRECEDENT (decisions that have previously been made about similar cases) rather than any specific action taken by the legislature [basically it wasn't on purpose, whoever committed the crime just needs to get up to date] - when it is brought forth as *negligence*: action is contrasted w/ what a reasonably prudent professional would have done in the same or similar circumstances - when the breach of duty is characterized as *malpractice*: the action is weighed AGAINST the professional standard
slander
An action with which an individual may be charged for ORALLY sharing information that is detrimental to a person's reputation. *Verbalizing false and malicious information about a person*
• Phencyclidine
An anesthetic used in veterinary medicine; used illegally as a hallucinogen, referred to as PCP or angel dust. • *substitution therapy* - The use of various medications to decrease the intensity of symptoms in an individual who is withdrawing from, or experiencing the effects of excessive use of, substances. o Various medications have been used to decrease the intensity of symptoms in an individual who is withdrawing from, or who is experiencing the effects of excessive use of, alcohol and other drugs. Substitution therapy may be required to reduce the life-threatening effects of intoxication or withdrawal from some substances. The severity of the withdrawal syndrome depends on the particular drug used, how long it has been used, the dose used, and the rate at which the drug is eliminated from the body.
*justice!* (aka "justice as fairness" or distributive justice)
An ethical principle reflecting that all individuals should be treated *equally and fairly* - its basic premise lies with the right of individuals to be treated equally regardless of race, sex, marital status, medical diagnosis, social standing, economic level, or religious belief - this principle suggests that all resources w/i the society (including health-care services) ought to be distributed evenly *w/o* respect to socioeconomic status - the vast disparity in the quality of care dispensed to the various classes within our society would be considered *unjust*... a more equitable distribution of care for all individuals would be favored!
*veracity!* discuss
An ethical principle that refers to one's duty to always be truthful. - "Veracity requires that the health care provider tell the truth and NOT intentionally deceive or mislead clients" - there are times when limitations must be placed on this principle, such as when the truth would knowingly produce harm or interfere with the recovery process - Being honest is not always easy, but rarely is lying justified - *clients have the right to know about their diagnosis, treatment, and prognosis*
*ethical egoism (!!!)*
An ethical theory espousing that what is "right" and "good" is what is best for the individual making the decision. - *An ethical theory that espouses making decisions based on what is most advantageous for the person making the decision* - An individual's actions are determined by what is to his or her own advantage - The action may not be best for anyone else involved, but consideration is only for the individual making the decision.
• Codependency
An exaggerated dependent pattern of learned behaviors, beliefs, and feelings that make life painful. It is a dependence on people and things outside the self, along with neglect of the self to the point of having little self-identity.
• Trauma
An extremely distressing experience that causes severe emotional shock and may have long-lasting psychological effects.
defamation of character
An individual may be liable for defamation of character by sharing with others information about a person that is detrimental to that person's reputation.
*Gamblers Anonymous (GA)*
An organization of inspirational group therapy, modeled after Alcoholics Anonymous (AA), for individuals who desire to, but cannot, stop gambling. o Possibly the most effective treatment of pathological gambling is participation by the individual in Gamblers Anonymous (GA). This organization of inspirational group therapy is modeled after Alcoholics Anonymous.
*the right to treatment* (ethical issues relevant to psychiatric mental health nursing)
Anyone who is admitted to a hospital has this right - example: a psychiatric pt cannot legally be hospitalized and then denied appropriate treatment - AHA although not having the authority of law, has also identified the rights of any hospitalized pt - AHA patient bill of rights was historically written with an emphasis on protecting the patient from a breach of reasonable standards while hospitalized - These rights were revised in 2003 to create an emphasis on the importance of the collaborative relationship b/w the client and the hospital health-care team - "The Patient Care Partnership": this brochure informs patients that they have a right to high-quality care while hospitalized, to a clean and safe environment, to be involved in their care, to have their privacy protected, to get help when leaving the hospital, and to get help with their billing claims - *nurses practicing in hospital settings need to be aware and adhere to legal statutes, accepted standards of practice, and organizational policies with regard to a client's rights during hospital treatment*
Application of the Nursing Process to Conduct Disorder
Background Assessment Data (Symptomatology) a. Physical aggression in the violation of the rights of others b. Use of drugs and alcohol c. Sexual permissiveness d. *Lack of feelings of guilt or remorse* e. Use of projection as a defense mechanism f. Low self-esteem manifested by "tough-guy" image g. Inability to control anger h. Low academic achievement i. Problems with inattentiveness, impulsiveness, and hyperactivity 2. Diagnosis/outcome identification a. *risk for other-directed violence* related to characteristics of temperament, peer rejection, negative parental role models, dysfunctional family dynamics i. *The nurse must recognize escalating aggressive behavior and intervene before violence occurs* b. Impaired social interaction related to negative parental role models, impaired peer relations leading to inappropriate social behaviors 3. Nursing intervention is aimed at protection of others from client's physical aggression; improvement in social interaction and self-esteem; and acceptance of responsibility for own behavior
*treatment modalities for gambling disorder*
Because most pathological gamblers deny that they have a problem, treatment is difficult. In fact, most gamblers only seek treatment due to legal difficulties, family pressures, or other psychiatric complaints. Behavior therapy, cognitive therapy, and psychoanalysis have been used with pathological gambling with various degrees of success - Some medications have been used with effective results in the treatment of pathological gambling. The *SSRIs (primarily Zoloft)* and clomipramine have been used successfully in the treatment of pathological gambling as a form of obsessive-compulsive disorder (Moreyra et al., 2000). *Lithium*, carbamazepine, and naltrexone have also been shown to be effective.
*Moderate IDD*
Capable of academic skill to 2nd grade level IQ 35-49.
*Oppositional defiant disorder (ODD)*
Characterized by a pattern of negativistic, defiant, disobedient, and hostile behavior toward authority figures that occurs more frequently than is typically observed in individuals of comparable age and developmental level, and interferes with social, academic, or occupational functioning. o *is characterized by a persistent pattern of ANGRY mood and defiant behavior that occurs more frequently than is usually observed in individuals of comparable age and developmental level and interferes with social, educational, or vocational activities* o For example, these patients have a history of arguing with authority figures for > 6 months. o Usually these children do *NOT* see themselves as being oppositional, but view the problem as arising from other people they believe are making unreasonable demands on them
TABLE 14-7 Psychoactive Substances: A Profile Summary *Alcohol*
Class of Drugs: CNS Depressants Alcohol SYMPTOMS OF USE: Relaxation, loss of inhibitions, lack of concentration, drowsiness, slurred speech, sleep THERAPEUTIC USES: Antidote for methanol consumption; ingredient in many pharmacological concentrates SYMPTOMS OF OVERDOSE: Nausea, vomiting; shallow respirations; cold, clammy skin; weak, rapid pulse; coma; possible death TRADE NAMES: Ethyl alcohol, beer, gin, rum, vodka, bourbon, whiskey, liqueurs, wine, brandy, sherry, champagne COMMON STREET NAMES: Booze, alcohol, liquor, drinks, cocktails, highballs, nightcaps, moonshine, white lightening, firewater
*moral behavior!!*
Conduct that results from serious critical thinking about how individuals ought to treat others; reflects respect for human life, freedom, justice, or confidentiality - reflects the way a person interprets basic respect for other persons, such as the respect for autonomy, freedom, justice, honesty, and confidentiality
*treating codependence*
Discuss the four stages in the recovery process for individuals with codependent personality. Stage I: The Survival Stage. In this stage, codependent persons must begin to let go of the denial that problems exist. This initiation of abstinence from blanket denial may be a very emotional and painful period. Stage II: The Reidentification Stage. Reidentification occurs when the individuals are able to glimpse their true selves through a break in the denial system. They accept the label of codependent and take responsibility for their own dysfunctional behavior. They accept their limitations and are ready to face the issues of codependence. Stage III: The Core Issues Stage. In this stage, the recovering codependent must face the fact that relationships cannot be managed by force of will. Each partner must be independent and autonomous. The goal of this stage is to detach from the struggles of life that exist because of prideful and willful efforts to control those things that are beyond the individual's power to control. Stage IV: The Reintegration Stage. This is a stage of self-acceptance and willingness to change when codependents relinquish the power over others that was not rightfully theirs but reclaim the personal power that they do possess.
Interpersonal Support System (assessment NP for suicidal client)
Does the individual have support persons on whom he or she can rely during a crisis situation? Lack of a meaningful network of satisfactory relationships may implicate an individual as a high risk for suicide during an emotional crisis.
Sociological Theories Predisposing Factors: Theories of Suicide
Durkheim (1951) studied the individual's interaction with the society in which he or she lived. He believed that the more cohesive the society and the more that the individual felt an integrated part of society, the less likely he or she was to commit suicide. Durkheim described three social categories of suicide: 1. egotistic suicide 2. altruistic suicide 3. anomic suicide
alcoholic cardiomyopathy
Effect of alcohol on the heart is an accumulation of lipids in the myocardial cells, resulting in enlargement and a weakened condition. Treatment is total permanent abstinence from alcohol. - generally relates to congestive heart failure or arrhythmia. Symptoms include decreased exercise tolerance, tachycardia, dyspnea, edema, palpitations, and nonproductive cough. Changes may be observed by electrocardiogram, and congestive heart failure may be evident on chest x-ray films. Treatment is total permanent abstinence from alcohol. Treatment of the congestive heart failure may include rest, oxygen, digitalization, sodium restriction, and diuretics. The death rate is high for individuals with advanced symptomatology.
*Attention Deficit/Hyperactivity Disorder (ADHD)*
Essential features include developmentally inappropriate degrees of inattention, impulsiveness, and hyperactivity - C. Predisposing Factors 1. Biological Influences *(5% of children 4-17 have ADHD)* a. Genetics, Frequency among family members has been noted. c. Prenatal, Perinatal, and Postnatal Factors (1) Prenatal factors include maternal smoking and alcohol intake during pregnancy (2) Perinatal factors include *prematurity*, signs of fetal distress, prolonged labor, and perinatal asphyxia, *low birth weight* (3) Postnatal factors include cerebral palsy, seizures, and CNS trauma or infections
*Nursing process: evaluation*
Evaluation involves reassessment to determine whether the nursing interventions have been effective in achieving the intended goals of care. Is the client still in denial? Has a correlation been made between personal problems and the use of substances? Does the client still make excuses or blame others for use of substances? Does the client accept responsibility for his or her own behavior?
Evaluation
Evaluation of the suicidal client is an ongoing process accomplished through continuous reassessment of the client as well as determination of goal achievement. Once the immediate crisis has been resolved, extended psychotherapy may be indicated. The long-term goals of individual or group psychotherapy for the suicidal client would be for him or her to *Develop and maintain a more positive self-concept.* Learn more effective ways to express feelings to others. Achieve successful interpersonal relationships. Feel accepted by others and achieve a sense of belonging. A suicidal person feels worthless and hopeless. These goals serve to instill a sense of self-worth while offering a measure of hope and a meaning for living.
• Ascites
Excessive accumulation of serous fluid in the abdominal cavity, occurring in response to portal hypertension caused by cirrhosis of the liver.
• Hyperactivity
Excessive psychomotor activity that may be purposeful or aimless, accompanied by physical movements and verbal utterances that are usually more rapid than normal. Inattention and distractibility are common with hyperactive behavior.
If a person has attempted suicide, they are not likely to do it again
FALSE
meaning and purpose in life (spiritual need)
Having a purpose in life gives one a sense of control and the feeling that life is worth living. Each nurse's exploration of their own spirituality and efforts to grow spiritually are foundational to being responsive to those needs in others.
religion risk factor for suicide
Historically, suicide rates among Protestants and Jews have been higher than among Roman Catholic or Muslim populations, but the degree of orthodoxy and affiliation with one's religion may be an important variable - men and women who consider themselves affiliated with a religion are less likely than their nonreligious counterparts to attempt suicide - *religious affiliation is associated with decreased suicide attempts in both the general population and in those with a mental illness, independent of the availability of social support systems*
*statutory law* (types of law)
*A law that has been enacted by legislative bodies*, such as: a county or city council state legislature U.S. Congress - example: nurse practice acts
curandero/a
*A male folk healer in the Latino culture* *a folk healer in the latino american culture*
Dynamics of Substance-Related Disorders
*Alcohol exerts a depressant effect on the CNS, resulting in behavioral and mood changes.* *The effects of alcohol on the CNS are proportional to the alcohol concentration in the blood.* Alcohol has the potential for abuse. Jellinek outlined 4 phases through which an alcoholic's pattern of drinking progresses.
Classes of Psychoactive Substances
*Alcohol* Caffeine *Cannabis* Hallucinogens Inhalants *Opioids* *Sedatives/hypnotics* *Stimulants* Tobacco
*assault* What charges may be brought against a nurse for confining a patient against their will?
*An act that results in a person's genuine fear and apprehension that he or she will be touched w/o consent* - Nurses may be *guilty of assault* for threatening to place an individual in restraints against his or her will. - Battery is the unconsented touching of another person. - These charges can result when a treatment is administered to a client against his or her wishes and outside of an emergency situation. - Harm or injury need not have occurred for these charges to be legitimate. - For confining a client against his or her wishes, and outside of an emergency situation, the nurse may be *charged with false imprisonment* - Examples of actions that may invoke these charges include: 1. locking an individual in a room 2. taking a client's clothes for purposes of detainment against his or her will 3. retaining in mechanical restraints a competent, voluntary client who demands to be released
*beneficence* discuss
*An ethical principle that refers to one's duty to benefit or promote the good of others* - Health-care workers who act in their clients' interests are beneficent, provided their actions really do serve the client's best interest. In fact, some duties seem to take preference over other duties - For example, the duty to respect the autonomy of an individual may be overridden when that individual has been deemed harmful to self or others - "The difficulty that sometimes arises in implementing the principle of beneficence lies in determining what exactly is good for another and who can best make that decision"
*personality factor psychological factor*
*Certain personality traits have been associated with an increased tendency toward addictive behavior. Some clinicians believe that low self-esteem, frequent depression, passivity, antisocial personality traits, the inability to relax or to defer gratification, and the inability to communicate effectively are common in individuals who abuse substances.* These personality characteristics cannot be called predictive of addictive behavior, yet for reasons not completely understood, they have been found to accompany addiction in many instances. In some cases, the substance user may be self-medicating to treat symptoms of depression or anxiety.
*Tay-Sachs disease*
*Fatal* hereditary disease occurring chiefly in infants and children, esp of eastern European Jewish origin, Characterized by a red spot on the retina, gradual blindness, and paralysis
Suicidal ideas or acts: ask the following questions (assessment NP for suicidal client)
*How serious is the client's intent to commit suicide? Does the person have a plan? If so, does he or she have the means? How lethal are the means? Has the individual ever attempted suicide before?* These are all questions that must be asked by the person conducting the suicidal client assessment. Individuals may provide both *behavioral and verbal clues* as to the intent of their act. Examples of behavioral clues that may indicate a decision to carry out the intent include giving away prized possessions, getting financial affairs in order, writing suicide notes, and sudden lifts in mood. Verbal clues may be both direct and indirect. Examples of direct statements include "I want to die" or "I'm going to kill myself." Examples of indirect statements include "This is the last time you'll see me," "I won't be around much longer for the doctor to have to worry about," or "I don't have anything worth living for anymore." Other assessments include determining whether the individual has a plan, and if so, whether he or she has the means to carry out that plan. If the person states the suicide will be carried out with a gun, does he or she have access to a gun? Bullets? If pills are planned, what kind of pills? Are they accessible?
socioeconomic status risk factor for suicide
*Individuals in the very highest and lowest social classes have higher suicide rates than those in the middle classes* - With regard to occupation, suicide rates are higher among physicians, artists, dentists, law enforcement officers, lawyers, and insurance agents - There are more suicides among the *unemployed* than among the employed, and suicide rates increase during economic recessions and depressions.
*cognitive factor psychological factor*
*Irrational thinking patterns have long been identified as a problem that is central in addictions.* Whether these thought patterns contribute to the development or simply perpetuate an existing addiction is an unanswered question, but their influence is widely accepted. Twerski (1997) describes these thought patterns as "addictive thinking" and suggests that when these thought patterns are unchallenged, they may culminate in additional addictions (drugs, sex, gambling, etc.) even when a person stops using the drug to which he or she first became addicted. Some examples of irrational thinking patterns often associated with addiction include denial ("I'm not really addicted"), projection ("It's my wife's fault that I take drugs"), and rationalization ("I have to take drugs because I am in pain"). Exploring these thought patterns and their influence on problematic behavior, which is the basis of cognitive behavior therapy (CBT), has been identified as beneficial in addictions treatment (NIDA, 2012).
*common law* (types of law)
*Law that is derived from decisions made in previous cases* - these laws apply to a body of principles that evolve from court decisions resolving various controversies - Because common law in the United States has been developed on a state basis, the law on specific subjects may differ from state to state - An example of a common law might be how different states deal with a nurse's refusal to provide care for a specific client.
*civil law* (type of unlawful acts)
*Law that protects the private and property rights of individuals and businesses* - Private individuals or groups may bring a legal action to court for breach of civil law. - These legal actions are of two basic types: torts and contracts.
*Arab Americans*
*Mental illness is a major social stigma* - Psychiatric symptoms may be denied or attributed to "bad nerves" or evil spirits - When individuals suffering from mental distress seek medical care, they are likely to present with a variety of vague complaints such as abdominal pain, lassitude, anorexia, SOB - Clients often expect and may insist on somatic treatment, at least vitamins and tonics. - When mental illness is accepted as a diagnosis, treatment with medications, rather than counseling, is preferred. Ancestry and traditions are traced to the nomadic desert tribes of the Arabian Peninsula. Arabic is the official language of the Arab world. Conversants stand close together, maintain steady eye contact, and touch (only between members of the same gender) the other's hand or shoulder. Speech is loud and expressive, with lots of gesturing. Time is present-oriented, and punctuality is not taken seriously except in the case of business or professional meetings. The man is the head of the household and women are subordinate to men. *The family is the primary social organization, and children are loved and indulged.* Women value modesty and many observe the custom of hijab—covering the body except for one's face and hands. *Cardiovascular disease is a common health concern.* *Sickle cell anemia and the thalassemias are prevalent in the eastern Mediterranean.* Many spices and herbs are used in cooking. Bread is served at every meal and is viewed as a gift from God. Lamb and chicken are the most popular meats. *Muslims are prohibited from eating pork and pork products.* Islam is the religion of most Arab countries and there is no separation of church and state. Spiritual medicine is combined with conventional medical treatment. *Mental illness is a major social stigma and symptoms are likely to be presented as physical complaints!*
Jellinek (1952) outlined four phases through which the alcoholic's pattern of drinking progresses. Some variability among individuals is to be expected within this model of progression.
*Phase I. Prealcoholic Phase* This phase is characterized by the use of alcohol to relieve the everyday stress and tensions of life. As a child, the individual may have observed parents or other adults drinking alcohol and enjoying the effects. The child learns that use of alcohol is an acceptable method of coping with stress. Tolerance develops, and the amount required to achieve the desired effect increases steadily. Phase II. Early Alcoholic Phase This phase begins with blackouts—brief periods of amnesia that occur during or immediately following a period of drinking. Now the alcohol is no longer a source of pleasure or relief for the individual but rather a drug that is required by the individual. Common behaviors include sneaking drinks or secret drinking, preoccupation with drinking and maintaining the supply of alcohol, rapid gulping of drinks, and further blackouts. The individual feels enormous guilt and becomes very defensive about his or her drinking. Excessive use of denial and rationalization is evident. Phase III. Crucial Phase In this phase, the individual has lost control, and *physiological addiction is clearly evident*. This loss of control has been described as the inability to choose whether or not to drink. *Binge drinking*, lasting from a few hours to several weeks, is common. These episodes are characterized by sickness, loss of consciousness, squalor, and degradation. In this phase, the individual is extremely ill. Anger and aggression are common manifestations. Drinking is the total focus, and he or she is willing to risk losing everything that was once important, in an effort to maintain the addiction. By this phase of the illness, it is not uncommon for the individual to have experienced the loss of job, marriage, family, friends, and most especially, self-respect. Phase IV. Chronic Phase This phase is characterized by emotional and physical disintegration. The individual is usually intoxicated more than he or she is sober. Emotional disintegration is evidenced by profound helplessness and self-pity. Impairment in reality testing may result in psychosis. Life-threatening physical manifestations may be evident in virtually every system of the body. Unmanaged withdrawal from alcohol results in a terrifying syndrome of symptoms that include hallucinations, tremors, convulsions, severe agitation, and panic. Depression and ideas of suicide are not uncommon. For long-term, heavy drinkers, abrupt withdrawal of alcohol can be fatal.
age risk factor for suicide
*Suicide risk and age are, in general, positively correlated, particularly with men* - Although rates among women remain fairly constant throughout life, rates among men show a higher age correlation - the highest rate of suicide occurred in the 45- to 64-year-old age group (with men at particular risk), and the 2nd-highest rate was for those 85 or older - A consistent high rate of suicide in both age groups was shown for the period 2000-2013, but the 45-64 age group showed a steady incline in suicide rates over the same period - Although adolescents may statistically have a lower rate of suicide than some other age groups, it is still important to note that it has been, over several years, the 3rd-leading cause of death in this population, and in 2013 it jumped to the second-leading cause of death - Several factors put adolescents at risk for suicide, including impulsive and high-risk behaviors, untreated mood disorders (e.g., major depression and bipolar disorder), access to lethal means (e.g., firearms), and substance abuse. The latest statistics from the Centers for Disease Control and Prevention (CDC) indicate that the most common method of completed suicide for adolescent males is by firearm; for adolescent females, it is suffocation Among children under 10 years of age, the statistics demonstrate a low number of suicides, and some have argued that younger children do not have the capacity to intentionally consider and follow through with a suicide attempt. Anecdotal evidence has shown this is not always the case, with some therapists identifying 5- to 9-year-olds actively talking about suicide. Further research is needed in this area. Although the elderly make up just over 13 percent of the population, they account for almost 15 percent of all suicides. In general, 70 percent of all suicides are among white males, but *white males over the age of 80 are at the greatest risk of all age, gender, and race groups* - *almost 84% of elderly suicides are male, which is about 5 times greater than for females, and firearms are the most common means of committing suicide* - The overall rate of suicide for females declines after age 65
*shaman*
*The Native American "medicine man" or folk healer.* - Religion and health practices are intertwined in the AI/AN culture. - The medicine man (or woman) may use a variety of methods in his or her practice. Some use crystals to diagnose illness, some sing and perform healing ceremonies, and some use herbs and other plants or roots to create remedies with healing properties. The AI/AN healers and U.S. Indian Health Service have worked together with mutual respect for many years. a AI/AN healer may confer with a physician regarding the care of a client in the hospital. Research studies have continued to show the importance of each of these health-care approaches in the overall wellness of AI/AN people.
*false imprisonment* What charges may be brought against a nurse for confining a patient against their will?
*The deliberate and unauthorized confinement of a person w/i fixed limits by the use of threat or force* - A nurse may be charged with this for placing a patient in restraints against his or her will in a non-emergency situation. - Health-care workers may be charged with this for restraining or secluding—against the wishes of the client—anyone having been admitted to the hospital voluntarily. - Should a voluntarily admitted client decompensate to a point that restraint or seclusion for protection of self or others is necessary, court intervention to determine competency and involuntary commitment is required to preserve the client's rights to privacy and freedom.
*utilitarianism!* "the greatest-happiness principle"
*The ethical theory that espouses the greatest happiness for the greatest number*. Under this theory, action would be taken based on the end results that will produce the *most* good (happiness) for the most people. - holds that actions are right to the degree that they tend to promote happiness and wrong as they tend to produce the reverse of happiness - the good is happiness and the right is that which promotes the good - the wrongness of an action is determined by its tendency to bring about unhappiness - an ethical decision based on the this view looks at the end results of the decision - action is taken on the basis of the end results that produced the MOST good (happiness) for the MOST people
*torts* (civil law)
*The violation of a civil law in which an individual has been wronged.* In this action, 1 party asserts that wrongful conduct on the part of the other has caused harm, and compensation for harm suffered is sought - may be intentional or unintentional - examples of unintentional: malpractice and negligence actions - an example of intentional: the touching of another person w/o that person's consent & intentional touching (e.g., a medical treatment) without the client's consent can result in a charge of battery
*yin and yang*
*a concept of folk medicine beliefs in the asian american culture* - The fundamental concept of Asian health practices. - Yin and yang are opposite forces of energy, such as negative/positive, dark/light, cold/hot, hard/soft, and feminine/masculine. - Food, medicines, and herbs are classified according to their yin and yang properties and are used to restore a balance, thereby restoring health. - Restoring the balance of yin and yang is the fundamental concept of Asian health practices. - The belief is that illness occurs when there is a disruption in the balance of these energy forces - In medicine, the opposites are expressed as "hot" and "cold," and health is the result of a balance between hot and cold elements - Food, medicines, and herbs are classified according to their hot and cold properties and are used to restore balance between yin and yang (cold and hot), thereby restoring health.
*Which value of the Northern European American culture should a nursing instructor include when teaching about cultural diversity? TEST* a. Northern European Americans are present oriented. b. Northern European Americans are highly religious and church attendance is critical. c. Northern European Americans value punctuality and efficiency. d. Northern European Americans emphasize family cohesiveness due to increased technology.
*c. Northern European Americans value punctuality and efficiency.* Punctuality and efficiency are highly valued in Northern European American culture.
*Malpractice and negligence are examples of what kind of law?*
*common law*
Withdrawal from nicotine results in
*dysphoric or depressed mood*; insomnia; irritability, frustration, or anger; anxiety; difficulty concentrating; restlessness; decreased heart rate; and increased appetite or weight gain
*Which ethical theory espouses that what is right and good is what is best for the individual making the decision?*
*ethical egoism*
*suicide*
*is not a diagnosis or a disorder; it is a behavior* - specifically, it is the act of taking one's own life, and it derives from the Latin words for "one's own killing." - *More than 90% of all persons who commit or attempt suicide have a diagnosed mental disorder* - More than 41,000 people committed suicide in 2013, this is the highest rate of suicide in 15 years - suicide is the 2nd-leading cause of death (behind unintentional injuries) among young Americans ages 15-34 years - the 4th-leading cause of death for ages 35 to 44 - the 5th-leading cause of death for individuals age 45 to 64 - the 10th-leading cause of death overall - *Many more people attempt suicide than succeed (about 12:1), and countless others seriously contemplate the act without carrying it out* - With a steady incline in rates of suicide over the 12-year period from 2000 to 2013, suicide has become a major health-care problem in the US today - Reports of dramatic rises in suicide rates among military personnel since 2008 have led to greater public awareness and concern - Historically, the suicide rate has been lower among military personnel than among the general population. - However, in some time periods since the Iraq War began—including in 2010 and 2011—MORE soldiers died by suicide than died in combat
*individual psychotherapy!!!*
*most common treatment for Adjustment Disorders* a. Individual psychotherapy is the most common treatment for adjustment disorder. Individual psychotherapy allows the client to examine the stressor that is causing the problem, possibly assign personal meaning to the stressor, and confront unresolved issues that may be exacerbating this crisis. Treatment works to remove these blocks to adaptation so that normal developmental progression can resume. Techniques are used to clarify links between the current stressor and past experiences and to assist with the development of more adaptive coping strategies.
social organization
*the major groups in which an individual becomes acculturated*
ethnicity risk factor for suicide
*whites are at highest risk for suicide, followed by Native Americans, African Americans, Hispanic Americans, and Asian Americans* - Recent research has highlighted 2 trends that illuminate issues of concern within specific ethnic groups. First, although suicide rates among whites are higher in adults and the elderly, within the American Indian community, young adults have a higher risk for suicide than does any other ethnic group, and the rate is higher than for the general population (Almendrala, 2015). Almendrala relays the story of a psychiatrist called to a reservation where there had been 17 suicides in the previous 8 months, and the community members described themselves as "grieved out." The second trend of concern, as Almendrala reports, is that the rates of suicide may be underestimated in this population because death certificates do not always report accurately regarding ethnicity. Another recent study looked at suicide trends among school-aged children under the age of 12 (Bridge et al., 2015). A significant finding was that suicide rates for black children 5 to 11 years of age nearly doubled over the period from 1993 to 2012, while the overall suicide rate in this age-group remained relatively stable during the same time period. The use of hanging and/or suffocation as a means of taking one's own life also significantly increased in this population. It is hard to imagine what causes children so young to take their own lives. The contributing factors to these recent trends are not well understood and will require further research, including a review of the impact of health-care disparities for select communities or populations
*Identify behaviors relevant to the psychiatric mental health setting for which specific malpractice action could be taken.* Types of Lawsuits That Occur in Psychiatric Nursing
- *most malpractice suits against nurses are civil actions: they are considered breach of conduct actions on the part of the professional, for which compensation is being sought, the nurse in the psychiatric setting should be aware of the types of behaviors that may result in charges of malpractice* - Basic to the psychiatric client's hospitalization is his or her right to confidentiality and privacy. - A nurse may be charged with breach of confidentiality for revealing aspects about a client's case, or even for revealing that an individual has been hospitalized, if that person can show that making this information known resulted in harm - when shared information is detrimental to the client's reputation, the person sharing the information may be liable for defamation of character - when the information is in writing, the action is called libel - oral defamation is called slander - defamation of character involves communication that is malicious and false - occasionally, libel arises out of critical, judgmental statements written in the client's medical record - *Nurses need to be very objective in their charting, backing up all statements with factual evidence* - invasion of privacy is a charge that may result when a client is searched without probable cause - many institutions conduct body searches on clients with mental illness as a routine intervention, in these cases, there should be a physician's order and written rationale showing probable cause for the intervention, many institutions are reexamining their policies regarding this procedure. - assault is an act that results in a person's genuine fear and apprehension that he or she will be touched without consent & battery is the unconsented touching of another person, these charges can result when a treatment is administered to a client against his or her wishes and outside of an emergency situation, harm or injury need not have occurred for these charges to be legitimate. - For confining a client against his or her wishes, and outside of an emergency situation, the nurse may be charged with false imprisonment, examples of actions that may invoke these charges include locking an individual in a room; taking a client's clothes for purposes of detainment against his or her will; and retaining in mechanical restraints a competent, voluntary client who demands to be released. - it is a positive practice to develop and maintain a good interpersonal relationship with the client and his or her family. - Some clients appear to be more "suit prone" than others, Suit-prone clients are often very critical, complaining, uncooperative, and even hostile, A natural response by the staff to these clients is to become defensive or withdrawn, Either of these behaviors increases the likelihood of a lawsuit should an unfavorable event occur - No matter how high the degree of technical competence and skill of the nurse, his or her insensitivity to a client's complaints and failure to meet the client's emotional needs often influence whether or not a lawsuit is generated - *A great deal depends on the psychosocial skills of the health-care professional.*
*TABLE 12-1 Facts About Suicide*
- 8/10 people who kill themselves have given definite clues and warnings about their suicidal intentions. Very subtle clues may be ignored or disregarded by others. NOT People who talk about suicide do not commit suicide. Suicide happens without warning. - Most suicidal people are very ambivalent about their feelings regarding living or dying. Most are "gambling with death" and see it as a cry for someone to save them. NOT You cannot stop a suicidal person. He or she is fully intent on dying. - People who want to kill themselves are suicidal for only a limited time. If they are saved from feelings of self-destruction, they can go on to lead normal lives. However, the number of attempts a person has made may have an impact on the chronicity of suicidal ideation. NOT Once a person is suicidal, he or she is suicidal forever. - Most suicides occur within about 3 months after the beginning of "improvement," when the individual has the energy to carry out suicidal intentions. NOT Improvement after severe depression means that the suicidal risk is over. - Suicide is not inherited. It is an individual matter and can be prevented. However, suicide by a close family member increases an individual's risk factor for suicide. Some studies suggest a genetic predisposition for depression, but more research is needed to identify those specific links to suicidal thoughts and behaviors. NOT Suicide is inherited, or "runs in families." - Although suicidal persons are extremely unhappy, they are not necessarily psychotic. They are merely unable at that point in time to see an alternative solution to what they consider an unbearable problem. NOT All suicidal individuals are mentally ill, and suicide is the act of a psychotic person. - All suicidal behavior must be approached with the gravity of the potential act in mind. Attention should be given to the possibility that the individual is issuing a cry for help. NOT Suicidal threats and gestures should be considered manipulative or attention-seeking behavior and should not be taken seriously. - Gunshot wounds are the leading cause of death among suicide victims. NOT People usually commit suicide by taking an overdose of drugs. - Between 50%-80% of all people who ultimately kill themselves have a history of a previous attempt. NOT If an individual has attempted suicide, he or she will not do it again.
• Opioids
- A group of compounds that includes opium, opium derivatives, and synthetic substitutes. • peer assistance programs- A program established by the American Nurses' Association to assist impaired nurses. The individuals who administer these efforts are nurse members of the state associations as well as nurses who are in recovery themselves. o In 1982, the American Nurses Association (ANA) House of Delegates adopted a national resolution to provide assistance to impaired nurses. Since that time, the majority of state nurses' associations have developed (or are developing) programs for nurses who are impaired by substances or psychiatric illness. The individuals who administer these efforts are nurse members of the state associations as well as nurses who are in recovery themselves. For this reason, they are called peer assistance programs. o The peer assistance programs strive to intervene early, to reduce hazards to clients, and increase prospects for the nurse's recovery. Most states provide either a hot-line number that the impaired nurse or intervening colleague may call or phone numbers of peer assistance committee members, which are made available for the same purpose. Typically, a contract is drawn up detailing the method of treatment, which may be obtained from various sources, such as employee assistance programs, Alcoholics Anonymous, Narcotics Anonymous, private counseling, or outpatient clinics. Guidelines for monitoring the course of treatment are established. Peer support is provided through regular contact with the impaired nurse, usually for a period of 2 years. Peer assistance programs serve to assist impaired nurses to recognize their impairment, to obtain necessary treatment, and to regain accountability within their profession.
pancreatitis
- may be categorized as acute or chronic. Acute pancreatitis usually occurs shortly after binge drinking. Symptoms include constant, severe epigastric pain, nausea and vomiting, and abdominal distention. The chronic condition leads to pancreatic insufficiency resulting in steatorrhea, malnutrition, weight loss, and diabetes mellitus. Acute: Usually occurs 1 or 2 days after a binge of excessive alcohol consumption. Symptoms include constant, severe epigastric pain; nausea and vomiting; and abdominal distention. Chronic: Leads to pancreatic insufficiency resulting in steatorrhea (fat in the stool), malnutrition, weight loss, and diabetes mellitus.
*the right to refuse treatment (including medication)* (ethical issues relevant to psychiatric mental health nursing)
- pts have this right UNLESS the treatment requires immediate intervention to prevent death or serious harm to the patient or another person - the U.S. Constitution and several of its amendments affirm this right (e.g., the First Amendment, which addresses the rights of speech, thought, and expression; the Eighth Amendment, which grants the right to freedom from cruel and unusual punishment; and the Fifth and Fourteenth Amendments, which grant due process of law and equal protection for all) - but in psychiatry there are both ethical and legal issues that must be considered - sometimes patients are involuntarily hospitalized bc they are at risk of harming themselves or others and do not recognize the dangerousness of their symptoms - in emergency cases sedative medication may be administered w/o the patient's consent in order to protect patients from harming themselves or others - bc laws vary from state to state, *it is important for nurses to know the laws that pertain in their local jurisdiction* - *organizational policies in the nurse's practice setting should also guide decision-making* - although many courts are supporting a client's right to refuse medications in the psychiatric area, exceptions DO exist - when making a decision about forced medication: the treatment team MUST determine that 3 criteria be met to force medication w/o client consent: the client must exhibit behavior that is dangerous to self or others; the medication ordered by the physician must have a reasonable chance of providing help to the client; and clients who refuse medication must be judged incompetent to evaluate the benefits of the treatment in question - some states have adopted laws that allow a court to mandate outpatient treatment for people with mental illness who have a history of violent behavior - in NYC, this law (aka Kendra's law) also includes a provision for ordering an individual to take medication as part of the treatment plan
*autonomy* discuss
Independence; self-governance - An ethical principle that emphasizes the status of persons as autonomous moral agents whose right to determine their destinies should always be respected. - The principle arises from the Kantian duty of respect for persons as rational agents, this viewpoint emphasizes the status of persons as autonomous moral agents whose right to determine their destinies should always be respected - presumes that individuals are always capable of making independent choices for themselves, health-care workers know this is not always the case - Children, comatose individuals, and people with serious mental illness are examples of clients who are incapable of making informed choices - In these instances, a representative of the individual is usually asked to intervene and give consent - health-care workers must ensure that respect for an individual's autonomy is NOT disregarded in favor of what another person may view as best for the client
Communication Exercises 1. Mr. J was brought to the emergency room by his brother who is concerned about Mr. J's worsening depression. During the assessment, Mr. J tells the nurse, "None of this matters. There's nothing that can make this any better." What would be an appropriate response by the nurse? 2. Mr. J admits to the nurse that he has had suicide ideas for the last couple of weeks. How would the nurse intervene with Mr. J at this point? 3. Mr. J tells the nurse that ever since his wife died three months ago, he doesn't want to go on living. What would be an example of empathic communication in response to this statement by Mr. J?
1. "Mr. J, it sounds like you have been feeling hopeless; this is a common symptom of depression." (Giving information) "Have you been having any thoughts of taking your own life?" (Closed-ended, directive questioning to assess for the presence of suicide ideation) 2. Communication at this point should be focused on thorough assessment of Mr. J's expressed suicide ideas. Assessment questions include (but are not comprehensive): "When you have these ideas do you have a plan in mind?" "How strong is your intention to die?" "Do you have access to the means for implementing this plan?" 3. "It sounds like you are grieving, that must be very painful, tell me more about your experience and feelings related to losing your wife." (Empathy, exploring/ encouraging description)
*nursing diagnosis/outcome identification for stress-related disorders*
1. *Complicated grieving* related to real or perceived loss of any concept of value to the individual, evidenced by interference with life functioning, developmental regression, or somatic complaints 2. *Risk-prone health behavior* related to change in health status requiring modification in lifestyle (e.g., chronic illness, physical disability), evidenced by inability to problem-solve or set realistic goals for the future a. Impaired ability to modify lifestyle behaviors that improve life status b. They have difficulty accepting new diagnosis c. NOTE: This diagnosis would be appropriate for the person with adjustment disorder if the precipitating stressor was a change in health status. 3. *Anxiety* (moderate to severe) related to situational and/or maturational crisis evidenced by restlessness, increased helplessness, and diminished productivity
Smucker (2001) identified the following factors as *types of spiritual needs associated with human beings*:
1. *Meaning and purpose in life* 2. *Faith or trust in someone or something beyond ourselves* 3. *Hope!!* 4. *Love* 5. *Forgiveness*
Nursing Diagnosis/Outcome Identification trauma-related disorders
1. *Posttrauma syndrome* related to distressing event considered to be outside the range of usual human experience evidenced by flashbacks, intrusive recollections, nightmares, psychological numbness related to the event, dissociation, or amnesia 2. *Complicated grieving* related to loss of self as perceived before the trauma or other actual or perceived losses incurred during or after the event evidenced by irritability and explosiveness, self-destructiveness, substance abuse, verbalization of survival guilt, or guilt about behavior required for survival - *Deals w/ loss NOT just death* - *Very important for clients to be able to talk about their experience*
Predisposing Factors to Trauma-Related Disorders [Theories of Etiology r/t trauma-related disorders]
1. *psychosocial theory: traumatic experience, the individual, & recovery environment* 2. learning theory 3. cognitive theory 4. biological theories
esophagitis
Inflammation and pain in the esophagus occurs because of the toxic effects of alcohol on the esophageal mucosa. It also occurs because of frequent vomiting associated with alcohol abuse. And esophageal varices - inflammation and pain in the esophagus—occurs because of the toxic effects of alcohol on the esophageal mucosa. It also occurs because of frequent vomiting associated with alcohol abuse.
Psychological Theories Predisposing Factors: Theories of Suicide
1. Anger Turned Inward: Freud (1957) believed that suicide was a response to the intense self-hatred that an individual possessed. The anger had originated toward a love object but was ultimately turned inward against the self. Freud believed that suicide occurred as a result of an earlier repressed desire to kill someone else. He interpreted suicide to be an aggressive act toward the self that often was really directed toward others. 2. Hopelessness and other Symptoms of Depression: Hopelessness has long been identified as a symptom of depression and as an underlying factor in the predisposition to suicide. Although many of the symptoms that are identified in suicide assessment tools attempt to assess for seriousness of suicide ideation, current research is attempting to glean which symptoms might be more predictive of the move from ideation to attempts; and one factor that has been identified as significant is the strength of the person's intention to die 3. History of Aggression and Violence: A history of violent behavior or impulsive acts has been associated with increased risk for suicide, although recent evidence suggests that impulsive traits are higher in individuals with suicide ideation but not necessarily associated with more attempts 4. Shame and Humiliation: Some individuals have viewed suicide as a "face-saving" mechanism—a way to prevent public humiliation following a social defeat such as a sudden loss of status or income. Often, these individuals are too embarrassed to seek treatment or other support systems.
*ethical decision-making model* The following is a set of steps that may be used in making an ethical decision. These steps closely resemble the steps of the nursing process. No D or OI [APPIE] use it to make an ethical decision
1. Assessment: Gather the subjective and objective data about a situation. Consider personal values as well as values of others involved in the ethical dilemma. 2. Problem identification: Identify the conflict between 2 or more alternative actions. 3. Planning: Explore the benefits and consequences of each alternative. Consider principles of ethical theories. Select an alternative. 4. Implementation: Act on the decision made and communicate the decision to others. 5. Evaluation: Evaluate outcomes
Application of the Nursing Process to Autistic Disorder
1. Background Assessment Data (Symptomology) a. Impairment in social interaction b. Impairment in communication and imaginative activity c. Restricted activities and interests 2. Outcomes, the client will... a. Exhibits no evidence of self-harm. b. Interacts appropriately with at least one staff member. c. *Demonstrates trust in at least one staff member (its important to provide consistent caregivers)* d. Is able to communicate so that he or she can be understood by at least one staff member. e. Demonstrates behaviors that indicate he or she has begun the separation/individuation process. 3. Nursing intervention is aimed at protection of the child from self-harm, and improvement in social functioning, verbal communication, and personal identity.
Application of the Nursing Process to ODD
1. Background Assessment Data (Symptomology) a. Symptoms include passive-aggression, exhibited by stubbornness, procrastination, disobedience, carelessness, negativism, testing of limits, resistance to directions, deliberately ignoring the communication of others, and unwillingness to compromise. b. Other symptoms may include running away, school avoidance, school underachievement, temper tantrums, fighting, and argumentativeness. is often unsatisfactory. 2. Diagnosis/outcome identification a. Noncompliance with therapy related to negative temperament, denial of problems, underlying hostility b. Defensive coping related to retarded ego development, low self-esteem, *unsatisfactory parent/child relationship* c. Low self-esteem related to lack of positive feedback, retarded ego development d. Impaired social interaction related to negative temperament, underlying hostility, *manipulation* of other 3. Nursing intervention is aimed at compliance with therapy, acceptance of responsibility for own behavior, increase in self-esteem, and improvement in social interaction. a. *Reinforce positive actions to encourage repetition of desirable behaviors* i. *Called Token economy*
Application of the Nursing Process to Cognitive Impairment/Intellectual Disability
1. Degree of severity of CI/ID is identified by level of IQ. 2. Four levels have been delineated: a. *Mild: May develop academic skills up to a sixth-grade level!!!* b. Moderate: *Nursing interventions include providing simple directions and praising patient's independent self-care efforts. These children can successfully complete elementary school.* c. Severe: *The patient communicates wants and needs by "acting out" behaviors. Most are instutionalized eventually* d. Profound: Definitely instutionalized. Usually very little brain function 3. Nurses must access strengths as well as limitations in order to encourage the client to be as independent as possible. 4. It is important to include *family* members in the planning and implementation of care. 5. Family members should receive information regarding the scope of the condition, realistic expectations and client potentials, methods for modifying behavior as required, community resources from whom they may see assistance and support. 6. Evaluation of care given to the client with CI/ID should reflect *positive* behavioral change.
cultural and ethnic influence sociocultural factor
1. Factors within an individual's culture help to establish patterns of substance use by molding attitudes, influencing patterns of consumption based on cultural acceptance, and determining the availability of the substance. For centuries, the French and Italians have considered wine an essential part of the family meal, even for the children. The incidence of alcohol addiction is low, and acute intoxication from alcohol is not common. However, the possibility of chronic physiological effects associated with lifelong alcohol consumption cannot be ignored. 2. Historically, a high incidence of alcohol addiction has existed within the American Indian/Alaska Native (AI/AN) culture. Alcohol-related deaths among AI/AN occur at rates 514 percent higher than that of the U.S. general population (Purnell, 2014). Veterans Administration records show that 45 percent of AI/AN veterans are addicted to alcohol, a rate two times that of non-AI/AN veterans. A number of reasons have been postulated for alcohol abuse among AI/ANs: a possible physical cause (difficulty metabolizing alcohol), children modeling their parents' drinking habits, unemployment and poverty, and loss of traditional AI/AN religion that some believe has led to the increased use of alcohol to fill the spiritual gap. 3. The incidence of alcohol addiction is higher among northern Europeans than southern Europeans. Alcohol problems in Ireland are among the highest internationally (Wilson, 2013), and certainly drinking alcohol is a part of the social culture, as pubs are considered a hub for social activity. 4. *Incidence of alcohol addiction among Asians is relatively low*, which may be a result of a possible genetic intolerance of the substance. Some Asians develop unpleasant symptoms, such as flushing, headaches, nausea, and palpitations, when they drink alcohol. Research indicates that these symptoms occur because of an isoenzyme variant that quickly converts alcohol to acetaldehyde and the absence of an isoenzyme that is needed to oxidize acetaldehyde. A rapid accumulation of acetaldehyde results, which produces the unpleasant symptoms
Northern European Americans
Language has roots in the first English settlers. Descendants of these immigrants comprise what is considered the dominant cultural group in the United States. They value territory; personal space is about *18in- 3 ft.* Less value is placed on marriage and religion than once was. *Punctuality and efficiency* are highly valued. They are future oriented. Most value a healthy lifestyle but still enjoy fast food.
biological influences predisposing factors to gambling disorder
1. Genetic Familial and twin studies show an increased prevalence of pathological gambling in family members of individuals diagnosed with the disorder. Hollander, Berlin, and Stein (2008) report the results of research that indicates a common genetic vulnerability for pathological gambling and alcohol addiction in men. 2. 2. Physiological Hodgins, Stea, and Grant (2011) suggest a correlation between pathological gambling and abnormalities in the serotonergic, noradrenergic, and dopaminergic neurotransmitter systems. They stated: Dopamine is implicated in learning, motivation, and the salience of stimuli, including rewards. Alterations in dopaminergic pathways might underlie the seeking of rewards (i.e., gambling) that trigger the release of dopamine and produce feelings of pleasure. (p. 1878) 3. 3. Biochemical theories suggest that, ironically, both winning and losing (perhaps related to the excitement of taking a risk) may stimulate the reward and pleasure centers of the brain, which could contribute to the persistent and repeated desire to gamble even though one is not winning. Other studies have indicated alterations in the electroencephalographic patterns of pathologic gamblers
*criminal law* (type of unlawful acts)
Law that provides protection from conduct deemed injurious to the public welfare. It provides for punishment of those found to have engaged in such conduct. *Provides protection from conduct deemed injurious to the public welfare* - commonly includes: imprisonment, parole conditions, a loss of privilege (such as a license), a fine, or any combination of these - an example of a violation of criminal law: the theft by a hospital employee of supplies or drugs
Biological Theories Predisposing Factors: Theories of Suicide *just know that there is a genetic predisposition*
1. Genetics: Twin studies have shown a much higher concordance rate for monozygotic twins than for dizygotic twins. Some studies with people who have attempted suicide have focused on the genotypic variations in the gene for tryptophan hydroxylase, with results indicating significant association to suicidality. Tryptophan hydroxylase is an enzyme associated with the synthesis of serotonin, and diminished serotonin has implications for both depression and suicidal behavior. These findings suggest the potential for genetic predisposition toward suicidal behavior. 2. Neurochemical Factors: A number of studies have revealed a deficiency of serotonin (measured as a decrease in the levels of 5-hydroxyindole acetic acid [5-HIAA] in the cerebrospinal fluid) in depressed clients who attempted suicide. These studies, as well as postmortem studies, have supported the hypothesis that deficiencies in central nervous system (CNS) serotonin are associated with suicide.
genetics biological factor
1. Hereditary factors appear to be involved in the development of substance use disorders, especially alcoholism. *Children of alcoholics are 4 times more likely than other children to become alcoholics*. Studies with monozygotic and dizygotic twins have demonstrated that monozygotic (one egg, genetically identical) twins have a higher rate for concordance of alcoholism than dizygotic (two eggs, genetically nonidentical) twins (Black & Andreasen, 2014). Furthermore, biological offspring of alcoholic parents have a significantly greater incidence of alcoholism than offspring of nonalcoholic parents whether the child was reared by the biological parents or by nonalcoholic adoptive parents (Puri & Treasaden, 2011). Research continues to discover genetic influences in addiction but currently scientists estimate that genetics accounts for 40 to 60 percent of a person's vulnerability
psychosocial influences predisposing factors to gambling disorder
1. Sadock and colleagues (2015) report that the following may be predisposing factors to the development of pathological gambling: "loss of a parent by death, separation, divorce, or desertion before the child is 15 years of age; inappropriate parental discipline (absence, inconsistency, or harshness); exposure to and availability of gambling activities for the adolescent; a family emphasis on material and financial symbols; and a lack of family emphasis on saving, planning, and budgeting" (p. 691). 2. The early psychoanalytical view attempted to explain compulsive gambling in terms of psychosexual maturation. In this theory, the gambling is compared to masturbation; both of these activities derive motive force from a build-up of tension that is released through repetitive actions or the anticipation of them. Another view suggests a masochistic component to pathological gambling and the gambler's inherent need for punishment, which is then achieved through losing
stress-related disorder outcome criteria, the client will...
1. Verbalizes acceptable behaviors associated with each stage of the grief process. 2. Demonstrates a reinvestment in the environment. 3. Accomplishes activities of daily living independently. 4. Demonstrates ability for adequate occupational and social functioning. 5. Verbalizes awareness of change in health status and the effect it will have on lifestyle. 6. Solves problems and sets realistic goals for the future. 7. Demonstrates ability to cope effectively with change in lifestyle
treatment modalities for trauma-related disorders
1. cognitive therapy 2. prolonged exposure therapy 3. group/family therapy 4. eye movement desensitization and reprocessing 5. psychopharmacology (antidepressants, anxiolytics, antihypertensives, other meds)
*Discuss legal issues relevant to psychiatric mental health nursing.* look at more info in book
1. confidentiality and right to privacy - HIPAA, Exception: A Duty to Warn (Protection of a Third Party), & Exception: Suspected Child or Elder Abuse 2. informed consent 3. restraints and seclusion
treatment for adjustment disorders
1. individual psychotherapy 2. family therapy 3. behavior therapy 4, self-help groups 5. crisis intervention (short term with focus on *problem solving techniques*) 6. psychopharmacology
African Americans
40.4% of households are headed by women They have large support groups of families and friends. Some (particularly from the rural South) practice folk medicine and receive their care from a "granny," "old lady," or "spiritualist." *Hypertension and sickle cell anemia* have genetic tendencies within the community. Diet differs little from mainstream culture, but "soul" food is popular, especially in the South
• General intellectual functioning
: is measured by both clinical assessment and a person's performance on IQ tests.
Native Americans
< 1/2 live on reservations. Touch is *not* highly regarded and a handshake may be viewed as aggressive. They sometimes appear silent and reserved. They can be uncomfortable expressing emotions Primary social organizations are the family and tribe. *Children are taught to respect tradition.* present-time oriented. *A medicine man is called a shaman and uses a variety of methods in practice; may work closely with conventional medicine to heal the sick.* Health problems include *diabetes, heart disease, tuberculosis, alcoholism, and nutritional deficiencies.*
Wernicke's encephalopathy
A brain disorder caused by thiamine deficiency and characterized by visual disturbances, ataxia, somnolence, stupor, and, without thiamine replacement, death. - *Most* serious form of thiamine deficiency in alcoholic patients. Symptoms include paralysis of the ocular muscles, diplopia, ataxia, somnolence, and stupor. *If thiamine replacement therapy is not undertaken quickly, the person will die.* - represents the most serious form of thiamine deficiency in alcoholics. Symptoms include paralysis of the ocular muscles, diplopia, ataxia, somnolence, and stupor. If thiamine replacement therapy is not undertaken quickly, death will ensue.
• hepatic encephalopathy
A brain disorder resulting from the inability of the cirrhotic liver to convert ammonia to urea for excretion. The continued rise in serum ammonia results in progressively impaired mental functioning, apathy, euphoria or depression, sleep disturbances, increasing confusion, and progression to coma and eventual death.
*ethics*
A branch of philosophy dealing with values related to human conduct, to the rightness and wrongness of certain actions, and to the goodness and badness of the motives and ends of such actions. - is a branch of philosophy that addresses methods for determining the rightness or wrongness of one's actions. - is a branch of philosophy that deals with systematic approaches to distinguishing right from wrong behavior
• dual diagnosis
A client has a dual diagnosis when it is determined that he or she has a co-existing substance disorder and mental illness. Treatment is designed to target both problems.
• Clinging
A common symptom of separation anxiety disorders in which the child excessively clings to the mother or other individual from whom the child fears being separated.
distance
A cultural characteristic that defines the means by which various cultures use interpersonal space to communicate. *concepts of space that influence communication*
*Autism spectrum disorder (ASD)*
A disorder that is characterized by impairment in social interaction skills and interpersonal communication and a restricted repertoire of activities and interests. o A heterogenous group of neurodevelopmental syndromes characterized by a wide range of communication impairments and restricted, repetitive behaviors o Characterized by a withdrawal of the child into the self and into a fantasy world of his or her own creation. o Prevalence of the disorder is about 6 per 1000 and occurs about 4 times more often in boys than in girls. Prevalence is about 1 in 88 children. Onset occurs prior to age 3 and in most cases runs a chronic course with symptoms persisting into adulthood. C. Predisposing Factors 1. Biological Factors. a. Neurological Implications. (1) *Role of neurotransmitters under investigation* c. Perinatal Influences. Women who suffered from asthma and/or allergies around the time of pregnancy are at increased risk of having a child affected by autism. a. *Poor parenting doesn't cause autistic spectrum disorder. Research has shown that abnormalities in brain structure or function are to blame. This is beyond parental control.*
*Disulfiram (Antabuse)*
A drug that is administered to individuals who abuse alcohol as a deterrent to drinking. Ingestion of alcohol while disulfiram is in the body results in a syndrome of symptoms that can produce a great deal of discomfort and can even result in death if the blood alcohol level is high.
Asian/Pacific Islander Americans
A large group in US today that comprises more than 4% of the U.S. population. Includes immigrants (and their descendants) from Japan, China, Vietnam, the Philippines, Thailand, Cambodia, Korea, Laos, India, and the Pacific Islands. Although they are viewed as 1 (Asian) culture, they constitute a multiplicity of differences regarding attitudes, beliefs, values, religious practices, and language. Many younger generation have become almost *totally* acculturated into the U.S. culture. oft-spoken; to raise the voice indicates a loss of control. Touching is not considered totally appropriate by some The family is the ultimate social organization and loyalty to family is emphasized above all else. *Education is highly valued, although many remain undereducated.* Religious practices and beliefs are diverse and exhibit influences of Taoism, Confucianism, Hinduism, Buddhism, Islam, and Christianity Time orientation is both past and present. *Restoring the balance of yin and yang is the fundamental concept of Asian health practices.* Rice, vegetables, and fish are the main staple foods. *Psychiatric illness is viewed as behavior that is out of control and brings great shame to the family.* Incidence of alcohol dependence is low, perhaps because of a possible genetic intolerance of the substance.
gender risk factor for suicide
More *women* than men attempt suicide, but *men* succeed more often - Successful suicides number about 70% for men and 30% for women, this success rate has to do with the lethality of the means, women tend to overdose; *men use more lethal means, such as firearms* - the most recent health statistics (2013) identified that 32,055 men and 9094 women died by suicide in the US - These differences b/w men and women may also reflect differing societal expectations; women are more likely than men to seek and accept help from friends or professionals, whereas *men often view help-seeking as a sign of weakness* - transgender individuals are also a high-risk population for suicide with an alarming 41% lifetime prevalence
*Physical dependence*
Need for increasing amounts to produce the desired effects.
Intervention With the Suicidal Client Following Discharge (or Outpatient Suicidal Client) Planning and Implementation
Nursing diagnoses are presented, along with outcome criteria, appropriate nursing interventions, and rationales for each. In some instances, it may be determined that suicidal intent is low and that hospitalization is not required. Instead, the client with suicidal ideation may be treated in an outpatient setting. Guidelines for treatment of the suicidal client on an outpatient basis include the following: The person should not be left alone. Arrangements must be made for the client to stay with family or friends. If this is not possible, hospitalization should be reconsidered. A no-suicide contract may be established with the client but only as an adjunct to other interventions. Evidence has not supported their efficacy as a primary intervention (Drew, 2001; Freedenthal, 2013; Rudd, Mandrusiak, & Joiner, 2006). The focus of this intervention is to formulate a written or verbal contract that the client will not harm himself or herself in a stated period of time. For example, the client writes or verbally agrees, "I will not harm myself in any way between now and the time of our next counseling session," or "I will call the suicide hotline (or go to the emergency room) if I start to feel like harming myself." When the time period of this short-term contract has lapsed, a new contract may be negotiated. Again, the contract for safety comes with no guarantee, and it holds no legal credibility. It should never be used as a single intervention but can be viewed as one among many interventions that may serve to promote safety. Assessment for suicidal risk and responsive intervention must be ongoing because suicidal ideas and intent may change over hours, days, or longer periods of time. Enlist the help of family or friends to ensure that the home environment is safe from dangerous items, such as firearms or stockpiled drugs. Give support persons the telephone number of the counselor or an emergency contact person in the event that the counselor is not available. Appointments may need to be scheduled daily or every other day at first until the immediate suicidal crisis has subsided. Establish rapport and promote a trusting relationship. It is important for the suicide counselor to become a key person in the client's support system at this time. Accept the client's feelings in a nonjudgmental manner. CLINICAL PEARL Be direct. Talk openly and matter-of-factly about suicide. Listen actively and encourage expression of feelings, including anger. Discuss the current crisis situation in the client's life. Use the problem-solving approach. Offer alternatives to suicide while at the same time empathizing with the client's pain that led to viewing suicide as an option (Jobes, 2012). An example of this kind of communication might be: "I understand how this emotional pain you've been experiencing led you to consider suicide, but I'd like to explore with you some alternative ways to decrease your pain and to identify some reasons for continuing to live." Help the client identify areas of the life situation that are within his or her control and those that the client does not have the ability to control. Discuss feelings associated with these control issues. It is important for the client to feel some control over his or her life situation in order to perceive a measure of self-worth. The physician or nurse practitioner may prescribe antidepressants for an individual who is experiencing suicidal depression. It is wise to prescribe no more than a 3-day supply of the medication with no refills. The prescription can then be renewed at the client's next counseling session. NOTE: Sadock and associates (2015) have stated: Patients with depressive disorders are at increased risk of suicide as they begin to improve and regain the energy needed to plan and carry out a suicide (paradoxical suicide). It is usually unwise to give a depressed patient a prescription for a large number of antidepressants, especially tricyclic drugs, at the time of their discharge from the hospital. (p. 366) Psychological interventions that have demonstrated effectiveness in reducing suicidal behavior include dialectical behavior therapy (DBT), cognitive behavior therapy, and CAMS (Jobes, 2015). In general, it is important to recognize that not all suicidal individuals are alike, so interventions should be multifaceted and suicide preventions plans should be comprehensive. Single interventions, including hospitalization, medication alone, and no-suicide contracts, are not supported by evidence to be effective in reducing suicides (Jobes, 2015). Clients need to be actively engaged as partners in each step of the assessment and intervention process.
Diagnosis and Outcome Identification (NP for suicidal client)
Nursing diagnoses for the suicidal client may include the following: Risk for suicide related to feelings of hopelessness and desperation. Hopelessness related to absence of support systems and perception of worthlessness.
*Spirituality and religion are intensely personal. How do you as a future nurse plan to help patients and their families meet their spiritual or religious needs? Complete a nursing care plan (NCP) on a person in spiritual distress (see page 116& 117). Role play with a classmate (you be the nurse and your peer be a patient of a culture that does not speak english) a conversation about spiritual or religious needs.*
Nursing intervention: *Emphasis is also placed on developing a trusting relationship with the client and family, and eliminating barriers to communication.* - It is important for nurses to be able to assess the spiritual needs of their clients. Nurses need not serve the role of professional counselor or spiritual guide, but because of the closeness of their relationship with clients, nurses may be the part of the health-care team to whom clients may reveal the most intimate details of their lives. - Just as answering a patient's question honestly and with accurate information and responding to his needs in a timely and sensitive manner communicates caring, so also does high-quality professional nursing care reach beyond the physical body or the illness to that part of the person where identity, self-worth, and spirit lie. In this sense, good nursing care is also good spiritual care.
*Alcoholics Anonymous (AA)* *Know about AA Programs and why they exist.*
A major self-help organization for the treatment of alcoholism. It is based on a 12-step program to help members attain and maintain sobriety. Once individuals have achieved sobriety, they in turn are expected to help other alcoholic persons. - It was founded in 1935 by two alcoholics—a stockbroker, Bill Wilson, and a physician, Dr. Bob Smith—who discovered that they could remain sober through mutual support. They accomplished sobriety not as professionals but as peers who were able to share their common experiences. Soon they were working with other alcoholics, who in turn worked with others. The movement grew, and remarkably, individuals who had been treated unsuccessfully by professionals were able to maintain sobriety through helping one another. o Today AA chapters exist in virtually every community in the United States. The self-help groups are based on the concept of peer support—acceptance and understanding from others who have experienced the same problems in their lives. The only requirement for membership is a desire on the part of the alcoholic person to stop drinking. Each new member is assigned a support person from whom he or she may seek assistance when the temptation to drink occurs. o A survey by the General Service Office of Alcoholics Anonymous in 2014 (Alcoholics Anonymous, 2015) revealed the following statistics: members ages 30 and younger comprised 12 percent of the membership, and the average age of AA members was 50; women comprised 38 percent; 89 percent were white, 4 percent were African American, 3 percent were Hispanic, 1 percent were Native American, and 3 percent were Asian American and other minorities. Almost half (49%) of people involved in AA were referred by a health-care professional or treatment facility. The sole purpose of AA is to help members stay sober. When sobriety has been achieved, members in turn are expected to help other alcoholic persons. The Twelve Steps that embody the philosophy of AA provide specific guidelines on how to attain and maintain sobriety (Box 14-6). o AA accepts alcoholism as an illness and promotes total abstinence as the only cure, emphasizing that the alcoholic person can never safely return to social drinking. They encourage the members to seek sobriety, taking one day at a time. The Twelve Traditions are the statements of principles that govern the organization. o AA has been the model for various other self-help groups associated with addiction problems. Some of these groups and the memberships for which they are organized are listed in Table 14-11. Nurses need to be fully and accurately informed about available self-help groups and their importance as a treatment resource on the health-care continuum so that they can use them as a referral source for clients with substance use disorders.
*adjustment disorder!!*
A maladaptive reaction to an identifiable psychosocial stressor that occurs within 3 months after onset of the stressor. The individual shows impairment in social and occupational functioning or exhibits symptoms that are in excess of a normal and expectable reaction to the stressor. - Characterized by a maladaptive reaction to an identifiable stressor or stressors *("normal stressors")* that results in the development of clinically significant emotional or behavioral symptoms a. *NOT extreme trauma* b. Difference b/w this and PTSD (1) It is a maladaptive rxn but NOT to extreme trauama 2. Symptoms occur within 3 months of the stressor and last no longer than 6 months a. *(exception: the "related to bereavement" subtype in which case the symptoms exist for at least 12 months following the death of a loved one).*
race
A more biological term, describing a group of people who share similar inherited characteristics such as skin color, facial features, and blood groups. - is a controversial term because of its association with racism or prejudicial views about a group of people based on their appearance - Some scientists argue that no group of individuals is genetically pure enough to define race as a set of biological distinctions - Other scientists argue the benefit of understanding racial differences in determining response to various treatments such as medications - The U.S. Census Bureau collects data on racial demographics and clarifies that the data is based on self-reported, self-identified affiliations - In 2000, the Census Bureau also began including a category that allows individuals to identify with 2 or more races.
*Have a good understanding of the Predisposing Factors for Substance Induced Disorders*
A number of factors have been implicated in the predisposition to abuse of substances. At present, there is no single theory that can adequately explain the etiology of this problem. No doubt the interaction between various elements forms a complex collection of determinants that influence a person's susceptibility to abuse substances. 1. biological factors: genetics, biochemical 2. psychological factors: developmental influences, personality factors, cognitive factors 3. sociocultural factors: social learning, conditioning, cultural and ethnic influences
*Culture*
A particular society's entire way of living, encompassing *shared patterns* of belief, feeling, and knowledge that guide people's conduct and are passed down from generation to generation. *a society's way of living that is passed down from generation to generation*
*Conduct disorder*
A persistent pattern of behavior in which the basic rights of others and age appropriate societal norms or rules are violated. Two subtypes based on age at onset: o Childhood-onset type: Defined by the onset of a least one criterion characteristic of conduct disorder prior to age 10. *More severe than the adolescent-onset type; more likely to develop antisocial personality disorder in adulthood* o Adolescent-onset type: Defined by the absence of any criteria characteristic of conduct disorder prior to age 10. b. Family Influences (1) The following family dynamics may contribute to the development of conduct disorder: a. *Parental rejection (parents working all the time, parents doing drugs/alcohol)* b. Inconsistent management with harsh discipline c. Early institutional living d. Frequent shifting of parental figures e. Large family size f. *Absent father* g. Parents with antisocial personality disorder or alcohol dependence h. Association with a delinquent subgroup i. Marital conflict and divorce j. Inadequate communication patterns k. *Parental permissiveness (children not given enough/too many rules)*
absolute right
A right is absolute when there is NO restriction whatsoever on the individual's entitlement.
religion
A set of beliefs, values, rites, and rituals adopted by a group of people. The practices are usually grounded in the teachings of a spiritual leader.
• Temperament
A set of inborn personality characteristics that influence an individual's manner of reacting to the environment and ultimately influences his or her developmental progression. o Personality characteristics that define an individual's mood and behavioral tendencies. The sum of physical, emotional, and intellectual components that affect or determine a person's actions and reactions.
*ethical dilemma* define
A situation that arises when on the basis of moral considerations an appeal can be made for taking each of 2 opposing courses of action. - Evidence exists to support both moral "rightness" and moral "wrongness" r/t a certain action. - The individual who must make the choice experiences conscious conflict regarding the decision. - Not all ethical issues are dilemmas - arises when there is no clear reason to choose one action over another. - generally create a great deal of emotion - Often, the reasons supporting each side of the argument for action are logical and appropriate - The actions associated with both sides are desirable in some respects and undesirable in others. In most situations, *taking no action is considered an action taken.*
Korsakoff's psychosis
A syndrome of confusion, loss of recent memory, and confabulation in alcoholics, caused by a deficiency of thiamine. It often occurs together with Wernicke's encephalopathy and may be termed Wernicke-Korsakoff syndrome. - Syndrome of confusion, loss of recent memory, and confabulation in alcoholic patients. It is frequently encountered in clients recovering from Wernicke's. - is identified by a syndrome of confusion, loss of recent memory, and confabulation in alcoholics. It is frequently encountered in clients recovering from Wernicke's encephalopathy. In the United States, the two disorders are usually considered together and are called Wernicke-Korsakoff syndrome. Treatment is with parenteral or oral thiamine replacement.
*posttraumatic stress disorder (PTSD)!!!*
A syndrome of symptoms that develops following a psychologically distressing event that is outside the range of usual human experience (e.g., rape, war). The individual is unable to put the experience out of his or her mind and has nightmares, flashbacks, and panic attacks. o More than half of individuals will experience a traumatic event in their lifetime but less than 10 percent will develop PTSD. The traumatic event is described as one that is "outside the range of usual human experience." The disorder appears to be more common in women than in men. The trauma that women experience is more likely to be sexual assault and child sexual abuse. o About 60% of men and 50% of women will be exposed to a traumatic event in their life 1. Defined as "a reaction to an *extreme trauma*, which is likely to cause pervasive distress to almost anyone, such as natural or man-made disasters, combat, serious accidents, witnessing the violent death of others, being the victim of torture, terrorism, rape, or other crimes" 2. Symptoms may be in first 3 months or delayed for years 3. When symptoms do occur to qualify for diagnosis: they must last longer than 30 days
goals for the client with trauma-related disorder
a. *Can acknowledge the traumatic event and the impact it has had on his or her life.* b. Is experiencing fewer flashbacks, intrusive recollections, and nightmares than he or she was on admission (or at the beginning of therapy). c. Can demonstrate adaptive coping strategies (e.g., relaxation techniques, mental imagery, music, art). d. Can concentrate and has made realistic goals for the future. e. Includes significant others in the recovery process and willingly accepts their support. f. Verbalizes no ideas or intent of self-harm. g. Has worked through feelings of survivor's guilt. h. Gets enough sleep to avoid risk of injury. i. Verbalizes community resources from which he or she may seek assistance in times of stress. j. Attends support group of individuals who have recovered or are recovering from similar traumatic experiences. k. Verbalizes desire to put the trauma in the past and progress with his or her life.
*Psychopharmacology!!!*
a. *NOT commonly used because their effect may be temporary and only mask the real problem, also potential for dependence!!!* b. *Psychoactive drugs carry the potential for physiological and psychological dependence* c. *Psychoactive drugs can interfere with the patient's ability to find a more permanent problem solution.* d. Anxiolytics or antidepressants may be used for symptoms of anxiety or depression in conjunction with psychotherapy but are NOT the primary therapy for AD. e. *Adjustment disorder is not commonly treated with medications because (1) their effect may be temporary and only mask the real problem, interfering with the possibility of finding a more permanent solution, and (2) psychoactive drugs carry the potential for physiological and psychological dependence.*
*An individual may be considered gravely disabled for which of the following reasons? Select all that apply.* a. A person, because of mental illness, cannot fulfill basic needs. b. A mentally ill person is in danger of physical harm based on inability to care for self. c. A mentally ill person lacks the resources to provide the necessities of life. d. A mentally ill person is unable to make use of available resources to meet daily living requirements.
a. A person, because of mental illness, cannot fulfill basic needs. b. A mentally ill person is in danger of physical harm based on inability to care for self. d. A mentally ill person is unable to make use of available resources to meet daily living requirements.
*Which of the following is LEAST likely to predispose a child to Tourette's disorder?* a. Absence of parental bonding b. Family history of the disorder c. Abnormalities of brain neurotransmitters. d. Structural abnormalities of the brain
a. Absence of parental bonding
*symptoms of alcohol withdrawal*
a. Alcohol Withdrawal: *Within 4 to 12 hours of cessation of or reduction in heavy and prolonged (several days or longer) alcohol use*, the following withdrawal symptoms may appear: *coarse tremor of hands, tongue, or eyelids*; nausea or vomiting; malaise or weakness; tachycardia; sweating; elevated blood pressure; *anxiety (raised pulse)*; depressed mood or irritability; transient hallucinations or illusions; headache; and *insomnia*. In about 1 percent of alcoholic patients (Sadock et al., 2015), complicated withdrawal syndrome may progress to alcohol withdrawal *delirium*, and concomitant medical problems may increase the risk. Onset of delirium is usually on the second or third day following cessation of or reduction in prolonged, heavy alcohol use. Symptoms include those described under the syndrome of delirium (Chapter 13, "Neurocognitive Disorders"). i. Withdrawal symptoms: Tremors, nausea/vomiting, malaise, weakness, tachycardia, sweating, elevated blood pressure, anxiety, depressed mood, irritability, hallucinations, headache, insomnia, seizures - early: very fine tremors of hands 1. Alcohol withdrawal begins within *4-6 hr* after last drink. May progress to delirium tremens on 2nd or 3rd day. Use of Librium or Serax is common for substitution therapy.
G. *Evaluation* of care for the patient with a trauma-related disorder is based on successful achievement of the previously established outcome criteria. p. 494 1. Reassessment is conducted in order to determine if the nursing actions have been successful in achieving the objectives of care. Evaluation of the nursing actions for the client with a trauma-related disorder may be facilitated by gathering information using the following types of questions:
a. Can the client discuss the traumatic event *without* experiencing panic anxiety? b. Does the client voluntarily discuss the traumatic event? c. Can the client discuss changes that have occurred in his or her life because of the traumatic event? d. Does the client have *flashbacks*? e. Can the client *sleep without medication*? f. Does the client have nightmares? g. Has the client learned new, adaptive coping strategies for assistance with recovery? h. Can the client demonstrate successful use of these new coping strategies in times of stress? i. Can the client verbalize stages of grief and the normal behaviors associated with each? j. Can the client recognize his or her own position in the grieving process? k. Is guilt being alleviated? l. Has the client maintained or regained satisfactory relationships with significant others? m. Can the client look to the future with optimism? n. Does the client attend a regular support group for victims of similar traumatic experiences? o. Does the client have a plan of action for dealing with symptoms if they return?
Joe, a American Indian, appears at the community health clinic with an oozing stasis ulcer on his lower right leg. It is obviously infected, and he tells the nurse that the shaman has been treating it with herbs. The nurse determines that Joe needs emergency care, but Joe states he will not go to the emergency department (ED) unless the shaman is allowed to help treat him. How should the nurse handle this situation? a. Contact the shaman and have him meet them at the ED to consult with the attending physician. b. Tell Joe that the shaman is not allowed in the ED. c. Explain to Joe that the shaman is at fault for his leg being in the condition it is in now. d. Have the shaman try to talk Joe into going to the ED without him.
a. Contact the shaman and have him meet them at the ED to consult with the attending physician.
Dan, who has been admitted to the alcohol rehabilitation unit after being fired for drinking on the job, states to the nurse, "I don't have a problem with alcohol. I can handle my booze better than anyone I know. My boss is a jerk! I haven't missed any more days than my coworkers." What defense mechanism is Dan using? a. Denial b. Projection c. Displacement d. Rationalization
a. Denial
Psychopharmacological intervention ADHD
a. Drugs of choice: CNS stimulants b. Examples: dextroamphetamine (Dexadrine), *methamphetamine*(Desoxyn), lisdexamfetamine (Vyvanse), methylphenidate (Ritalin), Dexmethylphenidate (Focalin), and dextroamphetamine/amphetamine composite (Adderall) c. Effects on children with ADHD: increased attention span, control of hyperactive behavior, and improvement in learning ability. d. Side effects: *insomnia, anorexia, weight loss, tachycardia, and temporary DECREASE in rate of growth and development. Tolerance can occur.* e. Warning: *Careful monitoring of cardiovascular function during treatment is necessary. Psychiatric symptoms may worsen.* f. A drug "holiday" should be attempted periodically under direction of the physician to determine effectiveness of the medication and need for continuation. g. *There is a risk for sudden death associated with CNS stimulants and atomoxetine in patients who have cardiovascular disease.* a. A careful history of cardiovascular disease should be obtained before prescribing these medications. b. Ongoing monitoring of cardiovascular function during administration
Bupropion (Wellbutrin): A nonselective reuptake inhibitor.
a. Exact mechanism in treatment of ADHD is unknown b. Side effects: Tachycardia, dizziness, shakiness, insomnia, nausea, anorexia, and weight loss. *Individuals with a history of seizures or eating disorders should not take this medication*
Atomoxetine (Strattera): A selective norepinephrine reuptake inhibitor.
a. Exact mechanism in treatment of ADHD is unknown. b. Side effects: Headache, nausea and vomiting, upper abdominal pain, dry mouth, decreased appetite, weight loss, constipation, insomnia, increased blood pressure and heart rate, and sexual dysfunction. c. Warning: Careful monitoring of cardiovascular and liver function during treatment is necessary. Psychiatric symptoms may worsen.
Mark, who has come to the mental health clinic with symptoms of depression, says to the nurse, "My father is dying. I have always hated my father. He physically abused me when I was a child. We haven't spoken for many years. He wants to see me now, but I don't know if I want to see him." With which spiritual need is Mark struggling? a. Forgiveness b. Faith c. Hope d. Meaning and purpose in life
a. Forgiveness
Some biological factors may be associated with the predisposition to suicide. Which of the following biological factors have been implicated? a. Genetics and decreased levels of serotonin b. Heredity and increased levels of norepinephrine c. Temporal lobe atrophy and decreased levels of acetylcholine d. Structural alterations of the brain and increased levels of dopamine
a. Genetics and decreased levels of serotonin
Which of the following has been implicated in the predisposition to substance abuse? a. Hereditary factor b. Fixation in the adolescent stage of psychosexual development c. Punitive ego d. Narcissistic and dependent personality traits
a. Hereditary factor Research has indicated that an apparent hereditary factor is involved in the development of substance-use disorders. This is especially evident with alcoholism.
*How does a State Board of Nursing view the impaired nurse?*
a. If suspicious behavior occurs, it is important to keep careful, objective records. Confrontation with the impaired nurse will undoubtedly result in hostility and denial. Confrontation should occur in the presence of a supervisor or other nurse and should include the offer of assistance in seeking treatment. If a report is made to the state board of nursing, it should be a factual documentation of specific events and actions, not a diagnostic statement of impairment. b. What will the state board do? Each case is generally decided on an individual basis. A state board may deny, suspend, or revoke a license based on a report of chemical abuse by a nurse. Several state boards of nursing have passed diversionary laws that allow impaired nurses to avoid disciplinary action by agreeing to seek treatment. Some of these state boards administer the treatment programs themselves, and others refer the nurse to community resources or state nurses' association assistance programs. Required treatment may entail successful completion of inpatient, outpatient, group, or individual counseling treatment program(s); evidence of regular attendance at nurse support groups or 12-step program; random negative drug screens; and employment or volunteer activities during the suspension period. When a nurse is deemed safe to return to practice, he or she may be closely monitored for several years and required to undergo random drug screenings. The nurse also may be required to practice under specifically circumscribed conditions for a designated period of time.
The physician orders sertraline (Zoloft) for a client who is hospitalized with Adjustment Disorder with Depressed Mood. What is this medication is intended to do? a. Increase energy and elevate mood b. Stimulate the central nervous system c. Prevent psychotic symptoms d. Produce a calming effect
a. Increase energy and elevate mood
prolonged exposure therapy
a. Just know that it's an option b. Prolonged exposure therapy has four main parts: (1) education about the treatment, (2) breathing retraining for relaxation, (3) imagined exposure through repeated discussion about the trauma with a therapist, and (4) exposure to real-world situations related to the trauma.
An operating room nurse asks a psychiatric nurse, "How can you work with the mentally ill day in and day out?" The psychiatric nurse replies, "It's just the right thing to do." The psychiatric nurse is operating from which ethical framework? a. Kantianism b. Christian ethics c. Ethical egoism d. Utilitarianism
a. Kantianism Kantianism focuses on the morality of actions. Actions are judged as right or wrong based on ethical principles. The nurse's response indicates a Kantian perspective.
learning theory Predisposing Factors to Trauma-Related Disorders [Theories of Etiology r/t trauma-related disorders]
a. Learning theorists view negative reinforcement as behavior that leads to a reduction in an aversive experience, thereby reinforcing and resulting in repetition of the behavior. The avoidance behaviors and psychic numbing in response to a trauma are mediated by negative reinforcement (behaviors that decrease the emotional pain of the trauma). Behavioral disturbances, such as anger and aggression and drug and alcohol abuse, are the behavioral patterns that are reinforced by their capacity to reduce objectionable feelings.
*Childhood Antisocial Personality Disorder!!!*
a. Mary Bell (1968) i. Strangled toddler Martin Brown May 24, 1968 when she was 10 years old b. West Memphis Three i. Damien Echols ii. Jessie Miskelley iii. Jason Baldwin c. Joran van der Sloot (Natalie Holloway) d. Amanda Knox
Trauma-informed care is a philosophical approach that includes which of the following principles? Select all that apply. a. Nurses need to be aware of the potential for trauma in any client and provide care that minimizes the risk of revictimization or retraumatization. b. Medications need to be given before any other interventions are considered. c. Trauma-informed care highlights the importance of providing care that protects the physical, psychological, and emotional safety of the client. d. Trauma-informed care is based on the principle that traumas are not correlated with depression or increased risk for suicide.
a. Nurses need to be aware of the potential for trauma in any client and provide care that minimizes the risk of revictimization or retraumatization. c. Trauma-informed care highlights the importance of providing care that protects the physical, psychological, and emotional safety of the client.
John, a veteran of the war in Iraq, is diagnosed with PTSD. Which of the following therapy regimens would most appropriately be ordered for John? a. Paroxetine and group therapy b. Diazepam and implosion therapy c. Alprazolam and behavior therapy d. Carbamazepine and cognitive therapy
a. Paroxetine and group therapy
Characteristic symptoms of PTSD include
a. Re-experiencing the traumatic event in dreams, nightmares, or intrusive memories b. A sustained high level of anxiety or arousal (1) Bc of this have difficulty concentrating or angry outbursts c. A general numbing of responsiveness d. Intrusive recollections or nightmares e. Amnesia to certain aspects of the trauma f. *Depression - common* g. Survivors guilt (1) If others didn't survive h. Substance abuse - common i. Anger and aggression j. Relationship problems (1) Bc not fun to be around (2) Have a feeling of detachment or
Which of the following interventions are appropriate for a client on suicide precautions? Select all that apply. a. Remove all sharp objects, belts, and other potentially dangerous articles from the client's environment. b. Accompany the client to off-unit activities. c. Obtain a promise from the client that she will not do anything to harm herself for the next 12 hours. d. Put all of the client's possessions in storage and explain to her that she may have them back when she is off suicide precautions.
a. Remove all sharp objects, belts, and other potentially dangerous articles from the client's environment. b. Accompany the client to off-unit activities. c. Obtain a promise from the client that she will not do anything to harm herself for the next 12 hours.
Which of the following nursing diagnoses would be considered the priority in planning care for the child with a severe ASD? a. Risk for self-mutilation evidenced by banging head against wall b. Impaired social interaction evidenced by unresponsiveness to people c. Impaired verbal communication evidenced by absence of verbal expression d. Disturbed personal identity evidenced by inability to differentiate self from others
a. Risk for self-mutilation evidenced by banging head against wall
XI. Reactive Attachment Disorder
a. Russian Child Sent Back Home i. Tennessee (7 years old) kept him 6 months 1. Certain percentage who are severely impaired/sociopathic 2. Can't hold them; cannot soothe them; invisible barrier. 3. Trouble bonding; believe the world is not safe. Cannot trust. Become oppositional and resistant. Addicted to chaos. b. Beth Thomas "Child of Rage" c. Occurs when child's needs are not met during the first 2 years of life d. These children are very "angelic looking," and extremely dangerous i. Will kill you and siblings
Mr. White is admitted to the hospital after an extended period of binge alcohol drinking. His wife reports that he has been a heavy drinker for a number of years. Laboratory reports reveal he has a blood alcohol level of 250 mg/dL. He is placed on the chemical addiction unit for detoxification. When would the first signs of alcohol withdrawal symptoms be expected to occur? a. Several hours after the last drink b. 2 to 3 days after the last drink c. 4 to 5 days after the last drink d. 6 to 7 days after the last drink
a. Several hours after the last drink
What two variables are considered to be the best predictors of posttraumatic stress disorder (PTSD) according to the psychosocial theory?
a. Severity of the stressor and the support they have around them afterword b. The severity of the stressor and the degree of psychosocial isolation
biological aspects/theories Predisposing Factors to Trauma-Related Disorders [Theories of Etiology r/t trauma-related disorders]
a. Suggests that symptoms of the trauma are related to peptoides are r/t arousal during stress b. May have opioid withdrawal s/s c. It has been suggested that an individual who has experienced previous trauma is more likely to develop symptoms after a stressful life event (Hollander & Simeon, 2008). These individuals with previous traumatic experiences may be more likely to become exposed to future traumas, as they can be inclined to reactivate the behaviors associated with the original trauma. d. Hollander and Simeon also report on studies that suggest an endogenous opioid peptide response may assist in the maintenance of chronic PTSD. The hypothesis supports a type of "addiction to the trauma," which is explained in the following manner. e. Opioids, including endogenous opioid peptides, have the following psychoactive properties: (1) Tranquilizing action (2) Reduction of rage/aggression (3) Reduction of paranoia (4) Reduction of feelings of inadequacy (5) Antidepressant action f. *These studies suggest that physiological arousal initiated by reexposure to trauma-like situations enhances production of endogenous opioid peptides and results in increased feelings of comfort and control. When the stressor terminates, the individual may experience opioid withdrawal, the symptoms of which bear strong resemblance to those of PTSD.* g. Other biological systems have also been implicated in the symptomatology of PTSD. Norepinephrine, dopamine, and benzodiazepine receptors are some of the neurotransmitters believed to be dysregulated in individuals with PTSD. Data has supported that the hypothalamic-pituitary-adrenal axis, noradrenergic, and endogenous opiate systems are hyperactive in some patients with PTSD (Sadock et al., 2015). Structural changes in the amygdala and lower-than-average volume in the hippocampus area of the brain have also been identified in studies of combat veterans with PTSD. Whether these factors are suggestive of vulnerability to PTSD or are changes that result from the brain's efforts to process trauma remains unclear. As with other disorders, it is likely that a complex dynamic of biological, social, and psychological factors is involved.
*When is a person alcohol intoxicated? Be able to measure it.*
a. Symptoms of alcohol intoxication include disinhibition of sexual or aggressive impulses, mood lability, impaired judgment, impaired social or occupational functioning, slurred speech, incoordination, unsteady gait, nystagmus, and flushed face. Intoxication usually occurs at blood alcohol levels between *100 and 200 mg/dL*. Death has been reported at levels ranging from 400 to 700 mg/dL. - *Most states consider that an individual is legally intoxicated with a blood alcohol level of 0.08%* b. Symptoms: Aggressiveness, impaired judgment, impaired attention, irritability, euphoria, depression, emotional lability, slurred speech, incoordination, unsteady gait, nystagmus, flushed face
A polysubstance abuser makes the statement, "The green and whites do me good after speed." How might the nurse interpret the statement? a. The client abuses amphetamines and anxiolytics. b. The client abuses alcohol and cocaine. c. The client is psychotic. d. The client abuses narcotics and marijuana.
a. The client abuses amphetamines and anxiolytics.
The nurse identifies the primary nursing diagnosis for Theresa as Risk for Suicide related to feelings of hopelessness from loss of relationship. Which is the outcome criterion that would most accurately measure achievement of this diagnosis? a. The client has experienced no physical harm to herself. b. The client sets realistic goals for herself. c. The client expresses some optimism and hope for the future. d. The client has reached a stage of acceptance in the loss of the relationship with her boyfriend.
a. The client has experienced no physical harm to herself.
As a last resort, an agitated, physically aggressive client is placed in four-point restraints. The client yells, "I'll sue you for assault and battery." The unit manager determines that the nurses are protected under which condition? a. The client is voluntarily committed and poses a danger to others on the unit. b. The client is voluntarily committed and has a history of being a danger to others. c. The client is involuntarily committed because of a history of violent behavior. d. The client is involuntarily committed and is refusing treatment.
a. The client is voluntarily committed and poses a danger to others on the unit. As a threat to others, the client can be restrained despite objections and voluntary commitment.
A client admitted to the emergency department smells strongly of alcohol, and his wife reports he has been a heavy drinker for the last 25 years. Which of the following assessment findings are consistent with long-term chronic alcohol abuse? Select all that apply. a. The client reports weak leg muscles, and his gait is unsteady. b. The client's abdomen is distended. c. The client reports he was coughing up some blood. d. The client reports he has double vision. e. Blood tests reveal a low white blood cell count.
a. The client reports weak leg muscles, and his gait is unsteady. b. The client's abdomen is distended. c. The client reports he was coughing up some blood. d. The client reports he has double vision. e. Blood tests reveal a low white blood cell count.
What are the elements that determine one's response (and subsequent adjustment) to a stressful situation?
a. The type of stressor involved (sudden-shock vs. chronic, continuous) b. Situational factors (economic conditions, family and social support) c. Intrapersonal factors (constitutional vulnerability, temperament)
cognitive theory Predisposing Factors to Trauma-Related Disorders [Theories of Etiology r/t trauma-related disorders]
a. These models take into consideration the cognitive appraisal of an event and focus on assumptions that an individual makes about the world. Epstein (1991) outlines three fundamental beliefs that most people construct within a personal theory of reality: (1) The world is benevolent and a source of joy. (2) The world is meaningful and controllable. (3) The self is worthy (e.g., lovable, good, and competent). b. As life situations occur, some disequilibrium is expected to occur until accommodation for the change has been made and it has become assimilated into one's personal theory of reality. An individual is vulnerable to trauma-related disorders when the fundamental beliefs are invalidated by a trauma that cannot be comprehended and a sense of helplessness and hopelessness prevail. One's appraisal of the environment can be drastically altered.
Guidelines relating to "duty to warn" state that a therapist should consider taking action to warn a 3rd party when his or her client does which of the following? Select all that apply. a. Threatens violence toward another individual b. Identifies a specific intended victim c. Is having command hallucinations d. Reveals paranoid delusions about another individual
a. Threatens violence toward another individual b. Identifies a specific intended victim
An individual who is diagnosed with Adjustment Disorder with Disturbance of Conduct most likely: a. Violates the rights of others to feel better. b. Expresses symptoms that reveal a high level of anxiety. c. Exhibits severe social isolation and withdrawal. d. Is experiencing a complicated grieving process.
a. Violates the rights of others to feel better.
Eye movement desensitization and reprocessing (EMDR)
a. You MUST complete it b. The exact biological mechanisms by which EMDR achieves its therapeutic effects are unknown. Some studies have indicated that eye movements cause a decrease in imagery vividness and distress as well as an increase in memory access. The process, which involves rapid eye movements while processing painful emotions, is thought to "relieve the anxiety associated with the trauma so that the original event can be examined from a more detached perspective, somewhat like watching a movie of what happened". While concentrating on a particular emotion or physical sensation surrounding the traumatic event, the client is asked to focus his or her eye movements on the therapist's fingers as the therapist moves them from left to right and back again. Although some individuals report rapid results with this therapy, research has indicated that from 5 to 12 sessions are required to achieve lasting treatment effects. The treatment encompasses an eight-phase process (history & txt planning, preparation, assessment, desensitization, installation, body scan, closure, & reevaluation) c. *Clients often feel relief quite rapidly with EMDR. However, to achieve lasting results, it is important that each of the eight phases be completed. Treatment is not complete until "EMDR therapy has focused on the past memories that are contributing to the problem, the present situations that are disturbing, and what skills the client may need for the future"*
Sedative/hypnotic/anxiolytic compounds
are drugs of diverse chemical structures that are all capable of inducing varying degrees of *CNS depression* from tranquilizing relief of anxiety to anesthesia, coma, and even death. These include: Barbiturates (Amytal, Seconal, etc) *Nonbarbiturate hypnotics (Lunesta, Ambien, etc)* Antianxiety agents (Xanax, Ativan, Klonopin, etc) Club drugs (Roofies) Effects on the body Effects on sleep and dreaming *(decreases dream time)* Respiratory depression Cardiovascular effects (hypotension) Renal function (can effect urine output) Intoxication With these central nervous system (CNS) depressants, effects can range from disinhibition and aggressiveness to coma and death *(with increasing dosages of the drug)* Withdrawal Onset of symptoms depends on the half-life of the drug from which the person is withdrawing. Severe withdrawal from CNS depressants can be *life threatening*
*ethical principle*
are fundamental guidelines that influence decision-making these principles: 1. autonomy 2. beneficence 3. nonmaleficence 4. veracity 5. justice are helpful and used frequently by health-care workers to assist with ethical decision-making
*Latino Americans*
are the fastest-growing group of people in the United States, comprising 16.9 percent of the population *They represent the largest ethnic minority group.* Ancestry is traced to Mexico, Spain, Puerto Rico, Cuba, and other countries of Central and South America. The common language is Spanish. *Touch is a common form of communication.* are group oriented and the primary social organization is a *large extended family.* present oriented. Roman Catholicism is the predominant religion. Folk medicine combines elements of Roman Catholicism with Indian and Spanish ancestries. The folk healer is called a curandero (male) or curandera (female). Many still subscribe to the "hot and cold" theory of disease (a concept similar to the yin and yang beliefs of Asian Americans). The prevalence for psychiatric illness is higher among U.S.-born Latinos than it is for immigrants from the same cultural group.
Nina, who is depressed following the breakup of a very stormy marriage, says to the nurse, "I feel so bad. I thought I would feel better once I left, but I feel worse!" Which is the best response by the nurse? a. "Cheer up, Nina. You have a lot to be happy about." b. "You are grieving the loss of your marriage. It's natural for you to feel badly." c. "Try not to dwell on how you feel. If you don't think about it, you'll feel better." d. "You did the right thing, Nina. Knowing that should make you feel better."
b. "You are grieving the loss of your marriage. It's natural for you to feel badly."
Dan, who has been admitted to the alcohol rehabilitation unit after being fired for drinking on the job, states to the nurse, "I don't have a problem with alcohol. I can handle my booze better than anyone I know. My boss is a jerk! I haven't missed any more days than my coworkers." What is the nurse's best response? a. "Maybe your boss is mistaken, Dan." b. "You are here because your drinking was interfering with your work, Dan." c. "Get real, Dan! You're a boozer and you know it!" d. "Why do you think your boss is a jerk, Dan?"
b. "You are here because your drinking was interfering with your work, Dan."
Maria is an Italian American who is in the hospital after having suffered a miscarriage at 5 months' gestation. Her room is filled with relatives who have brought a variety of foods and gifts for Maria. They are all talking, seemingly at the same time, and some, including Maria, are crying. They repeatedly touch and hug Maria and each other. How should the nurse handle this situation? a. Explain to the family that Maria needs her rest and they must all leave. b. Allow the family to remain and continue their activity as described, as long as they do not disturb other clients. c. Explain that Maria will not get over her loss if they keep bringing it up and causing her to cry so much. d. Call the family priest to come and take charge of this family situation.
b. Allow the family to remain and continue their activity as described, as long as they do not disturb other clients.
Conduct disorder may be a precursor to the diagnosis of which personality disorder? a. Narcissistic personality disorder b. Antisocial personality disorder c. Histrionic personality disorder d. Passive-aggressive personality disorder
b. Antisocial personality disorder Antisocial personality disorder is a pattern of socially irresponsible, exploitative, and guiltless behavior that reflects a disregard for the rights of others. Conduct disorder can be a precursor to the diagnosis of antisocial personality disorder. A diagnosis of antisocial personality disorder would not be assigned until a client is 18 years of age or older.
*The nurse assists the physician with electroconvulsive therapy on his client who has REFUSED to give consent. With which of the following legal actions might the nurse be charged because of this nursing action?* a. Assault b. Battery c. False imprisonment d. Breach of confidentiality
b. Battery
Which of the following groups is most commonly used for drug management of the child with ADHD? a. CNS depressants (e.g., diazepam [Valium]) b. CNS stimulants (e.g., methylphenidate [Ritalin]) c. Anticonvulsants (e.g., phenytoin [Dilantin]) d. Major tranquilizers (e.g., haloperidol [Haldol])
b. CNS stimulants (e.g., methylphenidate [Ritalin])
Theresa, who has been hospitalized following a suicide attempt, is placed on suicide precautions on the psychiatric unit. She admits that she is still feeling suicidal. Which of the following interventions is most appropriate in this instance? a. Obtain an order from the physician to place Theresa in restraints to prevent any attempts to harm herself. b. Check on Theresa every 15 minutes, or assign a staff person to stay with her on a one-to-one basis. c. Obtain an order from the physician to give Theresa a sedative to calm her and reduce suicide ideas. d. Do not allow Theresa to participate in any unit activities while she is on suicide precautions.
b. Check on Theresa every 15 minutes, or assign a staff person to stay with her on a one-to-one basis.
Which of the following medications is the physician most likely to order for a client experiencing alcohol withdrawal syndrome? a. Haloperidol (Haldol) b. Chlordiazepoxide (Librium) c. Methadone (Dolophine) d. Phenytoin (Dilantin)
b. Chlordiazepoxide (Librium)
The nurse decides to go against family wishes and tell the client of his terminal status because that is what she would want if she were the client. Which of the following ethical theories is considered in this decision? a. Kantianism b. Christian ethics c. Natural law theories d. Ethical egoism
b. Christian ethics
Nina recently left her husband of 10 years. She was very dependent on her husband and is having difficulty adjusting to an independent lifestyle. She has been hospitalized with a diagnosis of Adjustment Disorder with Depressed Mood. Which of the following is the priority nursing diagnosis for Nina? a. Risk-prone health behavior related to loss of dependency b. Complicated grieving related to breakup of marriage c. Ineffective communication related to problems with dependency d. Social isolation related to depressed mood
b. Complicated grieving related to breakup of marriage
The nurse must give Frank, a Latino American, a physical examination. She asks him to remove his clothing and put on an examination gown. Frank refuses. What cultural norm among Latino Americans most likely explains Frank's response? a. Frank does not believe in taking orders from a woman. b. Frank is modest and embarrassed to remove his clothes. c. Frank does not understand why he must remove his clothes. d. Frank does not think he needs a physical examination.
b. Frank is modest and embarrassed to remove his clothes.
Which of the following individuals is at highest risk for suicide? a. Nancy, age 33, Asian American, Catholic, middle socioeconomic group, alcoholic b. John, age 72, white, Methodist, low socioeconomic group, diagnosis of metastatic cancer of the pancreas c. Carol, age 15, African American, Baptist, high socioeconomic group, no physical or mental health problems d. Mike, age 55, Jewish, middle socioeconomic group, suffered myocardial infarction a year ago
b. John, age 72, white, Methodist, low socioeconomic group, diagnosis of metastatic cancer of the pancreas
Which is a misconception about suicide? a. Initial mood improvement can precipitate suicide. b. Most individuals commit suicide by taking an overdose of drugs. c. Most suicidal individuals are ambivalent about their feelings regarding suicide. d. Eight out of ten individuals who commit suicide give warnings about their intentions.
b. Most individuals commit suicide by taking an overdose of drugs. gunshot wounds are the leading cause of suicide
A nurse gave a client 5 mg of haloperidol (Haldol) for agitation. The client's chart was clearly stamped "Allergic HALDOL." The client suffered anaphylactic shock and died. How would the nurse's actions be labeled? a. Intentional tort b. Negligence c. Battery d. Assault
b. Negligence The nursing action was an unreasonable and careless act. The nurse was negligent and could be held liable for the client's death.
Which of the following statements is correct regarding the use of restraints? Select all that apply. a. Restraints may never be initiated without a physician's order. b. Orders for restraints must be reissued by a physician every 2 hours for children and adolescents. c. Clients in restraints must be observed and assessed every hour for issues regarding circulation, nutrition, respiration, hydration, and elimination. d. An in-person evaluation must be conducted within 1 hour of initiating restraints.
b. Orders for restraints must be reissued by a physician every 2 hours for children and adolescents. d. An in-person evaluation must be conducted within 1 hour of initiating restraints.
From which of the following symptoms might the nurse identify a chronic cocaine user? a. Clear, constricted pupils b. Red, irritated nostrils c. Muscle aches d. Conjunctival redness
b. Red, irritated nostrils
a. Very common symptoms of early-onset bipolar disorder:
b. Separation anxiety c. Rages & explosive temper tantrums (lasting up to several hours) d. Marked irritability e. Oppositional behavior f. Frequent mood swings g. Distractibility h. Hyperactivity i. Impulsivity j. Restlessness/fidgetiness k. Silliness, goofiness, giddiness l. Racing thoughts
In an effort to help the child with mild to moderate intellectual developmental disorder develop satisfying relationships with others, which of the following nursing interventions is most appropriate? a. Interpret the child's behavior for others. b. Set limits on behavior that is socially inappropriate. c. Allow the child to behave spontaneously, for he or she has no concept of right or wrong. d. This child is not capable of forming social relationships.
b. Set limits on behavior that is socially inappropriate.
The child with ADHD has a nursing diagnosis of impaired social interaction. Which of the following nursing interventions are appropriate for this child? Select all that apply. a. Socially isolate the child when interactions with others are inappropriate. b. Set limits with consequences on inappropriate behaviors. c. Provide rewards for appropriate behaviors. d. Provide group situations for the child.
b. Set limits with consequences on inappropriate behaviors. c. Provide rewards for appropriate behaviors. d. Provide group situations for the child.
Sarah is an African American woman who receives a visit from the psychiatric home health nurse. A referral for a mental health assessment was made by the public health nurse, who noticed that Sarah was becoming exceedingly withdrawn. When the psychiatric nurse arrives, Sarah says to her, "No one can help me. I was an evil person in my youth, and now I must pay." How might the nurse assess this statement? a. Sarah is having delusions of persecution. b. Some African Americans believe illness is God's punishment for their sins. c. Sarah is depressed and just wants to be left alone. d. African Americans do not believe in psychiatric help.
b. Some African Americans believe illness is God's punishment for their sins.
John, a veteran of the war in Iraq, is diagnosed with PTSD. He says to the nurse, "I can't figure out why God took my buddy instead of me." From this statement, the nurse assesses which of the following in John? a. Repressed anger b. Survivor's guilt c. Intrusive thoughts d. Spiritual distress
b. Survivor's guilt
Success of long-term psychotherapy with Theresa (who attempted suicide following a break-up with her boyfriend) could be measured by which of the following behaviors? a. Theresa has a new boyfriend. b. Theresa has an increased sense of self-worth. c. Theresa does not take antidepressants anymore. d. Theresa told her old boyfriend how angry she was with him for breaking up with her.
b. Theresa has an increased sense of self-worth.
Which of the following activities would be most appropriate for the child with attention deficit/hyperactivity disorder (ADHD)? a. Monopoly b. Volleyball c. Pool d. Checkers
b. Volleyball
Theresa, age 27, was admitted to the psychiatric unit from the medical intensive care unit where she was treated for taking a deliberate overdose of her antidepressant medication, trazodone (Desyrel). She says to the nurse, "My boyfriend broke up with me. We had been together for 6 years. I love him so much. I know I'll never get over him." Which is the best response by the nurse? a. "You'll get over him in time, Theresa." b. "Forget him. There are other fish in the sea." c. "You must be feeling very sad about your loss." d. "Why do you think he broke up with you, Theresa?"
c. "You must be feeling very sad about your loss."
The child with autism spectrum disorder (ASD) has difficulty with trust. With this in mind, which of the following nursing actions would be most appropriate? a. Encourage all staff to hold the child as often as possible, conveying trust through touch. b. Assign a different staff member each day so child will learn that everyone can be trusted. c. Assign same staff person as often as possible to promote feelings of security and trust. d. Avoid eye contact, because this is extremely uncomfortable for the child, and may even discourage trust.
c. Assign same staff person as often as possible to promote feelings of security and trust.
A client with a history of a suicide attempt has been discharged and is being followed in an outpatient clinic. At this time, which is the most appropriate nursing intervention for this client? a. Observe the client continuously to prevent self-harm. b. Provide the client with a safe and structured environment. c. Assist the client to develop more effective coping mechanisms. d. Isolate the client from all stressful situations that may precipitate a suicide attempt.
c. Assist the client to develop more effective coping mechanisms.
Symptoms of alcohol withdrawal include which of the following? a. Euphoria, hyperactivity, and insomnia b. Depression, suicidal ideation, and hypersomnia c. Diaphoresis, nausea and vomiting, and tremors d. Unsteady gait, nystagmus, and profound disorientation
c. Diaphoresis, nausea and vomiting, and tremors
A client diagnosed with chronic alcoholism says to the nurse, "I'm tired of using and I want to stop. Is there a medication that can help me maintain sobriety?" About which medication would the nurse provide information? a. Carbamazepine (Tegretol) b. Clonidine (Catapres) c. Disulfiram (Antabuse) d. Folic acid (Folvite)
c. Disulfiram (Antabuse) Disulfiram is used as a deterrent to drinking. Ingestion of alcohol while disulfiram is in the body results in a syndrome of symptoms that can cause varying degrees of discomfort. It can even result in death if blood alcohol levels are high. It is important that the client understands that all alcohol, oral or topical, and medications that contain alcohol, are strictly prohibited when taking this drug.
An adolescent diagnosed with attention-deficit/hyperactivity disorder (ADHD) is having difficulty maintaining concentration in the inpatient milieu. Which nursing intervention would help improve the client's task performance? a. Mandate that the client remains in his room until all homework is complete. b. Remove privileges if homework is not completed within a 2-hour period. c. Encourage dividing tasks into smaller, attainable steps and reward successful completion. d. Seek a physician's order to discontinue the stimulant methylphenidate (Ritalin).
c. Encourage dividing tasks into smaller, attainable steps and reward successful completion. A client with a short attention span can be over-whelmed with large tasks. Rewards for task completion are more successful than punishments for task completion failure. Positive reinforcements increase self-esteem and provide incentives for future positive behaviors
*A competent, voluntary client has stated he wants to leave the hospital. The nurse hides his clothes in an effort to keep him from leaving. With which of the following legal actions might the nurse be charged because of this nursing action?* a. Assault b. Battery c. False imprisonment d. Breach of confidentiality
c. False imprisonment
The nursing history and assessment of an adolescent with a conduct disorder might reveal all of the following behaviors except: a. Manipulation of others for fulfillment of own desires. b. Chronic violation of rules. c. Feelings of guilt associated with the exploitation of others. d. Inability to form close peer relationships.
c. Feelings of guilt associated with the exploitation of others.
Frank is a Latino American who has an appointment at the community health center for 1:00 p.m. The nurse is angry when Frank shows up at 3:30 p.m. stating, "I was visiting with my brother." How must the nurse interpret this behavior? a. Frank is being passive-aggressive by showing up late. b. This is Frank's way of defying authority. c. Frank is a member of a cultural group that is present-time oriented. d. Frank is a member of a cultural group that rejects traditional medicine.
c. Frank is a member of a cultural group that is present-time oriented.
In determining degree of suicidal risk with a suicidal client, the nurse assesses the following behavioral manifestations: severely depressed, withdrawn, statements of worthlessness, difficulty accomplishing activities of daily living, no close support systems. The nurse identifies the client's risk for suicide as which of the following? a. Low b. Moderate c. High d. Unable to be determined
c. High
The nurse decides to tell the client of his terminal status because she believes it is her DUTY to do so. Which of the following ethical theories is considered in this decision? a. Natural law theories b. Ethical egoism c. Kantianism d. Utilitarianism
c. Kantianism
*Know which nursing diagnoses you would use to care for patients that are substance addicted.* TABLE 14-9 Assigning Nursing Diagnoses to Behaviors Commonly Associated With Substance Use Disorders
c. Makes statements such as, "I don't have a problem with [substance]. I can quit any time I want to." Delays seeking assistance; does not perceive problems related to use of substances; minimizes use of substances; unable to admit impact of disease on life pattern i. Ineffective denial d. Abuse of chemical agents; destructive behavior toward others and self; inability to meet basic needs; inability to meet role expectations; risk taking i. Ineffective coping e. Loss of weight, pale conjunctiva and mucous membranes, decreased skin turgor, electrolyte imbalance, anemia, drinks alcohol instead of eating i. *Imbalanced nutrition: Less than body requirements* ii. Deficient fluid volume f. Risk factors: *malnutrition*, altered immune condition, failing to avoid exposure to pathogens i. Risk for infection g. Criticizes self and others, self-destructive behavior (abuse of substances as a coping mechanism), dysfunctional family background i. Chronic low self-esteem h. Denies that substance is harmful; continues to use substance in light of obvious consequences i. Deficient knowledge i. FOR CLIENT WITHDRAWING FROM CNS DEPRESSANTS j. Risk factors: CNS agitation (tremors, elevated blood pressure, nausea and vomiting, hallucinations, illusions, tachycardia, anxiety, seizures) i. *Risk for injury* (the highest priority!) k. FOR CLIENT WITHDRAWING FROM CNS STIMULANTS l. Risk factors: intense feelings of lassitude and depression; "crashing," suicidal ideation i. Risk for suicide
Nina has been hospitalized with Adjustment Disorder with Depressed Mood following the breakup of her marriage. Which of the following is true regarding the diagnosis of adjustment disorder? a. Nina will require long-term psychotherapy to achieve relief. b. Nina likely inherited a genetic tendency for the disorder. c. Nina's symptoms will likely remit once she has accepted the change in her life. d. Nina probably would not have experienced adjustment disorder if she had a higher level of intelligence.
c. Nina's symptoms will likely remit once she has accepted the change in her life.
The nurse is caring for an actively suicidal client on the psychiatric unit. What is the nurse's *priority* intervention? a. Provide opportunities for increasing the client's self-worth, morale, and control. b. Discuss strategies for the management of anxiety, anger, and frustration. c. Place client on suicide precautions with one-to-one observation. d. Explore experiences that affirm self-work and self-efficacy.
c. Place client on suicide precautions with one-to-one observation.
Sarah is an African American woman who lives in the rural South. She receives a visit from the public health nurse. Sarah says to the nurse, "Granny told me to eat a lot of poke greens, and I would feel better." What cultural norm among African Americans most likely explains Sarah's response? a. Sarah's grandmother believes in the healing power of poke greens. b. Sarah believes everything her grandmother tells her. c. Sarah has been receiving health care from a folk practitioner. d. Sarah is trying to determine if the nurse agrees with her grandmother.
c. Sarah has been receiving health care from a folk practitioner.
Dan has been admitted to the alcohol rehabilitation unit after being fired for drinking on the job. Dan's drinking buddies come for a visit, and when they leave, the nurse smells alcohol on Dan's breath. Which of the following would be the best intervention with Dan at this time? a. Search his room for evidence. b. Ask, "Have you been drinking alcohol, Dan?" c. Send a urine specimen from Dan to the lab for drug screening. d. Tell Dan, "These guys cannot come to the unit to visit you again."
c. Send a urine specimen from Dan to the lab for drug screening.
Miss Lee is an Asian American on the psychiatric unit. She tells the nurse, "I must have the hot ginger root for my headache. It is the only thing that will help." What cultural belief is likely associated with Miss Lee's request? a. She is being obstinate and wants control over her care. b. She believes that ginger root has magical qualities. c. She subscribes to the restoration of health through the balance of yin and yang. d. Asian Americans refuse to take traditional medicine for pain.
c. She subscribes to the restoration of health through the balance of yin and yang.
John, a veteran of the war in Iraq, is diagnosed with PTSD. He experiences a nightmare during his first night in the hospital. He explains to the nurse that he was dreaming about gunfire all around and people being killed. Which of the following is the nurse's most appropriate initial intervention? a. Administer alprazolam as ordered prn for anxiety. b. Call the physician and report the incident. c. Stay with John and reassure him of his safety. d. Have John listen to a tape of relaxation exercises.
c. Stay with John and reassure him of his safety.
Attempting to calm an angry client by using "talk therapy" is an example of which of the following clients' rights? a. The right to privacy b. The right to refuse medication c. The right to the least-restrictive treatment alternative d. The right to confidentiality
c. The right to the least-restrictive treatment alternative
adjustment disorder w/ disturbance of conduct
characterized by conduct in which there is violation of the rights of others or of major age appropriate societal norms and rules, must be differentiated from those of conduct disorder or antisocial personality disorder a. This category is characterized by conduct in which there is violation of the rights of others or of major age-appropriate societal norms and rules. Examples include truancy, vandalism, reckless driving, fighting, and defaulting on legal responsibilities. Differential diagnosis must be made from conduct disorder or antisocial personality disorder.
adjustment disorder w/ mixed disturbance of emotion and conduct
characterized by emotional disturbances (depression or anxiety) and disturbances of conduct a. The predominant features of this category include emotional disturbances (e.g., anxiety or depression) as well as disturbances of conduct in which there is violation of the rights of others or of major age-appropriate societal norms and rules (e.g., truancy, vandalism, fighting).
Which is a potential side effect from the prolonged use of methylphenidate (Ritalin)? a. Psychosis b. A decreased intelligence quotient (IQ) c. Weight gain d. A decrease in rate of growth and development
d. A decrease in rate of growth and development A temporary decrease in the rate of growth and development may be a side effect of Ritalin therapy.
*Joe is very restless and is pacing a lot. The nurse says to Joe, "If you don't sit down in the chair and be still, I'm going to put you in restraints!" With which of the following legal actions might the nurse be charged because of this nursing action?* a. Defamation of character b. Battery c. Breach of confidentiality d. Assault
d. Assault
Miss Lee, an Asian American on the psychiatric unit, says she is afraid that no one from her family will visit her. On what belief does Miss Lee base her statement? a. Many Asian Americans do not believe in hospitals. b. Many Asian Americans do not have close family support systems. c. Many Asian Americans believe the body will heal itself if left alone. d. Many Asian Americans view psychiatric problems as bringing shame to the family.
d. Many Asian Americans view psychiatric problems as bringing shame to the family.
An individual who is addicted to heroin is likely to experience which of the following symptoms of withdrawal? a. Increased heart rate and blood pressure b. Tremors, insomnia, and seizures c. Incoordination and unsteady gait d. Nausea and vomiting, diarrhea, and diaphoresis
d. Nausea and vomiting, diarrhea, and diaphoresis
Certain family dynamics often predispose adolescents to the development of conduct disorder. Which of the following patterns is thought to be a contributing factor? a. Parents who are overprotective b. Parents who have high expectations for their children c. Parents who consistently set limits on their children's behavior d. Parents who are alcohol dependent
d. Parents who are alcohol dependent
Carol, age 16, has recently been diagnosed with diabetes mellitus. She must watch her diet and take an oral hypoglycemic medication daily. She has become very depressed, and her mother reports that Carol refuses to change her diet and often skips her medication. Carol has been hospitalized for stabilization of her blood sugar. The psychiatric nurse practitioner has been called in as a consult. Which of the following nursing diagnoses by the psychiatric nurse would be a priority for Carol at this time? a. Anxiety related to hospitalization evidenced by noncompliance b. Low self-esteem related to feeling different from her peers evidenced by social isolation c. Risk for suicide related to new diagnosis of diabetes mellitus d. Risk-prone health behavior related to denial of seriousness of her illness evidenced by refusal to follow diet and take medication
d. Risk-prone health behavior related to denial of seriousness of her illness evidenced by refusal to follow diet and take medication
Which of the following may be influential in the predisposition to PTSD? a. Unsatisfactory parent-child relationship b. Excess of the neurotransmitter serotonin c. Distorted, negative cognitions d. Severity of the stressor and availability of support systems
d. Severity of the stressor and availability of support systems
Theresa is hospitalized following a suicide attempt after breaking up with her boyfriend. Freudian psychoanalytic theory would explain Theresa's suicide attempt in which of the following ways? a. She feels hopeless about her future without her boyfriend. b. Without her boyfriend, she feels like an outsider with her peers. c. She is feeling intense guilt because her boyfriend broke up with her. d. She is angry at her boyfriend for breaking up with her and has turned the anger inward on herself.
d. She is angry at her boyfriend for breaking up with her and has turned the anger inward on herself.
As a child, Mark was physically abused by his father. The father is now dying and has expressed a desire to see his son before he dies. Mark is depressed and says to the mental health nurse, "I'm so angry! Why did God have to give me a father like this? I feel cheated of a father! I've always been a good person. I deserved better. I hate God!" From this subjective data, which nursing diagnosis might the nurse apply to Mark? a. Readiness for enhanced religiosity b. Risk for impaired religiosity c. Readiness for enhanced spiritual well-being d. Spiritual distress
d. Spiritual distress
Joe, a American Indian, goes to the emergency department (ED) because he has an oozing stasis ulcer on his leg. He is accompanied by the tribal shaman, who has been treating Joe on the reservation. As a greeting, the physician extends his hand to the shaman, who lightly touches the physician's hand, then quickly moves away. What cultural norm among Native Americans most likely explains the shaman's behavior? a. The shaman is snubbing the physician. b. The shaman is angry at Joe for wanting to go to the ED. c. The shaman does not believe in traditional medicine. d. The shaman does not feel comfortable with touch.
d. The shaman does not feel comfortable with touch.
A client is brought to the emergency department. The client is aggressive, has slurred speech, and impaired motor coordination. Blood alcohol level is 347 mg/dL. Among the physician's orders is thiamine. Which is the rationale for this intervention? a. To prevent nutritional deficits b. To prevent pancreatitis c. To prevent alcoholic hepatitis d. To prevent Wernicke's encephalopathy
d. To prevent Wernicke's encephalopathy Wernicke's encephalopathy is the most serious form of thiamine deficiency in clients diagnosed with alcoholism. If thiamine replacement therapy is not undertaken quickly, death will ensue.
gastritis
fects of alcohol on the stomach include inflammation of the stomach lining characterized by epigastric distress, nausea, vomiting, and distention. Alcohol breaks down the stomach's protective mucosal barrier, allowing hydrochloric acid to erode the stomach wall. Damage to blood vessels may result in hemorrhage - The effects of alcohol on the stomach include inflammation of the stomach lining characterized by epigastric distress, nausea, vomiting, and distention. Alcohol breaks down the stomach's protective mucosal barrier, allowing hydrochloric acid to erode the stomach wall. Damage to blood vessels may result in hemorrhage.
*cognitive therapy!!!*
helps recognize and modify trauma-related thoughts and beliefs a. *Client has to change negative thoughts* b. *Helps change negative thoughts to positive thoughts* c. Cognitive therapy for PTSD and ASD strives to help the individual recognize and modify trauma-related thoughts and beliefs. The individual learns to modify the relationships between thoughts and feelings and to identify and challenge inaccurate or extreme automatic negative thoughts. The goal is to replace these negative thoughts with more accurate and less distressing thoughts and to cope more effectively with feelings such as anger, guilt, and fear. The individual is assisted to modify the appraisal of self and the world as it has been affected by the trauma and to regain hope and optimism about safety, trust, power and control, esteem, and intimacy.
*alcohol meds*
i. Benzodiazepines are the most widely used group of drugs for substitution therapy in alcohol withdrawal. Chlordiazepoxide (Librium), oxazepam (Serax), lorazepam (Ativan), and diazepam (Valium) are the most commonly used agents. The approach to treatment with benzodiazepines for alcohol withdrawal is to start with relatively high doses and reduce the dosage by 20 to 25 percent each day until withdrawal is complete. Additional doses may be given for breakthrough signs or symptoms (Black & Andreasen, 2014). In clients with liver disease, accumulation of the longer-acting agents (chlordiazepoxide and diazepam) may be problematic, and use of the shorter-acting benzodiazepines (lorazepam or oxazepam) is more appropriate. ii. Some physicians may order anticonvulsant medication (e.g., carbamazepine, valproic acid, or gabapentin) for management of withdrawal seizures. These drugs are particularly useful in individuals who undergo repeated episodes of alcohol withdrawal. Repeated episodes of withdrawal appear to "kindle" even more serious withdrawal episodes, including the production of withdrawal seizures that can result in brain damage (Julien, 2014). These anticonvulsants have been used successfully in both acute withdrawal and longer-term craving situations. iii. Multivitamin therapy in combination with daily injections or oral administration of thiamine is common protocol. Thiamine is commonly deficient in chronic alcoholics. Replacement therapy is required to prevent neuropathy, confusion, and encephalopathy.
*opioid meds*
i. Examples of drugs in the opioid classification include opium, morphine, codeine, heroin, hydromorphone, oxycodone, and hydrocodone. Synthetic opiate-like narcotic analgesics include meperidine, methadone, pentazocine, and fentanyl. With short-acting drugs such as heroin, withdrawal symptoms occur within 6 to 8 hours after the last dose, peak within 1 to 3 days, and gradually subside over a period of 5 to 7 days (Walton-Moss et al., 2010). With longer-acting drugs such as methadone, withdrawal symptoms begin within 1 to 3 days after the last dose, peak between days 4 and 6, and are complete in 14 to 21 days (Leamon et al., 2008). Withdrawal from the ultra-short-acting meperidine begins quickly, reaches a peak in 8 to 12 hours, and is complete in 4 to 5 days (Sadock et al., 2015). ii. Opioid intoxication is treated with narcotic antagonists such as *naloxone (Narcan)*, naltrexone (ReVia), or nalmefene (Revex). In 2015, the FDA approved an intranasal form of naloxone hydrochloride under a fast-track approval process in response to the continued increase in deaths associated with drug overdose, particularly from respiratory depression and arrest. It is reported to work within 2 minutes but must be given quickly to prevent death (Brown, 2015). Naloxone nasal spray can cause severe withdrawal in patients who are opioid dependent. Withdrawal therapy includes rest, adequate nutritional support, and methadone substitution. Methadone, if ordered, is given on the first day in a dose sufficient to suppress withdrawal symptoms. The dose is then gradually tapered over a specified time. As the dose of methadone diminishes, renewed abstinence symptoms may be ameliorated by the addition of clonidine. iii. In October 2002, the FDA approved two forms of the drug buprenorphine for treating opiate addiction. Buprenorphine is less powerful than methadone but is considered to be somewhat safer and causes fewer side effects, making it especially attractive for clients who are mildly or moderately addicted. Individuals are able to access treatment with buprenorphine in office-based settings, providing an alternative to methadone clinics. Physicians are deemed qualified to prescribe buprenorphine if they hold an addiction certification from the American Society of Addiction Medicine, the American Academy of Addiction Psychiatry, the American Psychiatric Association, or other associations deemed appropriate. The number of patients to whom individual physicians may provide outpatient buprenorphine treatment is limited to 100 (Gordon, 2009). A sublingual formulation of a combination medication with buprenorphine and *naloxone (Suboxone)* is also available. iv. Clonidine (Catapres) also has been used to suppress opiate withdrawal symptoms. As monotherapy, it is not as effective as substitution with methadone, but it is nonaddicting and serves effectively as a bridge to enable the client to stay opiate free long enough to facilitate termination of methadone maintenance.
depressants meds
i. Substitution therapy for CNS depressant withdrawal (particularly barbiturates) is most commonly with the long-acting barbiturate phenobarbital (Luminal). The dosage required to suppress withdrawal symptoms is administered. When stabilization has been achieved, the dose is gradually decreased by 30 mg/day until withdrawal is complete. Long-acting benzodiazepines are commonly used for substitution therapy when the abused substance is a nonbarbiturate CNS depressant
f. Hallucinogens and Cannabinols meds
i. Substitution therapy is not required with these drugs. When adverse reactions, such as anxiety or panic, occur, benzodiazepines (e.g., diazepam or chlordiazepoxide) may be prescribed to prevent harm to the client or others. Psychotic reactions may be treated with antipsychotic medications.
Spiritual Assessment Tool Relationships
i. These questions assess a person's ability to connect in life-giving ways with family, friends, and social groups and to engage in the forgiveness of others. ii. Who are the significant people in your life? iii. Who are your readily available, nearby support people? iv. Who are the people to whom you are closest? v. Describe any groups in which you are an active participant. vi. How comfortable are you with asking people for help when you need it? vii. How comfortable are you with sharing your feelings with others? viii. What are some of the most loving things that others have done for you? ix. What are the loving things that you do for other people? x. What are your thoughts about forgiving others?
Spiritual Assessment Tool Environment
i. These questions assess a person's ability to experience a sense of connection with life and nature, an awareness of the effects of the environment on life and well-being, and a capacity or concern for the health of the environment. ii. How does your environment have an impact on your state of well-being? iii. What are your environmental stressors at work and at home? iv. What strategies reduce your environmental stressors? v. Do you have any concerns for the state of your immediate environment? vi. Are you involved with environmental issues such as recycling environmental resources at home, work, or in your community? vii. Are you concerned about the survival of the planet?
Spiritual Assessment Tool Behavior and Activities
i. These questions assess a person's capacity for finding meaning in worship or religious activities, and a connectedness with a divinity. ii. How important is worship to you? iii. What do you consider the most significant act of worship in your life? iv. Describe any religious activities in which you are an active participant. v. Describe any spiritual activities, if any, that you find meaningful. vi. Do you find prayer meaningful? vii. To whom do you turn for support? viii. Describe any activities in which you engage for coping and support. ix. Describe any activities in which you have previously engaged and have not found helpful.
Spiritual Assessment Tool Interconnections
i. These questions assess a person's positive self-concept, self-esteem, and sense of self; sense of belonging in the world with others; capacity to pursue personal interests; and ability to demonstrate love of self and self-forgiveness. ii. How do you feel about yourself right now? iii. How do you feel when you have a true sense of yourself? iv. Describe any activities of personal interest that you pursue. v. What do you do to show love for yourself? vi. Can you forgive yourself? vii. What do you do to heal your spirit?
stimulants meds
i. Treatment of stimulant intoxication usually begins with minor tranquilizers such as chlordiazepoxide and progresses to major tranquilizers such as haloperidol (Haldol). Antipsychotics should be administered with caution because of their propensity to lower seizure threshold. Repeated seizures are treated with intravenous diazepam. ii. Withdrawal from CNS stimulants is not the medical emergency observed with CNS depressants. Treatment is usually aimed at reducing drug craving and managing severe depression. The client is placed in a quiet atmosphere and allowed to sleep and eat as much as is needed or desired. Suicide precautions may need to be instituted. Antidepressant therapy may be helpful in treating symptoms of depression.
*the individual (coping skills) [psychosocial theory]* Predisposing Factors to Trauma-Related Disorders [Theories of Etiology r/t trauma-related disorders]
i. do they have good coping skills? That's a big one ii. more at risk if there are preexisting psychopathology iii. The variables that follow are considered important in determining an individual's response to trauma: 1. Degree of ego strength 2. Effectiveness of coping resources 3. *Presence of preexisting psychopathology* 4. Outcomes of previous experiences with stress or trauma (stress overload) 5. Behavioral tendencies (temperament) 6. Current psychosocial developmental stage 7. Demographic factors (e.g., age, socioeconomic status, education)
*traumatic experience (the severity of the stressor) [psychosocial theory]* Predisposing Factors to Trauma-Related Disorders [Theories of Etiology r/t trauma-related disorders]
i. exposure to death is a big one ii. Specific characteristics relating to the trauma have been identified as crucial elements in the determination of an individual's long-term response to stress. They include the following: 1. Severity and duration of the stressor 2. Extent of anticipatory preparation for the event 3. Exposure to death 4. Numbers affected by life threat 5. Amount of control over recurrence 6. Location where the trauma was experienced (e.g., familiar surroundings, at home, in a foreign country)
*recovery environment (degree of isolation in recovery) [psychosocial theory]* Predisposing Factors to Trauma-Related Disorders [Theories of Etiology r/t trauma-related disorders]
i. less likely to develop PTSD then those who don't ii. It has been suggested that the quality of the environment in which the individual attempts to work through the traumatic experience is correlated with the outcome. Environmental variables include the following: 1. *Availability of social supports* 2. *The cohesiveness and protectiveness of family and friends* 3. *The attitudes of society regarding the experience* 4. Cultural and subcultural influences iii. In research with Vietnam veterans, it was shown that the best predictors of PTSD were the severity of the stressor and the degree of psychosocial isolation in the recovery environment.
*family therapy*
improves functioning within the family a. The focus of treatment is shifted from the individual to the system of relationships in which the individual is involved. The maladaptive response of the identified client is viewed as symptomatic of a dysfunctional family system. All family members are included in the therapy, and treatment serves to improve the functioning within the family network. Emphasis is placed on communication, family rules, and interaction patterns among the family members.
*Neurodevelopmental disorders*
intellectual disability (intellectual developmental disorder), autism spectrum disorder, attention deficit/hyperactivity disorder, Tourette's disorder
• *conditioning* (sociocultural predisposing factor to substance-related disorders)
is a learned response that occurs after repeated exposure to a stimulus. Substance abuse can become a learned response from the substance itself as well as from the environment where use occurs. Many substances create a pleasurable experience that encourages the user to repeat it. Thus, it is the intrinsically reinforcing properties of addictive drugs that "condition" the individual to seek out their use again and again. The environment in which the substance is taken also contributes to the reinforcement. If the environment is pleasurable, substance use is usually increased. Further, as the substance induces a state of pleasure the user may begin to associate that environment as pleasurable after which return to the same environment becomes associated with both drug using and pleasure. Aversive stimuli within an environment are thought to be associated with a decrease in substance use within that environment.
*ethical theory*
is a moral principle or a set of moral principles that can be used in assessing what is morally right or morally wrong. These principles provide different frameworks for ethical decision-making. 1. utilitarianism 2. kantianism 3. christian ethics 4. natural law theories 5. ethical egoism
*intoxication*
is a physical and mental state of exhilaration and emotional frenzy or lethargy and stupor. Substance intoxication is the development of reversible syndromes following excessive use of a substance. These symptoms are drug-specific and occur shortly after ingesting the substance. Judgment is disturbed, resulting in inappropriate and maladaptive behavior, and social and occupational functioning are impaired.
trauma-informed care
is a strength-based framework that is grounded in understanding of and responsiveness to the impact of trauma that emphasizes physical, psychological, and emotional safety for both providers and survivors to rebuild a sense of control and empowerment.
alcoholic hepatitis
is inflammation of the liver caused by long-term heavy alcohol use. Symptoms include an enlarged and tender liver, nausea and vomiting, lethargy, anorexia, elevated white blood cell count, fever, and jaundice. Ascites and weight loss may be evident in more severe cases. With treatment—which includes strict abstinence from alcohol, proper nutrition, and rest—the individual can experience complete recovery. Severe cases can lead to cirrhosis or hepatic encephalopathy. Is inflammation of the liver caused by long-term heavy alcohol use. Symptoms include an enlarged, tender liver; nausea and vomiting; lethargy; anorexia; elevated white blood cell count; fever; and jaundice. Also ascites and weight loss in severe cases. With strict abstinence from alcohol, proper nutrition, and rest, the individual can experience complete recovery.
forgiveness (spiritual need)
is the ability to release from the mind all the past hurts and failures, all sense of guilt and loss. enables a person to cast off resentment and begin the pathway to healing. Holding on to grievances causes pain, suffering, and conflict. Long-held feelings of bitterness and resentment can have a detrimental effect on an individual's health. offers freedom and peace of mind, and enables a person to begin the pathway to healing.
egoistic suicide (sociological theory; predisposing factor: theories of suicide)
is the response of the individual who feels separate and apart from the mainstream of society. Integration is lacking, and the individual does not feel a part of any cohesive group (such as a family or a church) - is the response of the individual who feels separate and apart from the mainstream of society. Integration is lacking, and the individual does not feel a part of any cohesive group (such as a family or a church).
*Table 19-1 | CARE PLAN FOR THE CLIENT WITH A TRAUMA-RELATED DISORDER* h. NURSING DIAGNOSIS: COMPLICATED GRIEVING i. RELATED TO: Loss of self as perceived prior to the trauma or other actual/perceived losses incurred during/following the event j. EVIDENCED BY: Irritability and explosiveness, self-destructiveness, substance abuse, verbalization of survival guilt or guilt about behavior required for survival
k. Short-Term Goal (1) *Client will verbalize feelings (guilt, anger, self-blame, hopelessness) associated with the trauma. !!!* l. Long-Term Goal (1) Client will demonstrate progress in dealing with stages of grief and will verbalize a sense of optimism and hope for the future. m. Nursing Interventions (1) *Acknowledge feelings* of guilt or self-blame that client may express. i. Guilt at having survived a trauma in which others died is common. The client needs to discuss these feelings and recognize that he or she is not responsible for what happened but must take responsibility for own recovery. (2) *Assess stage of grief* in which the client is fixed. Discuss *normalcy of feelings* and behaviors related to stages of grief. i. Knowledge of grief stage is necessary for accurate intervention. Guilt may be generated if client believes it is unacceptable to have these feelings. Knowing they are normal can provide a sense of relief. (3) Assess impact of the trauma on client's ability to resume regular activities of daily living (ADLs). Consider employment, marital relationship, and sleep patterns. i. Following a trauma, individuals are at high risk for physical injury because of disruption in ability to concentrate and problem-solve and because of lack of sufficient sleep. Isolation and avoidance behaviors may interfere with interpersonal relatedness. (4) Assess for self-destructive ideas and behavior. i. The trauma may result in feelings of hopelessness and worthlessness, leading to high risk for suicide. (5) *Assess for maladaptive coping strategies, such as substance abuse.* i. These behaviors interfere with and delay the recovery process. (6) Identify available community resources from which the individual may seek assistance if problems with complicated grieving persist. i. Support groups for victims of various types of traumas exist within most communities. The presence of support systems in the recovery environment has been identified as a major predictor in the successful recovery from trauma
love (spiritual need)
may be identified as a projection of one's own good feelings onto others. To love others, 1 must first experience love of self, and then be able and willing to project that warmth and affectionate concern for others. Some researchers suggest that love has a positive effect on the immune system. The giving and receiving of love may also result in higher levels of endorphins, thereby contributing to a sense of euphoria and helping to reduce pain. May be life's most powerful force and the greatest spiritual need May be an important key in the healing process by having a positive effect on the immune system Studies have shown that individuals can overcome the effects of a deleterious lifestyle if they have the benefit of a strong, loving relationship.
legal right
right on which the society has agreed and formalized into law - Both the NLN and AHA have established guidelines of pts' rights - Although these are not considered legal documents, nurses and hospitals are considered responsible for upholding these rights of patients.
*group/family therapy!!!*
strongly advocated for PTSD a. *Share things that help them get through the trauma* b. Group therapy has been strongly advocated for clients with PTSD. It has proved especially effective with military veterans (Sadock et al., 2015). The importance of being able to share their experiences with empathetic fellow veterans, to talk about problems in social adaptation, and to discuss options for managing their aggression toward others has been emphasized. Some PTSD groups are informal and leaderless, such as self-help or support groups, and some are led by experienced group therapists who may have had some first-hand experience with the trauma. Some groups involve family members, thereby recognizing that the symptoms of PTSD may also severely affect them. Hollander and Simeon (2008) state: Because of past experiences, [clients with PTSD] are often mistrustful and reluctant to depend on authority figures, whereas the identification, support, and hopefulness of peer settings can facilitate therapeutic change.
adjustment disorder unspecified
symptoms are not consistent with any of the other categories. a. This subtype is used when the maladaptive reaction is not consistent with any of the other categories. The individual may have physical complaints, withdraw from relationships, or exhibit impaired work or academic performance, but without significant disturbance in emotions or conduct
*adjustment disorder w/ depressed mood*
the most commonly diagnosed adjustment disorder, symptoms are less pronounced than that of MDD but exceed the expected response to an identified stressor a. This category is the most commonly diagnosed adjustment disorder. The clinical presentation is one of predominant mood disturbance, although it is less pronounced than that of major depressive disorder (MDD). The symptoms, such as depressed mood, tearfulness, and feelings of hopelessness, exceed what is an expected or normative response to an identified stressor.
*the right to the least restrictive treatment alternative* (ethical issues relevant to psychiatric mental health nursing)
this right means that clients who can be adequately treated in an outpatient setting should NOT be hospitalized, and if they are hospitalized, they should not be sedated, restrained, or secluded unless other less restrictive measures were found to be unsuccessful - clients have a right to whatever level of treatment is effective and least restricts their freedom - the "restrictiveness" of psychiatric therapy can be described in the context of a continuum based on severity of illness - clients may be treated on an outpatient basis, in day hospitals, or through voluntary or involuntary hospitalization - s/s may be treated with verbal rehabilitative techniques and move successively to behavioral techniques, chemical interventions, mechanical restraints, or electroconvulsive therapy - ethical issues arise in selecting the least restrictive means among involuntary chemical intervention, seclusion, and mechanical restraints - distinguishing among these interventions on the basis of restrictiveness proves to be a purely subjective exercise fraught with personal bias, each of these 3 interventions is both more and less restrictive than each of the other 2...the effort should be made to think in terms of restrictiveness when deciding how to treat patients
*BOX 12-1 Suicide RISK FACTORS*
• Previous suicide attempt • Mental disorders—particularly mood disorders such as depression and bipolar disorder • Co-occurring mental and alcohol and substance abuse disorders • Family history of suicide • Hopelessness • Impulsive and/or aggressive tendencies • Barriers to accessing mental health treatment • Relational, social, work, or financial loss • Physical illness • Easy access to lethal methods, especially guns • Unwillingness to seek help because of stigma attached to mental and substance abuse disorders and/or suicidal thoughts • Influence of significant people who have died by suicide—family members, celebrities, peers—through direct personal contact or inappropriate media representations • Cultural and religious beliefs—for instance, the belief that suicide is a noble resolution of a personal dilemma • Local epidemics of suicide that have a contagious influence • Isolation, a feeling of being cut off from other people
*informed consent*
Permission granted to a physician by a client to perform a therapeutic procedure, prior to which info about the procedure has been presented to the client with adequate time given for consideration about the pros and cons. - According to law, *ALL individuals have the right to decide whether to accept or reject treatment.* A health-care provider can be charged with assault and battery for providing life-sustaining treatment to a client when the client has not agreed to it. - The rationale for this doctrine is the preservation and protection of individual autonomy in determining what will and will not happen to the person's body - The client should receive info such as what treatment alternatives are available; why the physician believes this treatment is most appropriate; the possible outcomes, risks, and adverse effects; the possible outcome should the client select another treatment alternative; and the possible outcome should the client choose to have no treatment - example of a treatment in the psychiatric area that requires informed consent is: *electroconvulsive therapy* - There are some conditions under which treatment may be performed w/o obtaining informed consent - A client's refusal to accept treatment may be challenged under the following circumstances: 1. When a client is mentally incompetent to make a decision and treatment is necessary to preserve life or avoid serious harm 2. When refusing treatment endangers the life or health of another 3. During an emergency in which a client is in no condition to exercise judgment 4. When the client is a child (consent is obtained from parent or surrogate) 5. In the case of therapeutic privilege: Information about a treatment may be withheld if the physician can show that full disclosure would 6. hinder or complicate necessary treatment 7. cause severe psychological harm 8. be so upsetting as to render a rational decision by the client IMPOSSIBLE - Although most clients in psychiatric and mental health facilities are competent and capable of giving it, those w/ severe psychiatric illness do NOT possess the cognitive ability to do so - If an individual has been legally determined to be mentally incompetent, consent is obtained from the legal guardian. - Difficulty arises when no legal determination has been made, but the individual's current mental state prohibits informed decision-making (e.g., the person who is psychotic, unconscious, or inebriated), is usually obtained from the individual's nearest relative, or if none exist and time permits, the physician may ask the court to appoint a conservator or guardian - When time does not permit court intervention, permission may be sought from the hospital ADMINISTRATOR - A client or guardian ALWAYS has the right to withdraw consent after it has been given, when this occurs, the physician should inform (or re-inform) the client about the consequences of refusing treatment - If treatment has already been initiated, the physician should terminate treatment in a way least likely to cause injury to the client and inform the client or guardian of the risks associated with interrupted treatment
c. BOX 14-7 Diagnostic Criteria for Gambling Disorder
Persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress, as indicated by the individual exhibiting four (or more) of the following in a 12-month period: 1. Needs to gamble with increasing amounts of money in order to achieve the desired excitement 2. Is restless or irritable when attempting to cut down or stop gambling 3. Has made repeated unsuccessful efforts to control, cut back, or stop gambling 4. Is often preoccupied with gambling (e.g., persistent thoughts of reliving past gambling experiences, handicapping or planning the next venture, or thinking of ways to get money with which to gamble) 5. Often gambles when feeling distressed (e.g., helpless, guilty, anxious, depressed) 6. After losing money gambling, often returns another day to get even ("chasing" one's losses) 7. Lies to conceal the extent of involvement with gambling 8. Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling 9. Relies on others to provide money to relieve desperate financial situations caused by gambling - The gambling behavior is not better explained by a manic episode. iii. Specify if: 1. Episodic: meeting diagnostic criteria at more than one time point, with symptoms subsiding between periods of gambling disorder for at least several months. 2. Persistent: Experiencing continuous symptoms, to meet diagnostic criteria for multiple years. iv. Specify if: 1. In early remission: After full criteria for gambling disorder were previously met, none of the criteria for gambling disorder have been met for at least 3 months but for less than 12 months. 2. In sustained remission: After full criteria for gambling disorder were previously met, none of the criteria for gambling disorder have been met during a period of 12 months or longer. v. Specify current severity: 1. Mild: 4-5 criteria met. 2. Moderate: 6-7 criteria met. 3. Severe: 8-9 criteria met.
*values!*
Personal beliefs about the truth, beauty, or worth of a thought, object, or behavior, that influence an individual's actions - are personal beliefs about what is important and desirable
Pharmacological intervention w/ Tourette's disorder
Pharmacological intervention with Tourette's disorder with *Neuroleptic medications* is most effective when it is combined with other forms of therapy, such as behavioral therapy, individual counseling or psychotherapy, and family therapy. The most common medications used are: a. Haloperidol (Haldol). Because of the severe side effects, this medication should be reserved for children with severe symptoms or with symptoms that impede their ability to function in school, socially, or within their family setting. b. Pimozide (Orap). Similar in response rate and side effect profile to haloperidol. Used only with severe cases. Not recommended for children younger than age 12 years. c. Clonidine (Catapress). Sometimes used as drug of first choice because of few side effects. Results of studies on the efficacy of clonidine in the treatment of Tourette's disorder have been mixed. d. Atypical antipsychotics. The antipsychotics risperidone (Risperdal), olanzapine (Zyprexa), and ziprasidone (Geodon) have been used with some success in Tourette's disorder. Weight gain and abnormal glucose tolerance associated with olanzapine may be troublesome side effects, and ziprasidone has been associated with increased risk of QT (cardiac rhythm) interval prolongation.
• Palilalia
Repeating one's own sounds or words (a type of vocal tic associated with Tourette's disorder).
Antidepressants
SSRIS are now considered first-line treatment for PTSD (1) *Paroxetine and sertraline* has FDA approval for this (2) *Have good safety ratings* (3) *Antidepressants are 1st line of txt NOT anti-anxiety* (4) *Not addictive* (5) Selective serotonin reuptake inhibitors (SSRIs) are now considered first-line treatment of choice for PTSD because of their efficacy, tolerability, and safety ratings (Sadock et al., 2015). Paroxetine and sertraline have been approved by the FDA for this purpose. The tricyclic antidepressants amitriptyline (Elavil) and imipramine (Tofranil) have been supported by several well-controlled studies. Monoamine oxidase inhibitors (MAOIs; e.g., phenelzine), and trazodone have also been effective in the treatment of PTSD.
BOX 3-2 Ethical Decision Making—A Case Study
STEP 1. ASSESSMENT - Tonja is a 17-year-old girl who is currently on the psychiatric unit with a diagnosis of conduct disorder. Tonja reports that she has been sexually active since she was 14. She had an abortion when she was 15 and a second one just 6 weeks ago. She states that her mother told her she has "had her last abortion" and that she has to start taking birth control pills. She asks her nurse, Kimberly, to give her some information about the pills and to tell her how to go about getting some. Kimberly believes Tonja desperately needs information about birth control pills, as well as other types of contraceptives, but the psychiatric unit is part of a Catholic hospital, and hospital policy prohibits distributing this type of information. STEP 2. PROBLEM IDENTIFICATION A conflict exists between the client's need for info, the nurse's desire to provide that info, and the institution's policy prohibiting the provision of that info STEP 3. ALTERNATIVES—BENEFITS AND CONSEQUENCES Alternative 1: Give the client information and risk losing job. Alternative 2: Do not give client information and compromise own values of holistic nursing. Alternative 3: Refer the client to another source outside the hospital and risk reprimand from supervisor. STEP 4. CONSIDER PRINCIPLES OF ETHICAL THEORIES Alternative 1: Giving the client info would certainly respect the client's autonomy and would benefit the client by decreasing her chances of becoming pregnant again. It would not be to the best advantage of Kimberly, in that she would likely lose her job. And according to the beliefs of the Catholic hospital, the natural laws of God would be violated. Alternative 2: Withholding information restricts the client's autonomy. It has the potential for doing harm, in that without the use of contraceptives, the client may become pregnant again (and she implies that this is not what she wants). Kimberly's Christian ethic is violated in that this action is not what she would want "done unto her." Alternative 3: A *referral* would respect the client's autonomy, would promote good, would do no harm (except perhaps to Kimberly's ego from the possible reprimand), and this decision would comply with Kimberly's Christian ethic. STEP 5. SELECT AN ALTERNATIVE Alternative 3 is selected on the basis of the ethical theories of *utilitarianism* (does the most good for the greatest number), *Christian ethics* (Kimberly's belief of "Do unto others as you would have others do unto you"), *Kantianism* (to perform one's duty), and the ethical principles of *autonomy, beneficence, and nonmaleficence*. The success of this decision depends on the client's follow-through with the referral and compliance with use of the contraceptives. STEP 6. TAKE ACTION AND COMMUNICATE Taking action involves providing information in writing for Tonja, perhaps making a phone call and setting up an appointment for her with Planned Parenthood. Communicating suggests sharing the information w/ Tonja's mother. Communication also includes documentation of the referral in the client's chart. STEP 7. EVALUATE THE OUTCOME - An acceptable outcome might indicate that Tonja did indeed keep her appointment at Planned Parenthood and is complying with the prescribed contraceptive regimen. It might also include Kimberly's input into the change process in her institution to implement these types of referrals to other clients who request them. - An unacceptable outcome might be indicated by Tonja's lack of follow-through with the appointment at Planned Parenthood or lack of compliance in using the contraceptives, resulting in another pregnancy. Kimberly may also view a reprimand from her supervisor as an unacceptable outcome, particularly if she is told that she must select other alternatives should this situation arise in the future. This may motivate Kimberly to make another decision—that of seeking employment in an institution that supports a philosophy more consistent with her own.
TABLE 14-7 Psychoactive Substances: A Profile Summary *Opioids*
SYMPTOMS OF USE: Euphoria, lethargy, drowsiness, lack of motivation, constricted pupils THERAPEUTIC USES: As analgesics; antidiarrheals, and antitussives; methadone in substitution therapy; heroin has no therapeutic use SYMPTOMS OF OVERDOSE: Shallow breathing, slowed pulse, clammy skin, pulmonary edema, respiratory arrest, convulsions, coma, possible death TRADE NAMES Heroin Morphine Codeine Dilaudid Demerol Dolophine Percodan Talwin Opium COMMON STREET NAMES: Snow, stuff, H, harry, horse M, morph, Miss Emma Schoolboy Lords Doctors Dollies Perkies Ts Big O, black stuff
Separation anxiety disorder (SAD)
Screams and throws temper tantrums at disorder anticipated separation from mother. Fear of harm to self or mother.
Presenting Symptoms (assessment NP for suicidal client)
Several acronyms have been developed as mnemonic devices to summarize important factors that may increase a person's risk for suicidal behavior. One of these is the acronym IS PATH WARM? (American Association of Suicidology, 2015; Juhnke, Granello, & Lebron-Striker, 2007). The assessment items and descriptors for each letter are as follows: Ideation: Has suicide ideas that are current and active, especially with an identified plan Substance abuse: Has current and/or excessive use of alcohol or other mood-altering drugs Purposelessness: Expresses thoughts that there is no reason to continue living Anger: Expresses uncontrolled anger or feelings of rage Trapped: Expresses the belief that there is no way out of the current situation Hopelessness: Expresses lack of hope and perceives little chance of positive change Withdrawal: Expresses desire to withdraw from others or has begun withdrawing Anxiety: Expresses anxiety, agitation, and/or changes in sleep patterns Recklessness: Engages in reckless or risky activities with little thought of consequences Mood: Expresses dramatic mood shifts Mnemonic devices such as IS PATH WARM? can be helpful in remembering what types of presenting symptoms to assess for, but the overall assessment and management of suicidal behavior is far more complex and must consider available support systems, the patient's willingness to accept support, and the patient's ability to establish a trusting therapeutic alliance with health-care professionals intervening on their behalf. The Collaborative Assessment and Management of Suicidality (CAMS) model is an evidence-based approach that focuses on the importance of patient-centered, problem-focused intervention to build an alliance with patients for collaboration in reducing risk for suicidal behavior (Jobes, 2012). This model focuses on assessment, which necessarily includes asking the patient to identify what is driving the desire to take his or her own life so that alternatives can be explored. For all health-care professionals, this work begins with developing skill in asking basic and direct questions such as "Are you having thoughts of hurting or killing yourself?"
presenting symptoms (assessment NP for suicidal client)
Several acronyms have been developed as mnemonic devices to summarize important factors that may increase a person's risk for suicidal behavior. One of these is the acronym IS PATH WARM? (American Association of Suicidology, 2015; Juhnke, Granello, & Lebron-Striker, 2007). The assessment items and descriptors for each letter are as follows: Ideation: Has suicide ideas that are current and active, especially with an identified plan Substance abuse: Has current and/or excessive use of alcohol or other mood-altering drugs Purposelessness: Expresses thoughts that there is no reason to continue living Anger: Expresses uncontrolled anger or feelings of rage Trapped: Expresses the belief that there is no way out of the current situation Hopelessness: Expresses lack of hope and perceives little chance of positive change Withdrawal: Expresses desire to withdraw from others or has begun withdrawing Anxiety: Expresses anxiety, agitation, and/or changes in sleep patterns Recklessness: Engages in reckless or risky activities with little thought of consequences Mood: Expresses dramatic mood shifts Mnemonic devices such as IS PATH WARM? can be helpful in remembering what types of presenting symptoms to assess for, but the overall assessment and management of suicidal behavior is far more complex and must consider available support systems, the patient's willingness to accept support, and the patient's ability to establish a trusting therapeutic alliance with health-care professionals intervening on their behalf. The Collaborative Assessment and Management of Suicidality (CAMS) model is an evidence-based approach that focuses on the importance of patient-centered, problem-focused intervention to build an alliance with patients for collaboration in reducing risk for suicidal behavior (Jobes, 2012). This model focuses on assessment, which necessarily includes asking the patient to identify what is driving the desire to take his or her own life so that alternatives can be explored. For all health-care professionals, this work begins with developing skill in asking basic and direct questions such as *"Are you having thoughts of hurting or killing yourself?"*
altruistic suicide
Suicide based on behavior of a group to which an individual is excessively integrated. opposite of egoistic suicide. The individual who is prone to this is excessively integrated into the group. The group is often governed by cultural, religious, or political ties, and allegiance is so strong that the individual will sacrifice his or her life for the group.
anomic suicide (sociological theory; predisposing factor: theories of suicide)
Suicide that occurs in response to changes that occur in an individual's life that disrupt cohesiveness from a group and cause that person to feel without support from the formerly cohesive group. occurs in response to changes in an individual's life (e.g., divorce, loss of job) that disrupt feelings of relatedness to the group. An interruption in the customary norms of behavior instills feelings of "separateness" and fears of being without support from the formerly cohesive group
Gunshot wounds are the leading cause of death among suicide victims
TRUE
Most suicidal people have ambivalent feelings about living and dying
TRUE
*right*
That which an individual is entitled (by ethical, legal, or moral standards) to have, or to do, or to receive from others w/i the limits of the law - a valid, legally recognized claim or entitlement, encompassing both freedom from government interference or discriminatory treatment and an entitlement to a benefit or service
density
The # of people in a given environmental space, influencing interpersonal interaction. *concepts of space that influence communication*
*acute stress disorder!!*
The DSM-5 diagnostic category describing a trauma- and stressor-related disorder that is short term (from 3 days to 1 month duration) and results in significant distress or impairment in function. o The DSM-5 describes another disorder that is similar to PTSD called acute stress disorder (ASD). There are similarities between the two disorders in terms of precipitating traumatic events and symptomatology, but in ASD, the symptoms are time limited, up to 1 month following the trauma. By definition, if the symptoms last longer than 1 month, the diagnosis is PTSD - 1. Similar to PTSD in terms of precipitating traumatic events and symptoms a. Similar bc its an *extreme traumatic event* b. Symptoms are similar the difference is the time frame 2. *Symptoms are limited: up to 1 month following the trauma* 3. *If the symptoms last longer than 1 month, the diagnosis would be PTSD*
Jewish Americans
The Jewish people came to the United States predominantly from Spain, Portugal, Germany, and Eastern Europe. There are more than 5 million Jewish Americans living in the US, and most are located in the larger urban areas. main Jewish religious groups exist today. 1. Orthodox 2. Reform 3.Conservative 4. Reconstructionists The primary language is English. Hebrew is used for prayers and is taught in Jewish religious education. Formal education is a highly respected value Many hold advanced degrees and are employed as professionals. Time orientation is simultaneously to the past, present, and future. *Children are highly valued and are expected to be forever grateful to their parents for giving them the gift of life.* health conscious and maintenance of mental health is as important as physical health. *Genetic diseases common include Tay-Sachs disease, Gaucher's disease, and familial dysautonomia.* Alcohol, especially wine, is an essential part of religious holidays and festive occasions. It is viewed as appropriate and acceptable as long as it is used in moderation. Religious laws dictate how food is prepared, served, and consumed.
advocacy
The act of pleading for, supporting, or representing a cause or individual. - in nursing applies to any act in which the nurse is serving in the best interests of the patient, from simple procedures such as hand washing to protect the patient from infection to complex ethically and morally charged issues in which certain clients are unable to advocate for themselves - Nurses also advocate for their patients indirectly by serving in organizations that support and serve to improve health care for all individuals and by participating in policy-making legislation that affects health care of the public. - advocacy as an essential role for the psychiatric nurse - means acting in another's behalf—being a supporter or defender - Being a client advocate in psychiatric nursing means helping clients fulfill needs that, without assistance and because of their illness, may go unfulfilled - Individuals with mental illness are not always able to speak for themselves - Nurses serve in this manner to protect the clients' rights and interests, strategies include educating clients and their families about their legal rights, ensuring that clients have sufficient information to make informed decisions or to give informed consent, and assisting clients to consider alternatives and supporting them in the decisions they make - nurses may act as advocates by speaking on behalf of individuals with mental illness to secure essential mental health services.
*social learning sociocultural factor*
The effects of modeling, imitation, and identification on behavior can be observed from early childhood onward. In relation to drug consumption, the *family* appears to be an important influence. Various studies have shown that children and adolescents are more likely to use substances if they have parents who provide a model for substance use. Peers often exert a great deal of influence in the life of the child or adolescent who is being encouraged to use substances for the first time. Modeling may continue to be a factor in the use of substances once the individual enters the workforce, particularly if the work setting provides plenty of leisure time with coworkers and drinking is valued as a way to express group cohesiveness.
*Tourette's disorder*
The essential feature is the presence of multiple motor tics and one or more vocal tics. o The tics wax and wane in frequency but have persisted for >1 year since 1st tic onset o Onset of the disorder most commonly occurs during childhood, and is more common in boys than in girls. o is characterized by the presence of multiple motor tics and one or more vocal tics, which may appear simultaneously or at different periods during the illness (APA, 2013). The disturbance may cause distress or interfere with social, occupational, or other important areas of functioning. The age at onset of Tourette's disorder can be as early as 2 years, but the disorder occurs most commonly during childhood (around age 6 to 7 years). Prevalence of the disorder is estimated at 3 to 8 per 1,000 in school-age children. The lifetime prevalence is estimated to be about 1%. It is two to four times more common in boys than in girls. Although the disorder can be lifelong, most people with this condition experience the worst tic symptoms in their early teens with gradual improvement thereafter - Biochemical Factors. Abnormalities in levels of dopamine, serotonin, dynorphin, gamma-aminobutyric acid, acetylcholine, and norepinephrine have been associated with Tourette's disorder *(cocaine or other meds)* -2. Environmental Factors a. Severe nausea and vomiting or excessive stress during pregnancy b. Low birthweight c. Head trauma d. Carbon monoxide poisoning e. Encephalitis *(post-viral encephalitis)* f. Medical conditions: *Huntington's disease* g. Possible autoimmune response to strep infection
*Christian ethics*
The ethical philosophy that states we should treat others as moral equals and recognize the equality of other persons by permitting them to act as we do when they occupy a position similar to ours; sometimes referred to as the ethic of the golden rule. - *The ethical theory that espouses "Do unto others as you would have others do unto you"* - This approach to ethical decision-making is focused on the way of life and teachings of Jesus Christ - It advances the importance of virtues such as love, forgiveness, and honesty - 1 basic principle often associated with Christian ethics is known as the golden rule: "Do unto others as you would have them do unto you." - the imperative demand of Christian ethics is that all decisions about right and wrong should be centered in love for God and in treating others with the same respect and dignity with which we would expect to be treated
*Kantianism!*
The ethical principle espousing that decisions should be made and actions taken out of a sense of duty *ethical theory by which decisions are based on a sense on a sense of DUTY* - is directly opposed to utilitarianism - argues that it is NOT the consequences or end results that make an action right or wrong; rather it is the principle or motivation on which the action is BASED that is the morally decisive factor - This theory is often called deontology (from the Greek word deon, which means "that which is binding; duty") - these directed ethical decisions are made out of respect for *moral law* - example, "I make this choice bc it is morally right and my duty to do so" (NOT bc of consideration for a possible outcome)
*nonmaleficence!* discuss
The ethical principle that espouses *abstaining from negative acts toward another, including acting carefully to avoid harm* - is the requirement that health-care providers do NO harm to their clients, either intentionally or unintentionally - some philosophers suggest that this principle is MORE important than beneficence; that is, they support the notion that it is MORE important to avoid doing harm than it is to do good - ethical dilemmas often arise when a conflict exists b/w an individual's rights and what is thought to best represent the welfare of the individual - example: when a psychiatric client refuses antipsychotic medication (consistent with his or her rights), and the nurse must then decide how to maintain client safety while psychotic s/s continue
*natural law theory*
The ethical theory that has as its moral precept to "do good and avoid evil" at ALL costs. Are grounded in a concern for the human good that is based on people's ability to live according to the dictates of reason. - *The theory on which decisions are based in which evil acts are NEVER condoned, even if they are intended to advance the noblest of ends* - is based on the writings of St. Thomas Aquinas - it advances the idea that decisions about right vs. wrong are self-evident and determined by human nature - espouses that, as rational human beings, we inherently know the difference between good and evil (believed to be knowledge that is given to man from God), and this knowledge directs our decision-making
*malpractice* (nursing liability)
The failure of 1 rendering professional services to exercise that degree of skill and learning commonly applied under all the circumstances in the community by the average prudent reputable member of the profession w/ the RESULT of injury, loss, or damage to the recipient of those services or to those entitled to rely upon them. - *The failure of a professional to perform or to refrain from performing in a manner in which a reputable member within the profession would be expected to do so. Professional negligence (MUST result in injury)* - *any person may be negligent & malpractice is a specialized form of negligence applicable ONLY to professionals* - this is an instance of negligence or incompetence on the part of a professional - to succeed in a this sort of claim, a plaintiff must also prove proximate cause and damages -basic elements of this type of nursing lawsuit: 1. A duty to the pt existed based on the recognized standard of care 2. A breach of duty occurred, meaning that the care rendered was NOT consistent with the recognized standard of care 3. *The client was injured* 4. The injury was DIRECTLY caused by the breach of a standard of care - each of these elements must be proved for the pt to win in court - juries' decisions are generally based on the testimony of expert witnesses bc members of the jury are laypeople and CANNOT be expected to know what nursing interventions should have been carried out - *w/o the testimony of expert witnesses, a favorable verdict usually goes to the defendant nurse*
*negligence* (nursing liability)
The failure to do something that a reasonable person, guided by those considerations that ordinarily regulate human affairs, would do or doing something that a prudent and reasonable person would NOT do. - any conduct that falls below the legal standard established to protect others against unreasonable risk of harm, except for conduct that is intentionally, wantonly, or willfully disregardful of others' rights - ANY person may be negligent, - malpractice is a specialized form of negligence applicable only to professionals.
Information for Family and Friends of the Suicidal Client Planning and Implementation
The following suggestions are made for family and friends of an individual who is suicidal: Take any hint of suicide seriously. Anyone expressing suicidal feelings needs immediate attention. Do not keep secrets. If a suicidal person says, "Promise you won't tell anyone," do not make that promise. Suicidal individuals are ambivalent about dying, and suicidal behavior is a cry for help. It is that ambivalence that leads the person to confide to you the suicidal thoughts. Get help for the person and for you. 1-800-SUICIDE is a national hotline that is available 24 hours a day. Be a good listener. If people express suicidal thoughts or feel depressed, hopeless, or worthless, be supportive. Let them know you are there for them and are willing to help them seek professional help. Many people find it awkward to put into words how another person's life is important for their own well-being, but it is important to stress that the person's life is important to you and to others. Emphasize in specific terms the ways in which the person's suicide would be devastating to you and to others. Express concern for individuals who express thoughts about committing suicide. The individual may be withdrawn and reluctant to discuss what he or she is thinking. Acknowledge the person's pain and feelings of hopelessness, and encourage the individual to talk to someone else if he or she does not feel comfortable talking with you. Familiarize yourself with suicide intervention resources, such as mental health centers and suicide hotlines. Ensure that access to firearms or other means of self-harm is restricted. Fleener (2013) offers the following suggestions for interacting with people who are suicidal: Acknowledge and accept their feelings and be an active listener. Try to give them hope, and remind them that what they are feeling is temporary. Stay with them. Do not leave them alone. Go to where they are, if necessary. Show love and encouragement. Hold them, hug them, touch them. Allow them to cry and express anger. Help them seek professional help. Remove any items from the home with which the person may harm himself or herself. If there are children present, try to remove them from the home. Perhaps friends or relatives can assist by taking the children to their home. This type of situation can be extremely traumatic for children. DO NOT judge suicidal people, show anger toward them, provoke guilt in them, discount their feelings, or tell them to "snap out of it." This is a very real and serious situation to suicidal individuals. They are in real pain. They feel the situation is hopeless and that there is no other way to resolve it aside from taking their own life.
*spirituality*
The human quality that gives meaning and sense of purpose to an individual's existence - exists within each individual regardless of belief system and serves as a force for interconnectedness between the self and others, the environment, and a higher power. - The human quality that gives meaning and sense of purpose to an individual's existence
*Why is it important to have a class on culture in every course in psychiatry?*
The nurse working in *psychiatry must realize that psychiatric illness is stigmatized in some cultures*. Individuals who believe that expressing emotions is unacceptable (e.g., Asian Americans and Native Americans) will present unique problems when they are clients in a psychiatric setting. - Nurses must have patience and work slowly to establish trust in order to provide these individuals with the assistance they require.
*stereotyping*
The process of classifying all individuals from the same culture or ethnic group as identical. *assuming that all individuals who share a culture or ethnic group are the same* -Caution must be taken, however, not to assume that all individuals who share a culture or ethnic group are identical or exhibit behaviors perceived as characteristic of the group - Such assumptions constitute this and must be *avoided* - Many variations and subcultures occur within a culture - These differences may be related to status, ethnic background, residence, religion, education, or other factors.
• Detoxification
The process of withdrawal from a substance to which one has become addicted.
*developmental influence psychological factor*
The psychodynamic approach to the etiology of substance abuse focuses on *a punitive superego and fixation at the oral stage of psychosexual development* Individuals with punitive superegos turn to drugs to diminish unconscious anxiety and increase feelings of power and self-worth. Sadock and colleagues (2015) state, "As a form of self-medication, alcohol may be used to control panic, opioids to diminish anger, and amphetamines to alleviate depression" (p. 619-620). - Punitive superego- internally fbeating on themselves, don't have a lot of self worth, insult themselves
marital status risk factor for suicide
The suicide rate for single, never married persons is twice that for married persons, and divorce increases risk for suicide particularly among men, who are three times more likely to take their own lives than are divorced women Widows and widowers also have high risk. The variables that influence greater suicide rates among single, never married individuals are not clear. For those who are divorced and widowed, the stresses associated with major life changes and loss are influential.
opioid use disorder
The term opioid refers to a group of compounds that includes opium, opium derivatives and synthetic substitutes. Opioids exert both a sedative and an analgesic effect, and there major medical uses are for relief of pain. They are the most known agent for the *relief of intense pain* A profile of the substance Opioids of natural origin (Opium, Codeine) Opioid derivatives (Hydromorphone, Oxycodone) Synthetic opiate-like drugs (Meperidine, Fentanyl) Intoxication Symptoms are consistent with the half-life of most opioid drugs and usually last for *several hours*. Symptoms include *initial euphoria* followed by apathy, dysphoria, psychomotor agitation or retardation, and impaired judgment. Severe opioid intoxication can lead to respiratory depression, coma, and death.
bioethics
The term used with ethical principles that refer to concepts within the scope of medicine, nursing, and allied health.
BOX 5-4 Spiritual Assessment Tool Meaning and Purpose
These questions assess a person's ability to seek meaning and fulfillment in life, manifest *hope*, and accept ambiguity and uncertainty. 1. What gives your life meaning? 2. Describe your sense of purpose in life. 3. How does your illness affect your life goals? 4. How hopeful are you about obtaining a better degree of health? 5. How would you describe your role in maintaining your health? 6. What kind of changes will you be able to make in your life to maintain your health? 7. Describe your level of motivation to get well. 8. What is the most important or powerful thing your life?
*gambling disorder*
This disorder is defined by the DSM-5 as persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress (APA, 2013). The preoccupation with and impulse to gamble often intensifies when the individual is under stress. Many impulsive gamblers describe a physical sensation of restlessness and anticipation that can only be relieved by placing a bet. Blume (2013) states: In some cases the initial change in gambling behavior leading to pathological gambling begins with a "big win," bringing a rapid development of preoccupation, tolerance, and loss of control. Winning brings feelings of special status, power, and omnipotence. The gambler increasingly depends on this activity to cope with disappointments, problems, and negative emotional states, pulling away from emotional attachment to family and friends. o As the need to gamble increases, the individual is forced to obtain money by any means available, which may include borrowing money from illegal sources or pawning personal items (or items that belong to others). As gambling debts accrue, or out of a need to continue gambling, the individual may desperately resort to forgery, theft, or even embezzlement. Family relationships are disrupted, and impairment in occupational functioning may occur because of absences from work in order to gamble. o Gambling behavior usually begins in adolescence; however, compulsive behaviors rarely occur before young adulthood. The disorder generally runs a chronic course, with periods of waxing and waning, largely dependent on periods of psychosocial stress. Prevalence estimates for problem gambling range from 3 to 5 percent, and about 1 percent meet the criteria for a gambling disorder (Sadock et al., 2015). It is more common among men than women. o Various personality traits have been attributed to pathological gamblers. Unwin, Davis, and Leeuw (2000) stated: Evidence points to the common existence of narcissistic personality characteristics and impulse control problems in pathologic gamblers. High rates of personality disorders (e.g., obsessive-compulsive, avoidant, schizotypal and paranoid) are noted in several studies. Personality profiles of persons who are alcoholics and pathologic gamblers are also similar in some studies. Some experts view pathologic gambling as an addictive disorder, citing as evidence the tolerance and withdrawal symptoms exhibited by pathologic gamblers because of debt escalation behaviors. However, no physical or biochemical markers exist to help physicians make the diagnosis. (p. 744) o Gambling problems may be episodic and increase during periods of stress or depression, or the behavior may be persistent (APA, 2013). The DSM-5 diagnostic criteria for pathological gambling are presented in Box 14-7.
alcoholic myopathy
Thought also to result from same B vitamin deficiency that contributes to peripheral neuropathy. Acute: Sudden onset of muscle pain, swelling, and weakness; reddish tinge to the urine; rapid rise in muscle enzymes in the blood. Chronic: Gradual wasting and weakness in skeletal muscles. Alcoholic myopathy can occur as an acute or chronic condition. In the acute condition, the individual experiences a sudden onset of muscle pain, swelling, and weakness. These symptoms are usually generalized, but pain and swelling may selectively involve the calves or other muscle groups. Chronic alcoholic myopathy includes a gradual wasting and weakness in skeletal muscles. Neither the pain and tenderness nor the elevated muscle enzymes seen in acute myopathy are evident in the chronic condition.
Analysis of the Suicidal Crisis (assessment NP for suicidal client)
Three aspects of assessment that enhance understanding of the client's current suicidal crisis include an evaluation of the client's precipitating stressors, relevant history, and life stage issues. The precipitating stressor: Adverse life events in combination with other risk factors, such as depression, may lead to suicide. Life stresses accompanied by an increase in emotional disturbance include the loss of a loved person either by death or by divorce, problems in major relationships, changes in roles, or serious physical illness. Relevant history: Has the individual experienced numerous failures or rejections that would increase his or her vulnerability for a dysfunctional response to the current situation? Life-stage issues: The ability to tolerate losses and disappointments is often compromised if those losses and disappointments occur during various stages of life in which the individual struggles with developmental issues (e.g., adolescence, midlife).
*acculturation*
To CHANGE one's cultural beliefs, behaviors, and/or values as a result of engagement with people of a different culture *internalizing the attitudes and beliefs of another cultural group* - People of many different cultures reside in the US and some maintain traditional cultural practices, while others acculturate to dominant cultural practices (give up cultural practices or values as a result of contact with another group)
• trauma- and stressor-related disorders:
Traumas such as the Japan earthquake and tsunami of 2011 test the very fiber of our human spirit and sense of emotional well-being. The events recounted by Yuri Sato were painfully traumatic. For some, the stress associated with such traumas continues to cause enduring, significant distress and interference with their ability to function.
• Complicated grieving:
a disorder that occurs after the death of a significant other [or any other loss of significance to the individual], in which the experience of distress accompanying bereavement fails to follow normative expectations and manifests in functional impairment"
*morals (definition for morality)*
a doctrine or system denoting what is right and wrong in conduct, character, or attitude
*hope* (spiritual need)
a special kind of positive expectation. individuals look at a situation, and no matter how negative, find something positive on which to focus. functions as an energizing force this and optimism produce positive physical changes in the body that can influence the immune system and the functioning of specific body organs.
Dan begins attendance at AA meetings. Which of the statements by Dan reflects the purpose of this organization? a. "They claim they will help me stay sober." b. "I'll dry out in AA, then I can have a social drink now and then." c. "AA is only for people who have reached the bottom." d. "If I lose my job, AA will help me find another."
a. "They claim they will help me stay sober."
If a suicidal person is intent on dying, he or she cannot be stopped
FALSE
Tom is a patient on the alcohol treatment unit. He says to the nurse, "My boss and my wife ganged up on me. They think I have a drinking problem. I don't have a drinking problem! I can quit any time I want to!" How would the nurse respond appropriately to this statement by Tom?
"Tom, you are here because it has been determined that drinking alcohol is causing problems for you at home and at your work." (Confronting reality)
Tom says to the nurse, "My head hurts. I didn't sleep very well last night. I'm getting shaky, and it's hot in here! I could sure use a cup of coffee and a cigarette." How would the nurse respond appropriately to this statement by Tom?
"Tom, you are experiencing symptoms related to your body's withdrawal from alcohol. When did you have your last drink? I will bring you a cup of coffee." (Confrontation with caring)
*risk for spiritual distress*
"Vulnerable to an impaired ability to experience and integrate meaning and purpose in life through connectedness within self, literature, nature, and/or a power greater than oneself which may compromise health" Risk Factors 1. Physical: Physical/chronic illness; substance abuse 2. Psychosocial: Low self-esteem; depression; anxiety; stress; poor relationships; separate from support systems; blocks to experiencing love; inability to forgive; loss; racial/cultural conflict; change in religious rituals; change in spiritual practices 3. Developmental: Life changes 4. Environmental: Environmental changes; natural disasters
Tom says, "Sure, I missed a couple days of work. Everyone gets sick now and then. I don't think my wife cares about what happens to me. She and my boss got together and decided I needed to be here, or I lose my job!" How would the nurse respond appropriately to this statement by Tom?
"You are feeling angry toward your boss and your wife, but your drinking is apparently interfering with your job and your marriage. Unless you abstain from alcohol, you are at risk of losing both." (Confronting reality)
*Which psychiatric diagnosis is common within the Native American culture?* a. Schizophrenia b. Alcohol use disorder c. Posttraumatic stress disorder d. Impulse control disorder
*b. Alcohol use disorder* A variety of physical, sociocultural, and environmental causes have been linked to the high rate of alcoholism among Native Americans.
battery
*The unconsented touching of another person* - Nurses may be charged with this should they participate in the treatment of a client w/o his or her consent and outside of an emergency situation
*What charges may be brought against a nurse for confining a patient against their will?*
- false imprisonment - assault - battery
risk factors for suicide
- marital status - gender - age - religion - socioeconomic status - ethnicity
BOX 19-2 Diagnostic Criteria for Acute Stress Disorder
- Exposure to actual or threatened death, serious injury, or sexual violation, in one (or more) of the following ways: 1. Directly experiencing the traumatic event(s). 2. Witnessing, in person, the event(s) as it occurred to others. 3. Learning that the event(s) occurred to a close family member or close friend. Note: In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental. 4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains, police officers repeatedly exposed to details of child abuse). Note: This does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related. - Presence of nine (or more) of the following symptoms from any of the five categories of intrusion, negative mood, dissociation, avoidance, and arousal, beginning or worsening after the traumatic event(s) occurred: INTRUSION SYMPTOMS 1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). Note: In children, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed. 2. Recurrent distressing dreams in which the content and/or affect of the dream are related to the event(s). Note: In children, there may be frightening dreams without recognizable content. 3. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.) Note: In children, trauma-specific reenactment may occur in play. 4. Intense or prolonged psychological distress or marked physiological reactions in response to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). NEGATIVE MOOD - Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings). DISSOCIATIVE SYMPTOMS - An altered sense of the reality of one's surroundings or oneself (e.g., seeing oneself from another's perspective, being in a daze, time slowing). Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs). AVOIDANCE SYMPTOMS 1. Efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). 2. Efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). AROUSAL SYMPTOMS 1. Sleep disturbance (e.g., difficulty falling or staying asleep, or restless sleep). 2. Irritable behavior and angry outbursts (with little or no provocation), typically expressed as verbal or physical aggression toward people or objects. 3. Hypervigilance. 4. Problems with concentration. 5. Exaggerated startle response. - *Duration of the disturbance (symptoms in Criteria B) is 3 days to 1 month after trauma exposure. Note: Symptoms typically begin immediately after the trauma, but persistence for at least 3 days and up to a month is needed to meet disorder criteria.* - The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. - The disturbance is not attributable to the direct physiological effects of a substance (e.g., medication or alcohol) or another medical condition (e.g., mild traumatic brain injury), and is not better explained by brief psychotic disorder.
*BOX 19-1 Diagnostic Criteria for Posttraumatic Stress Disorder* Note: The following criteria apply to adults, adolescents, and children older than 6 years.
- Exposure to actual or threatened death, serious injury, or sexual violence, in one (or more) of the following ways: 1. Directly experiencing the traumatic event(s). Witnessing, in person, the event(s) as it occurred to others. 2. Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental. 3. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse). Note: Criterion A4 does not apply to exposure through electronic media, television, movies, or pictures unless this exposure is work related. - *Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:* 1. *Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). Note: In children older than 6 years, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed.* 2. *Recurrent distressing dreams in which the content and/or effect of the dream is related to the traumatic event(s). Note: In children, there may be frightening dreams without recognizable content.* 3. Dissociative reactions *(e.g., flashbacks)* in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.) Note: In children, trauma-specific reenactment may occur in play. 4. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). 5. Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s). - Persistent avoidance of stimuli associated with the traumatic event(s) beginning after the traumatic event(s) occurred, as evidenced by one or both of the following: 1. Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). 2. Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s). - Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two or more of the following: 1. Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs). 2. Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., "I am bad," "No one can be trusted," "The world is completely dangerous," "My whole nervous system is permanently ruined"). 3. Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others. 4. Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame). 5. Markedly diminished interest or participation in significant activities. 6. Feelings of detachment or estrangement from others. 7. Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings). - *Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two or more of the following:* 1. *Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects.* 2. Reckless or self-destructive behavior. 3. Hypervigilance. 4. Exaggerated startle response. 5. *Problems with concentration.* 6. *Sleep disturbance* (e.g., difficulty falling or staying asleep or restless sleep). - *Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month.* - The disturbance causes clinically significant distress or impairment in social, occupation, or other important areas of functioning. - The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition. Specify whether: - With dissociative symptoms (depersonalization or derealization) - With delayed expression (full diagnostic criteria not met until at least 6 months after the event)
other risk factors for suicide
- more than 90% of people who kill themselves have a diagnosable mental disorder, most commonly a *mood disorder or a substance abuse disorder* - Individuals who have been hospitalized for a psychiatric illness have a 5-10 times greater risk of suicide than those with psychiatric illness in the general population, This higher risk may be a reflection of the severity of their mental illness - suicide risk may increase early during treatment with antidepressants, 1 possible reason is that as an individual's energy returns, he or she may have an increased ability to act out self-destructive wishes - although suicide is often thought of as strictly related to depression, there is also a recognized risk of suicide among people with schizophrenia, bipolar disorders, personality disorders, eating disorders, anxiety disorders, and substance use disorders. The importance of good suicide risk assessment for anyone seeking mental health services cannot be overstated. *Severe insomnia* is associated with increased suicide risk even in the absence of depression. *Use of alcohol, and particularly a combination of alcohol and barbiturates*, increases the risk of suicide. Withdrawal from stimulants increases suicide risk as the person begins to "crash." Psychosis, especially with command hallucinations (hearing voices telling one to harm or kill oneself), poses a higher risk. Affliction with a *chronic painful or disabling illness* also increases the risk of suicide. Several studies have indicated a higher risk factor for suicide among gay men and lesbian women (Cochran & Mays, 2000; Eisenberg & Resnick, 2006; King et al., 2008; Medscape Psychiatry, 2011; Plöderl, 2013). It is thought that this increased risk may be a function of the social stigma and discrimination associated with being part of a marginalized group. Additional personal stressors, including isolation, victimization, and stressful interpersonal relationships with family, peers, and community, are not uncommon. A report from the CDC (2015c) identified that in a study of youth in grades 7 to 12, lesbian, gay, and bisexual youth were two times more likely to attempt suicide than their heterosexual peers. Higher risk is also associated with a *family history of suicide*, especially in a same-gender parent. *Persons who have made prior suicide attempts are at higher risk for suicide. About 1/2 of individuals who kill themselves have previously attempted suicide*. *Loss of a loved one through death or separation* and lack of employment or increased *financial burden* also increase risk. In recent years, a number of suicides have been reported in the media among young people who are the victims of bullying. Klomek, Sourander, and Gould (2011) report: Studies among *middle school and high school students show an increased risk of suicidal behavior among bullies and victims*. Both perpetrators and victims are at the highest risk for suicidal ideation. Being bullied via the Internet or e-mail (called cyberbullying) has also been associated with increased risk of depression and suicidal behavior among young people. Researchers found that both perpetrators and victims of cyberbullying had more suicidal ideation and were more likely to attempt suicide than those who had not experienced such forms of peer aggression
Application of the Nursing Process to ADHD
1. Background Assessment Data (Symptomatology) a. *Remember to evaluate the child's behavior according to developmental norms.* b. Highly distractible with extremely limited attention span c. Difficulty forming satisfactory interpersonal relationships d. Low frustration tolerance and outbursts of temper e. Excessive levels of activity, restlessness, and fidgeting 2. Comorbidity. As many as two-thirds of children with ADHD have at least one other diagnosable psychiatric disorder. Common ones include: a. Oppositional defiant disorder b. Conduct disorder c. Learning disorders d. Anxiety e. Depression f. Bipolar disorder g. Substance use disorder 3. Nursing intervention is aimed at protection from injury due to excessive hyperactivity, improvement in social interaction, self-esteem, and compliance with task expectations. 4. Comorbid conditions must also be treated. a. Anxiety and depression may be treated concurrently with symptoms of ADHD b. Substance addiction must be stabilized before treating the ADHD c. Bipolar symptoms must be controlled with a mood stabilizer before stimulants are prescribed for ADHD
Application of the Nursing Process to Separation Anxiety Disorder
1. Background Assessment Data (Symptomatology) a. Onset of separation anxiety disorder may occur as early as preschool age, rarely as late adolescence. b. Child has difficulty separating from mother c. Separation results in tantrums, crying, screaming, complaints of physical problems, and "clinging" behaviors. d. School reluctance or refusal e. Fear of sleeping away from home f. Fear of harm to self or attachment figure g. Nightmares may occur h. Phobias and depressed mood are not uncommon 2. Nursing intervention is aimed at maintaining anxiety at moderate level or below; improvement in social interaction; and development of adaptive coping strategies that prevent maladaptive symptoms of anxiety in response to separation from attachment figure. 3. Evaluation a. requires reassessment of the behaviors for which the family sought treatment. i. *In some instances, separation anxiety disorder symptoms persist into adulthood and may be a precursor to adult panic disorder.* b. Both the client and the family members will have to change their behavior. c. Can continue into adulthood and can be a precursor to adult panic disorder
Application of the Nursing Process to Tourette's Disorder
1. Background Assessment Data (Symptomatology) a. Simple motor tics include eye blinking, neck jerking, shoulder shrugging, facial grimacing, and coughing. b. Complex motor tics include touching, squatting, hopping, skipping, deep knee bends, retracing steps, and twirling when walking. c. Vocal tics include words or sounds such as clicks, grunts, yelps, barks, sniffs, snorts, coughs, and in about 10 percent of cases, the uttering of obscenities. d. Vocal tics may also include repeating one's own sounds or words (called palilalia), ore repeating the words of others (called echolalia). 2. Nursing intervention is aimed at *protection/safety* of the client and others, improvement in social interaction, and improvement in self-esteem.
*name the 3 major elements of informed consent* The nurse's role in obtaining informed consent is usually defined by agency policy. A nurse may sign the consent form as witness for the client's signature. However, *legal liability for informed consent lies with the physician*. The nurse acts as client advocate ensuring that the following 3 major elements of informed consent have been addressed:
1. Knowledge 2. Competency 3. Free will
Predisposing Factors: Theories of Suicide
1. Psychological Theories 2. Sociological Theory 3. Biological Theroies
avoiding liability Hall and Hall (2001) suggested the following proactive nursing actions in an effort to avoid nursing malpractice[6]:
1. Responding to the patient 2. Educating the patient 3. Complying with the standard of care 4. Supervising care 5. Adhering to the nursing process 5. Documenting carefully 6. Following up by evaluating the care that was given
biochemical biological factor
1. There is good evidence that changes in brain structure and brain neurochemistry occur in the process of developing addiction, but whether these changes wholly explain etiology remains controversial. Neurotransmitters believed to be involved in substance abuse include opioid, catecholamine (especially dopamine), and gamma-aminobutyric acid (GABA) systems (Sadock, Sadock, & Ruiz, 2015). Neuronal pathways that are responsible for sensing pleasure and reward, once activated, are believed to be responsible for pleasurable sensations associated with these drugs as well as creating a "memory" that triggers desire for repeated use of the drug. These pathways are referred to as the brain-reward circuitry. Over time, the brain tries to compensate for this excessive activation by lowering levels of these neurotransmitters, and the result is that an individual begins to feel sick. At this point, the substance user may be drawn to continue use of the substance simply to feel less sick. Skeptics of the biochemical theories of addiction argue that since drug dependent individuals have the capacity to change their behavior, addiction is more likely a complex interaction of several factors than strictly a single biochemical process.
*Know the medications that could be used in treating substance intoxication and substance withdrawal.* Psychopharmacology for Substance Intoxication and Substance Withdrawal
1. alcohol 2. opioid 3. depressants 4. stimulants 5. hallucinogens and cannabinoids
predisposing factors to gambling disorder
1. biological influences (genetic, physiological, biochemical) 2. psychosocial influences
*Describe ethical issues relevant to psychiatric mental health nursing.* *All* clients that a nurse attends to has the following rights:
1. the right to treatment 2. the right to refuse treatment (including medication) 3. the right to the least treatment alternative - While these rights may seem reasonable and expected, it is important to recognize that clients with mental illness have historically been hospitalized against their will simply because they had a mental illness - O'Connor v. Donaldson (1976), the Supreme Court ruled that harmless mentally ill individuals cannot be confined against their will if they are able to remain safe outside of a hospital setting, ONLY if they are considered dangerous to themselves or others or are so unable to care for themselves that their safety and survival are at risk may they be confined involuntarily - 1981, the case of Roger v. Oken culminated in the ruling that ALL patients, even those involuntarily hospitalized, are competent to refuse treatment, but a legal guardian may authorize treatment - These laws and policies have attempted to better protect the rights of clients with mental illness while still recognizing that, at times, individuals with acute mental illness may be unable to make decisions in the interest of their safety and survival. - it is hoped that the person with mental illness recognizes his or her need for treatment and agrees voluntarily to be hospitalized if so recommended by the health-care provider - the client who is voluntarily hospitalized typically signs a consent to treatment upon admission, but it remains the client's right, as a voluntary patient, to revoke that consent and to be discharged from the hospital if he or she so chooses.
privileged communication
A doctrine common to most states that grants certain privileges under which health-care professionals may refuse to reveal information about and communications with clients.
folk medicine
A system of health care within various cultures that is provided by a local practitioner who is not professionally trained but who uses techniques specific to that culture in the art of healing. *health care provided by a member of the cultural group*
General Therapeutic Approaches
A. Behavior Therapy 1. Based on the concepts of classical conditioning and operant conditioning. 2. Common and effective treatment for disruptive behavior disorders (ADHD, conduct disorder, and ODD). 3. Principle: positive reinforcements encourage repetition of desirable behaviors, and aversive reinforcements (punishments) discourage repetition of undesirable behaviors. B. Family Therapy 1. Therapy for children and adolescents must involve the entire family if problems are to be resolved. 2. Genograms are helpful. 3. Family dynamics has an impact on disruptive behavior and disruptive behavior affects family dynamics. The treatment plan must be instituted within the context of family-centered care. C. Group Therapy 1. Group therapy provides children and adolescents with the opportunity to interact within an association of their peers. 2. May learn appropriate social behaviors from the positive and negative feedback of peers. 3. May also learn to accept differences in others, to learn to offer and receive support from others, and to practice these new skills in a safe environment. 4. May take the form of music therapy groups, art or activity groups, or craft therapy groups. 5. Play therapy groups are effective treatment for children between the ages of 3 and 9. 6. Psychoeducational groups are very beneficial for adolescents. D. Psychopharmacology 1. Research has indicated that medication alone is not as effective as a combination of medication and psychosocial therapy.
Your neighbor tells you he is going to visit his sister-in-law in the hospital. The sister-in-law has been hospitalized after attempting suicide. Your neighbor asks, "What should I say when I go to visit Jane?" What suggestions might you give him?
Acknowledge and accept her feelings of emotional pain; be an active listener; show love and encouragement; hug her; allow her to cry; do not judge or discount her feelings in any way
How do age, race, and gender affect suicide risk?
Age is positively correlated w/ suicide risk. The highest number of suicides are completed by individuals older than 65 years. Women attempt suicide more often, but men succeed more often. Whites are at highest risk for suicide.
anxiolytics
Alprazolam has been prescribed for PTSD for its antidepressant and anti-panic effects despite the absence of controlled studies to demonstrate efficacy. The addictive properties of antianxiety drugs make them less desirable than some of the other medications. (1) Short term only because they are very addictive (2) Must be tapered off not just abruptly stopped (3) *Alprazolam* has been prescribed for PTSD clients for its antidepressant and antipanic effects. Other benzodiazepines have also been used, *despite the absence of controlled studies demonstrating their efficacy in PTSD. Their addictive properties make them less desirable than some of the other medications in the treatment of posttrauma patients.* (4) *Buspirone*, which has serotonergic properties similar to those of SSRIs, may also be useful. Further controlled trials with this drug are needed to validate its efficacy in treating PTSD.
*substance intoxication*
Development of a *reversible* syndrome of symptoms following excessive use of a substance. Direct effect on the central nervous system. Disruption in physical and psychological functioning. Judgment is disturbed and social and occupational functioning is impaired.
*substance withdrawal*
Development of symptoms that occurs upon abrupt reduction or discontinuation of a substance that has been used. Symptoms are specific to the substance that has been used and are clinically-significant physical signs as well as psychological changes such as disturbances in thinking, feeling and behaving.
Attention-deficit/hyperactivity (ADHD)
Developmentally inappropriate degrees of inattention, impulsiveness, and hyperactivity.
biological variations
Differences among people in various racial groups include *body structure, skin color, physiological responses to medication, electrocardiographic patterns, susceptibility to disease, and nutritional preferences and deficiencies.*
*Separation anxiety disorder*
Essential feature of this disorder is excessive anxiety concerning separation from the home or from those to whom the person is attached. o The anxiety exceeds that expected for the person's developmental level and interferes with social, academic, occupational, or other areas of functioning. o *interferes with social, academic, and occupational areas of functioning* - 3. Family Influences a. Possible overattachment to the mother. b. Separation conflicts between parent and child. c. Families that are very close knit. d. Overprotection by parents. e. *Transfer of fears and anxieties from parents to child through role modeling (The child's mother may have an anxiety disorder and that's being projected onto the child)*
• Aggression
Harsh physical or verbal actions intended (either consciously or unconsciously) to harm or injure another.
*CAGE Questionnaire*
Have you ever felt you should Cut down on your drinking? Have people Annoyed you by criticizing your drinking? Have you ever felt bad or Guilty about your drinking? Have you ever had a drink first thing in the morning to steady your nerves (Eye-opener)?
Coping Strategies (assessment NP for suicidal client)
How has the individual handled previous crisis situations? How does this situation differ from previous ones?
*contracts* (civil law) not on test
In an action, 1 party asserts that the other party, in failing to fulfill an obligation, has breached the this, and either compensation or performance of the obligation is sought as remedy. - example: an action by a mental health professional whose clinical privileges have been reduced or terminated in violation of an implied contract between the professional and a hospital.
Severe IDD
May be trained in elementary hygiene skills. Requires complete supervision. IQ 20-34.
What is associated with the onset of an adjustment disorder?
Maladaptive reaction to an identifiable stressor. The rxn occurs w/I 3 mos of the stressor.
Profound IDD
No capacity for independent functioning IQ <20
What agents are considered first-line psychopharmacological treatment for PTSD?
SSRIs
• Negativism
Strong resistance to suggestions or directions; exhibiting behaviors contrary to what is expected.
The nurse notes that the mood of a client being treated for depression and suicidal ideation suddenly brightens and the client states, "I feel fine now. I don't feel depressed anymore." Why would this statement alert the nurse of a potential problem?
Sudden improvements in mood may suggest that a pt has reached a secret decision to commit suicide. When pts take antidepressant medication, as the depression lifts, they become energized and are thus able to put their suicidal actions into plan.
Intervention With Families and Friends of Suicide Victims Planning and Implementation
Suicide of a family member can induce a whole gamut of feelings in the survivors. It has long been recognized that the bereavement process for families in which a member has taken his or her own life is complicated and requires an understanding by health-care providers of some unique burdens of this type of loss. Macnab (1993) identified the following symptoms, which may be evident in family and friends after the suicide of a loved one: A sense of guilt and responsibility Anger, resentment, and rage that can never find its "object" A heightened sense of emotionality, helplessness, failure, and despair A recurring self-searching: "If only I had done something," "If only I had not done something," "If only...." A sense of confusion and search for an explanation: "Why did this happen?" "What does it mean?" "What could have stopped it?" "What will people think?" A sense of inner injury; family feels wounded; does not know how they will ever get over it and get on with life A severe strain placed on relationships; a sense of impatience, irritability, and anger possible between family members A heightened feeling of vulnerability to illness and disease possible with this added burden of emotional stress Strategies for assisting survivors of suicide victims include the following: Encourage the clients to talk about the suicide, each responding to the others' viewpoints and reconstructing of events. Share memories. Be aware of any blaming or scapegoating of specific family members. Discuss how each person fits into the family situation, both before and after the suicide. Listen to feelings of guilt and self-persecution. Gently move the individuals toward the reality of the situation. Encourage the family members to discuss individual relationships with the lost loved one. Focus on both positive and negative aspects of the relationships. Gradually, point out the irrationality of any idealized concepts of the deceased person. The family must be able to recognize both positive and negative aspects about the person before grief can be resolved. No two people grieve in the same way. It may appear that some family members are "getting over" the grief faster than others. All family members must be educated that if this occurs, it is not because those family members "care less"—it is just that they "grieve differently." Variables that enter into this phenomenon include individual past experiences, personal relationship with the deceased person, and individual temperament and coping abilities. Recognize how the suicide has caused disorganization in family coping. Reassess interpersonal relationships in the context of the event. Discuss coping strategies that have been successful in times of stress in the past, and work to reestablish these strategies within the family. Identify new adaptive coping strategies that can be incorporated. Identify resources that provide support: religious beliefs and spiritual counselors, close friends and relatives, support groups for survivors of suicide. One online connection that puts individuals in contact with survivors groups specific to each state is the American Foundation for Suicide Prevention at www.afsp.org. A list of resources that provide information and help for issues regarding suicide is presented in Box 12-2.
cultural syndromes
Syndromes that are specific to a cultural group. - Symptoms associated with specific cultures that may be expressed differently from the American culture - Most are considered to be "illnesses" and most have local names
*knowledge* (major element of informed consent)
The client has received adequate information on which to base his or her decision.
*Ethnicity*
The concept of people identifying with each other because of a shared heritage. - A somewhat narrower term and relates to people who identify with each other because of a shared heritage *identification w/ a group bc of a shared heritage*
• *cannabis*
The dried flowering tops of the hemp plant. It produces euphoric effects when ingested or smoked and is commonly used in the form of marijuana or hashish. Symptoms include impaired motor coordination, euphoria, anxiety, *sensation of slowed time*, and impaired judgment. withdrawal: Occurs upon cessation of cannabis use that has been *heavy and prolonged* o is the most commonly used illicit drug in the United States (NIDA, 2015) and the fourth-most commonly used psychoactive substance after caffeine, alcohol, and nicotine (Sadock et al., 2015). These trends may change as marijuana is becoming legalized in some states for recreational and/or medicinal use. The major psychoactive ingredient of this class of substances is delta-9-tetrahydrocannabinol (THC). It occurs naturally in the plant Cannabis sativa, which grows readily in warm climates. Marijuana, the most prevalent type of cannabis preparation, is composed of the dried leaves, stems, and flowers of the plant. Hashish is a more potent concentrate of the resin derived from the flowering tops of the plant. Hash oil is a very concentrated form of THC made by boiling hashish in a solvent and filtering out the solid matter (Publishers Group, 2012). Cannabis products are usually smoked in the form of loosely rolled cigarettes. Cannabis can also be taken orally when it is prepared in food, but about two to three times the amount of cannabis must be ingested orally to equal the potency of that obtained by the inhalation of its smoke o Psychological addiction has been shown to occur with cannabis, and tolerance can occur. Controversy has existed about whether physiological addiction occurs with cannabis. In the past, symptoms of cannabis withdrawal were considered less than clinically significant to include the diagnosis in the DSM. However, the DSM-5 Substance-Related Work Group determined that subsequent research has provided significant data to support cannabis withdrawal as a valid and reliable syndrome that can negatively impact abstinence attempts of heavy cannabis users. The diagnosis of Cannabis Withdrawal is included in the DSM-5.
John's father committed suicide when John was a teenager. John's wife, Mary, tells the mental health nurse that she is afraid John "inherited" that predisposition from his father. How should the nurse respond to Mary?
The nurse should tell Mary that suicide is not inherited. Its an individual matter and can be prevented however suicide by a close family member increases an individuals risk factor for suicide.
• Echolalia
The parrot-like repetition, by an individual with loose ego boundaries, of the words spoken by another.
enculturation
The process of learning the norms w/i a culture.
• Impulsiveness
The trait of acting without reflection and without thought to the consequences of the behavior. An abrupt inclination to act (and the inability to resist acting) on certain behavioral urges.
• Impulsivity
The urge or inclination to act without consideration to the possible consequences of one's behavior.
*types of law*
There are 2 general categories of law that are of most concern to *nurses*: statutory law and common law. These laws are identified by their source or origin.
Spiritual Assessment Tool Inner Strengths
These questions assess a person's ability to manifest joy and recognize strengths, choices, goals, and faith. 1. What brings you joy and peace in your life? 2. What can you do to feel alive and full of spirit? 3. What traits do you like about yourself? 4. What are your personal strengths? 5. What choices are available to you to enhance your healing? 6. What life goals have you set for yourself? viii. What do you think is the role of stress, if any, in your illness? 7. How aware were you of your body before you became sick? 8. What do you believe in? 9. How has your illness influenced your faith? 10. How important is faith in your overall health and sense of well-being?
*Imagine you are traveling alone to a friend's wedding in a foreign land. You experience an extreme health event and lose consciousness. You wake up and find yourself alone in a hospital bed surrounded by strangers dressed in starched white clothes who speak an unknown language and exhibit peculiar gestures and expressions. You are experiencing extreme pain and feel terrified because you do not know what is happening to you and why. Two people approach you and tell you something you do not understand and transfer you to a stretcher and whisk you out into a dark hallway. You look down and see you have an indwelling urinary catheter and your abdomen has been prepped with iodine solution (you think you are allergic to iodine, but can not remember!). You cry and beg someone to help you understand what is happening. Two people standing at your side look at each other bewildered. What would you want and need in this scenario?*
Think about what it would be like to be transported to such a strange and frightening place gives us insight into what people under our care may be thinking and feeling. We as nurses are committed to understanding different cultures in order to provide competent and compassionate care.
*discuss the [chemically] impaired nurse*
a. Substance abuse and addiction is a problem that has the potential for impairment in an individual's social, occupational, psychological, and physical functioning. This becomes an especially serious problem when the impaired person is responsible for the lives of others on a daily basis. Approximately 10 percent of the general population suffers from the disease of chemical addiction. It is estimated that 10-15% of nurses suffer from this disease (Thomas & Siela, 2011). *Alcohol is the most widely abused drug, followed closely by narcotics*. Nurses who abuse substances have an added vulnerability because they often handle controlled substances when providing patient care. b. For years, the impaired nurse was protected, promoted, transferred, ignored, or fired. These types of responses promoted the growth of the problem. Programs are needed that involve early reporting and treatment of chemical addiction as a disease, with a focus on public safety and rehabilitation of the nurse. c. How does one identify the impaired nurse? It is still easiest to overlook what might be a problem. Denial, on the part of the impaired nurse as well as nurse colleagues, is still the strongest defense for not dealing with substance-abuse problems. Some states have mandatory reporting laws that require observers to report substance-abusing nurses to the state board of nursing. They are difficult laws to enforce, and hospitals are not always compliant with mandatory reporting. Some hospitals may choose not to report to the state board of nursing if the impaired nurse is actively seeking treatment and is not placing clients in danger. d. A number of clues for recognizing substance impairment in nurses have been identified (Ellis & Hartley, 2012; Thomas & Siela, 2011). Signs of substance impairment are not easy to detect, and they vary according to the substance being used. There may be high absenteeism if the person's source is outside the work area, or the individual may rarely miss work if the substance source is at work. There may be an increase in "wasting" of drugs, increased incidences of incorrect narcotic counts, and a higher record of signing out drugs than for other nurses. e. Poor concentration, difficulty meeting deadlines, inappropriate responses, and poor memory or recall usually occur late in the disease process. The person may also have problems with relationships. Some other possible signs are irritability, mood swings, tendency to isolate, elaborate excuses for behavior, unkempt appearance, impaired motor coordination, slurred speech, flushed face, inconsistent job performance, and frequent use of the restroom. He or she may frequently medicate other nurses' patients, and there may be patient complaints of inadequate pain control. Discrepancies in documentation may occur. Ideally, suspicious behavior has been recognized by peers and intervention sought before the impaired nurse reaches late stages of the disease process. As uncomfortable as it may seem to tell a supervisor about suspected impairment in one of your peers, it is in the interest of the nurse's health and most critically important to ensuring patient safety.
The nurse decides to respect family wishes and not tell the client of his terminal status because that would bring the most happiness to the most people. Which of the following ethical theories is considered in this decision? a. Utilitarianism b. Kantianism c. Christian ethics d. Ethical egoism
a. Utilitarianism
*unlawful acts* Classifications Within Statutory and Common Law
broadly speaking, there are 2 kinds: civil and criminal - both statutory law and common law have civil and criminal components.
adjustment disorder r/t bereavement
disturbances in grieving process following the death of a loved one, symptoms are exaggerated and have existed for at least 12 months.
*Table 19-1 | CARE PLAN FOR THE CLIENT WITH A TRAUMA-RELATED DISORDER* b. NURSING DIAGNOSIS: POSTTRAUMA SYNDROME c. RELATED TO: Distressing event considered to be outside the range of usual human experience d. EVIDENCED BY: Flashbacks, intrusive recollections, nightmares, psychological numbness related to the event, dissociation, or amnesia
e. Short- Term Goals (1) Client will begin a *healthy grief resolution*, initiating the process of psychological healing (within time frame specific to individual). (2) *Client will demonstrate ability to deal with emotional reactions in an individually appropriate manner (no drugs or alcohol)* f. Long-Term Goal (1) The client will integrate the traumatic experience into his or her persona, renew significant relationships, and establish meaningful goals for the future. g. Interventions (1) Assign the same staff as often as possible. i. Use a nonthreatening, matter-of-fact, but friendly approach. ii. Respect client's wishes regarding interaction with individuals of opposite gender at this time (especially important if the trauma was rape). iii. Be consistent; keep all promises; convey acceptance; spend time with client. 1. A post-trauma client may be suspicious of others in his or her environment. All of these interventions serve to facilitate a trusting relationship. (2) Stay with client during periods of flashbacks and nightmares. *Offer reassurance of safety and security and that these symptoms are not uncommon following a trauma of the magnitude he or she has experienced.* i. Presence of a trusted individual may calm fears for personal safety and reassure client that he or she is not "going crazy." (3) Obtain accurate history from significant others about the trauma and the client's specific response. i. Various types of traumas elicit different responses in clients (e.g., human-engendered traumas often generate a greater degree of humiliation and guilt in victims than trauma associated with natural disasters). (4) *Encourage the client to talk about the trauma at his or her own pace.!!!* Provide a nonthreatening, private environment, and include a significant other if the client wishes. Acknowledge and validate client's feelings as they are expressed. i. This debriefing process is the first step in the progression toward resolution. (5) Discuss *coping strategies* used in response to the trauma, as well as those used during stressful situations in the past. Determine those that have been most helpful, and discuss alternative strategies for the future. Include available support systems, including religious and cultural influences. Identify maladaptive coping strategies (e.g., substance use, psychosomatic responses) and practice more adaptive coping strategies for possible future post-trauma responses. i. Resolution of the post-trauma response is largely dependent on the effectiveness of the coping strategies employed. (6) Assist the individual to try to comprehend the trauma if possible. Discuss feelings of vulnerability and the individual's "place" in the world following the trauma. i. Post-trauma response is largely a function of the shattering of basic beliefs the survivor holds about self and world. Assimilation of the event into one's persona requires that some degree of meaning associated with the event be incorporated into the basic beliefs, which will affect how the individual eventually comes to reappraise self and world
*Intellectual disability (intellectual development disorder (IDD))*
has its onset prior to age 18 years and is characterized by impairments in measured intellectual performance and adaptive skills across multiple domains. o Defined by deficits in general intellectual functioning (as measured by intelligence quotient exams) and adaptive functioning (the ability to adapt to the requirements of daily living and the expectations of age and cultural group). Hereditary/Genetic Factors a. Implicated in approximately 5% of cases. Includes: (1) Inborn errors of metabolism, such as *Tay-Sachs disease*, phenylketonuria, and hyperglycinemia 4. General Medical Conditions Acquired in Infancy or Childhood a. Account for approximately 5% of cases of CI/ID b. Can be caused by: (1) *Infections, such as meningitis and encephalitis* Environmental Influences and Other Mental Disorders a. Accounts for between 15-20% of cases of CI/ID b. May be attributed to: (1) *Deprivation of nurturance and social, linguistic, and other stimulation!!!*
faith (spiritual need)
is often thought of as the acceptance of a belief in the absence of physical or empirical evidence. Having this requires that individuals rise above that which they can only experience through the five senses. Evidence suggests that this, combined with conventional treatment and an optimistic attitude, can be a very powerful element in the healing process.
cirrhosis of the liver
may be caused by anything that results in chronic injury to the liver, but it is also the end-stage of alcoholic liver disease and results from long-term chronic alcohol abuse. There is widespread destruction of liver cells, which are replaced by fibrous (scar) tissue. Symptoms nausea and vomiting, anorexia, weight loss, abdominal pain, jaundice, edema, anemia, and blood coagulation abnormalities. Treatment includes abstention from alcohol, correction of malnutrition, and supportive care to prevent complications of the disease. - Cirrhosis is the end-stage of alcoholic liver disease and is believed to be caused by chronic heavy alcohol use. There is widespread destruction of liver cells, which are replaced by fibrous (scar) tissue. Treatment includes abstention from alcohol, correction of malnutrition, and supportive care to prevent complications of the disease.
*Disruptive behavior disorders*
oppositional defiant disorder, conduct disorder
adjustment disorder w/ mixed anxiety and depressed mood
predominant features include depressed mood and manifestations of anxiety, symptoms are more pronounced that what would be normally expected a. The predominant features of this category include disturbances in mood (depression, feelings of hopelessness and sadness) and manifestations of anxiety (nervousness, worry, jitteriness) that are more intense than what would be expected or considered to be a normative response to an identified stressor.
adjustment disorder w/ anxiety
predominant manifestation is anxiety, diagnosis must be differentiated from those of anxiety disorders a. This category denotes a maladaptive response to a stressor in which the predominant manifestation is anxiety. For example, the symptoms may reveal nervousness, worry, and jitteriness. The clinician must differentiate this diagnosis from those of anxiety disorders.
antihypertensives
propranolol and clonidine have shown marked *reduction in nightmares*, impulsivity, irritability and violent behavior in clinical trials. (1) The beta blocker *propranolol* and alpha2-receptor agonist *clonidine* have been successful in alleviating some of the symptoms associated with PTSD. In clinical trials, marked reductions in nightmares, intrusive recollections, hypervigilance, insomnia, startle responses, and angry outbursts were reported with the use of these drugs
*spiritual assessment tool*
provides reflective questions for assessing, evaluating, and increasing awareness of spirituality in patients and their significant others. - The tool's reflective questions can facilitate healing because they stimulate spontaneous, independent, meaningful initiatives to improve the patient's capacity for recovery and healing - It is important for nurses to consider spiritual and religious needs when planning care for their clients. - *The Joint Commission requires that nurses address the psychosocial, spiritual, and cultural variables that influence the perception of illness.* - Assessing the spiritual needs of a client with a psychotic disorder can pose some additional challenges - Approximately 25% of people with schizophrenia and 15-22% of people with bipolar disorder have religious delusions - sometimes these delusions can be difficult to differentiate from general religious or cultural beliefs, but "longitudinal studies suggest that nonpsychotic religious activity may actually improve long-term prognosis in patients with psychotic disorders" - Engaging family members and significant others in the assessment process can be a great help in determining which religious beliefs and activities have been beneficial to the client versus those that have been detrimental to their progress.
*BOX 12-1 Suicide PROTECTIVE FACTORS*
• Effective and appropriate clinical care for mental, physical, and substance abuse disorders • Easy access to a variety of clinical interventions and support for help seeking • Restricted access to highly lethal methods of suicide • Family and community support • Support from ongoing medical and mental health care relationships • Learned skills in problem solving, conflict resolution, and nonviolent handling of disputes • Cultural and religious beliefs that discourage suicide and support self-preservation instincts
