Nursing 243 ch. 18, SOMATOFORM AND DISSOCIATIVE DISORDERS- 12, Nursing 243 ch. 19, Nursing 243 exam 1 (ch. 1-9, 11, 12, 27)

Catharsis

"The healthful (therapeutic) release of ideas through 'talking out' conscious material, accompanied by an appropriate emotional reaction; the release into awareness of repressed material from the unconscious"

Deinstitutionalization

(the closing of state mental hospitals and discharging of individuals with mental illness)

Body Dismorphic Disorder

- Characterized by the exaggerated belief that the body is deformed or defective in some specific way - If true defect is present, the person's concern is unrealistically exaggerated and grossly excessive - Symptoms of depression and obsessive-compulsive personality are common

Psychoanalytic theory for OCD

- Clients with weak, underdeveloped egos - Aggressive impulses are channeled into thoughts and behaviors that prevent the feelings of aggression from surfacing and producing intense anxiety fraught with guilt

Cognitive theory of GAD

- Faulty, distorted, or counterproductive thinking patterns result in anxiety that is maintained by mistaken or dysfunctional appraisal of a situation

Specific Phobia

- Fear of specific objects or situations that could conceivably cause harm, but the person's reaction to them is excessive, unreasonable, and inappropriate. - Exposure to the phobic object produces overwhelming symptoms of panic, including palpitations, sweating, dizziness, and difficulty breathing APPEAR MORE OFTEN IN WOMEN THAN MEN

Biological Aspects in anxiety Disorders

- Genetics: possible with trichotillomania - Neuroanatomy: possible abnormalities in basal ganglia and orbitalfrontal cortex with OCD -Physiology: some individuals with OCD exhibit EEG changes - Biochemical factors: possible decrease in serotonin with OCD and body dysmorphic disorder

Treatment Modalities

- Individual psychotherapy - Cognitive therapy - Behavior therapy 1. Systematic desensitization 2. Implosion therapy

Individual therapy (AD)

- Individual psychotherapy is the most common treatment for adjustment disorders. - Techniques are used to clarify links between the current stressor and past experiences, and to assist with the development of more adaptive coping strategies.

Predisposing variables to truama (Biological)

- It is suggested that the symptoms related to the trauma are maintained by the production of endogenous opioid peptides that are produced in the face of arousal, and which result 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.

GAD diagnosis

- The client must exhibit excessive anxiety and worry about two (or more) domains of activities or events, such as family, health, finances, and school/work difficulties. - The excessive anxiety and worry must occur on more days than not for three months or more. - The anxiety, worry, or physical symptoms must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. - Some clients might use alcohol or other addictive substances in an attempt to self-medicate and reduce the anxiety.

Panic Disorder

- The disorder generally develops in young adulthood and is more common in women. - Genetics and alterations in the neurotransmitters norepinephrine, serotonin, and GABA have been implicated in the development of panic disorder.

Family Therapy (AD)

- The focus of treatment is shifted from the individual to the system of relationships in which the individual is involved. - Emphasis is placed on communication, family rules, and interaction patterns among the family members.

EMDR Contraindications

- 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, - In clients who have neurological impairments (e.g.,seizure disorders), clients who are suicidal or experiencing psychosis, those with severe dissociative disorders or unstable substance abuse, and those with detached retina or glaucoma.

Trichotillomania

- The recurrent pulling out of one's own hair that results in noticeable hair loss - Preceded by increasing tension and results in sense of release or gratification - The disorder is not common, but it occurs more often in women than in men

Generalized Anxiety Disorder (GAD)

- This condition is often accompanied by depression, somatization (where the client experiences multiple physical symptoms that cannot be explained by disease), and the development of phobias. - Genetics and alterations in the neurotransmitters serotonin, norepinephrine, and gamma-aminobutyric acid (GABA) have been linked to the development of GAD.

Psychopharmacology (PTSD and ASD)

- the selective serotonin reuptake inhibitors (SSRIs) are now considered first-line treatment of choice for PTSD because of their efficacy, tolerability, and safety ratings ( - Alprazolam has been prescribed for PTSD clients for its antidepressant and antipanic effects. - Buspirone, which has serotonergic properties similar to the SSRIs, may also be useful. - The beta blocker propranolol and alpha2-receptor agonist clonidine have been successful in alleviating some of the symptoms associated with PTSD. - Carbamazepine, valproic acid,and lithium carbonate have been reported to alleviate symptoms of intrusive recollections, flash-backs, nightmares, impulsivity, irritability, and violent behavior in PTSD clients.

Statisitcs

-Anxiety disorders are the most common of all psychiatric illnesses -More common in women than men -Minority children and children from low socioeconomic environments are at risk -A familial predisposition probably exists

Predisposing factors to AD (Psychosocial)

-Childhood trauma, dependency, arrested development -Constitutional factor (birth characteristics) -Developmental stage and timing of the stressor -Available support systems -Dysfunctional grieving process

Nursing Interventions for Panic Disorder

-During a panic attack, nursing interventions include: • Remaining calm • Staying with the client during a panic episode • Offering reassurance about distressing physical symptoms • Using short, clear sentences when communicating with the client • Reducing environmental stimuli -Prior to a panic attack, nursing interventions include: • Teaching anxiety management techniques to use during panic episodes • Teaching the client signs and symptoms of increased anxiety • Reinforcing appropriate coping mechanisms • Encouraging the client to reduce the use of caffeine-containing beverages such as coffee • Teaching the client about any prescribed medications and their side effects

Psychodynamic theory of GAD

-Ego unable to intervene between id and superego - Overuse or ineffective use of ego defense mechanisms results in maladaptive responses to anxiety

Predisposing factors to AD (Biological)

-Genetics -Vulnerability related to neurocognitive or intellectual developmental disorders

Group/Family therapy (PTSD and ASD)

-Group therapy has been strongly advocated for clients with PTSD. -It has proved especially effective with military veterans - 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. - 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.

Eye movement Desensitization and Reprocessing (EMDR) (PTSD and ASD)

-It has been used with other disorders,including depression, adjustment disorders, phobias, addictions, generalized anxiety disorder, and panic disorder.

Predisposing variables to truama (Learning)

-Negative reinforcement leads to the reduction in an aversive experience, thereby reinforcing and resulting in repetition of the behavior -Avoidance behaviors -Psychic numbing

Prolonged exposure therapy (PE) (PTSD and ASD)

-Prolonged exposure therapy (PE) is a type of behavioral therapy somewhat similar to implosion therapy or flooding - In vivo exposure involves systematic confrontation, within safe limits, of trauma-related situations that are feared and avoided. This intense emotional processing of the traumatic event serves to neutralize the memories so that they no longer result in anxious arousal or escape and avoidance behaviors. - PE 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.

Predisposing factors to AD ( Transactional)

-Sudden-shock stressors occur without warning, and continuous stressors are those that an individual is exposed to over an extended period. - Situational factors include personal and general economic conditions; occupational and recreational opportunities; and the availability of social supports, such as family, friends, neighbors, and cultural or religious support groups.

Acute stress Disorder

-Symptoms are time limited: up to 1 month following the trauma -If the symptoms last longer than 1 month, the diagnosis would be PTSD

Panic Attack Onset

-The attacks usually last minutes, or more rarely, hours. -The individual often experiences varying degrees of nervousness and apprehension between attacks. -Symptoms of depression are common. -The average age of onset of panic disorder is the late 20s.

Cognitive therapy (CT) (PTSD and ASD)

-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.

Adjustment disorder

-a psychological response to an identifiable stressor or stressors. - Accordingly, stress reactions from "normal" daily events (e.g., divorce, failure, rejection) were characterized as adjustment disorders - more common in women, children and younger people. The response occurs within 3 months after onset and has persisted for no longer than 6 months after stressor has ended.

PTSD

-trauma that precedes PTSD as an event that is outside the range of usual human experience, such as rape, war, physical attack, torture, or natural or man-made disaster. - more common in women than men -symptoms must be present for more than 1 month and interfere with social, occupational and other areas of functioning

Neurotansmitters

1. Cholinergics (Acetylcholine) 2. Monoamines ( NorE, Dopamine, Serotonin, Histamine) 3. Amino Acids ( GABA, Glycine, Glutamine)

Topography of the mind

1. Conscious 2. Preconscious 3. Unconscious

Stages of Grief

1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance

Eight phase process of EMDR

1. History and treatment planning 2. preparation 3. Assessment 4. Desensitization 5. Installation 6. Body scan 7. Closure 8. Reevaluation

Types of spiritual needs

1. Meaning and purpose in life 2. Faith or trust in someone or something beyond ourselves 3. Hope 4. Love 5. Forgiveness

Development of the personality

1. Oral stage (birth to 18 months) 2. Anal stage (18 months to 3 years) 3. Phallic stage (3 to 6 years) 4. Latency stage (6 to 12 years) 5. Genital stage (13 to 20 years)

Phases of the Nurse Client Relationship

1. Preorientation 2. Orientation 3. Working 4. Termination

The public health model

1. Primary Prevention 2. Secondary Prevention 3. Tertiary Prevention

Dynamics of the personality

1. Psychic energy 2. Cathexis 3. Anticathexis

Avoiding liability

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 6. Documenting carefully 7. Following up by evaluating the care that was given

AD treatment goal

1. To relieve symptoms associated with a stressor. 2. To enhance coping with stressors that cannot be reduced or removed. 3. To establish support systems that maximize adaptation.

Tidal Commitments

1. Value the voice 2. Respect the language 3. Develop genuine curiosty 4.Become the apprentice 5. Use the available toolkit 6. Craft the step beyond 7. Give the gift of time 8. Reveal personal wisdom 9. Know that change is constant 10. Be transparent

Challenging Informed consent

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 a.hinder or complicate necessary treatment, b.cause severe psychological harm, or c.be so upsetting as to render a rational decision by the client impossible.

Peplau's four levels of anxiety ch.1

1. mild 2. moderate 3. severe 4. panic

Maslow's hierarchy of needs ch.1

1. physiological needs- food, water, air sleep, exercise, elimination, shelter and sexual expression 2. Safety and security- avoiding harm, comfort, order, structure, physical safety, freedom from fear and protection. 3. Love and Belonging- affection, companionship, satisfactory interpersonal relationships,identification with a group 4. Self-esteem/self esteem of others- seeks self respect and respect from others, works to achieve success and recognition in work, and desires prestige from accomplishments 5. Self actualization- the individual possesses a feeling of self fulfillment and the realization of his or her highest potential

Predisposing variables to truama (Psychosocial)

1. the traumatic experience 2. the individual 3. the recovery environment

A nurse assesses a patient diagnosed with conversion disorder. Which comment is most likely from this patient? a. "Since my father died, I've been short of breath and had sharp pains that go down my left arm but I think it's just indigestion." b. "I have daily problems with nausea, vomiting, and diarrhea. My skin is very dry and I think I'm getting seriously dehydrated." c. "Sexual intercourse is painful. I pretend like I'm asleep so I can avoid it. I think it's starting to cause problems with my marriage." d. "I get choked very easily and have trouble swallowing when I eat. I think I might have cancer of the esophagus."

A

A nurse counseling a patient with a dissociative disorder should understand that the assessment of highest priority is: a. risk for self-harm. b. cognitive functioning. c. identification of drug abuse. d. readiness to reestablish identity or memory.

A

A patient says, "I feel detached and weird all the time, like I'm looking at life through a cloudy window. Everything seems unreal. These feelings really interfere with my work and study." The nurse can assess that the patient is experiencing: a. depersonalization disorder. b. body dysmorphic disorder. c. dissociative amnesia. d. hypochondriasis.

A

A patient with somatization disorder has the nursing diagnosis Interrupted family processes related to patient's disabling symptoms as evidenced by spouse and children assuming roles and tasks that previously belonged to patient. An appropriate outcome is that the patient will: a. demonstrate resumption of former roles and tasks. b. assume roles and functions of other family members. c. focus energy on problems occurring in the family. d. rely on family members to meet personal needs.

A

To assist a patient with a somatoform disorder, a nursing intervention of high priority is: a. shift focus from somatic symptoms to feelings. b. imply that somatic symptoms are not real. c. help the patient suppress feelings of anger. d. investigate each physical symptom as it is offered.

A

To plan effective nursing care for a patient with somatization disorder, the nurse should be aware that the etiology of somatoform disorders may be related to: a. faulty perceptions and assessments of body sensations. b. traumatic memories of childhood events. c. culture-bound phenomena. d. depressive equivalents.

A

Which assessment finding supports dissociative fugue? The patient states: a. "I cannot recall why I'm living in this town." b. "I feel as if I'm living in a fuzzy dream state." c. "I feel very anxious and worried about my problems." d. "I feel like different parts of me are at war."

A

Which assessment would be more relevant to a patient with somatoform disorder than a patient with dissociative disorder? a. Voluntary control of symptoms b. Ability to perform self-care activities c. Effect of symptoms on family processes d. Use of alcohol, psychoactive drugs, and anxiolytics

A

Groups ch. 9

A collection of individuals whose association is founded on shared commonalities of interest, values, norms, or purpose

Complementary Medicine ch. 12

A complementary therapy is an intervention that is different from, but used in conjunction with,traditional or conventional medical treatment.

Anxiety ch.1

A diffuse apprehension that is vague in nature and is associated with feelings of uncertainty and helplessness.

Predisposing variables to truama (Cognitive)

A person is vulnerable to posttraumatic stress disorder when fundamental beliefs are invalidated by experiencing trauma that cannot be comprehended and when a sense of helplessness and hopelessness prevail

Phase 3. Final or termination phase

A sense of loss, precipitating the grief process, may be experienced by group members. The leader encourages the group members to discuss these feelings of loss and to reminisce about the accomplishments of the group. Feelings of abandonment may be experienced by some members. Grief for previous losses may be triggered.

Panic

A sudden overwhelming feeling of terror or impending doom. This most severe form of emotional anxiety is usually accompanied by behavioral,cognitive, and physiological signs and symptoms considered to be outside the expected range of normalcy.

Torts

A violation of a civil law in which an individual has been wronged. Can be intentional or unintentional

A patient with somatoform pain disorder says to the nurse, "Why has God chosen me to lead the life of an invalid, unable to provide for my family? The burden on my family may be even worse than the pain I bear. God is punishing my innocent family." Which nursing diagnoses should be developed for the patient? (More than one answer is correct.) a. Spiritual distress b. Self-care deficit c. Decisional conflict d. Ineffective role performance e. Impaired social interaction

A,D

Peripheral Nervous System

A.Afferent system 1.Sensory neurons a.Somatic b.Visceral B.Efferent system 1.Somatic nervous system a.Somatic motor neurons 2.Autonomic nervous system a.Sympathetic nervous system i.Visceral motor neurons b.Parasympathetic nervous system i.Visceral motor neurons

Central Nervous system

A.Brain 1.Forebrain a.Cerebrum i.Frontal lobes ii.Parietal lobes iii.Temporal lobes iv.Occipital lobes b.Diencephalon i.Thalamus ii.Hypothalamus iii.Limbic system 2.Midbrain a.Mesencephalon 3.Hindbrain a.Pons b.Medulla c.Cerebellum B.Nerve tissue 1.Neurons 2.Synapses 3.Neurotransmitters C.Spinal cord 1.Fiber tracts 2.Spinal nerves

Utilitarianism

Action is taken based on the end results that produced the most good(happiness) for the most people.

Psychopharmacology

Adjustment disorders are not commonly treated with medications, for the following reasons: (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.

The sustained response ch.1

Adrenocorticotropic hormone (ACTH) stimulates the adrenal cortex to release glucocorticoids and mineralocorticoids, resulting in increased gluconeogenesis and retention of sodium and water and decreased immune and inflammatory responses. Vasopressin (antidiuretic hormone) increase sfluid retention and also increases blood pressure through constriction of blood vessels. Growth hormone has a direct effect on protein, carbohydrate, and lipid metabolism,resulting in increased serum glucose and free fatty acids. Thyrotropic hormone stimulates the thyroid gland to increase the basal metabolic rate. Gonadotropins cause a decrease in secretion of sex hormones, resulting in decreased libido and impotence.

Ego

Also called the rational self or the "reality principle". develops between the ages of 4 to 6 months. A primary function of the ego is one of mediator, that is to maintain harmony among the external world, the id and the superego.

2. Curative factors

Altruism: individuals provide assistance and support to each other, thereby helping to create a positive self-image and promote self-growth. Corrective recapitulation of the primary family group: group members are able to re-experience early family conflicts that remain unresolved. Development of socializing techniques: through interaction with and feedback from other members of the group, individuals are able to correct maladaptive social behaviors and to learn and develop new social skills.

Assault

An act that results in a person's genuine fear and apprehension that he or she will be touched without consent

Intellectualization

An attempt to avoid expressing actual emotions associated with a stressful situation by using the intellectual processes of logic, reasoning, and analysis

Identification

An attempt to increase self-worth by acquiring certain attributes and characteristics of an individual one admires

OCD and body dysmorphic disorder Pharmacology

Antidepressants

Neuroendocrine System

Antidiuretic hormone- Polydipsia, altered pain response, Modified sleep pattern Oxytocin- Stress response Growth hormone- Anorexia nervosa TSH- ↑ insomnia, anxiety, emotional lability ↓ depression, fatigue ACTH- ↑ mood disorders, psychosis ↓ depression, apathy, fatigue Prolactin- ↑ depression, anxiety ↓ libido, irritability Gonadotropic hormone- ↑ aggressiveness ↓ depression, anorexia nervosa Melanocyte stimulating- ↑ depression

Cognitive theory to Phobias

Anxiety is the product of faulty cognitions or anxiety-inducing self-instructions 1. Negative self-statements 2. Irrational beliefs

Anxiety vs. Fear

Anxiety may be distinguished from fear in that the former is an emotional process, where as fear is a cognitive one. Fear involves the intellectual appraisal of a threatening stimulus; anxiety involves the emotional response to that appraisal. FEAR INVOLVES THE CEREBRAL CORTEX.

Panic and GAD Pharmacology

Anxiolytics Antidepressants Antihypertensive agents

Phobias Pharmacology

Anxiolytics Antidepressants Antihypertensive agents

Anxiety

Apprehension, tension, or uneasiness from anticipation of danger, the source of which is largely unknown or unrecognized. Anxiety may be regarded as pathological when it interferes with social and occupational functioning, achievement of desired goals, or emotional comfort

Diagnosis

Are clinical judgments about individual, family, or community responses to actual or potential health problems/life processes.

Outcomes

Are measurable, expected, patient-focused goals that translate into observable behaviors.

The nursing process

Assessment Diagnosis Outcomes Planning Implementation Evaluation

Rationalization

Attempting to make excusesor formulate logical reasons to justify unacceptable feelings or behaviors

Projection

Attributing feelings or impulses unacceptable to one's self to another person

A medical-surgical nurse works with a patient diagnosed with a somatoform disorder. Care planning is facilitated by understanding that the patient will probably: a. readily seek psychiatric counseling. b. be resistant to accepting psychiatric help. c. attend psychotherapy sessions without encouragement. d. be eager to discover the true reasons for physical symptoms.

B

A nurse counsels a patient diagnosed with body dysmorphic disorder. Which nursing diagnosis would be a priority for the plan of care? a. Anxiety b. Risk for suicide c. Ineffective role performance d. Disturbed body image

B

A patient has blindness related to a conversion disorder but is unconcerned about the problem. The nurse states, "I can't understand why the patient isn't more worried about this problem." The understanding that should guide planning is that the: a. patient is suppressing true feelings regarding the problem. b. patient's anxiety is relieved through the physical symptom. c. patient's needs have been met by hospitalization. d. patient has decided not to disclose authentic fears.

B

A patient has blindness related to conversion disorder. To help the patient eat, the nurse should: a. establish a "buddy" system with other patients who can feed the patient at each meal. b. expect the patient to feed self after explaining arrangement of the food on the tray. c. address needs of other patients in the dining room, then feed this patient. d. direct the patient to locate items on the tray independently and feed self unassisted.

B

A patient says, "I know I have a brain tumor despite the results of the MRI. The radiologist is wrong. People with brain tumors vomit. Yesterday I vomited all day." Which response by the nurse fosters cognitive restructuring? a. "You do not have a brain tumor. The more you talk about it, the more it reinforces your illogical thinking. We'll talk about something else." b. "Let's see if there are any other possible explanations for your vomiting." c. "You seem so worried. Let's talk about how you're feeling." d. "What interpersonal problems have you had recently?"

B

A patient with blindness related to conversion disorder tells a nurse, "I'm really popular here in the hospital. All the doctors and nurses stop by to check on me. Other patients are really interested in my blindness, too. Too bad people outside the hospital don't find me so interesting." Which nursing diagnosis is most relevant? a. Social isolation b. Chronic low self-esteem c. Interrupted family processes d. Ineffective health maintenance

B

A person who is unemployed comes to the clinic reporting, "I wear a scarf across my lower face when I go out but because of my ugly appearance. I don't know how I'll interview for jobs." Assessment reveals average looks with no actual disfigurement. These symptoms suggest which problem? a. Dissociative identity disorder b. Body dysmorphic disorder c. Hypochondriasis d. Malingering

B

Establishing a therapeutic relationship with a patient with a dissociative disorder may be more difficult for the nurse than establishing a relationship with a psychotic patient. This is because the patient with a dissociative disorder: a. seems arrogant, distant, and aloof. b. has symptoms that may seem contrived. c. seems too needy, overwhelming the nurse. d. seeks enormous amounts of secondary gain.

B

Which treatment modality could a nurse recommend to help a patient with pain disorder cope more effectively? a. Flooding b. Relaxation techniques c. Response prevention d. Systematic desensitization

B

A nurse assesses a patient suspected to have somatization disorder. Which findings support the diagnosis? (More than one answer is correct.) a. Patient is 41 years old b. Patient reports frequent syncope c. Patient complains of heavy menstrual bleeding d. Patient was first diagnosed with psoriasis at age 12 e. Patient reports back pain, painful urination, frequent diarrhea, and hemorrhoids

B,C,E

Therapeutic Community Conditions

Basic physiological needs are fulfilled. The physical facilities are conducive to achievement of the goals of therapy. A democratic form of self-government exists. Responsibilities are assigned according to client capabilities. A structured program of social and work-related activities is scheduled as part of the treatment program. Community and family are included in the program of therapy in an effort to facilitate discharge from treatment.

Crisis Intervention (AD)

Because of increased anxiety, the individual with an adjustment disorder is unable to problem-solve, so he or she requires guidance and support from another to help mobilize there sources needed to resolve the crisis.

Oral stage (Birth to 18 months)

Behavior is directed by the id, and the goal is immediate gratification. Relief from anxiety through oral gratification of needs. A sense of security and the ability to trust others are derived from the gratification of fulfilling basic needs during this stage.

A patient being counseled for somatoform pain disorder says, "My pain is from an undiagnosed injury. I can't perform my own activities of daily living or walk 20 minutes. I have to take pain medicine six or seven times a day. I feel like a baby because my family has to provide so much care for me." The nurse understands that it is important to assess: a. mood. b. cognitive style. c. secondary gain. d. identity and memory.

C

A patient is 5 feet, 7 inches, 160 pounds, wears a size 8 shoe, and says, "My feet are huge compared with the rest of my body. I've asked three orthopedic surgeons if they can surgically reduce my feet." The patient tries to buy shoes to make the feet look smaller and in social settings conceals both feet under a table or chair. Which health problem is likely? a. Hypochondriasis b. Somatoform pain disorder c. Body dysmorphic disorder d. Depersonalization disorder

C

A patient reports fears of having cervical cancer and says to the nurse, "I've used up all my sick leave at work having Pap smears by six different doctors. The results were all normal, but I'm sure that's because the slides weren't preserved correctly before they were sent to the lab." Which disorder would the nurse suspect? a. Dissociative fugue b. Conversion disorder c. Hypochondriasis d. Pain disorder

C

A patient was encouraged to seek help regarding episodes of strange behavior that the patient cannot remember. The roommate observed the patient leaving home wearing uncharacteristically seductive clothing, returning 12 to 24 hours later, and then sleeping for 8 to 12 hours. After arguments between the patient and roommate, the patient sat on the floor in the corner and spoke like a young child. Which health problem should be considered? a. Conversion disorder b. Depersonalization disorder c. Dissociative identity disorder d. Body dysmorphic disorder

C

A patient with somatoform pain disorder who has been in treatment for 4 weeks tells the clinic nurse, "Although I'm still having pain, I notice it less and am able to perform more activities." The nurse should evaluate the treatment plan as a. unsuccessful. b. minimally successful. c. partially successful. d. totally achieved.

C

An essential difference between somatoform disorders and dissociative disorders is: a. symptoms of somatoform disorders are under voluntary control, whereas symptoms of dissociative disorders are unconscious and automatic. b. symptoms of dissociative disorders are precipitated by psychological factors, whereas symptoms of somatoform disorders are related to stress. c. dissociative disorders entail stress-related disruptions of memory, consciousness, or identity, whereas somatoform disorders involve expression of psychological stress through somatic symptoms. d. symptoms of dissociative disorders are individually determined and related to childhood sexual abuse, whereas symptoms of somatoform disorders are culture bound.

C

The emotional reaction that nurses who counsel patients with somatoform disorder are most likely to experience is: a. fear and anxiety. b. pleasure and interest. c. frustration and resentment. d. sympathy and desire to rescue.

C

The spouse of a patient diagnosed with depersonalization disorder says to the nurse, "Am I responsible for this illness? Our relationship is very mutually supportive and no trauma has occurred recently." The nurse's reply should be based on knowledge that this disorder is possibly related to: a. faulty learning. b. genetic predisposition. c. childhood emotional abuse. d. intentional production of symptoms.

C

To plan effective care for patients with somatoform disorders, the nurse should understand that patients may have difficulty giving up the symptoms because the symptoms: a. are generally ego dystonic. b. can be voluntarily controlled. c. provide relief of anxiety. d. have a physiological basis.

C

A patient's roommate has observed the patient behaving in uncharacteristic ways, but the patient cannot remember the episodes. A dissociative disorder is suspected. During the assessment, which questions would be most relevant? (More than one answer is correct.) a. "Are you sexually promiscuous?" b. "Do you think you need an antidepressant medication?" c. "Have you ever found yourself someplace and did not know how you got there?" d. "Are your memories of childhood clear and complete or do you have blank spots?" e. "Have you ever found new things in your belongings that you can't remember buying?"

C,D,E

4. Curative factors

Catharsis: within the group, members are able to express both positive and negative feelings Existential factors: the group is able to assist individual members to take direction of their own lives and to accept responsibility for the quality of their existence

Amygdala

Center of emotional awareness and response; sustains long-term emotional memories

Generalized Anxiety Disorder (GAD)

Characterized by persistent, unrealistic, and excessive anxiety and worry, which have occurred more days than not for at least 6 months and cannot be attributed to specific organic factors, such as caffeine intoxication or hyperthyroidism.

Panic Disorder

Characterized by recurrent panic attacks, the onset of which is unpredictable, and manifested by intense apprehension, fear, or terror, often associated with feelings of impending doom and accompanied by intense physical discomfort. *May or may not be accompanied by agoraphobia*

Hair-pulling disorder Pharmacology

Chlorpromazine Amitriptyline Lithium carbonate SSRIs and pimozide Olanzapine

Learning Theory or OCD

Conditioned response to a traumatic event Passive avoidance (Staying Away) Active avoidance (provide relief from the anxiety and discomfort associated with the traumatic situation)

Occipital lobe

Controls the individual's visual areas and functions.

Compensation

Covering up a real or perceived weakness by emphasizing a trait one considers more desirable

Culture ch.5

Culture describes a particular society's entire way of living, encompassing shared patterns of belief, feeling, and knowledge that guide people's con-duct and are passed down from generation to generation.

A nurse assessing a patient with a somatoform disorder is most likely to note that the patient: a. readily sees a relationship between symptoms and interpersonal conflicts. b. rarely derives personal benefit from the symptoms. c. has little difficulty communicating emotional needs. d. has altered comfort and activity needs.

D

A patient who fears serious heart disease was referred to the mental health center by a cardiologist. After extensive diagnostic evaluation, no physical illness was found. The patient says, "I have tightness in my chest and a sensation of my heart missing a beat. I've missed a lot of time from work and I don't go out much anymore because I need to rest each evening." These findings are consistent with which health problem? a. Somatization disorder b. Dysthymic disorder c. Antisocial disorder d. Hypochondriasis

D

A patient with depersonalization disorder tells the nurse, "It's starting again. I feel as though I'm going to float away." The nurse should help the patient by: a. encouraging meditation. b. administering an anxiolytic. c. helping the patient visualize a pleasant scene. d. helping the patient focus on the here and now.

D

Complete this nursing diagnosis for a patient with dissociative identity disorder: Disturbed personal identity related to: a. obsessive fears of harming self or others. b. poor impulse control and lack of self confidence. c. depressed mood secondary to nightmares and intrusive thoughts. d. cognitive distortions associated with unresolved childhood abuse issues.

D

For a patient with dissociative amnesia, complete this outcome: "Within 4 weeks, patient will demonstrate ability to execute complex mental processes by : a. verbalizing feelings of safety." b. functioning independently." c. regularly attending diversional activities." d. describing previously forgotten experiences."

D

Development

Developmental theories identify behaviors associated with various stages through which individuals pass, thereby specifying what is appropriate or inappropriate at each developmental level. -identified by age - affected by temperament (inborn personality characteristics)

Depression

During this stage, the full impact of the loss is experienced. The sense of loss is intense, and feelings of sadness and depression prevail. This is a time of quiet desperation and disengagement from all association with the lost entity. This stage differs from pathological depression in that it represents advancement toward resolution rather than the fixation in an earlier stage of the grief process.

Alarm reaction ch.1

During this stage, the responses of the fight-or-flight syndrome are initiated.

Life Experiences related to Phobias

Early experiences may set the stage for phobic reactions later in life

Diagnostic procedures

Electroencephalography- measures brain electrical activity Computerized EEG mapping- Measures brain electrical activity CT scan- Measures accuracy of brain structures MRI- Measures anatomical and biochemical status of various segments of the brain PET- Measures specific brain activity and functioning SPECT- measures brain activity and functioning

Guiding principles of Recovery

Emerges from hope Is person-driven Occurs via many pathways Is holistic Is supported by peers and allies Is supported through relationship and social networks Is culturally based and influenced Is supported by addressing trauma Involves individual, family, and community strengths and responsibility Is based on respect

Ethics

Ethics is a branch of philosophy that deals with systematic approaches to distinguishing right from wrong behavior

Ethnicity

Ethnicity is a somewhat narrower term and relates to people who identify with each other because of a shared heritage

Planning

Evidenced based interventions for achieving the outcome criteria are selected

Social Phobia

Excessive fear of situations in which the affected person might do something embarrassing or be evaluated negatively by others.

Symptoms of social phobia

Exposure to the phobic situation usually results in feelings of panic anxiety, with sweating, tachycardia, and dyspnea.

Psychotropics- benzodiazepins

Facilitate the transmission of GABA

Phobia

Fear cued by the presence or anticipation of a specific object or situation,exposure to which almost invariably provokes an immediate anxiety response or panic attack even though the subject recognizes that the fear is excessive or unreasonable. The phobic stimulus is avoided or endured with marked distress

Agoraphobia

Fear of being in places or situations from which escape might be difficult or in which help might not be available in the event of panic-like symptoms or other incapacitating symptoms.

Learning Theory to Phobias

Fears are conditioned responses and thus are learned by imposing reinforcements for certain behaviors.

Psychoanalytic Theory

Freud believed basic character was formed by age 5. He organized the structure of the personality into three major components: id, ego and superego.

Freud

Freud first introduced the term anxiety neurosis in 1895.

Dream Analysis

Freudians believe that behavior is rooted in the unconscious and that dreams are a manifestation of the troubles people repress.

Monoamines- NorEpinephrine

Function: (Fight or flight) May have a role in the regulation of mood, in cognition and perception, in cardiovascular functioning, and in sleep and arousal. Implications: low levels in depression high levels in mania, anxiety and schizophrenia

Cholinergics- Acetylcholine

Function: Implicated in sleep, arousal, pain perception, the modulation and coordination of movement and memory acquisition and retention Implications: high levels in depression low levels in parkinsons, Alzheimers and huntingtons

Amino Acids- Glutamate

Function: In the relay of sensory information and in the regulation of various motor and spinal reflexes Implications: low levels can induce psychotic behavior high levels in parkinsons and neurodegenerative disorders.

Amino Acids- GABA

Function: Interrupts the progression of the electrical impulse at the synaptic junction, producing a significant slowdown of body activity. Implications: Low levels in anxiety disorders, movement disorders, and epilepsy

Monoamines- Dopamine

Function: Involved in regulation of movements and coordination, emotions, voluntary decision making ability. Implications: low levels in parkinsons and depression high levels in schizophrenia and mania

Monoamines- Serotonin

Function: May play role in sleep and arousal, libido, appetite, mood, aggression, and pain perception Implications: Low levels in depression high levels in schizophrenia and anxiety

Amino Acids- Glycine

Function: recurrent inhibition of motor neurons within the spinal cord and is possibly involved in the regulation of spinal and brainstem reflexes. Implications: in pathogenesis of certain types of spastic disorders

Monoamines- Histamine

Function: unclear Implications: May play role in depression and weight gain with psychotropic meds.

Anal stage (18 months to 3 years)

Gaining independence and control, with particular focus on the excretory function. Adult retentive personality traits influenced by this type of training include stubbornness, stinginess, and miserliness.

Risk factors for Anxiety Disorders

Gender, Age, Personality, family history, social factors, traumatic events, medical conditions

Biological Aspects of GAD

Genetics Neuroanatomical Biochemical Neurochemical

Diet and nutrition

Good nutrition is essential for good health and important for physical growth and development, good body composition, and mental development. A person's nutritional state can protect him from or predispose him toward chronic disease. Only recently has it been dis-covered that nutrition influences our genetic code. Medical treatment for many diseases includes diet therapy. Nutrition is thus both a preventive and a therapeutic science.

Grief

Grief is a subjective state of emotional, physical, and social responses to the loss of a valued entity.

Least restrictive treatment

Health-care personnel must attempt to provide treatment in a manner that least restricts the freedom of clients. The "restrictiveness" of psychiatric therapy can be described in the context of a continuum, based on severity of illness.

Four dimensions of recovery

Health:Overcoming or managing one's disease as well as living in a physically and emotionally healthy way. 2. Home:A stable and safe place to live .3. Purpose:Meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income, and resources to participate in society. 4. Community:Relationships and social net-works that provide support, friendship, love,and hope.

Hypnosis

Hypnotherapy is sometimes used in psychoanalysis as a tool for unlocking the unconscious or for searching further into "past life regression."Hypnosis is very deep relaxation during which the therapist, who has been trained in techniques of trance formation, asks certain questions of the client.

Bargaining

If God will help me through this, I promise I will go to church every Sunday and volunteer my time to help others." During this stage, which is usually not visible or evident to others, a "bargain" is made with God in an attempt to reverse or postpone the loss. Sometimes the promise is associated with feelings of guilt for not having performed satisfactorily, appropriately, or sufficiently.

3. Curative factors

Imitative behavior: group members who have mastered a particular psychosocial skill or developmental task serve as valuable role models for others. Interpersonal learning: group offers varied opportunities for interacting with other people. Group cohesiveness: members develop a sense of belonging rather than separating the individual ("I am") from group ("we are").

Mileu Therapy ch. 8

In psychiatry, therapy involving the milieu, or environment, may be called milieu therapy, therapeutic community,or the therapeutic environment. The goal of milieu therapy is to manipulate the environment so that all aspects of the client's hospital experience are considered therapeutic.

Stage 2. Awareness

In this stage, the individual comes to a realization that a possibility for recovery exists.

Obsessive-Compulsive Disorder

Include the presence of obsessions,compulsions, or both, the severity of which is significant enough to cause distress or impairmentin social, occupational, or other important areas of functioning

Unconscious

Includes all memories that one is unable to bring to conscious awareness. It is the largest of the three topographical levels.

Conscious

Includes all memories that remain within an individual's awareness. It is the small-est of the three categories. Events and experiences that are easily remembered or retrieved are considered to be within one's conscious awareness. The conscious mind is thought to be under the control of the ego, the rational and logical structure of the personality.

Individual Psychoterapy

Individual psychotherapy takes place on a one-to-one basis between a client and a therapist

1. Curative factors

Instillation of hope: by observing the progress of others in the group with similar problems, a group member garners hope that his or her problems can also be resolved. Universality: individuals come to realize that they are not alone in the problems, thoughts, and feelings they are experiencing. Imparting of information: group members share their knowledge with each other. Leaders of teaching groups also provide information to group members.

Introjection

Integrating the beliefs and values of another individual into one's own ego structure

Secondary Prevention

Interventions aimed at minimizing early symptoms of psychiatric illness and directed toward reducing the prevalence and duration of the illness.

Implementation

Interventions selected during the planning stage are executed

Alternative medicine

Interventions that differ from the traditional or conventional biomedical treatment of disease. "Alternative" refers to an intervention that is used instead of conventional treatment.

Repression

Involuntarily blocking unpleasant feelings and experiences from one's awareness

Hippocampus

Involved in emotional reactions and learning; processes, stores nd retrieves memories.

Temporal lobe

Involves all aspects of auditory processing. upper portion involved with auditory functions Lower portion involved with short term memory.

Kantianism

Is the principle or motivation on which the action is based that is the morally decisive factor.

Therapeutic Interpersonal Relationship

Is the process by which nurses provide care for clients in need of psychosocial intervention. Therapeutic use of self is the instrument for delivery of that care.Interpersonal communication techniques(both verbal and nonverbal) are the "tools" of psychosocial intervention.

The tidal model

It is a mental health nursing recovery model that may be used as the basis for interdisciplinary mental health care. The focus is on the individual's personal story

Latino Amercians

Large family groups are important, and touch is a common form of communication.The predominant religion is Roman Catholicism,and the church is often a source of strength in times of crisis. Health care may be delivered by a folk healer called a curandero,who uses various forms of treatment to restore the body to a balanced state.

Phase 1. initial or orientation phase

Leader and members work together to establish rules and goals for the group. Leader promotes trust and ensures that rules do not interfere with fulfillment of the goals. Members are superficial and overly polite. Trust has not yet been established

Mental illness ch.1

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

The role of the nurse

Medication administration Development of a one-to-one relationship Setting limits on unacceptable behavior Client education

Stress

Mental, emotional, or physical strain experienced by an individual in response to stimuli from the external or internal environment.

Mild anxiety ch.1

Mild anxiety prepares people for action. It sharpens the senses, increases motivation for productivity,increases the perceptual field, and results in a heightened awareness of the environment.Learning is enhanced, and the individual is able to function at his or her optimal level.

Panic Anxiety ch.1

Misperceptions are common, and a loss of contact with reality may occur. The individual may experience hallucinations or delusions.Behavior may be characterized by wild and desperate actions or extreme withdrawal.Human functioning and communication with others are ineffective. Panic anxiety is associated with a feeling of terror, and individuals may be convinced that they have a life-threatening illness or fear that they are "going crazy," are losing control, or are emotionally weak.Prolonged panic anxiety can lead to physical and emotional exhaustion and can be life threatening.

Moral Behavior

Moral behavior is defined as conduct that results from serious critical thinking about how individuals ought to treat others.

Ethical and legal issues ch. 4

Nursing competency and client care accountability are compromised when the nurse has inadequate knowledge about the laws that regulate the practice of nursing.

Personality Disorders

Only when personality traits become inflexible and personality functioning becomes individually and interpersonally impaired do they constitute personality disorders.

Agoraphobia Onset

Onset of symptoms most commonly occurs in the 20s and 30s and persists for many years. It is diagnosed more commonly in women than in men. Impairment can be severe.

Social Phobia Onset

Onset of symptoms of this disorder often begins in late childhood or early adolescence and runs a chronic, sometimes lifelong, course. It appears tobe more common in women than in men

Slander

Oral defamation of character

Mental Health Assessment

Orientation Appearance Behavior Mobility Assessment of speech Mood Affect Thought Process Cognition

Right to refuse medications

Patient's Bill of Rights states,"The patient has the right to refuse treatment to the extent permitted by law and to be informed o fthe medical consequences of his action." In psychiatry, refusal of treatment primarily concerns the administration of psychotropic medications. The treatment team must determine that three criteria be met to force medication without 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.

A nursing model: Peplau

Peplau identifies seven nursing roles in which nurses function to assist individuals in need of health services: Stranger Resource person Counselor Teacher Leader Technical expert Surrogate

Parietal Lobe

Performs sensory functions. Language interpretation is associated with the left hemisphere.

Personality risk factors

Personality- Shy and impaired socialization people are more prone to anxiety disorders

Age risk factor

Phobias and OCD can begin in childhood. Social phobia and panic disorder begin in adolescence.

Reaction Formation

Preventing unacceptable or undesirable thoughts or behaviors from being expressed by exaggeratin gopposite thoughts or types of behavior

Phase 2. Middle or working phase

Productive work toward completion of the task is undertaken. Leader role diminishes and becomes more one of facilitator. Trust has been established among the members and cohesiveness exists. Conflict is managed by the group members themselves.

Maladaptive grief responses

Prolonged response- characterized by an intense preoccupation with memories of the lost entity for years after the loss has occurred. Delayed/inhibited response- the individual becomes fixed in the denial stage of the grieving process. Distorted response- individual is fixed in the anger stage of grieving.

Sublimation

Rechanneling of drives of impulses that are personally or socially unacceptable into activities that are constructive

Superego

Referred to as the "perfectionist principle". Develops between ages 3 and 6 years. Derived from a system of rewards and punishments. Composed of two major components: the ego-ideal and the conscience.

Veracity

Refers to one's duty to always be truthful.

Beneficence

Refers to one's duty to benefit or promote the good of others

Counter transference

Refers to the nurse's behavioral and emotional response to the client.

Denial

Refusing to acknowledge the existence of a real situation or the feelings associated with it

Relaxation Therapy

Relaxation therapy is an effective means of reducing the stress response in some individuals. The degree of anxiety that an individual experiences in response to stress is related to certain predisposing factors, such as characteristics of temperament with which he or she was born, past experiences resulting in learned patterns of responding, and existing conditions, such as health status, coping strategies,and adequate support systems.

Compulsions

Repetitive ritualistic behavior or thoughts, the purpose of which is to prevent or reduce distress or to prevent some dreaded event or situation.The person feels driven to perform such actions in response to an obses-sion or according to rules that must be applied rigidly, even though the behaviors or thoughts are recognized to be excessive or unreasonable

Regression

Responding to stress byretreating to an earlier level of development and the com-fort measures associated withthat level of functioning

Recovery ch. 11

Restoration to a former and/or better state or condition.

Active listening

SOLER S- Sit squarely facing the client O- Observe an open posture L- Lean forward toward the client E- Establish eye contact R- Relax

Flight or flight syndrome ch. 1

Selye called this general reaction of the body to stress the general adaptation syndrome.

Isolation

Separating a thought or memory from the feeling tone or emotion associated with it

Primary Prevention

Services aimed at reducing the incidence of mental disorders within the population. 1. Assisting individuals to increase their ability to cope effectively with stress. 2. Targeting and diminishing harmful forces(stressors) within the environment.

Tertiary Prevention

Services aimed at reducing the residual defects that are associated with severe and persistent mental illness. Preventing complications of the illness. 2. Promoting rehabilitation that is directed toward achievement of each individual's maximum level of functioning.

Religion

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.

Functions of groups

Socialization: the teaching of social norms occurs through group interaction Support: fellow group members are available in time of need. Task completion: groups can assist in endeavors that are beyond the capacity of one individual alone. Camaraderie: individuals receive joy and pleasure from interactions with significant others. Informational: learning takes place when group members share their knowledge with the others in the group Normative: different groups enforce established norms in various ways Empowerment: change can be made by groups at times when individuals alone are ineffective Governance: large organizations often have leadership that is provided by groups rather than by a single individual

Cormorbid disorders with Trichotillomania

Some of these include mood disorders, eating disorders, anxiety disorders, substance-abuse disorders, and personality disorders—most commonly histrionic, borderline,and obsessive-compulsive

The psychological Rcovery model

Stage 1. Moratorium stage 2. Awareness Stage 3. Preperation Stage 4. Rebuilding Stage 5. Growth

Native Americans

Still live on reservations.They speak many different languages and dialects. They often appear silent and reserved and many are uncomfortable with touch and expressing emotions. Health care may be delivered by a healer called a shaman.

Anxiety vs. Stress

Stress, or more properly, a stressor, is an external pressure that is brought to bear on the individual. Anxiety is the subjective emotional response to that stressor.

Psychosocial influences in Trichotillomania

Stressful situations Disturbances in mother-child relationship Fear of abandonment Recent object loss Possible childhood abuse or emotional neglect

Undoing

Symbolically negating or canceling out an experience that one finds intolerable

Biological Aspects to Phobias

Temperament- Characteristics with which one is born that influence how he or she responds throughout life to specific situations (e.g., innate fears)

Immediate Response ch.1

The adrenal medulla releases norepinephrine and epinephrine into the bloodstream. The pupils of the eye dilate.Secretion from the lacrimal (tear) glands is increased. In the lungs, the bronchioles dilate and the respiration rate is increased. The force of cardiac contraction increases, as does cardiac output, heart rate, and blood pressure. Gastrointestinal motility and secretions decrease, and sphincters contract. In the liver, there is increased glycogenolysis and gluconeogenesis and decreased glycogensynthesis. The bladder muscle contracts, and the sphincter relaxes; there is increased ureter motility. Secretion from the sweat glands is increased. Lipolysis occurs in the fat cells.

Free association

The client is allowed to say whatever comes to mind in response to a word that is given by the therapist.

Systemic Desensitization

The client is gradually exposed to the phobic stimulus, either in a real or imagined situation. *COMMONLY USED TO TREAT PHOBIC DISORDERS AND BEHAVIOR IN OCD*

Personality ch. 2

The combination of character, behavioral, temperamental, emotional, and mental traits that are unique to each specific individual.

OCD prevalence

The disorder is equally common among men and women. It may begin in childhood, but more often begins in adolescence or early adulthood.The course is usually chronic, and may be complicated by depression or substance abuse. Single people are affected more often than are married people

Acceptance

The final stage brings a feeling of peace regarding the loss that has occurred. It is a time of quiet expectation and resignation. The focus is on the reality of the loss and its meaning for the individuals affected by it.

Thorazine

The first major tranquilizers 1960's brought on deinstitutionalization (moving from asylums to community settings)

Latency stage (6 years to 12 years)

The focus changes from egocentrism to one of more interest in group activities, learning and socialization with peers. Sexually repressed; focus on relationships with same gender peers.

Working

The focus is on addressing issues of concern to the client and exploring different approaches to problem solving

Phallic stage (3 years to 6 years)

The focus of energy shifts to the genital area. Discovery of differences between genders results in a heightened interest in the sexuality of self and others. Oedipus and electra complex occur during this stage.

Therapeutic touch

The goal is to re-pattern the energy field by performing slow, rhythmic, sweeping hand motions over the entire body. Heat should be felt where the energy is blocked. The therapist "massages" the energy field in that area, smoothing it out, and thus correcting the obstruction.

Resolution

The grief response can last from weeks to years. It cannot be hurried, and individuals must be allowed to progress at their own pace. After the loss of a loved one, grief work usually lasts for atleast a year, during which the grieving person experiences each significant "anniversary" date for the first time without the loved one present. Resolution of the process of mourning is thought to have occurred when an individual can look back on the relationship with the lost entity and accept both the pleasures and the disappointments.

Stage 4. Rebuilding

The hard work of recovery takes place in the rebuilding stage. The individual"takes the necessary steps to work towards his or her goals in rebuilding a meaningful life"

Basic Assumptions of the Mileu Therapy

The health in each individual is to be realized and encouraged to grow. Every interaction is an opportunity for therapeutic intervention. The client owns his or her own environment. Each client owns his or her own behavior. Peer pressure is a useful and powerful tool. Inappropriate behaviors are dealt with as they occur. Restrictions and punishment are to be avoided

Spirituality

The human quality that gives meaning and sense of purpose to an individual's existence. Spirituality 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.

Adjustment disorder unspecified

The individual may have physical complaints, with-draw from relationships, or exhibit impaired work or academic performance, but without significant disturbance in emotions or conduct.

Stage of Resistance ch.1

The individual uses the physiological responses of the first stage as a defense in the attempt to adapt to the stressor. If adaptation occurs, the third stage is prevented or delayed. Physiological symptoms may disappear.

The limbic system

The limbic system, which is sometimes called the "emotional brain," is associated with fear and anxiety; anger and aggression; love, joy, and hope; and sexuality and social behavior.

Acupressure and Acupuncture

The main concept is that healing energy (qi) flows through the body along specific pathways called meridians. The meridians connect a series of acupoints. In acupressure therapy, the clinician applies pressure to these acupoints. In acupuncture, hair-thin, sterile, disposable, stainless steel needles are inserted into acupoints to dissolve the obstructions along the meridians.

Genital Stage (13 years to 20 years)

The maturing of the genital organs results in a reawakening of the libidinal drive. Libido reawakened as genital organs mature; focus on relationships with members of the opposite gender.

Moderate anxiety ch.1

The moderately anxious individual is less alert to events occurring within the environment. The individual's attention span and ability to concentrate decrease, although he or she may still attend to needs with direction. Assistance with problem-solving may be required. Increased muscular tension and restlessness are evident.

Orientation

The nurse and client begin to lay the foundation for trust and establish the contract for the relationship, including forming the client when the relationship will end.

Termination

The nurse and client evaluate the progress of the relationship and whether the identified goals have been met (this phase is addressed throughout the nurse-client relationship)

Preorientation

The nurse reviews the client's chart and prepares for the first encounter

Yoga

The objective of yoga is to integrate the physical,mental, and spiritual energies that enhance health and well-being

Stage 5. Growth

The outcome of the psychological recovery process is growth. Although it is called the final stage of the psychological recovery model, it is important to remember that this is a dynamic stage and that personal growth is a continuing life process.

Parasympathetic nervous system

The parasympathetic nervous system is dominant in the nonstressful or relaxed state.

Severe anxiety ch.1

The perceptual field of the severely anxious individual is so greatly diminished that concentration centers on one particular detail only or on many extraneous details.Attention span is extremely limited, and the individual has much difficulty completing even the simplest task. Physical symptoms(e.g., headaches, palpitations, insomnia) and emotional symptoms (e.g., confusion, dread,horror) may be evident. Discomfort is experienced to the degree that virtually all overt behavior is aimed at relieving the anxiety.

Adjustment disorder with mixed anxiety and depressed mood

The predominant features of this category include disturbances in mood (e.g., depression, feelings of hopelessness and sadness) and manifestations of anxiety (e.g., nervousness, worry, jitteriness) that are more intense than what would be expected

Adjustment disorder with mixed disturbance of emotions and conduct

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).

Cathexis

The process by which the id invests energy into an object in an attempt to achieve gratification.

Evaluation

The process of determining both the client's progress toward the attainment of expected outcomes and the effectiveness of nursing care.

Nonmaleficence

The requirement that health-care providers do no harm to their clients, either intentionally or unintentionally

Behavior Therapy (AD)

The situations that promote ineffective responses are identified, and carefully designed reinforcement schedules, along with role modeling and coaching, are used to alter the maladaptive response patterns.

Psychobiology ch.3

The study of the biological foundations of cognitive, emotional, and behavioral processes.

Mental Health ch.1

The successful adaptation to stressors from the internal and external environment, evidenced by thoughts, feelings and behaviors that are age-appropriate and congruent with local and cultural norms.

Sympathetic nervous system

The sympathetic nervous system becomes the dominant component during stressful situations. Activation of the sympathetic nervous system results in the fight-or-flight response.

Adjustment disorder with depressed mood

The symptoms, such as depressed mood, tearfulness, and feelings of hopelessness,exceed what is an expected or normative response to an identified stressor.

Bioethics

The term applied to these principles when they refer to concepts within the scope of medicine, nursing, and allied health.

Pet Therapy

The therapeutic value of pets is no longer just theory. Evidence has shown that animals can directly influence a person's mental and physical well-being.

Displacement

The transfer of feelings from one target to another that is considered less threatening or that is neutral

Battery

The unconsented touching of another person

Anticathexis

The use of psychic energy by the ego and the superego to control id impulses.

Suppression

The voluntary blocking of unpleasant feelings and experiences from one's awareness

Chiropractic medicine

Theory behind this type of healing is that energy flows from the brain to all parts of the body through the spinal cord and spinal nerves; when vertebrae of the spinal column become displaced, they may press on a nerve and interfere with normal nerve transmission

Biological Variations

These differences include body structure (both size and shape), skin color,physiological responses to medication, electrocardiographic patterns, susceptibility to disease, and nutritional preferences and deficiencies.

Christian ethics

This approach to ethical decision-making is focused on the way of life and teachings of Jesus Christ.

Adjustment disorder with anxiety

This category denotes a maladaptive response to a stressor in which the predominant manifestation is anxiety.

Adjustment disorder with disturbance of conduct

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.

Denial

This is a stage of shock and disbelief. The response may be one of "No, it can't be true!" The reality of the loss is not acknowledged. Denial is a protective mechanism that allows the individual to cope within an immediate time frame while organizing more effective defense strategies.

Stage 3. Preparation

This stage begins with the individual's resolve to begin the work of recovery.

Stage 1. Moratorium

This stage is identified by dark despair and confusion. "It is called moratorium, because it seems 'life is on hold'"

Stage of exhaustion ch.1

This stage occurs when there is a prolonged exposure to the stressor to which the body has become adjusted. The adaptive energy is depleted, and the individual can no longer draw from the resources for adaptation described in the first two stages.Diseases of adaptation (e.g., headaches, men-tal disorders, coronary artery disease, ulcers,colitis) may occur. Without intervention for reversal, exhaustion and even death ensues.

Autonomy

This viewpoint emphasizes the status of persons as autonomous moral agents whose right to determine their destinies should always be respected.

Reality Therapy

Through the skillful use of reality therapy, it is possible to help a person evaluate whether behavioral change is desirable and possible and whether adjusting to the demands of the "real world" would be appropriate and satisfying. If clients decide that change is beneficial to them, they are helped to make better choices designed to maintain or increase their need fulfillment.

Industry vs. Inferiority (6 to 12 years)

To achieve a sense of self-confidence by learning, competing, performing successfully, and receiving recognition from significant others, peers, and acquaintances

Generativity vs. Stagnation (30 to 65 years)

To achieve the life goals established for oneself while also considering the welfare of future generations

Trust vs. Mistrust (birth to 18 months)

To develop a basic trust in the mothering figure and learn to generalize it to others

Initiative vs. Guilt (3 to 6 years)

To develop a sense of purpose and the ability to initiate and direct own activities

Intimacy vs. Isolation (20 to 30 years)

To form an intense, lasting relationship or a commitment to another person, cause, institution, or creative effort

Autonomy vs. Shame and Doubt (18 months to 3 years)

To gain some self-control and independence within the environment

Identity vs. Role Confusion (12 to 20 years)

To integrate the tasks mastered in the previous stages into asecure sense of self

Ego Integrity vs. Despair (65 years to death)

To review one's life and derive meaning from both positive and negative events while achieving a positive sense of self-worth

Asian Americans

Touching during communication has historically been considered unacceptable. Asian Americans may have difficulty expressing emotions and appear cold and aloof. Family loyalty is emphasized. Psychiatric illness is viewed as behavior that is out of control and brings shame on the family.

Arab Americans

Trace their ancestry and traditions to the nomadic desert tribes of the Arabian Peninsula. Arabic is the official language of the Arab world and the dominant religion is Islam.Mental illness is considered a social stigma and symptoms are often somaticized.

Trauma and stress related disorders

Trauma- An extremely distressing experience that causes severe emotional shock and may have long-lasting psychological effects.

Treatment modalities (PTSD and ASD)

Trauma-related disorders Cognitive therapy Prolonged exposure therapy Group/family therapy Eye movement desensitization and reprocessing Psychopharmacology

Theory of Psychosocial Development: Erikson

Trust vs. Mistrust (birth to 18 months) Autonomy vs. Shame and Doubt (18 months to 3 years) Initiative vs. Guilt (3 to 6 years) Industry vs. Inferiority (6 to 12 years) Identity vs. Role Confusion (12 to 20 years) Intimacy vs. Isolation (20 to 30 years) Generativity vs. Stagnation (30 to 65 years) Ego Integrity vs. Despair (65 years to death)

Psychoanalytic Theory to Phobias

Unconscious fears may be expressed in a symbolic manner as phobia

Value

Values are personal beliefs about what is important and desirable

Values Clarification

Values clarification is a process of self-exploration through which individuals identify and rank their own personal values.

Herbal medicine

Virtually every culture in the world has relied on herbs and plants to treat illness. The Food and Drug Administration (FDA) classifies herbal remedies as dietary supplements or food additives. Therefore, their labels cannot indicate medicinal uses, and they are not subject to FDA approval.

Frontal lobe

Vital to cognition and thinking processes. The frontal lobes control voluntary body movement, including, movements that permit speaking, thinking, and judgment formation. The alterations include fear, aggressiveness, depression, rage, euphoria, irritability, and apathy and are likely related to a frontal lobe connection to the limbic system.

Anticipatory Grief

When a loss is anticipated, individuals often begin the work of grieving before the actual loss occurs. Most people re-experience the grieving behaviors once the loss occurs, but having this time to prepare for the loss can facilitate the process of mourning, actually decreasing the length and intensity of the response.

Defamation of character

When shared information is detrimental to the client's reputation

Transference

When the client unconsciously displaces or transfers to the nurse feelings formed toward a person from his or her past. Can be positive or negative.

Anger

Why me?" and "It's not fair!"are comments often expressed during the anger stage. Envy and resentment toward individuals not affected by the loss are common. Anger may be directed at the self or displaced on loved ones, caregivers, and even God. There may be a preoccupation with an idealized image of the lost entity.

Libel

Written defamation of character

Mini mental status examination

a 30-item test used to assess cognitive function. The MMSE is particularly useful for determining cognitive changes occurring over time, such as in Alzheimer disease.

Cognitive Therapy

a form of psychotherapy that focuses on the role of the individual's thoughts and attitudes in determining feelings and behaviors.

Beck Depression Inventory

a screening tool that identifies symptoms of depression, which might later lead to a diagnosis of depression.

Ethical dilemmas

a situation that requires an individual to make a choice between two equally unfavorable alternatives

Assessment

a systematic, dynamic process by which the nurse, through interaction with the client, significant others, and health-care providers, collects and analyzes data about the client.

Northern european Americans

are the descendants of the first immigrants to the United States and make up the current dominant cultural group. They value punctuality, work responsibility, and a healthy lifestyle.

Abnormal Involuntary Movement scale

assesses abnormal muscle movements, including: akathisia (a sense of restlessness that causes a person to be unable to be still) and tardive dyskinesia (involuntary or repetitive body movements related to use of psychiatric medication).

Natural law theories

based on the writings of St. Thomas Aquinas. It advances the idea that decisions about right versus wrong are self-evident and determined by human nature.

Jewish People

came to the United States predominantly from Spain, Portugal, Germany,and Eastern Europe. Four main Jewish religious groups exist today: Orthodox, Reform,Conservative, and Reconstructionist. The primary language is English. A high value is placed on education. Jewish Americans are very health conscious and practice preventive health care. The maintenance of one's mental health is considered just as important as the maintenance of one's physical health.

Anxiety Disorder due to another medical Condition and Substance/Medication-Induced Anxiety Disorder

cardiac conditions, such as myocardial infarction, congestive heart failure, and mitral valve prolapse; endocrine conditions, such as hypoglycemia, hypo- or hyperthyroidism, and pheochromocytoma; respiratory conditions, such as chronic obstructive pulmonary disease and hyperventilation; and neurological conditions, such as complex partial seizures, neoplasms, and encephalitis. *EVIDENCE OF INTOXICATION OR WITHDRAWAL MUST BE PRESENT*

Obsessions

current and persistent thoughts, impulses, or images experienced as intrusive and stressful. Recognized as being excessive and unreasonable even though they are a product of one's mind. The thought, impulse, or image cannot be expunged by logic or reasoning

Ego defense mechanisms ch.1

either used conciously or unconciously as protective devices for the ego and in an effort to relieve mild to moderate anxiety.

Ethical egoism

espouses that what is right and good is what is best for the individual making the decision

Gravely disabled

generally defined as a condition in which an individual, as a result of mental illness, is in danger of serious physical harm resulting from inability to provide for basic needs such as food, clothing, shelter, medical care, and personal safety. Inability to care for oneself cannot be established by showing that an individual lacks the resources to provide the necessities of life. Rather, it is the inability to make use of available resources.

Western Europeans

have their origins in Italy, France, and Greece. They are warm and expressive and use touch as a common form of communication. The dominant religion is Roman Catholicism for the Italians and French, and Greek Orthodox for the Greeks.Most Western European Americans follow the health practices of the dominant culture, but some folk beliefs and superstitions endure.

Minnesota multiphase personality inventory

identifies and assesses patterns of emotional and personality functioning for abnormalities such as personal, social, and behavioral problems.

Individual Psychotherapy

in which the client talks one-on-one with a mental health clinician such as a psychiatrist, psychologist, advanced practice nurse, social worker, or other professional.

Preconscious

includes all memories that may have been forgotten or are not in present awareness but, with attention, can readily be recalled into consciousness. It is thought to be partially under the control of the superego, which helps to suppress unacceptable thoughts and behaviors.

Axis 1

includes major mental health disorders except for mental retardation and personality disorders (disorders in which a person's cognition or ability to accurately perceive and appropriately relate to others and the world around them is disturbed).

Psychotropics- Psychostimulants

increase release of norepinephrine, serotonin and dopamine.

Axis 3

indicates specific diagnoses of medical conditions.

Axis 2

involves mental retardation, personality disorders, and use of specific defense mechanisms (mental processes that help to protect a person against anxiety, shame, and other unpleasant emotions).

Justice

its basicpremise lies with the right of individuals to betreated equally regardless of race, sex, marital status, medical diagnosis, social standing, economic level, or religious belief

Axis 4

lists social or environmental stressors such as lack of housing, low levels of education, legal issues, and poor access to health care.

Gender risk factor

more common in women then men but OCD affects both sexes equally

Phases of group Development

phase 1. Initial or orientation phase phase 2. Middle or working phase phase 3. Final or termination phase

Civil Law

protects the private and property rights of individuals and businesses.

Self- Help Groups (AD)

provide an arena in which members may consider and compare their responses to individuals with similar life experiences. Members benefit from learning that they are not alone in their painful experiences.

Axis 5

provides a rating score for the client's global assessment of functioning (GAF). The GAF is a numeric scale ranging from 0-100 that assigns a ranking for the social, occupational, and psychological functioning of adults.

Criminal Law

provides protection from conduct deemed injurious to the public welfare.

African Americans

race their roots in the United States to the days of slavery. Most have large support systems and a strong religious orientation. Many have assimilated into and have many of the same characteristics as the dominant culture. Some African Americans from the rural South may receive health care from a folk practitioner.

Geriatric Depression scale

rates depression in older adults.

Characteristic symptoms of PTSD

re-experiencing the traumatic event, a sustained high level of anxiety or arousal, or a general numbing of responsiveness. Intrusive recollections or nightmares of the event are common. Some individuals may be unable to remember certain aspects of the trauma.

Psychic Energy

the force or impetus required for mental functioning. Originating in the id, it instinctually fulfills basic physiological needs.

Id

the locus of instinctual drives-- the pleasure principle. Id-drive behaviors are impulsive and may be irrational.

Implosion Therapy

therapeutic process in which the client must imagine situations or participate in real-life situations that he or she finds extremely frightening for a pro-longed period of time. Relaxation training is not a part of this technique. *COMMONLY USED TO TREAT PHOBIC DISORDERS AND BEHAVIOR IN OCD*

Culture bound syndromes

unique patterns of aberrant behavior and troubling experiences,[that occur] in various parts of the world, whose clinical descriptions do not readily fit into the Western conventional diagnostic categories"

Children's depression rating scale

used to assess depressive symptoms specific to children.

Psychotropics- antipsychotics

work by blocking specific neurotransitter receptors

Psychotropics- antidepressants

work by blocking the reuptake of nuerotransmitters, specifically Serotonin and norepinephrine.

Medical Conditions risk factors

• Certain medical conditions cause anxiety. Some of these include hypoglycemia, angina, hypo- or hyperthyroidism, adrenal tumors, and conditions that impair respiration, such as congestive heart failure, emphysema, asthma, lupus, and myasthenia gravis.

OCD symptom patterns

• Contamination, followed by excessive washing or avoidance of "contaminated" objects • Pathologic doubt, followed by a compulsion of checking (e.g., electrical appliances or door locks) • Intrusive thoughts without a compulsion, often of a sexual or violent act • The need for symmetry or precision Other symptom patterns include religious obsessions, compulsive hoarding, trichotillomania (compulsive hair pulling), and nail biting.

Nursing interventions for OCD

• Conveying acceptance of the client as a person (because such clients might feel shame knowing that the behavior is irrational and that they are powerless to stop it) • Encouraging alternate activities to distract from compulsions • Encouraging the client to wake up earlier to complete rituals and be available to perform other activities • Avoiding interrupting ritual behaviors unless they are interfering with client safety • Planning client teaching after completion of rituals • Teaching about prescribed medication • Reducing demands on the client

Nursing Interventions for GAD

• Help the client to learn new coping strategies. • Teach the client about any prescribed medications and their side effects. • Provide a relaxed, nonstimulating environment. • Use a calm and supportive approach. • Assess your own feelings and level of anxiety when interacting with your client because anxiety can be contagious.

Family history risk factor

• Many individuals who develop an anxiety disorder were reared by parents or guardians who themselves demonstrated extreme anxiety, fears, and phobias. • A genetic trait might be responsible for development of these disorders. However, behavioral theorists suggest that feelings of mental uneasiness and apprehension and behavioral responses to these feelings are learned

Social Risk factor

• Modern society is complex and can be extremely stressful at times. • Individuals who lack appropriate support might feel isolated and overwhelmed and develop anxiety disorders.

Nursing Interventions for PTSD

• Providing a nonthreatening environment, such as one with no sudden, loud noises • Monitoring the client's current level of anxiety and encouraging and reinforcing appropriate self-calming techniques • Teaching new coping strategies • Teaching the client about prescribed medications, proper administration, and actions and side effects • Assessing and acknowledging feelings of guilt, grief, and shame • Assisting the client with resuming regular activities • Providing physical, social, and occupational therapy • Assisting the client to identify personal and family support

Nursing Interventions for Phobias

• Providing assurance to the client that he/she is in no danger • Providing structure and direction for the client (in acute episodes) • Providing emotional support in a nonjudgmental manner • Assisting the client to rethink or reframe the ability to manage the anxiety • Assisting the client to reappraise the level or threat as less damaging • Teaching the client relaxation techniques, such as deep breathing • Assisting the client to gain insight into his/her reactions

Nursing interventions for all Anxiety disorders

• Reduce fear. • Reduce anxiety. • Promptly intervene with clients experiencing panic. • Promote enhanced coping skills and problem solving. • Promote effective communication. • Promote safety.

Traumatic Risk factor

• Traumatic events in childhood (e.g., abuse) or in adulthood (e.g., wars and rape) can increase an individual's anxiety beyond his or her ability to cope effectively. • Such events can trigger an anxiety disorder

The recovery envrionment

■Availability of social support ■The cohesiveness and protectiveness of family and friends ■The attitude of society regarding the experience ■Cultural and subcultural influences

The individual variables

■Degree of ego-strength ■Effectiveness of coping resources ■Presence of preexisting psychopathology ■Outcomes of previous experiences with stress/trauma ■Behavioral tendencies (temperament) ■Current psychosocial developmental stage ■Demographic factors (e.g., age, socioeconomicstatus, education)

Symptoms of Panic Attack

■Palpitations, pounding heart, or accelerated heart rate ■Sweating ■Trembling or shaking ■Sensations of shortness of breath or smothering ■Feelings of choking ■Chest pain or discomfort ■Nausea or abdominal distress ■Feeling dizzy, unsteady, lightheaded, or faint ■Chills or heat sensations ■Paresthesias (numbness or tingling sensations) ■Derealization (feelings of unreality) or depersonalization (feelings of being detached from oneself) ■Fear of losing control or going crazy ■Fear of dying *4 or more need to present for diagnosis*

The traumatic experience characteristics

■Severity and duration of the stressor ■Extent of anticipatory preparation for the event ■Exposure to death ■Numbers affected by life threat ■Amount of control over recurrence ■Location where the trauma was experienced(e.g., familiar surroundings, at home, in a foreign country)