180 Mental Health Exam 2 Flashcards
Change in the brain that disrupts a person’s interpretation and/or experience of the world secondary to complex neurobiological changes
Hallucinations, delusions, and/or disorganized thinking are hallmark characteristics
Psychosis
Failure to thrive syndrome
Slowed physical growth d/t the inability to integrate the physical, emotional, and sensorimotor realms of functioning
Related to neglect, environmental problems, and severe family stress
Risk factors:
* Genetic influences
* Complications during pregnancy or birth
* Biochemical imbalances
* Environmental factors
Psychosis in Childhood
Schizophrenia is a seldom diagnoses
May spend the remainder of their days in long-term care facilities
Acute onset of psychotic behavior must be investigated
Psychosis in Older Adults
The average teen is in contact with reality; the adolescent with schizophrenia is not.
Changes in behavior noted include:
* Poor hygiene
* Strange, vague speech
* Social withdrawal
* Odd behaviors
* Bizarre thoughts and beliefs
* Unusual superstition
Psychosis in Adolescence
Onset of acute symptoms most often occurs in men during their middle twenties, while women usually present with symptoms in their late twenties
Prognosis for individuals with schizophrenia is better if adaptive interpersonal relationships and acceptable school performance and work histories were in place before the onset of symptoms.
Psychosis in Adulthood
What are 5 subtypes of schizophrenia?
Catatonic
Disorganized
Paranoid (most seen)
Undifferentiated
Residual
What are S/s of Psychosis-Positive Symptoms?
Delusions
Hallucinations
Disorganized thinking
Disorganized/abnormal motor behavior
Visual (seeing things)
Auditory (hearing voices)
Tactile (feeling things touch your skin)
Olfactory (smelling things, or not smelling the same things as others)
Gustatory experiences (tasting things)
Hallucinations (positive sign)
What are Psychosis-Negative Symptoms?
Alogia (reduction in quantity of words spoken)
Affective blunting (emotional expressions don’t show outwardly)
Asociality (reduction in social initiative due to decreased interest in forming close relationships with others)
Anhedonia (reduced experience of pleasure)
Avolition (reduced goal-directed activity due to decreased motivation)
Anosognosia (someone is unaware of their own mental health condition or that they can’t perceive their condition accurately)
What is the course of schizophrenia marked by?
Episodes of acute psychosis alternating with periods of relatively normal functioning
The symptoms of schizophrenia must occur for at least _______ before a diagnostic label is assigned.
A) 6 months
B) 8 Months
C) 1 year
D) 2 years
C) 1 year
The slide into schizophrenia commonly occurs over what four stages?
Prodromal phase
Pre-psychotic phase
Acute phase
Remission
Typical agents: Blocks action of dopamine in the brain
* Ex: Halperidol (Haldol)
Atypical agents: Blocks serotonin receptors & dopamine receptors
* Ex: Aripiprazole (Abilify), Olanzapine (Zyprexa)
Use:
* Treat psychoses associated with mental illnesses (schizophrenia, mania, psychotic depression, psychotic organic brain syndrome)
Side effects:
* Peripheral Nervous System Effects (PNS)
* Constipation, urinary retention, urinary hesitation
* Dry mouth, nasal congestion
* Blurred vision, photophobia
* Hypotension or orthostatic hypotension
* Tachycardia, sedation, weight gain.
Anti Psychotic Agents
Drug induced condition that produces serious, irreversible side effect of long-term treatment
Produces involuntary, repeated movements of the muscles of the face, trunk, arms, and legs
Facial movements are usually affected first with protrusion of the tongue, puffing of cheeks or tongue in cheek, lip smacking, puckering
Difficult to treat and is irreversible except in the very early stages.
Tardive Dyskinesia
unpredictable / potentially fatal extrapyramidal side effect of antipsychotic medications
Must be recognized and treated quickly
* Neurologic emergency
Occurs in men more than women.
* Can affect all individuals of all ages.
Death occurs from respiratory or kidney failure, aspiration pneumonia or pulmonary emboli
Usually associated with high-potency antipsychotics or other dopamine altering drugs
* Development can occur suddenly after a single dose or years after drug treatment
S/s:
* Sudden change in LOC
* Rapid onset of rigid muscles
* Cardinal sign is a high body temperature.
Neuroleptic Malignant Syndrome (NMS)
A cardinal sign of neuroleptic malignant syndrome is:
A) low body temperature (95° F to 98.6° F).
B) high body temperature (102° F to 108° F).
C) rapid speech.
D) muscle flaccidity.
B) high body temperature (102° F to 108° F).
Tardive dyskinesia involves involuntary muscle movements that most often are associated with the:
A) mouth, lips, and tongue.
B) extremities.
C) trunk.
D) head.
A) mouth, lips, and tongue.
What are S/s related to Anticholinergic Effects?
Dry mouth, hot feeling
Blurred vision
Urinary retention
Photophobia
Tachycardia more serious side effect and can cause sudden death.
Blind
Which is the only anxiety problem that presents with psychotic features?
A) Panic
B) severe anxiety
C) Post traumatic stress disorder
D) Substance abuse
D) Substance abuse
Which of the following is an example of secondary psychosis:
A) Encephalitis
B) Schizophrenia
C) Depressive disorder
D) Personality Disorders
A) Encephalitis
The nurse is caring for a patient who states that she has never been able to experience pleasure in life. The patient’s condition is known as what?
A) Perseveration
B) Alexithymia
C) Apathy
D) Anhedonia
D) Anhedonia
The nurse is caring for a patient who has an inability to sit still. The patient feels nervous and jittery. What is this patient experiencing?
A) Akathisia
B) Akinesia
C) Bradykinesia
D) Dyskinesia
A) Akathisia
The nurse is caring for a patient who is in the process of sliding into schizophrenia. Her patient is withdrawn, lacks energy, and has little motivation. The patient is in what phase?
A) Prodromal
B) Prepsychotic
C) Acute
D) Residual
A) Prodromal
The patient has just been placed on antipsychotic drugs. It is important for the patient to know that it may take how long for the drug to become effective and stabilize the behavior?
A) Hours
B) Days
C) Weeks
D) Months
C) Weeks
Ineffective coping responses
Appropriate but insufficient
Use or abuse of alcohol or other substances
• Smoking
• Overeating
• Denial
•Avoidance
Maladaptive Coping
After performing a screening interview on a patient, which finding should be documented as a physiological stressor?
A) Dementia
B) Caregiving of parent
C) Divorce
D)Death of friend
A) Dementia
A patient has come to the health clinic for an annual checkup. He reports increased stress at work and having to work a lot of mandatory overtime. He has not been able to do his usual daily exercise for several weeks. What is the best response by the nurse?
A) “There are other ways you can reduce your stress, such as cutting back on your work hours.
B) “Have you considered a medication to help you sleep at night?”
C) “Including exercise in your schedule will just increase the stress from work.”
D) “Regular exercise would be good because it helps the body deal with stress.
D) “Regular exercise would be good because it helps the body deal with stress.
The nurse is caring for a pt diagnosed w/ a degenerative neuromuscular disease with no known cure. Which statement by the patient alerts the nurse that information about effective coping strategies is needed?
A) “I have decided to take some art lessons at the community center.”
B) “I am sleeping much better when I have two drinks and smoke before bed.”
C) “I am scheduling a family reunion for the upcoming holiday.
D) “I have decided to sell my house and move into an apartment with my son.”
Spring term
B) “I am sleeping much better when I have two drinks and smoke before bed.”
Normal emotional response to a perceived threat, frustration, or distressing event
Can be focused on the self or others
Associated with anxiety and loss of control
Can be used as a coping mechanism
Anger
forceful attitude or action that is expressed physically, symbolically, or verbally
Aggression
the ability to directly express one’s feelings or needs in a way that respects the rights of other people yet retains one’s dignity
Assertiveness
Aggressive behavior that violates another person or a person’s preperty
Studies have shown that assault and violence occur
in a predictable pattern of ergational responses
5 stages in the assult cycle:
* Trigger
* Escalation
* Crisis
* Recovery
* Depression
Assult
Stress-producing event that brings out anger, fear, anxiety, or a similar response
Client chooses coping mechanisms to achieve control
* For lack of efficient coping, assaultive behavior becomes automatic
Clients ability to solve problems or use nonviolent behavior decreases as aggressive feelings escalate
Crisis interventions are very successful if begun early
Trigger stage of assult cycle
What are the 3 levels of intervention for aggressive or potentially aggressive client behaviors?
Level 1: Focus on the prevention of violence
Level 2: Focus on protecting client & others from harm
Level 3: Reserved for clients who are out of control
Defined as compulsive masculinity
Characteristics:
* Attitude of male pride
* Engages in thrill seeking behavior, enjoys contact sports
* Treats women as objects or commodities
* Egocentric (Self centered)
* Dislikes being gentle or vulnerable
* Displays sexist attitudes
* Unable to cooperate w/ women
* Uses aggression to physically solve problems
* Agrees to sexual use & physical abuse of women
Machismo
What are some characteristics of a dysfunctional family?
Family members are self-centered
Authority is inconsistent or lacking
Roles are not clearly defined
Family members are unable to meet own/others needs
No common goals are identified
Communication is cold/indifferent
Family violence is present
What are some characteristics of a women who is at risk of being abused?
Trusting nature
Raised to be nonaggressive & traditional
Believes that the men is master & protector of household
What are some characteristics of a man who has the potential to be an abuser of women?
Poor emotional control
Superior attitude toward women
Hx of substance abuse
High levels of jealousy & insecurity
Uses threats, punishments,
& physical violence to control anothers behavior
What effects does abuse have on a pregnant woman?
Low birth weight infants
Pre-term deliveries
Lack of prenatal care
Most vulnerable individuals in society
Spanking & other forms of physical punishment teach children that power & violence are approved coping mechanisms
Mistreatment forms:
* Physical abuse
* Sexual abuse
* Emotional abuse
* Negelct
S/s of abuse:
* Little eye contact w/ adults
* Withdraw from physical contact w/ adults
* Fractures, bruises & welts in different healing stages
Child abuse
