ati book Flashcards
phase where the NURSE:
Introduce self to the client and state purpose
Set the contract: meeting time, place, frequency, duration, and date of termination
Discuss confidentiality
Build trust by establishing expectations and boundaries
Set goals with the client
Explore the clients ideas, issues, and needs
Explore the meaning of testing behavior
Enforce limits on testing or other inappropriate behavior
orientation
is the expression of psychological stress through physical manifestation.
The physical manifestations of somatic symptom disorder cannot be explained by underlying pathology
spend a significant amount of time worrying about their physical manifestations to the point where it assumes a central role in the clients life and relationship
Somatization
MALADAPTIVE USE:
A person who learns he has a terminal illness focuses on creating a will and financial matters rather than acknowledging his grief
Intellectualization
interactions that occur with ________
Concurrent use with MAO’s can cause severe hypertension.
Concurrent use with antihistamines and other anticholinergic agents can result in additive
anticholinergic effects.
Concurrent use with direct-acting sympathomimetics can result in increased effects of these
medications, because uptake is blocked by TCAs.
Concurrent use with indirect-acting sympathomimetics can result in decreased effect of these medications
Concurrent use with alcohol, benzodiazepines, opioids, and antihistamines can result in additive CNS
depression.
Tricyclic antidepressants
Communication that occurs between two or more people in a small group.
allows the nurse to discuss a change in the clients behavior with the health care team or discuss concerns with clients during a group therapy session
Small-group communication:
Members who take on these roles tend to help maintain the purpose and process of the Group.
For example, the harmonizer attempts to prevent conflict in the group
Maintenance roles:
COMPLICATIONS:
seizures supression of appetite headache drymouth GI distress constipation increased heart rate nausea insomnia restlessness
Atypical antidepressants
A therapist or others serve as role models for a client, who imitates this modeling to improve behavior
help clients improve interpersonal skills
modeling
MALADAPTIVE USE:
A person who dislikes her neighbor tells others what a great neighbor she is
Reaction formation
This examination is used to obtain a baseline assessment of a clients level of consciousness, and for ongoing assessment Eye, verbal, and motor response is evaluated, and a number value based on that response is assigned. The highest value possible is 15, which indicates that the client is awake and responding appropriately
Glasgow Coma Scale
is short term memory losss and confusion normal after and ECT?
yes
these agents, known as serotonin norepinephrine reuptake inhibitors (SNRIs), increase the amount of these neurotransmitters available in the brain for impulse transmission. SNRIs have little effect on other neurotransmitters and receptors
Venlafaxine, duloxefine, desvenlafaxine, levomilnacipran
Atypical antidepressants
These medications block reuptake of norepinephrine and serotonin in the synaptic space, thereby intensifying the effects of these neurotransmitters
THERAPEUTIC USES: Depressive disorders Neuropathic pain Fibromyalgia Anxiety disorders Insomnia Bipolar disorder
Tricyclic antidepressants
level of anxiety that
Slightly reduced perception and processing of information occurs, and selective inattention can occur
Ability to think clearly is hampered, but learning and problem-solving can still occur
concentration difficulties, tiredness, pacing, change in voice pitch, voice tremors, shakiness, and increased heart rate and respiratory rate
somatic manifestations including headaches, backache, urinary urgency and frequency, and insomnia
usually benefits from the direction of others
Moderate
is one in which all members share a certain chosen characteristic, such as diagnosis
or gender
homogeneous group
uses electrical current to induce brief seizure activity while the client is anesthetized
ECT
ADAPTIVE USE:
A student puts off thinking about a fight she had with her friend so she can focus on a test
Suppression
Abdominal pain Back pain Pain in the extremities/joints Menstrual problems or cramps Headaches Chest pain Dizziness Fainting Heart pounding or racing Dyspnea Problems or pain with sexual intercourse Problems with bowel elimination (constipation/diarrhea) Nausea, indigestion, or gas Lethargy
are all most common ___________ symptoms
somatic symptom disorder
•
experiencing a sudden event with little or no time to prepare
Perception of the event as ovemhelrning or life-threatening
Loss or decrease in communication with significant others
Sense of displacement from the familiar
An actual or perceived loss
ARE ALL COMMON ________CHARACTERISTICS
CRISIS
Phenelzine
Isocarboxazid
Tranylcypromine
Selegiline: transdermal patch
are what kind of medictions
Monoamine oxidase inhibitors
This therapy uses various techniques to control pain, tension, and anxiety
A nurse can teach diaphragmatic breathing to a client having a panic attack, or to a female client in labor
Meditation, guided imagery, diaphragmatic breathing, muscle relaxation, and biofeedback
A nurse or other health professional trained in this method uses a sensitive mechanical device to assist the client to gain voluntary control of such autonomic functions as heart rate and blood pressure
Biofeedback
These roles tend to prevent teamwork, because individuals take on roles to promote their own agenda
Examples include the dominator, who tries to control other members, and the recognition seeker, who
boasts about personal achievements
Individual roles
is based on the cognitive model, which focuses on individual thoughts and behaviors to solve
current problems. It treats depression, anxiety, eating disorders, and other issues that can improve by changing a clients attitude toward life experiences
Cognitive therapy
Communication that addresses an individual’s spiritual needs and provides interventions to meet those needs
used when the nurse assists the client with meditation as a means of relaxation
Transpersonal communication:
Emphasizing strengths to make up for weaknesses
Compensation
MALADAPTIVE USE:
A person who is shy works at computer skills to avoid socialization
Compensation
Teaching a client, when negative thoughts or compulsive behaviors arise, to say or shout, ‘stop,” and substitute a positive thought The goal over time is for the client to use the command silently
Thought stopping:
INTERACTIONS
Concurrent use with MAO’s, such as phenelzine, can increase the risk for toxicity.
There is an increased risk of seizures with concurrent use of SSRls.
Atypical antidepressants
Transcrania/ magnetic stimulation is used for pateints with ____
depression
Dealing with unacceptable feelings or impulses by unconsciously substituting acceptable forms of expression
Sublimation
phase of major depressive disorder where:
Remission of manifestations
- This phase can last for year
- Prevention of future depressive episodes is the goal of treatment
Maintenance phase:
Communication that occurs within an individual
Intrapersonal communication:
This agent increases the release of serotonin and norepinephrine, thereby increasing the amount of these neurotransmitters available for impulse transmission
Mirtazapine
Monitor for cardiac dysrhythmias, which are an indication of toxicity
Administer at bedtime due to sedation and risk for orthostatic hypotension
Tricyclic antidepressants
Appearance Posture Gait Facial expressions Eye contact Gestures Sounds Territoriality Personal space Silence
things to look at with nonverbal communication
Conscious or unconscious assumption of the characteristics of another individual or group
Identification
type of anxiety that:
A healthy life force that is necessary for survival, normal anxiety motivates people to take action
For example, a potentially violent situation occurs on the mental health unit, and the nurse moves
rapidly to defuse the situation
Normal
the spontaneous, uncensored verbalization of whatever comes to a clients mind
Free association
type of loss that:
Losses normally expected due to the developmental processing of life
Maturational loss:
Tricyclic antidepressants are conrtaindicated in patients with _____________
seizure disorder
ADAPTIVE USE:
An adolescent boy says, “she must already have a boyfriend” when rejected by a girl
Rationalization
enhance the emotional climate of the therapeutic milieu by promoting:
interaction and communication between staff and clients
Decision making skills of clients
A feeling of self-worth among clients
Discussions of common unit objectives, such as encouraging clients to meet treatment goals and plan for discharge
Discussion of issues of concern to all members of the unit, including common problems, future activities,
and the introduction of new clients to the unit
Meetings may be structured so that they are client-led with decisions made by the group as a whole
commuinty meetings
Dealing with anxiety by reaching out to others
Altruism
ADAPTIVE USE:
A young child temporarily wets the bed when she learns that her pet died
Regression
stage of rettribution treatment that:
Work with the provider and client to develop a treatment plan that allows for regular follow-up visits
Stage 4: Negotiating further treatment:
stage of rettribution treatment that:
Use therapeutic communication to acknowledge the lack of a physical cause for the manifestations while allowing the client to maintain self-esteem
Stage 3: Making the link:
is a noninvasive therapy that uses magnetic pulsations to stimulate the cerebral cortex of the brain
Transcrania/ magnetic stimulation
Separation of emotions and logical facts when analyzing or coping with a situation or event
Intellectualization
ADAPTIVE USE:
A man who is trying to quit smoking repeatedly talks to adolescents about the dangers of nicotine
Reaction formation
ADAPTIVE USE
A person who has feelings of anger and hostility toward his work supervisor sublimates those feelings by working out vigorously at the gym during his lunch period
Sublimation
Collaborate with client to identify interventions while in an acute crisis that promote safety
Secondary care
phase of major depressive disorder where:
Increased ability to function
- Treatment is generally 4 to g months in duration
- Relapse prevention through education, medication therapy, and psychotherapy is the goal of treatment
Continuation phase:
selectively block reuptake of the monoamine neurotransmitter serotonin in the synaptic space, thereby intensifying the effects of serotonin
• First line treatment for depression
Selective serotonin reuptake inhibitors
This therapy is the planned, progressive, or graduated exposure to anxiety-provoking stimuli in real-life
situations, or by imagining events that cause anxiety During exposure, the client uses relaxation techniques to suppress anxiety response
Systematic desensitization
a short period of _____ may occur after ECT
hypertension
is the way the group behaves during sessions, and, over time, it provides structure for the group
Group norm
A form of depression that occurs seasonally, usually during the winter, when there is less daylight Light therapy is the first-line treatment
Seasonal affective disorder
MALADAPTIVE USE:
A person experiences deafness after his partner tells him she wants a divorce
Conversion
Sudden use of childlike or primitive behaviors that do not correlate with the person’s current developmental level
Regression
type of anxiety that
This level of anxiety is precipitated by an imminent loss or change that threatens one’s sense of security
Acute (state)
Flat, blunted, labile affect
Tearfulness, crying
Lack of energy
Anhedonia: loss of pleasure and lack of interest in activities, hobbies, sexual activity
Physical reports of discomfort/pain
Difficulty concentrating, focusing, problem-solving
Self-destructive behavior, including suicidal ideation
Decrease in personal hygiene
Loss or increase in appetite and/or sleep, disturbed sleep
Psychomotor retardation or agitatio
are all_________ characteristics
depressive characteristics of bipolar disorder
Misinterprets physical manifestations as evidence of a serious disease process. Illness anxiety disorder,
previously known as hypochondriasis, can lead to obsessive thoughts and fears about illness
Physical manifestations can be minimal or absent
illness anxiety disorder
assists clients in addressing specific problem. It can improve interpersonal relationships, communication, role-relationship, and bereavement
Interpersonal psychotherapy
Members are often consistent, the focus of the group is on growth, external influences are limited, and the leader can allow members an opportunity in determining the group’s direction
Outpatient setting:
are based on clients’ level of functioning and personal needs, such as adverse effects of medication
Psychoeducational
type of crisis that:
Often unanticipated loss or change experienced in everyday, often unanticipated, life events
Situational/ external:
is characterized by scheduled sessions with a mental health provider to address specific mental health concerns, such as depression
Individual therapy
Pretending the truth is not reality to manage the anxiety of acknowledging what is real
Denial
sexual dysfunction anxiety, aggitation, insomnia weight changes serotonin syndrome withdrawal syndrome hyponatremia rash sleepiness, faintness, lightheadedness GI bleed
are all complications of ___________ meds
Selective serotonin reuptake inhibitors
is an acute, time-limited (usually lasting 4 to 6 weeks) event during which a client experiences an
emotional response that cannot be managed with the clients normal coping mechanism
A crisis
MALADAPTIVE USE:
A young adult explains he had to drive home from a party after drinking alcohol because he had to feed his dog
Rationalization
Members can vary on a daily basis, and the focus of the group is on relief.
Unit activities will directly impact the group, and the leader must provide a higher level of structure
Acute mental health setting:
phase of major depressive disorder where:
Severe clinical findings of depression
- Treatment is generally 6 to 12 weeks in duration
- Potential need for hospitalization
- Reduction of depressive manifestations is the goal of treatment
- Assess suicide risk, and implement safety precautions or one-to-one observation as needed
Acute phase:
A single episode or recurrent episodes of unipolar depression resulting in a significant change in a clients normal functioning (social, occupational, self-care) accompanied by at least five of the following specific clinical findings, which must occur almost every day for a minimum of 2 weeks, and last most of the day:
Depressed mood Difficulty sleeping or excessive sleeping Indecisiveness Decreased ability to concentrate Suicidal ideation Increase or decrease in motor activity inability to feel pleasure Increase or decrease in weight of more than 5% of total body weight over 1 month
Major depressive disorder
assists clients to identify negative thoughts that produce anxiety, examine the cause, and develop supportive ideas that replace negative self-talk
Cognitive reframing
type of loss that:
Any loss of a valued person or item
Actual loss:
ADAPTIVE USE:
An adolescent who is physically unable to play contact sports excels in academic competitions
Compensation
type of loss that:
Part of the cycle of life: anticipated, but can still be intensely felt
Necessary loss:
restraints
- Age 18 years and older: __ hr
- Age 9 to 17 years: __ hr
- Age 8 years and younger: __ hr
- Age 18 years and older: 4 hr
- Age 9 to 17 years: 2 hr
- Age 8 years and younger: 1 hr
type of loss that:
Unanticipated loss caused by an external event
Situational loss:
contraindications to ECT?
There are no absolute contraindication. However, the nurse should assess for medical conditions that place
clients at higher risk of adverse effect:
- cardivascular disorders
- cerebrovascular disorders
is a cognitive-behavioral therapy for clients who have a personality disorder and exhibit self-injurious behavior
This therapy focuses on gradual behavior changes and provides acceptance and validation for these clients
Dialectical behavior therapy
Explores the clients life goals or motivations by presenting a hypothetical situation in which the client no longer has the mental health disorder
Presupposition questions:
stage of rettribution treatment that:
Provide acknowledgment of the clients concerns and provide feedback about assessment findings
Stage 2: Broadening the agenda:
provides electrical stimulation through the vagus nerve to the brain through a device that is surgically implanted under the skin on the clients chest
believed to result in an increased level of neurotransmitters
Indicted for depression
vagus nerve stimulation
Thirty minutes prior to the beginning of the ECT procedure, an 1M injection of ________ or _________ is administered to decrease secretions that could cause aspiration and to counteract any vagal stimulation effects, such as bradycardia
A muscle relaxant, such as____________, is then administered to paralyze the clients muscles during the
seizure activity, which decreases the risk for injury
atropine sulfate or glycopyrrolate
succinylcholine
The quality of doing good: can be described as charity
beneficence
Overcompensating or demonstrating the opposite behavior of what is felt
Reaction formation
Four or more episodes of hypomania or acute mania within 1 year
Rapid cycling
type of crisis that:
Achieving new developmental stages, which requires learning additional coping mechanisms
Maturationa/ linternal
Shifting feelings related to an object, person, or situation to another less threatening object, person, or situation
Displacement
Concurrent use with indirect-acting sympathomimetic medications (ephedrine, amphetamine) can
promote the release of norepinephrine and lead to hypertensive crisis.
Concurrent use with TCAs can lead to hypertensive crisis.
Concurrent use with SSRls can lead to serotonin syndrome.
Concurrent use with antihypertensives can cause additive hypotensive effects.
Concurrent use with meperidine can lead to hyperpyrexia.
Hypertensive crisis (severe hypertension as a result of intensive vasoconstriction and stimulation of the heart) can result from intake of dietary tyramine.
concurrent use with vasopressors
interactions of _________ med
Monoamine oxidase inhibitors
Uses “what if” or similar questions to assist clients in exploring feelings and to gain greater understanding of problems and possible solutions
Projective questions:
THERAPEUTIC USES:
- Depression
- Bulimia nervosa
- First-line treatment for atypical depression
Monoamine oxidase inhibitors
First-degree relative who has somatic symptom disorder
Decreased levels of neurotransmitters: serotonin and endorphins
Depressive disorder, personality disorder, or anxiety disorder
Childhood trauma, abuse, or neglect
Learned helplessness
Female gender (especially age 16 to 25)
ARE ALL RISK FACTORS FOR ____________
somatic symptom disorder
MALADAPTIVE USE:
A person who has a fear of the dentist continually forgets to go to his dental appointments
Repression
Asking irrelevant personal questions Offering personal opinions Giving advice Giving false reassurance Minimizing feelings Changing the topic Asking "vvhy" questions Offering value judgments Excessive questioning Responding approvingly or disapprovingly
barriers to effective communication
phase where the NURSE:
Discuss the clients previous experience with separations and loss
Elicit the clients feelings about the therapeutic work in the nurse-client relationship
Summarize goals and achievements
Review memories of work in the session
Express own feelings about sessions to validate the experience with the client
Discuss ways for the client to incorporate new healthy behaviors into life
Maintain limits of final termination
termination
Anxiety disorders: These disorders are comorbid in approximately 70% of clients who have a depressive
disorder This combination makes a clients prognosis poorer, with a higher risk for suicide and disability
Psychotic disorders, such as schizophrenia
Substance use disorders: Clients often use substances in an attempt to relieve manifestations of depression or self-treat mental health disorders
Eating disorders
Personality disorders
ARE ALL COMORIBDITIES OF _______
DEPRESSION
phase where the NURSE:
Perform ongoing assessment to plan and evaluate therapeutic measure
Facilitate the clients expression of needs and issue
Encourage the client to problem-solve
Promote the clients self-esteem
Foster positive behavioral change
Explore and deal with resistance and other defense mechanism
Recognize transference and countertransference issue
Reassess the clients problems and goals, and revise plans as necessary
Support the clients adaptive alternatives and use of new coping skills
Remind the client about the date of termination
working
MALADAPTIVE USE:
A person who has a disagreement with a co-worker begins throwing things at her office
Regression
employs the same tools as psychoanalysis, but it focuses more on the clients present state, rather than his early life
Psychodynamic psychotherapy
is a therapeutic process of assessing unconscious thoughts and feelings, and resolving conflict by talking to a psychoanalyst Clients attend many sessions over the course of months to year
unlikely to be the sole therapy of choice
Classical psychoanalysis
RISK FACTORS for __________
Genetics: having an immediate family member who has a bipolar disorder
Psychological: stressful events or major life changes
Physiological: neurobiological and neuroendocrine disorders
Substance use disorder: alcohol or cocaine use disorder
bipolar disorder
stage of rettribution treatment that:
Use therapeutic communication, active listening, and empathy to obtain a thorough history of manifestations while focusing on the clients perception of the manifestations and their cause. This stage also includes a brief physical assessment
• Stage 1: Feeling understood:
MALADAPTIVE USE:
A married woman who is attracted to another man accuses her husband of having an extramarital affair
Projection
Responding to stress through the unconscious development of physical manifestations not caused by a physical illness
Conversion
Amitriptyline Imipramine Doxepin Nortriptyline Arnoxaplne Trimiprarnine
are all types of ___________ medications
Tricyclic antidepressants
3 indications for ECT
Acute manic episodes:
• Clients who have bipolar disorder with rapid cycling, unresponsive to treatment with lithium and antipsychotic medications
Schizophrenia spectrum disorders:
• Clients who have schizophrenia with catatonic manifestations, schizoaffective disorder pregnant and have a schizophrenia spectrum disorder
Major depressive disorder:
• Clients for whom the risks of other treatments
first trimester of pregnancy, not responsive to pharmacological treatment, suicidal or homicidal and for whom there is a need for rapid therapeutic response
psychotic manifestations
CONTRAINDICATIONS/ PRECAUTIONS:
Bupropion is a Pregnancy Risk Category B medication
This medication is contraindicated in clients who have a seizure disorder
This medication is contraindicated in clients taking MAOIs
Bupropion is contraindicated in clients who have anorexia nervosa or bulimia nervosa
Atypical antidepressants
The client receives positive rewards for positive behavior (positive reinforcement)
client receives tokens for good behavior, and he can
exchange them for a privilege or other items
Operant conditioning
ADAPTIVE USE:
A person initially says, “No, that can’t be true” when told they have cancer
Denial
what is a rare but potential complicaation of TMS
seizure
• Instruct the client to take antidepressant medication as prescribed on a daily basis to establish therapeutic
plasma levels
• Assist with medication regimen compliance by informing the client that therapeutic effects might not be
experienced for 1 to 3 vveeks Full therapeutic effects can take 2 to 3 months
• Instruct the client to continue therapy after improvement in manifestation• Sudden discontinuation of the
medication can result in relapse or major withdrawal effects
Advise the client that therapy usually continues for 6 months after resolution of manifestations, and it can
continue for 1 year or longer
Atypical antidepressants
ADAPTIVE USE:
A person preparing to give a speech unconsciously forgets about the time when he was young and kids laughed at him while on stage
Repression
type of anxiety that
This level of anxiety is one that usually develops over time, often starting in childhood The adult might display that anxiety in physical manifestations, such as fatigue and frequent headaches
Chronic (trait)
Labile mood with euphoria
Agitation and irritability
Restlessness
Dislike of interference and intolerance of criticism
Increase in talking and activity
Flight of ideas: rapid, continuous speech with sudden and frequent topic change
Grandiose view of self and abilities (grandiosity)
Impulsivity: spending money, giving away money or possessions
Demanding and manipulative behavior
Distractibility and decreased attention span
Poor judgment
Attention-seeking behavior: flashy dress and makeup, inappropriate behavior
Impairment in social and occupational functioning
are all_________ characteristics
manic characteristics of bipolar disorder
stage of grief that
The client accepts what is happening and plans for the future
Acceptance:
Also known as functional neurological disorder, conversion disorder results when a client exhibits neurologic manifestations in the absence of a neurologic diagnosis
conversion disorder
is the verbal and nonverbal communication that occurs during group sessions, including how the work progresses
Group process
MALADAPTIVE USE:
A person who is angry about losing his job destroys his child’s favorite toy
Displacement
ADAPTIVE USE:
A law enforcement officer blocks out the emotional aspect of a crime so he can objectively focus on the investigation
Intellectualization
nursing interventions for what kind of anxiety:
Use active listening to demonstrate willingness to help, and use specific communication techniques
Provide a calm presence, recognizing the client’s distress.
Evaluate past coping mechanisms.
Explore alternatives to problem situations
Encourage participation in activities, such as exercise that can temporarily relieve feelings of inner tension.
Mild to moderate anxiety
A milder form of depression that usually has an early onset, such as in childhood or adolescence, and lasts at least 2 years for adults (1 year for children) contains at least three clinical findings of depression and can, later in life, become major depressive disorder
Dysthymic disorder:
Communication that occurs within large groups of people.
commonly occurs during educational endeavors where the nurse is teaching a large group of individuals.
Public communication:
Voice changes due to the proximity of the implanted lead on the vagus nerve to the larynx and pharynx
hoarseness, throat or neck pain, dysphagia Dyspnea, especially with physical exertion
are all common complications from______
vagus nerve stimulation
Attributing one’s unacceptable thoughts and feelings onto another who does not have them
Projection
type of loss that:
Any loss defined by a client that is not obvious to others
Perceived loss
The client enters the mental health facility against her will for an indefinite period of time.
the admission is based on the clients need for psychiatric treatment, the risk of harm to self or others,
the inability to provide self-care
Involuntary admission:
mood disorders with recurrent episodes of depression and mania
bipolar disorders
level of anxiety that
occurs in the normal experience of everyday living
increases one’s ability to perceive reality
identifiable cause of the anxiety
vague feeling of mild discomfort, restlessness, irritability, impatience, and apprehension
The client can exhibit behaviors such as finger- or foot-tapping, fidgeting, or lip-chewing as mild tension-
relieving behavior•
Mild
Creating reasonable and acceptable explanations for unacceptable behavior
Rationalization
This agent has moderate selective blockade of serotonin receptors, thereby increasing the amount of that neurotransmitter available for impulse transmission
Trazodone
The clients right to make her own decision
Autonomy
allows the nurse to perform a self-assessment of her values or beliefs prior to caring for a client whose diagnosis can trigger an emotional response
intrapersonal communication
Chronic anxiety or panic attacks
Depression, chronic pain, sleep disturbances
Weight gain or loss
Increased risk for myocardial infarction, stroke
Poor diabetes control, hypertension, fatigue, irritability, decreased ability to concentrate
Increased risk for infection
PROLONGED STRESS (MALADAPTIVE RESPONSE)
ADAPTIVE USE:
A parent blocks out the distracting noise of her children in order to focus while driving in
Dissociation
is characterized by scheduled sessions for a group of clients to address common mental health issues, such as substance use disorder
Group therapy
Bupropion
This medication acts by inhibiting dopamine uptake
Treatment of depression
- Alternative to SSRIs for clients unable to tolerate the sexual dysfunction side effects
- Aid to quit smoking
- Prevention of seasonal pattern depression
Atypical antidepressants
Demonstrating an inability to reconcile negative and positive attributes of self or others
Splitting
MALADAPTIVE USE:
A person who has lost his job states he will worry about paying his bills next week
Suppression
: Assists clients to identify what requires priority, such as devoting energy to pleasurable activities
Priority restructuring
: A less severe episode of mania that lasts at least 4 days accompanied by three or more manifestations of mania
Hypomania
stage of grief that
The client negotiates for more time or a cure
Bargaining:
THERAPEUTIC USES:
Major depression
Obsessive compulsive disorder
Bulimia nervosa
Premenstrual dysphoric disorders
Panic disorders
Posttraumatic stress disorder (PTSD)
Bipolar disorder
Selective serotonin reuptake inhibitors
Communication that occurs one-on-one with another individual In nursing,
is used when the nurse obtains a psychosocial history from a client or when listening to a client discuss his feelings
Interpersonal communication:
commonly prescribed daily for a period of 4 to 6 weeks
can be performed as an outpatient procedure
procedure lasts 30 to 40 min
A noninvasive electromagnet is placed on the clients scalp, allowing the magnetic pulsations to pass through
The client is alert during the procedure
Clients might feel a tapping or knocking sensation in the head, scalp skin contraction, and tightening of the
jaw muscles during the procedure
Transcrania/ magnetic stimulation
These medications block MAO in the brain, thereby increasing the amount of norepinephrine, dopamine, and serotonin available for transmission of impulse. An increased amount of those neurotransmitters at nerve
endings intensifies responses and relieves depression
Monoamine oxidase inhibitors
complications of ______________
orthostatic hypotension sedation toxicity decreased seizure threshold excissive sweating increased appetite anticholinergic effects
Tricyclic antidepressants
stage of grief that
Anger is directed toward self, others, or objects
anger
type of crisis that:
- The occurrence of natural disasters, crimes, or national disasters
- People in communities with large-scale psychological trauma caused by natural disasters
Adventitious
Specific mental health issues include disclosing ________, the duty to warn and protect third parties, and the reporting of child and vulnerable adult abuse
HIV status
level of anxiety that:
- characterized by markedly disturbed behavior
- The client is not able to process what is occurring in the environment and can lose touch with reality
- The client experiences extreme fright and horror
- The client experiences severe hyperactivity or flight
- Immobility can occur
• Other characteristics can include dysfunction in speech, dilated pupils, severe shakiness, severe withdrawal, inability to sleep, delusions, and hallucinations
Panic-level
nursing interventions for what kind of anxiety:
Provide an environment that meets the physical and safety needs of the client. Remain with the client.
Provide a quiet environment with minimal stimulation.
Use medications and restraint, but only after less restrictive interventions have failed to decrease
anxiety to safer levels.
Encourage gross motor activities, such as walking and other forms of exercise.
Set limits by using firm, short, and simple statements. Repetition may be necessary.
Direct the client to acknowledge reality and focus on what is present in the environment
Severe to panic-level anxiety
Members take on various tasks within the group process
An example is the recorder, who takes notes and records what occurs during each sessiorn
Task roles:
Voluntarily denying unpleasant thoughts and feelings
Suppression
cns stimulation
orthostatic hypotension
hypertensive crisis
local rash
ARE ALL COMPLICATIONS OF ______________
Monoamine oxidase inhibitors
stage of grief that:
The client has difficulty believing a terminal diagnosis or loss
denial
includes opportunities for the nurse and other staff to observe clients as they interact spontaneously within the milieu
Unstructured, flexible time
has been used successfully to treat clients who have phobias, substance use or addictive disorders, and other issues
• Behavioral therapy
Fluoxetine Citalopram Escitalopram Paroxetine Sertraline Vilazodone
are __________ kind of meds
Selective serotonin reuptake inhibitors
uses both cognitive and behavioral approaches to assist a client with anxiety Management
Cognitive-behavioral therapy
Clinical findings of depression that are associated with the use of, or withdrawal from, drugs and alcohol
Substance-induced depressive disorder:
Preventing a client from performing a compulsive behavior with the intent that anxiety will diminish
Response prevention:
A depressive disorder associated with the luteal phase of the menstrual cycle.
Primary manifestations include emotional lability and persistent or severe anger and irritability
Other manifestations include a lack of energy, overeating, and difficulty concentrating
Premenstrual dysphoric disorder
ADAPTIVE USE:
A nurse who lost a family member in a fire is a volunteer firefighter
Altruism
Creating a temporary compartmentalization or lack of connection between the person’s identity, memory, or how they perceive the environment
Dissociation
First-degree relative who has illness anxiety disorder
Previous losses or disappointments resulting in feelings of anger, guilt, or hostility
Childhood trauma, abuse, or neglect
Depressive disorder or anxiety disorder
Major life stressor
Low self-esteem
ARE ALL RISK FACTORS FOR ___________
illness anxiety disorder
ADAPTIVE USE:
A girl who has a chronic illness pretends to be a nurse for her dolls
Identification
The client is admitted for emergent mental health care due to the inability to make decisions regarding care
The medical healthcare provider may initiate the admission which is then evaluated by a mental healthcare provider
often is not to exceed 15 days
Temporary emergency admission
stage of grief that
The client mourns and directly confronts feelings related to the loss
Depression:
Advise clients to take these medications in the morning to minimize sleep disturbance
Advise clients to take these medications with food to minimize gastrointestinal disturbance
Obtain baseline sodium levels for older adult clients taking diuretic• Monitor these clients periodically
SSRIS
level of anxiety that
- Perceptual field is greatly reduced with distorted perceptions
- Learning and problem-solving do not occur
- Functioning is ineffective
• Other characteristics include confusion, feelings of impending doom, hyperventilation, tachycardia,
withdrawal, loud and rapid speech, and aimless activity
• The client who has severe anxiety usually is not able to take direction from others
Severe
This examination is used to objectively assess a clients cognitive status by evaluating the following:
- Orientation to time and place
- Attention span and ability to calculate by counting backward by seven
- Registration and recalling of objects
- Language. including naming Of objects. following Of commands. and ability to Mite
mini mental status exam
Interactions:
Concurrent use with MAO’s, TCAs, or St. John’s wort increases the risk of serotonin syndrome.
Concurrent use with warfarin can displace warfarin from bound protein and result in increased warfarin
Concurrent use with tricyclic antidepressants and lithium can result in increased levels of these
medications.
Concurrent use with NSAlDs and anticoagulants can further suppress platelet aggregation, thereby
increasing the risk of bleeding.
Selective serotonin reuptake inhibitors
MALADAPTIVE USE:
A child who observes his father be abusive toward his mother becomes a bully at school
Identification
developed by Sigmund Freud toresolve internal conflicts which, he contended, always occur from early childhood experience
• Past relationships are a common focus for therapy
Classical psychoanalysis
: A type of admission that is similar to temporary commitment but must be imposed by the courts.
time of commitment varies, but is usually 60 to 180 day. Sometimes, there is no set release date
Long-term involuntary admission
The typical course of ECT treatment is byo to three times a week for a total of _____-_____ treatments
six to 12
Apprehension Unhappiness or sorrow Decreased appetite Increased respiratory rate, heart rate, cardiac output, blood pressure Increased metabolism and glucose use Depressed immune system
ACUTE STRESS (FIGHT OR FLIGHT)
The shortest, simplest communication is usually most effective
Clarityl brevity
MALADAPTIVE USE:
A woman forgets who she is following a sexual assault
Dissociation
This agent is usually used with another antidepressant agent Sedation can be an issue, so it can be indicated
for a client who has insomnia caused by an SSRI Advise the client to take at bedtime
Priapism can be a serious adverse effect Instruct to seek medical attention immediately if this occur
This medication should be used with caution in clients who have cardiac disease
Trazodone
Exposing a client, while in the company of a therapist, to a great deal of an undesirable stimulus in an
attempt to turn off the anxiety response
Flooding:
Unconsciously putting unacceptable ideas, thoughts, and emotions out of awareness
Repression
Pairing of a maladaptive behavior with a punishment or unpleasant stimuli to promote a change in the behavior
use unpleasant stimuli, such as bitter taste or mild electric shock, as punishment for behaviors such as alcohol use disorder, violence, self-mutilation,
and thumb-sucking
Aversion therapy
• Provide clients with a list of foods containing tyramine to reduce the risk of hypertensive crisis
• Instruct the client to avoid taking any other prescription or nonprescription medications unless approved by
the provider
MAOIS
ADAPTIVE USE:
An adolescent angrily punches a punching bag after losing a game
Displacement
is based on the theory that behavior is learned and has consequence
Abnormal behavior results from an attempt to avoid painful feeling.
Changing abnormal or maladaptive behavior can occur
without the need for insight into the underlying cause of the behavior
Behavioral therapy
Advise clients who have seasonal pattern depression to begin taking bupropion in autumn each year and
gradually taper dose and discontinue by spring
• Avoid concurrent use with MAOIs
ATYPICAL ANTIDEPRESSANTS
An abnormally elevated mood, which can also be described as expansive or irritable: usually requires
hospitalization
episodes last at least 1 week
mania
Collaborate with client to identify potential problems: instruct on coping mechanisms: and assist in
lifestyle changes
Primary care
Substance use disorder Anxiety disorders Borderline personality disorder Oppositional defiant disorder Social phobia and specific phobias Seasonal affective disorder
ARE ALL COMORBIDITIES of __________
bipolar disorder
MALADAPTIVE USE:
A parent who is informed that his son was killed in combat tells everyone one month later that he is coming home for the holidays
Denial
Collaborate with client to provide support during recovery from a severe crisis that include outpatient clinics, rehabilitation centers, and workshops
Tertiary care
MALADAPTIVE USE:
A client tells a nurse that she is the only one who cares about her, yet the following day, The same client refuses to talk to the nurse
Splitting
- Phenelzine is a Pregnancy Risk Category C medication
- clients taking SSRIs
- clients who have pheochromocytoma, heart failure, cardiovascular and cerebral vascular disease, or severe renal insufficiency
- Use cautiously in clients who have diabetes or seizure disorders, or those taking TCAs
- Transdermal selegiline is contraindicated for clients taking carbamazepine or oxcarbazepine
CONTRAINDICATED WITH _________ MEDS
Monoamine oxidase inhibitors
