Behavioral/Psychosocial 4% Flashcards
1
Q
Adventitious Crises
A
- Follow accidental or uncommon events leading to major environmental changes
- Ie. Natural disasters
2
Q
ANTICHOLINERGIC AGENTS
A
- Blocks the parasympathetic nervous system
- Stimulates the sympathetic nervous system
Includes:
- atropine
3
Q
Anxiety
A
- Anxiety is a vague uneasiness accompanied by tension and helplessness
- Patients often cannot pinpoint a cause for anxiety
- Anxiety disorder = presence of anxiety for at least 6 months
- Both short-term and long-term methods of treatment
4
Q
Most commonly prescribed anxiolytics used in the critical care setting?
A
- Benzodiazepines
- Cause sedation and some degree of amnesia
- Less likely than other agents to cause significant side effects
- Ex. diazepam, lorazepam, alprazolam
5
Q
Assault
A
- Specific type of threat
- To threaten a patient with bodily harm
6
Q
Battery
A
- Unlawful use of force
- Requires the actual use of force rather than just threatening to use force
7
Q
Death and Dying Process
A
- Shock and Disbelief
- Denial
8
Q
Delirium
A
- Acute organic mental syndrome with potentially reversible impairment of consciousness and cognitive function that fluctuates in severity
- Types:
- Mixed: hyperactive and hypoactive, most common
- Hypoactive: second most common
- Hyperactive: lease common
- May result in agitation
- Delirium has increase in 6 month mortality and severity of delirium predicts mortality rate
9
Q
Delusion
A
- Perception that has no actual external stimulus
- Common during alcohol withdrawal syndrome
10
Q
Denial
A
- Inability to face reality
11
Q
Release of Epinephrine in Stressful Situation causes what?
A
- Oxygen consumption increases
- Glucose is mobilized
- Blood vessels are constricted
- Increase in heart rate, contractility, and conductivity
- Vasoconstriction
- Bronchodilation
- Pupil dilation
- Stimulation of glycogenolysis and gluconeogenesis to mobilize glucose
- Redistribution of blood flow from nonessential to essential organs (Heart & Brain)
12
Q
What is epinephrine?
A
- Neurotransmitter for the sympathetic nervous system
13
Q
Illusion
A
- Misperception or misinterpretation of an actual external stimulus
- Common during alcohol withdrawal syndrome
14
Q
Malpractice
A
- Professional negligence that results in injury to the patient
15
Q
Mania
A
- Distinguished from psychosis by absence of hallucinations
16
Q
Mania & Anticonvulsants
A
- Anticonvulsants are used to improve mood stability in patients
17
Q
Maturational crises
A
- Arise as a result of growth and development and involve changes in self-concept and roles
18
Q
Post-Traumatic Stress Disorder (PTSD
A
- Arises from traumatic events
- Produces anxiety due to repeated stressful memories and intrusive thoughts about the experience
- Causes physiologic reactivity and re-experiencing related to previous experiences
19
Q
Psychosis (psychotic episode) S/S
A
Classic signs:
- Bizarre behavior
- Disorganized thoughts
- Presence of delusions
- Disorganized thoughts
- Hallucinations
20
Q
Effective Communication Technique for Patients with Psychosis
A
Keep sentences short and simple
- Patients with psychosis
- Aberrant speech patterns
- Grossly disorganized behavior
- Will not be able to track long and complex sentences
- “Out of touch with reality”
21
Q
BETA-BLOCKERS
ß-BLOCKERS
A
- ß-blockers inhibit the stimulation of the ß receptors
- May be given to patients with history of bipolar disorder.
- Block catecholamine effects
- Inhibits ß1 stimulation, which will lower the patient’s heart rate
- Used after myocardial infarction to decrease the effects of catecholamines on the myocardium and decrease the oxygen requirements of the myocardium
includes
- metoprolol
22
Q
Sensory Overload
A
- Overload of non-meaningful stimuli
- Interventions:
- Darkening the room (especially at bedtime)
- Decreasing the volume of noises (including the beeping of the cardiac monitor)
- Avoiding unnecessary conversation (chitchat)
- Family visitation should not be limited because it is a meaningful stimulus
- Possible to have sensory overload and sensory deprivation simultaneously
23
Q
Situational Crises
A
- Follows an external event or experience and the associated losses and changes
- Ie. Life-threatening illness in a loved one
24
Q
Suicide Attempt Assessment Priorities
A
- Injury
- Intent
- Lethality
Evaluate Intent, Plan, and Ability
25
Q
Sympathetic Nervous System Stimulation
A
- Hyperventilation
- Increased musle tension
- Palpitations
- Reduced oral and gastrointestinal secretions
26
Q
When is denial after a myocardial infarction most beneficial?
A
Denial during the first 72 hours limits catecholamine release and decreases myocardial oxygen demand and ectopy potential.
27
Q
Significant Risks for Delirium
A
- Preexisting dementia
- History of hypertension
- History of alcoholism (2-3 drinks or more per day)
- High severity of illness at admission
- Coma - primary neurological, sedative induced, multifactorial
- Benzodiazepine drugs
28
Q
Lesser RIsk for Delirium
A
- Age
- Pain
- Restraints
- Tubes and lines
- Sensory deprivation or overload
29
Q
Delirium Assessment Tools
A
- Confusion assessment method for the ICU (CAM-ICU)
- Intensive care delirium screening checklist (ICDSC)
30
Q
Delirium Prevention - ABCDE Bundle
A
A: Awakening
B: Breathing trials
C: Communication and collaboration
D: Delirium monitoring/management
E: Early progressive mobility and exercise
31
Q
Dementia
A
- Neurocognitive disorder
- Affects brain’s ability to think, reason, and remember clearly
- Most common affect areas: memory, visual-spatial, language, attention, and problem solving
- Most common form is Alzheimer’s disease
- Vascular brain disease/stroke another form
32
Q
Tricyclic Antidepressents
A
- Use declined with availability of SSRIs
- Includes:
- amitriptyline
- nortriptyline
- imipramine
- clomipramine
- desipramine
- Adverse effects:
- highly lethal in overdose (tachycardia, hypotension, fatal arrhythmias)
- vertigo
- dry mouth, dental caries
- urinary retention
- constipation
- orthostatic hypotension
- prolonged QT
33
Q
Selective Serotonin Reuptake Inhibitors (SSRIs)
A
- First-line pharmacological therapy for depression
- Abnormalities in brain serotonin activity have been implicated in many emotional and behavioral disorders (mood disorders, obsessive-compuslive disorder, aggresive behaviors)
- Block action of presynaptic serotonin reuptake pump, increasing amount of serotonin available in synapse and increasing postsynaptic serotonin receptor occupancy
- Well tolerated
- QDay administration
- Fewer adverse effects than tricyclic antidepressants
- Adverse effects:
- Dose dependent, most subside after 1-2 weeks or dose reduction
- headache, abdominal pain, nausea, diarrhea, sleep changes, jitteriness, agitation
- less common - diaphoresis, akathisia (restlessness and inability to sit still), bruising, changes in sexual functioning
- can induce a manic or hypomanic episode
- potential for increased suicidality
- inhibit metabolism of meds - antiarrhythmics, benzodiazepines, warfarin, tricyclics, neuroleptics
34
Q
Suicide
A
- 33,000 suicides annually / 11th leading cause of death
- 4 men : 1 woman, women attempt 2x as men, men > 65yo greater risk
- Suicide behavior continuum:
- Ideation - contemplation without action
- Gesture - nonlethal action
- Attempt - potentially lethal
- Suicide - 30% successful on 1st try
35
Q
Suicide Nursing Interventions
A
- Establish SAFE environment
- 1:1 observation
- Explain precautions to patient
- Comprehensive documentation
- Safety measures
- remove hazards from room (sharp or hazardous objects, personal items)
- contraband check
- paper/plastic food service
- do not allow visitors to leave anything with patient
- make sure patient swallows medications
- move near nurses’ station
36
Q
Alcohol Withdrawal
A
- minor, initial signs (first 6 - 3 hours without alcohol)
- tremulousness
- mild anxiety
- headache
- diaphoresis
- palpitations
- anorexia
- GI upset
- seizures may occur during first 48 hours
- “alcoholic hallucinosis” (after 12-48 hours without alcohol
- visual, auditory, and/or tactile hallucinations
- Delirium tremens (DTs) (may occur 48-96 hours without alcohol with delirium, agitation, tachycardia, hypertension, fever, diaphoresis
37
Q
Alcohol Withdrawal Treatment
A
- DT prevention with oral benzodiazepines such as lorazepam (Ativan), diazepam (Valium), or chlordiazepoxide (Librium)
- Benzos enhance effect of neurotransmitter GABA, resulting in sedative, hypnotic, anxiolytic, anticonvulsant, and muscle relaxant properties
- Symptom-triggered treatment with valid tool (CIWA-Ar)
- Phenobarbital for refractory DTs
- Restore fluid volume (Glucose and thiamine to prevent Wernicke’s encephalopathy and Korsakoff syndrome
- Multivitamins with folate
- Correct potassium, magnesium, and phosphate deficiencies
38
Q
Wernicke’s Encephalopathy
A
- Gait disturbances
- Nystagmus
- Eye muscle paralysis
39
Q
Korsakoff Syndrome
A
- Decreased spontaneity
- Amnesia
- Denial of memory loss by making up facts
