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CCRN Study Deck > Behavioral/Psychosocial 4% > Flashcards

Behavioral/Psychosocial 4% Flashcards

1
Q

Adventitious Crises

A
  • Follow accidental or uncommon events leading to major environmental changes
  • Ie. Natural disasters
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2
Q

ANTICHOLINERGIC AGENTS

A
  • Blocks the parasympathetic nervous system
  • Stimulates the sympathetic nervous system

Includes:

  • atropine
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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
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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
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5
Q

Assault

A
  • Specific type of threat
  • To threaten a patient with bodily harm
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6
Q

Battery

A
  • Unlawful use of force
  • Requires the actual use of force rather than just threatening to use force
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7
Q

Death and Dying Process

A
  1. Shock and Disbelief
  2. Denial
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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
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9
Q

Delusion

A
  • Perception that has no actual external stimulus
  • Common during alcohol withdrawal syndrome
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10
Q

Denial

A
  • Inability to face reality
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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)
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12
Q

What is epinephrine?

A
  • Neurotransmitter for the sympathetic nervous system
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13
Q

Illusion

A
  • Misperception or misinterpretation of an actual external stimulus
  • Common during alcohol withdrawal syndrome
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14
Q

Malpractice

A
  • Professional negligence that results in injury to the patient
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15
Q

Mania

A
  • Distinguished from psychosis by absence of hallucinations
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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
  1. Confusion assessment method for the ICU (CAM-ICU)
  2. 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

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