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Psychosocial > Chapter 7 & 12 > Flashcards

Chapter 7 & 12 Flashcards

1
Q

What is cognitive theory?

A

an outgrowth of theoretic perspectives, including the behavioral and psychodynamic, that attempts to link internal thought processes with human behavior

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2
Q

What is transference?

A

Unconscious assignment to a therapist or nurse of a pts feelings and attitudes that were originally associated with important figures like parents or siblings

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3
Q

What is countertransference?

A

Therapist or nurse reaction to a pt that are based on interpersonal experiences, feelings, and attitudes. It can significantly interfere with the nurse-pt relationship

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4
Q

What is psychoanalysis?

A

Freudian concept that focuses on repairing the trauma of the original psychological theory through the process of accessing the unconscious conflicts that originate in childhood and then resolving those issues with a mature adult mind

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5
Q

Who are the psychoanalytic theorists?

A

Sigmund and Anna Freud

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6
Q

Sigmund Freud

A

Founder of psychoanalysis and believed that the unconscious can be accessed through dreams and free association. Has a theory on infantile sexuality

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7
Q

Anna Freud

A

Psychoanalytic theorist, talked about defense mechanisms in kids

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8
Q

Who are the Non-Freudian theorists? (I used their last names)

A

Adler, Jung, Rank, Fromm, Klein, Horney

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9
Q

Alfred Adler

A

Non-Freudian; 1st defected from Freud, founded school of individual psychology. He focused on inferiority and added to the understanding of human motivation. His theory is based on principles of mutual respect, responsibility, consequences, and belonging

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10
Q

Carl Gustav Jung

A

Non-Freudian; founded school of psychoanalytic psychology. He created analytical psychology. He believed in introversion and extroversion for personalities.

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11
Q

Otto Rank

A

Non-Freudian; Birth trauma

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12
Q

Erich Fromm

A

Non-Freudian; emphasized that society and individual are not separate and that desires are formed by society

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13
Q

Melanie Klein

A

Non-Freudian; devised play therapy techniques that shows how a kids interaction with toys reveals earlier infantile fantasies and anxieties. She is a pioneer in object relations identifications

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14
Q

Karen Horney

A

Non-Freudian; opposed Freuds theory of castration complex in women and his emphasis on the oedipal complex. Situational neurosis. She was the beginning of feminist analysis of psychoanalytic thought

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15
Q

Who was the interpersonal relations theorist?

A

Harry Stack Sullivan

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16
Q

Harry Stack Sullivan

A

Interpersonal relations; impulses and striving need to be understood, provided framework for the introduction of interpersonal theories in nursing

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17
Q

Who are the humanist theorists?

A

Maslow, Perls, Rogers

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18
Q

Abraham Maslow

A

Humanist; focused on needs and motivation, healthy people rather than sick, and approached from a holistic-dynamic viewpoint. Used to prioritize care

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19
Q

Maslows hierachy of needs

A

-physiologic needs (air, water, food, sleep)
-safety and security (shelter, predictable environment)
-love and belonging
-esteem
-self-actualization (development of full personal potential)

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20
Q

Frederick S. Perls

A

Humanist; developed Gestalt therapy. the root of human anxiety is frustration with the inability to express natural biologic and psychological desires in civilization. Reality, here and now

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21
Q

Carl Rogers

A

Humanist; based on the view of human potential for goodness. He used the term client instead of patient. Empathy, unconditional positive regard. never give advice and always clarify the clients feelings. Client-centered therapy

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22
Q

What are Freuds thoughts on the unconscious?

A

It is remembered in dreams

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23
Q

What is preconscious?

A

Describes unconscious material that is capable of entering consciousness

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24
Q

What are the 3 aspects of personality according to Freud?

A

ID, ego, superego

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25
Q

What is ID?

A

Formed by unconscious desires, primitive instincts, and unstructured drives including sexual and aggressive tendencies

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26
Q

What is ego?

A

Controls movement, perception, and contact with reality. The capacity to form relationships is not present at birth and is developed throughout childhood

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27
Q

What is superego?

A

Ethics, standards, self-criticism

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28
Q

What is object relations?

A

Freud; the psychological attachment to another person or object

ex: child imitates their mom, and later becomes like their mom in adulthood.

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29
Q

What are Freuds thoughts on anxiety and defense mechanisms?

A

Anxiety is the reaction to danger and is experienced as a specific state of physical unpleasantness.

Defense mechanisms are coping styles that protect a person from unwanted anxiety

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30
Q

Libido

A

Energy or psychic drive associated with sexual instinct. This is ID according to Freud

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31
Q

Behavior theories attempt to explain…

A

how people learn and act and never attempt to explain the cause of the mental disorders. They focus on normal human behaviors. Stimulus-response and reinforcement theories are important

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32
Q

Who are the early-stimulus response theorists?

A

Pavlov and Watson

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33
Q

What is the Pavlovian theory?

A

Ivan Pavlov; Dog salivated when he heard the bell instead of when he saw the food. This is classical conditioning by using an unconditioned stimuli, unconditioned response, and conditioned stimuli

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34
Q

What is Watsons theory?

A

He introduced behaviorism and believed that learning was classical conditioning called reflexes. He rejected the distinction between mind and body. He introduced the principle of frequency and recency.

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35
Q

What is the principle of recency?

A

The closer in time a response is to a particular stimulus, the more likely the response will be repeated

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36
Q

What is the principle of frequency?

A

The more often a response is made to a stimulus, the more likely the response to that stimulus will be repeated

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37
Q

Who were the theorists for reinforcement theories?

A

Thorndike and Skinner

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38
Q

Edward Thorndike

A

Experimental animal psychology; 1st person that believed in reinforcing positive behavior for learning.

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39
Q

B. F. Skinner

A

Studied operant behavior/conditioning. if a behavior is reinforced or rewarded with success, praise, money, etc. the behavior will probably be repeated. This was important for behavior modification

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40
Q

Who are the cognitive theorists?

A

Bandura, Beck, Lewin, Tolman

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41
Q

Albert Bandura

A

social cognitive theory; importance of modeling behavior. Self-efficacy is also emphasized

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42
Q

Aaron Beck

A

Cognitions are verbal or pictorial events in the stream of consciousness. Depression improved when pts started viewing themselves in a positive light. Depression is from distorted cognition.

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43
Q

Kurt Lewin

A

Developed field theory which is a system for understanding, learning, motivation, personality, and social behavior. He focused on life space and positive valences

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44
Q

Edward Chace Tolman

A

Introduced the concept of cognitions; believed that human beings act on beliefs and attitudes and strive towards goals. He focused on negative valences and cognition. He was important in identifying person’s beliefs

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45
Q

How are behavioral theories applied to nursing?

A

Patients education interventions are usually derived from them

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46
Q

Developmental theories explain…

A

normal human growth and development over time

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47
Q

Erik Erikson

A

Psychosocial development most often used in nursing. There are 8 stages: trust vs mistrust, autonomy vs shame and doubt, initiative vs guilt, industry vs inferiority, identity vs role diffusion, intimacy vs isolation, generatively vs stagnation, and ego integrity vs despair

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48
Q

Eriksons thoughts on identity and adolescence

A

When adolescence beings, childhood ways are given up, bodily changes occur, and an identity is formed

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49
Q

What age does basic trust vs mistrust go with and what is the long-term outcome?

A

Infant; drive and hope

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50
Q

What age and long-term outcome does autonomy vs shame and doubt go with?

A

Toddler; self-control and willpower

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51
Q

What age and long-term outcome does initiative vs guilt go with?

A

Preschool-aged kids; direction and purpose

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52
Q

What age and long-term outcome does industry vs inferiority and doubt go with?

A

School-aged kids; method and competence

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53
Q

What age and long-term outcome does identity vs role diffusion and doubt go with?

A

Adolescence; devotion and fidelity

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54
Q

What age and long-term outcome does intimacy vs isolation go with?

A

Young adult; affiliation and love

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55
Q

What age and long-term outcome does generativity vs stagnation go with?

A

Adulthood; production and care

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56
Q

What age and long-term outcome does ego integrity vs despair go with?

A

Maturity; renunciation and wisdom

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57
Q

Jean Piaget

A

He views intelligence as an adaptation to the environment. His theory was developed through observation of his own kids and never received formal testing. It provides a framework to recognize different levels of thinking in the assessment and intervention process

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58
Q

Carol Gilligan

A

Gender differentiation in moral development. Boys separate from their moms and girls attach. Ethic of care: pre-conventional (selfishness) to conventional (responsibility to others) to post-conventional (don’t hurt others or self)

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59
Q

Sensorimotor stage of Piaget

A

Birth to 2 yrs; characterized by reflexes, habit, insight and object permanence

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60
Q

Pre-operational stage of Piaget

A

2-7 yrs old; symbolic play, graphic imagery, reasoning, egocentrism

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61
Q

Concrete operations stage of Piaget

A

7-11 yrs; conservation of quantity, weight, height, volume, length, and time based on reversibility or reciprocity

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62
Q

Formal operations stage of Piaget

A

Variables are isolated and all possible combinations are examines, hypothetical-deductive thinking.

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63
Q

Jean Baker Miller

A

A sense of connection; female development within relationships and experiences. Focuses on connections and disconnections

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64
Q

How do the developmental theories apply to psychiatric nursing?

A

They are used in understanding childhood and adolescent experiences and their manifestations as an adult. It can be used to gauge mood and development. They don’t account for diversity in gender, lifestyle, and cultures

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65
Q

Family dynamics

A

Social theory; patterned interpersonal and social interactions that occur within the family structure over the life of a family. These are useful to nurses who are assessing family dynamics and planning interventions. Not usually used in psychiatric nursing

66
Q

Formal support systems

A

Large organizations like hospitals or nursing homes that provide care to individuals

67
Q

Informal support system

A

Family, friends, and neighbors. People with this system usually live longer than those without

68
Q

Social distance

A

The degree to which values of the formal organization and primary group members differ

69
Q

Role theories

A

Universal roles of a healer may be a nurse in one culture and a spiritual leader in another. They emphasize the importance of social interaction in either the persons choose or societies recognition of a particular role

70
Q

Margaret Mead

A

Sociocultural perspective; She established the importance of culture in determining human behavior. Accepted in anthropology; criticized for being filled with misinterpretations

71
Q

Madeleine Leininger

A

Transcultural health care directed toward holistic, congruent, and beneficent care.

72
Q

How is social theories applied to psychiatric nursing?

A

You must consider the role of the patient within the family and society

73
Q

Hildegarde Peplau

A

Nursing theory, interpersonal; empathetic linkage. Anxiety, self-system, and needs are a key concept

74
Q

What is empathetic linkage?

A

The ability to feel in oneself the feelings experienced by another person

75
Q

What are the levels of anxiety?

A

-Mild: awareness heightens
-Moderate: awareness narrows
-Severe: focused narrow awareness
-Panic: unable to function

76
Q

Ida Jean Orlando

A

Identified 3 areas of nursing concern: the nurse-pt relationship, the nurses professional role, and the identity and development of knowledge that is distinctly nursing. Helpful in fall prevention

77
Q

Rosemarie Rizzo Parse

A

Humanbecoming theory which views humans as indivisible, unpredictable, and ever-changing. Major themes are meaning, rhythmicity, and transcendence. Living a human life is illuminating, paradox, freedom, and mystery.

78
Q

Jean Watson

A

Theory of transpersonal caring. She believes that caring is the foundation of nursing. There are 3 foundational concepts to her theory; transpersons caring, 10 caritas process, and caritas field. This model emphasizes the importance of sensitivity to self and others, helping and trusting relationships, teaching and learning. Her theory has been show to decrease pt emotional strain and increase confidence as well as increase nurse satisfaction

79
Q

Imogene King

A

System model; developed theory of goal attainment that is based on 3 interacting systems: personal, interpersonal, and social. This process is initiated to help the patient cope with a health problem that compromises their ability to maintain social roles, functions, and ADLs

80
Q

Betty Neuman

A

System model; key components are a client system interacting with the environment. This can be applied to prevention and treatment.

81
Q

Dorothea Orem

A

Systems model; self-care is the focus of the general theory of nursing. It has 3 parts (self-care, self-care deficit, and nursing systems). It promotes independence of the person

82
Q

According to Orem’s theory, what can nurses do to help meet self-care for the patient?

A

Acting or doing for, guiding, teaching, supporting, and providing an environment to promote the pts ability to meet current or future demands

83
Q

Martha Rogers

A

Model of unitary human beings

84
Q

Calista Roy

A

Adaptation model

85
Q

T/F
Nursing theories form the conceptual basis for nursing practice and are useful is psychiatric nursing

A

T

86
Q

Akathisia

A

An extrapyramidal side effect characterized by the inability to sit still/restlessness. Its more common in middle aged pt’s

87
Q

What are atypical antipsychotics? (in general)

A

Newer antipsychotics that are equally or more effective than conventional antipsychotics but have fewer side effects

88
Q

What are typical antipsychotics? (in general)

A

Conventional; “older” meds used to treat psychotic disorders with more side effects than “newer” atypical antipsychotics

89
Q

Dystonia

A

Usually occurs within a few days of administering an antipsychotic. Characterized by involuntary muscle spasms, especially in head and neck. It is the 1st extrapyramidal effect to occur

90
Q

Phototherapy

A

Light therapy; exposes pt to artificial light source during the winter months to help relieve seasonal depression

91
Q

What is pseudoparkinsonism

A

Drug-induced Parkinsonism; presents are Parkinson’s but without the destruction of dopaminergic cells

92
Q

Serotonin Syndrome

A

Life-threatening side effects that results from overactivity of serotonin. Symptoms are mental status changes (hallucination, agitation, coma), autonomic instability (tachycardia, hyperthermia, changes in BP), neuromuscular problems (hyperreflexia, incoordination), and GI (n/v, diarrhea)

93
Q

Tardive dyskinesia

A

A late appearing extrapyramidal effect of antipsychotics meds that involve irregular, repetitive involuntary movements of the mouth, face, and tongue (lip smacking, chewing, tongue protrusion)

94
Q

Phases of new drug testing

A

1: range of dosages tolerated in healthy people
2: effects of drug are studied in limited amount of people w/disorder. Defines range of clinically effective dosage
3: studies done with large amounts of pts. Ends with new drug application submitted to FDA
4: drug studies continue after FDA approval to find rare adverse reactions.

95
Q

If someone has blurred vision while on a medication, what do you do?

A

Give reassurance, it generally subsides in 2-6 weeks

96
Q

Pharmacodynamics

A

Action or effect of drugs on living organisms

97
Q

Efficacy

A

Ability of a drug to produce a response

98
Q

Norepinephrine reuptake inhibition

A

Antidepressant. Side effects are tachycardia, tremors, insomnia, erectile/ejaculation dysfunction. It interacts with guanethidine
Examples: Desipramine, Venlafaxine

99
Q

Serotonin reuptake inhibitor

A

Antidepressant and antiobsessional. Side effects are GI distress, nausea, headache, restlessness, anorgasmia
Examples: Fluoxetine, Fluvoxamine

100
Q

Dopamine reuptake inhibition

A

Antidepressant and antiparkinsons. Side effects are aggravation of psychosis and increase in psychomotor activities

101
Q

Histamine receptor blockade

A

Examples: clozapine, olanzapine
Side effects: sedation, drowsiness, hypoTN, weight gain

102
Q

Dopamine receptor blockade

A

Antipsychotic action
Side effects: extrapyramidal effects, endocrine changes
Examples: haloperidol, Ziprasidone

103
Q

Pharmacokinetics

A

Process where drug is absorbed, distributed, metabolizes, and eliminated by the body

104
Q

Pharmacogenomics

A

Study of how a persons genetic makeup affects their response to drugs

105
Q

Phases of drug treatment

A

Initiation, stabilization, maintenance, and discontinuation of the medicine

106
Q

Polypharmacy

A

Using more than 1 group from a class of medications

107
Q

What types of disorders do antipsychotic medications treat?

A

Schizophrenia, mania, autism, psychosis (hallucinations, delusions, disorganized thinking, agitation, aggressiveness)

108
Q

What 2 antipsychotic meds are approved for treating Tourette syndrome?

A

Typical antipsychotic: haloperidol and pimozide. They reduce the frequency and severity of vocal tics

109
Q

What route are antipsychotic medications given and how are they metabolized?

A

PO, IM
Liver

110
Q

What are the long-acting injectable atypical antipsychotics?

A

Risperidone, paliperidone, olanzapnie, and aripiprazole

111
Q

Conventional antipsychotics are usually water or oil based?

A

Oil based

112
Q

General side effects of antipsychotic medications

A

Ortho hypoTN, prolonged QT, anticholinergic s.e. (dry mouth, constipation, blurred vision), weight gain (atypical!!), diabetes, sexual side effects, blood dyscrasia (clozapine), neuroleptic malignant syndrome, photosensitivity, seizure, EPS, TD

113
Q

Lorazepam (Ativan)

A

Benzodiazepine, it may cause drowsiness, lethargy, and general sedation or paradoxical agitation. It can be given PO/IM. Helps to treat medication-related movement disorders

114
Q

What medications work in treating akathisia?

A

None, it is more difficult to relieve and doesn’t respond well to anticholinergic meds.

115
Q

When do symptoms of tardive dyskinesia start to show?

A

They usually show 6 months after treatment or when the medication is reduced/withdrawn

116
Q

What are mood stabilizers used for?

A

Antimanic; stabilizes mood swings, especially those of mania in bipolar disorders

117
Q

Which drug is the gold standard for bipolar disorder, decreasing suicide, and preventing return of mania and depression?

A

Lithium

118
Q

What types of meds are used for their mood stabilization/antimania

A

Anticonvulsants, CCB, adrenergic blocking agents, atypical antipsychotics

119
Q

What is the action of lithium?

A

Uncertain, crosses all cell membranes, alters sodium transport, not protein bound

120
Q

What are some side effects lithium?

A

Lithium toxicity, thirst, metal taste, weight gain, diarrhea, thyroid dysfunction

121
Q

Lithium contraindications

A

Pregnancy, taking NSAIDs and diuretics

122
Q

What are the lithium levels for the following:
-acute mania
-maintenance phase
-therapeutic

A

Acute: 0.8-1.4
Maintenance: 0.4-1
Therapeutic: 0.6-0.8 and 1.2-1.4

123
Q

How often does a CBC need to be drawn when taking lithium for bipolar?

A

Every 6 months

124
Q

What do anticonvulsants treat?

A

Bipolar and acts as a mood stabilizer

125
Q

What are the 3 anticonvulsant drugs approved for treatment of bipolar disorder, mania, or mixed episodes?

A

Valproate, carbamazepine, and lamotrigine

126
Q

Anticonvulsant side effects

A

Carbamazepine: rare aplastic anemia, agranulocytosis, rash, cardiac problems, SIADH
Valproic acid: weight gain, alopecia
Lamotrigine: rash occurring with in 2-8 weeks

127
Q

What disorder is antidepressants used cautiously in?

A

Bipolar because it can precipitate a manic episode

128
Q

Name a few antidepressant medications

A

SSRI (Lexapro, prozac, sertraline), Norepi dopamine RI (bupropion), trazodone (desyrel)

129
Q

SSRI action and side effects

A

-Inhibits the reuptake of serotonin by blocking its transport to the presynaptic neuron
-Side effects: HA, anxiety, insomnia, n/v, sedation, sexual dysfunction
-examples: prozac, sertraline, lexapro

130
Q

Serotonin norepinephrine reuptake inhibitor action and side effects

A
  • prevents reuptake of serotonin and norepinephrine
    -side effects: increased BP, mild sedation, dry mouth, liver failure
    -examples: venlafaxine, nefazodone, desipramine (technically a tricyclic antidepressant)
131
Q

Tricyclic antidepressant

A

Treats depression. These meds are highly bound to proteins. Side effects are cardio toxicity, anticholinergic effects, blood dyscrasias, NMS, EPS

132
Q

Monoamine oxidase inhibitors (MAOI)

A

It increases the amount of serotonin and norepinephrine at the synapse. PO forms are phenelzine, isocarboxazid, tranylcypromine and transdermal form is selegiline. These interact with tyramine-rich foods (aged cheeses, not fresh meat, fava bean, tap beers, red wine, marmite, sauerkraut, soy sauce)

133
Q

Buspirone and lorazepam (Ativan) help with what disorder?

A

anxiety; buspirone is an anxiolytic and lorazepam is a sedative-hypnotic

134
Q

Examples of benzodiazepines

A

alprazolam (Xanax), lorazepam (Ativan), diazepam (Valium), chlordiazepoxide, flurazepam, triazolam

-relieve anxiety and insomnia

135
Q

Benzodiazepine side effects

A

Drowsy, memory impairment, ataxia, confusion, rebound insomnia/anxiety, CNS depression

136
Q

Nonbenzodiazepine example

A

Buspirone

137
Q

Buspirone

A

-treats anxiety but not panic disorder or OCD, lacks potential for abuse
-2-4 weeks of continual use for symptom relief
-side effects: digoxin toxicity, dizzy, drowsy,
-avoid giving to pregnant people

138
Q

Antihistamines

A

Used to treat anxiety as a substitute for benzodiazepines
-example: hydroxyzine (itching, nausea)
-side effects: deep sleep, incoordination, sedation, hypoTN, tinnitus, dry mouth

139
Q

What do sedatives do?

A

Reduce anxiety, nervousness, and excitability without causing sleep. When given in large doses, it can have a hypnotic effect

140
Q

What do hypnotics do?

A

Cause drowsiness and facilitate the onset and maintenance of sleep

141
Q

What medications are considered sedative-hypnotics?

A

Benzos, GABA enhancers, melatonergic hypnotics, antihistamines, and the orexin receptor antagonist

142
Q

Stimulants and wakefulness-promoting agents are approved for what medical uses?

A

Narcolepsy, ADHD, and obesity unresponsive to other treatments. It can also be used as an adjunctive treatment in depression

143
Q

Psychostimulant side effects

A

They occur within 2-3 weeks after use begins; appetite suppression, insomnia, irritability, weight loss, nausea, HA, palpitations, constipation, dry mouth. They can suppress growth and development in kids. Social withdrawal can occur.

144
Q

Herbal therapies are often used in addition to or in place of ….

A

Antidepressants and anti anxiety medications

145
Q

St. Johns wort (SJW)

A

Used for depression, pain, anxiety, insomnia, and PMS. It modulates serotonin, dopamine, and norepinephrine. This herbal med increases chance of serotonin syndrome, interacts with birth control, and can’t be taken with antidepressants.

146
Q

Kava

A

Used for anxiety reduction. There is a severe liver injury associated with this as well as thrombocytopenia, leukopenia, and hearing impairment

147
Q

Valerian

A

Used for insomnia and nervousness. Relatively safe, but can cause liver toxicity

148
Q

Tryptophan

A

Dietary precursor for serotonin. Low levels of this can cause depression and aggressive behavior

149
Q

Melatonin

A

Used for insomnia and to prevent jet lag

150
Q

Lecithin

A

Used to improve memory and treat dementia

151
Q

Electroconvulsive therapy (ECT)

A

Used for severe depression, mania, and schizophrenia. It produces seizures lasting 25-150 seconds and the pt won’t feel stimulus or recall the procedure. It can be repeated 2-3 times a week for a total of 6-12 treatments. Must be NPO after midnight.

152
Q

Phototherapy

A

Light therapy; used for seasonal depression. Expose pt to artificial light source during the winter which will help cause a shift in the circadian rhythm. It can cause eye strain, HA, or insomnia.

153
Q

Transmagnetic stimulation (TMS)

A

It acts as an anticonvulsant medication as well as treating depression. There is repetitive and deep TMS.

154
Q

Vagus nerve stimulation

A

Approved for adjunctive therapy of severe depression for those who are unresponsive to 4 or more adequate antidepressant treatments because VNS is a permanent implant. It is not a cure for depression

155
Q

How can adherence to medications be improved?

A

Engaging in psychoeducation

156
Q

Antipsychotic meds are used for schizophrenia and act by blocking dopamine or serotonin postsynaptically. Older typical antipsychotics work on positive symptoms and are inexpensive but produce more side effects than newer atypical antipsychotic drugs which work on positive and negative symptoms.

A

Just read the front

157
Q

Mood stabilizers or antimanic meds control variations in mood related to mania. Lithium and anticonvulsants are chemically unrelated and act in different ways to stabilize mood

A

Just read the front

158
Q

Newer antidepressants like SSRIs have fewer side effects and are less lethal in overdose than TCAs

A

Just read the front

159
Q

Antianxiety meds primarily consist of benzodiazepines and nonbenzos. Benzodiazepine enhances effect of GABA & can be used PRN and nonbenzo buspirone acts on serotonin & must be taken regularly.

A

Just read the front

160
Q

Psychostimulants are used for narcolepsy and ADHD

A

Just read the front

Psychosocial (5 decks)

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