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3400 Mental Health > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

clinical epidimiology

A

a broad field examines health and illness at the population level

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2
Q

comorbid condition

A

presence of two or more disorders

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3
Q

incidence

A

conveys information about risk of contracting a disease; refers to number of new cases in healthy population within given time period (usualy annually)

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4
Q

prevalence

A

describes total number of cases new and existing in given population during specific time period

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5
Q

diagnostic and statistic manual of mental disorders, 5th edition (DSM-5)

A

publication of american psychiatric association to identify disorders based on specific criteria

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6
Q

cultural competence

A

adjusting practices to meet pt cultural beliefs, practices, needs, preferences

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7
Q

mental health

A

state of wellbeing in which individuals reach own potential to cope with normal stressed of life, work productively, and contribute to community

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8
Q

mental health continuum

A

one end is mental health and the other is mental illness; everyone falls somewhere on the continuum and can shift along

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9
Q

mental illness

A

refers to all psychiatric disorders that have definable disorders manifested in significant dysfunctions (ex. impaired ability to think = alzheimers)

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10
Q

recovery

A

process of change through which individuals improve their health and wellness, live self directed life, and strive to reach full potential

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11
Q

resilience

A

ability and capacity for people to secure resources they need to support their well-being; how we over come things

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12
Q

stigma

A

belief that the overall person is flawed characterized by shunning disgrace and shame; negative stereotype that leads to attitude or belief that causes one to view person in certain way (ex. mentally ill pt is dangerous)

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13
Q

diathesis stress model

A

most accepted explanation for mental illness; diathesis = biological predisposition; stress = environmental stress or trauma

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14
Q

epidimiology

A

quantitative study of distribution of diseases/mental disorders in human populations

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15
Q

superego

A

develops between ages 3-5 and represents moral component of personality; resides inn conscious, preconscious, and unconscious level of awareness (allows for sense of guilt or pride)

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16
Q

id

A

present at birth; totally unconscious and impulsive; source of drive instincts reflexes and needs; lacks ability to problem solve

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17
Q

ego

A

develops within the first few years of life; resides in conscious, preconscious, unconscious levels of awareness; it is the problem solver and reality tester

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18
Q

unconscious

A

includes all repressed memories, passions, and unacceptable urges; exerts powerful but unseen effect on the conscious (trauma is an example)

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19
Q

preconscious

A

material that can be retrieved easily through conscious effort

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20
Q

conscious

A

contains all material a person is aware of at any one time such as perceptions, memories, thoughts, fantasies, feelings

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21
Q

mental health parity act

A

1996- US insurers must offer same benefits at same level coverage for mental illness as for other conditions

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22
Q

mental disorders with strong biological influences

A

schizophrenia, bipolar, major depression, obsessive compulsive and panic disorders, PTSD, autism, anorexia nervosa, attention deficit. hyperactivity disorder

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23
Q

factors that can affect mental health

A

biological/hormones/genetic, spirituality/religion, culture/regional differences, family/friends/community, personality traits, health practices and beliefs, environmental experiences, economics, impaired parenting, psychosocial stressors, negative influences

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24
Q

DSM-5 and cultural accomodations

A

discusses cultural variations for each clinical disorder, describes culture-bound syndromes, outline assist clincians in evaluating and reporting impact of an individuals cultural context

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25
Q

outpatient psych mental heath care

A

primary care providers. specialty psychiatric care providers, pt-centered health/medical homes, community clinics, psychiatric home care, assertive treatment, intensive outpatient programs, partial hospitalization programs, telephone crisis, telepsychiatry

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26
Q

role of nurse in outpatient setting

A

strong problem-solving and clinical skills, promoting recovery and continuation of treatment, knowledge of community resources, flexibility, autonomy, cultural competence

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27
Q

settings for inpatient care

A

crisis stabilization/observational units, general hospital and private hospital, state hospital

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28
Q

entry to acute inpatient care

A

direct admission on referral, ED or crisis service, voluntary or involuntary (sect.12)

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29
Q

Pt rights

A

hospitalized pt retain rights as citizens, pt need for safety needs to be weighed against pt rights, mental health facilities have written statements of pt rights and applicable state laws, pt have the rights to decline meds unless court ordered

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30
Q

CNS

A

brain and spinal cord

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31
Q

PNS

A

cranial nerves, spinal nerves, autonomic nervous system

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32
Q

akithisia

A

side effect of antipsychotic causes body to move and be restless

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33
Q

brain consists of

A

3lbs and 100 billions neurons; forebrain- cerebrum, diencephalon; midbrain- mesencephalon; hindbrain- pons, medulla, cerebellum

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34
Q

neurons are composed of

A

cell body, axons, dendrites

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35
Q

classes of neurons

A

afferent, efferent, interneurons

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36
Q

parasympathetic nervous system

A

stimulates flow of saliva, slows HR, constricts bronchi, stimulates peristalsis and secretion, stimulates release of bile, contracts bladder

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37
Q

sympathetic nervous system

A

dilates pupil, inhibits saliva, increases HR, dilates bronchi, inhibits peristalsis and secretion, conversion of glycogen to glucose, secretion of adrenaline and noradrenaline, inhibition of bladder contraction

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38
Q

neurotransmitters

A

play important role in human emotions and behaviors and are target for mechanism of action in many psychotropic meds; released from of neuron across synapse and received by dendrites of next neuron

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39
Q

insufficient transmission

A

insufficient degree of transmission caused by deficient release or neurotransmitters from presynaptic cell or by decrease in receptors on postsynaptic

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40
Q

excessive transmission

A

may be due to excessive release of a transmitter or increased receptor responsiveness (occurs in schizophrenia)

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41
Q

psychiatric illness is…

A

related to number of factors such as genetics, neurodevelopmental factors, drugs, infection, psychosocial experience

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42
Q

psychiatric illness results in

A

alteration in neurotransmitters and are the target of psychotropic drugs

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43
Q

functions of the brain

A

maintenance of homeostasis, regulation of autonomic nervous system and hormones, control of biological drives and behavior, cycle of sleep and wakefulness, circadian rhythm, conscious mental activity, memory, social skills

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44
Q

neuroimaging used for

A

picking up electrical activity in the brain; examples of test are computed tomography (CT), magnetic resonance imaging (MRI), functional magnetic resonance imaging (fMRI), positron emission tomography (PET), single photon emission computed tomography (SPECT)

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45
Q

increased neurotransmitter: dopamine

A

scizophrenia, mania

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46
Q

decreased neurotransmitter: dopamine

A

parkinsons, depression

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47
Q

increased neurotransmitter: serotonin

A

anxiety states

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48
Q

increased neurotransmitter: norepinephrine

A

anxiety states

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49
Q

decreased neurotransmitter: epinephrine

A

depression

50
Q

decreased neurotransmitter: serotonin

A

depression

51
Q

increased neurotransmitter: histamine

A

depression and anxiety

52
Q

monoamine neurotransmitters

A

dopamine, norepinephrine, serotonin, histamine

53
Q

amino acid neurotransmitters

A

gamma-amino butyric acid (GABA), glutamate

54
Q

increased neurotransmitter: GABA

A

reduction of anxiety, schizophrenia, mania

55
Q

decreased neurotransmitter: GABA

A

anxiety disorders, schizophrenia, mania, huntington chorea

56
Q

glutamate amino acid neurotransmitter

A

major mediator of excitatory signal in the central nervous system; involved in most aspects of normal brain function, cognition, memory, learning

57
Q

cholinergic neurotransmitter

A

acetylcholine

58
Q

increased neurotransmitter: acetylcholine

A

depression

59
Q

decreased neurotransmitter: acetylcholine

A

alzheimers, huntington chorea, parkinsons

60
Q

peptides-neuromodulator neurotransmitters

A

substance P, somatostatin, neurotensin

61
Q

substance p

A

regulation of mood and anxiety, role in pain management

62
Q

increased neurotransmitter: somatostatin

A

huntington disease

63
Q

decreased neurotransmitter: somatostatin

A

alzheimer

64
Q

neurotensin

A

decreased levels in spinal fluid of pt with schizophrenia

65
Q

types of psychotropic drugs

A

antianxiety, anti-depressants, mood stabilizers, anti-convulsants, anti-psychotics, ADHD agents, alzheimer agents, herbal supps

66
Q

Antidepressants

A

monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitor (SNRIs), serotonin-norepinephrine disinhibitors (SNDIs), Norepinephrine-dopamine reuptake inhibitors (NDRIs), Serotonin antagonist/reuptake inhibitors, Selective norepinephrine reuptake inhibitor

67
Q

Monoamine oxidase inhibitors (MAOIs)

A

drugs that increase concentration of monoamines by inhibiting action of monoamine oxidase

68
Q

MAOIs precaution

A

avoid tyramine found in OTC meds, beer, wine, aged cheese, organ meats, avocados; dietary restriction must be maintained 2 weeks after stopping MAOIs

69
Q

TCA

A

increase norepinephrine; side effects: anticholinergic- cant pee cant see cant spit cant shit (amitriptylene, nortriptyline)

70
Q

TCA precaution

A

inability to pee can lead to potential infection

71
Q

SSRIs

A

increases serotonin; side effects: fewer anticholinergic effects than TCAs, N/V, sexual dysfunction, can cause serotonin syndrome (fluoxetine, sertraline, paroxetine)

72
Q

SNRIs

A

increases serotonin and norepinephrine; side effects: fewer anticholinergic effects (venlafaxine and duloxetine)

73
Q

SNDIs

A

increase serotonin and norepinephrine; usually combined with SSRIs to augment efficacy or counteract serotonergic side effects (mirtazapine)

74
Q

NDRIs

A

do not act on serotonin system; inhibit nicotinic acetylcholine receptors to reduce addictive effects (bupropion)

75
Q

SARIs

A

not first choice for antidepressant treatment, but useful for insomnia; side effects: can cause priapism (trazodone)

76
Q

NRIs

A

treat ADHD when stimulants are not tolerated but no significant antidepressant effects (atomoxetine)

77
Q

Anxiolytics or anti-anxiety

A

benzodiazepines

78
Q

anxiety medications

A

diazepam, clonazepam, alprazolam, lorazepam; should only be used short term; not first choice for anxiety but first choice for panic disorder; lorazepam/alprazolam not soporific at lower doses

79
Q

insomnia medications

A

flurazepam, triazolam

80
Q

non benzodiazepine anxiolytics

A

buspirone, z-hypnotics, melatonin-receptor agonist

81
Q

buspirone

A

anxiolytic with less potential for dependence

82
Q

z-hypnotics

A

short acting sedative and hypnotic sleep agents; provide sedative effects without the antianxiety, anticonvulsant, or muscle relaxant effects of benzos

83
Q

melatonin-receptor agonist

A

hypnotic drug that acts similar to melatonin; thought to regulate circadian rhythm

84
Q

mood stabilizer

A

lithium: stabilizes depression and mania (bipolar); very narrow therapeutic range, has potential for toxicity; titrate from low dose up to desired amount but monitor BUN and creatinine for kidney function

85
Q

toxicity of lithium

A

tremor, ataxia, confusion, convulsions, N/V

86
Q

anticonvulsant mood stabilizers

A

valproate- very effective in managing impulsive aggression (monitor LFT and enzymes-liver), carbamazepine- administered for acute mania, lamotrigine- administered for maintenance therapy (watch for Steven Johnson)

87
Q

off-label mood stabilizers

A

oxycarbazepine, gabapentin, topiramate

88
Q

first-generation antipsychotic drugs

A

chlorpromazine (thorazine), fluphenazine (prolixin), haloperidol (haldol); all treat positive symptoms of schizophrenia

89
Q

positive symptoms of schizophrenia treated by first gens

A

delusions (paranoia), hallucinations (visual, auditory, tactile, gustatory, olfactory), illusion (morphing of something)

90
Q

adverse/extrapyramidal side effects of first-gen antipsychotics

A

dystonia- muscle stiffness, akathisia- restlessness, tardive dyskinesia- lip-smacking (irreversible),drug induce parkinsonism- shuffling gait, drooling, neuroleptic malignant syndrome- muscle stiffness/wasting (life-threatening), orthostatic hypotension (non-reversible)

91
Q

how to treat reversible side effects of 1st gen antipsychotics

A

mainly cojentin, sometimes diphenhydramine (benadryl), propanolol, dantroline

92
Q

2nd generation atypical antipsychotic drugs

A

fewer extrapyramidal side effects; target negative side effects and positive side effects of schizophrenia

93
Q

ex of 2nd gen antipsychotics

A

clozapine, quetiapine, olanzapine, aripiprazole

94
Q

positive symptoms vs negative symptoms schizophrenia

A

+ = symptoms added to pt such as hallucinations or illusions; - = absence of normal behaviors like anhedonia

95
Q

anhedonia

A

lack of pleasure or enjoyment or interest

96
Q

why choose second gen antipsychotics

A

much lower risk of EPS but still possible; 2nd gen can cause metabolic syndrome

97
Q

metabolic syndrome

A

increased weight, increased blood glucose, increased triglyceride levels, insulin resistance

98
Q

best treatment for most psychiatric problems

A

combination of medication and psychotherapy

99
Q

importance of talk therapy

A

based on psychotherapy (freud) and found to change brain chemistry in similar ways as medication

100
Q

therapeutic relationships…

A

needs of pt are identified and explored, clear boundaries established, problem-solving approaches taken, new coping skills developed, behavioral change encouraged

101
Q

professional and ethical boundaries

A

maintaining prolefessional role helping meet patients goals and never personal goals of nurse

102
Q

legal boundaries

A

pt rights to confidentiality; breach of confidentiality i a common law tort which is a civil wrong; results in lawsuit for monetary compensation and/or loss of license

103
Q

over-involvement increases risk of…

A

boundaries being crossed- relationship becomes personal (RN needs being met); boundary violations- reversal of roles (RN needs met and pt needs not met); sexual misconduct (physical or verbal)

104
Q

peplaus nurse pt relationship

A
  1. preorientation phase 2. orientation phase 3. working phase 4. termination phase
105
Q

preorientation phase

A

prepare for your assignment; research pt HX, recognize own thoughts and feeling about meeting pt; anticipate and set ground rules prior to first meeting

106
Q

orientation phase

A

establishing rapport; parameters of relationship, formal or informal contract; confidentiality; terms of termination (begin talking abut end); initial interview takes place

107
Q

working phase

A

maintaining relationship, gather further data; promote patients problem-solving skills; self-esteem and use of language; facilitate behavioral change; overcome resistant behaviors; evaluate problems and goals; promote practice and expression of alternative adaptive behaviors

108
Q

termination phase

A

summarize goals and obj. achieved; discuss ways for pt to incorporate new coping strategies learned; review situation of relationship and exchange memories

109
Q

factors promoting patient growth

A

empathy (not sympathy), genuineness, positive regard, SOLER

110
Q

empathizing with someone is…

A

aiming to understand the feeling of the patient which is therapeutic not pittying or feeling sorrow for pt

111
Q

SOLER

A

s- sitting at comfortable angle and distance; O- open posture arms and legs uncrossed; L- leaning forward from time to time, looking genuinely interested, listen attentively; E- eye contact without staring; R- remaining relatively relaxed

112
Q

components of nonverbal communication

A

physical appearance and dress, body movement and posture, touch (be very careful), facial expressions, eye behavior, vocal cues or paralanguage

113
Q

active listening

A

listen to pt verbally and nonverbally, SOLER

114
Q

transference

A

occurs when client unconsciously displaces to the nurse feelings formed towards a person from his or her past

115
Q

countertransference

A

refers to nurses behavior and emotional response to client. Responses maybe related to unresolved feelings toward significant other from nurses past or may be generated in response to transference feelings on part of client

116
Q

process recordings

A

written reports of verbal interactions with clients used to improve communication technique

117
Q

therapeutic communication techniques

A

using silence, accepting, giving recognition, offering self, giving broad openings, offering general leads, placing the even in time or sequence, making observations, encouraging description of perceptions, encouraging comparison, restating, reflecting, focusing, exploring, seeking clarification and validation, presenting reality, voicing doubt, verbalizing the implied, attempting to translate words into feelings, formulating plan of action

118
Q

non-therapeutic communication techniques

A

giving reassurance, rejecting, giving approval or disapproval, agreeing/disagreeing, giving advice, probing, defending, requesting an explanation, indicating the existence of an external source of power, belittling feelings expressed, making stereotyped comments, using denial, interpreting, introducing an unrelated topic

119
Q

preexisting conditions impacting communication

A

values/attitudes/beliefs, culture/religion, social status, gender, age/developmental level, physical impairments (glasses/hearing aids), environment of transaction (territoriality/density/distance), personal space

120
Q

clinical epidemiology studies

A

the natural history of a disorder/disease (if no interventions occurred, the studies of diagnostic screenings, and observational and experimental studies of interventions used to treat individuals with said disorder/symptoms

3400 Mental Health (8 decks)

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