Exam 1 Flashcards
Peplau
Mother of psych nursing
Created the nursing process
Applied interpersonal theory to nursing practice and nurse-client relationship
Nurses acts s maturing force
Acetylcholine
Cholinergic
Location: Autonomic Nervous System
Function: implicated in sleep, arousal, pain perception, modulation & coordination of movement & memory
Implications: Parkinson’s, Huntington’s, Alzheimer’s,increased levels of depression
Norepinephrine
Monoamine
Regulation of mood, cognition, perception, cardiovascular function, sleep & arousal
Implications: Increased in mania, anxiety states, schizophrenia, and decreased in depression
Dopamine
Monoamine
Reg. Of movements & coordination, emotions, decision making, pleasure & pain reward centers
Implications: decreased levels in depression & Parkinson’s; increased levels in mania & dyregulation in schizophrenia
Serotonin
Monoamine
Cognition, sleep, arousal, libido, appetite, mood, aggression, & pain perceptions
High concentrations in GI w nausea w SSRIs
Implications: increased levels in mania and decreased levels in dyregulation anxiety
Gamma-Aminobutyric Acid
GABA
Amino Acid
Inhibitory
Widespread in CNS
Interrupts prog of electrical impulse @ synaptic junction, slow down body activity
Implications: decreased level in anxiety, movement disorders & epilepsy
Glutamate
Amino Acid
Excitatory
Pyramidal cells in cortex, cerebellum & primary sensory afferent systems
Relays sensory info & reg. Of motor and spinal reflexes
Implications: etiology of certain neurogenic disorder & schizophrenia
Endorphins & Enkephalins
Opioid peptides
Location: Hypothalamus, thalamus, lambic structures, midbrain, brain stem, enkephalins founds in GI tract
Pain modulation and Pleasure
Implications: addict tigons, schizophrenia
Id
Instinctual drives, immediate gratification, impulsive & irrational
Ego
Rational self, develops at 4-6 MO
Experiences the reality of the external world, adapts to it, and responds to it
Role to maintain harmony among external world, the id & superego
Superego
The perfection principle
Developers b/w 3-6 yrs, internalize the values and morals set forth by primary caregivers
Oral Stage
Birth - 18 MO
Infant feels attach & unable to differentiate self from mothering
4-6 MO, infant starts to view self as separate from mothering fig.
Sense of security & ability to trust others derived from gratification of fulfilling basic needs during this stage
Phallic Stage
3-6 Yrs Superego development Sexual ID w parent Oedipus complex Electra complex
Latency Stage
6-12 Yrs
Elementary school yrs
Change from egocentricism to more interest in group activities, learning & social w peers
Sexuality is obscure & imperceptible to others
Preference for same-gender relationship, even rejecting members of opposite gender
Anal Stage
18MO - 3yrs
Toilet training
Gain independence & control
Stubbornness, stinginess, controlling
Genital Stage
13-20 Yrs
Mature of genital organs from reawakening of libidinal drive
Focus on opp gender & prep for mate
Sexual maturity evolves from self-grat. To behaviors deemed accepted by societal norms
Interpersonal relation. Based on genuine pleasure, not child associations.
Compensation
Covering up a real or perceived weakness by emphasizing a trait one considers more desirable.
Rationalization
Attempting to make or formulate logical reasons to justify unacceptable feelings or behaviors
Denial
Refusing to acknowledge the existence of a real situation or feelings associated with it.
Reaction Formation
Preventing unacceptable or undesired thoughts or behaviors from being expressed by exaggerations opposite thoughts or types of behaviors
Displacement
Transfer of feelings from one target to another that’s considered less threatening or neutral
Regression
Retreating is response to stress to an earlier level of development & comfort measures associated w that level of functioning
Repression
involuntary blocking of unpleasant feelings and experiences from one’s awareness
Intellectualization
An attempt to avoid expressing emotions associated w a stressful situation by using the intellect
Sublimation
The diversion of energy of a sexual or other biological impulse from its immediate goal to one of a more acceptable one
Undoing
Symbolically negating or canceling out an experience that one finds intolerable
Projection
Attributing unacceptable feelings or impulses to another person
Trust v Mistrust
Birth-18MO
develop a basic trust in the mothering fig & to gen it to others
Self confidence, optimist, hope for future
Non achievement: emotional dissatisfaction with others, suspiciousness, & difficulties w interpersonal relationships
Autonomy v Shame
18MO-3 yrs
Gain self-control & independence w/in environ.
Delay gratification, self confidence in ability to perform
Autonomy achieved when parent encourage & provide opportunity for independent activities
Non achievement: lack of self confidence, lack of pride in ability to perform, feeling of being controlled by others, primary caregiver restriction of independent behavior both physically and verbally.
Initiative v Guilt
3-6 Yrs
develop a sense of purpose & ability to initiate & direct own activities
Able to exercise restraint & self control
Creativity encouraged
Non achieve: feelings of inadequacy & guilt and sense of defeat
Industry v Inferiority
6-12 Yrs
Achieve self confidence by learning, competing, performing successfully, and receiving recognition from significant others & peers
Satisfaction & pleasure in interactions involved w others.
Master reliable work habit, trust & pride in achieve
Non achieve: difficulty interpreting relationships because feelings of inadequacy. Inability to cooperate or compromise, problem solve successfully
Identity v Role Confusion
12-20 Yrs
Sense of confidence, emotional stability & view of self esteem as unique individual
Values system, career choice, relationship with both gender
Parents relinquish control
Intimacy v Isolation
20-30 Yrs
Form lasting relationships or commitments to person, cause, institution, or creative effort.
Capacity for mutual love & respect b/w people
Non achieve: social isolation; aloneness
Generativity v Stagnation/ Self-absorption
30-50 Yrs
Achieve life’s goals established for oneself while considering welfare and future generation
Sense of gratification from personal and professional achieve & meaningful contributions to others
Non achieve: lack of concern or welfare of others & total preoccupation w self with dawn, isolated, self-indulgent
Ego Integrity v Despair
65-Death
Review one’s life & derive meaning from both + & - events while achieving positive sense of self
Self worth/achievement
Non achieve: disgust with how life progressed, want to start over; want 2nd chance
“Good Me”
Part of personality that develops in response to positive feedback from primary caregiver, a positive response as it becomes incorporated into self-system
“Bad Me”
Part of personality that develops in response to negative feedback from primary caregiver. Alter behavior in response to negative feelings
“Not Me”
Part of personality that develops in response to situations that produce intense anxiety in a child, denial of feelings in an effort to relieve anxiety, withdrawal from emotions
Symptoms of Manic Episodes
Inflated self-esteem/grandiosity decreased need for sleep Talkative/pressured speech Flight of ideas/racing thoughts Distractibility Increase in goal directed activity Excessive involvement in activities with increased potential for painful consequence Agitation, irritability, aggression
Bipolar Disorder
Mood swings from profound depression to extreme euphoria w intervening periods of normalcy
delusions may be present
Onset of symptoms may follow seasonal pattern
Hypomanic Episode
4 day period of increased, expansive, or irritable mood
episode is change in behavior
Disturbance in mood and change in function are observed by others
Not sever enough to cause marked impairment in function
Not attributed to substances/meds or medical condition
Cyclothymic Disorder
Chronic, fluctuating mood disturbance of @ least 2 yr duration
Numerous periods of elevated mood (doesn’t meet crit for hypomanic episode)
Numerous period of depressed mood (insuff crit to meet MDD)
Never w/o sump for +2MO
Mood
Pt’s internal & sustained emotional state
Affect
Emotional rxn associated with an experience
Expression of mood or what pt’s mood appears to be to the clinician
Congruent/incongruent
Abstract Reasoning
Ability to shift back & forth b/w general concepts & specific examples
Can pt interpret proverbs
Cultural & educ. limits need to be kept in mind
Insight & Judgement
Ability to solve prob & make decisions
Knowledge about self
Adaptive / maladaptive use of coping mech.
Psychosis
Loss of contact w reality
Disorganization of the personality
Deterioration of social function
Delusions
Fixed false beliefs
Persecutory: ppl out to get them
Referential: everything refers to them
Grandiose: Think they’re God
Somatic: Bodily delusions (think something’s wrong with them)
Hallucinations
Perception like experiences that occur w/o an external stimulus
Vivid, clear w full force & impact
Occur in sensory: auditory, visual, olfactory, tactile, gustatory
Disorganized Thinking
Thought Disorder
Inferred from person's speech
Loose associations/derailment
Tangential speech
Word Salad
Must be severe enough to substantially impair effective communication
Negative Symptoms of Psychosis
Diminished emotional expression Avolition (lack of motivation) Alogia (inability to speak) Anhedonia (inability to feel pleasure) Asociality (lack of motivation in social interactions)
Positive Symptoms of Schizophrenia
Hallucinations Delusions Illusions Disorganized Thinking Bizarre behavior
Negative Symptoms of Schizophrenia
Flat Affect Anhedonia Avolition Social isolation Diminished self care
Waxy flexibility
Person maintains the body position into which they are placed (catalepsy)
Posturing
Strange, fixed & bizarre bodily positions (catatonic posturing)
Anergia
Lack of energy
Side Effects of Typical Antipsychotics
EPS: Extra Pyramidal Side Effects Cog wheeling Dystonia Akathesia Tardive dyskinesia Parkinsonianism
Neuroleptic Malignant Syndrome
Orthodontic hypotension
Tardiness Dyskinesia
Syndrome characterized by abnorm involuntary movements of pt’s face, mouth, trunk or limbs
Monitor symptoms with AIMS scale
Vascular Dementia
Secondary to CV disease
Fluctuating pattern of prog
R/t interruption of vascular flow
Mult sm. strokes
Picks Disease
Frontotemporal NCD
Language, behavioral and motor subtypes
Lewy Body Dementia
Dementia accompanied by delirium, visual hallucinations, & Parkinsonism.
Symptoms: syncope, falls, sleep disorder & depression
Amyloid plaques, deficiencies in dopamine & acetylcholine
Pseudo dementia
Can be reversed w appropriate treatment
not caused by organic disease
Kubler-Ross Stages of Grief
I. Denial II. Anger III. Bargaining IV. Depression V. Acceptance
John Boulby Stages of Grief
I. Numbness/Protest
II. Disequilibrium
III. Disorganization & despair
IV. Reorganization
George Engel Stages of Grief
I. Shock & disbelief II. Developing awareness III. restitution IV. Result ion of loss V. Recovery
Tasks to be Reconciled
William Worden
I. Accepting reality of the loss
II. Processing pain of grief
III. Adjusting to world w/o lost entity
IV. Finding an enduring connection w lost entity in midst of embarking on new life
Anticipatory Grief
Experiencing feelings/emotions associated w normal grief before loss occurs
Becomes more intense as loss becomes more imminent
Defense mechanism
Delayed/Inhibited Grief
A sense of Grief
Fixed in denial
Distorted (exaggerated) Grief Response
Symptoms exaggerated
Dysfunc in managing ADLs
Fixed in anger phase; depression may result
Chronic/prolonged Grieving
Disabling behavior that prevents bereaved from ADLs
Major Depressive Disorder
Depressed mood/loss of interest in activities for @ least 2 wks
Evidence of impaired social & occupational function
No hist of manic behavior
Symptoms not attributed do to substance/medical condition
Decrease/increase in weight (significantly)
Insomnia/hyperinsomnia
Psychomotor agitation
SSRI,SNRI
Side effects of SSRIs and SNRIs
Headache Nausea Insomnia/anxiety Weight gain/loss Sexual dysfunction Serotonin syndrome
Serotonin Syndrome
Most commonly drug-drug interaction
Symptoms: diarrhea, restlessness, agitation, hyperreflexia, autonomic instability, myoclonus, seizures, delirium, coma, status epileptius, cardiovascular collapse
Fix by remove agent; meds to block serotonin receptors
Autism Spectrum Disorder
Wide range of impairment in 2 domains Social communication Restricted & repetitive behavior Onset first 3 yr life Seizure disorder common co-morbidity
ADHD
Persistent pattern of inattention &/or hyperactivity-impulsivity that interferes w func or development
Types:
Hyperactive-impulse
Inattentive
Combined
Stimulant Side Effects
Restlessness Overstimulation Insomnia Anorexia Tolerance Dependence
Clozapine (Clozaril)
1st effective antipsychotic w decrease EPS
Associated w risk of agranulocytosis & risk for myocarditis
Monitor WBC closely
Used for severely ill pt who fail to respond to standard treatment
Lamotrigine (Lamictil)
Anticonvulsant
Side effects: Steven Johnson’s Syndrome
Lithium
Mood stabilizer
Acute mania: 1.0-1.5 mEq/L
Maintenance: 0.6-1.2 mEq/L
Side effect: drowsiness, dry mouth/ thirst, GI upset, hand tremor, polyuria, dehydration, weight gain, acne, lithium toxicity
Valproic Acid (Depakote)
Anticonvulsant
Side effects: sedation, weight gain, hepatotoxicity w liver fail, pancreatitis, prolonged bleed time
Carbamazepine (Tegretol)
Anticonvulsant
Side effects: Steven Johnson syndrome, aplastic anemia, hyponatremia
