Exam 1 Flashcards
Freud
Id
Ego
Superego
Id
Pleasure-pain principle
Immediate gratification
Instinctive and primitive mind is dominant
Birth-1 1/2 years
Ego
Behaviors
Problem solving skills
Perception
Ability to mediate id impulses
1 1/2-3 years
Superego
Perfection principle
Unconscious
Reward and punishment principle
Incorporating moral values, ideals, judgments from right and wrong that are held by parents
3-7 years
Skinner
Operant conditioning
Punishment causes behavior to recur again
Erin beck
Negative and self critical thinking causes depression
Cognitive behavioral therapies assist to identify negative thought patterns and replace with rational ones (involves hw)
Maslow hierarchy of needs
- Physiological
- Safety
- Love and belonging
- Self esteem
- Self actualization
Dopamine
Cognitive
Motivation
Movement
Serotonin
Mood
Attention
Body temp
Norepinephrine
Mood
Cognition
Perception
GABA
Excitement
Anxiety
Orientation phase
Assessment
Getting to know patient and their history
Sort of like job orientation
Working phase
Doing work Setting goals Nursing diagnosis Nursing intervention Nursing plan of care
Termination phase
Reflect on relationship
Nurse-client relationship/partnership
Patient centered
Patient has control over healthcare decisions
Don’t discuss things about yourself
Understanding nurse is safe, reliable, consistent, info is private
Ex. Bipolar patient/ won’t know boundaries
Social relationships
Each person gets something out of relationship
Psych RN
Cannot medically diagnose
Promote autonomy
Cannot run personal therapy- can group
Advanced practice provider
Focused on therapy and medical diagnosis
MH and disease management/ traditional medicine
Developing goal/outcome
SMART
Specific e Measurable Attainable Realistic Timely
Mental health
Sense of well- being
Ability to adapt to stress
Mental illness
Diagnosis
MSE
Mental status exam
Physical behavior, nonverbal comm, appearance (weight, BMI), speech, mood and affect, thought content, perception, cognitive ability, insight, judgement
Empathetic
Understanding feelings
“I understand your feelings…”
Sympathetic response
Feel the feelings
Your experience can relate
Beneficence
Act or promoting good to others
Negligence
Malpractice
Breeching act resulting in injury
Autonomy
Nurse being able to make own decisions
Justice
Distributing resources equally
Fidelity
Maintaining loyalty to patient
No wrong
Veracity
Truthful in documentation, report, speaking truthfully
Patients rights
Informed consent
Right to refuse (trtmt, med)
Involuntary admission
Right to hold
Can refuse meds and have informed consent
Can’t leave
Duty to warn: inpatient
Warn treatment team and staff members
Duty to warn: advanced practice nurse
Let victim know they were threatened
HIPAA
Health insurance portability and accountability act
Confidentiality
Psychopharmacology
Tools for chemical imbalances
NOT a “cure all”
Used to function properly
Social relationship
Friendship
Socialization
Environment
Accomplishment
Mutual needs met
Little emphasis on evaluation of interaction
Therapeutic relationship
Nurse maximizes their comm skills
Understand human behavior
Personal strengths
Enhance patient growth
Address concerns
Respect patient as partner in decision making
Language straight forward
Clinical competence
principles of knowledge for specific situation
Awareness and incorporation of latest knowledge (EBP)
Delaying judgment
Avoid transferring own values and beliefs to others
Supervision
More experienced clinician or team member overlooks
Essential to develop competence
Assessment of children
Gather data from variety of sources
Best source of determining feelings is by parents
Can describe behavior, performance, conduct of child
INTERVIEW AND OBSERVATION
position yourself at child’s level
Assessment of adolescents
Substance abuse and sexual abuse are confidential
Threats of suicide or homicide, use of illegal drugs must be shared with professionals and parents
HEADSSS interview
Assessment of older adult
Sensory condition
Motor condition
Medical condition
Possible cause of increased anxiety, stress, physical discomfort
Assess mental and emotional needs
HEADSSS
Home environment Education and employment Activities Drugs, alcohol, tobacco use Sexuality Suicide risk Savagery (violence or abuse)
Dopamine and illness
Decrease Parkinson’s, depression
Increase schizo and mania
Norepinephrine and illness
Decrease depression
Increase anxiety
Serotonin and illness
Decrease depression
Increase anxiety
Histamine and illness
High levels associated with anxiety and depression
Gamma-amino butyric acid (GABA) and illness
Decrease anxiety, schizo, mania, Huntington chorea
Increase reduction of anxiety, schizo, mania
Glutamate and illness
Excitatory signals in CNS
Cognition
Memory
Learning
Pharmacokinetic
Effects of drugs on plasma concentrations of each other
Pharmacodynamic
Combined effects of drugs
Acetylcholine and illness
Increase depression
Decrease Alzheimer’s, Huntington chorea, Parkinson’s
Supstance P
Regulation of mood and anxiety
Pain management
Somatostatin and illness
Decrease Alzheimer’s
Increase Huntington
Neurotensin and illness
Decrease levels of spinal fluid of patients with schizo
Monoamines
Organic
Neurotransmitters divide into subgroups
Catecholamines
Indolamines
Catecholamines
Norepinephrine
Epinephrine
Dopamine
Indolamines
Serotonin
Monoamine oxidase (MAO)
Enzyme destroys monoamines
Monoamine oxidase inhibitors (MOAIs)
drugs that increase concentrations of monoamines
Inhibit MAO
EMSAM (delegitimization transdermal system)
Delivers MAOIs through skin
Hypertensive crisis
Patient ingests tyramine found in OTC meds Beer Wine Aged cheese Organ meats Avacados
RESTRICTION should be maintained 2 weeks after stopping MAOIs
Antidepressant drugs
TCAs SSRIs SNRIs (serotonin noripenephrine) SNDIs (disinhibitors) NDRIs SARIs NRIs
TCAs drugs
Amitriptyline (elavil)
Nortriptyline (pamelor)
TCAs use and SE
Increase norepinephrine
SE: anticholinergic, dizziness, hypotension
Taper slowly
6-8 weeks full effect
SSRIs drugs
Fluoxetine (Prozac)
Sertaline (Zoloft)
Paroxetine (paxil)
SSRIs use and SE
Increase serotonin
SE: some anticholingeric, nausea, vomiting, serotonin syndrome
Watch for suicidal tendencies
SNRIs use and SE
Increase serotonin and norepinephrine
SE: few anticholinergic
SNDIs use and SE
Increase serotonin and norepinephrine
Added to SSRIs to increase effectiveness (augment)
NDRIs
Norepinephrine dopamine reuptake inhibitors
Bupropion (Wellbutrin)
NDRIs use and SE
Don’t act on serotonin system
Inhibit nicotin acetylcholine receptors to reduce additive effects
SARIs
Serotonin antagonist reuptake inhibitors
Trazadone (Desyrel)
SARIs
Not first choice as antidepressant
Good for insomnia
SE: priapism (prolonged erection)
NRIs
Selective norepinephrine reuptake inhibitors
Atomoxetine (strattera)
NRIs use
ADHD when stimulants not tolerated
No significant antidepressant effects
Anxiety drugs/ anxiolytics
BENZO
Diazepam (Valium)
Clonazepam(klonopin)
Alprazolam (Xanax)
Lorazepam (Ativan) and Xanax reduce anxiety without insomnia
Insomnia: flurazepam (dalmane) and triazolam (halcion)
Anti anxiety and hypnotic
NONBENZO
Busiprone (buspar)
X-hypnotics
Melatonin receptor agonist
Busiporne (buspar)
Less potential for dependence
Z-hypnotics
Short acting sedatives and hypnotic sleep agents
Melatonin receptor agonist
Ramelteon (rozerem)
Acts similar to melatonin
Regulate circadian rhythms
Mood stabilizers meds
Lithium (eskalith, lithobid)
Valproate (depakote/ depakene)
Carbamazepine (Tegretol)
Lamotrigine (lamictal)
Mania
Bipolar disorder
Lithium SE
Toxicity can include tremor, ataxia, confusion, convulsions, nausea, vomiting
Valproate (depakote/depakene)
Managed impulsive aggression
Carbamazepine (Tegretol)
Acute mania
Lamotrogine (lamictal)
Maintenance therapy
Stevens-Johnson’s
Off label mood stabilizers
Oxcarbazepine (trileptal)
Gabapentin (neurontin)
Topiramate (topamax)
Antipsychotics first generation (FGA)
Chloropromazine (thorazine)
Fluphenazine (prolixin)
Haloperidol (haldol)
Extrapyramidal side effects
Caused from dopamine blocking
Dystonia (muscle stiffness) Akathisia (restlessness) Tarditive dyskinesia (TD) -involuntary mvmts (tremors) Drug induced Parkinsonism Neuroleptic malignant syndrome (NMS) Ortho hypo
Blocking muscarinic cholinergic receptors?
Blurred vision
Second generation antipsychotics
Atypical
Fewer extrapyramidal side effects
Target neg and positive symptoms of schizo
SE: increase weight, BG, triglyceride, insulin resistance
Psychiatrist
Medical physician
Role of psychiatric nurse on inpatient unit
Maintain therapeutic milieu
Psychoanalytic theory
Freud
Unconscious thoughts and psychosexual development
Erickson’s stages: adolescence
12-20
Identity vs role confusion
Temporary identity diffusion
Integrate all tasks previously
Erickson’s stages: young adult
20-30
Intimacy vs isolation
Fear of losing identity or relationship
Forming intense long relationships
Erickson’s stages: middle adult
30-65
Generatively vs self absorption
Achieving goals
Goals of therapeutic relationships
- Facilitate comm of distressing thoughts and feelings
- Assist patients with problem solving for ADLs
- Help patients examine self defeating behaviors and test alternatives
- Promote self care and independence
Restraining orders by age
4 hrs (18+)
2 hrs (9-17)
1 hr (under 9 years)
Assess every 15-30 min and DOC!
Serotonin syndrome
Fever Agitation Increased reflexes Tremor Sweating Dilated pupils Diarrhea Siezures
