Exam 1 (Lecture 3, 4, 5, 6) Flashcards
**What are the seven patient factors that are barriers to eliciting patient concerns?
Time
Embarrassment
Language barrier
Intimidated
Deaf (Sensory barriers)
Trust
Mental handicaps
**What are the 8 provider factors that are barriers to eliciting patient concerns?
Time
Hypocrisy
Provider bias/prejudice
Cultural differences
“Frequent fliers”
Keeping your composure
Personal or emotional conflicts
Patient being inattentive
What are the two portions of the HPI, are the _____ and _____
patient centered and clinician centered
What are some nonverbal sources of communication that often fall in the patient centered HPI?
nonverbal cues
physical characteristics
autonomic changes
accoutrements (clothing, jewelry, makeup)
environment
self
The empathy skill NURS, what does it stand for?
Naming
Understanding
Respecting
Supporting
**What is one important question that needs to be asked during the social context of the HPI?
Does it affect your ADLs?
Job function
Daily activities
Hobbies
Family
In the patient education section, what are some key points to cover?
Assessment of patient understanding
Communication at patient level
Tailor your education for each patient:
Self-management education
What are some benefits of shared decision making?
More likely to feel secure in the healthcare setting
Stronger commitment to recover
Improved perception of the quality of care
Better self-efficacy and patient responsibility for their outcomes
Improved self-management
Better adherence to care plans
Strengthens provider-patient bond
What are some disadvantages of shared decision making?
Patient may not desire to make decisions or feel comfortable making decisions
Patient misunderstanding may lead to incorrect decisions
Possible association with increased costs and services in hospitalized patients
**What are some patient factors that are barriers to ending the visit?
Failure to comprehend education
Continuous questions
Casual conversation
New complaint at end of encounter
Family members
**What are some provider factors that are barriers to ending the visit?
Poor flow of patient encounter
Lack of proper communication with patient
Failure to “enforce” the end of the visit
Casual conversation
Name some skills that define someone as a “good communicator”
Effectively listens to others
Understands and uses nonverbal communication appropriately
Manages stress well
Emotionally aware of others
Effective verbal expression of thoughts
What is the “fast food” rule?
Whoever is the “hungriest” gets to talk first
Repeat their message sincerely
Remember mirroring!
Oftentimes what does an incomplete history equal ?
incomplete data to make decisions
A lot of times, this leads to costly and UNNECESSARY testing!
What are some common patient reasons as to why they did not adhere to the care plan?
disagreed with treatment
cost
instructions were too difficult to understand
went against their personal beliefs
did not understand
Name some factors that affect patient satisfaction
expectations
communication
control
decision-making
time spent with patient
clinical team
referrals
continuity of care
dignity
What is the root cause in the majority of malpractice causes?
poor communication
What is a quick summary of the biopsychosocial model? Who was it proposed by?
Interrelation of biological, psychological, and social factors that all contribute to the presence or absence of disease
George Engel
Hereditary (Genetics)
Anatomic
Molecular
Gender
Age
Ethnicity
All fall under what Biopsychosocial Factors category?
Biological
Temperament
Personality
Motivation
Emotion
Attention
Cognition
All fall under what Biopsychosocial Factors category?
Psychological
Family
Society
Culture
Environment
Spiritual
Economic
All fall under what Biopsychosocial Factors category?
Social
What is the the triple overlap of the Biopsychosocial model?
mental health
What are the 5 core values of the provider-patient relationship?
attentiveness
support
partnership
respect
empathy
Name some forms of nonverbal communication
kinesics (facial expression)
proxemic
paralanguage
autonomics
appearance
____ are specific, deliberate movement
gestures
_____ are communication through touch
haptics
____ space around individual
proxemic
____ is nonverbal speech. Name some things it includes
paralanguage
Pitch
Tone
Volume
Speed
Rhythm
Emphasis
____ physiologic changes caused by autonomic nervous system
autonomic
____ Patient’s body is engaged, relaxed and in an open posture
Safe Pattern
_____ Patient’s body is engaged but has increased tension - response of “attack” or “retaliation” due to feeling unsafe
Fight Pattern
_____ Patient’s body is not engaged and has increased tension, as in preparing for “flight” - response of “guarding” or “pulling away” due to feeling unsafe
Flight Pattern
_____ - Patient’s body is not engaged; the person is overwhelmed with excessive input and is withdrawn, unable to mount a response
Withdrawal Pattern
Name 4 common body patterns found in a clinical setting
safe
fight
flight
conservation-withdrawal
Define sexuality
Encompasses thoughts, feelings and behaviors connected with sexual gratification and reproduction
_____ individual with genetic, hormonal, and/or physical features
of both male and female at once
intersex
we all start out _____ during the early stages of fetal life
anatomically female
______ Innate sense of feeling male, female, some combination of both male and female, neither, or an alternative such as third gender
gender identity
What does gender identity relate to ?
psychological aspects of behavior related to masculinity and femininity
____ how one presents one’s gender to others
gender expression
_____ discrepancy between assigned (biological) gender and gender identity
Gender discordance (dysphoria)
_____ Gender discordant people who make changes to their perceived gender and/or anatomic sex in order to conform with their gender identity
transsexual (older term is transgender)
____ a person whose gender identity, gender expression, and biological sex all align (e.g., man, masculine, and male)
cisgender
_____ a person who is not cisgender
transgender
_____ a person whose gender identity is neither masculine nor feminine, is some combination of both, or is fluid
Nonbinary/Genderqueer
What are the 4 steps in the sexual response sequence?
Desire
Excitement
Orgasm
Resolution
What phase of the sexual response?
_____ characterized by sexual fantasies and desire to have sexual activity
Phase 1: Desire
What phase of the sexual response?
_____ brought on by psychological OR physiological stimulation OR combination
subjective sense of pleasure
Phase 2: Excitement and arousal
What phase of the sexual response?
_____ peaking of sexual pleasure; releasing of sexual tension; rhythmic contraction of perineal muscles and pelvic reproductive organs
Phase 3: orgasm
What phase of the sexual response?
____ disgorgement of blood from genitalia (detumescence); subjective sense of well-being and relaxation
Phase 4: Resolution
Name 3 hormones that lead to increased sexual desire
dopamine
testosterone
estrogen
_____ also increases vaginal lubrication, blood flow to female genitalia, and fullness/engorgement of female genitalia
Estrogen
Name 2 hormones that lead to decreased sexual desire
Serotonin and progesterone
increased levels in the brain = decreased desire
sexual desire for males is commonly ____ stimuli
sexual desire for females is commonly ___ stimuli
physical
psychological
What is the sexual dysfunction that is associated with the desire phase?
hypoactive sexual desire disorder; sexual aversion disorder
What is the sexual dysfunction that is associated with the excitement phase?
female sexual arousal disorder; male erectile disorder
What is the sexual dysfunction that is associated with the orgasm phase?
orgasmic disorder, premature ejaculation
What is the sexual dysfunction that is associated with the resolution phase?
postcoital dysphoria, postcoital headache
Sexual dysfunction is frequently associated with _____
other psychiatric syndromes
______ Deficiency or absence of sexual fantasies, desire for sexual activity
Hypoactive sexual desire disorder
_____ characterized by an aversion to, and avoidance of, genital sexual contact
sexual aversion disorder
What are some treatment options for hypoactive sexual desire disorder and sexual aversion disorder?
therapy
Serotonergic drugs - flibanserin (Addyi)
Melanocortin agonists - bremelanotide (Vyleesi)
Testosterone + estrogen
What is the serotonergic drug that is associated with hypoactive sexual desire disorder and sexual aversion disorder?
flibanserin (Addyi)
What is the melanocortin agonist drug that is associated with hypoactive sexual desire disorder and sexual aversion disorder?
bremelanotide (Vyleesi)
_____ dysfunction with lubrication-swelling response of sexual excitement, can be persistent or recurrent, partial or complete. What is the treatment
Female sexual arousal disorder
consider therapy referral
Testosterone
Bupropion (Wellbutrin) : is associated with SSRI use
Sildenafil (Viagra)
What are some factors that play a role in male erectile disorder?
Available sex partner
History of consistent sexual activity
Absence of vascular disease
If you have a young/middle aged male with ED what is the likely cause?
psych problem
What is important to determine in a male with ED?
can he get an erection some of the time (masturbation/morning)? or just with a specific partner?
some of the time points to psych as the cause
What are some pelvic complaints that are associated with female orgasmic disorder?
Endometriosis, pelvic floor dysfunction, pelvic organ prolapse, uterine fibroids
Childbirth or miscarriage/abortion
Atrophy of genital tissues
What is the treatment for male orgasmic disorder? What is likely the cause?
therapy, dopamine agonists (experimental)
Rigid, puritanical background
Unconscious guilts
History of abuse
How is premature ejaculation usually diagnosed?
man regularly ejaculates before or immediately after entering his partner
____ is the second most common complaint among men with sexual disorders
premature ejaculation
premature ejaculation can be helped by using the ________ or ____
squeeze technique
consider an SSRI
_____ recurrent or persistent genital pain occurring in either men or women before, during, or after intercourse
Dyspareunia
_____ involuntary muscle constriction of the outer 1/3 of vagina. What is one helpful technique?
vaginismus
Dilation: dilating vaginal opening with patient’s fingers or with graduated dilators (PT with pelvic subspecialty may help)
What pt population is vaginismus most common in?
highly educated women, high socioeconomic groups
Name some common causes of dysparenia in women
Inflammation, infection, or scarring of external genitalia
Thinning of vaginal mucosa and/or reduced lubrication
Endometriosis
Leiomyomas (uterine fibroids)
Chronic cystitis (UTIs, Interstitial cystitis)
Name some common causes of dysparenia in men
Peyronie’s Disease (abnormal fibrous penile tissue)
Name some psych medications that can affect sexual function
Antipsychotics → decrease dopamine
Antidepressants (SSRIs, SNRIs, and TCAs) → increase serotonin
Anti-anxiety agents → May improve sexual function in persons inhibited by anxiety, but certain agents may increase serotonin
Anticholinergics may produce ____ and ____ leading to sexual dysfuntion
dry mucous membranes and impotence
What is the criteria for diagnosing sexual dysfunction
Experience the disorder 75-100% of the time
Have experienced the disorder for at least 6 months
Have significant distress due to the disorder
Not have another factor that could better explain symptoms (e.g. nonsexual mental disorders, relationship distress, etc.)
Female hypoactive desire dysfunction and Female arousal dysfunction merged into a single syndrome _____
Sexual interest/arousal disorder)
Dyspareunia and vaginismus were merged into a single syndrome called _____
Genitopelvic pain/penetration disorder
____ sexual arousal not associated with psychological desire. **What is it believed to be the root cause?
Persistent Genital Arousal Disorder
Believed to be defect in sensory nerves
What is the treatment for Persistent Genital Arousal Disorder?
SSRIs, psychotherapy, topical or injected
anesthetic agents
____ achievement of arousal by exposing genitalia to strangers
exhibitionism
_____ consists of recurrent cross-dressing in a heterosexual man
tranvestism
____ attaining arousal watching an unsuspecting person or people
voyeurism
____ inflicting pain upon the sexual object as a means of arousal
sexual sadism
_____ erotic pleasure being achieved by being humiliated, enslaved, or physically bound or restrained
Sexual masochism
_____ erotic fantasies and sexual urges or behavior involving non-living objects (i.e., female undergarments)
fetishism
_____ sexual arousal derived from touching or rubbing against a nonconsenting person
frotteurism
What is the treatment for paraphilias?
pharmacotherapy (if evidence for its use) and psychotherapy
What is a heterogenous fishbowl?
Central sub-group discusses the topic, while a larger outer group observes and offers silent support, varied points of view on an issue are all represented in the center group
What is a homogenous fishbowl?
Central sub-group discusses the topic, while a larger outer group observes and offers silent support
everyone in a particular class/point of view sits in the center group and states their points first, then the groups change out for each point of view
What are good qualities in a good team leader?
Open communication/good communication
Having good motives for being the leader
Organized
Seeing themselves as equal to others on the team, not better than others
What are some qualities of a good team participant?
Actually participate/willing to work
Flexible
Different/diverse backgrounds
Involves others in decisions
