Exam 2 Flashcards
common traits of people with schizophrenia (5)
-asocial
-isolative
-psychotic
-impoverished
-poor relationships
schizophrenia: symptoms (5)
-thought disorder
-distortion of reality
-adding thing, taking things away
-poor health outcomes
-positive and negative sx
positive symptoms:
add something to a person’s perception of reality
2 types of positive sx
-hallucinations
-delusions
types of hallucinations (5)
-audiovisual
-gustatory
-olfactory
-tactile
-command
types of delusions (3)
-paranoid
-religious
-persecutory
negative sx:
subtract something from a person’s perception of reality
ex of negative sx (6)
-alogia (poverty of speech)
-anhedonia (lack of pleasure)
-avolition (loss of motivation)
-asociality (social isolation, lack of socialization)
-attention deficit
-flat, blunted affect
assessing pts. w/schizophrenia
-top priority: safety
-med compliance
-side effects
-thought content
-+ and - sx
-recurrent pschotic breaks/degeneration of mental status
safety and schizophrenia concerns (2)
-command a/v hallucinations
-suicidal ideation
schizophrenia nursing actions (6)
-assess for thought content and command
-rapport and trust building
-validation of feelings
-med compliance and encouragement
-advocacy
-disposition planning
DO NOT DO (schizophrenia) (5)
-feed in to delusions, hallucinations
-challenge thoughts and feelings
-forcing language
-discipline negative behaviors
-force socialization
observation (schizophrenia) (8)
-mood
-affect
-actions
-pacing
-interactions
-self-dialoguing
-responding to internal stimuli
-isolation
questions for verbal assessment (schizophrenia) (4)
-“Are you seeing anything that isn’t really there?”
-“Are you hearing voices telling you to do anything?”
-“Are you having any thoughts to harm yourself or others?”
-“Are you feeling safe?”
how to ensure safety (schizophrenia) (6)
-frequent observation
-be reasonable
-1:1 constant observation
-offer support
-encourage med compliance
-build rapport and trust
client insight (schizophrenia) (4)
-variable
-awareness of dx
-spectrum of awareness
-therapeutic communication techniques adapt to pt’s insight
therapeutic environment
-welcoming
-group therapy
-normal energy level
-risk reduction (violence, agitation, outbursts)
Limits/boundaries of therapeutic mileu (6)
-established rules
-adherence to policies and procedures
-redirection if needed
-identifying unsafe behaviors for the client and others
-reducing risk
-impulse control
evaluating outcomes (schizophrenia) (6)
-improvement in thought process and content
-med adherence
-elimination or reduction of safety concerns
-improvement in both positive and negative sx
-appropriate dispo planning
-prevention of readmission
schizophrenia quick tx guide (7)
- always evaluate for safety
- assess both + and - sx
- utilize therapeutic communication techniques
- maintain therapeutic environment
- establish limits and boundaries as needed
- ensure medication plan adherence
- always consider client rights
aspects of healthy eating
-variety of foods
-response to hunger
-stop when full
-no guilt or anxiety
eating disorders (5)
-disruption of healthy eating
-binge eating
-not eating enough
-only eating certain foods
-experiencing guilt or anxiety related to eating
types of abuse (6)
-physical
-emotional
-sexual
-economic
-neglect
-abandonment
anger is (3)
-emotional response
-can be appropriate or inappropriate
-poor control=negative effects
aggression is: (3)
-outwardly violent behavior
-intent to cause harm
-physical, emotional, etc.
risk factors for aggression (7)
-history of violence
-history of mental health disorder including substance abuse
-being a victim of a crime
-witnessing abuse or violence
-poor self-esteem and inadequate coping skills
-no presence of positive role models throughout childhood
-adverse childhood experiences
warning signs for aggression (7)
-declining to eat or drink
-attempting to leave area before discharge
-verbally antagonistic toward staff or visitors
-harming self
-staring
-pacing
-destroying inanimate objects
perpetrator behavior (3)
-excuses, raionalizations
-noncommunicative
-sexual aggression/ poor coping skills
victim behavior (4)
-blames self
-no resolution to behaviors
-feels emotionally / financially trapped
-poor sexual boundaries
childhood traumatic events have _______ term effects leading to ___________ adaptation
long; poor
childhood trauma can lead to:
-aggressive behavior
-attention-seeking behavior
-bullying
teenage aggression (3)
-start seeing intimate partner violence
-issues with self-control
-overt signs of aggressions
elder abuse
-dependence for basic needs
-risk for neglect, physical, emotional, financial abuse
-isolation
nursing role (4)
-be aware
-document thoroughly
-know the law
-know your responsibility
stages of grief
- denial
- anger
- depression
- bargaining
- acceptance
TEAR Model of Grief
To accept reality of loss
Experience pain of grief
Adjust to change
Reinvest into new reality
Prolonged Grief Disorder (4)
-Sx of grief become prolonged, pervasive, and persistent
-preoccupied w/ deceased
-experiencing separation distress
-ability to function in daily life is disrupted
grief sx (9)
-sleep disruption
-headaches
-appetitie changes
-sadness/fear
-anxiety
-depression
-confusion
-issues with concentration
-anger
anticipatory grief
-occurs concurrently w/ loss process
-not always death related
childhood loss (babies, young children, adolescents)
-babies: more irritation, clinginess
-young children: regression
-adolescents: withdrawal; adult like responses
Stress def.
mental, emotional, or physical response and adaptation to real or perceived changes and challenges
or
condition in which the body responds to changes affecting its normally balanced state
3 types of causes of stress
physical/physiological
emotional
psychological
physical/physiological causes of stress (2)
-illness
-injury
emotional causes of stress (3)
-loss of a loved one
-school/professional setbacks
-divorce
psychological causes of stress
-trauma (PTSD?)
-altered mental status
-psychological disease process
types of stress
-acute
-episodic acutes stress
-chronic stress
acute stress defined/described (3)
-most common and frequent
-usually brief and can be positive or negative
-causes an immediate reaction (fight or flight)
episodic acute stress defined/described (3)
-acute stress experienced episodically, repeatedly
-occurs when someone experiences frequent bouts of acute stress
-over time can negatively impact relationships, work, overall health
chronic stress defined
-disabling condition
-constant prolonged stress
-requires careful tx
effects of chronic stress (4)
-declined mental health
-PTSD (or acute stress disorder in acute episodic stress)
-poor physical health
-declining relationship quality
acute stress disorder def.
intense, unpleasant, and dysfunctional reaction beginning shortly after an overwhelming traumatic event and lasting less than one month
PTSD defined
intense, unpleasant and dysfunctional reaction beginning shortly after a traumatic event and lasting longer than one month
physical stressors:
-hot
-cold
-wet
-noisy
-messy
physiological stressors
injury
illness
pain
fatigue
psychological stressors
anxiety
fear
behavioral health d/o
Transactional Theory of Stress and Coping
-process by which a person interprets a stressor as a threat or a challenge
-influences their stress response
-2 stages: primary appraisal and secondary appraisal
Primary appraisal
event evaluated with respect to what is at stake
secondary appraisal
consideration of possible coping strategies or resources available to help
General Adaptation Syndrome (GAS) stages
Stage 1: alarm
Stage 2: resistance
Stage 3: exhaustion
GAS occurs whether ________ or _________
eustress
distress
Goal of GAS
-body’s return to homeostasis to maintain optimal fx
GAS alarm stage features stimulation of _________nervous system
sympathetic
GAS alarm stage causes adrenal medulla to release 2 hormones:
-epinephrine
-norepinephrine
physiological response to GAS alarm stage (5)
dilation of pupils and increased:
-HR
-BP
-blood glucose
-mental activity, alertness
GAS resistance stage physiological events
stabilization of
-hormones
-BP
-HR
GAS exhaustion stage
-body not able to maintain response to stressor
-inability to adapt
-ends in death or recovery
Local Adaptation Syndrome (LAS)
-includes inflammatory response and repair processes at local site of tissue injury
Local Inflammatory Response (LAS): 2 local adaptation responses
-reflex pain responses: response of CNS to pain
-inflammatory response: local response to injury or infection
cardiovascular effects of stress on health
-HTN
-Coronary artery disease
respiratory effects of stress
asthma
GI effects of stress (4)
-Esophageal reflux
-constipation
-diarrhea
-ulcerative colitis
Autoimmune disorders associated with stress (4)
-Graves disease (hyperthyroidism)
-rheumatoid arthritis
-psoriasis
-systemic lupus erythematous
stress assessment: objective findings: appearance
-observed irritability, anxiety, tension
-sleep, appetite, weight
-eye contact, verbal/motor/cognitive status
stress assessment: objective findings: physical assessment (2)
-V/S
-clinical manifestations
stress assessment: objective findings: lab data (1)
stress-induced hyperglycemia
Stress Assessment: subjective findings
questions focus on:
-present stressors (life changes?)
-Coping skills (how dealt with stress in past?)
-Sx of stressors
-support network (who do you talk to/get help from?)
Nurse role for clients experiencing stress (3)
-conduct comprehensive assessment
-establish rapport and trusting relationsip
-be aware of S/S of stress, anxiety, educate pt.
Common stressors in elderly (3)
-loss of independence (declines in vision, cognition, and hearing
-relocation
-loss of partner
caregiver burden def.
-caring for a family member for a long period of time
-caregivers often need assistance to adapt to difficult situation
caregiver burden sx (6)
-chronic fatigue
-sleep problems
-increase in stress related illness
-ineffective coping/defense mechanisms
-difficulty with job, relationship
-poor self-esteem
coping def:
strategies an individual uses to deal w/ stressors; highly influenced by psychological, sociological, and cultural factors
examples of healthy coping strategies
-eating nutritious foods
-daily exercise
-building personal resistance
-implementing self-care activities
types of defense mechanisms (6)
-denial
-rationalization
-projection
-suppression
-regression
-compartmentalization
anxiety def:
stress response that causes apprehension or uncertainty; manifests as nervousness or feeling of dread
chronically suppressed anger can lead to: (3)
-HTN
-GI upset
-Depression
psychological stress response
-depression from a loss, professional failure, diminished physical appearance
nursing priority for stress:
safety
suicide precautions: (3)
- 1:1 constant observation
- safety assessment
- remove hazardous objects from vicinity
Coping skills: time management
-prioritize tasks
-set goals
-decrease distractions
-avoid procrastination
-set boundaries
-maintain self-discipline
Coping skills: anger management
-express feelings in a calm and nonconfrontational manner
-exercising
-identifying potential solutions
-take a time-out
-forgiving
-diffusing the situation with humor
-“owning” the negative feelings
-deep-breathing exercises
Coping Skills: support groups
-reduce stress-related to specific life circumstances
-meeting with others who share a common disease or loss
-support from knowing that the person is not alone
-online support groups
