Exam 2 Flashcards
What is the continuum of defense mechanisms?
Primitive/Narcissistic 🡪 Immature 🡪 Neurotic 🡪 Mature
Define denial as a defense mechanism.
Refusing to admit reality or what is really occurring.
Provide an example of denial.
An alcoholic who denies having a problem because they can still function.
What is projection in the context of defense mechanisms?
Attributing one’s own unacceptable qualities or feelings and attributing them to another.
Provide an example of projection.
A spouse who is cheating accuses their spouse of cheating.
Define splitting as a defense mechanism.
Inability to integrate the positive and negative qualities of oneself or others into a cohesive image.
Provide an example of splitting.
A patient talks negatively about providers she doesn’t like despite their common goal.
What is acting out in immature defenses?
Avoiding conscious experience of the emotion through impulsive action.
Provide an example of acting out.
Instead of feeling sad or angry, the person gets drunk.
Define somatization as a defense mechanism.
Transformation of emotion into bodily symptoms.
Provide an example of somatization.
A woman feels body aches every time her husband goes out of town.
What is regression in the context of defense mechanisms?
Reverting to an earlier, more primitive and childlike pattern of behavior.
Provide an example of regression.
A child begins wetting the bed after his parents’ divorce.
Define reaction formation.
Taking up opposite feeling/behavior to decrease anxiety.
Provide an example of reaction formation.
Treating someone you dislike in a friendly manner.
What is intellectualization?
Focusing on the intellectual component rather than the emotional component.
Provide an example of intellectualization.
Focusing on details of medical procedures after a terminal diagnosis.
Define repression as a defense mechanism.
Unconscious exclusion of unpleasant experiences from conscious awareness.
Provide an example of repression.
A child cannot remember abuse from a parent.
What is displacement in the context of defense mechanisms?
Transference of emotions associated with a particular person or situation to another non-threatening one.
Provide an example of displacement.
A man gets angry at work and comes home and kicks the dog.
Define rationalization.
Explaining an unacceptable behavior or feeling in a rational or logical manner.
Provide an example of rationalization.
I didn’t get the job because the boss was playing favoritism.
What is dissociation?
Avoiding emotional distress through an altered state of consciousness.
Provide an example of dissociation.
A person loses several hours of time and does not remember what happened.
Define undoing in the context of defense mechanisms.
Attempt to take back an unconscious behavior or thought that is unacceptable.
Provide an example of undoing.
Sending flowers after an argument.
What is altruism as a mature defense mechanism?
Dedication to meeting the needs of others and gratification from helping them.
Provide an example of altruism.
A woman gives money to charity to help the homeless.
Define compensation.
Counterbalancing perceived deficiencies by emphasizing strengths.
Provide an example of compensation.
A shy woman asserts her confidence to excel in her career.
What is humor in the context of defense mechanisms?
Pointing out funny or ironic aspects of a situation to express feelings.
Provide an example of humor.
Using self-deprecating humor to put others at ease.
Define sublimation.
Converts unacceptable impulses into more acceptable ones.
Provide an example of sublimation.
A person with extreme anger goes to the gym to box.
What is suppression?
Conscious removal of unwanted information out of awareness.
Provide an example of suppression.
A woman puts aside her grief to finish her workday.
Define identification.
The unconscious modeling of one’s self upon another person’s character and behavior.
Provide an example of identification.
A child dresses up like a princess.
What are personality disorders?
An ingrained part of who someone is; not necessarily a mental illness.
List the risk factors for personality disorders.
- Genetic
- Neurobiological
- Psychological
- Environmental
- Diathesis-Stress Model
What are the clusters of personality disorders?
- A – Eccentric
- B – Erratic
- C – Anxious
Describe paranoid personality disorder.
Distrust & suspiciousness, hypervigilant, may initiate counter-attacks.
What is the nursing approach for paranoid personality disorder?
Adhere to schedule, keep promises, be clear & straightforward.
What is the treatment for paranoid personality disorder?
Psychotherapy is 1st line, group setting to improve social skills.
Describe schizoid personality disorder.
Lifelong pattern of social withdrawal, difficulty expressing emotions.
What is the nursing approach for schizoid personality disorder?
Do not try to be too nice; focus on coping & anxiety.
What is the treatment for schizoid personality disorder?
Psychotherapy and group therapy.
Describe schizotypal personality disorder.
Magical thinking, odd beliefs, delusional, strange speech patterns.
What is the nursing approach for schizotypal personality disorder?
May prefer social isolation.
What is the treatment for schizotypal personality disorder?
Psychotherapy and antipsychotic medications.
Describe borderline personality disorder.
Most attention-seeking, impulsivity, emotional instability, manipulative.
What is the nursing approach for borderline personality disorder?
Clear & consistent boundaries, prevent self-harm.
What is the treatment for borderline personality disorder?
Psychotherapy: CBT, dialectical behavior therapy.
Describe narcissistic personality disorder.
Entitled, lack of empathy, grandiosity, fear of abandonment.
What is the nursing approach for narcissistic personality disorder?
Remain neutral, role model empathy.
What is the treatment for narcissistic personality disorder?
Couples/family therapy, CBT, group therapy.
Describe histrionic personality disorder.
Drama queens, excitable, dramatic, self-centered.
What is the nursing approach for histrionic personality disorder?
Keep interactions professional.
What is the treatment for histrionic personality disorder?
Psychotherapy and group therapy.
Describe antisocial personality disorder.
Disregard & violation of rights of others, impulsive, manipulative.
What is the nursing approach for antisocial personality disorder?
Provide consistency, boundaries & limits.
What is the treatment for antisocial personality disorder?
Intense & long-term; criminal justice system for adults.
Describe avoidant personality disorder.
Believe world is rejecting them, low self-esteem, socially inhibited.
What is the nursing approach for avoidant personality disorder?
Friendly, accepting, reassuring approach.
What is the treatment for avoidant personality disorder?
Assertiveness training and social skills.
Describe dependent personality disorder.
Paralyzed by decision-making, need someone else to decide.
What is the nursing approach for dependent personality disorder?
Risk for strong countertransference.
What is the treatment for dependent personality disorder?
Psychotherapy and CBT.
Describe obsessive-compulsive personality disorder.
Perfectionist, rigid & inflexible, overly strict standards.
What is the nursing approach for obsessive-compulsive personality disorder?
Develop coping skills and avoid power struggles.
What is the difference between OCD and OCPD?
OCD is debilitating; OCPD is not debilitating.
What is anxiety?
Constant state of fight or flight; feeling of impending danger.
Differentiate fear and anxiety.
Fear is a reaction to specific danger; anxiety is a vague sense of dread.
List types of anxiety disorders.
- Specific phobias
- Agoraphobia
- Separation anxiety disorder
- Panic disorder
- Generalized anxiety disorder
Describe Peplau’s levels of anxiety.
- Mild: heightened awareness
- Moderate: focus on immediate concerns
- Severe: focus on specific detail
- Panic: dread & terror
What is the nursing approach for mild anxiety?
Identify signs & symptoms and triggers.
What is the nursing approach for moderate anxiety?
Stay with patient, provide reassurance, deep breathing exercises.
What is the nursing approach for severe anxiety?
Use short/clear directions, reduce external stimuli.
What is the nursing approach for panic anxiety?
Maintain a safe environment, provide reassurance, use short directions.
List treatments for anxiety.
- Beta blockers
- Benzodiazepines
- Anticonvulsants
- Antihistamines
- Antipsychotics
- Alpha agonists
What is response prevention in OCD treatment?
Making a choice not to do the compulsion when triggered.
Define obsessive-compulsive disorder (OCD).
Must follow through with ritualistic compulsions to prevent bad things.
What is body dysmorphic disorder?
Obsession about minor or unnoticeable flaws in appearance.
What is hoarding disorder?
Persistent difficulty discarding or parting with possessions.
What is trichotillomania?
Hair pulling disorder.
What is excoriation disorder?
Skin picking disorder.
What characterizes mild schizophrenia?
Extreme discomfort with close relationships and distorted reality.
What are the symptoms of delusional disorder?
Delusions are the main symptoms.
Describe brief psychotic disorder.
Sudden onset of psychotic behavior lasting less than 1 month.
What is schizophrenia?
Life-long disorder characterized by delusions, hallucinations, disorganized thinking.
What is schizoaffective disorder?
Schizophrenia and mood disorder symptoms may occur at the same time.
What are the diagnostic criteria for schizophrenia?
2+ of the following for most of the time in 1 month:
* Delusions
* Hallucinations
* Disorganized speech
* Gross disorganization or catatonia
* Negative symptoms
* Functional impairment
What differentiates schizophrenia from brief psychotic disorder?
Continuous disturbance for more than 6 months.
What are the DSM-V criteria for diagnosing Schizophrenia?
2+ of the following for most of the time in 1 month:
* Delusions
* Hallucinations
* Disorganized speech
* Gross disorganization or catatonia
* Negative symptoms
* Functional impairment
Continuous disturbance for > 6 months differentiates from brief psychotic or schizophreniform.
What are the predictable phases of Schizophrenia?
- Prodromal: Onset with mild changes
- Acute: Exacerbation of symptoms
- Stabilization: Symptoms diminishing
- Maintenance/Residual: New baseline established
Patients may not return to their former self.
Define positive symptoms in Schizophrenia.
Exaggerated normal behaviors, including:
* Alterations in speech
* Alterations in behavior
* Alterations in thought
* Alterations in perception
* Alterations in reality
Examples include hallucinations and delusions.
What is word salad in the context of Schizophrenia?
Most extreme form of disorganized speech; a meaningless jumble of real words.
This reflects severe cognitive disorganization.
What is catatonia in Schizophrenia?
Disrupts a person’s awareness of the world around them, including symptoms like waxy flexibility and posturing.
Can involve significant motor agitation or retardation.
What are negative symptoms of Schizophrenia?
Affect changes and lack of motivation, including:
* Anhedonia
* Avolition
* Asociality
* Apathy
* Alogia
These symptoms represent a withdrawal from the world.
What is the difference between hallucinations and illusions?
Hallucinations are not based in reality and affect the senses, while illusions are distorted perceptions of what is there.
Hallucinations can be auditory, visual, etc.
What are first-generation antipsychotics?
Typical antipsychotics such as Haldol and Thorazine that primarily reduce dopamine levels and address positive symptoms.
They can cause extrapyramidal side effects.
What are second-generation antipsychotics?
Atypical antipsychotics like Abilify and Seroquel that rebalance dopamine and serotonin, addressing both positive and negative symptoms.
They have a lower risk of extrapyramidal side effects.
What is neuroleptic malignant syndrome?
A rare but serious side effect of antipsychotic medications characterized by high fever, irregular pulse, muscle rigidity, and altered mental status.
Treatment may involve dantrolene and increasing dopamine.
What is the significance of anosognosia in Schizophrenia?
Patients may not believe they are ill, complicating treatment and engagement.
Building trust and involving patients in peer activities can help.
What are the symptoms of alcohol withdrawal?
Symptoms include:
* Agitation
* Anxiety
* Tremors
* Hallucinations
* Delirium Tremens (DT)
DT is life-threatening and requires ICU care.
What is the role of thiamine in alcohol withdrawal treatment?
Thiamine (Vitamin B1) is needed to prevent Wernicke-Korsakoff encephalopathy due to alcohol’s effects on the GI tract.
Supplementation is crucial during withdrawal.
What are the stages of the Transtheoretical Stages of Change Theory?
- Precontemplation
- Contemplation
- Preparation
- Action
- Maintenance
Relapse would restart the process.
What is the definition of addiction?
A chronic medical condition characterized by periods of remission and relapse without a real cure.
It significantly impacts a person’s life.
What are common comorbidities associated with substance use disorders?
Common comorbidities include:
* Bipolar disorder
* Schizophrenia
* Antisocial personality disorder
* Depression
Individuals may self-medicate with substances.
What is the treatment for opioid overdose?
Treatment includes:
* Aspirate secretions
* Insert airway
* Mechanical ventilation
* Narcan
Respiratory assessment is the #1 priority.
What are the first-line interventions for alcohol use disorder?
- Promote safety and sleep
- Reintroduce good nutrition and hydration
- Support self-care and hygiene
- Explore harmful thoughts
These interventions aim to stabilize the patient.
