Exam 2 Flashcards
2) What is catastorphizing? – p. 190
Exaggerating negative consequences of an event. One of 5 themes common in irrational beliefs.
3) What are group norms?- p. 197
Small groups (no more than 7-8 members) are more cohesive and function well with one leader. Large groups (more than 8-10 members) are effective for specific problems or issues. May be difficult to capture everyone’s attention. Group dynamics are verbal and nonverbal communications that occur within the group and group process is the development and culmination of the session-to-session interactions of the members that move the group towards its goals.
1) What is the definition of cognitive behavior therapy? –p. 187-188
Cognitive Behavior Therapy (CBT) is a highly structured psychotherapeutic method used to alter distorted beliefs and problem behaviors by identifying and replacing negative inaccurate thoughts and changing the rewards for behaviors. It operates on the following assumptions: people are disturbed not by an event but by the perception of the event, whenever and however a belief develops, the person believes it, Work and practice can modify beliefs that create difficulties in thinking. The goal of CBT is to restructure how a person perceives events in his/her life to facilitate behavioral and emotional changes.
Model of perception, thoughts, and mood states: the cycle of cognition
Event
+ Perception -
+ Mood status -
+ Feelings -
+ Thoughts -
+ Beliefs -
4) What are the types of crisis? –p. 303-304
- Developmental Crisis: child develops positive characteristic after experiencing a crisis. If he or she develops less desirable traits, the crisis is not resolved
- Situational Crisis: specific stressful event threatens a person’s biophysical integrity and results in some degree of psychological disequilibrium. It can be internal (such as a disease process) or external (moving, job promotion)
- Traumatic Crisis: Initiated by unexpected, unusual events that can affect an individual or a multitude of people. People face hazardous events that include injury, trauma, destruction, or sacrifice (riots, war, rape, murder, kidnapping, earthquakes, floods)
5) Study the definition of uncomplicated grief. –p.
- Uncomplicated Grief: painful and disruptive. Person may have physical response (tightening , SOB, empty feeling in abdomen). A sense of unreality sets in and there is increased emotional distance. Gradually accept sense of loss as reality.
- Traumatic Grief: A more difficult and prolonged grief in which external factors influence the reactions and potential outcomes including: (1) suddenness and lack of anticipation; (2) violence, mutilation and destruction; (3) degree of preventability or randomness of the death; (4) multiple deaths (bereavement overload); and (5) mourner’s personal encounter with death involving a significant threat to personal survival.
- Complicated Grief: Occurs in approx. 10-20% of bereaved persons. The person becomes frozen or stuck in a state of chronic mourning. Person feels bitter over loss and wishes life could revert to the time they were together. Characterized by intense longing and yearning for deceased lasting more than 6 months. Other characteristics include: trouble accepting the death, inability to now trust others, excessive bitterness r/t death, and feelings that life is meaningless without the other person.
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Biologic assessment must include a physical ROS and though hx of medical problems with special attention to CNS fx, endocrine fx, anemia, chronic pain, autoimmune illness, diabetes, or menopause. Additional medical history includes: surgeries, hospitalizations, head injuries, loss of consciousness, pregnancies, childbirths, miscarriages and abortions. Complete list of Rx and OTC meds. Physical exam useful in establishing a baseline. Also includes evaluating patient for characteristic of neurovegetative symptoms: appetite and weight change, sleep disturbances, and decreased energy, tiredness, and fatigue.
14) Study tricyclic antidepressants (TCA) and suicide.-p. 413
12) What is parasuicide?-p.318
It is a voluntary, apparent attempt at suicide commonly called a suicidal gesture, but the aim is not death. Some may wish to truly die while others may wish to feel nothing for awhile
11) What drug would be prescribed for depression after someone has attempted suicide?- p.411
SSRI’s or SNRI’s. Not TCA (tricyclic antidepressants) because lethal dose is only 3-5 times greater than therapeutic dose.
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13) Study Dysthymic disorder.-p. 402 How does it differ from Major Depression
?
Milder but more chronic major depressive episode (either a depressed mod or a loss of interest or pleasure in nearly all activities for at least 2 weeks) and is diagnosed when the depressed mood is present for most days for at least 2 years with 2 or more of the following: poor appetite or overeating, insomnia or oversleeping, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, and feelings of hopelessness.
14) Study tricyclic antidepressants (TCA) and suicide.-p. 413
TCA are contraindicated because lethal dose is only 3-5 times greater than therapeutic dose. Most common effects are antihistamine (sedation and weight gain) and anticholinergic (potentiation of CNS drugs, blurred vision, dry mouth, constipation, urinary retention, sinus tachy, and decreased memory) side effects. Serum levels should be evaluated when overdose is suspected. Basic OD treatment includes induction of emesis, gastric lavage, and cardioresp. supportive care.
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15) What food restrictions are associated with MAOI’s?-p. 413
Substances containing tyramine (aged cheese, beer, red wine); can cause a hypertensive crisis.
16) Why is a depressed client at risk for suicide if showing improvement?- p.421
AS patients begin to feel better and have increase energy, they may be at a greater risk for suicide. If a previously depressed pt appears o become energized overnight, he/she may have made a decision to commit suicide and be relieved that the decision is made. These indiv should be monitored to maintain safety
17) What would be a priority in the assessment of a depressed person ?-p. 406
Safety because these indiv experience self-destructive thoughts and suicidal ideation
18) Study interactions between fluoxetine and St John’s wort. P-414
Combination may cause hypertension.
19) Study Anhedonia- p. 416
Loss of interest or pleasure. May report not caring anymore, have decrease in libido, irritability and anger.
20) Study Mirtazapine- p. 411
• Drug class: Antidepressant
• Receptor affinity: belived to enhance entral noradrenergic and serotonergic activity antagonizing central presynaptic alpha2-andreneric receptors. Mechanism of action unknown
• Indications: treatment of depression
• Routes and Dosage: 15 and 30 mg tabs
i. Adults: initially, 15 mg/day as a single dose in the pm before bed. Max dose of 45 mg/day
ii. Geriatric: Use with caution; reduced dosage may be needed.
iii. Children: Safety and efficacy not estabilished
• Half-life: 20-40 hours
• Adverse Reactions: Somnolence, increased appetite, dizziness, weight ain, elevated cholesterol or triglyceride and transaminase levels, malaise, abd pain, htn, vasodilation, vomiting, anorexia, thirst, myasthenia, arthralgia, hypoesthesia, apathy, depression, vertigo, twitching, agitation, anxiety, amnesia, sinusitis, prutitis, UTI, mania (rare) agranulocytosis (rare)
• Boxed warning: suicidality in children, adolescencts, and young adults; use w/ caution in older adults and patients w/ impaired hepatic fx, breastfeeding
21) Study Lithium-p. 434-436
Most widely used mood stabilizer
• Drug class: mood stabilizer
• Receptor affinity: alters sodium transport in nerve and muscle cells, increases norepinephrine uptake and serotonin recptor sensitivity, slightly increases intraneuronal stores of catecholamines, delays some second messenger systems. Mechanism of action unknown
• Indications: Treatment and prevention of manic episodes in bipolar affective disorder
• Routes:
o Adults: In acute mania, optimal response is uaually 600 mg tid or 900 mg bid. Obtain serum levels twice weekly in acute phase. Maintence: use lowest possible does to alleviate symptoms and maintain level of 0.6-1.2 mEq/L. In uncomplicated maintenance, obtain serum levels every 2-3 months. Do not rely on serum levels alone; monitor for side effects
o Geriatric: increased risk for toxic effects; use lower dosage; monitor frequently
o Children: Safety and efficacy in children younger than 12 y/o has not been established.
• Half-life: Mean 24 hr (peak 1-4 hrs) steady state reached in 5-7 days
• Adverse reactions; weight gain
• Warning: Avoid use during pregnancy or while breastfeeding. Hepatic or renal impairments increase plasma concentration
• Teaching/Education: avoid alcohol or CNS depressants, notify prescriber of other meds (RX and OTC), may impair judgment, thinking or motor skills, do not abruptly discontinue use
22) Study Lamotrigine- p. 438
- Drug class: Antiepileptic
- Receptor affinity: Lamotrigine had a weak inhibitory effect on serotonin 5-HT3 receptor. It does not exhibit high affinity binding: adenosine A1 and A2; adrenergic alpha 1&2 and beta; dopamine D1 and D2; GABA A and B; Histamine H1; kappa opioid; muscarinic acetylcholine; and serotonin 5-HT2
- Indications: Epilepsy, bipolar disorder (acute mood with standard therapy)
- Routes and Dosage: available in tabs: 25 mg, 100 mg, 150 mg, and 200 mg scored
- Chewable tabs: 2 mg, 5 mg, and 25 mg
- Half-life: 32 hours but can increase if taking valproate
- Selected adverse reactions: Dizziness, somnolence, and other S&S of CNS depression
- Boxed warning: serious rashes requiring hospitalization and discontinuation of treatment; the incidence is 0.08%
- Warning: hypersensitivity reaction, multiorgan failure, blood dyscrias, and suicidal behavior and ideation have occurred
- Education: Do not drive or operate machinery until side effects are well established. If rash occurs you may need to be hospitalized and discontinue use. Death rarely occurs
24) What are the risks associated with Benzodiazepines?- p. 459-460
They are associated with rebound anxiety or anxiety that increases after peak effects of med decreases. They can decrease rate and depth of respirations. Symptoms of withdrawal more likely to occur after high dosage and long term therapy. Withdrawal symptoms can manifest as: psychological (apprehension, irritability, insomnia, and dysphoria), physiological (tremor, palpitations, vertigo, sweating, muscle spasms, and seizures), and perceptual (sensory, hypersensitivity, depersonalization, feelings of motion, metallic taste)
23) Describe the experience of panic disorder.- p. 452
Often characterized by sudden, discrete periods of intense fear or discomfort accompanied by physical (palpitations, chest discomfort, rapid pulse, nausea, dizziness, sweating, paresthesia’s, trembling, shaking, SOB) and cognitive (disorganized thinking, irrational fears, depersonalization, and decreased ability to communicate). Usually peaks at 10 min but can last 30 min. Can cause fear of death because it mimics symptoms of heart attack.
25) What nursing diagnosis is associated with agoraphobia?-p.453
Anxiety
Anxiety
26) What is a priority intervention when you have a patient experiencing a panic attack? p. 467
Social Isolation, Impaired Social Interaction, and Risk for Loneliness and sometimes Interrupted Family Processes
27) What medication used more frequently in clients experiencing panic disorders?-p. 458
Antidepressants (SSRI, SNRI, TCA and MAOIs) and antianxiety meds (benzodiazepines). Use of TCAs is declining and MAOIs are reserved for those who don’t respond to SSRIs and SNRIs.
28) Why do clients with OCD perform rituals?- p. 474
Patients will often feel increased anxiety and distress if ritual isn’t performed. They are necessary not pleasurable. Initially attempts to resist behavior, it fails, and repetitive behaviors are incorporated into daily routines.
29) What signs and symptoms are associated with anxiety?-p. 450 (Box 26.1).
• Cardiovascular:
i. Sympathetic: palpitations, heart racing, increased blood pressure
ii. Parasympathetic: Actual fainting, decreased blood pressure, decreased pulse rate
• Respiratory: rapid breathing, difficulty getting air, SOB, pressure of chest, shallow breathing, lump in throat, choking sensations, gasping, spasms of bronchi
• Neuromuscular: increased reflexes, startle reaction, eyelid twitching, insomnia, tremors, rigidity, spasm, fidgeting, pacing, strained face unsteadiness, generalized weakness, wobbly legs, clumsy motions
• Skin: flushed face, pale face, localized sweating (palms), generalized sweating, hot and cold spells, itching
• Gastrointestinal: loss of appetite, revulsion toward food, abd discomfort, diarrhea, abd pain, nausea, heartburn, vomiting
• Eyes: dilated pupils
• Urinary-Parasympathetic: Pressure to urinate, increased frequency
• Affective symptoms: edgy, impatient, uneasy, nervous, tense, wound up, anxious, fearful apprehensive, scared, frightened, alarmed, terrified, jittery, jumpy
• Sensory-Perceptual: mind is hazy, cloudy, foggy, dazed, objects appeared blurred or distant, environment seems different or unreal, feelings of unreality, self-consiousness, hypervigilance
• Thinking Difficulties: Cannot recall imp things, confused, unable to control thinking, difficulty concentrating, difficulty focusing attention, distractibility, blocking, difficulty reasoning, loss of objectivity and perspective, tunnel vision
• Conceptual: cognitive distortion, fear of losing control, fear of not being able to cope, fear of physical injury or death, fear of mental disorder, fear of negative evaluations, frightening visual images, repetitive fearful ideation
• Behavioral Symptoms: inhibited, tonic, immobility, flight, avoidance, speech dysfluency, impaired coordination, restlessness, postural collapse, hyperventilation
30) What is a quick acting medication used to relieve anxiety?- p.459-460 (Box 26.5)
Benzodiazepines (Xanax*, Ativan, clonazepam)
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31) Why do individuals self injure?- p. 500
It is an effort to self-soothe by activating endogenous endorphins. Nurse can suggest using 5 senses exercise:
- Vision- go outside and look at star or flowers or leaves
- Hearing- listening to invigorating music or sounds of nature
- Smell- light a scented candle, boil a cinnamon stick in water
- Taste- drink soothing, warm, nonalcoholic beverage
- Touch- take a hot bubble bath, pet dog or cat, get a massage
32) How does DBT help clients change behavior?-p. 503-504
It combines behavior and cognitive therapies. Patients learn to understand their disorder by participating in establishing goals, collecting data about own behavior, identifying treatment targets, and working with therapist to change problematic behaviors. Core interventions include: problem solving, exposure techniques, skill training, reinforcement of positive behaviors, and cognitive modification. Skills groups are integral and teach patients emotional regulation (to manage intense labile moods), interpersonal effectiveness (to develop assertiveness and problem-solving skills), distress tolerance (helps to tolerate and accept distress as normal part of life), core mindfulness, and self-management skills
33) What are characteristics of someone diagnosed with Paranoid Personality Trait?-p. 527
Traits are longstanding suspiciousness and mistrust of persons in general. Refuse to assume personal responsibility for feelings, assign responsibility to others, and avoid relationships in which they are not in control or lose power. Actions are often misinterpreted as deception, deprecation, and betrayal.
success, power, beauty, or ideal love. Overvalue personal worth, direct affection towards themselves, and expect to be held in high esteem.
34) What are the characteristics of Narcissistic Personality?- p.-526
Traits are grandiose, have inexhaustible need for admiration, and lack of empathy. Starting in childhood, they believe they are superior, special, or unique. Preoccupied with fantasies of unlimited
35) What is Trichotillomania?- 533
Chronic self-destructing hair pulling resulting in noticeable hair loss, usually in the crown, occipital or parietal areas. Sometimes eyebrows or eyelashes. Patient usually has increase in tension immediately before pulling out hair or attempting to resist the behavior. After hair is pulled, feels sense of relief. May ritualistically eat hairs or discard them.
37) For someone who has Anorexia Nervosa (AN), what would be important to know when taking the client history?- p. 562
Depression is common and at risk to attempt suicide. Anxiety disorders such as OCD, phobias, and panic disorders are associated with anorexia nervosa. OCD is often a causative factor in AN
Social
Psychological
Biologic
38) What are the characteristics of a client with Bulimia nervosa (BN)?-p. 576
More prevalent than AN and generally older at age of onset than in AN. Individuals often binge and purge in secret and normal weight. Treatment can be delayed for years. Pts typically recover completely except in cases in which personality disorders and comorbid serious depression is present. Often overwhelmed and overly committed individuals, “social butterflies,” difficulty setting limits and establishing appropriate boundaries. They have enormous number of rules regarding food and food restriction. They feel shame, guilt, and disgust over binge eating and purging.
39) What nursing diagnosis would be associated with a client with Anorexia Nervosa?-p.568
Imbalanced Nutrition: Less Than Body Requirements
