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Community Mental Health Nursing > Exam 2 > Flashcards

Exam 2 Flashcards

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1
Q

Psychosis

A

Alterations in mental state

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2
Q

Schizophrenia Clinical Picture

A

Affects 1% of adults

Characterized by psychosis

Develops gradually, presenting at 15 to 25 years

Child-onset and late-onset are more rare

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3
Q

DSM-V Criteria for Schizophrenia

A

Two or more of the following for a significant portion of time in one month:
Delusions, hallucinations, disorganized speech, gross disorganization or catatonia, negative symptoms (not showing emotions)

Continuous disturbance for at least 6 months

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4
Q

Epidemiology of Schizophrenia

A

1 in 40,000 children

No difference related to race, social status, culture

More frequently diagnosed among males and in urban areas

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5
Q

Comorbidities of Schizophrenia

A

Substance abuse disorders

Anxiety, depression, risk for suicide

Physical health or illness

Polydipsia

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6
Q

Etiology of Schizophrenia

A

Biological factors: Genetics

Neurobiological: dopamine therapy, neurochemical hypotheses

Brain structure abnormalities

Prenatal stressors, psychological stressors, environmental stressors, prognostic considerations

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7
Q

Phases of Schizophrenia

A

Prodromal: onset, mild changes

Acute: exacerbation of psychotic symptoms

Stabilization: symptoms diminishing, movement toward previous level of functioning

Maintenance or Residual: new baseline is established

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8
Q

Assessment During Prodromal Phase of Schizophrenia

A

Positive symptoms: present but not actually present

Negative symptoms: absence of something that should be there

Cognitive symptoms: symptoms that impair thinking or memory

Affective symptoms: involve our emotions

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9
Q

Positive Symptoms of Schizophrenia

A

Alterations in reality testing

Delusions, alterations in speech, concrete thinking (inability to think abstractly)

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10
Q

Alterations in Speech with Schizophrenia

A

Associative looseness (word salad, jumble of words meaningless to listener)

Clang association (words chosen based on sound)

Neologisms (meaning for the patient only)

Echolalia (pathological repetition of another’s words)

Circumstantiality, tangentiality, cognitive retardation, pressured speech, flight of ideas, symbolic speech

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11
Q

Distortions of Thought with Schizophrenia

A

Thought blocking: reduction or stoppage of thought; hallucinations may cause this

Thought insertion: belief that someone else has inserted thoughts into their brains

Thought deletion: belief that thoughts have been taken or are missing

Magical thinking: believing that thoughts affect others’ consequences

Paranoia

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12
Q

Alterations in Perception with Schizophrenia

A

Depersonalization: feeling of being unreal or having lost identity

Derealization: feeling that the environment has changed

Hallucinations

Illusions: misperceptions or misinterpretations of a real experience

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13
Q

Alterations in Behavior with Schizophrenia

A 
Catatonia
Motor retardation
Motor agitation
Stereotyped behaviors
Waxy flexibility
Echopraxia
Negativism
Impaired impulse control
Gesturing or posturing
Boundary impairment
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14
Q

Negative Symptoms with Schizophrenia

A

Absence of essential human qualities

Anhedonia: lack of pleasure

Avolition: lack of motivation

Asociality: don’t want to interact with anyone

Affective blunting: no affect, no expressions, monotone

Apathy: lack of interest

Alogia: poverty of speech

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15
Q

Cognitive Symptoms of Schizophrenia

A

Concrete thinking

Impaired memory

Impaired information processing

Impaired executive functioning

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16
Q

Affective Symptoms of Schizophrenia

A

Assessment for depression is crucial (may herald impending relapse, increases substance abuse, increases suicide risk, further impairs functioning)

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17
Q

Self-Assessment with Schizophrenia

A

Anosognosia: inability to recognize illness

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18
Q

Assessment Guidelines with Schizophrenia

A

Any medical problems

Drug/alcohol use disorders

Mental status examination

Cognitive assessment

Assess for hallucinations, delusions, suicide risk

Assess ability to ensure personal safety

Assess prescribed meds

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19
Q

Potential Nursing Diagnoses for Schizophrenia

A

Positive Symptoms: disturbed sensory perception, risk for self-directed or other-directed violence, impaired verbal communication

Negative Symptoms: social isolation, chronic low self-esteem

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20
Q

Outcomes Identification for Schizophrenia

A

Phase I-Acute: patient safety and medical stabilization

Phase II-Stabilization: help patient understand illness/treatment, stabilize medications, control/cope with symptoms

Phase III-Maintenance: maintain achievement, prevent relapse, achieve independence, satisfactory quality of life

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21
Q

Planning for Schizophrenia

A

Phase I-Acute: best strategies to ensure patient safety and provide symptom stabilization

Phase III-Maintenance: provide patient and family education, relapse prevention skills are vital

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22
Q

Implementation during Acute Phase of Schizophrenia

A

Psychiatric, medical, and neurological evaluation

Psycopharmalogical treatment

Support, psychoeducation, and guidance

Supervision and limit setting in the milieu

Monitor fluid intake

Working with aggression

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23
Q

Interventions for Stabilization and Maintenance Phases of Schizophrenia

A

Medication administration/adherence

Relationships with trusted care providers

Community-based therapeutic services

Teamwork and safety

Activities and groups

Counseling and communication techniques

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24
Q

Psychobiological Interventions for Schizophrenia

A

Antipsychotic medications (1st, 2nd, and 3rd generation)

Injectable antipsychotics (short- and long-acting)

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25
Q

First-Generation Antipsychotics

A

Dopamine antagonists
Target positive symptoms of schizophrenia

Advantage: less expensive

Disadvantages: extrapyramidal side effects (dystonia, akathisia, pseudoparkinsonism), ACh side effects (dry mouth), tardive dyskinesia (repetitive movements), weight gain, sexual dysfunction, endocrine disturbances

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26
Q

Second-Generation Antipsychotics

A

Serotonin and dopamine antagonists (clozapine)

Treat both positive and negative symptoms

Minimal to no EPS or tardive dyskinesia

Disadvantage: tendency to cause significant weight gain, risk of metabolic syndrome (increased risk for diabetes)

27
Q

Third-Generation Antipsychotics

A

Really a subset of the SGAs

Ariprazole, brexpiprazole, calprazine

Dopamine system stabilizers

May improve positive and negative symptoms and cognitive function

Little risk of EPS or tardive dyskinesia

28
Q

Potentially Dangerous Responses to Antipsychotics

A

ACh toxicity

Neuroleptic malignant syndrome

Agranulocytosis

Prolongation of QT interval

Liver impairment

29
Q

Advanced Practice Interventions for Schizophrenia

A

Individual and group therapy

Psychoeducation

Medication prescription and monitoring

Basic health assessment

Cognitive remediation

Family therapy

30
Q

Anxiety

A

Apprehension, uneasiness, uncertainty, or dread from real or perceived threat

Normal anxiety is necessary for survival

31
Q

Fear

A

Reaction to a specific danger

32
Q

Mild Anxiety

A

Everyday problem-solving leverage

Grasps more information effectively

33
Q

Moderate Anxiety

A

Selective inattention

Clear thinking hampered

Problem-solving not optimal

Sympathetic nervous system symptoms begin

34
Q

Severe Anxiety

A

Perceptual field greatly reduced

Difficulty concentrating on environment

Confused and automatic behavior

Somatic symptoms increase

35
Q

Panic

A

Markedly disturbed behavior–running, shouting, screaming, pacing

Unable to process reality; impulsivity

36
Q

Defense Against Anxiety

A

Automatic coping styles

Protect people from anxiety

Maintain self-image by blocking feelings, conflicts, memories

Can be healthy or unhealthy

37
Q

Separation Anxiety Disorder

A

Developmentally inappropriate levels of concern over being away from a significant other

38
Q

Panic Disorder

A

Panic attacks

Unpredictable, self-limiting

Typically last 10min or longer

May have palpitations, tremors, SOB, feeling of smothering, chest pain, nausea, abdominal pain, dizziness, paresthesia

All other medical issues have been ruled out if given this diagnosis

39
Q

Agoraphobia

A

Excessive anxiety or fear about being in places or situations from which escape might be difficult or embarrassing

40
Q

Social Anxiety Disorder

A

Severe anxiety or fear provoked by exposure to a social or a performance situation that will be evaluated negatively by others

41
Q

Generalized Anxiety Disorder

A

Excessive worry that lasts for months

Easily fatigued, difficulty concentrating, muscle tension, sleep disturbance, difficulty functioning due to worry

42
Q

Other Anxiety Disorders

A

Substance-induced anxiety disorders

Anxiety due to medical condition (COPD)

43
Q

Obsessions

A

Thoughts, impulses, or images that persist and recur, so that they cannot be dismissed from the mind

44
Q

Compulsions

A

Ritualistic behaviors an individual feels driven to perform in an attempt to reduce anxiety

45
Q

Obsessive-Compulsive Disorders

A

Obsessive-compulsive disorder

Body dysmorphic disorder

Hoarding disorder

Hair pulling and skin picking disorders

46
Q

Epidemiology of Anxiety Disorders

A

Decreased levels of serotonin and dopamine

47
Q

Assessment of Anxiety Disorders

A

Sound physical and neurological exam

Determine source of anxiety (primary vs. secondary)

Determine current level of anxiety

Assess for potential self-harm

Complete psychosocial assessment (ask patent about causes they can identify)

Self-assessment

48
Q

Nursing Diagnoses and Outcome Identification for Anxiety

A

Anxiety (self-monitors intensity, uses reduction techniques)

Ineffective coping (identifies ineffective and effective patterns)

49
Q

Planning with Anxiety

A

Patients do not usually require inpatient admission

Planning involves selecting community-based interventions

Encourage active participation in planning to increase positive outcomes

Patient experiencing severe levels may not be able to participate in planning

50
Q

Implementation for Anxiety

A

Identify their anxiety

Counseling

Teamwork and safety

Promotion of self-care activities

Pharmacological interventions (antidepressants, anti-anxiety drugs, other classes)

Psychobiological interventions

Integrative therapy

Health teaching

51
Q

Concepts Central to Addictive Use Disorders

A

Addiction

Intoxication

Tolerance

Withdrawal

52
Q

Comorbidities with Substance Abuse Disorders

A

Psychiatric comorbidities (schizophrenia, anxiety)

Medical comorbidities (diabetes, hepatitis C, psoriasis)

53
Q

Etiology of Substance Abuse Disorders

A

Neurobiological factors

Psychological factors

Sociocultural factors

54
Q

Caffeine

A

Most widely used psychoactive substance in the world

Can result in intoxication and withdrawal

55
Q

Cannabis

A

Most widely used illicit drug in the world

Fourth most commonly used psychoactive drug in the United States after caffeine, alcohol, and nicotine

56
Q

Hallucinogens

A

Cause a profound disturbance in reality

57
Q

Inhalants

A

Solvents for glues and adhesives

Propellants

Thinners

Fuels

58
Q

Opioids

A

Heroin and prescription drugs

Pharmacologic treatment: methadone, buprenorphine, and naltrexone

Withdrawal symptoms start within 6-8 hours and peak within 2-3 days

Withdrawal symptoms: bone pain, insomnia, hostility, aggression, vomiting, diarrhea

59
Q

Sedative, Hypnotic, and Antianxiety Medications

A

Benzodiazepines, benzodiazepine-like drugs, carbamates, barbiturates, barbiturate-like hypnotics

CNS depressants–drowsiness, low BP, slow breathing

Withdrawal symptoms include insomnia, anxiety, tremors, sweating, increased HR and BP, seizures

NG tube and gastric lavage for overdose

60
Q

Stimulants

A

Amphetamine-type, cocaine, or other stimulants

Second only to cannabis as the most widely used illicit substances in the United States

61
Q

Systemic Effects of Alcoholism

A

Peripheral neuropathy

Alcoholic myopathy and cardiomyopathy

Esophagitis, gastritis, and pancreatitis

Alcoholic hepatitis

Cirrhosis of the liver

Leukopenia

Thrombocytopenia

Cancer of the head and neck

62
Q

Screening Tools

A

SBIRT: Screening, Brief Intervention, Referral to Treatment

AUDIT: Alcohol Use Disorders Identification Test

CAGE: 4 questions to identify alcohol abuse

CAGE-AID: same questions as CAGE but adds drug use to alcohol

T-ACE: Tolerance, Annoyance, Cut down, Eye opener

63
Q

Implementation for Substance Abuse Disorders

A

Promote safety and sleep (first-line interventions)

Reintroduce good nutrition and hydration

Support for self-care

Explore harmful thoughts and spiritual distress

64
Q

Care Continuum for Substance Abuse

A 
Detoxification
Rehabilitation
Halfway houses
Other housing
Partial hospitalization
Intensive outpatient treatment
Outpatient treatment
Alcoholics Anonymous
Relapse Prevention

Community Mental Health Nursing (4 decks)

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