Exam 2/Final Flashcards

Question

Cluster A Personality Disorders

Answer 1

``` - those in which patients are considered withdrawn, odd, or eccentric. Include: - paranoid - schizoid - schizoptypal ```

Answer 2

- not an axis I - there are delusions - on guard, hypervigilant - doesn't affect global functioning - think people want to harm them - bear grudges

Answer 3

- pervasive pattern of detachment; lots of isolation - unlikely to seek treatment - could be hospitalized - no social connectedness - non-nurturing/empathetic parents - mostly men

Answer 4

- odd & eccentric - limited capacity for interpersonal r/s - lots of social anxiety - hyper-sensitive - genetic markers for schizophrenia- likely grew up with someone w/it - odd ways of seeing the world

Answer 5

- establish rapport - minimize potential for aggressive behaviors - support adaptive behaviors: talk about how pt. can communicate with people - do not need the increased level of precision in speech like in a schizophrenic patient

Answer 6

- approach pt in calm manner - maintain a comfortable distance based on the patient's verbal and nonverbal communication (assess everything) - administer psychotropics and observe the patient's responses- both desired and adverse effects - provide structured social interactions

Answer 7

``` - patients seek attention and engage in erratic behavior Include: - antisocial - borderline - histrionic - narcissistic ```

Answer 8

- the "conman" - regularly engage in risky behavior - lack sense of fidelity - repetitive legal problems - dysfunctional family - watch out for being manipulated - ADHD hx

Answer 9

- deep, painful base - tremendous fear of abandonment - regulating affect - chronic feelings of emptiness - love/hate manifests in splitting - "affect dysregulation disorder"

Answer 10

- exaggerated, labile emotion - flamboyant/dramatic - think r/s more intimate than they are - theatrical - sexualization of relationships

Answer 11

- grandiose sense of self - require a lot of admiration - arrogant - etiology: child from cold/rejecting parents - lack of positive self worth - aloof, detached, hauty - depression common later in life - illness: "narcissistic injury"

Answer 12

- respond to patient's maladaptive behavior with firm and consistent limit setting - approach patient in a sensitive and nonjudgemental manner to facilitate trust and rapport; they fear and mistrust intimacy and closeness

Answer 13

- form a nurse-patient relationship based on clearly stated, realistic expectations - assist in reduction of self-destructive behavior and intent - encourage verbalization of feelings about self - tend to be out of themselves- don't want to talk about their pain - goal: affect regulation - dialectical behavior therapy: 5 part series. meditation, cognitive, behavioral - meds: antipsychotics, mood stabilizers, antidepressants

Answer 14

- treatment is similar to that of other PD and e.g. BPD - consistency - understanding - managing countertransference issues - providing an environment that minimizes maladaptive coping patterns - psychopharmacologic approaches center on depression, anxiety, and psychosis (fixed delusions)

Answer 15

- hospitalization is usually precipitated by depression, suicidal behaviors, and mood swings that often follow failure and rejection - group therapy may be avoided by the pt because it would require them to balance the desire for a special patient-therapist r/s and because they may fear confrontation by group members - may be alcohol connected with this - older--> symptoms get worse - medical illness- lot of distress

Answer 16

``` - conditions in which the symptoms are anxiety and fear Include: - avoidant - dependent - obsessive-compulsive ```

Answer 17

- any kind of activity that can cause criticism - avoid intimate r/s - preoccupied with rejection - don't engage in intimate r/s - produces a lot of anxiety - etiology: parental rejection/criticism - self doubt

Answer 18

- very submissive - child-like - fearful of making own decisions - like having someone tell them what to do - mostly females - etiology: fear of making decisions- controlling environment

Answer 19

- not Axis I - pervasive rigidity and pre-occupation with control - exaggerated feeling of losing control - inflexible - interferes with ability to establish r/s, get along with others - etiology: overly controlling parents - organized, efficient

Answer 20

- establish trust to minimize anxiety - once anxiety is minimized, the nurse-patient relationship focuses on exploration of old behaviors with consideration for individual change, improved insight, improved sense of self, and overall improved quality of life relationships

Answer 21

a recurrent mood disorder featuring one or more episodes of mania or mixed episodes of mania and depression. Differs from major depression in that there is a history of manic or hypomanic (milder and not psychotic) episodes.

Answer 22

- mania - hypomania - depression - mixed episodes (mania & depression) spectrum disorder: mild, moderate, severe. severe- psychotic s/s

Answer 23

- a mood disturbance ranging from pure euphoria or elation to an irritable labile admixture that also includes dysphoria (unpleasant mood) - "crazed, frenzied" - irritability: very difficult symptom to differentiate.

Answer 24

A. a distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary) B. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree: 1. inflated self-esteem or grandiosity 2. Decreased need for sleep (e.g. feels rested after only 3hrs of sleep) 3. More talkative than usual or pressure to keep talking 4. flight of ideas of subjective experience that thoughts are racing (rapid series of ideas- about one topic.) 5. distractibility (e.g. attention too easily drawn to unimportant or irrelevant external stimuli) 6. increase in goal-directed activity (either socially, at work, or school, or sexually) or psychomotor agitation 7. excessive involvement in pleasurable activities that have a high potential for painful consequences (gambling, shopping, sex)

Answer 25

- mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features. - increased rate of recidivism - stages you might see when people decomensate

Answer 26

- subsyndromal counterpart of mania - never psychotic - not associated with marked impairments or judgements/performance - some long for this productive energy & heightened creativity - see in bipolar I or II - beginning stages of full-blown episode in I - fears the depressive end of things - many don't want to come down/take meds - key to issue is non-compliance - road to mania starts with hypomania

Answer 27

- coexistence of depressive & manic symptoms - can be expressed on a continuum ranging from psychotic features to milder and subclinical states - frequently present with severe depression with agitated features and acceleration of thought suggestive of a depressive mixed state - labile: mood shifting all the time

Answer 28

- presence or history of one or more Major Depressive Episodes - presence (or hx) of at least one hypomanic episode - there has never been a manic episode - the symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning - always want to rule out alcohol use- very high co-morbidity (self-medicating)

Answer 29

- for at least 2 years - presence of numerous periods w/hypomanic symptoms and numerous periods with depressive symptoms that do not meet criteria for a Major Depressive Episode - in children and adolescents duration must be at least 1 year - sometimes known as bipolar III - 1/3 develop into type I - like dysthymia: baseline of a bipolar state - never had a true manic episode

Answer 30

- Bipolar I affects 1-1.5% pop - equal numbers men and women - Bipolar II affects 0.5-0.6% of the population with females affected more than males - males have more manic episodes, are likely to have comorbidity of substance abuse/dependence - initial episodes of mania: males display more hyperactivity,grandiosity, and risky behavior. females: racing thoughts, distractibility

Answer 31

- Depression: imbalance of Norepi & serotonin - Mania: less understood. Suggested inability to modulate neuronal excitation. - Lithium acts on second messenger system inhibiting neurons to release, activate or respond to NTs. Restores daily rhythms. Highly effective. - also suggested that Depakote increases GABA thereby dampening aberrant neuronal excitation

Answer 32

- mood stabilizers: LIthium, Depakote, Lamictal, Topamax, Tegretol - antipsychotics - benzodiazepines: Ativan, Klonapin - anti-depressants: Wellbutrin, SSRIs

Answer 33

- effective and often lifesaving - pts are anesthetized - performed in a closely monitored medical setting by a psychiatrist - 5-10 treatments bi or unilateral - most common side effects: headaches, n/v, mild confusion, temp. memory loss. - start with meds before considering this tx

Answer 34

- SAFETY - safety best address in context of patient, family, milieu mgmt - patients and families need to be assisted in design of a crisis intervention plan, family focused psychoeducation. - manic episodes: tend to neglect self care - limit setting v. important - healthy coping mechanisms - managing emotions, helping w/interpersonal relationships

Answer 35

It provides relief from acute MANIA or DEPRESSION. The direct action of Lithium is complicated physiological process but Lithium (a salt) has a direct effect on receptors that effect proteins that help to restore daily rhythms and cycles to mood. **** Lithium has a direct effect on KIDNEY FUNCTION as Lithium is excreted through the kidneys with an interplay between electrolytes, ie, With a decrease in sodium (sometimes caused by excessive water drinking ) you can see an increase in intracellular Lithium which can produce a TOXICITY of Lithium in the body. IMPORTANT TO MONITOR LITHIUM, BUN AND CREATININE LEVELS. Thyroid function is also effected by Lithium with 4% (approx) of all lithium patients developing thyroid issues. It is estimated that long term use of Lithium (15 to 20 years) can cause kidney damage and the prescriber needs to do a risk/benefit determination to see if continued Lithium treatment is indicated. THERAPEUTIC RANGE IS 0.5 to 1.5 mEq/L. ****TAKES 1 to 2 weeks for therapeutic response. Patients are usually given Antipsychotics and/or Benzo to help stabilize before Lithium full therapeutic response is evident.

Answer 36

avoiding dehydration and diarrhea which can effect electrolyte levels. Especially important in hot weather.

Answer 37

very effective to calm down the agitated manic patient. It is suggested that it works on the GABA network which means it has a calming effect as it inhibits excitation. Remember the process of KINDLING EFFECT to prevent full excitation/agitation of mood symptoms. Depakote is said to enhance seratonergic and dopaminergic functioning. This means you can see positive changes in the mood of the patient.

Answer 38

monitoring of LIVER ENZYMES – baseline and every 3 months. One patient concern is HAIR LOSS that is actually not loss from the hair root but breakage of hair. Recommend use of Selinium (vitamin replacement) and Panthenol (pantene shampoo).

Answer 39

sed effectively for newer diagnosis of Bipolar Depression. Major concern is STEVEN JOHNSON RASH – a life threatening condition involving a rash in the oral and nasal mucosa that can obstruct breathing. This is an ICU condition. Problem can be avoided by slowly titrating dose of medication no more than 25 mg every 2 weeks.

Answer 40

- Topirimate - has a side effect of decreased appetite and is therefore used to prevent weight gain from other meds. At best it is a mild mood stabilizer.

Answer 41

(Carbamazepine) – used for agitated states; mostly in developmental disabled.

Answer 42

- antidepressant | - can be added as it has less chance of inducing mania.

Answer 43

can be added slowly and in low doses after a person is stabilized and only if there are symptoms of social phobia, ocd, or other co-morbid problems

Answer 44

1. HT is an international problem. In fact, it is happening here with high numbers of illegal activity happening at Kennedy airport 2. Trafficking occurs only for sex trade. (could be forced labor) 3. Poverty and inequality are the causes of HT (it's big business including recruiters, traffickers, and criminals. Silent partners: travel agents, landlords, publications). 4. People who are traffickers have a common stereotypical profile

Answer 45

the internal process of one's self concept of their gender. For some this matches their assigned gender and bodies and social perceptions and for others it does not.

Answer 46

the direction of one's sexual attractions and for some this can be fluid

Answer 47

- benzo - short acting: 4-6 hrs - short term use only- dependency an issue - used for bipolar disorder, anxiety, ETOH withdrawal

Answer 48

- benzo - long acting in system and used for long term anxiety disorders, flashbacks, panic symptoms. - if tx discontinued, pt needs to be tapered off - used in bipolar disorder, anxiety

Answer 49

- benzo | - mostly for short term use, high potential for dependence

Answer 50

- principle drug in non-benzo family - serotinergic/ anxiety component - non addictive - needs to be taken on a regular basis - not effective as a PRN medication

Answer 51

work on neural inhibition and re-uptake of serotonin. - used to treat anxiety and depression - Prozac, Zoloft, Paxil, Lexapro, Celexa, Luvox

Answer 52

- original meds used to treat anxiety and depression - work on norepi NT and mediates fight or flight mechanism Meds include: - Nortriptyline, Trazadone, Elavil, Imipramine Major side effect: anticholinergic, Dry mucous membranes, sedation, weight gain

Answer 53

- works effectively for anxiety but has a side effect potential that can be difficult for pt to follow - newer forms are in patch form and do not have food contraindications

Answer 54

- blocks physiological aspect of anxiety symptoms, esp. CV & pulmonary - good for pts with somatic symptoms - caution in pts with asthma meds: Inderal, Attenelol

Answer 55

- beta blocker - used to cardiac conditions but can also slow down palpitations and rapid pulse in anxiety disorders - good for stage fright

Answer 56

- used for HTN but has same effect of slowing down phys. manifestations of anxiety

Answer 57

- benzos increase GABA to inhibit the excitation of the CNS - may also use Librium or Phenobarbital - antipsychotics used for hallucinations and severe agitation - thiamine used for nutritional deficiencies that may cause encephalopathy - LIbrium or Ativan giving in progressively decreasing doses - selection of medication and dosing guided by pt's liver function

Answer 58

- ReVia and Campral: decrease cravings | - Anabuse: allergic reaction when alcohol is consumed

Answer 59

- substance dependence is a complex biogenetic psychological disorder that is chronic, progressive, and potentially fatal.

Answer 60

- denial is an integral part of addiction and fuels the addictive behaviors - patients minimize or disconnect from the negative impact of chemical use - s.a. being understood as a chronic, relapsing disorder with similarities to other long-term chronic illnesses - relapses are part of the course of the illness - tx outcomes need to be viewed as effective based on the decrease in substance use and length of time person has been substance free (harm reduction)

Answer 61

- dependent pattern - ability to moderate or stop is repeatedly unsuccessful - sense of craving in absence of substance - uncontrolled compulsion to use despite knowledge of negative consequences - loss of control over frequency and amount is key indicator

Answer 62

- pharmacologic property of some abused substances - chronic uses produces changes in CNS - more needed to produce desired effects - withdrawal syndrome may occur

Answer 63

A. a maladaptive pattern of substance use leading to conically significant impairment or distress, as manifested by one (or more) of the following within a 12 month period: 1. recurrent substance use resulting in failure to fulfill major role obligations 2. recurrent use in situations in which it is physically hazardous 3. recurrent substance abuse-related legal problems 4. continued substance use despire having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance B. The symptoms have never met the criteria for Substance Dependence for this class of substance

Answer 64

See criteria A for Abuse as manifested by three or more of the following occurring at the same time in the same 12 month period. 1. Tolerance: a. need to markedly increased amts to achieve desired effect b. markedly diminished effect with continued use of the same amt 2. Withdrawal: a. characteristic withdrawal syndrome for the substance b. same (or closely related) substance is taken to relieve or avoid withdrawal symptoms 3. taken in larger amts or over a longer period of time than was intended 4. persistent desire or unsuccessful efforts to cut back 5. lot of time spent trying to obtain 6. important social, occupational, recreational activities given up b/c s.a. 7. continued despite knowledge of problem

Answer 65

- changes can be produced in alertness, coordination, attention, judgment, and thinking - pulse, respiration, blood pressure - all classes of substances (except caffeine & nicotine) may cause delirium and psychosis during intoxication - varying degrees of depression and anxiety with intoxication or during/after withdrawal

Answer 66

- binge drinking= 5 + drinks on the same occasion in the past month - heavy drinking: 5+ drinks on the same occasion on each of 5 days in the same month - use before 18 more likely to be dependent - stronger in males - female use woven into context of intimate relationships - women more susceptible to ETOH b/c absorb more through GI tract - men have more ETOH dehydrogenase - men find way to tx due to legal problems - women seek tx in response to health concerns (gyn issues, heart and lung disorders)

Answer 67

- absorbed quickly - stimulates release of body's own opiods and endorphins which turn on the central dopamine reward system (id) - abuse and dependence underdiagnosed and undertreated in the primary care setting - legal problems, car accidents, predisposition to variety of health problems

Answer 68

- associated with neuronal excitation in the face of abrupt cessation - dose dependent- heavier drinkers more likely to develop withdrawal - brain adapts to regular doses- can't fx without presence of alcohol - the last time and amt of alcohol consumed is an important assessment question

Answer 69

- tremors - hyper-arousal: easily startled, anxious, irritable, tachycardic, elevated bp, n/v/d, flushing, diaphoresis - hallucinations - symptoms usually peak @ 4 days after last drink and gradually subside. Symptoms can persist for 1-2 wks - can become a medical emergency, esp in presence of medical comorbidity such as CV or renal disease.

Answer 70

- seizures - profound confusion and disorientation (stay with patient!) - hallucinations - autonomic nervous system arousal: hyperprexia, HTN, tachycardia, course tremor, agitation * * without medical intervention Hyperthermia and/or CV collapse can occur

Answer 71

- reversible condition associated with thiamine deficiency | - s/s: ataxia, delirium, palsy of 6th cranial nerve (abducens muscle of the eye)

Answer 72

- thiamine deficiency - profound memory impairment - inability to learn new material - 50% cases have permanent impairment - use confabulation: will make up a story. another kind of denial.

Answer 73

- sedatives-hypnotics & anxiolytics: abuse usually consists of obtaining rxs from multiple physicians - alprazolam (Xanax) associated with immediate and severe withdrawal due to substances short half-life - opioids: morphine & codeine, heroin

Answer 74

- caffeine - nicotine - amphetamines & cocaine - hallucinogens - cannabis - inhalants - club drugs - PCP

Answer 75

- dual diagnosis: the presence of substance-related disorders and psychiatric disorders occurring at the same time - codependency/enabling: the spouse or significant other may devote inordinate amounts of time and energy to control the addicted person's behavior and forestall or soften a variety of impending disruptions or crises. many times the partner has more psychological symptoms than the alcoholic

Answer 76

- inpatient detox: med mgmt of withdrawal - inpatient/outpatient rehab: models. ongoing knowledge and awareness - individual therapy, group therapy: slowly deal with underlying issues. don't want to uncover too quickly- pain can make the pt go back to use - self help, support grps

Answer 77

C: cut down on drinking? A: annoyed by criticism or complaining by others about drinking? G: guilty about drinking? E: eye opener in the morning?

Answer 78

- insight - independence - relationships - initiative - creativity - humor - care-giving, personality, temperament - support of family/community - religious/spiritual beliefs - faith & hope - mental health prevention, intervention, promotion

Answer 79

the power of the individual person to initiate action and sustain power on their own behalf

Answer 80

- immigrant status: difficulty in acculturation, culture shock, intergenerational conflict - refugee status: entry into new culture not active choice, trauma by experiences in homeland, vulnerable to PTSD - minority status: SE disadvantage, poverty, limited opportunities for education and jobs, residence in disadvantaged neighborhoods - higher incidence of mental health problems in minority groups is related to poverty, not ethnicity

Answer 81

All the atypical antipsychotic medications mentioned for Schizophrenia also have an indication for the treatment of mania. They can be used in conjunction with a mood stabilizer or alone (mono therapy). Many times bipolar patients are maintained on antipsychotics alone because of the issues with Lithium and Depakote

Answer 82

CONTROVERSIAL addition to medication regiment as it may induce MANIA.

Answer 83

- awareness of patient's vulnerability and fear in the illness state - aware that HCP has a higher degree of power over patients - second self: nurse is cognizant of the need to maintain the patient's rights for self-determination - help the person get their agency back

Answer 84

Culture - groups with shared beliefs, values, and practices - influences their thinking and behavior Cultural Norms - define what is normal or abnormal within a culture Enculturation - learning the rules of right and wrong - preparing a child to live within his or her culture

Answer 85

height of the effect of a particular substance is different for each substance. While intoxicated, a patient can demonstrate psychosis and delirium. You can see changes in alertness, coordination, attention, judgement and thinking, as well as physical symptoms of increase in pulse, blood pressure and changes in respiration rate.

Answer 86

engaging the client in a trusting relationship, health assessments, monitor vital signs, administer meds and monitor for side effects, continuous education re illness and treatment, advocates for client by collaborating with psych and medical, works with in-patient discharge planning, facilitate the process of housing which the client may be resistant to. The ACT RN functions at a high level of decision making in the community.

Answer 87

``` Social Isolation Ineffective Coping Disturbed Sensory Perception: Auditory/Visual Disturbed Thought Process Impaired Verbal Communication Self Care Deficit Insomnia ```

Answer 88

``` Risk for Suicide Low self esteem Impaired social interaction/social isolation Powerlessness Disturbed Thought Process Imbalanced Nutrition Disturbed Sleep Pattern ```

Answer 89

``` Risk for injury Risk for self directed or other violence Imbalanced Nutrition Disturbed thought Process Disturbed Sensory Perception Impaired Social Interaction ```

Answer 90

``` Anxiety (Panic) Ineffective Coping Powerlessness Fear Self Care Deficit Social Isolation ```

Answer 91

``` Risk for self-mutilation/Risk for self-directed or other-directed violence Anxiety (Severe to Panic) Impaired Social Interaction Low self esteem Ineffective Coping Defensive Coping ```

Answer 92

``` Ineffective coping Ineffective denial Imbalanced Nutrition Chronic Low Self Esteem Deficient Knowledge (Effects of Substance Abuse on the Body) Dysfunctional Family Processes ```