Exam #3 Flashcards
What is the literal definition of anorexia ?
lack of appetite
What is the BMI of a person with anorexia nervosa?
17 or lower
What are common signs/symptoms in a patient with anorexia?
bradycardia, hypotension, hypothermia, and lanugo (newborn-like hair to keep body warm)
What are possible lab findings in a patient with anorexia?
hypokalemia, hypomagnesia, anemia, leukopenia, and thrombocytopenia
What are important nursing interventions for patients with anorexia?
monitored bathroom trips, do not overfeed patients because this can cause refeeding complications
How do patients with bulimia nervosa usually present?
normal weight
What do clients who have recurrent eating binges but do not engage in compensatory behaviors qualify for?
binge eating disorder
What are common signs/symptoms of bulimia?
scarring on knuckles (russell’s signs), dental erosion, and tachycardia
What is a common laboratory finding in bulimia?
metabolic alkalosis
What are the stages in the Kubler-Ross model of grief?
denial, anger, bargaining, depression, acceptance
What is maladaptive grief?
occurs when grief is inhibited, exaggerated, or prolonged and is accompanied by feelings of worthlessness or low self-esteem
What is melancholic depression?
dark and unremitting. patient experiences early morning awakening and loss of appetite. Suicidal thoughts are common
What is mood-congruent depression?
experience delusions, strong feelings of guilt, may think they are responsible for someone’s death or a catastrophe. also they may believe they have a severe illness or their body is “rotting.” Auditory hallucinations may occur.
What is the chance of relapsing after a depressive episode? After two episodes?
50%, 80%
What is bipolar I?
clients experience mania and usually depression
What is bipolar II?
clients experience hypomania and depression
What has a strong basis for development of bipolar disorder?
genetics
What are important nursing interventions for patients with bipolar disorder?
- decrease environmental stimuli
- set limits on dangerous and manipulative behaviors
- avoid power struggles. dont become emotional
How many people in 2016 killed themselves?
45,000
10th leading cause of death
What percentage of people that killed themselves have a diagnosable mental illness?
90%
What are important nursing interventions for suicide prevention?
normalization (sometimes when clients are going through intense emotional pain, they have thoughts about killing themselves. Have you had any thoughts like this). Pay attention to indirect statements. Watch for sudden improvement in client’s mood.
What is ECT normally used for?
severe depression
What are adverse effects of ECT?
headache, elevated vitals, memory loss. (VERY SAFE,CAN BE USED IN PREGNANT WOMEN)
What is the nurse’s top priority for patients that have been under anesthesia?
airway
What are schneider’s four E’s of personality disorder?
-Early: symptoms present early, become developed in adulthood.
-Enduring: present in all situations w all people
-Egosyntonic: clients have decreased insight.
-Externalization: clients externalize their stress onto others.
What are the Cluster A personality disorders?
paranoid, schizoid, and schizotypical disorder (mild, functional versions of schizo)
How are cluster A disorders characterized?
odd or eccentric behaviors
What are cluster B personality disorders?
Histrionic and Narcissistic personality disorder
How are cluster B disorders characterized?
trouble with maintaining boundaries. dramatic, erratic behaviors.
What are the cluster C disorders?
avoidant, dependent, and obsessive-compulsive personality disorder
How are cluster C disorders characterized?
anxious emotions and behaviors.
What is paranoid personality disorder?
clients are highly s u s p i c i o u s of others, even close
companions.
What is schizoid personality disorder?
clients are reclusive and have very limited social interaction. They have little interest in others. They prefer solitude.
What is schizotypal personality disorder?
clients have disorganized speech and behavior. They are odd and
eccentric. They do not have hallucinations or delusion, but they may engage in magical thinking and
experience illusions (e.g., UFO sightings).
What is histrionic personality disorder?
clients are dramatic and love the spotlight. They usually dress
s e d u c t i v e l y and can be very flirtatious.
Who are three times more likely to have antisocial personality disorder?
M e n
What are important nursing interventions for clients with antisocial personality disorder?
-Maintain the attitude that it is not the person but his or
her b e h a v i o r that is unacceptable.
-Clients with antisocial personality disorder often misuse the ego defense mechanism of
d i s p l a c e m e n t .
What are characteristics of borderline personality disorder?
Clients have intense fears of a b a n d o n m e n t .S p l i t t i n g is a common ego defense mechanism. Clients are emotionally u n s t a b l e .
What are nursing considerations for patients with borderline personality disorder?
-Don’t allow yourself to have
personal “triggers.” Monitor your thoughts and emotions. Watch out for
c o u n t e r t r a n s f e r e n c e .
Remember that clients who have borderline personality disorder have strong fears of
a b a n d o n m e n t .
-Encourage clients to v e r b a l i z e painful emotions.
Assess for suicidal ideation. About 1 0 % of clients with borderline personality disorder will complete
suicide.
What happens in alcohol intoxication?
In lower amounts, alcohol primarily depresses f r o n t a l lobe activity, causing euphoria, disinhibition,
and impaired judgment. As blood levels rise, p a r i e t a l lobe activity is depressed, causing impaired
speech and motor function. Further drinking impairs the occipital lobe and cerebellum, causing impaired
v i s i o n and problems with b a l a n c e . Eventually, the brain stem is affected, causing coma and
respiratory d e p r e s s i o n .
How quickly can alcohol withdrawal occur?
within a few h o u r s of cessatio
What are common symptoms of alcohol withdrawal?
course hand
tremors, nausea, vomiting, headache, malaise, autonomic activation anxiety, insomnia, and irritability. Some clients experience seizures.
More rarely, some clients experience hallucinations (alcoholic hallucinosis). These hallucinations are usually
v i s u a l .
What % of clients who experience withdrawal go onto develop DT’s? (delirium tremens)
5 %
What are extreme DT’s characterized by?
c o n f u s i o n , hallucinations (usually visual), and
autonomic activation. Electrolytes and blood gases abnormalities are common.
What do heavy drinkers sometimes have poor intake of?
t h i a m i n e (vitamin B1)
What does thiamine deficiency cause?
Wernicke-Korsakoff syndrome
What is Wernicke’s encephalopathy?
a serious neurological disorder characterized by abnormal eye movements,
ataxia, confusion, and stupor. Left untreated, clients will die.
What is Korsakoff’s pychosis?
a serious neurological disorder characterized by an inability to convert short-term
memory into long-term memory. Clients with this condition often c o n f a b u l a t e
What is the CAGE questionnaire?
-Have you ever felt you should c u t down on our drinking?
-Have people a n n o y e d you by criticizing your drinking?
-Have you felt g u i l t y about your drinking?
-Have you ever needed a drink first thing in the morning (e y e -opener) to calm your nerves or get rid of a
hangover?
What is the key to treating alcohol withdrawal syndromes?
p r e v e n t them
What is the normal treatment for patients experiencing severe withdrawal in the hospital?
Clients are also given intravenous fluid containing thiamine, folate, a multivitamin, and dextrose. This mixture
has a yellow color and is colloquially called a b a n a n a bag.
What are common pharmacological treatments for alcohol abstinence?
Acamprosate, Naltrexone, Disulfiram
How does acamprosate work?
Acamprosate helps reduce some of the unpleasant feelings abstinence produces. It works by restoring the
balance of G A B A and glutamate in the brain.
How does Naltrexone work?
Naltrexone, an opioid antagonist, blocks the e u p h o r i c effects of alcohol, making it less desirable. This
drug can assist clients who want to abstain from alcohol.
What are nursing interventions for patients with alcohol withdrawal disorder?
-Clients who have a substance use disorder sometimes misuse the ego defense mechanisms d e n i a l
and r a t i o n a l i z a t i o n . Arguing with clients is not likely to halt their use of these defense
mechanisms.
-Clients who are withdrawing from alcohol have an increased seizure risk. Pad the headboard and bed rails.
Make sure oxygen and suction are ready for use.
What are the primary goals of motivational interviewing?
Clients who have an addiction tend to be very a m b i v a l e n t . Part of them enjoys the addiction. It
may relieve stress or bestow some other benefit. However, the client also dislikes the addiction. It impairs their
relationships with others, harms their health, interferes with work, etc.
The goal of motivational interviewing is not to argue or overpower clients. Rather, the goal is to help clients
e x p l o r e and r e s o l v e their ambivalence.
What are the guiding principles of motivational interviewing?
Motivation to change is elicited from the c l i e n t , not the counselor.
It’s the client’s task, not the counselor’s, to articulate and resolve a m b i v a l e n c e .
Direct persuasion is not an effective method for resolving ambivalence.
The counseling style is generally a quiet and eliciting one.
The counselor is d i r e c t i v e in helping the client examine and resolve ambivalence.
Readiness to change is not a client trait, but a fluctuating product of interpersonal interaction.
The therapeutic relationship is more like a p a r t n e r s h i p than expert/recipient roles.
What are physiological and self-care concerns for patients with somatic symptom disorder?
- Sleep pattern disturbances
- Lack basic nutrition
- No physical exercise
- May be taking multiple prescriptions for pain or other complaints
What are common nursing diagnoses for somatic symptom disorder?
- Pain
- Disturbed sleep patterns
- Ineffective coping
What are expected outcomes for treatment of somatic symptom disorder?
- Identify the relationship between stress and physical symptoms
- Demonstrate healthier behaviors regarding rest, activity, and
nutritional intake - Demonstrate alternative ways to deal with anxiety, and other
feelings
Somatic symptom illnesses are chronic or recurrent, so changes are likely to
occur slowly
If treatment is effective, the client should make fewer visits to physician as a
result of physical complaints, use less medication, and more positive coping
techniques and functional abilities
What are common interventions for patients with somatic symptom disorder?
provide health teaching (adequate nutrition, healthy sleep), help client express emotions, and teach coping strategies
What is kleptomania?
impulsive, repetitive theft of items not
needed by the person
What is oppositional defiant disorder?
Characterized by a persistent pattern of angry mood and defiant behavior
Nursing treatment for patients with ODD?
-parents learn to ignore maladaptive behavior
-reward positive behaviors to reinforce
What is intermittent explosive disorder?
Repeated episodes of impulsive, aggressive, violent behavior; angry verbal
outbursts
Nursing interventions for IED?
SSRIs, lithium, anticonvulsant mood stabilizers, CBT, anger management, relaxation techniques, avoidance of alc and other substances (often times a combination of these treatments is optimal)
What are the stages of dementia?
mild, moderate,severe
What does mild dementia entail?
forgetfulness is the hallmark. It exceeds the normal, occasional forgetfulness experienced with aging
What does moderate dementia entail?
confusion is apparent, along with progressive memory loss. The person can no longer perform tasks but remains oriented to person and place.
What does severe dementia entail?
personality and emotional changes occur. The person may be delusional, wander at night, forget names of spouse and children, and requires assistance with ADLs
What are important nursing interventions for delirium?
– Promote client safety
– Manage confusion
– Face client while speaking
– Phrase questions and directions in short simple sentences
– Orienting cues
– Call client by name
– Refer to time of day
– Refer to expected activity
– Promote sleep, proper nutrition
What are common signs/symptoms of a patient with dementia?
– Aphasia – deterioration of language function
– Apraxia – impaired motor function despite intact mobile abilities
– Agnosia – inability to recognize or name objects despite intact sensory abilities
– Disturbance in executive function
What is delirium?
– Acute and fluctuating
– Usually resolved by treating the
underlying medical condition
– Prognosis involves complete
resolution of the impairments
What is dementia?
– Progressive
– No treatments found to reverse,
current therapies only temporarily
slow the progress
– Progressive deterioration until
death
What substances are CNS stimulants?
Caffeine, nicotine,
cocaine,
amphetamines, diet
pills, low doses of
MDMA
What do CNS stimulants do to vital signs?
increase them
What are the CNS depressants?
Alcohol,
benzodiazepines,
barbiturates, opioids
marijuana, many
inhalants
What do CNS depressants do to vital signs?
alcohol increases them, the rest decrease
What are the hallucinogens?
LSD, PCP, ketamine,
high doses of
MDMA
What do hallucinogens do to vital signs?
increase
What do CNS stimulants do to the eyes?
Cocaine and
amphetamines cause
pupillary dilation
What do CNS depressants do to the eyes?
Alcohol and
benzodiazepines
cause nystagmus.
Opioids cause
pupillary constriction
(miosis). Marijuana
causes reddened eyes.
What do hallucinogens do to the eyes?
Most cause pupillary
dilation (mydriasis).
PCP causes vertical
and horizontal
nystagmus.
What happens to the brain in lower amounts of alcohol?
depresses frontal lobe activity, causing euphoria, disinhibition, and impaired judgement
What happens as alcohol blood levels rise?
p a r i e t a l lobe activity is depressed, causing impaired speech and motor function.
What happens as alcohol blood levels rise even more?
Further drinking impairs the occipital lobe and cerebellum, causing impaired
v i s i o n and problems with b a l a n c e . Eventually, the brain stem is affected, causing coma and respiratorydepression .
What is the lifetime prevalence of alcohol use disorder?
30%
What type of people have higher rates of alcohol use disorder?
young adults and men
What are common pharmacological treatments for ADHD?
adderall and ritalin
What are typical treatments for bipolar disorder?
lithium, anticonvulsants (valproic acid, lamotrigine, carbmazepine) and atypical antipsychotics
What is the key number for lithium?
1.5
What are normal side effects for lithium?
mild GI problems, polydipsia, polyuria, and fine hand tremors
What are the signs of lithium toxicity?
S-sedation & slurred speech
C-course hand tremors
A-Ataxia (clumsiness)
N-N/V/D
What are the MAOIs?q
- Isocarboxazid
- Phenelzine
- Selegiline transdermal
- Tranylcypromine
How many personality disorders does the DSM-5 identify?
10
What are expected pharm treatments for IED?
fluoxetine, lithium, and anticonvulsant mood stabilizers
What is the lifetime prevalence of depression?
17%
What may depression be related to?
deficiencies of serotonin, norepi, and dopamine in the brain
What percentage of people that kill themselves have a diagnosable mental illness?
90%
What happens with psychosomatic illnesses?
real symptoms can begin, continue, or worsen as a result of emotional factors (ex: diabetes, stress resulting in HTN or tension headaches and colitis)
What happens with psychosomatic illnesses?
real symptoms can begin, continue, or worsen as a result of emotional factors (ex: diabetes, stress resulting in HTN or tension headaches and colitis)
What is the primary gain of somatic symptoms?
always relieves the stress, anxiety, or unacceptable emotions
What are characteristics of somatic symptoms?
- Physical complaints suggest major medical illness but have no demonstrable organic basis.
-“First do a physical assessment to determine” -Davis - Psychological factors and conflicts seem important in initiating, exacerbating, and maintaining the symptoms
- Symptoms not under the client’s conscious control.
- Clients convinced they harbor serious physical problems despite negative results during diagnostic testing.
-“This person will say ‘no there is something wrong with you because i know that i am sick.’” -Davis - Clients experience these physical symptoms as well as the accompanying pain, distress, and functional limitations such symptoms induce.
- Although their illnesses are psychiatric in nature, many clients do not seek help from mental health professionals.
-They will keep going to the ER and get mad when you tell them to talk to a psychiatrist
What is malingering?
Intentional production of false or grossly exaggerated symptoms motivated by external incentives or outcomes
What is the overall goal for somatic symptom illness intervention?
“Overall goal is for the client to be able to verbally express their emotions”
What are nursing interventions for somatic symptom illness?
“challenge for the nurse is to validate the client’s feelings while encouraging them to participate in activities”
“Encourage journaling to help them make connections” -Davis
What is an example of Cyberchondria?
Ex: Looks up everything under the sun and says “I got that”- Davis
What are examples of behaviors of someone with ASD?
“Little eye contact and few facial expressions to others. Limited capacity to relate to peers. Lack spontaneous enjoyment, flat affect. They can’t engage in make believe, they engage in hand flapping, body twisting or head banging. They prefer routine. They don’t respond to questioning.”- Davis
