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3400 Mental Health > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

anxiety

A

feeling of apprehension, uneasiness, uncertainty, or dread resulting from a real or perceived threat whose actual source is unknown or unrecognized

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2
Q

fear

A

reaction to a specific danger

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3
Q

levels of anxiety

A

mild, moderate, severe, panic

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4
Q

mild anxiety

A

everyday problem-solving leverage; grasps info more effectively; possible slight physical discomfort such as restlessness, irritability, or fidgety

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5
Q

moderate anxiety

A

selective inattention; clear thinking is hampered; problem solving is not optimal, sympathetic nervous system symptoms begin

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6
Q

severe anxiety

A

perceptual field greatly reduced; difficulty concentrating on environment; confused and automatic behavior; somatic symptoms increase; stay by pt side and dont leave alone

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7
Q

panic

A

markedly disturbed behavior like running, shouting, screaming, pacing; unable to process reality; impulsivity; may not be able to implement coping mechanisms or encourage certain behavior; do not leave pt alone

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8
Q

5 important properties of defense mechanisms

A

major means of managing unconscious conflict; they are for the most part unconscious; they are discrete from one another; they can be seen as part of many psychiatric disorders; they can be both adaptive and pathological

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9
Q

defense mechanisms

A

are automatic coping styles; protect people from anxiety; maintain self-image by blocking feelings conflicts and memories; can be healthy or unhealthy; are reversible

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10
Q

examples of healthy defense mechanisms

A

altruism, sublimation, humor, suppression, repression, displacement, reaction formation, somatization, undoing, rationalization

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11
Q

examples of immature defense mechanisms

A

passive aggression, acting-out behaviors, dissociation, devaluation, idealization, splitting, projection, denial

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12
Q

frequent co-occurring conditions with anxiety

A

depressive disorders, alcohol/drug use disorders, eating disorders, bipolar disorders, MDD

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13
Q

chronic anxiety can…

A

lead to increased risk for cardiovascular morbidity and mortality

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14
Q

types of anxiety disorders

A

generalized anxiety disorder, social anxiety disorder, panic disorder, specific phobias, agoraphobia, separation anxiety disorder

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15
Q

when diagnosing someone with an anxiety disorder…

A

need to rule out other medical causes and/or causes of anxiety d/t substance use

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16
Q

GAD- generalized anxiety disorder

A

hallmark feature is excessive worry out of proportion to event; nedd 3 associated symptoms of feeling on edge/restless, irritability, fatigue, concen. impairment (ADHD must be ruled out), sleep disturbances, muscle tension; causes change in social, occupational, or other areas of function;

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17
Q

difference between diagnosing children vs adults with GAD

A

adults need 3 associated symptoms where children need 1

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18
Q

comorbidities of GAD

A

depression, other anxiety disorders

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19
Q

gold standard of treatment for generalized anxiety disorder

A

SSRI/SNRI

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20
Q

social anxiety disorder

A

severe anxiety caused by exposure to social or performance situation; fear of saying something foolish or not being able to answer a question in class or eating in front of others or performing on stage or being among others; fear of public speaking is most common

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21
Q

panic disorders

A

feelings of terror; suspension of normal functioning; severely limited perceptual field; misinterpretation of reality; sudden onsets (not always in present of stress); often coupled with OCD; do not leave pt alone

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22
Q

s/s of panic attacks

A

palpitations, chest pain, diaphoresis, muscle tension, urinary frequency, hyperventilation, breathing difficulties, nausea, feelings of choking, chills, hot flashes, GI symptoms

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23
Q

panic agoraphobia

A

intense and excessive level of anxiety and fear of being in places or situations where escaping is impossible; avoidance of feared places is common; avoiding behaviors become debilitating and life constricting

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24
Q

when someone arrives at the ED with panic…

A

assess for proper cardiac workup; referral is needed for potential diagnosis and treatment of anxiety disorder

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25
Q

specific phobias

A

intense fear or anxiety when in or anticipating presence of stimulus; person either avoids or tolerates with great discomfort; results in impairment in social, work, and relationships

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26
Q

agoraphobia

A

intense fear or anxiety about being in places/situations from which escape might b difficult or embarrassing or help may not be available in event of panic attack; situation is actively avoided, requires companion, or endured with intense fear/anxiety causing pt to become housebound; panic/anxiety is out of proportion to actual event/situation

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27
Q

situations/places must include 2 of the following

A

public transportation, open spaces, enclosed spaces, in line/crowd, outside of home alone

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28
Q

separation anxiety disorder

A

normal part of infant development 8 months - 18 months; fear that something will happen to attached person resulting in permanent separation

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29
Q

s/s of separation anxiety

A

GI disturbances and headaches most common in children

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30
Q

obsessive-compulsive disorder

A

obsessions are unwanted, intrusive, persistent ideas, thoughts, impulses, or images that cause significant anxiety or distress; compulsions are unwanted, ritualistic behavior that the individual feels driven to perform to reduce anxiety; exists as a continuum; mild compulsions are values in the US; not a diagnosis until begins to impair ones life

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31
Q

severe symptoms of OCD

A

center on dirtiness, contamination, germs; corresponding compulsions are cleaning and handwashing

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32
Q

most severe OCD symptoms

A

persistent thoughts of sexuality, violence, illness, and death

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33
Q

diagnoses related to OCD

A

body dysmorphic disorder, hoarding, trichotillomania, excoriation disorder

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34
Q

body dysmorphic disorder

A

preoccupation with an imagined defective body part, obsessive thinking about the body, impaired normal social activities either occupational or educational

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35
Q

hoarding

A

excessive collection of items considered worthless, individual is ashamed of failure to discard, disrupts life and causes distress, social isolation is common, unsafe living conditions

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36
Q

trichotillomania

A

pulling hair out of head, eyebrows, eyelashes, pubic area, axillae, limbs (anywhere on body); hair pulled in patches or singular; trichophagia is secretly swallowing the pulled hair

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37
Q

excoriation disorder

A

skin picking, mostly on the facial area, to deal with stress and relieve anxiety; damages to the skin; complications include pain, sores, scars, infections; trichotillomania can also occur

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38
Q

nursing problems related to anxiety

A

anxiety- self-monitors intensity, uses reduction techniques, maintains role performance; ineffective coping- identifies ineffective and effective patterns, asks for assistance and information, modifies as needed; chronic low self-esteem- verbalizes self-acceptance and increases confidence

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39
Q

planning related to anxiety

A

do not usually require inpatient; involves community-based interventions, encourage active participation in planning to increase positive outcomes; pt who experiences severe levels may not be able to participate in planning

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40
Q

nursing intervention for mild to moderate anxiety

A

therapeutic communication and listening- open ended questions, clarification, exploration; be aware of nonverbal communication; remain calm and nonjudgmental

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41
Q

nursing interventions for severe to panic anxiety

A

provide privacy; remain calm, speak quietly, softly; reduce environmental stimuli; provide for safety needs; reinforce reality; listen for themes; medications

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42
Q

psychopharmacology interventions for…

A

anxiety- first line is SSRIs and SNRIs for daily use; OCD- old TCA clomipramine (anafranil) and anxiolytics like benzodiazepines

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43
Q

how do benzodiazepines work?

A

agonize GABA (depress CNS); risk for dependence and tolerance; can cause sedation, ataxia, decreased cognitive function

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44
Q

other anxiety prescribed meds

A

antihistamines PRN like hydroxyzine (vistaril); anticonvulsants daily like gabapentin (neurontin), pregabalin (lyrica);’ antipsychotics in severe cases

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45
Q

behavioral therapy/techniques

A

relaxation techniques - deep breathing, guided imagery, progressive relaxation, autogenic training, self-hypnosis, biofeedback-assisted relaxation; behavioral therapy- aversion, flooding, systemic desensitization, exposure and response prevention, modeling, thought stopping

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46
Q

thought stopping example

A

snapping elastic on wrist to stop thinking and focus on the pain

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47
Q

evaluation of anxiety interventions

A

is pt able to recognize symptoms as related to anxiety, can pt use newly learned behaviors to manage anxiety, is pt taking care of self, is pt maintaining interpersonal relations, and is pt assuming usual roles?

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48
Q

trauma-related disorders in children

A

PTSD, reactive attachment disorder, disinhibited social engagement disorder

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49
Q

Types of adverse childhood experiences (ACEs)

A

physical abuse, physical neglect, household member with mental health issues, sexual abuse, loss of parent/divorce/abandonment, emotional abuse, emotional neglect, household member with substance abuse, household member who was incarcerated, witnessing domestic abuse

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50
Q

biological factors contributing to trauma related disorders

A

genetic- how individuals react to trauma; neurobiological- trauma dysregulates neural pathways that integrate emotional regulations and arousal, triggers hypoaroused stated causing dissociation, polyvagal theory; psychological factors- attachment theory; environmental factors- dependence on adults and systems, external factors that support or add stress

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51
Q

when assessing trauma-related disorders in children…

A

need to understand what the appropriate developmental level for the individual is

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52
Q

3 stages of intervention for trauma-related disorders: children and adults

A

stage 1- provide safety and stabilization; stage 2- reduce arousal and regulate emotion through symptom reduction; stage 3- catch up on development and social skills, develop a value system

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53
Q

interventions for children with PTSD

A

establish trust/safety, use developmentally appropriate language, teach relaxation techniques, use art/play to promote expression of feelings

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54
Q

PTSD in adults

A

re-experiencing the trauma, avoiding stimuli associated with trauma, persistent symptoms of increased arousal, alterations in mood

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55
Q

S/S of PTSD in adults

A

flashbacks, nightmares (ex. veterans avoiding 4th of july)

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56
Q

outcome identification/planning for PTSD adults

A

manage anxiety, increase self-esteem, improve ability to cope

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57
Q

implementation for PTSD in adults

A

stage 1- provide safety and stabilization; stage 2- reduce arousal and regulate emotion through symptom reduction; stage 3- catch up on development and social skills, develop a value system; psychodeducations; psychopharmacology

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58
Q

acute distress disorder

A

occurs immediately after highly traumatic event that can show S/S for 3 days; DX made within a month; after 1 month it either resolves or becomes PTSD

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59
Q

Acute distress disorder diagnoses

A

alterations in concentration, anger, dissociative amnesia, headache, irritability, nightmares

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60
Q

acute stress disorder implementations

A

establish therapeutic relationship, assist to problem solve, connect person to supports, collaborate for coordination of care, ensure and maintain safety, refer to licensed mental health provider, monitor response and/or adherence to treatment

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61
Q

advanced practitioner implementation for acute stress disorder

A

cognitive-behavioral therapy

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62
Q

adjustment disorder

A

precipitated by stressful event; debilitating cognitive, emotional, and behavioral symptoms that negatively impact normal functioning; responses to stressful event may include combinations of depressing, anxiety, and conduct disturbances

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63
Q

dissociative disorders…

A

occur after significant adverse experiences/traumas; individuals respond to stress with severe interruption of consciousness, unconscious defense mechanism; protect individual against overwhelming anxiety through emotional separation

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64
Q

types of dissociative disorders

A

depersonalization/derealization disorder, dissociative amnesia, dissociative identity disorder

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65
Q

depersonalization

A

focus on self; “I a not really me in a real world”

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66
Q

derealization

A

focus on outside world; “I am real, the world around me is not real”

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67
Q

dissociative amnesia

A

inability to recall important personal info; often of traumatic or stressful nature; commonly experience dissociative fugue

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68
Q

dissociative fugue

A

sudden unexpected travel and inability to recall ones identity; traveling with no memory

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69
Q

dissociative identity disorder

A

presence of two or more distinct personality states; each alternate personality has own patter of perceiving, relating to, and thinking about self and environment

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70
Q

assessment of dissociative disorders consists of…

A

history (HX of trauma?; avoid having pt recall events), moods, impact on pt and family, suicide risk, self-assessment

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71
Q

planning for dissociative disorders

A

Phase 1- establishing safety, stabilization, and symptom reduction; Phase 2- confronting, working through, and integrating traumatic memories; Phase 3- Identity integration and rehabilitation

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72
Q

implementation for dissociative disorders

A

psychoeducation, pharmacological interventions

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73
Q

schizophrenia spectrum disorders…

A

affect how a person thinks, feels, and behaves; not a mood disorder but a sensory disorder; primary psychotic disorder

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74
Q

psychotic disorders lead to abnormalities in 5 different symptomatic domains

A

delusions, hallucinations, disorganized thoughts, disorganized or abnormal motor behavior, and negative symptoms

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75
Q

what are secondary psychotic disorders

A

due to something such as substance abuse or diseases that affect the neurological system such as a brain tumor, dementia, neurological diseases, prescription meds (steroids), environmental toxins

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76
Q

risk factors for developing schizophrenia

A

alterations in brain structure, disruptions in brain’s neurotransmitter system, alterations to neural circuits caused by genetic and nongenetic factors

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77
Q

neurochemical contributing actors to schizophrenia

A

dopamine, serotonin, NMDA receptors, glutamate

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78
Q

physiological factors proving schizophrenia is disease of brain

A

neuroanatomical factors- decreased tissue volume, decreased brain volume, larger lateral and third ventricles, frontal lobe atrophy, more CSF

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79
Q

cultural considerations for schizophrenia

A

generally consistent; some symptoms can be interpreted differently such as some cultures commonly see hallucinations of a loved one after they pass which is normal; culture differ in attributions to mental illnesses

80
Q

course of schizophrenia

A

prodromal phase, acute phase, stabilization phase, maintenance phaseprodro

81
Q

prodromal phase of schizophrenia

A

s/s that precede the acute, fully manifested s/s of the disease (withdrawal, isolation, hyperfixations)

82
Q

acute phase of schizophrenia

A

well developed symptoms grouped into 4 categories: positive symptoms, negative symptoms, cognitive symptoms, mood symptoms

83
Q

stabilization phase of schizophrenia

A

period in which acute symptoms particularly “positive symptoms” decrease in severity

84
Q

maintenance phase of schizophrenia

A

period in which symptoms are in remission although there might be milder symptoms still persisting (residual symptoms); for example some individuals will never not hear voices

85
Q

positive symptoms of schizophrenia

A

symptoms added to a pt that is not normally present: hallucinations, delusions, bizarre behavior, paranoia, disorganized speech and thoughts

86
Q

negative symptoms of schizophrenia

A

taken away from the patient: apathy, lack of motivation, anhedonia, avolition, blunted affect; harder to see negative symptoms

87
Q

cognitive symptoms of schizophrenia

A

memory issues, inability to process social cues, impaired sensory perception, decreases ability to reason and problem sove, decreased focus/attention, disruption in social learning

88
Q

mood symptoms of schizophrenia

A

depression, anxiety, dysphoria, suicidality

89
Q

primary psychotic disorders other than schizohrenia

A

shizophreniform disorder, brief psychotic disorder, schizoaffective disorder, delusional disorder, substance/medication-induced psychotic disorder

90
Q

schizophreniform disorder

A

essential features are identical to those of schizophrenia but shorter durationsbri

91
Q

brief psychotic disorder

A

sudden onset of psychotic symptoms; need to treat the underlying cause to solve issue

92
Q

schizoaffective disorder

A

considered part of the schizophrenia spectrum disorders and consists of the mood component of bipolar with the psychosis of schizophrenia

93
Q

delusional disorder

A

involves non-bizarre delusions

94
Q

substance/medication-induced psychotic disorder

A

caused by ingestion or withdrawal from a substance

95
Q

when assessing fro schizophrenia and other psychotic disorders

A

need to rule out medical/substance induced psychosis, assess for command hallucinations, review pt beliefs, assess co-occurring conditions, inventory pt meds, determine family response to symptoms, assess pt interaction with family, review support system of pt

96
Q

examples of nursing DX for schizophrenia/psychotic disorders

A

impaired perceptions (specify), hallucinations (specify), anxiety: panic levels, risk for suicide, impaired coping, social isolation, loneliness, self-esteem low, anxiety

97
Q

outcome identification for schizophrenia/psychotic disorders

A

Phase I (Acute)- goal is pt safety and medical stabilization; Phase II (stabilizations) and Phase III (Maintenance)- improve functioning via participation in social vocational and self-care skills training as well as involvement in social groups , control anxiety and prevent relapse to psychosis

98
Q

planning for schizophrenia.psychotic symptoms

A

Phase I (Acute)- brief hospitalization if pt is danger to self or others or pt refuses to eat or pt is too disorganize to provide self-care, aftercare needs and appropriate referrals, discharge planning; Phase II (Stabilization) and Phase III (Maintenance)- identify social interpersonal coping and vocational skills needed, teach relapse prevention, determine how/where needs can be best met in community

99
Q

schizophrenia/psychotic disorders interventions

A

Phase I (Acute)- crisis intervention, acute symptom stabilization, med adherence, safety; Phase II (Stabilization) and Phase III (Maintenance)- meds, nursing interventions, community support, pt and family psychoeducation, health promotion/maintenance

100
Q

when communicating with someone experiencing internal stimuli…

A

wait longer for pt to respond and think, repeat as necessary, use short phrases and concrete language

101
Q

when suspecting a pt is hallucinating (Schizophrenia/psychotic disorders)…

A

watch for cues of hallucinations, ask pt directly if they are hallucinating, determine if voices are commanding harm (warn others who may be target if outpatient), document what pt states, accept that voices are real to pt but state you cannot hear them, stay with t and tell pt to tell voices to go away at times, help pt focus on one thing at a time, identify times/situations that hallucinations most prevalent, intervene once anxiety fear or agitation is noticed

102
Q

when suspecting a pt is delusions (Schizophrenia/psychotic disorders)…

A

assess for need of external controls, be aware pt delusions represent way pt is experiencing reality, identify feelings, engage individual in yoga or exercise or walk, do not argue with pt, do not touch pt

103
Q

when suspecting a pt is paranoia(Schizophrenia/psychotic disorders)…

A

place self bedside not face-to-face, avoid eye contact, use matter of fact/business-like approach, offer food/fluids in closed container, engage ot in reality-based non-competetive activities, observe for events that trigger delusions, use least restrictive measures if pt loses control

104
Q

when pt demonstrating associative looseness…

A

dont pretend to understand and state when confused, verbalize implied, place difficulty on self not on pt, observe for recurring themes, emphasize here and now to pt and involve pt in simple reality based activities, tell pt what you do understand

105
Q

benefits of providing practical education

A

increase persons ability to manage symptoms of disease, can instill hope, can promote wellness, can increase a person’s self-esteem

106
Q

a therapeutic milieu provides…

A

emotional and physical safety, useful activities, resources for resolving conflicts, opportunities for learning social and vocational skills

107
Q

antipsychotic medications

A

first generation/conventional antipsychotics and second generation/atypical antipsychotics

108
Q

extrapyramidal side effects (EPS)

A

Tardive dyskinesia (irrversible), acute dystonia- neck and shoulder stiffness, akathisia- inability to stay still and may treat with beta blockers, pseudoparkinsonism- shuffling and drooling

109
Q

additional side effects to antipsychotics

A

anticholinergic effects (drying out), anticholinergic delirium, neuroleptic malignant syndromes, drug induced liver problems

110
Q

substitutes to antipsychotics drug therapy

A

antidepressants; benzodiazepines

111
Q

program of assertive community treatment

A

designed for most marginally adjusted and poorly functioning patients; aim to prevent relapse, maximize social and vocational functioning, and keep individual in community

112
Q

cognitive behavioral therapy methods for schizohrenia/psychotic disorders

A

recovery oriented cognitive therapy- target distress and disturbance by correcting self-defeating beliefs; cognitive remediation- use specific learning activities to improve cognitive skill; social skills training- train to improve social interactions, social cognition, self and illness management skills, community participation and workplace skills

113
Q

Evaluation of treatment for schizophrenia/psychotic disorders

A

realistic, attainable, mutually agreed upon outcomes are more successful; critical for staff to remember change occurs over time; period may be prolonged for someone diagnosed with schizophrenia

114
Q

Support resources for those with psychotic disorders

A

National alliance on mental illness (NAMI), national institute of mental health (NIMH), mental health America, mantalhelp.net, schizophrenia.com, schizophrenia and related disorders alliance of America (SARDAA), Janssen Canada

115
Q

recovery model and recovery-oriented care

A

interventions toward pt strength and highest level of functioning/quality of life; defines recovery as process of change; four dimensions

116
Q

4 dimensions of recover-oriented care for psychotic disorder pt

A

health- overcoming or managing your disease, home- having stable place to live, purpose- meaningful daily activities and resources to participate in society, community- having supportive relationships and hope

117
Q

Evidence based psychosocial therapies for pt with schizophrenia and their families

A

Recovery after an initial schizophrenic episode Project (RAISE), The recovery model and recovery-oriented care, cognitive behavioral therapy

118
Q
A
119
Q

anger

A

emotional response to frustration of desires, threat to ones needs, or a challenge; anger is normal and is a continuum

120
Q

aggression

A

motor counterpart of anger; goal-directed action or behavior resulting in verbal or physical attack; verbal or physical lashing out; may be appropriate if self protective or protecting someone else like family

121
Q

violence

A

does not always have roots in anger but does have discrete intention of doing harm to specific group or person; defined as unjust unwarranted or unlawful display of verbal threats, intimidation, or physical force; intended to inflict harm

122
Q

bullying

A

offensive, intimidating, malicious, condescending behavior designed to humiliate and terrorize; persistent systemic violence toward a person or group; done by a person with higher status

123
Q

lateral bullying

A

bullying by a person of equal status

124
Q

environmental/demographic correlations to violence

A

childhood aggression is strongest predictor of adult violence; setting fires, animal cruelty, conduct disorders are red flags; violence experienced in childhood; low socioeconomic status; poor populations; learned angry reactions; genetics; neurobiological factors/brain structure

125
Q

assessment of angry individual

A

gather medical and psych HX from all possible sources (fam., friends, pt when calm); obtain HX of pt background and coping skills as well as pt perception of issue; does pt have HX of violence, substance abuse, or psychotic behavior

126
Q

subjective assessment questions for angry individual

A

have you thought of harming someone else? have you ever seriously injured another person? what is the most violent thing you have ever done?

127
Q

s/s preceding violence

A

angry, anxious, irritable affect, hyperactivity- most important predictor of imminent violence (slamming doors, restless, pacing), increasing anxiety and tension (clenching jaw or fist, rigid posture, tense facial expression, verbal expression), loud voice, intense eye contact, substance withdrawal, possession of weapon, paranoia

128
Q

milieu characteristics conducive to violence

A

loud, overcrowding, staff inexperience, provocative/controlling staff, poor limit setting, staff inconsistency (staff splitting)

129
Q

nursing diagnoses related to anger/violent pt

A

safety is always priority: risk for self-directed violence, risk for other-directed violence; ineffective coping, risk for stress overload, confusion, disturbed though processes, disturbed sensory perception

130
Q

short term outcome identification for angry/violent individual

A

pt will display nonviolent behavior toward self and others, recognize when anger/aggressive tendencies are escalating and use new tension-reducing behavior, make plans to continue with long-term therapy to work on violence prevention strategies and to increase coping skills

131
Q

long term outcome identification for angry/violent individual

A

pt and other remain free from injury, hostile and abusive behavior will cease, use of assertive and cognitive reasoning behaviors to replace aggressive behaviors is evident, variety of healthy anxiety reduction techniques will be used to keep anger in check, aggressive/violent impulse will be controlled

132
Q

stages of violence

A

preassaultive- de-escalation approaches, assaultive- meds/seclusion/restraint, post-assaultive- seclusion/restraint

133
Q

de-escalation techniques during pre-assaultive stage

A

emphasize you are on pt side, stand at angle to appear nonconfrontational, assess/provide for personal safety, appear calm and in control, do not speak while pt yelling, speak softly and nonjudgementally/nonprovocatively, show genuineness and concern, do not treat in humiliating manner, ask what will help pt now?

134
Q

seclusion intervention

A

involuntary confined alone in a room; pt is physically prevented from leaving

135
Q

restraints

A

physical or mechanical device that restricts freedom of movement; use least restrictive first

136
Q

medication

A

IM injection of barbiturate, antihistamine, or antipsychotic depending on physicians orders or underlying conditions

137
Q

reintegration interventions

A

monitor every 15 minutes face-to-face through locked window (constant face-to-face if under 14); gradual reintegration geared toward pt ability to handle increased stimulation; structured reintegration is moving from 4 point restrain to 2 point then out of seclusion and use time out periods to move slowly into milieu

138
Q

alternatives to seclusion and restrain

A

no therapeutic value to seclusion or restrain, only used to protect pt from self harm and protect others; comfort rooms to self-isolate when anxious/stressed are great; trauma informed approach

139
Q

steps to trauma informed approach

A
  1. safety, 2. trustworthiness and transparency, 3. peer support, 4. collaboration and mutuality, 5. empowerment voice and choice, 6. cultural historical and gender issues
140
Q

post-assaultive stage interventions

A

assure quality of care, provide self care opportunity for staff, document the violent episode itself and the staff response

141
Q

meds for acute aggression

A

benzodiazepines are first choice for episodic dyscontrol and incipient rage; 2nd gen antipsychotics fo emergencies

142
Q

evaluation of aggressive/violent pt

A

was assessment accurate and thorough?, were DX applicable to assessment?, did nursing DX drive the interventions?, was plan comprehensible and individualized?, were interventions carried out properly?, was correct protocol used?, were quality improvement methods used for future?

143
Q

interventions with pt with cognitive deficit

A

reality orientation, provide calm unhurried soothing responses, validation therapy (do not attempt reorientation if pt unable to perceive life situation), psychotherapy

144
Q

planning for pt with anger/violence

A

watch own tone, choice of words, triggers, nonverbal communication to avoid impulsive emotion based responses that may be harmful

145
Q

if verbal abuse is taking place with angry pt…

A

leave immediately and inform pt that you will return when pt is calmer, if unable pt leave then discontinue convo immediately and stop eye contact, respond positively to nonabusive communication

146
Q

what is a substance use disorder

A

problematic pattern of substance use leading to clinically significant impairment or distress

147
Q

risky drinking numbers

A

over 3 drinks in 1 day for women or up to 7 drinks a weeks; over 4 drinks in 1 day or up to 14 drinks a week for men

148
Q

CNS depressants

A

benzodiazepines, barbiturates, alcohol

149
Q

3 classes of drugs to seek detox from

A

alcohol, benzodiazepines, opioids

150
Q

s/s of cns depressants intoxication

A

physical- slurred speech, incoordination, unsteady, drowsiness; psychological- disinhibition of sexual/aggressive drive, impaired judgement, impaired social/occupational function, impaired attention/memory, irritable

151
Q

alcohol withdrawal

A

early signs develop within few hours and peak 24-48 hours then disappear

152
Q

alcohol withdrawal symptoms

A

hyper alert, jerky movements, irritanility, startle easily, intense tremors, cramps, vomiting, increase in HR, HTN, febrile, grand mal seizures

153
Q

delirium tremens

A

alcohol withdrawal delirium which is a medical emergency and causes tachycardia, diaphoresis, disorientation, agitation, visual/tactile hallucinations

154
Q

alcohol overdose effects

A

cardiovascular or respiratory depression/arrest, coma, shock, convulsions, death

155
Q

alcohol withdrawal meds

A

benzodiazepines, chlordiazepoxide (librium) or diazepam (valium), serax, phenobarbitol (NOT GIVEN WITH BENZOS),

156
Q

alcohol withdrawal adjunct therapy

A

clonidine, beta blockers, calcium channel blockers to decrease BP HR and anxiety, thiamine, folic acid, theragran, ondansetron

157
Q

meds given to maintain alcohol sobriety

A

disulfiram (antabuse)- causes violent reaction when mixed with alcohol; naltrexone (reVia, vivitrol)- reduces pleasant feelings of alcohol; acamprosate (campral)- reduces feelings of anxiety/tension

158
Q

alcohol and nursing interventions

A

supportive care, replace electrolytes, seizure precautions, CIWA to assess alcohol withdrawal severity, symptom trigger policy (less meds given with less symptoms)

159
Q

benzodiazepine withdrawal

A

short acting withdrawal symptoms can occur within 24 hours; long acting withdrawal symptoms can occur within 24-72 hours

160
Q

benzodiazepine withdrawal symptoms

A

anxiety, insomnia, N/V, tremor, incoordination, restlessness, sweating, delirium, seizures (occur up to 2 weeks after)

161
Q

opioid intoxication effects

A

physical- constricted pupils, decreased RR, drowsiness, hypotension, slurred speech, psychomotor retardation; psychological- initial euphoria followed by dysphoria and impairment of attention, judgment, and memory

162
Q

opioid withdrawal effects

A

yawning, insomnia, irritability, rhinorrhea, panic, diaphoresis, cramps, N/V, muscle aches, chills, fever, lacrimation, diarrhea: flu like symptoms

163
Q

opioid overdose

A

pinpoint pupils, respiratory depression/arrest, coma, possible dilation of pupils due to anoxia = triad of symptoms; cardiac arrest, shock, convulsions, death; treat with naloxone

164
Q

meds to detox from opioids

A

methadone- reduces severe withdrawals and has long half life; buprenorphine (subutex)- opioid partial agonist with weaker opioid effects causing less chance of OD and helps to alleviate cravings; suboxone- buprenorphine with naloxone that is used for long-term treatment and as a later substitute; clonidine- treats anxiety, decrease BP, and decrease HR

165
Q

adjunct treatment for opioid detox

A

ibuprofen for pain, hydroxyzine (atarax) for anxiety, trazodone for sleep, bentyl for abdominal cramps, loperamide for diarrhea, ondansetron for nausea; avoid benzos if possible

166
Q

cocaine/crack

A

extracted from coca leaf; when smoked effects take 4-6 secons and last 5-7 minutes; causes anesthetic and stimulant effects; produces imbalance in neurotransmitters

167
Q

cocaine/crack withdrawals

A

depression, paranoia, lethargy, anxiety, insomnia, N/V, sweating and chills

168
Q

marijuana

A

from hemp plant; generally smoked; THC is active ingredient; causes depressant and hallucinogenic effects; desired effects are euphoria, detachment, and relaxation; long-term effects are lethargy, anhedonia, difficulty concentrating, loss of memory, motivational syndrome

169
Q

nicotine

A

acts as stimulant, depressant, and tranquilizer; can lead to cancer, mouth cancer, emphysema, CV disease, adverse pregnancy outcomes

170
Q

nicotine withdrawal symptoms

A

strong cravings, impaired concentration, nervousness, restlessness, irritability, impatience, increased appetite

171
Q

pharmacological aids for nicotine cessation

A

patches, gum, lozenges, nasal sprays, inhalers; nicotine free products are varenicline (chantix) and bupropion (wellbutrin)

172
Q

psychoactive drugs

A

aka club drugs: cause stimulation and hallucinogenic effects; MDMA, GHB, ketamine, rohypnol, methamphetamine, LSD

173
Q

other common substances

A

mescaline, psilocybin, salvia are all similar to LSD; bath salts and cathinones are new psychoactive substances (NPS); inhalants like spray paint, glue, cigarette lighter fluid, propellant gas used in aerosols

174
Q

initial assessment for substance use disorder

A

symptoms of brain injury can mimic intoxication; trauma victims should have tox screen or BAL

175
Q

assessment guide for substance abuse

A

HX of pt substance abuse- amount, type of drug, pattern, dates, last use; med HX- coexisting conditions, current meds, mental status, HX of withdrawal, seizures, DT; psychiatric HX- comorbid psych conditions , HX of abuse (sexual or physical), HX of suicide or homicidal ideations or current SI; psychosocial HX- affected relationships from substance abuse, support system, legal issues, unable to meet role expectations

176
Q

substance abuse guideline numbered

A
  1. ensure s/s not due to medical cause. 2. establish substance being used, route, pattern, quantity, last use. 3. assess fo overdose and potential for withdrawal. 4. asses SI. 5. assess for physical complaints. 6. explore pt interests in addressing susbtance abuse. 7. assess pt knowledge of resources or support system
176
Q

helpful screening tests for identifying problem and extent of substance use

A

alcohol use disorders identification test (AUDIT), michigan alcohol screening test (MAST), CAGE- cut down, annoyed, guilty, eye opener/ease, clinical opiate withdrawal scale (COWS)

177
Q

nursing DX for substance use disorder

A

vomiting/diarrhea- deficient volume, risk for electrolyte imbalance; audiovisual hallucinations, impaired judgement d/t substance withdrawal/intoxication- risk for violence to self/others, risk for injury; feelings of hopelessness- risk for suicide; excessive substance abuse affecting areas of life- defensive coping, ineffective relationship, risk for loneliness

178
Q

nursing outcome identification related to substance use

A

free from injury while withdrawing, safety; attending groups/programs to stay sober, identifying cues/situations that pose relapse risk, positive substance free support system, identifying coping skills

179
Q

nursing planning for substance abuse

A

attention to gender/age, social status, income, culture, substance use history, current condition; propose abstinence as treatment goal

180
Q

nursiing implimentations for subatcne abuse

A

aim of treatment is self responsibility not compliance; choice of inpatient/outpatient depends on cost, availability, insurance; outpatient programs work best for those who are not employed and have social support; relapse prevention- identify triggers; strategies for relapse prevention- learn how to cope with threats to recovery

181
Q

substance abuse nursing evaluation

A

judged by increased length of time in abstinence, decreased denial, functioning in occupation, improved relationships, ability to relate comfortably to other humans

182
Q

recovery from substance abuse

A

recovery paradigm- emerges from hope and is person driven; psychotherapy using alternative coping to reduce reliance on substance; cognitive behavioral therapy- recognize and avoid triggers as well as offers coping strategies; group therapy; AA- 12 step program; residential programs- addiction and antisocial behavior

183
Q

common types of abuse prevalent in all social strata

A

family violence and trusted authority figure violence

184
Q

4 abuse categories

A

emotional, physical, sexual, neglect

185
Q

child abuse

A

when a child is harmed by someone else; children younger than 4 are the most vulnerable

186
Q

when assessing a child involved and child abuse…

A

reassure child di nothing wrong, do not pressure child to talk, nonthreatening and supportive experience, interview should not resemble a trial, children may express experience through dolls or drawing, do not suggest answers, do not promise confidentiality, do not react with shock

187
Q

when interviewing child…

A

open-ended questions are most effective; how did this happen to you?, who takes care of you?, what do you do after school?, who are your friends? what happens when you do something wrong?

188
Q

intimate partner violence

A

pattern of assault and course of behaviors that may include physical injury, psychologic abuse, sexual assault…

189
Q

forms of teen abuse

A

extreme possessiveness, jealousy, stalking, manipulation, devaluation, humiliation, threatening suicide, unwanted touching, forcing intimacy or sex

190
Q

different types of abuse seen in all age groups

A

intimate partner violence, teen abuse, child abuse, elder violence

191
Q

cycle of violence

A

consists of three phases: tension-building, acute battering, honeymoon

192
Q

3 common categories of elder violence

A

domestic, institutional, or self-neglect

193
Q

the 5 kinds of elder abuse

A

physical abuse, emotional abuse- inflicting mental anguish, financial abuse- misuse of someones property and resources, neglect- failure to fulfill caretaking obligation or a self-neglect, sexual abuse

194
Q

adult protective services

A

where reports or suspected elder abuse should be filed to

195
Q

child protective services (CPS)

A

who to contact if children are being hurt or abused

196
Q

mandated reporter for children and elderly

A

nurses are legally responsible for reporting child abuse to the appropriate child protective agency; social workers, medical and mental health professionals, teachers, childcare providers are also mandated reporters

3400 Mental Health (8 decks)

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