Exam 3 Flashcards
addiction causes (5)
-pain management
-stress management
-self medication
-exposure
-use at early age
addiction risk factors (5)
-mental illness
-stress
-genetics
-peer pressure
-abuse
protective factors (5)
-positive family support
-caregiver involvement
-positive relationships
-employment
-community resources
addiction comorbidities (6)
-heart disease
-stroke
-dental issues
-hepatitis
-cirrhosis
-mental illness
sx of use (3)
-mood and behvior changes
-poor movement coordination
-slurring words
concerns re: alcohol use (3)
-safety
-accidents (esp. auto)
-risk for bleeding
CIWA protocol
-detox protocol every 2 hrs
alcohol withdrawal (3)
-can be deadly
-has degrees of severity
-CIWA assessment
detox sx (10)
-agitation
-anxiety
-sweating
-insomnia
-delerium
-tremors
-vomiting
-hallucinations
-confusion
-hypertension
CIWA assessment
-numerical scale for each sx
-determines how much medication the pt. should receive
-gives the nurse control over the detox
-highly subjective
CIWA criteria
-n/v
-tremors
-paroxysmal sweating
-anxiety
-agitation
-tactile disturbances
-auditory disturbances
-visual disturbances
-headache
-orientation
additional considerations in detox
-blood pressure elevation
-patient behaviors
-drug-seeking behaviors
-inconsistency
CIWA protocol d/c when
pt. doesn’t score for 24 hrs.
Delerium Tremens (6)
-most severe stage of withdrawal
-seizures
-hallucinations
-global confusion
-hyperactivity
-can be deadly
alcohol withdrawal timeline
1) anxiety, insomnia, nausea, abdominal pain
2) high blood pressure, increased body temp
3) hallucinations, fever, seizures, agitation
short term alcohol tx
1) benzos
2) antiepileptics
3) thiamine (a B vitamin)
4) introduction of resources
long term alcohol tx
-naltrexone (prevent relapses)
-acomprosate (reduces desire to drink alcohol
-disulfiram - antabuse - creates physical reaction to alcohol
benzodiazepine withdrawals
-very similar to alcohol
-depends on drug half life
when to assess detox
when substance is out of person’s system
typical opioids abused (5)
-fentanyl
-heroin
-prescribed narcotics
-oxycodone/oxycontin
-percocet
dangerous signs of opioid use
-CNS depression
-respiratory failure
-overdose
opioid detox sx (7)
-restlessness
-muscle aches
-insomnia
-diarrhea
-vomiting
-cold flashes
-flu-like sx
detox tx (5)
-comfort meds
-controlled narcotics
-methadone
-suboxone
-subutex
healthcare worker impairment
-drug diversion
-burnout
-staffing shortages
-poor ratios
-pain
what happens if drug diversion suspected
-board receives complaint
-nurse can self-report
-investigation is launched
-hearing for practice violation
-nurse is placed in assistance program
-risk for losing license
mood d/o categories
-depression
-mania
-bipolar
depression general characteristics (3)
-both a sx and a dx
-biochemical component
-“everything is down”
Mania
-“everything is up”
-hyperactivity
-can have a psychotic component
bipolar disorder
-fluctuating between mania and depression
-Type I or Type II
Bypolar Type I
fluctuate between mania and depression
Bipolar Type II
fluctuate between hypomania and depression
mania v. hypomania
-mania is more severe
-mania includes a psychotic component
nursing priority for mood d/o (3)
-risk for suicide
-frequent assessment
-evaluating safety measures
risk factors for suicide- individual (9)
-having made a previous attempt at self-harm
-mental illness
-lacking social support
-legal problems
-financial problems
-risky impulsive behaviors
-loss of job
-serious medical illness
-use of substances
suicide risk factors- relationships
-hx of having been abused or neglected as a child
-having been bullied
-family history of suicide
-personal relationship problems
-sexual violence
suicide risk factors: community (7)
-barriers to access to healthcare
-cultural/religious beliefs such as a belief that suicide is a noble resolution
-personal problem
-community cluster of suicides
-stigma associated with mental illness or help-seeking
-access to lethal weapons, meds
-media portrayals of suicide
warning signs (5)
-stating they want to die or kill themselves
-stating they feel helpless or empty, with no reason to live
-stating they feel trapped, without solutions to problems
-stating that they feel like a burden to others
more warning signs (6)
-withdrawing socially from family and friends
-giving away loved possessions
-bidding goodbye to friends and family
-arranging affairs, planning to die
-engaging in risky behavior, such as fast driving
-obsessively thinking and talking about death
SADPERSONS
S sex=male
A age <19 or >45
D depression
P previous attempt
E ethanol
R rational thinking loss
S social supports lacking
O organized plan
N no partner
S sickness (major or chronic)
Assessing for suicide
-ways and means
-plan
-intent
tx for suicide
-safety considerations
-imminent risk=inpatient
-otherwise outpatient psychotherapy
psychopharm for suicide
-antidepressants (SSRI/SNRI, tricyclics, MAOIs)
-PRNs (sleep, anxiety)
Non-pharm tx
-ECT
-CBT
-DBT
-ACT
-TMS
mania and depression cycles in bipolar are usually
slow to change
mania s/s (8)
-pressured speech
-hyperactivity
-insomnia
-risky behavior
-poor inhibition
-implulse control
-disorderly conduct
-hypersexuality
nursing considerations for bipolar
-safety
-milieu management
-compliance
-social interactions
other considerations for bipolar
-sleep
-nutrition
-skin integrity
inpatient psychopharm mood stabilizers (5)
-lithuim
-depakote
-tegretol
-abilify
-latuda
depakote/valproic acid forms
-pill
-liquid
-beads in caps
depakote / valproic acid class
anticonvulsant
depakote / valproic acid pt. concerns
-weight gain
-sexual dysfunction
valproic acid normal levels
50-100 mcg/mL
lithium (4)
-effective mood stabilizer
-can cause kidney damage
-narrow therapeutic index
-risk for toxicity
s/s lithium toxicity
-fine tremor
-n/v
-abd pain
-bloating
s/s lithium toxicity s/s moderate - severe
-coarse tremors
-twitching / jerking movements
-altered mental status
-ataxia
-seizures
key considerations
-mild toxicity sx while pt tapering up
-do not d/c if lab range is low
-if pt. stops taking, restart regiment
lithium range
0.6 - 1.2 mEq/L
ideal lithium level is
1.0 mEq/L
3 classes of antidepressant
-SSRI/SNRI
-tricyclics
-MAOIs
SSRIs/SNRIs
-ex. escitalopram, Prozac
-Serotonin syndrome
-4-6 weeks to see effects
-suicide risk
Tricyclics
risk for orthostatic hypotension
MAOIs
-avoid foods with tyramine (smoked, fermented, aged foods or drinks)
benzodiazepines (4)
-risk for addiction
-anxiolytic effect
-CNS depression
-detox if stopped
Mood disorders (3)
-Bipolar (I or II)
-Depression
-Mania
-Bipolar I
-mania and depression
Bipolar II
-hypomania with more pronounced depression than bipolar I
Depression first priority
safety risk
Mania (3)
-psychotic component
-way too much energy
-poor sleep
Meds for alcohol detox
-benzos
-comfort meds
Meds for after alcohol detox
-antabuse
-naltrexone
-acomprosate
opioid detox
-not deadly
-if using, pupils dilated, hypotension, bradycardia
-detox = comfort meds
-can use methadone, suboxone, subutex
eating disorders
-bulimia
-anorexia
bulimia s/s
-vomiting
-tooth decay
-Russell’s sign
-assess F+E
-assess safety
-may not have weight change
anorexia s/s
-minimal intake
-assess F+E
-low weight
Personality disorders: Cluster A
-antisocial (no remorse)
-schizotypal (positive symptoms)
-schizoid (negative symptoms)
Personality disorders: Cluster B
-borderline (risk for self-harm, assess for suicidal ideation/safety)
Personality Disorders Cluster C
-avoidant
-dependent
Personality disorder tx
-CBT
-DBT
-Behavioral therapies
-Meds don’t work
neurodevelopmental
-assess in childhood
-performance in school
-ADHD (treat w/ uppers)
-Autism spectrum (levels of severity)
-dyslexia (poor academic performance)
-tourette’s (tics, verbal tics (shouting, swearing)
neurocognitive: delerium
-goes away
-treat underlying cuse
neurocognitive: dementia
-degenerative
-does not go away
-optimize functioning
-monitor for safety
neurocognitive considerations
-ADLs
-caregiver strain
-paradoxical effects of benzos/sleep meds
personality disorders are on what DSM axis
2: not usually primary disorders; usually with something else
how personality develop (4)
-hitting developmental milestones (trust vs. mistrust to get needs met)
-environment
-family dynamics or lack thereof
-socialization
risk factors for personality disorders (5)
-missing milestones
-bad environment
-family disruption
-abuse
-poor socialization
Personality disorders: Cluster A are generally ________
odd/eccentric
Personality disorders: Cluster A disorders listed (3)
-paranoid personality disorder
-schizoid personality disorder
-schizotypal personality d/o
-paranoid personality disorder characteristics
-distrust
-poor relationship forming
-suspicious
-doubting loyalty
*schizoid personality disorder characteristics
-negative sx of schizophrenia
-detachment
-poor relationships
-social avoidance
schizotypal personality disorder characteristics
-positive sx of schizophrenia
-flight of ideas
-odd beliefs
-eccentric behaviors
Personality disorders: Cluster B are generally _________
dramatic, emotional, erratic
Personality disorders: Cluster B listed (4)
-antisocial personality d/o
-borderline personality d/o
-histrionic personality d/o
narcistic personality d/o
*antisocial personality d/o
-serial killers
-no remorse for actions
-rebellious to authority
-deceitfulness
*borderline personality d/o
-instability, impulsivity, poor relationships
-self harm, suicidal ideation
-identity disturbance
-fear of abandonment
*histrionic personality d/o
-overly emotional responses
-attention seeking
-poor relationship boundaries
*narcissistic personality d/o
-grandiosity
-need for admiration
-entitlement
-lack of empathy
Personality disorders: Cluster C general characteristics
anxious, fearful
Personality disorders: Cluster C listed (3)
-avoidant personality d/o
-dependent personality d/o
-obsessive compulsive d/o
Avoidant personality d/o
-social inhibition
-fear of criticism, rejection
-feelings of inadequacy in social settings
*dependent personality d/o
-need to be taken care of
-fear of separation
-seeks nurturing from others
obsessive compulsive d/o
-perfectionism
-compulsive/obsessive thoughts
-hoarding
Personality d/o tx (5)
-not meds
-cbt
-dbt
-behavioral therapies
-supportive therapies (maybe prn med)
nursing approach for cluster A (trouble relating to others)
empathetic; help clients process feelings and emotions they cannot share with others
cluster B personality d/o (others may shun their dramatic behaviors)
empathetic; help client process their needs while setting boundaries
cluster C personality d/o (trouble taking on responsibilities that lead to success due to fear)
empathetic; decrease anxiety by suggesting coping skills; empower clients
personality disorder nursing priorities
-safety
-monitoring for self-harm
-suicide assessment
-social safety
-dangerous (antisocial) behavior
-provocation of violence
-poor boundaries
disruptive behavior disorders
-group of conditions
-poor impulse control
-poor self-control of emotions
-aggression
-disruption
-endanger self or others
disruptive behavior disorder list (6)
-impulse control d/o
-oppositional defiant d/o
-intermittent explosive d/o
-conduct d/o
-kleptomania
-pyromania
trends in disruptive behavioral d/o
-typically seen in children
-often classified as temperament
-require behavioral tx
neurodevelopmental disorders
-motor and tic disorders
-intellectual disabilities
-adhd
-autism spectrum disorder
-language communication disorders
adhd characteristics
-inattention
-hyperactivity
-impulsivity
adhd: inattention
-unable to concentrate, easily distracted, short attention span
-unable to follow instructions
-difficulty organizing
adhd: hyperactivity
-unable to sit still
-fidgeting
excessive physical movement, talking, or interrupting
adhd: impulsivity
-acting w/out thinking
-lack of regard for consequences
-no sense of danger, frequently getting injured
adhd etiology
-genetics
-environment (low birth weight, prenatal exposure to alcohol or tobacco)
adhd comorbidities
-learning disabilities
-epilepsy
-children (ODD, conduct disorder)
-Adolescents and adults (substance use d/o, sleep d/o, anxiety d/o, somatic conditions)
adhd problems across the lifespan
-problems w/ school/learning
-problems w/relationships
-problems at work
-may manifest as anxiety or depression
cognitive signs of learning disability
-spelling same word differently in same assignment
-trouble with open-ended ? on test
-poor reading and language comprehension
-weak memory skills
-difficulty adapting skills from one setting to another
-slow work pace
-difficulty grasping concepts
-inattention to details
-excessive focus on details
-frequent misreading / misinterpretation of info
-trouble filling out applications or forms
-easily confused by instructions
-poor organizational skills
mental health problems like depression or anxiety
behavioral signs of learning disability
-not wanting to go to school
-complaining about the teacher
-reluctance to engage in reading/writing activities
-saying work is to hard
-not wanting to show you schoolwork
-avoiding assignments/ homework
-saying negative things about academic work, own intellect
-disobeying teacher’s directions
-frequent misreading/ misinterpretation of info
-cutting class, skipping school (teens)
-bullying
dyslexia related difficulties in preschoolers (6)
-recognizing letters and sounds
-word pronunciation
-learning new vocabulary
-learning the alphabet
-learning the days of the week
-rhyming
dyslexia related difficulties in school aged (6)
-spelling rules and letter placement
-remembering facts or numbers
-handwriting
-learning new skills
-reading
-following sequences
dyslexia related difficulties in adolescence and adulthood (6)
-reading at grade level
-understanding jokes, idioms, expressions
-organizing and time management
-learning a foreign language
-memorization
-summarizing a story
ASD characterisitics
-marked by significant social, communication, and behavioral deficits
-ASD are a group of developmental disabilities ranging from very mild to very severe
-hallmark signs include rocking, flapping hands, spinning
ASD level 1
-needs some support
-sometimes just awkward or asocial
-change is difficult, thrives on routine
-fidgets can be seen as quirky or annoying to others
-sometimes perceived as lazy or insecure
ASD level 2
-needs more support
-most people can tell they have a disability
-don’t engage socially
-doesn’t handle change well
has repetitive behaviors that are noticeable
-is developmentally delayed
ASD level 3
-everyone can tell there is a disability
-doesn’t communicate, except when necessary
-any change to routine is nearly impossible
-repetitive behavior helps client stay calm
-major developmental delays/ missed milestones
ASD etiology
-genetics (linked to specific inherited genes or de novo mutations)
-environment
-advanced parental age
-no evidence it is related to immunizations
ASD across the lifespan
-behavioral issues may worsen with age
-limited social life
-unemployment / underemployment
ID DSM definition
disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual, social, and practical domains; may be mild, moderate, severe, or profound
mild ID
-85% of identified cases
-can learn to read, write, and perform math skills at a 3rd to 6th grade level; usually able to work and live independently
moderate ID
-10% of identified cases
-usually able to learn to read and write at a basic level, perform basic life skills; often requires assistance working or living independently
severe ID
-5% of identified cases
-likely not able to read or write, but able to perform some basic living skills; requires supervision in daily activities
Profound ID
-1% of identified cases
-usually able to communicate verbally or non-verbally to some degree; needs extensive support and usually has coexisting medical conditions that
ID etiology
-genetic disorders (Down’s Syndrome, Fragile X, other genetic mutations)
-environmental factors (pre/post natal infections, exposures to toxins, nutritional deficiencies
3 types of communications d/o
-receptive
-social
-expressive
Communication d/o etiology
-most have no known etiology
-possible genetic links
-boys 2-3x more likely to stutter (can be an anxiety component)
motor movement d/o listed (3)
-developmental coordination disorder
-stereotypic movement disorder
-tic disorder
developmental coordination disorder
lack of appropriate motor skills
stereotypic movement d/o
repetitive Non purposeful movements
tic d/o described
-characterized by fast, unanticipated, nonrhythmic movement or vocalizations
-motor tics (shaking, copyig others’ movements, obscene gestures, blinking
-vocal tics (throat clearing, echolalia (repeating others’ words/phrases), pallia (repeating self constantly), copropraxia (cursing)
types of tic d/o
-provisional: one or more motor and/or vocal tics for less than 1 year prior to 18 y.o.
-persistent: chronic; single or multiple motor or vocal tics must be present for 1 year and prior to 18 y.o.
-Tourette syndrome: most severe tic disorder; multiple motor and a vocal tic, must persist for one year and must be present prior to age 18
Cognitive disabilities defined
confirmation by both clinical assessment and individualized, standardized intelligence testing of deficiencies in intellectual fx
possible aspects of cognitive disabilities
-reasoning
-problem solving
-planning
-abstract thinking
-judgment
-academic learning
-learning from experience
cognitive disabilities alternate definition
deficiencies of adaptive functioning that do not meet developmental and sociocultural standards of daily function and social responsibility
learning d/o def.
difficulties learning and using academic skills, with at least one of the following difficulties having persisted for at least 6 months despite interventions
aspects of learning difficulties
-pronunciation of words
-reading comprehension
-spelling; written expression
-mastering number sense, number facts, calculation, or mathematical reasoning
-academic skills below expectations for grade or age and interfere with academic or occupational performance or ADLs
-may begin during school-age years but not be fully apparent until later years or w/ standardized testing
-no evidence of ID, uncorrected vision/hearing problems, other mental/neuro d/o, psychosocial adversity, lack of proficiency in language of instruction, or inadequate educational instruction
ADHD DSM-5 criteria
-persistent pattern (at least 6 months) of inattention and/or hyperactivity-impulsivity that interferes with functioning, development, social activities, or other activities
-inattention to details
-difficulty maintaining attention span
-appears not to listen when spoken directly
-shows a lack of follow through with instructions, organizations, or other tasks
-easily loses necessary items
-easily distracted, forgetful in daily activities
-dislikes tasks that require concentration
-manifestations are present in two or more settings and are apparent before the age of 12, and interfere with, or reduce the quality of social, academic, or occupational fx
-manifestations are not better explained by another mental d/o, including psychotic d/o, such as schizophrenia
motor d/o: stereotypic: criteria
-movements that are repetitive, driven, and seemingly w/out purpose
-behavior interferes w/social, academic, occupational, or other fx and possibly results in self-injury
-onset occurs in the child’s early developmental period
-no evidence of substance abuse, a neuro condition, or other d/o that may cause similar sx
nurse’s role
-therapeutic relationship (Peplau’s phases: orientation, working, resolution)
-holistic, person-centered care (manage illness, promote health/well-being, prevent further illness, monitor for abuse)
-advocacy (reduce stigma, focus on strengths)
-teaching (illness, medications, plan of care)
nurse’s role ID or learning disabilities
-cognitive -based communication
-focus on strengths
nurse’s role communication d/o
-assess for barriers
-create alternative communication strategies
nurse’s role autism spectrum d/o
-appropriate screening
-liaison to community services
nurse’s role ADHD
advocacy
Tic d/o
-maintain client dignity
-educate client, family, public
Recognize Cues
-comprehensive assessment
-standardized developmental screenings at well child visits (milestones)
-autism screening at 18 and 24 months or when concerns raised
-observations of mental, behavioral, physical performance in play and school settings
-history of head injury, trauma, or severe emotional stress
Erickson: Crisis and Virtue: infancy
C: trust vs. msitrust
V: hope
Erickson: Crisis and Virtue: early childhood
C: autonomy vs shame/doubt
V: will
Erickson: Crisis and Virtue: preschool
C: initiative vs. guilt
V: purpose
Erickson: Crisis and Virtue: school age
C: industry vs. inferiority
V: competency
Erickson: Crisis and Virtue: adolescence
C: identity vs. confusion
V: fidelity
Erickson: Crisis and Virtue: young adult
C: intimacy vs. isolation
V: love
Erickson: Crisis and Virtue: middle adult
C: generativity vs. stagnation
V: care
Erickson: Crisis and Virtue: mature
C: integrity vs. despair
V: wisdom
