Exam #3 Flashcards
Why is adequate sleep required?
- restore brain tissue
- conserve energy
- regulate immune function
- regulate hormones
- provide thermoregulation
How much sleep do infants need?
14- 17 hours of sleep a day
How much sleep do school aged children need?
9 - 11 hours
How much sleep do adults need?
7-9 hours
What factors can contribute to someone developing insomnia?
- Hx of anxiety or depression
- various medical/ psychiatric disorders
- high levels of stress
- poor sleeping habits
What is narcolepsy?
Frequent and uncontrollable periods of deep sleep
What is thought to be the cause of narcolepsy?
- deficiency of the brain chemical hypocretin which regulates sleep because the immune system mistakenly attacks parts of the brain that produces hypocretin
What medication is used to treat narcolepsy?
Stimulants such as dextroamphetamine
What is hypersomnolence disorder?
- excessive daytime sleepiness that persists for more than 3 months even with 9+ hours of sleep
What is restless leg syndrome?
Uncomfortable sensation in the legs accompanied by the urge to move
What is the treatment for restless leg syndrome?
- dopamine receptor agonist such as ropinrole or pramipexole
What are the risk factors for developing sleep apnea?
Obesity
What are non- REM sleep arousal disorders?
Sleep walking and sleep tremors
What are potential treatments for nightmare disorder?
-hypnosis
What is REM sleep behavior disorder?
Djouldé
Characterized by physically act out vivid dreams ( talking, physical movements)
What actions promote proper sleep hygiene?
- decreased caffeine
- don’t watch tv or use your phone right before sleeping
- calm/ quiet environment
- avoid daytime napping
- exercise
What are three classifications for neurocognition?
- delirium
- mild neurocognitive disorders
- major neurocognitive disorders
What is delirium?
Reverse able
An acute disturbed state of mind characterized by restlessness, illusions, incoherence of thought and speech
What are the most common causes of delirium?
- UTI
- dehydration
- intoxication
What are some manifestations of delirium?
- labile mood
- anger/ agitation
- pull IV’s
- self care deficits
- hyper or hypo activity
- changes in sleep wake
- abnormal vital signs
What are mild neurocognitive disorders ?
- a decline from previous cognitive functioning, doesn’t impact daily functioning
What are major neurocognitive disorders?
Impairments interfere with daily function and the ability to be independent
What are the risk factors of developing Alzheimer’s disease?
- family member has dementia
- age
- cardiovascular disease
- poor diet and social isolation
- head injury/ traumatic brain injury
What is thought to be the cause of Alzheimer’s?
Genetics- if fam member has dementia
What are some ways we can teach our pt’s to reduce the risk for Alzheimer’s?
- staying physically active
- stop smoking
- maintain healthy weight
- drink mod or not at all
- adequate sleep
- avoid chronic stress or depression
What are the different stages of Alzheimer’s disease?
M, M, S
- Mild
- moderate
- severe
How is mild Alzheimer’s characterized ?
Stage 1
- memory lapse occurs but the pt can still function independently
How is moderate Alzheimer’s characterized?
Stage 2
Symptoms become noticeable and behavior is markedly changed
How is severe Alzheimer’s characterized ?
Stage 3
May have difficulty w/ communication and needs 24hr care
What is confabulation?
Trump
Creation of stories to maintain self esteem
What is preservation?
Religion of phrases or gestures
What is agnosia?
Loss of sensory ability to recognize objects
What is the treatment used for Alzheimer’s?
- cholinesterase inhibitor which doesn’t cure but helps delay or prevent symptoms from becoming worse
What are some possible intervention for a pt experiencing Alzheimer’s?
- transportation
- suppor groups
- home health services
What is dyscalculia?
Persistent difficulty in mathematics
What is dysgraphia?
Persistent difficulty in written expression
What is an intellectual disability?
- deficits in intellectual, social, and daily functioning
What is autism spectrum disorders?
A neurobiological and developmental disability that typically appears during a child first three years of life
What are the clinical manifestations of Autism spectrum disorders?
- deficit in social/ emotional interactions
- repetitive speech and or behaviors
- sensory processing issues
- difficulty w/ changes to routines
What are common manifestations of ADHD?
- child shows inappropriate level of inattention, impulsivity, and hyperactivity
- low frustration tolerance and labile moods
What drug class are used to treat ADHD?
Dextroamphetamine sulfate
Stimulants adderall
What should be encouraged in a patient taking a ADHD medications?
Drug holidays and parents should properly store and administer stimulant medications
What are the common side effects of taking stimulants?
WL/A, WT, HTN, IS, T, I
- weight loss
- anorexia
- worsen tics/ tremors
- HTN
- impaired sleep
- tachycardia
What is intermittent explosive disorders?
- inability to control aggressive impulses
- verbal or physical aggression
What is conduct disorder?
- rights of others are violated and societal normal or rules are disregarded
- if left untreated it will develop into antisocial personality disorder
What are some interventions that can be used for pt experiencing an impulse control disorder?
- ensure a safe enviormental
- set clear limits and expectations
- provide structure and boundaries
How is cluster A personality disorders characterized by?
- odd
- eccentric
What personality disorders fall under cluster A?
PSS.. do you know the government is watching us??
- Paranoia PD
- Schizoid
- schizotypical
What are the clinical manifestations of Cluster A paranoid PD?
- distrust/ suspicion of others that’s unsupported by evidence
- hyper vigilance
- often provoke a hostile response
- tend to have difficulty in relationships due to jealousy, controlling, and unwillingness to forgive
What nursing intervention is appropriate for Cluster A paranoid PD?
- stick to the schedule and don’t change it
- avoid being nice w/ the pt
- be consistent
What are some treatment options for paranoid PD?
- psychotherapy
- group therapy
- anti anxiety and antipsychotics
What are the clinical manifestations of Cluster A schizoid PD?
- lifelong pattern of social withdrawal, limited emotional expression, they tend to confine in imaginary friends/ fantasies
What nursing interventions should be considered of Cluster A paranoid PD?
- avoid being too nice/ friendly
- DO NOT increase socialization
- focus on coping/ anxiety
What are the treatment options for Cluster A paranoid PD?
- psychotherapy
- individual therapy then move to group therapy
- antidepressants and antipsychotics
What are the clinical manifestations of Cluster A schizotypical PD?
Magical thinking- they think something happen because they thought it or manifested it
- tend to ramble w/ lengthy unclear, overly detailed, and abstract content + paranoia
- odd/ eccentric behavior w/magical thinking
What are the nursing considerations for a pt with cluster A schizotypical PD?
- respect the need for iso
- adhere to schedule
- be respectful to religious practices, thought, and beliefs
What are the treatment options for a pt with cluster A schizotypical PD?
- psychotherapy
- antipsychotic
- antidepressants
- anti anxiety
How is cluster B personality disorders characterized by?
- dramatic
- emotional
- erratic
What personality disorders fall under cluster B?
BANH
- borderline
- narcissistic
- antisocial
- histrionic
How is cluster C personality disorders characterized by?
- fearful
- anxious
What PD’s fall under cluster C?
- avoidant
- dependent
- obsessive compulsive
What are the clinical manifestations of cluster B borderline personality disorder?
- instability ( moods, relationships)
- impulsive
- distorted self image/ identity
- labile
- splitting
- separation anxiety
- self harm
What are some nursing interventions of cluster B borderline personality disorder?
- therapeutic relationship is essential
- monitor for manipulation and splitting
- monitor for self harm behaviors
What are some treatments for cluster B borderline personality disorder?
- DBT
- antidepressants and mood stabilizers
What are the clinical manifestations of antisocial personality disorder?
- disregards the right of others and frequently violates
- deceitful, manipulative, and hostile when they can’t manipulate the person
- no remorse / guilt
- criminal misconduct and substance misuse are common
What are some nursing interventions for cluster b antisocial PD?
- direct and clear language to avoid manipulation
- monitor for violence
- usually not hospitalized
What are some treatment options for cluster b antisocial PD?
- mood stabilizers
- antidepressants
- benzodiazepines
- therapy
What are the clinical manifestations of cluster B histrionic personality disorder?
- extroversion and flamboyance
- emotional seeking behavior
- impulsive
- may act flirtatiously
What are some nursing care interventions for cluster B histrionic personality disorder?
- professional communication
- ## monitor for exaggerated symptoms
What are some treatment options for cluster B histrionic personality disorder?
- individual therapy
- group therapy
- antidepressant
- anti anxiety
What are the clinical manifestations of cluster B narcissistic PD?
- feelings of entitlement
- exaggerated belief in ones importance
- lack of empathy
- poor self esteem and hypersensitive to criticism
What are some nursing intervention for a person with cluster b narcissist PD?
- remain neutral
- model healthy communication/ empathy
- do not engage in power struggles
What are treatment options for a person with cluster b narcissist PD?
- CBT
- group therapy
- lithium
- antidepressants
What are the clinical manifestations of cluster c avoidant PD?
- extreme sensitivity to rejection
- feelings of inadequacy
- socially inhibited
- low self esteem
What are some nursing interventions used for cluster C avoidant pd?
- friendly/ reassuring approach
- ease into social situations
- provide assertiveness training
What are some treatment options used for cluster C avoidant pd?
- individual and group therapy
- antidepressants
- anti anxiety
What are the clinical manifestations of cluster C dependent PD?
- overwhelming need to be cared for
- submissive and clingy behavior
- intensive fear of separation
What are some nursing interventions used for Cluster C dependent PD?
- identify stressor
- teach assertiveness training
- beware of countertransference
What are some treatment options used for Cluster C dependent PD?
- CBT
- antidepressants
- anti anxiety
What are the clinical manifestations of cluster C obsessive compulsive PD?
- limited emotional expression
- stubbornness
- indecisive
- perfectionist
- always think they are right
What are some nursing interventions used for Cluster C obsessive compulsive PD?
- avoid power struggle
- provide structure
- help identify ineffective coping
What are some treatment options used for Cluster C obsessive compulsive PD?
- group and individual therapy
- antidepressants (specifically SSRIs)
What are paraphiliac disorder?
Sexually aroused by things that are outside of societal norms
What are the risk factors for developing SDD?
- hormonal
- vascular issues
- cognitive factors
What are some nursing interventions used for pt’s with sexual disorders?
- be non judgmental
- maintain and reinforce appropriate interpersonal boundaries
- explain consequences of actions
What are risk factors for developing anxiety?
- psychological factors
- negative life events
- genetics
- neurobiological
- low levels of GABA
What are the different levels of anxiety?
M, M, S, P
- mild
- moderate
- severe
- panic
How is mild anxiety characterized?
- they are able to perceive what’s happening around them
- restlessness, irritability, psychomotor agitation
( foot tapping, fidgeting)
How is moderate anxiety characterized?
- decreased perception and grasp less information, and has selective attention
- thinking is impaired but learning can still occur
- increased RR/ HR, GI problems, tremors, and headache
How is severe anxiety characterized?
- very low perception, unable to learn or problem solve
- nausea, dizziness, confusion, hyperventilation, impending doom
How is panic anxiety characterized?
- complete loss of touch of reality
- screaming, shouting, social withdrawal, or hallucinations
What is panic disorder?
Sudden onset for extreme apprehension or fear of impending doom
- intense, unpredictable, lasts 10 min.
What is generalized anxiety disorder?
Characterized by excessive worrying that is out of proportion for more than 6 months.
- avoids events or puts off things due to anxiety
- difficulty w/ relationships due to need for reassurance and high anxiety levels
What is body dysmorphic disorder?
- obsessive focus on a perceived flaw in appearance
- often has a hx of abuse or neglect
What are some effective nursing interventions for a pt experiencing anxiety?
- promote self care activities
- health teaching
- encouragement of therapy
What are some clinical manifestations of a pt w/ PTSD?
- recurrent dreams or flashbacks
- avoidance of stimuli associated with/ trauma
- numbing response
- persistent symptoms of increased arousal
What are some treatment options for a pt with PTSD?
- SSRI like Zoloft and Paxil
What is dissociative disorder?
- when the person separates themselves emotionally after significant trauma(s)
- dissociation is an involuntary response that protects individuals from full awareness of trauma
What are positive symptoms of dissociative disorder?
- flashbacks
- emotional triggers
What are negative symptoms of dissociative disorder?
- lack of self control or control of body parts
- decline in memory
What is depersonalization disorder?
The persistent felling of observing oneself from outside their body and that their surroundings aren’t real
- feeling mechanic, dreamy, or detached from body
What kinds of survivors experience depersonalization disorder?
- severe acute stress
- childhood sexual abuse
What are the different kind of dissociative amnesias?
- localized
- selective
- dissociative
What is localized dissociative amnesia?
- inability to remember all event in certain periods
What is selective dissociative amnesia?
- some but not all events can be recalled
What is dissociative fugue amnesia?
Traveling away and forgetting your identity and past
What are the signs of a dissociative disorder?
- change in behavior, voice, or dress
- referring to self by another name or third person
- partial memory or memory gaps
- disoriented X4
- presence of blackouts
What are some nursing implementation that can be used for a pt’s struggling with dissociative disorders?
- coping skills for stressor
- establish routine
- encourage expression of feelings
- long term therapy
What is somatic symptom disorder?
Extreme focus on physical symptoms such as pain or fatigue because of emotional distress and problems functioning
What is the most lethal substance to have a pt withdrawal on?
Alcohol then benzo’s
What is the definition of intoxication?
- occurs when the individual use a substance to excess
What are drug classes and how are they categorized?
The lower the # the increased risk for abuse
- 5 categories based on acceptable medical use and potential for abuse
What are schedule I drugs and some examples?
Street drugs
Not for medical use, high abuse potential
- heroin
- LSD
- Shrooms
What are schedule II drugs and some examples?
A, F, D
Acceptable for medical use, tightened regulated, high risk for abuse
- Adderall
- fentanyl
- dilaudid
What are schedule III drugs and some examples?
T w/ C, K
Acceptable medical use, less abuse potential than S2
- Tylenol w/ codeine
- Ketamine
What are schedule IIII drugs and some examples?
Acceptable for medical use, medium risk for abuse
- Xanax
- Valium
What are schedule IV drugs and some examples?
OTC, R
Acceptable medical use, with decrease abuse potential
- OTC
- Robitussin
What neurotransmitters are involved in addiction?
- opioid, catecholamine, and GABA
- the dopaminergic neurons in the VTA are implicated
What are the common risk factors for developing an addiction?
B, E, S
- biological
- environmental risks
- sociocultural
