Exam 3 Flashcards
A client reports she went to dinner and a movie last night. She resides in a nursing home.
a. ) confabulation
b. ) illusion
b. ) agnosia
d. ) agraphia
A - confabulation a defense mechanism
A client with dementia is waiting an ER assessment. She is touching all item in the exam room
a. ) hypermetamorphosis
b. ) hypervigilance
c. ) hyperorality
d. ) hypervanity
A - hypermetamorphosis
All s&s of dementia though
The client that has a diagnosis of pneumonia reports seeing rats in the hospital room today
a. ) dementia
b. ) delirium
c. ) Depression
d. ) Dystonia
B - delirium
A client gets confused and irritated each evening and tries to elope form the facility
a. ) preservation
b. ) sundowning
c. ) aphasia
d. ) agnosia
B -sundowning
A client is provided cereal breakfast. She is given a spoon and she appears to brush her hair
a. ) agnosia
b. ) amnesia
c. ) aphasia
d. ) apraxia
A - Agnosia
A client is experiencing a steady decline in mental and physical functioning
a. ) delirium
b. ) dementia
c. ) autism
d. ) ADD
B - Dementia
Addiction
Continued use of substances despite adverse consequences
Use
Ingestion, smoking, sniffing, or injection of mind altering substances
Abuse
Use for purposes of intoxication or beyond intended use
Withdrawlal
Symptoms occurring when substance no longer used
Detoxification
Process for safe withdrawal
Relapse
Recurrence
What neurotransmitter pathway is activated in the brain when abusing substances
Dopamine pathways - reward seeking
What is the most abused drug?
Alcohol
What is the second most abused drug?
Marijuana
Comorbid mental disorders to substance abuse
Psychotic
Anxiety
Mood disorder
Alcohol is a CNS ___. So what drugs would you want to avoid?
Alcohol is a CNS depressant
Avoid other drugs that ca cause sedation
BAL 0.05
Or 1-2 drinks
Impaired judgement, giddiness, mood changes
BAL 0.10
Or 5-6 drinks
Difficultly driving and coordinating movements
BAL 0.20
Or 10-20 drinks
Motor functions severely impaired, resulting in ataxia; emotional lability
BAL 0.30
Or 15-20 drinks
Stupor, disorientation and confusion
BAL 0.40
Or 20-24 drinks
Coma
BAL 0.50
25 drinks
Respiratory failure
Assessment of substance abuse
What your using
How often are you using
How long have you been using
When was the first use
Alcohol can impair what organs?
Liver
Cardiac function
Wernicke encephalopathy
ACUTE
Thaimine deficit
Vision impairment, ataxia, hypotension, confusion
Korsakoff’s amnestic syndrome
CHRONIC
Heart, vascular, nervous system problems
Difficultly acquiring new info and retrieving memories
Wernicke-Korsakoff Syndrome
Amnesia
Confabulation
Alcohol withdrawal syndrome happens:
Usually within 12 hours after abrupt d/c
Symptoms of alcohol withdrawal syndrome:
Delirium tremen
Seizures
Elevated temp, pulse, and BP
A pt. is withdrawal from alcohol and starts having seizure activity. How would the nurse stage the withdrawal?
Stage 3 - Severe
Pt is withdrawal from alcohol and has a HR of 115. How would the nurse stage the withdrawal?
Stage 2 - Moderate
Pt is withdrawal from alcohol and has visual and auditory hallucinations. How would the nurse stage the withdrawal?
Stage 2 - Moderate
CAGE assessment
Screening for substance abuse problems
C - ever need to CUT down drinking
A - do you ever feel ANNOYED when people tell you to stop drinking
G - do you ever feel GUILTY about drinking
E - Do you need an EYE opener in the morning (Drink)
What is the first symptoms the nurse would notice on a pt. that is withdrawing form alcohol?
Elevation of heart rate, temp, and BP
Delirium Tremens
Hyperarousal Disoriented Hallucinations Tremors MOST SERIOUS: seizures
CIWA protocol
Clinical institute withdrawal of alcohol
Rating scale for symptoms: N/V, Tremors, Anxiety, Sweats, Agitation
Meds for alcohol withdrawal
Benzos
Antidepressants
Sleep meds
Antipsychotics
Relapse Px meds for alcohol:
Disulfiram
Naltrexone
What is important teaching for a pt. taking Disulfiram?
Do not drink anything with alcohol in it. Will make you very sick. You will vomit.
Ex. mouth wash, hand sanitizer, cough syrups
Naltrexone
Help reduce craving for alcohol and opioids
Do not admin Naltrexone unless pt. is clean for __-__ days
Do not admin Naltrexone unless pt. is clean for 7-10 days
Naltrexone is contraindicated in what kind of pt.?
Pregnant
Use cautiously in: acute hepatitis, liver failure, depression, SI, and breast feeding
Do not admin Disulfiram until the pt. is clean from alcohol for at least __ hour
Do not admin Disulfiram until the pt. is clean from alcohol for at least 12 hour
Alcohol nutrition teaching
Increase protein
Increase thaimine
Increase Folic Acid
Cocaine increases what neurotransmitters?
Increases: Dopamine, norepinephrine, serotonin
Cocaine rush
lasts 10-20 min followed by intense letdown effect:
Irritability, depression, tiredness, and craving more drug
Cocaine withdrawal with long term use
Long term depletion of norepinephrine > “ crash” and sleeping 12-18 hr.
Amphetamines block reuptake of what neurotransmitters?
Amphetamines block reuptake of norepinephrine and dopamine
MDMA (Ecstasy) increases what neurotransmitter?
MDMA (Ecstasy) increases serotonin and dopamine
Methamphetamines increases what neurotransmitter?
Methamphetamines increases dopamine
The term “binge and crash” is used for pt. that are addicted to this class of drugs?
Pt. that abuse methamphetamines “binge and crash”
Date rape drug
Rohypnol GHB
Marijuana binds to ___ receptors in the brain and blocks reuptake of ___ neurotransmitter?
Marijuana binds to mu receptors in the brain and blocks reuptake of dopamine neurotransmitter?
Severe reactions of Hallucinogens
Paranoia Fear of losing one's mind Depersonalization illusion Delusions Hallucination
Most abused opioid
Heroin
Naloxone
Emergency Tx of opioid intoxication or overdose
Maintenance therapy for drug withdrawal
Methadone therapy and behavioral therapy and counseling
Inhalants are CNS ___
Inhalants are CNS depressants
Severe risk with inhalant drugs
Severe risk for sudden sniffing death
Long term use of inhalant drugs can cause chronic __ __
Long term use of inhalant drugs can cause chronic neurological syndromes
Steroid can cause what symptoms?
Increases irritability and aggression
Mild withdrawal symptoms
Yawning Rhinorrhea Perspiration Restlessness Lacrimation Sleep disturbance Increased craving Anxiety Dysphoria
Moderate withdrawal Symptoms
Dilated pupils Bone and muscle aches Sensation of "goose flesh" Hot/cold flashes Irritability Increase anxiety and craving
Severe withdrawal symptoms
N/V Stomach cramps Diarrhea Insomnia Weight loss Twitching Increased BP, HR, RR Depression Anxiety Dysphoria
Withdrawal Assessment
Behaviors and substance use Hx Denial of prob Motivation for change Countertransference Codependence (Enabling)
Intense fear of gaining weight or becoming fat
Anorexia Nervosa
Two types of Anorexia Nervosa
Restricting
Binging and purging
Onset of Anorexia Nervosa
Early adolescence
Then becomes chronic with relapses
Interoceptive awarenes
Awareness to sensory cues to hunger
F and E complications of purging
Hypokalemia
Hypochloremia
Hypomagnesemia
Increased BUN
Med for Anorexia Nervosa
Fluoxetine (SSRI)
Interventions for Anorexia Nervosa
Journaling Understanding feelings Restructuring distortions Movement and dance therapy Imagery and relaxation Interpersonal therapy Pt. and family education
Criteria for hospitalization for Anorexia Nervosa
Acute weight loss < 85% HR near 40 Temp <36.1 BP < 80/50 Hypokalemia Hypophosphatemia Hypomagnesemia Poor motivation to recover SI Severe depression Failure to comply with Tx
Dichotomous/All-or-Nothing Thinking
“I’ve gained 2 lb, so I’ll be up by 100 lb soon.”
Magnification
“I binged last night, so I can’t go out with anyone.”
Selective Abstraction
“I can only be happy 10 lb lighter.”
Overgeneralization
“I didn’t eat anything yesterday and did okay, so I don’t think not eating for a week or two will harm me.”
Catastrophizing
“I purged last night for the first time in 4 months—I’ll never recover.”
Risk factor survey for Anorexia Nervosa
McKnight Risk Factor Survey
Bulimia Nervosa
Binging and purging in secret
Normal weight
Bulimia Nervosa diagnostic criteria
Episodes occurring at least once a week for at least 3 months
Difference between Bulimia Nervosa and Anorexia Nervose
Anorexia Nervosa: Severe weight loss and amenorrhea
Bulimia Nervosa - normal weight
Characteristics of Bulimia Nervosa
Impulsivity
Boundary probs
Limit-setting difficulties
Meds for Bulimia Nervosa
SSRIs
Assessment for Bulimia Nervosa
Eating patterns
# of times/day they binge or purge
Sleep patterns
Exercise
Interventions for Bulimia and Anorexia Nervosa
Strict I and Os
Supervision of bathroom visits
Sleep management
SSRIs
Binge eating disorder cirteria
Binge eating
distress about binge
Eating until uncomfortably full
Feelings of guilt or depression afterward
True/False: Prevalence of sleep wake disorders increase with age
True
parasomnia disorders
Sleep walking
Night terrors
Circadian disorder
Jeg lag
Work-Shift
Sleep wake transition disorders
Trouble starting sleep
sleep talking
When sleeping what neurotransmitters are involved?
GABA Adenosine Histamine Hypocretin Melatonin Cortisol
Sleep latency
Bedtime to the beginning of sleep
Sleep architecture
pattern of NREM and REM sleep
Sleep efficiency
Ratio of total sleep time to nocturnal time in bed
Cycle of sleep
1 > 2 > 3 > 4 > 3 > 2 > REM > 2 > 3 > 4 > 3 > 2 > REM
Where is the biological clock located?
Hypothalamus
When does restorative function happen when sleeping?
Stages 3 and 4
When does vivid dreaming happen when sleeping?
REM
How long does it take for NREM to start after falling asleep?
90 min
Fragmented sleep
Body response when deprived of REM and slow wave sleep debt
Deprivation of REM sleep can lead to:
Rebound effect
Insomnia diagnostic criteria
Daytime fatigue
Difficulty with concentration
Poor mood
No indication of other disorders
Insomnia often causes relapses is what mental disorders?
PTSD and depression
What is one major cause of insomnia?
Depression
What meds are used for pt with insomnia?
Benzos
Nonbenzos: Zaleplon (Sonata) and Ezopiclone (Lunesta)
Melatonin: Ramelteon
Antidepressants: Trazadone, amitriptyline, doxepin, mirazapine
OTC: Antihistamines
What nonpharm interventions can the nurse do for a pt. with insomnia?
Sleep hygiene
Diagnosis tool for sleep apnea
polysomnography
Primary Hypersomnia
Excessive sleepiness for at least 1 month with daytime sleep episodes OR sleeping extended periods at night
How long does a pt. with Primary Hypersomnia sleep?
8-12 hours
Symptoms of Primary Hypersomnia
8-12 hours of sleep Difficulty awakening Poor concentration and memory Excessive daytime sleepiness Napping
Diagnosis tool for Primary Hypersomnia
Polysomnography
Multiple sleep latency tests
Meds for Primary Hypersomnia
Dextroamphetamine and amphetamine mix Modafinil Methylphenidate Pemoline Caffeine Stimulants to help daytime sleepiness
Narcolepsy
Irresistible urge to sleep at any time of the day regardless of amount of previous sleep
Cataplexy
Bilateral loss of muscle tone
Symptom of narcolepsy
Symptoms of Narcolepsy
Daytime sleepiness
Hypnagogic hallucinations
Sleep paralysis
Cataplexy
Meds for Narcolepsy
CNS stimulants
TCAs - cataplexy
Restless Leg Syndrome
urge to move legs
worsens at times of rest
Chronotherapy
timed interventions, manipulates the sleep schedule by progressively delaying bedtime until acceptable time
Chronopharmacotherapy
Resets the biologic clock by using medications to induce sleep
Luminotherapy
(light therapy)
Used to manipulate the circadian system
Meds for Restless leg syndrome
Pramipexole
Rotigotine
Cabergoline
Gabapentin***
Prazosin is helpful when Tx what sleep disorder?
Nightmare disorder
also PTSD
Disorders of arousal meds:
Benzos
Exhibitionism
The behavior involves exposing one’s genitals to strangers, with occasional masturbation
Fetishism
An object such as women’s undergarments or foot apparel is used for sexual arousal. Fetishism usually begins in adolescence and continues throughout life.
Frotteurism
Sexually arousing urges, fantasies, and behaviors occur when touching or rubbing one’s genitals against the breasts, genitals, or thighs of a NONconsenting person. begins in early adolescence or young adulthood and diminishes with age.
Pedophilia
Sexual activity occurs with a child usually 13 yrs of age or younger by an individual at least 16 yrs of age or 5 yrs older than the child.
AGAINST THE LAW
Sexual masochism
This behavior involves the act of being humiliated, beaten, bound, or made to suffer. Self-induced masochistic acts include use of electric shock, pin sticking, restraints, and mutilation
Sexual sadism
Sexual excitement occurs when causing physical or psychological suffering to another individual. various forms of physical punishment, use of restraints, rape, burning, stabbing, strangulation, torture, and murder.
Transvestic fetishism
This behavior applies generally to the heterosexual man who cross-dresses for the purpose of sexual excitement.
Voyeurism
This behavior involves “peeping,” for the purpose of sexual excitement, at unsuspecting people who are nude, undressing, or engaged in sexual activity.
AGAINST THE LAW
zoophilia
sexual activities involving animals
necrophilia
sexual activities involving dead bodies
coprophilia
sexual activities involving feces
urophilia
sexual activities involving urine
partialism
sexual activities involving body parts
telephone scatalogia
sexual activities involving obscene telephone calls
A client has been diagnosed with erectile dysfunction. The nurse would expect the client to be placed on which of the following medications?
PDE5 Meds: sildenafil, vardenafil, tadalafil, and avanafil
Which of the following is a characteristic of Anorexia Nervosa?
a. ) Uncontrollable binging w/o compensatory behaviors
b. ) intense fear of weight gain
c. ) inappropriate compensatory behaviors
c. ) recurrent episodes of uncontrollable binging
B - intense fear of weight gain
Autism spectrum disorder (ASD)
Neurodevelopment delays with or w/o intellectual disabilities
Nurse is caring for a pt with autism spectrum disorder. What skill can the nurse expect the pt. to lack?
Social skills
May be intelligent and have appropriate language
What type of repetitive behaviors might be exhibited in a pt. with autism spectrum disorder
Rocking
Hand flapping
Interventions for autism spectrum disorder
Education of self-care skills Physical safety Admin antipsychotics for behavioral difficulties Focus on building strengths Positive reinforcement Structured environment Redirect Ignore repetitive behavior
ADHD commonly diagnosed at what age?
3-17
ADHD
Persistent pattern of inattention, hyperactivity and impulsiveity
ADHD is Tx with what kind of meds?
Psychostimulants Atomexetine Bupropion TCAs Alpha agonists
Pt. has ADHD and is taking psychostimulants for Tx. The pt came in last year for annual check up. This year the nurse will want to check for what SE of psychostimulants?
Assess height and weight
Psychostimulants can cause growth stunt
When should the psychostimulants be given?
Preferably in the morning w/ meals
A minimum of 6 hours before bedtime
Atomexetine used to Tx ADHD
SNRI
Taken in conjunction with psychostimulants
Assessments for alpha agonist used to Tx ADHD
Monitor BP
Stay hydrated
Avoid extreme high temps.
Where should a kid with ADHD do their homework?
a. ) At the kitchen table
b. ) A room with music playing quietly
c. ) on the couch
d. ) in a room by themselves
In a room by themselves - quiet and no distractions
Environment for ADHD
Predictable environment with decreased stimuli
One task at a time
Motor Tics
Quick jerky movements of the eyes, face, neck, and shoulders
Phonic tics
Repetitive throat clearings, grunting, or other noises or complex sounds such as words, or parts of words, or possibly obscenities
Tourette disorder
Multiple motor and phonic tics
OCD also frequently occurs
Affects boys more than girls
Onset: 7 yr.
What meds are used to Tx Tourette disorder
Antipsychotics - aripiprazole (2nd gen)
Alpha agonists - clonidine
True/False: Phonic tic come before motor tics
False - motor tics first
Schoolphobia
manifestation of anxiety
OCD Tx with what kind of meds?
SSRI
Enuresis
Bed wetting after potty training; regression
Encopresis
Fecal soiling after potty training; regression
Fecal deposition in inappropriate places
Test for Hirschsprung disease (colon died)
Desmopressin
Used for Tx of Enuresis
Does not cure disorder; acute control
Sexual maturation
4 areas: biosexual identity, gender identity, sex role identity, and sexual orientation
Biosexual identity
anatomic and physiologic states of being male and female
Gender identity
the conviction of belonging to a male or female gener
Sex role identity
outward expression of gender, including behaviors, feelings, and attitudes
Sexual orientation
a person’s sexual attraction to those f the opposite sex, same sex, or both sexes
Sexual desire
the ability, interest, or willingness to recieve or a motivational state to seek sexual stimulation
Masters and Johnson Classic Human sexual response cycle
4 phases: Excitement Plateau Orgasmic Resolution
Kaplan model of sexual response
3 phases:
Desire
Excitement
Orgasm
Anorgasmia
Inability to achieve an orgasm
Orgasmic disorder
The inability to reach orgasm by any means
Senate focus
Method for partners to learn what each finds arousing and learn to communicate those preferences
Premature ejaculation
Inability to control ejaculation before or shortly after penetration
Erectile Dysfunction
refers to the inability to acheive or maintain an erection sufficient for satisfactory completion of the sexual activity
Dyspareunia
genital pain associated with sexual intercourse
Vaginismus
Spastic involuntary constriction of the parineal and out vaginal muscles
Gender dysphoria
an incongruence between an individuals experience/expressed gender and assigned gender
Egocentrism
concept of imaginary audience and personal fable (they are special and unique)
Attachment
the emotional bond between an infant and his/her parental figure
Attachment disorganization
consequence of extreme insecurity that results from feared or actual seperation from the attached figure.
Temperament
person’s characteristic intensity, activity level, threshold of responsiveness
Easy temperament
positive mood, regular patterns of eating and sleeping, positive approach to new situations, and low emotional intensity
Difficult temperament
irregular sleep and eating patterns, negative response to new stimuli, slow adaptation, negative mood, and high emotional intensity
Slow to warm up temperament
negative, mildly emotional response to new situations that is expressed with intensity and initially slow adaptation but evolves into a positive response
What is the key diagnostic criteria for delirium?
Impaired consciousness
Aphasia
Alteration in language ability
Apraxia
Impaired ability to execute motor activities despite intact motor functions
Agnosia
Failure to recognize or identify objects despite intact sensory function
Disturbance of executive functioning
Ability to think abstractly, plan, initiate, sequence, monitor, and stop complex behavior
Hallmarks of alzheimer’s disease
Beta-amyloid plaques
Neurofibrillary tangles
What neurotransmitter is reduced in a pt. with alzheimer’s disease?
ACh - acetylcholine
Catastrophic reactions
overreactions or extreme anxiety reactions to everyday situations
Meds for Alzheimer’s Disease
Acetylcholinesterase inhibitors - inhibit enzymes that breakdown ACh Donepezil Galantamine Mementine Rivastigmine
What mental impairment in that occurs usually in older adults is an EMERGENCY?
Delirium
What major med can cause delirium?
Steroids
What physical disorder can cause delirium?
UTI**
Hypoglycemia
Hypoxia
True/False: The nurse should inform the family member of an Alzheimer’s pt. that things will only get worse
True but word it better lol
Sleep wake disturbance that occurs in Alzheimer’s
Sun downing
What is an intervention the hospital can implement for pt. with alzheimer’s trying to leave the hospital consitently
Put locks higher than eye level
Erikson’s Stage: Trust vs. mistrust
Infancy
Is my world safe
Feeding/comfort
Erikson’s Stage: Autnomy vs. shame/doubt
Early Childhood 2-3 years
Can I do things by myself or need I always rely on others?
Toilet training/Dressing
Erikson’s Stage: Initiative vs. guilt
Preschool 3-5 years
Am I good or bad?
exploration/play
Erikson’s Stage: Industry vs. Inferiority
School Age 6-11
How can I be good?
School/activities
Erikson’s Stage: Identity vs. Role Confusion
Adolescence 12-18
Who am I and where am I going?
Social relationships/Identity
Erikson’s Stage: Intimacy vs. Isolation
Young adult 19-40
Am I loved and wanted?
Intimate relationships
Erikson’s Stage: Generatively vs. Stagnation
Middle Adulthood 40-65
Will I provide something of real value
Work and parenthood
Erikson’s Stage: Ego identity vs. despair
Maturity 65 +
Have I lived a full life?
Reflection on life
Nuclear Family
2+ people living together and related by blood/marriage/adoption
Extended family
Several nuclear families
Calgary Family Model
Structure
Development
Functional
Four stages: engagement, assessment, intervention, and termination
Minuchin Family Model
Family structure
Subsystems
Boundaries
Bowen Family System Model
Differentiation of self Triangles Family projection Emotional process Multigenerational transmission process Sibiling position Emotional cutoff
Examples of using coercion and threats
Threatening to leave, commit suicide, hurt her
Make her drop charges or do illegal things
Examples of using intimidation
Making her afraid by using looks, actions, gestures
Smashing things, destroying property, abusing pets. displaying weapons
Examples of using economic abuse
Preventing her from getting/keeping a job
Making her ask for money
Taking her money
Not letting her have access to money
Examples of using male priviledge
Treating her like a servant
Master of the castle
Making all big decisions
Examples of emotional abuse
Putting her down Making her feel bad Calling names Playing mind games Humiliating her Making her feel guilty
Examples of using isolation
Controlling what she does, reads, or sees, where she goes, limiting outside involvement
Examples of using children
Making her feel guilty about the children
Using children to rely messages
Threatening to take the children away
Examples of minimizing, denying, and blaming
Making light of the abuse and not taking her concerns about it seriously
Saying the abuse doesn’t happen
Saying she caused it
Stalking
Repeated unwanted contact, attention, and harassment
Sexual assualt
Include any form on nonconsenting sexual activity, ranging from fondling to penetration
Child maltretment
Includes all type of abuse or neglect of a child under 18
Intergenerational transmission of violence
Theory suggests that children who witness or experience violence in their homes often perpetuate violent behavior
