Exam 3- mental health Flashcards
Anxiety-
feeling of
normal-
provides
Feeling of apprehension, uneasiness, or uncertainty resulting from a Real or perceived threat
Normal is healthy for survival
Provides energy needed to do tasks-
how is anxiety Different from fear-
however
fear is reaction to specific danger-
however the body will react in similar ways
Mild anxiety-
normal
allows
normal experience of everyday living
allows an individual to perceive reality in sharp focus.
physical symptoms Mild anxiety
d
r
i
discomfort
restlessness,
irritable
mild anxiety
__ information
what’s more effective
Sees, hears, and grasps more information,
problem solving is more effective.
Moderate-
what for information
sees , hears, and grasps less information
Moderate anxiety
demonstrates
ability
problem solving
demonstrates selective inattention,
ability to think clearly is hampered,
problem solving is not optimal
s/s moderate anxiety
heart
increased x2
p
voice
s
pounding heart,
increased hr and rr,
perspiration
, voice tremors
shaking
Mild/moderate level interventions-
help pt
antipate
use non
encourage
avoid closing
ask pt
help pt identify anxiety
anticpate anxiety proviking sitautions
use nonverbal language like eye contacnt
encourage pt to talk about feelings
avoid closing off avenues that are important to pt
ask pt to clarify
Mild/moderate level interventions-
help pt
encourage p
help develop
explore b
provide other
help pt identify what is onset of anxiety
encourage problem solving
help develop alternative solutions
explore behaviors that have worked in the past
provide other outlets for working off excess energy
Severe-
what’s reduced
may not notice what
what problem solve
perceptual field is greatly reduced.
May not notice what’s going on in the environment,
not possible to problem solve///
Severe anxiety s/s
h
n
d
what heart
hyper
headache,
nausea,
dizziness,
trembling and pounding heart,
hyperventilation
Panic-
extreme
unable
extreme level of anxiety,
unable to process environment,
s/s panic anxiety
p
r
s
s
w
possible
what movements
pacing,
running
shouting,
screaming
withdrawal
possible hallucinations,
uncoordinated movements
interventions severe/panic anxiety
maintain
always
minimize
use what statemetns
use what voice
reinforce
maintain a calm manner
always remain with person
Mimize enviromntal stimuli
use clear and simple statements
use low pitched voice
reinforce reality
interventions for severe/panic anxiety
listen for
attent to
set
provide
offer
assess need for
listen for themes
attend to physical needs
set limits
provideoppurtinnites for ecxercise
offer high calorie foods.
Assess need for meds and seclusion
Defenses against anxiety
adaptive
maladaptive
Adaptive- used to lower anxiety and achieve goals in a healthy way- like deep breathing, mediation, walks
Maladaptive-when several defenses are used in unacceptable ways like alcohol, smoking, anger
Altruism
motivaton
- motivation to feel caring and concerns for others
Compensation
counterbalances
- counterbalances perceived deficiencies by emphasizing strengths
Conversion
transforms
- transforms anxiety into a physical symptom- like becoming blind
Denial
escaping
- escaping unpleasant thoughts and feelings by ignoring existence
Displacement
transfer
- transfer of emotions from one person into another person that is not involved in the situation
Dissociation
disruption
- disruption of consciousness, memory or identity of environment
Identification
attributing
attributing one groups charactiestics into your own
Intellecualzation
events
- events are analyzed based on cold hard facts instead of using emotions
Projection
unconscious
- unconscious rejection of emotionally unacceptable features and attributing them to others-
Rationalization
justifying
- justifying unreasonable acts by developing explanations that satify the teller
Reaction formation-
defense
defense mechanism that involves behaving in a way that is the opposite of how someone actually feels
Regression
reverting
- reverting to an earlier and more primitive childlike pattern
Repression
unconscious
- unconscious exclusion of unpleasant expeiernces from conscious awareness
Splitting
inability
- inability to integrate positive or negative qualities into image
sublimation
unconscious
- unconscious process of transforming negative impulses into less damaging and productive impulses
like getting angry and going for a run
undoing
person
- person makes up for regrettable acts
Suppresion
delay
- delay addressing a disturbing emotion or feeling
Panic Disorders-
sudden
associated w
have what for reality
feels like what
sudden onset of extreme apprehension or fear,
associated with impending doom
have misintepteations of reality,
feel like they are alosing mind or having a heart attack
Separation anxiety
develop
what age in children
- develop inapprorate level of concern when away from significant other
occurs 8 months -2 yrs
Social Anxiety disorder-
sever anxiety or fear provoked by exposure to a social or performance situation
Generalized anxiety disorder-
excessive
huge
might also
what’s common
excessive worry-
huge amounts of time are spent preparing for situations
might also put things off and avoidance may result in lateness
sleep disrubances are common
Generalized anxiety disorder-
short term goal
to state immediate distress and relieve immediate distress
Generalized anxiety disorder
medium trem goal
pt will identify precipitants of anciety by specific date
Generalized anxiety disorder
long term is
pt will identify strengths and coping skills
Agoraphobia –
excessive
fear of
excessive anxiety about being in a place where escape isn’t possible or help might not be available
- fear of open spaces
OCD
when
they
severe does what
- when obsessive behaviors continue on a daily basis-
they interfere with daily routine
severe takes over the persons entire life
Body Dysmorphic Disorder-
have
will
false
have a preoccupation with body parts that they belveie to be ineffective
will check very often
false assumptions about the importance of their appearance
Hoarding Disorder
-when trying to get rid of things becomes extremely distressing and hard to get rid of things
Trichotillomania –
hair pulling disorder
Excoriation disorder
– skin picking disorder
Substance-induced anxiety disorder-
develop when
obsessions and compulsions that develop with use if substance within a month of stopping the subtance
phobias examples
Acrophobia Heights
Agoraphobia Open spaces
Astraphobia Electrical storms
Claustrophobia Closed spaces
Glossophobia Talking
Hematophobia Blood
Hydrophobia Water
Monophobia Being alone
Mysophobia Germs or dirt
Nyctophobia Darkness
Pyrophobia Fire
Xenophobia Strangers
Zoophobia Animals
Cognitive Therapy-
combines cognitive therapy with behavioral therapies,
to reduce anxiety response
Modeling- therapy
someone
someone acts as a role model to demonstrate appropriate behavior
Systemic desensitization
pt
- pt is gradually introduced to a. Feared object or experience through a series of steps
Flooding exposes
exposes the pt to large amounts of undesirable stimulus
Thought stopping-
negative
negative thought or obsession is uninterrupted by staying stop out loud
Response prevention-
used for
doesn’t allow
used for compulsive behaviors-
doesn’t allow pt to do obsessive behaviors like keep washing hands over and over again
Relaxation Techniques
yoga
guided imagery
therapy
walking
breathing excercises
cognitive reframing
reassessing
reassessing situation by replacing beliefs with a more positive outlook
Posttraumatic Stress Disorder (PTSD)
f
avoidance
numbing
difficulty
Flashbacks
Avoidance of stimuli
Numbing of responsiveness
Difficulty in interpersonal relationships
PTSD
what is hardest thing
can lead to
watch for
Trust is hardest thing w thest pts.
Can lead to abuse of spouses or of chemicals
Watch for safety for self /others/thelselves
OCD
obsessions
compulsions
interferes with
Obsessions - thoughts/images that persist
Compulsions – ritualistic behaviors a person does to reduce anxiety
Interferes with daily life- will always worry about things like doors and lights
Common obsessions and compulsions
losing
h
unwanted
p
v
c
s
Losing control and religious concerns
Harm
Unwanted sexual thoughts
Perfectionism
Violence
Contamination
superstitions
Non-Suicidal Self Injury
attempts
Deliberate/direct attempts to cause bodily harm that does not result in death
non suicidal self injury examples
cutting
burning
scraping skin
biting
hittinh
skin picking
interfering with wound healing
non suiocidal self injury
prevalence
gender
biolodigcal factors
societal factors
Prevalence- 2 million cases annualy
Gender – females
Biological Factors-brain disoerders
Societal Factors-isolation from others and negative self worth
nursing interventions for non suicidal self injuries
assess x2
care for
establish
teaching what
watch for
assess how it happened/suicide risk
care for wounds
establish therapeutic communication
teaching coping skills
watch for ability to have devices of harm
Pt teaching meds
do not
avoid
take
no
how long
Do not drive or operate heavy machinery.
Avoid alcohol or sedating medications.
take w food
no caffeine
takes 2-4 weeks
Medications used for anti-anxiety-
Benzodiazepines
Antidepressants
Tricyclics
MAOIs
Anticonvulsants
Antihistamines
Beta Blockers
Major Depression Disorder
leading
interferes w
may have
not a
leading cause of diasiblity
Interferes with social, occupational, causes disability
May have delusions and hallucinations
Not a result of aging
Depression risk factors
what gender
what childhood
what eveents
who has it
what conditions
what use
female
adverse childhood
stressful events
family has it
chronic conditions
substance use
other depressive disorders
Substance/Medication-Induced Depressive disorder
Depressive disorder due to another Medical Condition
Premenstrual Dysphoric Disorder
Disruptive Mood Dysregulation Disorder
Depression and the Seasons known as Seasonal affective disorder (SAD)
Depression and Grieving
dominating symptom in children
older adults at more risk for what
depression
children- irritbility
older adults at risk for not being diagnosed
appearance assessment
Major depressive disorders
a
slowed
what posture
what mood
looks
may look/ unable to
Affect-how they are on outside
Thought Process- slowed
Poor posture
Mood-Worthlessness
Looks older then they are
May look sad/be unable to cry
Major depressive disorders assessment for feelings
g
h
h-what risk
a/I
may experience
Guilt
Helplessness-inability to carry out simple tasks- adls
Hopelessness (Suicide Risk!)
Anger/Irritability- may hurt others
May experience delusions/punish themselves for those feelings
Major depressive disorders assessment physical behavior
psychomotor
what’s neglected
changes in __habits
changes in __patters
loss of
what’s impaired
may have
Psychomotor retardation or agitation
Grooming is neglected
Changes in eating habits
Changes in sleeping patterns
Loss of libido
memory is impaired
may have difficulty in making decisions
Major depressive disorders assessment communication/speech
speaks
can become
speaks about
Speak slow
Can become mute
speaks about failure
Major depressive disorders Interventions
what assessmnet
waht techniques
promotion on what
what management
Risk for Suicide Assessment
Counseling and Communication Techniques
Promotion of self-care
Milieu Management
subsuicide behaviors
anything that hurts them like drugs/ alcohol etc
guidelines for communication with severely withdrawn person(catatonic/ vegetative state)
do what when pt is silent
use what words
allow
listen for
avoid
when the pt is silent - make observations
use simple concrete words
allow time to respond
listen for covert messages
avoid platitudes like things will go up
Guidelines for counseling people with depression-
help pt
identify
help pt
encourage
encourage
provide
Help pt question underlying assumptions and beliefs
identify what is resulting in negative self impression
Help pt identify coping skills
Encourage exercise
Encourage relationships
Provide referrals
SSRI-fluoxetine/ sertraline
se
a
I
h
/
dysfunction
hypo
agitation
insomnia
headache
n/v
sexual dysfunction
hyponatramia
SNRI- duloxetine
se
n
mouth
reduced
s
vision
nausea
dry mouth
reduced appetite
sweating
blurred vision
TCA- amitriptyline, doxepin
mouth
what gi
retention
what vision
bp
cardiac
s
dry mouth
constipation
urinary retention
blurred vision
hypotension
cardiac toxicity
sedation
MAOI- isocarboxazid, phenelzine
se
I
n
a
c
crisis
insomnia
nausea
agitation
confusion
hypertensive crisis
foods that interrupt with MAOI
veg
fruit
what meat
what fish
what dairy
what supplements
s
what sauce
veg-avocado
fruit-figs
smoked meats
dried fish
dairy- cheese
protein supplemetns
soup
soy sauce
SSRI family teaching
may cause
no what
avoid
what tests
do not
may cause sexual dysfunction
no over the counter drugs
avoid alcohol
liver/renal tests
do not drive or operate machinery
serotonin syndrome- SSRI-report immediately
increase in
skin
rapid
throat
difficulty
temp
what food
unusal
what behavior
severe
increase in depression
skin rash/hives
rapid heartbeat
sore throat
difficulty urinating
fever
anorexia/ wt loss
unusual bleeding
hyperactive behavior
severe headache
adverse reactions to moai
bp
s
changes in
muscle
retention
weight
hypotension
sedation
changes in cardiac rhythm
muscle cramps
urinary retention
wt gain
toxic effects of maoi
what crisis
severe
hr
/
hypertensive crisis
severe headache
tachycardia
n/v
nutrition Interventions for vegetative state
offer
encourage
include
weigh
offer small high calorie foods
Encourage family to participate
Include pt in deciding meals
Weigh pt daily
provide
encourage
encourage
provide
Sleep Interventions for vegetative state
Provide periods of rest
Encourage pt to dress and stay out of bed
Encourage relaxation measures
Provide decaff coffee and soda
Self care deficits
encourage
when
Interventions for vegetative state
Encourage use of toothbrush, washcloth/ adl supplies
When appropriate, give step by step reminders
monitor
offer
encourage
evaluate
Elimination Interventions for vegetative state
Monitor I /0
Offer high fiber foods
Encourage intake of fluids
Evaluate need for laxatives
assess for what in trouble sleeping (what use/ daytime/ normal)
always assess for what
depression assessment
assess for caffeine use / daytime naps and normal sleep patters
always assess for a suicide risk
Major depressive disorders Treatments
what remission rate
how many per week for how many treatments
uses what
what’s induced
takes how long
Electroconvulsive Therapy
70-90% remission rate
2-3 treatments per week for 6-12 treatments (depends on pt)
EEG monitors brain waves and ECG monitors cardiac
Brief seizures are induced
Takes 15 minutes
pt after electrocionsvuslive therapy
pt may be
what for a few weeks
will need
Patient maybe confused afterwards,
memory deficits may last a couple weeks
Will need someone to drive home
internal stimulating therapy’s
v stimulation
d stimulation
Vagus Nerve stimulation
Deep Brain stimulation
External stimulating therapy
r
L
e
E
Repetitive Transcranial magnetic stimulation
Light therapy
Exercise
ECT
Bipolar I
1// alternating
may be
1 episode of mania alternating with major depression
May be psychotic with mania
epidemiology bipolar
men more likely to
More likely to have legal problems and commit violence
women more likely to
bipolar
More likely to abuse alcohol, commit suicide, thyroid disorders
comobridities bipolar
__attacks
__ abuse
_phobia
what illnesses
Panic attacks
Alcohol abuse
Social phobia
chronic illnesses
etiology bipolar
biological
psychological
environmental
Biological
Genetic predisposition
Psychological
Stressful events
Environmental
Upper, socioeconomic status
Higher incidence with higher education
bipolar assessment
moods
m
I
g plans
Mania- unstable- pts feels euphoric/ overjoyed but then…..
Irritable transitions quickly into irritation
Grandiose plans-more details then necessary
Bipolar assessment behavior
what’s emergency
extravagant
what life
constant
what behavior
what self esteem
how do they dress
Mania = emergency!
Extravagant spending,
social life
, constant activity
Risky behavior
Inflated self esteem
Dress bizzare
Thought Process and speech patterns assessment bipolar
pressured speech->
circumstantial speech->
tangental speech
loose ___
flight __
__ association
Pressured speech-sense of urgency when talking
Circumstantial speech-adds unnecessary information
Tangential speech-lose point and never goes back to original topic
Loose associations-lack of connection between ideas
Flight of ideas- change ideas fast
Clang associations –words that rhyme
Thought Content
grandiose delusions- is what
Persecutory delusions- is what
what function
assessment bipolar
Grandiose delusions-belief that one is famous/wealthy
Persecutory delusions- belief that someone is attempting to harm them
Cognition Function
Nursing self-assessment
Pts can be
pts are also
Pts can be very manipulative
pts are also very energy consuming
Staff-splitting
a
I
p–p
bipolar
Anger
Isolation
Power-plays
bipolar assessment
if
need for p
need for h
status
knowledge
assess if danger to self/others
need for protection from behaviors like spending money
assess need for hospitalization
medical status
family knowledge
interventions bipolar
set
c
c
what is key
Set limits
Collaboration- work as a team
Communication
Consistency is key for these pts
acute phase bipolar
what
what is priority
injury prevention
priority- medical stabilization and safety// I and o, sleep and rest, self control of thoughts, no self harm
continuation phase bipolar
what
what is priority
relapse prevention
What is the priority? Educate them and families, med compliance, knowledge of disease, s/s of relapse, support groups
maintenance phase bipolar
what
what is priority
Relapse prevention
Lessen severity and duration of future episodes
Pt and family teaching bipolar
what causes relapse
what is critical to stability
what is important
what is helpful
keep what accessible
Use of alcohol, drugs caffeine can cause a relapse
Good sleep is critical to stability
Coping strategies are important for dealing with life
Group therapy is helpful
Keep phone numbers is easily accessible place
lithium bipolar indications
what ideas
m
a
what behavior
flight of ideas
manipulation
anxiety
self injurious behavior
early signs of toxicity
1.5-2.0
s/s
what uspet
hand
c
intervention-what x2 med
gi upset
hand tremor
confusion
intervention- withheld med and revelate med
advanced signs of lithium toxicity
2.0-2.5
s/s
vision
urine
c
g
interventions- x2
blurred vision
large amounts of urine
coma
giddiness
intervention- stop drug potential bowel irrigation
severe lithium toxicity
>2.5
s/s
c
o
d
intervention-above + d
convulsions
oliguria-producing no urine
death
intervention- above+ dialysis
takes how long to be effective
checked how often
then checked how often
lithium bipolar
maintenance
takes 7-14 days to be effective
checked every 2-3 days until levels are reached,
then checked every 3-6 months
lithium bipolar
contraindications
pts with cardiovascular disease, brain damage, renal disease, pregnancy
atypical antipshyotocs
what effects
mood
help prevent
Sedative effects
Mood stabilizing
Help prevent mania relapse
Lithium teaching
monitor what
maintain
maintain what electrolyte
be screened for
Monitor levels closely
Maintain consistent fluid levels
Maintain consistent sodium levels
Be screened for organ diseases before taking
Lithium teaching
take w
may what
give
how get off
want
Take with meals
May gain wt
Give referral
Taper doses gradually
Want adherence to plan
communication interventions for mania
use what approach
use what explanations
be what
identify expectations how
act on what
redirect what
use firm and calm approach- come with me)
use short/ concise explanations
be consistent
identify expectations in simple , concrete terms
act on legitmaiate complains
redirect energy into more appropriate channels
safe milieu interventions for mania
maintain
provide what activities
provide what periods
redirect what
store
maintain low level of stimuli
provide structured activites
provide frequent rest periods
redirect aggressive behavior
store valuables until rational behavior continues
nutrition interventions bipolar
montior
offer what drinks
offer what foods
remind pt
montior I/o
offer high calorie protein drinks
offer finger foods
remind pt to eat
sleep interventions bipolar
encourage
keep pt in what area
do what at nights
encourage frequent rest periods
keep patient in low stimualtion area
night- warm baths and soothing music
hygiene/elimination bipolar
encoaurage
step
offer what food/drink
encourage approiarte clothes
step by step reminders
offer fluids/high fiber foods
suicide
feelings of
p
h
h
pain, hopelessness and helplessness.
what Ages
waht gender
what social support
what diagnosis
what medical illness
what abuse-
suicide assessment
Age over 60 or adolescents
gender males
social support - single or divorced or widowed
diagnosiso depression or scizo
medical illness0 chronic
abuse- substances
Evaluation suicide
contracts
verbalizes f
verbalizes desire
verbalizes absence
demonstates
involved
contracts no self harm
verbalizes feelings openly
verbalizes desire to live
verbalizes absence of suicidal ideation
demonstrates hope
involved in daily life
Assess for what in suicide-
m
t
a
c
method,
timing,
availability,
chance of rescue.
limit what
c
close
e s
suicide interventions
limit access to means
contract with client
close observation
emotional support
involve who
watch
continuously
suicide assessment
involve family and friends
watch for cues
Continuously reassess and revise plan as needed
warning factors -immediate risk of suicide
talks
expresses
increased
dramatic
what behavior
cues- suicide
Talks about death
Expresses no reason of living
Increased substance use
Withdrawal
Dramatic mood changes
Reckless behavior
Risk factors-more likely to consider
previous
use of
what disorder
access
hx
what illness
cues- suicide
Previous attempts
Substance use
Mood disorder
Access to lethal means
Hx of abuse
Chronic illness
Protective factors-makes it less likely that they commit
effective
strong
m
contact
problem
cues- suicide
Effective mental healthcare
Strong connections to family
Marriage
Contact w providers
Problem solving skills
Difference between overt and covert
Overt is like I cant take it anymore
Covert is like everything will be fine soon
Preventing suicide
implement
promote
report
reduce
provide
Implement research designed to prevent suicide
promote wellness
Report high risk of suicide
Reduce access to lethal means
Provide care
nursing repsosbilities for 1-1 observation
how often per day
how often chart
ensure meal has no
when sleeping
observe for
24 hrs a day-dont let them out of sight
chart every 15 minutes
ensure meal has no glass/metal
when sleeping hands needs to be in veiw
observe for pt to swallow all meds
1 thing you always need to do and always need to assess for
RISK for suicide assessment
environmental guidelines for suicidal behavior
use what/ count
use what in shower
electrical cord length
do what to rooms
search visitors for what
search pt when
use plastic utensils /count them
breakaway shower rods and nozzles
electrical cord minimal length
lock all other rooms
why search pt if they are allowed to leave
why search visitors
search for harmful objects if allowed to leave
visitors can accidenelty bring in a gift or have items that may harm pt- like nail file, vase, shoelaces
