Exam 3 Study Guide: Q (part 1) Flashcards
negative symptoms of schizophrenia
o anergia
o anhedonia
o aphasia
o ataxia
loss of energy
anergia
inability to experience pleasure
anhedonia
loss of speech
aphasia
loss of fully bodily movements
ataxia
o cannot be explained medically and are associated with psychosocial distress
o the individual persistently focuses on the seriousness of the physical symptoms
somatic symptoms disorder
S/S of somatic symptom disorder
o heightened emotionally
o anxiety
o strong dependency needs
o a preoccupation with symptoms and oneself
o substance abuse issues are common
o an inability to cope (self perception)
nursing interventions for somatic symptom d/o
planning and implementation
o relief of discomfort from the physical symptoms
o assistance to determine strategies for coping w/stress other than preoccupation with physical symptoms
o helping client cope with stress
treatments for somatic symptom disorder
o individual psychotherapy
o group psychotherapy
o cognitive behavior therapy (CBT) and psychoeducation
o psychopharmacology
what are some interventions for patients with OCD
do not stop compulsions unless it is life threatening-compulsions are a way for them to cope with their anxiety
the client has a perceived/believed defect; they will seek to alter this defect through means such as plastics procedures -
most common complaints involve perceived defects in skin, such as wrinkles or scars; the shape or size of the nose; or hair
body dysmorphic disorder
what do patients with body dysmorphic disorder seek to remove
o wants to cure the imagined defect
o if true defect is present, the person’s concern is unrealistically exaggerated and grossly excessive.
o they will seek to alter this defect through means such as multiple procedures
lacks interest or concern (about their symptom that seem very serious to others)
La Belle Indifference
diagnositc critieria for Dissociative Identity Disorder (DID - formerly multiple personality disorder)
o existence of two or more personalities in a single individual
S/S of body dysmorphic disorder
preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others
“faking symptoms” (an act - not psychological condition)
o people might do it to avoid military service or jury duty
o do it for personal gain or to escape personal responsibility
malingering
“faking symptoms”
o conscious, intentional feigning of physical and/or psychological symptoms
o formerly known as Munchausen Syndrome
o mental health condition with no clear cause
facticious disorder
side effect so Bupropion
the only psychotropic medication that does not have some sexual side effect
what determines the length of time a psychiatric facility can hold a patient
determined by state law
what are positive symptoms of schizophrenia
o anything created or amplified by schizophrenia
disturbances in thought content, though process manifested in speech, or disturbances in perception
what are negative symptoms of schizophrenia
anything taken away or reduced by schizophrenia
disturbances in affect, lack of interest/skills in interpersonal interaction, lack of abstract thinking, waxy flexibility, regression, pacing/rocking, and abnormal eye movements
what are the side effects of SSRIs
WOF: increased risk of suicide
o feeling agitated, shaky or anxious
o feeling or being sick
o indigestion
o diarrhea or constipation
o loss of appetite and weight loss
o dizziness
o blurred vision
o dry mouth
what type of therapies will help a client with anxiety
o individual psychotherapy
o cognitive behavior therapy
o behavior therapy
o other nonpharmacological treatments (deep breathing exercises, progressive muscle relaxation, guided imagery, mindfulness meditation, and exercise)
o pharmacotherapy (anxiolytics, antidepressants, antihypertensive agents)
what are common coping behaviors of a person with acute anxiety (short term)
o socially withdrawn
what are some interventions for a client experiencing a severe panic attack
o offer reassurance of safety
o remain calm
o use simple explanations
o administer tranquilizers/medications as ordered
S/S of social anxiety disorder
o excessive fear of situations in which a person might do something embarrassing or be evaluated negatively
S/S of general anxiety disorder
o chronic
o fatigue
o insomnia
o irritability
o excessive anxiety and worry
o for at least 6 months
S/S of illness anxiety disorder (hypochondriasis)
o unrealistic or inaccurate interpretation of physical symptoms or sensations
what is hypertensive crisis
o severe increase in blood pressure that can lead to a stroke
o extremely high blood pressure - greater than 180/120
o caused when patients taking MAOI - antidepressant consume foods high in tyramine
most serious form of thiamine deficiency in alcoholic patients
wernicke’s encephalopathy
syndrome of confusion, loss of recent memory, and confabulation in alcoholic patients
korsakoff’s psychosis
a disease in which the body doesn’t have enough vitamin B-1 (thiamine)
beriberi
what is the purpose of the COWS scale
opioid withdrawal symptoms
what is the purpose of the CIWA scale
alcohol withdrawal symptoms
o high risk condition for those who regularly drink large quantities of alcohol
o reduced level of platelets in the bloodstream
thrombocytopenia
unhealthy coping mechanisms
o disruption of individual integrity or persistent disequilibrium
maladaption
how does genetics play a role in a client’s vulnerability to alcoholism
o genetics account for 40-60% of person’s vulnerability to alcoholism
o children of alcoholics are 4x more likely to become an alcoholic
occurs within 4 - 12 hours of cessation of or reduction in heavy and prolonged alcohol use
alcohol withdrawal
phase 1 of alcohol withdrawal
8 hours;
o anxiety
o insomnia
o nausea
o abdominal pain
phase 2 of alcohol withdrawal
1 - 3 days
o hypertension
o pyrexia
phase 3 of alcohol withdrawal
1 week
o hallucination
o fever
o seizure
o agitation
on exam:
if person starts wandering/goes to a new place and forgets things - dissociative fugue
what is dissociative fugue
specific subtype of dissociative amnesia
o wandering to places and forgetting autobiographical information
o inability to recall some or all of one’s past
o may be caused by underlying severe psychosocial distress
what is conversion d/o
a loss of or change in body function that cannot be explained by any known medical disorder or pathophysiological mechanism
o it is difficult to diagnose and is unconsciously triggered
groups at risk for conversion disorder
o lower socioeconomic groups
o rural populations
o less education
o military personnel exposed to combat situations
examples of conversion disorder
o paralysis
o aphonia
o seizures
o difficulty swallowing
o urinary retention
o blindness
o deafness
o false pregnancy
what are the effect of prolonged exposure to stress in the body
o leads to decreased immune response and resistance to disease
o psychological stress can affect medical conditions
o exhaustion stage of selye’s general adaptation syndrome
what is maladaptive response to stress
o when behavior disrupts the integrity of the individual
o maladaptive coping generally increases stress and anxiety, with examples including self-harm, binge eating, and substance abuse
what difference is noted in a patient diagnosed with panic disorder compared to someone with GAD?
depersonalization - derealization
symptoms:
o anxiety
what is the criteria to diagnose someone with a panic attack?
at least four of the following symptoms must be present to identify the presence of a panic attack
o palpitations, pounding heart, or accelerated heart rate
o sweating
o trembling or shaking
o sensations of SOB or smothering
o feelings of choking
o chest pain or discomfort
o nausea or abdominal distress
o feeling dizzy, unsteady, lightheaded or faint
o chills or heat sensations
o paresthesias (numbness or tingling sensations)
o derealization (feelings of being detached from oneself)
o fear of losing control or going crazy
o fear of dying
what is phobia
an irrational fear of specific object or situation resulting in an intense aversion toward the feared stimulus
what are indications of risperidone
o positive and negative symptoms of schizophrenia
o relief of psychotic manifestations in other disorders such as bipolar
what is assessed on an MSE
o observations
o mood
o cognition
o perception
o thoughts
o insight
o behavior
o judgement
vital sign monitoring is not included in the actual MSE; it is a separate intervention
what manifestation is unique to patients who are bipolar and abusing substances
on top of the other manifestations, patient will most likely be malnourished and not maintaining ADLs properly
S/S of acute stress disorder
o exposure to traumatic events causes anxiety, detachment, and other manifestations about the event
at least 3 days but no longer than 1 month
how to manage patients going through benzodiazepine overdose/toxicity
o priority nursing intervention: assess level of consciousness since benzo are CNS depressants
o check they are alert and oriented
what are important points of eye movement desensitization and reprocessing therapy
○ Form of therapy which allows experiences that are causing problems to be “digested” and stored appropriately by the brain.
○ While concentrating on a particular emotion or physical sensation surrounding the traumatic event, the patient is asked to focus his or her eye movements on the therapist’s fingers as the therapist moves them from left to right and back again.
what is AIMS used for
side effects of antipsychotics
(abnormal involuntary movements)
for patients in the psychiatric unit, which symptoms or indicators need the providers immediate attention after medication
o extrapyramidal symptoms
o agranulocytosis (clozaril therapy)
o neuroleptic malignant syndrome
o hormonal changes
what is given to prevent or eliminate antipsychotic side effects
o anticholinergics (benztropine or benadryl)
which types of clients would benefit from group therapy
o somatic symptom disorder
o dissociative identity disorder
o schizophrenia
o agoraphobia
o fear of the marketplace
o fear of being in open public places, but more specifically, is defined as the fear of being vulnerable and unable to get help or escape the setting
agoraphobia
treatments of agoraphobia
o do not benefit from ECT
o thought stopping (process of suppressing, or pushing away unwanted thoughts - cognitive behavioral)
o flooding (vivo exposure therapy)
medications used for alcoholics
o disulfram (antabuse)
- - can produce a good deal of discomfort for the individuals
symptoms:
o flushed skin
o throbbing in the head and neck
o respiratory difficulty
o dizziness
o nausea and vomiting
o confusion
o hypotension
o tachycardia
what is used to prevent/treat wernicke’s encephalopathy
thiamine
vitamin B1
which drug does not have sexual side effects
bupropion/buspar
What are important points with the first 2 phases of schizophrenia?
o Phase I-Premorbid Phase
§ Personality and behavior indicators:
· Shy and withdrawn
· Poor peer relationships
· Poor school performance
· Antisocial behavior
§ Current research is focused on the premorbid phase to identify potential biomarkers and at-risk individuals in an effort to prevent transition to illness or provide early intervention.
o Phase II-Prodromal Phase
Person starts showing significant deterioration in function
50 percent have depressive symptoms
Social withdrawal
Cognitive impairment
Obsessive-compulsive behavior
Recognition of the behaviors associated with the prodromal phase provides an opportunity for early intervention with a possibility for improvement in long-term outcomes
This phase can be brief, but most studies indicate that the average length of the prodromal phase is between 2 and 5 years
What are important points with the last 2 phases of schizophrenia?
o Phase III-Active Psychotic Phase
Psychotic symptoms are typically prominent- hospitalization required
Delusions
Hallucinations
Disorganized speech and behavior
Decreased level of functioning in work, personal relationships, or self-care
o Phase IV-Residual Phase
Active psychotic phase symptoms are either absent or no longer prominent.
Positive symptoms may remain.
Flat affect and impairment in role functioning are common.
Current research indicates that negative symptoms can improve over time; residual impairment often increases with additional episodes of active psychosis
what disorder has physical symptoms that suggest medical disease but which have no organic pathology
somatic disorder
the phase in schizophrenia where patient manifests active positive symptoms
phase 3
active phase
a client comes in with signs of alcoholism and substance abuse.
as a nurse, you know that genetics accounts for ____% of the client’s vulnerability to alcoholism
40-60%
this occurs when an individual’s physical or behavioral response to any change in his or her internal or external environment results in disruption of individual integrity or in persistent disequilibrium
maladaptation/maladaptive coping skills
what type of delusion is this:
“the government is watching everything i do”
persecutory delusion
what are those that reflect a decrease in normal functions
(functions that have been “taken away”) by the illness?
is it the positive or negative symptom of schizophrenia
negative
what is fear cued by a specific object or situation in which exposure to the stimulus produces an immediate or intense anxiety response
phobia
the nurse is educating the parents of a child diagnosed with schizophrenia on how to reply when their child experiences auditory hallucinations.
which is the nurse’s best reply
ask what the voices are saying
“i havent left my house for six years”
this client is demonstrating a hallmark trait of those that are afraid of other environments and situations that might cause panic or helplessness.
what is this type of disorder?
agoraphobia
o experiences fear of being in places or situations from which escape might be difficult or in which help might not be available if panic symptoms should occur
this medication will make the client ill with any alcohol exposure to the body orally or otherwise, this medication has many side effects, clients may need to take this medication for months or more
disulfram
antabuse
clients who have ___________ constantly worry and presents with too much anxiety about the presence of a serious illness even though medical tests do not support this concern
illness anxiety disorder
warren’s college roommate actively resists going out with friends whenever they invite him.
he says he cant stand to be around other people and confides to warren “they wouldnt like me anyway”
which disorder is warren’s roommate likely suffering from
social anxiety
o excessive fear of social situations related to fear that one might do something embarrassing or be evaluated negatively by others
positive or negative symptom
hallucinations and paranoia
both positive
