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concepts 4 > final > Flashcards

final Flashcards

1
Q

abuse

A

deliberate mistreatment of a person

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2
Q

subcategories of abuse

A

physical abuse

sexual abuse

psychological/emotional or verbal abuse

child abuse

elder abuse

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3
Q

prof responsibilities related to abuse

A

public health act

adult guardianship trustee

public guardianship act

child, family, community service act

criminal code of canada

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4
Q

why would you call the police if you suspect someone is at immediate risk (criminal code)

A

(criminal code)

  • suspect crime has occurred, might occur, or someone is exhibiting behaviour indicating a lack of wellbeing and unpredictability
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5
Q

for neglect/abuse, why would you call the adult guardianship act

A
  • concerned that an adult is being abused, neglected, or is self neglecting and is unable to seek support and assistance due to (physical restraint, physical handicap limiting ability, an illness affecting ability to make decision)
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6
Q

financial legal risk, why would you call public guardian and trustee

A

adult is not capable of managing financial and legal affairs & imminent risk to assets (under duress and going along with decisions they don’t agree with, financial mismanagement)

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7
Q

vulnerable groups for abuse

A
  • ppl with psych disorder
  • LGBTQ2+
  • ppl in care
  • immigrants
  • children & youth
  • intimate partners
  • older adults
  • indigenous ppl
  • ppl with disabilities
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8
Q

why are women reluctant to identify their abuser

A
  • fear retaliation against themselves or children
  • may hold strong feelings toward partners or family members, despite abuse
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9
Q

women abuse

A

domestic abuse, spousal abuse, or intimate partner abuse

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10
Q

stalking/harassment

A

crime of intimidation, involved behaviour that occurs over a period of time, and which causes individuals distress or fear

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11
Q

battering

A

repeated physical or sexual violence with the intent of coercive control

associated with anxiety, SI

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12
Q

risk of violence increases w/ prego and can result in harm to unborn baby

A

true

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13
Q

rape & sexual assault

A

any form of nonconsenting sexual activity, ranging from fondling to penetration

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14
Q

risk factors for elder abuse

A

environmental risk (caregiver who is depressed, overwhelmed, burnt out)

inadequate economic resources

cognitive impairment

lack of empowerment

difficulties with ADLs

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15
Q

types of abuse for older adults

A

physical, emotional, sexual, financial, neglect, over medicating, under medicating, restraining, secluding

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16
Q

self neglect

A

Vulnerable adults who neglect themselves are unwilling or unable to do needed self-care. This can include such things as: Not eating enough food to the point of malnourishment. Wearing clothes that are filthy, torn, or not suited for the weather.

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17
Q

sexual assault and age of consent

A
  • 16 consent (kissing to intercourse)
  • 18 years where sexual activity involves exploitative activity when it occurs in a relationship of authority, trust, or dependency
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18
Q

exemptions for sexual assault and consent

A

Exceptions: Persons under16years can have consensual sex with someone close in age.

12-13year old (two-year age difference)

14-15year old (five-year age difference)

These exceptions only apply if the older person isnotin a position of authority or trust and there is no exploitation or dependency.

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19
Q

consent is

A

voluntary agreement to engage in sexual activity or contact

absence of “no” does not mean “yes”

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20
Q

consent is feeling

A

willing, certain, comfortable, sober, informed, respected

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21
Q

consent is not feeling

A

pressured, confused, scared, drunk or high, ignored, disrespected

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22
Q

is it the responsibility of the person initiating sexual activity to establish consent

A

YES

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23
Q

cycle of abuse phases

A
  1. tension building
  2. violence erupts
  3. remorse ensues
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24
Q

tension building phase

A
  • minor incidents
  • perp total control of victim (psych/emotional)
  • isolates victim
  • monitor victim activities
  • degrades victim
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25
Q

violence erupts

A
  • severe injury
  • victim may incite violence as way to control mounting terror
  • period of calm follows battering
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26
Q

remorse ensues

A
  • perp becomes kind, loving - begging for forgiveness & promise to never inflict violence again
  • tension builds; cycle repeats
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27
Q

why do people stay in abusive relationships

A
  • economic/financial dependence
  • societal, cultural, religious
  • fear of retaliation, threats, harassment
  • mental health problems (depression/PTSD)
  • violence occurs once relationship established
  • history of trauma & abuse
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28
Q

traumatic bonding

A

strong emotional ties between 2 people, one of whom intermittently abuses the other

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29
Q

biological effects of abuse

A
  • mild injuries (bruises/abrasions of head, neck, face)
  • severe injuries (multiple traumas, fractures, lacrations, loss of vision, hearing)
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30
Q

common mental health responses of biological effects of abuse

A

major depression, acute stress, PTSD, dissociative identity disorder

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31
Q

psychological effects of abuse

A

low self-esteem

guilt & shame

anger

problems with intimacy

revictimization

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32
Q

PTSD related symptoms

A
  • hyperarousal & hypervigilance
  • intrustive thoughts, flashbacks, memory impairment
  • avoidance & numbing
  • anhedonia
  • dissociation
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33
Q

rpn role in identifying abuse

A
  • assessment (what to look for)
  • causes? (medical, environment)
  • look at what to rule out first
  • don’t get hung up on diagnosis
  • take all complaints of abuse seriously
  • safety
  • duty to report
  • referrals
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34
Q

barriers to assessing for abuse include

A

perceived insufficient time

lack of understanding or knowledge

ensuring privacy of client

discomfort with asking questions about abuse

not knowing what to do once disclosure occurs

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35
Q

competent adults hvae the right to choose how they live, they can decline or refuse treatment, services, or resources despite living at risk (t/f)

A

true

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36
Q

rpn role with competent adults and abuse

A
  • recognize potential victims
  • report suspected abuse to social worker
  • establish safety and trust
  • assess for injuries, urgency of situation, abuse, neglect, self-neglect
  • document your findings and interventions
  • do not announce / no information client
  • empower survivors
  • collab approach
  • respect client’s choice, remain nonjudgemental
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37
Q

binge eating

A

episodes of uncontrolled eating of large amounts of food within discrete periods of time followed by feelings of guilt and purging behaviours

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38
Q

body dissatisfaction

A

belief that one’s current body size differs from a highly valued ideal body size and deserves negative appraisal

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39
Q

dietary restraint

A

cognitive effort to restrict food intake for the purpose of weight loss or prevention of weight gain

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40
Q

interoceptive awareness

A

sensory response to emotional and visceral cues such as hunger

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41
Q

maturity fears

A

feeling overwhelmed by adult responsibilities (underlying issues for ppl with anorexia)

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42
Q

purging

A

compensatory behaviour to rid oneself of food already eating by means of self-induced vomiting or use of laxatives, enemas, diuretics

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43
Q

psych characteristics relating to eating disorders

A
  • diff expressing anger
  • low self-esteem
  • body dissatisfaction
  • powerlessness
  • ineffectiveness
  • obsessiveness
  • compulsiveness
  • non-assertiveness
  • cognitive distortion
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44
Q

common eating disorder warning signs

A
  • constant dieting
  • rapid, unexplained weight loss
  • obsession with calories, food, nutrition
  • taking laxatives or diet pills
  • going to bathroom right after meals
  • eating alone, at night, or in secret
  • hoarding high calorie food
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45
Q

anorexia nervosa

A

life threatening eating disorder characterized by refusal to maintain body weight appropriate for age, intense fear of gaining weight or becoming fat, a severely distorted body image, and refusal to acknowledge seriousness of weight loss

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46
Q

psychological characteristics specific to AN

A
  • decreased interoceptive awareness
  • sexuality conflict
  • maturity fears
  • ritualistic behaviours
  • perfectionism
  • dietary restraint
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47
Q

anorexia subtypes

A

restricting, binge eating/purging

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48
Q

restricting AN

A

restricting dietary intake

during current episode of AN, person does not binge or purge

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49
Q

binge eating/purging AN

A

during current episode of AN, the person engages in binge-eating and purging behaviours

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50
Q

whats the difference between BN & binge/purge AN

A

b/p AN person is severely under weight and has symptoms characteristics of AN in addition to b/p

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51
Q

MHA and eating disorders

A

pt only certified for MEDICAL reasons, otherwise voluntary on eating disorders unit or outpt

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52
Q

assessment for eating disorders

A

history

collateral

LABS

VS

insight/judgement

weight, appearance, lifestyle, triggers

recent changes?

MSE/ HTT

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53
Q

Labs for AN

A

low LH, FSH. T3, RBS
high GH, cortisol

anemia

thrombocytopenia

hypercholesterolemia

hypophosphatemia

electrolyte imbalance

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54
Q

reasons for admission for AN

A

medical = weight loss, physiological instability, severe dehydration

symptoms of starvation = electrolyte imbalance, syncope, seizures, HR < 40bpm, cardiac BMI < 16

psychiatric = SI, psychosis, OCD, family dysfunction, lack of improvement, decreased functioning

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55
Q

communication strategies for AN

A
  • rapport/trust
  • be direct
  • be encouraging & supportive
  • defuse shame, blame, guilt
  • understand eating disorders as a coping mechanism against internal/external stressors
  • collab TR
  • use medical information to enhance motivation for change
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56
Q

interventions during hospital stay for AN

A

-monitor and record all intake
- start with low caloric intake
- monitor and adjust fluid, electrolyte, vitamin, mineral requirements based on labs
- supplemental enteral feeds when indicated

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57
Q

evaluation for AN

A
  • closely monitor and evaluate outcomes of interventions
  • full weight restoration is biggest factor for full recovery
  • continued monitoring and assessment of symptoms following discharge to prevent or mitigate relapse
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58
Q

refeeding syndrome

A

due to metabolic and hormonal changes that occur due to aggressive nutritional rehabilitation

at risk with enteral or parenteral feeds

experience potentially fatal shifts of fluids & electrolytes

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59
Q

risk after refeeding (electrolyte imbalances)

A

hypophosphatemia, hypokalemia, hypomagnesemia

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60
Q

symptoms of hypophosphatemia

A

hypotension, seizures, anemia, resp distress

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61
Q

symptoms hypokalemia

A

delirium, resp distress, tetany, decreased DTRs

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62
Q

symptoms hypomagnesemia

A

seizures, anemia, gi symptoms, hypocalcemia

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63
Q

common symptoms of electrolyte imbalances

A

arrhythmias, neuromuscular disturbances, weakness, lethary, paresthesias

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64
Q

a surge of what causes electrolyte imbalances?

A

surge of insulin from hte increased ingested carbohydrates and an abrupt shift from fat to carbohydrate metabolism

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65
Q

preventing risk of refeeding

A
  • start low and go slow when starting increased cal intake
  • monitor pt presentation (VS, symotims, lab work)
  • adjust fluid, electrolyte, vitamin based on lab work
  • provide thiamine & multivitamin
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66
Q

BN

A

individual engages in recurrent epsiodes of binge eating and compensatory behaviour to avoid weight gain through purging methods such as self-induced vomiting or laxatives

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67
Q

psychological characteristics specific to BN

A

impulsivity, boundary problems, limit-setting difficulties, dietary restraints

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68
Q

binge purge cycle

A

dietary restraint <–> hunger <–> binge eating <–> shame, humiliation, failure <–> dieting/purging via vomiting etc

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69
Q

risk factors for BN

A

dieting tends to be predisposing factor of BN for vulnerable ppl

food/eating sometimes becomes a coping mechanism to deal with stress and negative emotions which can lead guilt/shame and worry about weight gain leading to binge/purge cycle

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70
Q

BN & hospitalization

A

dehydration, electrolyte imbalance, depression, SI

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71
Q

assessment BN

A
  • assess eating patterns
  • # of times/day binge/purge
  • sleep pattern
  • oral health
  • exercise
  • triggers
  • dysfunctional behavioural & thought patterns
  • knowledge gaps
  • MSE, HTT, lab work
  • risk assessment
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72
Q

priority care issues for BN

A
  • comorbid conditions of depression, anxiety, substance misuse, BPD, risk for SI

risk for self harm

high levels of impulsivity (shop lifting, overspending)

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73
Q

assessing BN specific symptoms

A
  • lack of control over eating
  • secrecy surrounding eating
  • eating unusually large amounts of food
  • disappearance of food
  • alternating between overeating and fasting
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74
Q

purging symptoms

A
  • going to the bathroom after meals
  • using laxatives, diuretics
  • smell of vomit
  • excessive exercising
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75
Q

concern for purging

A
  • purging removes electrolytes
  • low electrolytes cause cardiac arrhythmias
  • cardiac arrhythmia can cause death
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76
Q

interventions for BN

A
  • TR
  • assertiveness, limit setting, boundaries
  • discuss feelings & emotions
  • trauma informed
  • address distorted thinking with CBT
  • encourage self monitoring to doc binge/purge cycle
  • psychoeducation
  • healthy sleep & coping patterns
  • fluoxetine for symptom remission
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77
Q

psychoeducation checklist for BN

A
  • psychopharm agents
  • binge/purge cycle & effects on body
  • nutrition & eating patterns
  • hydration
  • avoidance of cues
  • cognitive distortions
  • limit setting
  • appropriate boundary setting
  • assertiveness
  • resources
  • realistic goal setting
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78
Q

evaluation for BN

A
  • early detection
  • monitor behaviours & thinking patterns
  • encourage self care & healthy lifestyle
  • monitor comorbid conditions & symptoms
  • watch for signs of relapse
  • remain nonjudgemental & accepting
  • encourage emotional regulation & healthy interpersonal connections
  • provide resources
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79
Q

binge eating disorder

A

clinical eating disorder characterized by frequent consumption of very large amounts of food, coupled with feelings of being out of control, ashamed and disgusted by eating behaviour, and experiencing high body dissatisfaction

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80
Q

assessment for BED

A
  • assess current binge eating patterns and triggers
  • assess associated symptoms of gastric distress
  • assess physical mobility, activity, and sleep patterns
  • assess for cognitive distortions and knowledge gaps
  • assess for symptoms of comorbid psych disorders like mood
  • MSE & HTT
  • risk assessment
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81
Q

priority care issues for BED

A

comorbid obesity, overweight, depression, anxiety can contribute to cardiac and other health crises

risk of type 2 diabetes is significant

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82
Q

behavioural symptoms of binge eating and compulsive overeating

A
  • inability to stop eating or control what eating
  • rapidly eating large amounts of food
  • eating even when your full
  • hiding or stockpiling food to eat later in secret
  • eating normally around others, but gorging when ur alone
  • eating continuously throughout the day, with no planned mealtimes
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83
Q

emotional symptomsof binge eating and compulsive overeating

A
  • stress or tension that is only relieved by eating
  • embarassment over how much eating
  • feeling numb while binging
  • never feeling satisfied
  • feeling guilty, disgusted or depression after overeating
  • desperation to control weight and eating
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84
Q

interventions for BED

A
  • TR
  • feelings & emotions
  • trauma informed
  • address distorted thinkning with CBT
  • encourage to record intake, binges, and emotions
  • pharm for weight loss treatment
  • establishing healthy sleep and coping patterns
  • psychoeducation
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85
Q

10 strategies for overcoming binge eating

A
  • manage stress
  • eat 3 meals a day + healthy snacks
  • avoid temptation
  • stop dieting
  • exercise
  • fight boredom
  • get enough sleep
  • listen to your body
  • keep a food diary
  • get support
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86
Q

pica

A

eating non-food, non-nutritive over period of month

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87
Q

rumination disorder

A

repeated regurgitation of food over period of 1 month

regurgitated food may be re-chewed, re-swallowed, or spit out

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88
Q

avoidant/restrictive food intake disorder

A

persistent failure to meet appropriate nutritional and/or energy needs associated with:

  • sig weight loss
  • sig nutritional deficiency
  • dependence on enteral feeding or oral nutritional supplements
  • marked interference with psychosocial functioning
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89
Q

purging disorder

A

recurrent purging behaviour to influence weight or shape

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90
Q

night eating syndrome

A

recurrent epiosdes of night eating, as manifested by eating after awakening from sleeo or by excessive food consumption after the evening mea;

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91
Q

personality

A

complex pattern of characteristics, largely outside the person’s awareness, that compose the individuals distinct and enduring patterns of perceiving, feeling, thinking, coping, and behaving

emerges from hte complicated interaction of biological dispositions, psychological experiences, and environmental situations

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92
Q

personality traits

A

persistent patterns of perceiving, thinking, feeling, and behaving the shape the way in wihch a person responds to hte world

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93
Q

temperament

A

recognizable, distinctive, and relatively stable patterns of individual differences that are evident in early life

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94
Q

5 key traits of personality

A

openness to experience (O) = being imaginative and creative, inventive, open to unusual ideas, adventure, and nonconformity

conscientiousness (C) = responsible, careful or diligent

extraversion (E) = talkative, energetic, assertive, and outgoing

agreeableness (A) = ooperative, polite, kind, and friendly

neuroticism (N) = emotional instability, irritability, anxiety, self-doubt, depression, and other negative feelings

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95
Q

personality disorder

A

diagnosis when the perceptions, emotions, cognition, and behaviours of an individual substantially deviate from cultural expectations in a persistent and inflexible way, causing distress or impairment

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96
Q

contributing factors to personality disorder

A

genetic, epigenetic, neurobiological, trauma, stress, environment

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97
Q

common features of personality disorders

A
  • impaired metacognition
  • maladaptive emotional response
  • impaired self-identity and interpersonal functioning
  • impulsivity and destructive behaviours
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98
Q

cluster A

A
  • odd, eccentric

includes: paranoid, schizoid, schizotypal

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99
Q

cluster B

A

dramatic, unpredictable

includes: antisocial, borderline, histrionic, narcissistic

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100
Q

cluster C

A

anxious, fearful

includes: avoidant, dependent, obsessive-compuslive

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101
Q

cluster A characteristics

A
  • not see on ward
  • tend to be socially isolative, with lack of social supports
  • might simply be odd/eccentric
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102
Q

treatment for cluster A

A
  • psychotherapy most effective to improve quality of life (can be diff to TR, careful to adapt to pt verbal/nonverbal)
  • medications XX not effective
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103
Q

cluster B characteristics

A
  • only hospitalizaed when in acute phase of disorder (crisis) or for co-existing medical/psych condition
  • can be seen in acute inpt settings for brief interventions
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104
Q

antisocial

A

disregard for rights of others that begins in childhood/early adolescence

sneaky, impulsive, deceitful behaviours with no remorse

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105
Q

narcissistic

A

grandiosity with need for admiration and lack of empathy for others

preoccupied with competence, power, and prestige

often envious of others with a sense of entitlement and will exploit others to meet their needs

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106
Q

histrionic

A

excessive need for approval and desire to be the center of attention

often animated, dramatic, seductive, or flirtatious

feels relationships are closer than what they may be

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107
Q

borderline

A

poor self image/identity with an abnormal level of mood swings

chaotic and unbalanced in their interpersonal relationships with fear of abdondonment

will swing from worshipping someone to demonizing

high levels of impulsive behaviours

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108
Q

treatment for cluster B

A
  • best = counselling & therapy (DBT), psychoeducation, healthy living
  • consistent and supportive approach is important, boundaries, assertiveness, acceptance, and limit setting
  • developing safety plans, preventing and treating self harm
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109
Q

characteristics of BPD

A
  • affective instability
  • identity disturbances
  • unstable relationships
  • cognitive dysfunction
  • dysfunctional behaviours (impaired problem solving, impulsivity, self harm)
  • risk SI
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110
Q

behavioural patterns in BPD

A
  • emotional vulnerability
  • self invalidation
  • unrelenting crisis
  • inhibited grieving
  • active passivity
  • apparent competence
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111
Q

psychoeducation checklist BPD

A
  • manage medications
  • regular sleep routines
  • nutrition
  • safety measures
  • functional vs dysfunctional behaviours
  • cognitive strategies
  • structure and limit setting
  • social relationships
  • community resources
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112
Q

all or nothing thinking

A

tendency to see things in black&white categories, with no shades of grey

seen in extremes (very good/very bad)

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113
Q

overgeneralization

A

assumption that one error/problem means a lifetime of the same error/problems

“if i lose this job, i will never succeed in making a living”

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114
Q

mental filter

A

filtering out the good things that happen and retaining only the negative

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115
Q

magnification/minimization

A

over exaggeration of fears, imperfections, or errors

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116
Q

jumping to conclusions

A

concluding things that are not justified based on available evidence

(includes mindreading & fortune telling)

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117
Q

labelling

A

putting a negative label on yourself or others, a way to believe that no one can change

“my roommate is a slob, i have to tidy everything”

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118
Q

personalization and blame

A

making yourself feel responsible for things out of your control

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119
Q

should/must statements

A

thinking in terms of “should” and “must”

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120
Q

discounting the positive

A

refusing to credit the positive aspects of situations

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121
Q

emotional reasoning

A

believing something must be true becuase one “feels” it so strongly, ignoring any evidence to hte contrary

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122
Q

avoidant

A

avoids others and activities, fears rejection, feels inhibited and inept

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123
Q

dependent

A

passive, indecisive, fear loss of approval, difficulty doing things alone, fails to assume responsibility

124
Q

obsessive-compulsive

A

perfectionist, controlling, inflexible, overconscientious, stubborn, miserly

125
Q

treatment for cluster c

A
  • treated in community, best group therapy
  • cbt to deal with cognitive distortions, emotional reasoning, and personalization
  • utilize strength-based approach
  • take time to develop TR
  • medications (anxiolytics & antidepressants)
126
Q

overall treatment for personality disorders

A
  • difficult to “treat” a personality
  • medications CANT “cure” personality but can help treat other conditions that often accompany depression, anxiety
  • counselling and skills to manage emotions
  • CBT & DBT
127
Q

sheas signal signs

A

observable behaviours and styles of interaction

128
Q

sheas signal symptoms

A

clients reported complaints

129
Q

assessment & management paranoid PD

A

prominent feature: distrust, suspicion

experience of illness: heightened sense of fear and vulnerability

problematic behvaiour in medical: fear clinician may cause harm, arugements, conflict

management strategy: provide clear explanations, empathic to fear, avoid direct challenge to paranoid ideation

130
Q

assessment and management of schizoid

A

prom features: social detachment, emotional restriction

experience of illness: anxiety because of forced contact with others

prob behav in medical setting: delay seeking care, appear unappreciative

management strategy: prof stance, clear explanations, avoid over involvement in personal and social issues

131
Q

assessment and management of schizotypal

A

prom features: odd beliefs, socially isolative

experience of illness: odd interpretation of illness, anxiety because of forced contact with others

prob bx in medical setting: delay seeking treatment, odd beliefs, odd behaviours

management strategy: prof stance, clear explanations, tolerate odd beliefs and behaviours, avoid over involvement in personal and social issues

132
Q

assessment and management of antisocial

A

prom features: disregards rights of others

experience of illness: anger, entitlement masking fear

prob behaviour in medical setting: anger, impuslivity, deceit, manipulative bx

management: carefully investigate concerns and motives, communicate in clear and nonpunitive manner, set clearlimits

133
Q

assessment and management of BPD

A

pro features: instability in interpersonal relationships, self image, and affects, marked impulsivity

experience of illness: terrifying fantasies about illness

prob bx in medical setting: fear of rejection and abandonment, self destructive acts, idealiztion and devaluation of clinican

managemnet: avoid excessive familiarity, schedule regular visits, provide clear explanations, tolerate angry outburst but set limits, maintain awareness of personal feelings

134
Q

histrionic assessment and management

A

prom features: excessive attention-seeking behaviour, emotionality

experience of illness: threatened sense of attractiveness and self-esteem

prob bx: overly dramatic, attention seeking, inability to focus on facts and details, somatization

management: avoid excessive familiarity, show prof concern for feelings, emphasize objective issues

135
Q

somatization

A

medical symptoms with no identifiable organic cause

136
Q

narcissistic assessment and management

A

prom features: grandiosity, need for admiration, lack of empathy

experience of illness: anxiety caused by doubts of personal adequacy

prob bx: demanding, attitude of entitlement, denial of illness

management: validate concerns, give attention and factual responses to questions, channel pt’s skills into dealing with illness

137
Q

avoidant assessment and management

A

prom features: social inhibition d/t fear of rejection

experience of illness: heightened sense of inadequacy, low self esteem

prob bx: withholds information, avoids qting, disagrees with tx team

management: provide reassurance, validate concerns, encourage reporting of sx & concerns

138
Q

dependent assessment and management

A

prom features: excessive need to be taken care of, submissive and clinging behaviour

experienceof illness: fear of abandonment, helplessness

prob bx: urgent demands for attention, prolongation of illness bx to obtain care

management: provide reassurance, schedule regular check ups, set realistic limits, enlist others to support pt, avoid rejection

139
Q

obsessive compulsive assessment nad management

A

prom features: preoccupation with orderliness, perfection, control

experience of illness: fear of losing control of bodily function and emotions

prrob bx; fear of relinquishing control, excessive pting and attention to details, anger about disruption of routines

management strateguy: complete hx, provide explanations, do not overemphasize uncertainity, encourage participation in treamtent

140
Q

psychotherapy

A

type of talk therapy with focus on helping client become aware of their thought patterns which is believed to allow the individual to have better control over them

141
Q

psychoanalytic therapy

A

type of talk therapy with the focus on uncovering and resolving unconscious emotions and memories

142
Q

psychoeducation

A

type of therapy with the focus on helping client understand their condition and ways in which they can be treated

143
Q

common tx for paranoid

A

psychotherapy

144
Q

commontx for schizoid

A

cbt, group therapy

145
Q

common tx for schizotypal

A

psychotherapy, cbt, group therapy

146
Q

common tx for antisocial

A

psychoanalytic, cbt

147
Q

common tx for BPD

A

dbt, cbt, group, family, mindfulness and acceptance based treatments

148
Q

common tx for histrionic

A

psychotherapy

149
Q

common tx for narcissistic

A

psychotherapy

150
Q

common tx for avoidant

A

psychoanalytic, cbt, group

151
Q

common tx for dependent

A

psychotherapy, cbt, dbt, group

152
Q

common tx for obsessive-compulsive

A

cbt

153
Q

mindfulness

A

assists in disengaging the automatic pilot allowing the person to explore their thought patterns

154
Q

5 core elements of mindfulness

A

attention (receptivity) & awareness (being deeply self-aware and self-monitoring)

present centeredness (being in the moment)

external events (the outer milieu’s impact on the mind and body)

cultivation (fostering of tranquility and insight)

ethical mindfulness (social awareness)

155
Q

benefits of mindfulness

A

learn to accept yourself and experiences

experience peace and freedom

live life more fully

156
Q

acceptance based tx

A

involves being aware and acknowledging your experiences

157
Q

2 main things about acceptance based tx is

A

1 = acknowledge the feeling, experience

2 = identify ways to cope with said feeling or identify ways to change it

158
Q

cognition

A

the mind

perception, thinking, language

159
Q

emotions

A

how we react, feel, behave

160
Q

3 components of emotions

A

physiological changes

subjective feelings

associated behaviour

161
Q

cbt

A

psychotherapy focused on identifying, analyzing, and ultimately changing the habitually inflexible and begative cognitions about oneself, others, and the world that contributes to distress and problematic behaviours

162
Q

cbt is effective for

A

depression & anxiety

163
Q

cbt is used for PD but is not the 1st choice

A

true

164
Q

10 principles of cbt

A
  • evolving cb formulation of pt
  • requires TR
  • emphasizes collab & participation
  • goal oriented & problem focused
  • emphasizes present
  • educative & emphasizes relapse prevention
  • time limited
  • structured
  • teaches how to identify, evaluate, & respond to dysfunctional thoughts
  • variety of techniques to change thinking, mood, behaviour
165
Q

3 levels of cognition

A

core beliefs

intermediate beliefs

automatic thoughts

166
Q

core beliefs

A

core knowledge structure that hold, organize, and interpret information about ones view of self, others, and the world

167
Q

intermediate beliefs

A

attitudes, rules, or expectation, and assumptoms that influence one’s perception, affect, and behaviour

168
Q

automatic thoughts

A

the knee-jerk or initial and most superficialand accessible response

169
Q

cognitive restructuring

A

cognitions (automatic thoughts, core beliefs) are identified, analyzed, and modified to effect positive change in mood and behaviour

170
Q

dbt

A

combines numerous cognitive and behavioural strategies

requires pt to understand their disorder by actively participating in formulating tx goals by collecting data about their own behaviour, identifying tx targets in therapy, and work with the therapist in changing these behaviours

171
Q

pre tx dbt

A

goals: orient dbt, identify goals, enhance motivation and commitment

interventions: individual dvt

172
Q

stage 1 dbt

A

commitment, safety, stability

173
Q

stage 1 dbt targets

A

life threatening bx

serious therapy interfering bx

severe quality of life interfering bx

174
Q

stage 1 dbt interventions

A

individual dbt

skills training

phone coaching

175
Q

stage 2 dbt

A

symptom reduction

176
Q

stage 2 dbt targets

A

trauma

eating disorders

anxiety disorders

mood disorders

177
Q

stage 2 dbt interventions

A

individual dbt

skill training

phone coaching

dbt consultation team

178
Q

stage 3 dbt

A

regulating emotions through acceptance and change (REACH)

179
Q

stage 3 dbt targets

A

low self esteem

relationship difficulties

difficulty with problem solving

inadequate quality of life

180
Q

cognitive reframing

A

identifying and challenging situations or thoughts

181
Q

self harm cycle

A

emotional suffering –> emotional overload –> panic –> self harm –> temp relief –> shame/grief

182
Q

why do people self harm

A
  • manage intense/uncomfortable feelings (release tension)
  • communicate how one feels
  • have control (obtain control over body, SH to feel normal)
  • punish oneself
183
Q

managing self-harming behaviours

A
  • delay: wait for period of time before harming
  • ride the wave: acknowledge urge, use distractions to redirect thoughts
  • call support person
  • call crisis line
  • avoid drugs/alcohol
  • grounding
  • challenge thoughts: address thinking errors with CBT
  • harm reduction
  • PRNs
184
Q

non-harmful ways to manage self harm

A
  • write down feelings
  • punch something soft
  • scream into pillow
  • go for walk
  • play a sport
  • bite into something spicy
  • squeeze stress ball
  • snap elastic band
185
Q

interventions in hospital for SH

A
  • rapport
  • TIP
  • MSE, safety, risk
  • triggers, strengths, stressors
  • explore alternative coping mechanisms
  • safety planning
186
Q

12 tips to provide support to help victims of abuse

A
  • no judgements
  • encourage conversations
  • respond with patience, support
  • keep things private
  • be there regardless of excuses, rejection
  • reassure them ths is not their fault
  • do not assue the abuse is not that serious
  • le t them make their own decisions
  • provide practical support
  • help them rebuild themselves
  • do not mediate
  • look after yourself
187
Q

what types of assessments tools for abuse

A
  • abuse assessment tool
  • danger assessment tool
188
Q

can you document abuse on your own judgement

A

NO, pt has to confirm abuse – document findings

189
Q

interventions for pt abuse

A
  • safe environment
  • treat injuries
  • support clinet in verbalizing experiences
  • assist the clinet in identifying their sterngths
  • psychoeducation on coping
  • education on self protection & when to get help
  • refer to psychotherapy
  • safety planning
190
Q

clients must be ifnormed that there is increase risk of violence and homicide if abuser finds resources, safety plans, leaving bags

A

TRUE

191
Q

encourage client to hide documents and store in a safe secure place

A

TRUE

192
Q

things to bring when someone is leaving

A

money, keys, extra clothes, medicine, important documents, passports, unpaid bills, personal protective orders

193
Q

services available for abuse

A

crisis line

kids help phone

ministry of children and family development

ACT adult abuse

194
Q

sexual health

A

state of physical, emotional, mental and societal well being r/t sexuality, it is not merely the absence of disease, dysfunction

195
Q

goals of sexual education

A

assist individuals to achieve positive outcomes (self esteem, respect, rewarding sexual relationships)

avoid negative outcomes (pregnancy, stds)

196
Q

sexuality

A

central aspect of being human throughout life, and encompasses sex, gender identity and roles, sexual orientation, eroticism, pleasure

197
Q

factors that can affect sexuality

A
  • societal & cultural expectations
  • family expecctations
  • hx trauma
  • stages of development
  • support systems
  • stressors and responsibilities
198
Q

sexual orientation

A

who your attracted too

199
Q

gender identity

A

personal sense of being male or female

200
Q

sexuality intervention/health promotion

A
  • provide sex education
  • teaching self examination
  • educating on responsible sexual behaviour
  • providing privacy during intimate body care
  • provide acceptance and respect to body, appearance, choice of dress, identity, name
201
Q

gender diverse

A

gender roles & expression that do not match societal expectations

202
Q

gender expresssion

A

how one outwardly shows gender through name, dress, voice

203
Q

gender dysphoria

A

discomfort/distress that is caused by a discrepancy between a person’s gender identity and that person’s gender assigned at birth

204
Q

in most children, gender dysphoria will resolve without intervention prior to or early in puberty

A

TRUE

205
Q

goal of treatment for gender dysphoria

A

help the individual find the gender role and expression that they are comfortable with

206
Q

treatment options for gender dysphoria

A

individual counselling

education & resource management

family & couple therapy

support groups

207
Q

puberty blockers

A

supresses puberty to prevent development of secondary sex caracteristics

allows person & support system time to determine long-term plan

208
Q

hormone therapy

A

individualized, based on hte pt goals, risk/benefit ratio, and medical

209
Q

rpns play a supportive role in the process of working with gender dysphoria but are not considered experts and require additional education for formal interventions

A

TRUE

210
Q

transaffirmative practices of nurses

A
  • knowledge that sexual & gender diversity exists on continuum
  • awareness of how one’s attitude toward and knowledge of gender identity affects care
  • understanding how stigma and discrimination affect the health
211
Q

what to do if you make a mistake with pronouns etc

A
  1. apologize briefly
  2. use the correct term
  3. move on
212
Q

10 tips for trans inclusion

A
  1. language
  2. manners (do not discuss persons transgender status)
  3. focus on what pt wants/asking for
  4. policies
  5. confront - safe space
  6. paperwork - make sure inclusive
  7. know & tell - asking about personal infrmation, share why you need to know beforehand
  8. empower
  9. be creative
  10. advocate
213
Q

ulcerative colitis

A

autoimmune disease

chronic inflammation & ulcers inner lining of colon & rectum

214
Q

does ulcerative colitis affect small intestin

A

no

215
Q

with UC, what develop & break through the submucosal layer

A

abscesses develop = ulceration = bleeding

216
Q

symptoms of UC

A
  • pain, cramping
  • blood diarrhea
  • bleeding from rectum
  • anemia
  • N & V
  • bloating
  • tender abdo
  • no appetite
  • fatigue
217
Q

VS with UC

A

hypotensive, tachycardia

218
Q

intestinal complications

A

hemorrhage

toxic megacolon

perforation

colon cancer

extra-intestinal complications (joints, skin, anemia) d/t autoimmune

219
Q

toxic megacolon

A

dilation & paralysis of colon

220
Q

perforation

A

bowel contents move into peritoneal space leading to septic shock

221
Q

crohns disease

A

affect any part of digestive tract

inflammation occurs in patches = skip lesions (cobblestone appearance)

involves all layers of bowel

222
Q

typical symptoms crohns

A

abdo pain

diarrhea

weight loss

fatigue

N & V

223
Q

crohns complication

A

strictures = obstruction

  • fistulas & abscesses
224
Q

diagnosis of bowel complications

A

colonoscopy, scopes, barium enema, BW, CT

225
Q

BW for bowel complications

A

hemoglobin, electrolyte (CP7) = potassium, sodium, WBC, CRP

226
Q

nursing goals for bowel complications

A
  • pain assessment
  • VS = increased resps, tachycardia
  • GI assessment
  • stool chart
  • monitor in/out
  • NPO (let bowel rest) = IV fluids
  • control & reduce inflammation (NSAIDs, corticosteroids)
  • TR
227
Q

what kind of diet to let bowels rest

A

low/no fibre

228
Q

medications for bowel complications

A

NSAIDs

corticosteroids

immunosuppressants

antimicrobials (2nd infection)

immunomodulators

229
Q

what does liver do

A

metabolism, detoxification, production of protein, bile production

230
Q

acute liver failure

A

rapid deterioration of liver

231
Q

causes of liver dysfunction

A

viral infections (hep B/C)

alcohol abuse

non-alcohol fatty liver disease (obesity)

autoimmune conditions

toxins & medications

232
Q

cirrhosis

A

chronic inflammation of liver = scar tissue development

233
Q

symptoms of liver dysfunction

A
  • abdo edema & leg/feet
  • jaundice
  • purities
  • pale “clay” stool
  • encephalopathy
234
Q

why does abdo & leg/feet edema happen with liver dysfunction

A
  • decrease albumin
  • cause distended, round, firm, dilated veins = pushing on diaphragm = SOB = fluid in vascular space
235
Q

encephalopathy symptoms

A

lethargic

stupor

extremely confused

inappropriate behaviours

difficulty concentrating

changes in LOC

236
Q

for encephalopathy, whats treatment with regards to liver dysfunction

A

lactulose (2-3 BM/day)

237
Q

complications of liver dysfunction

A
  • encephalopathy (increased ammonia levels)
  • esophageal varices (dilated veins from portal HTN, risk of bleeding)
  • ascites (accumulation of serous fluid in the peritoneal cavity d/t decrease albumin levels)
238
Q

nursing managemnet for liver dysfunction

A

medications (rifaximin, lactulose, diuretics, beta blockers)

education (lifestyle changes)

monitoring (LOC, stool chart, weight, intake, CIWA)

bloodwork

239
Q

pts need to avoid ASA, NSAIDs, sedatives with liver dysfunction

A

YES

240
Q

blood work for liver dysfunction

A

albumin, ammonia, urea, clotting factors PTT & INR, CRP, LFT

241
Q

pancreas

A

enzymes for digestion into small intestine to digest food

glucagon production

endocrine functions

242
Q

inflammation of pancreas

A

potential necrosis

auto digestion & leakage of enzymes = swelling, pain, can go septic

243
Q

pancreatitis

A

acute!!!

severe pain

244
Q

causes of pacreatitis

A

alcohol misuse

gallstones

ERCP

fatty diet

245
Q

how does alcohol misuse cause pancreatitis

A

chronic misuse –> acute pancreatitis –> chronic

more common younger men

246
Q

gallstones & pancreatitis

A

thigns get stuck

women affected more

247
Q

symptoms of pancreatitis

A

dull continuous pain (deep visceral pain)

N & V

elevated VS

pale, diaphoresis

248
Q

assessment for pancreatitis

A

alcohol consumption

diet

distention

ins/out

medications? (tylenol mask fever, decrease pain)

249
Q

interventions for pancreatitis

A
  • CBG = hyperglycemia bc don’t have insulin production
  • decrease inflammation
  • pain management
  • NPO (let everything settle)
  • antiemetics
  • IV fluids
250
Q

diagnostics for pancreatitis

A
  • BW = lipase, amylase
  • clinical presentation
  • abdo ultrasound
  • CT
251
Q

thyroid role

A

body metabolism

regulation of temperature

growth/development

energy levels

thoughts/feelings

digestion

252
Q

pituitary gland

A

thyroid stimulating hormone

253
Q

hypothyroid

A

not enough hormones

everything is low & slow

254
Q

common cause of hypothyroid

A

hashimotos

255
Q

hashimotos

A

immune system attacks thyroid

cells become fibrous

256
Q

medication for hashimotos

A

synthyroid = levothyroxine

257
Q

symptoms of hypothyroid

A
  • slow metabolism
  • constipation
  • muscle aches/joint pain
  • men = low libido
  • women = mensural irregularities
  • brittle hair
  • feel cold
258
Q

BW for hypothyroid

A

not enough T4, high TSH

259
Q

drugs to be careful with for hypothyroid

A

opioids, benzo

260
Q

other causes of hypothyroid

A

decrease iodine

tumor

261
Q

worst case scenario for hypothyroid

A

myxedema coma

hyperthermia

extreme drowsiness

everything starts shut down (bradycardia, low glucose, resp failure)

262
Q

goiter

A

constant stimulation

protrusion of thyroid gland

263
Q

hyperthyroid

A

too much thyroid hormones = everything on overdrive

264
Q

msot comon cause hyperthyroid

A

graves

265
Q

graves

A

protuding eyes

toxic goiter

266
Q

symptoms of graves

A
  • fast metabolism
  • jittery
  • anxious
  • palpations
  • hypermotility = bowels
  • feel hot
  • a fib
267
Q

other causes of hyperthyroid

A

increase iodine

thyroiditis

268
Q

BW for hyperthyroid

A

increase T4, decrease TSH (pituitary not active)

269
Q

treatment for hyperthyroid

A

radioactive tx = destroy hyperactive cells = reduction in hormones

PTU or tapazole = decrease production of thyroid hormone

270
Q

medications for hyperthyroid

A

beta blockers

271
Q

worse case hyperthyroid

A

thyroid storm = multi system complications

272
Q

TB is infectious disease caused by

A

mycobacterium tuberculosis & is reportable

273
Q

TB spread by

A

airborne!

274
Q

once TB inhaled

A

replicate slowly and spreads via lymphatic system

find favourable envrionments to grow = lobes

275
Q

primary healing of lesion in TB

A

takes place by resolution, fibrosis, calcification & granulation tissue surroinding lesion become fibrous & form collagenous scar

276
Q

ghon complex

A

calcified ghon complexes may be seen on chest xray

277
Q

when TB lesion regresses and heals, infection..

A

enters latent period in which it may persist without producing symptoms

278
Q

infected with TB but not have TB disease cannot spread to others

A

TRUE

279
Q

reactivation of TB can occur

A

if hosts defence mechanisms become impaired (HIV)

280
Q

clinical manifestations of TB

A

systemic = fatigue, malaise, anorexia, weight loss, low grade fevers, night sweats

pulmonary = cough & sputum, slight SOB

acute, sudden: high fever, chills, generalized flulike symptoms, pleuritic pain, productive cough

281
Q

HIV infected pt with TB often has

A

atypical physical examinations & chest xray findings

282
Q

where else can TB spread

A

bones, kidneys, lymph nodes

283
Q

granulomas

A

inflammatory cells

284
Q

does latent TB have symptoms

A

no immune response inactive

284
Q

what do i need for a positive diangosis

A

tuberculin skin test = immune response demonstrated by hypersensitivity to test

xray

285
Q

positive reaction of TB skin test occucrs

A

2-12 weeks

286
Q

sputum test for TB (AFB)

A

3 times sputum collection in morning

287
Q

NAA is a

A

rapid diagnositc test for TB

288
Q

medication therapy for TB

A

min 8 months

TX consists of combo of 4+ meds

289
Q

nursing care

A
  • resp assessment
  • sputum test
  • TB skin test
  • TB blood test
  • VS
  • chest xray
  • education: wear mask, isolate until cleared, cover mouth when sneezing
290
Q

patho of HIV

A

attacks immune system

enter WBC –> replicate –> destroy –> weakens immune –> opportunistic infection

291
Q

what kind of cells are affected in HIV

A

CD4+

292
Q

who is at risk of HIV

A
  • IV drug users
  • immunocomprised
  • indigenous
  • sex workers
  • health care workers
293
Q

what does transmission of HIV depend on

A
  • blood & bodily fluids
  • breast milk, vaginal fluids, semen, blood
294
Q

most common tranmission HIV

A

semen & vaginal fluids

295
Q

how quickly is HIV transmitted

A

few weeks begin to show symptoms

young people = flu like symptoms

296
Q

characteristics of HIV transmission

A
  • amount of virus in fluid
  • frequency and duration = higher risk
  • volume of fluid
  • immune system
297
Q

stages of HIV infection

A
  • acute
  • early chronic
  • symptomatic HIV infection
  • late AIDS
298
Q

acute stage HIV

A
  • initial
  • increase amout of virus in blood
  • flu like symptoms
299
Q

early chronic stage HIV

A

prolonged period (10-12 years) of low HIV in blood

few symptoms

300
Q

symptomatic HIV infection stage

A
  • CD4+ count falls below 500
  • night sweats, fever, weight loss
  • no longer can fight infection
301
Q

late stage HIV

A
  • increased viral load
  • decreased T cells (CD4 count less than 200)
  • develop one opportunistic infection
302
Q

can you transmit HIV to others without symptoms

A

yes, may not test + or show sx depending on immune system

303
Q

opportunistic infections in HIV

A

neurological conditions

thrush

latent TB

304
Q

tests for HIV

A

antibody test

self testing

EAI = detect HIV antigens and ABX

NAT = looks for actual virus in blood

305
Q

nursing goals for HIV

A

ART

prep

education = medications

support

safe sex materials

306
Q
A

concepts 4 (4 decks)

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