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Final Flashcards

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1
Q

physical environment needs of dementia

A
  • light
  • sound
  • temperature
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2
Q

subudural hematoma in older adults

A

have decreased brain size - more space to acommodate subdural bleed

Sx might now show for 3 days to a week later

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3
Q

children and prescription medications

A
  • metabolize and eliminate faster than adults
  • can be prescribed as young as preschool age
  • approved for syndromes not symptoms
  • effectiveness and safety still clinical concerns
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4
Q

coping mechanisms of personality disorders

A
  • attempts to cope with anxiety r/t threatened or actual loneliness
  • manipulative people view others as objects
    • defenses protect against potentiaal psychological pain
  • people w/ antisocial personality disorder use projection, splitting
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5
Q

global elements of MI

A
  • evocation
  • collaboration
  • autonomy/support
  • empathy
  • direction
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6
Q

3 D’s

A
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7
Q

cognitive deficits in Alzheimer’s

A
  • cause significant impairment in social or occupational functioning
  • represent significant decline from previous level of functioning
    • gradual and worsen steadily
  • not due to other causes
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8
Q

adolescent non-suicidal self-injury

A
  • differentiate suicide and self-destructive behaviors
    • biting, cutting, hitting, burning
  • intent
    • relieve negative emotions, unpleasant thoughts/feelings
    • release anger, tension, emotional pain
    • provide security or control
    • punishment
    • set boundaries with others
    • end depersonalization/derealization, flashbacks or racing thoughts
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9
Q

LEAR(N)S

A
  • naps
  • limit daytime naps to
  • limit naps to 3x per week
    • none is best with insomnia complains - sleep restriction therapy
  • when overnapping, reduce time in bed
  • find out if someone is napping
    • might be getting necessary hours of sleep, but need to add those to night, not day
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10
Q

neurological comorbidities with depression in older adults

A
  • post-CVA
  • Alzheimer’s
  • Parkinson’s and dementia with Lewy bodies
  • Huntington’s
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11
Q

window of tolerance

A

from baseline to fight/flight/freeze

shorted window in people with trauma - baseline is nearer to fight/flight threshold

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12
Q

psycho-social needs of dementia

A
  • affect
  • assitsance matches ability
  • diversional activities
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13
Q

adolescents and sleep

A
  • decreased total sleep time
    • later bedtime, later wake time
  • maturation of suprachiasmatic nucleus during puberty
  • increased daytime sleepiness due to inadequate restorative needs
    • restoration, physiologically
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14
Q

diagnostic features of RLS

A
  1. urge to move limbs associated with paresthesias or dysesthesias
  2. symptoms start/worsen with rest
  3. partial relief with physical activity
  4. worsening of sx in evening/night
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15
Q

social environment needs of dementia

A
  • staff mix
  • staff stability
  • ward ambiance
  • presence of others
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16
Q

assessment of adolescent mental health

A
  • family interview
    • define problems, genogram, parental health, family interactions
  • child interview
    • mental state, fears, mood, sleep, hallucinations, development, play, physical exam
  • other
    • school, friends, bullying, psych tests, labs, neuroimaging
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17
Q

depression in medically ill older adults associated with:

A
  • amplified somatic Sx
  • increased use of alcohol/sedatives
  • increased use of health services
  • interferene with medical care
  • medical complications
  • prolonged illness, length of stay
  • excess disability
  • risk of institutionalization
  • increased mortality
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18
Q

RASS scale -4

A

deep sedation: no response to voice, but movement or eye opening to physical stimulation

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19
Q

Cluster A

A
  • paranoid
  • schizotypal
  • schizoid

odd or eccentric in nature

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20
Q

trauam: the disconnet

A

Your Experience vs Their Experience

  • emotional and moody vs intense emotional pain
  • impulsive vs immediate gratification
  • self-injurious/suicidal vs relief of emotional pain
  • manipulative vs desperate need to regulate
  • dependent vs fear of rejection
  • inflexible vs fear of internal disruption
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21
Q

outcomes identification for personality disorders

A
  • expected outcome: patient will obtain maximum interpersonal satisfaction by establishing and maintaining self-enhancing relationships with others
  • short term goals progress from simpler to more complex behavior changes
    • examples: develop goals with patient participation; consider ability to tolerate anxiety before setting goals
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22
Q

personality disorder diagnosis

A
  • symptoms are fixed and long lasting
  • cannot change personality - use meds only to treat Sx
  • appearance and severity can vary overtime
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23
Q

worry time

A
  • remove thoughts and cognitive activation of those thoughts far away from bedtime hours
  • during day: write down thoughts and brainstorm solutions
  • order priorities for attention during day
  • practice problem solving strategies during day
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24
Q

emotional dysregulation

A
  • emotional world of trauamtized person is unexpected tidal wave of changing emotions
  • easily triggered by external and internal stimuli
  • when thoughts and perceptions intrude on fragile sense of equilibrium
  • individual often not aware of triggers
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25
Q

phases of sleep

A
  • NREM 1-4
  • REM
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26
Q

non-pharmacological tx for adolescent mental health

A
  • health education
  • play therapy
  • behavioral therapy
  • family therapy
  • group therapy
  • individual therapy
  • cognitive behavioral therapy
  • milieu management
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27
Q

apraxia

A

impaired ability to carry out motor acticities despite intact motor function

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28
Q

ambivalence

A
  • “I want to, but I don’t want to”
  • natural phase in process of change
  • not pathological
  • key issue to resolve for change to occur
  • ambivalence = good
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29
Q

older healthy adults and sleep

A

decreased sleep efficiency of 3% each decade

REM decreases 2-3% also

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30
Q

RASS scale + 2

A

agitated: frequent non-purposeful movement, fights ventilator

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31
Q

ICSD sleep-wake disorders

A
  • insomnia
  • sleep-related breathing disorders
  • hypersomnia
  • circadian rhythm sleep dx
  • parasomnias - disorders of arousal or REM
  • sleep-related movement disorders - RLS, bruxism
  • isolated symptoms
  • others
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32
Q

sleep latency

A
  • period of time when head hits pillow until you go into REM sleep
  • important to have enough
    • too short: REM sleep too early
      • early awakening
  • many reasons why sleep latency is shortened
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33
Q

epidimiology of delirium

A
  • > 7 million hospitalized/year
  • rates of persistent delirium
    • discharge 45%
    • 1 mo 33%
    • 3 mo 26%
    • 6 mo 21%
  • >60% not recognized by healthcare system
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34
Q

contemplation

A
  • person is aware that problem exists and seriously considering changing, but has not made commitment to take action.
  • contemplators perform risk-reward analysis.
  • ambivalence
  • clinicians: tip decisional balance
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35
Q

cultural considerations in adolescent mental health

A
  • not just about race/ethnicity
  • SES, geographic locatio, acculturation vs assimilation
  • avoid misdiagnoses by attending to relevant cultural factors
  • acknowledge differences in emotional expression
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36
Q

depression cascade

A
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37
Q

mixed delirium

A

shift between hyper and hypoactive states

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38
Q

preparation

A
  • individuals intending to take action and may practice some of the behaviors necessary
  • clinicians: help determine course of action; develop plan
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39
Q

MDD & sleep

A
  • impaired sleep continuity
    • increased sleep latency and wakenings
    • early morning awakenings
    • more common in older patients
  • REM abnormalities
    • negatively impacted by antidepressants
  • daytime sleepiness
    • fatigue anergia r/t depression
    • more common in young bipolar patients
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40
Q

RLS and PLMs

A

restless leg syndrome and periodic limb movements

occurring more commonly and recognized/Tx’d more

trigger = inactivity during daytime

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41
Q

characteristics of motivational interviewing

A
  • guiding, more than directing
  • dancing, rather than wrestling
  • listening more than talking
  • collaborative conversation
  • evokes from person what he/she already has
  • honors autonomy
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42
Q

adolescent psychosis

A
  • psychotic dx
    • schizophrenia
    • schizoaffective
    • delusional dx
  • positive and negative symptoms
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43
Q

trauma spectrum disorders

A

dissociative disorders, PTSD, etc.

some believe that all psychological disorders have root in trauma, cumulative or overt

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44
Q

physiological needs of dementia

A
  • nutrition
  • hydration
  • elimination
  • oxygenation
  • comfort
  • rest
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45
Q

common nursing diagnoses for adolescent mental health

A
  • risk for self-directed violence (#1 priority)
  • chornic or situational low self-esteem
  • ineffective coping
  • anxiety
  • risk for other-directed violence
  • readiness for enhances family processes
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46
Q

emotional dysregulation in trauma survivor

A
  • intensity of feelings has roots in past
  • feelings may seem out of sync with here/now but not with there/then
  • may feel fine one minute and tsunami of negative emotions the next
  • may not have awareness to differentiate feelings of today and link to past
    • vulnerable to abuse
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47
Q

reflective listening

A
  • develop skill
  • key to accurate empathy
  • fundamental skill of MI
  • to get ahead of patient
    • when she’s about to shut down
  • determine what individual means and reflect back in a statement
    • can have multiple meanings
    • choose most likely
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48
Q

legal issues in adolescent mental health

A
  • state-based regulation on treatment consent
  • in PA, teens over 14 can receive mental health services w/o parental consent
  • balance child/teen’s rights to privacy/confidentiality with parent’s desire for info
  • mandatory disclosure issues
    • plan to harm self/others
    • physical or sexual abuse
    • when in doubt, talk to someone
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49
Q

goal to promote adolescent mental health wellness

A

PET

P: prevention

E: early identification

T: treatment

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50
Q

mental health as we age

A
  • exercise
    • moderate 30 min 5x/week or 50 min 3x/week
    • maintains cognition
    • increases serotonin and mood
  • education
    • helpful for mental health long term - cognitively
    • keeps mind active
  • social engagement
    • friends and family
  • spirituality
    • not necessarily an organized religion
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51
Q

treatment plan for personality disorders

A
  • guide for intervention
  • promotes consistency among treatment staff
  • help patients and families understand disorders that cause maladaptive social responses
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52
Q

transference

A
  • person transferring feelings and expectations from an important object in childhood onto present day relationships
  • reflects individual’s early experiences, shedding light on childhood relationships with important people
  • brings individual’s formative dynamics to helping relationship
  • understanding of transference can help the helper better understand past experiences and how they impact patient’s present
  • understanding can help build more compassion
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53
Q

Staging of Alzheimer’s

A
  1. no cognitive/functional delcine
  2. mild forgetfulness; some work difficulties
  3. mild cognitive impairment, concentration prlblems, some difficulty at work
  4. late confusional stage, increased denial of problems; withdrawal
  5. poor recall of recent events; help with proper clothing, bathing
  6. more advanced memory problems; ADL assistance needed
  7. late dementia with loss of verbal abilities
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54
Q

sleep and newborn infants

A

no established circadian rhythm

sleep 16-20 hrs daily

NREM and REM established at ~ 3 mo

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55
Q

RASS scale -2

A

light sedation: briefly awakens with eye contact to voice

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56
Q

personality disorder treatment options

A
  • psychotherapy (primary)
  • engaging patients as collaborators
  • one clinician in charge of care
  • psychoeducation
  • family involvement
  • limited use of medication
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57
Q

continuum of social responses

A
  • adaptive
    • solitude
    • autonomy
    • mutuality
    • interdependence
  • in between
    • loneliness
    • withdrawal
    • dependence
  • maladaptive
    • manipulation
    • impulsivity
    • narcissism
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58
Q

RASS scale +3

A

very agitated: pulls or removes tubes/catheters; aggressive

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59
Q

maintenance

A
  • work to prevent relapse and consolidate gains
  • clinician: identify strategies to prevent relapse
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60
Q

DMDD

A
  • b/c of bipolar overdiagnosis
  • Core
    • chronic, severe, persistent irritability
  • up to 12 yo with persistent irritability and frequent episodes of extreme behavioral dyscontrol
  • severe recurrent verbal/behavioral temper outbursts
    • out of proportion to situation/provocation
  • typically develop unipolar depressive disorderes or anxiety, not bipolar
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61
Q

cycle of bonding

A
  1. need to release painful material
  2. mental health professional is safe source of intimate exposure
  3. attachment to helper

paradox:

  • in an effort to avoid abandoment, human faults/errors are overlooked or denied: necessary for survival
  • in traumatized individual, they are intolerant of human faults/errors because it signifies danger
    • when they used to overlook faults of abuser
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62
Q

adolescent suicide risk assessment

A
  • Ask Suicide-Screening Questions (ASQ)
    • past few weeks, wished you were dead?
    • past few weeks, felt that you/family would be better off if you were dead?
    • in past week, thoughts about killing self?
    • tried to kill self? how? when?
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63
Q

implications of adolescent mental health disorders

A
  • suicide-related injury and death
  • unintended sexual health outcomes
  • poorer physical and mental health, work performance and financial management in adulthood
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64
Q

reasons treatment is sought for adolescent mental health

A
  • change in school performance
  • aggressive beahvior (or other conduct issues)
  • physical illness
  • irritability
  • withdrawal
  • outside referral
  • suicide attempt
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65
Q

insomnia and suicide

A
  • depressed patient with sleep problems have increased suicidal behavior
  • adolescents:
    • increased suicidal behavior r/t
      • sleep
      • nightmares
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66
Q

narcissim

A
  • may express frustration caused by lack/loss of recognition as:
    • anger
    • depression
    • substance abuse
    • other maladaptive behaviors
  • fragile self-esteem
    • drive to constantly search for praise, appreciation, admiration
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67
Q

NREM

A

non-rapid eye movement

75-80% of total sleep time

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68
Q

testing behaviors

A
  • may have a template of how relationships “should be” and what interactions mean
  • have to ‘test’ helpers to confirm relationship and reshape template
  • confirm what is acceptable
    • if they are cared about
    • how consistent helper will be
  • can manifest in testing behaviors throughout course of relationship
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69
Q

summarizing in MI

A
  • allow individual to hear self a second time
  • can reflect both sides of ambivalence
    • one one hand, on the other
  • summary of conversation up to that point
  • can transition to new topic
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70
Q

DELIRIUM PS

A

D: drugs (added or removed)

E: eyes and ears (vision and hearing)

L: low oxygen

I: infections

R: retention (urine, stool)

I: ictal states

U: underhydration/nutrition

M: metabolic

P: pain

S: subdural

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71
Q

CEASE SAAD

A

to investigate hx of present depressive illness

C: crying

E: eating

A: anxiety

S: sleep

E: energy

S: sex

A: anhedonia

A: agitation

D: depressed mood

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72
Q

medication management of delirium

A
  • use meds when:
    • behaviors associated with psychotic thinking/perceptual disturbances pose safety risk or are distressing
    • delirium interferes with needed medical therapies
    • behavioral interventions fail
  • DO NOT use meds as:
    • substitue for detection, correction, elimination of underlying causes of delirium
  • Use LOW doses over shortest possible time period
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73
Q

Cluster B

A
  • antisocial
  • borderline
  • histrionic
  • narcissistic

erratic, dramatic, emotional - most likely to attempt suicide

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74
Q

non-bendodiazepine hypnotics

A
  • as effective as BZD and provide normal sleep architecture
  • sleep changes not significantly changed with usual hypnotic doses
  • anti-convulsant and muscle relaxant effect
  • nextday hangover effects are minimal
  • less liable to cause tolerance, dependence, rebound insomnia
  • examples
    • synota, nesta, rozerone (melatonin agonist)
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75
Q

adolescent borderline personality disorder

A
  • most prevalent personality disorder
    • highest suicide rate
  • absence of separation-individuation during development
    • can’t separate completely from primary caretaker
  • common Sx
    • impulsive aggression
    • clinging
    • depression
    • detachment and withdrawal
  • setting boundaries and enforcing restrictions is key
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76
Q

differentiating delirium from depression and dementia

A
  • cognitive impairment in dementia
    • gradual
    • > 1 mo
    • irreversible
  • most are alert and able to maintain attention in early stages
  • depression may present actuely with deficits in ability to sustain attention
  • depression may present similar to hypo/hyper active delirium
    • important to screen for depression in adults with a mixed picture
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77
Q

medication management of dementia behavior

A
  • OBRA regulations limits med use
  • HCFA has list of meds to avoid in elderly
  • go low, go low
    • frequent med reduction attempts
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78
Q

interpretation based on assumption

A
  • can create disconnect between helper and client
  • important information can be missed
  • behaviors can continue and cause friction in relationship as opposed to becoming understood and ultimately resolved
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79
Q

general management of delirium

A
  • multi-component interventions
  • prompt recognition/treatment of underlying cause
  • maximum supportive environment
  • immediate medical Tx as necessary
  • discontinuation or reduced doses of deliriogenic meds
  • environmental interventions i.e. delirium room
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80
Q

NANDA-I diagnoses: personality disorders

A
  • defensive coping
  • chronci low self-esteem
  • risk for self-mutilation
  • impaired social interaction
  • risk for violence
    • self or other
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81
Q

how to make therapeutic relationship work with trauma patient

A
  • be mindful
  • be trustworthy (safe space, not trust)
  • be consistent
  • know yourself
  • take care of yourself
  • understand actual motivations behind behaviors, not your assumptions
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82
Q

depressive symptoms in adults

A
  • mood
    • depressed
    • anhedonic
    • suicide thoughts
  • somatic
    • sleep
    • appetite
    • psychomotor
    • increased pain
  • cognitive
    • decreased concentration
    • indecisiveness
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83
Q

implementation of treatment plan for personality disorders

A
  • come for help with depression, anxiety, alcoholism, difficulties in relationships
  • personality is NOT changed
    • intrusive
  • help patients change maladaptive thinking and behavior that result from personality traits
  • treat co-morbidities
  • involve patient in own care
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84
Q

RASS scale -1

A

drowsy: not fully alert, but has sustained awakening to voice

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85
Q

aphasia

A

language disturbance

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86
Q

NEECHAM confusion scale

A
  • 9 item interactive observational scale
  • 3 subscales
    • processing
    • behavior
    • physiological control
  • requires vital signs and pulse oximetry
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87
Q

mental status examination

A
  • appearance and self-care
  • psychomotor behvaior
  • variant presentations of mood and affect
    • withdrawal
    • weariness
    • comorbid anxiety
  • thought content
    • somatic preoccupations
    • pain
    • complaints r/t cognitive functioning
    • psychosis
  • suicide and death ideation
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88
Q

principles of milieu treatment

A
  • establish control without option to escape involvement
  • provide experienced, consistent staff
  • implement clear structure with fiar, firm, consistently enforced rules
  • provide support while patient learns to experience painful feelings, try out new behavioral responses
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89
Q

types of reflective statements

A

repeating

rephrasing

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90
Q

reinterpretation

A

thought: i cannot go to sleep no matter what i do

one has not often lost control over daytime & nighttime routines, which in turn can greatly impact ability to go to sleep

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91
Q

therapeutic relationship in trauma

A
  • warmth and empathy crucial in helping relationship
  • betrayal and rejection fears can disrupt the relationship
  • understand:
    • motivations behind behaviors of traumatized individual
    • communications in relationship (transference)
    • helpers own feelings and reactions (countertransference)
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92
Q

REM

A

rapid eye movement

20-25% sleep time

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93
Q

benzodiazepines and sleep

A
  • induce GABA (inhibitory response) in brain
  • CNS depression
  • not for long term
    • tolerance, dependence
    • physical and physiological withdrawal syndrome
  • examples
    • valium, ativan, xanax, lorazepam
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94
Q

hypnopompic

A

hallucinations at beginning of sleep cycle

not psychotic illness

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95
Q

milieu therapy in personality disorders

A
  • treated in community not inpatient because it is difficult and takes a long time to change maladaptive social responses
  • can gain insight into behvaior
  • focused on realistic expectations, decision-making, social behaiors in “here and now”
  • sometimes hospitalized for self-destructive person with borderline
  • antisocial person may require structured hospital environment with related limit setting to expect mature, responsible behavior
    • not to control, but to work together towards change
    • can make experience productive or counterproductive depending on how it is implemented
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96
Q

autism

A
  • 1 in 68 or 14 in 1000
  • 3-4X more in boys than girls
  • impairment of communication, social sills, overregulated or repetitive behaviors
  • assess for depression, anxiety
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97
Q

LE(A)RNS

A
  • activity
  • vigorous activity before 6pm (5 hrs before bedtime)
  • bedroom for sleep and sex only
  • computers/tvs OUT of bedroom
  • no work in bed
  • avoid cognitive activation near bedtime
  • “worry time” scheduled during day
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98
Q

adolescent depression

A
  • most common
  • 14% major depressive episode before age 15
  • distinct symptoms from adults
    • children
      • irritable mood, limited weight gain, withdrawal
    • adolescents
      • physical complaints, poor school performance, boredom/lethargy, risk-taking
  • review medical hx and consider co-occurring dx
99
Q

delirium superimposed on dementia

A
  • collateral source report who also doesn’t have dementia
  • acute onset
  • attention/disorganized thinking
  • sleep-wake cycle disturbance
  • change in level of consciousness
100
Q

Stuart stress adaptation model

A
101
Q

countertransference

A
  • feelings that come up within helper in response to individual
  • feelings that belong to you
    • be aware of yourself, reactions, history
  • can be used to understand how individiaul’s effects on others where insight is lacking
  • can help identify individual’s feelings
    • projection identification
102
Q

RASS scale -5

A

unarousable: no response to voice or physical stimulation

103
Q

responsibility lies with helper

A
  • person receiving services ahs no code to uphold nor standard of behavior to violate
  • responsibility lies in hands of helper
  • role of helper carries inherent power
  • role of client leaves person vulnerable
104
Q

projection

A

putting issue on someone else - making it their fault

places responsibility for behavior outside of oneself

105
Q

bright side of traumatic symptomology

A
  • fear of abandonment = loyalty
  • unstable relationshps = love of friendship
  • unstable self-image = knowing yourself fully
  • impulsivity = spontaneity
  • suicidal behaviors = love of life
  • self-mutilating behaviors = will to live/creativity
  • intense feelings = emptahy/versatility
  • chronic feelings of emptiness = love of activity
  • intense anger = fiery spirit
  • dissociation = capacity for protection and self preservation/love of memories
  • paranoid ideation = trust/acceptance
106
Q

stages of change

A
  • precontemplation
  • contemplation
  • preparation
  • action
  • maintenance
  • termination
  • relapse
107
Q

adolescent anxiety

A
  • fear of separation
  • highest during times of transition
  • persistent anxiety disorders predict adult panic dx
  • types
    • panic
    • phobias
    • OCD
    • PTSD
    • generalized anxiety
108
Q

impulsivity

A
  • impulsive aggression is a hallmark of borderline personality disorder
  • pivotal in
    • self mutilation
    • unstable relationships
    • violence
    • completed suicides
  • can be frustrating
    • behavior is defense against fear of loneliness, not consciously planned
  • inability to plan, learn from experience
  • poor judgment, unreliability
109
Q

rephrasing

A

stay close to what client said, but substitute words or slightly rephrase

110
Q

Confusion Assessment Method

A

Feature 1: acute onset of mental status change OR fluctuating course

AND

Feature 2: inattention

AND EITHER

Feature 3: disorganized thinking

OR

Feature 4: altered level of consciousness

111
Q

FDA approved TX for bipolar

A
  • acute
    • lithium - hard with frail older adults b/c of narrow therapeutic range
    • valproic acid (divalproex sodium)
    • antipsychotics (olanzapine, risperidone, quetiapine, aripiprazole, ziprasidone)
  • mania and depressive episodes - quetiapine only
  • maintenance
    • lithium
    • olanzapine
    • lamotrigine
112
Q

common infections that cause delirium

A
  • UTI
  • pneumonia
  • skin cellulitis
  • c. diff
  • CNS infection
113
Q

repeating

A

repeat portion of what client has said. may consit of one or two words

114
Q

UTS and responding to pain

A
  • not effectice at managing behavior of others
  • respond to emotional pain with desperate behaviors seeking immediate relief
  • do not use reason, respond to emotions through reflex
115
Q

emotional regulation is psychosocial

A
  • self regulation - being able to sit with painful feelings and self sooth - is learned
  • begins in earliest relationships when feeling states are acknowledged and efforts to manage them come from caregiver
  • responsibility for self-management increases as skills increase
  • lack of skills contributes to emotional dysregulation
116
Q

family involvement in personality disorders

A
  • intimate relationships always affected - involve significant others in plan of care
  • especially for manipulative patients who shit attention away from selves by creating conflict between family and staff
117
Q

manipulation in personality disorders

A
  • behavior in which people treat others as objects, form relationships, centered around control issues
    • unaware of lack of relatedness, assumes interpersonal relationships are formed to take advantage of others
  • little motivation to change becuase behavior has rewards
  • cannot imagine intimate, sharing relationship
  • believes in always maintaining control to avoid being controlled
  • rational, premeditated way
  • patience in carrying out plan
  • acts from reason not reflex
  • typical of borderline and antisocial
118
Q

OARS

A

O: open-ended questions

A: affirm - accentuate positives, seek and acknowledge person’s strengths and efforts - leads to change and builds relationship

R: reflective listening

S: summarize

119
Q

personality disorders development through life cycle

A
  • shaped by biology, social learning
  • seed of personality = temperament
    • hereditary, biological dispositions evidence from birth
  • establishing strong affective bonds
    • crucial to developing mature personality
120
Q

resilience

A
  • ability to withstand stress
  • protective factors
    • sense of autonomy
    • adaptive distancing (family & past)
    • understanding emotions of self & others
    • responsive protective, stable, affectionate caregiving
    • parenting that fosters competence
    • positive self-esteem
    • making friends and getting along with peers
121
Q

SCN

A
  • suprachiasmatic nucleus - regulates circadian rhythms in all organs
  • receives input from retina nerve cells that act as brightness detectors
  • detectors reset clock genes in SCN on daily basis
  • SCN transmits messages to rest of brain (hypothalamus) and body to promote synchrony with external day-night cycle
  • SCN also controls melatonin secretion
122
Q

spirit of motivational interviewing

A
  • underlying set of mind and heart within which MI is practiced
    • includes partnership, acceptance, compassion, and evocation
  • paradigm of strength that needs to be evoked rather than installing something new the client doesn’t have
    • not viewing them from a deficit perspective
123
Q

dialetical behavior therapy

A
  • form of CBT that is an effectice treatment for borderline personality
  • uses behavior and cognitive techniques:
    • psychological education
    • problem solving
    • training in social skills
    • exercises in monitoring moods
    • modeling by therapist
    • homework assignments
    • meditation
  • reduces rates of suicide attempts, hospitalization for suicidal ideation, overall medical risk
124
Q

sedatives

A

drug that reduces excitement, calms patient and is commonly used as anxiolytic in therapeutic doses

in larger doses: hypnosis (subject becomes passive and highly suggestible)

depresses CNS

125
Q

LEA(R)NS

A
  • routine
  • regularize bedtime and wake time
  • keep similar sleep-wake schedule through weekends
  • develop beditime ritual and hour prior to bedtime
  • relaxation techniques
126
Q

personality definition

A

set of deeply ingrained, enduring patterns of thinking, feeling, behaving

127
Q

primary progressive aphasia

A
  • rare, ages 40-65
  • decline in 1+ language: speaking/understanding, naming, reading, writing
  • early: memory, reasoning, visual perception not affected
  • funciton for routine activities intact
  • increasing difficulty thinking of words
    • substitue wrong word
    • pronunciation mistakes
    • talk around word
  • problems reading and writing
    • checks, directions
  • difficulty understanding speech
    • following conversations despite normal hearing
128
Q

relaxation therapy

A
  • reduce physiologic and cognitive arousal at bedtime
  • techniques
    • progressive muscle relaxation
    • biofeedback
    • breathing exercises
    • yoga
    • meditation
129
Q

risks to helping relationship

A
  • feelings that arise in helping relationship can be similar to those experienced early in life toward significant others
    • transference
  • what person experienced in past is expected in present, impacting current relationships
  • shadows of individual’s previous relationships can come alive in current ones
130
Q

splitting

A

ex: i like this nurse, but not that one

manipulating to get what they want

borderlie or narcisstic - views people/objects as all good/bad

131
Q

agnosia

A

failure to recognize or identify objects despite intact sensory function

132
Q

personality disorders definition

A

set of patterns or traits that hidner a person’s ability to maintain meaningful relationships, feel fulfilled, and enjoy life

usually begins in adolescence or early adulthood

133
Q

personality disorder coping resources

A
  • encouragement to seek help even with broad social network
  • creative ways to express feelings
134
Q

effects of delirium anticholinergics

A

See - blurred vision

Pee - urinary retention

Shit - constipation

Spit - dry mouth

Willy-nilly - confusion

Up-down - fall

135
Q

behavioral assessment: reframing

A

essential for designing appropriate interventions

  • suspend judgment
  • avoid labeling
  • collect cues
  • behavioral assessment
136
Q

biopsychosocial assessment of adolescent mental health

A
  • developmental hx
  • family hx
  • stress and trauma hx
  • strengths of child
  • mental status exam
    • general description
    • emotional state
    • experiences
    • thinking
    • sensorium and cognition
  • relevant labs
137
Q

reenacting the unresolved trauma

A
  • when felings of abuse are triggered in current relationships, present situation can be perceived/responded to in same way as old trauma
  • templates formed of early interactions used to understand current ones
  • apparently safe/normal interactions may be perceived as potential danger
  • thought that what is not remembered is reenacted until worked through
138
Q

L(E)ARNS

A
  • environment
  • dark: no environmental light during sleep
  • cool: too hot or too cold produces disruption
    • increase body temp during day
  • quiet: irregular sounds disrupt sleep
    • regular sounds can be habituated to
139
Q

hypnagogic

A

hallucination at end of sleep cycle

not psychotic illness

140
Q

melatonin

A

hormone produced by pineal gland that is mainly secreted at night to consolidate circadian rhythms

only has limited direct effects on sleep

141
Q

re-attribution

A

thought: every problem is r/t sleep

sleep is not the cause of all of one’s problems

142
Q

hypnotic

A

drug which produces sleep resembling natural sleep

in higher doses = general anesthesia

depresses CNS

143
Q

DSM 5 Sleep disorders

A
  • insomnia
  • hypersomnolence
  • narcolepsy
  • breathing related sleep dx
    • obstructive sleep apnea
    • central sleep apnea
    • sleep related hypoventilation
144
Q

morbidity of insomnia

A
  • increased risk for psychiatric dx
  • decreased quality of life
  • increased utilization of health care, increased cost
  • absentesim, poor occupational performance
  • cognitive decline
  • motor vehicle accdients, occupational injuries
145
Q

patients with unresolved traumatic symptomology (UTS)

A
  • may respond to words/actions of helper as potential re-eneactment or re-experincing of trauma
  • behaviors and expectations of others are dissected at unconscious level, constantly scanning for danger
  • expectations may be high as they search for safety and proof of being cared for
    • over and over again
  • self protection and pain management = priority
  • when perceiving danger, defensive behaviors employed
  • understand what motivates individual’s behavior and how they respond to environment can move client/helper relationship into positive direction
146
Q

adolescents and prescription medications

A
  • not children or adults
  • SSRIs preferred over TCAs
  • limit benzodiazepine due to drug use and effects on larning and memory
  • lithium, abilify, seroquel for mania, aggression, conduct dx
  • low dose antispychotics are effective
    • watch for increased extrapryamidal side effects
  • psychostimulants for ADHD
147
Q

sleep efficiency

A

time in bed attempting to sleep (over) time in bed sleeping

stabilizes at 5 yo - why toddlers need naps

148
Q

sleep & psychiatric disorders

A
  • psych dx common in patients with sleep/wake Sx
  • psych Sx common in patients with sleep dx
  • sleep/wake problems risk factor for psych dx
  • sleep disturbed in many psych dx
  • sleep/wake disturbances provoke worst outcomes in patients with psych dx
149
Q

ECT for bipolar

A
  • for mania and depression
  • for pharmacologically refractory or intolerant patients
  • severe cases
    • catatonia, mlancholia, psychosis
  • bilateral electrode placement in manic, mixed
  • unilateral in depression
150
Q

adolescent bipolar dx

A
  • high suicidality, psychosis, functional impairment
  • diagnosis by history of >1 mania episode
  • hallmark signs
    • sustained impulse control or conduct problems
    • rapid cycle, mixed mania - decreased need for sleep
    • 1/3 of 6-12 yo depressed children will develop bipolar
  • chronic irritability may be first Sx in children
  • differentiate from ADHD
  • monitor suicide risk due to impulsivity and self-injurious behaviors
151
Q

olanzapine and personality disorders

A

atypical antipsychotic

can reduce:

  • anger
  • impulsive aggression
  • depression
  • interpersonal sensitivity
152
Q

RASS

A

Richmond Agitation and Sedation Scale

153
Q

symptoms vs disorders

A
  • symptoms - individual problem/manifestation
    • sadness, anger, impulsivity, fear
  • disorder
    • group of symptoms that happen together
    • classified via DSM
  • treat symptoms not dx
154
Q

motivational interviewing: clinical definition

A

a person-centered counseling style for addressing common problem of ambivalence about change

cognitive dissonace between:

  • where one is
  • where one wants to be
155
Q

hypoactive delirium

A
  • lethargy
  • slowed speech
  • decreased alertness
  • apathy
156
Q

dementia care planning

A
  • advanced directives
  • Alzheimer’s association
  • safe return or medic alert bracelet
  • discuss delirium and depression
  • discuss social engagement with caregiver
  • encourage caregiver to ask for help
  • discuss possibility of physical/verbal aggression as disease progresses
157
Q

behavior management: mental health and aging

A

need driven behaviors - communicate an unmet need

  • wandering
  • repetitive questioning
  • agitation
  • restlessness
  • combativeness
  • sexually ianppropriate behavior
  • incontinence
158
Q

perceived meaning of progress in trauma victim

A
  • progress = abandonment
  • if i am perceived as being better, the important people helping me may leave me
  • noting progress is important, but presentation is crucial
  • regressions do not mean treatment failure
159
Q

motivation and the change process

A
  • patients not unmotivated
  • enaging in behaviors that others think harmful OR not ready to engage in behaviors others think helpful
  • belongs to individuals and process of change
  • motivation can be enhanced or hindered by interactions with others
160
Q

professionals using MI

A
  • aim to help people explore and resolve their ambivalence about behavior change
  • elicit from the person their own motivations for change
  • assess readiness for change
161
Q

adolescent conduct dx

A
  • types of behaviors
    • oppositional
    • aggressive
    • defiant
  • largest group of psych dx
  • more in boys
  • family, biological, psychosocial factors
  • limited guilt/remorse, delinquency
  • 40% may develop antisocial personality dx
162
Q

medications in personality disorders

A
  • primarily for anxiety, mood swings, impulsive aggression
  • Cluster A may need antipsychotics for subtle symptoms
  • Cluster B may need mood-stabilizers or atypical antipsychotics for subtle biopolar
  • Cluster C may benefit from serotonergic antidepressents for anxiety-related disorders
163
Q

depressive symptoms in geriatrics

A
  • mood
    • weary, hopeless, angry
    • anxious
    • death ideation
  • somatic
    • increased pain
    • Sx overlap with effects of medications and comorbidities
  • cognitive: decreased…
    • selective attention
    • working memory/retrieval
    • new learning
    • processing speed
    • executive function
164
Q

adolescent suicide risk factors

A
  • hx of previous attempts
  • family hx of suicide
  • hx of depression, mental illness
  • somatic complaints
  • alcohol/drug use
  • stressful life event/loss
  • easy access to lethal methods
  • exposure to suicidal behavior of others
  • incarceration
  • sexual identity issues
165
Q

(L)EARNS

A
  • light
  • use light to stabilize/shift sleep wake behaviors
  • examples
    • keep light on during day, don’t lower lights until later evening hours
    • decrease electronic light
      • feed into SCN to provoke wakefulness
      • increases adenosine which is opposite of melatonin (wake neurochemical)
166
Q

cysto-cerebral connection

A

delirium caused by urinary retention

167
Q

compared to hospitalized patients with no delirium, delirious patients have:

A
  • higher mortality rates
  • longer hospital stays
  • higher propability of receiving long-term care after discharge
  • higher probability of developing dementia at 48 mo
168
Q

antisocial personality disorder

A
  • 3% men, 1% women
  • difficult to diagnose/treat
  • diagnosis applied when
    • consistently ignores social rules (after age 15)
    • manipulative, exploitative, dishonest
    • no sense of trust
    • lacks remorse
    • involved in criminal activity
  • responsible for large portion of crime, violence, social distress
  • childhood histories of abuse, neglect, absence of early emotional attachment
169
Q

pharmacological treatment of adolescent mental health

A
  • approved uses
    • medication is FDA approved for use in tx of a specific disorder
  • off label
    • not approved for children/adolescents
    • use best judgment
170
Q

cumulative trauma

A
  • unable to point to specific event
  • no obvious fight/flight/freeze response
  • repeated empathic parent/child fractures
    • abuse disguised as joke
    • name calling
    • criticizing and judgment
    • undermining
    • occasional empathic fractures, resolved through positive communication, builds bonds
  • invalidating environment
171
Q

termination

A

problem ceases to be a problem

172
Q

RASS scale +1

A

restless: anxious but movements not aggressive; vigorous

173
Q

nursing assessment: medicines that suppress CNS

A
  • also depress RR
  • monitor if they are taking alcohol or other substances
    • can die in their sleep
    • very dangerous
    • ex: Michael Jackson
174
Q

hyperactive delirium

A
  • increased psychomotor activity:
    • rapid speech
    • irritability
    • restlessness
175
Q

action

A
  • modify behavior, experiences, environment to overcome problems
  • clinician: help implement plan
176
Q

elements of therapeutic alliance

A
  • agreement on goals of treatment
  • agreement on tasks
  • development of a personal bond made up of reciprocal positive feelings
177
Q

reasons for precontemplation stage

A
  • reluctance: lack of knowledge or inertia. impact of problem not fully conscious
  • resignation: lack of energy/investment. given up on possiblity of change. overhwelmed by problem.
    • instill hope and explore barriers
  • rationalization: why problem is not a problem - or only a problem for others. session feels like a debate.
    • empathy and reflective listening
178
Q

delirium defined

A

abrupt onset of a cluster of global, transient changes constituting disturbances in attention, cognition, psychomotor activity, level of consciousness, and/or sleep-wake cycle

179
Q

depression DSM V

A
  • MDD represents classic condition
  • discrete episodes of >2 wks duration involving clear-cut changes in affect, cognition, and neurovegetative functions and inter-episode remissions
180
Q

key features of personality disorders

A
  • inflexibile and maladaptive approach to relationships and environment
  • individual’s needs, perceptions, behavior foster cycles that promote unhelpful patterns and negative reactions from others
  • coping skills are unstable and fragile
    • lack of resilience when faced with stress
181
Q

communicating with children

A
  • therapeutic alliance with children and guardians
  • communication by disorder type
    • internalizing: child
    • externalizing: parents
  • stay away from problem-centered communication
  • age-related norms/development
  • familiar vocabulary
  • needs in relation to immediate situation
  • coping capacity
  • nonverbal communication
  • develop trust through honesty and consistency
182
Q

nature vs nurture

A
  • not either/or, both/and
  • genetic predisposition to symptoms
  • environmental triggers
    • trauma
    • led ingestion
    • SES
183
Q

adolescent ADHD

A
  • 5-10%
    • symptoms begin in infancy
    • 50% undiagnosed
  • more in boys than girls
  • hallmarks
    • attention deficits
    • hyperactivity and impulsivity
184
Q

borderline personality disorder

A
  • 1-6% of general population
  • most prevalent prsonality disorder (15-25%) in mental health settings
  • women > men
  • characterized by polarized thinking…all or none, good or bad
185
Q

insomnia definition

A

one or more required:

  • difficulty initiating sleep
  • difficulty maintaining sleep
  • waking up too early
  • sleep that is chronicaly non-restorative, or poor in quality

sleep difficulty despite adequate opportunity and circumstances for sleep

186
Q

nursing functions in milieu therapy

A
  • provide structured enviornment
  • serve as emotional sounding board
  • diagnose conflicts, consequences of actions
  • facilitate adaptive change in behavior
    • hold patients responsible for behavior
  • communicate with staff for consistent messages
  • encourage individuals to identify strengths and mobilize strengths for self-esteem via adpative defenses and positive coping skills
187
Q

4 principles of MI

A
  1. resist “righting reflex”
  2. understand motivations of client
  3. listen with empathy
  4. empower the person
188
Q

daytime impairments of insomnia

A

at least one reported:

  • fatigue/malaise, attention, concentration, memory, social dysfxn, school performance problem, mood disturbance/irritability, daytime sleepiness, motivation/energy reduction
  • 3x/week
  • for at least 1 mo
189
Q

similarities of dementia types

A
  • usually older adults
    • prior yo 65 = early onset
    • usually genetic risk factor or TBI
  • slow
  • insidious
  • irreversible
  • progressive
190
Q

trauma and manipulation

A

exerting shrewd or devious influence especially for one’s own advantage

  • shrewd = having or showing sharp powers of judgment, astute
  • devious = showing skillful use of underhanded tactics to achieve goals

three conditions must be met:

  • guiding the behaviour of someone
  • in the direction one wants
  • without the subject realizing it
191
Q

decatastrophizing

A

thoughts: i will never be able to go to sleep, i haven’t slept at all in a week

192
Q

LEARN(S)

A
  • substances
  • no caffeine after 4 (noon preferrable)
    • high variability in metabolism and response
    • educate on types, amounts
  • do not use ETOH for sleep
    • preferred > 5 hrs prior
    • advances sleep latency and REM
      • increase risk for early awakenings middle of night
  • no smoking within hr before bed
  • substances/medications - adjust times if needed
193
Q

bullying

A
  • negative effects can extend into adulthood
  • direct vs indirect
  • bullies usually mimic behavior seen at home
  • teen victims suffer from depression, suicidal ideation, decreasing functioning
    • perpetrators tend ot have adult delinquency
  • cyber-bullying
194
Q

RASS scale +4

A

combative: overly combative, immediate danger to staff

195
Q

delirium background

A
  • diagnosis is highly c linical and depends on clinician expertise, systematic screening, careful observation
  • cardinal sign of geropsychiatric emergency
    • promptly identified and addressed w/ biopsychosocial and environmental interventions
  • progression to stupor and/or coma, seizures, death is possible
  • early recognition + rapid management of underlying factors decreases severity and leads to improved outcomes
196
Q

adolescent weight and body image problems

A
  • anorexia, bulimia, obesity
  • body dysmorphic dx
  • special issues for children
    • oral behaviors - nail biting, thumb sucking
  • special issues for adolescents
    • motivation: without, Tx is difficult
    • cognitive skills: abstract and long-term thinking less developed
    • interpersonal skills: communication difficulties
197
Q

adolescent mental health background

A
  • 1/2 lifetime mental illnesses begin by age 14
  • 20% of youth affected by mental disorder at some point in lifetime
  • in 2014, 2.8 mil youth (11.4%) had at least one major depressive episode in previous year
198
Q

cognitive therapy of insomnia

A
  • identify dysfunctional beliefs and attidues about sleep
    • write down thoughts before sleep, use standardized scales
  • explore validity of statements about sleep
    • may be catastrophizing or have too high expectations
  • approach beliefs, statements as hypothesis not absolute
  • replace dysfunctional attitudes and beliefs about sleep with appropriate realistic goals
199
Q

relationship dyad

A
  • rescuer - victim
  • victim - perpetrator
  • perpetrator - rescuer

caused by a failed protector - victims angrier with failed protector than with abuser. can look different when failed protector was also abused

200
Q

precontemplation

A
  • no intention to change behavior in foreseeable future
  • unaware or under-aware of behavior problem
  • clinician: increase client’s perception of risks w/ current behavior
201
Q

what is trauma

A

any event in which individual experienced, witness, confronted with actual or threatened death/serious injury or a theat to physical integrity of self or others

  • elicits strong emotional reactions
  • experience overwhelems individual’s capacity to cope with event
  • signal fight, flight, freeze response

when traumatic event NOT processed:

  • individual may remain aroused as thought fight, flight, freeze response is close to activation
202
Q

sleep hygiene assessment

A

also: sleep hygiene promotion and sleep disorder Tx

L: light

E: environment

A: activity

R: routine

N: napping

S: substances

203
Q

RASS scale 0

A

alert and calm

204
Q

senile dementia - Alzehimer’s type (SDAT)

A
  • usually after age 65
  • starts in medial temporal area - hippocampus and spreads
  • loss of nerve cells, amyloid plaques, tau tangles
  • begins with memory loss
    • can’t learn new info
    • can’t orient self
  • later personality and behavior changes
  • possible hallucinations and delusions later in stages
205
Q

readiness ruler

A
  • willing: the importance of change
  • able: confidence for change
  • ready: a matter of priorities
206
Q

sleep disorders can cause psychiatric symptoms

A
  • obstructive sleep apnea
    • depression, anergia, fatigue, cognitive changes
  • narcolepsy
    • hallucinations, depression
  • RLS
    • paresthesias
  • circadian rhythm dx
    • social avoidance

15-30% w/ MDD have obstructive sleep apnea: severities correlate

207
Q

Cluster C

A
  • avoidant
  • dependent
  • obsessive-compulsive

anxious, fearful in nature

208
Q

RASS scale -3

A

moderate sedation: movement or eye opening to voice (no eye contact)

209
Q

depression overview

A
  • depression and anxiety common response to loss and other stressors
  • not inevitable with aging
  • predisposing factors
    • medical illness
    • disability
210
Q

triggers for abandonment

A

Their Trigger vs Your Response

  • separation (object constancy) vs validation (transitional object)
  • severe emotional distress vs your presence
  • inconsistency vs stick to it
  • progress vs note with caution
211
Q

behavior management in children

A
  • respond warmly to positive behaviors
  • communicate approval
  • ignore negative behavior when appropriate
    • respond calmly/effectively when needed
  • time outs when necessary
    • 30-60 seconds per year of age
    • nonpunitive - to help child regain control
  • avoid negative remarks about child
212
Q

relapse

A

clinician: help client recyle through stages of contemplation, preparation, and action again

213
Q

DSM V of Alzheimer’s

A
  • development of multiple cognitive deficits manifested by impaired memory (long or short), can’t learn new info, can’t recall information previously learned, and distinguished by 1+ of the following:
    • aphasia
    • apraxia
    • agnosia
    • disturbance in executive functioning
214
Q

adolescent suicide

A
  • 2nd leading cause of death in males 10-24; 3rd in females 10-14 and 2nd in females 15-25
    • suffocation and firearms most common
  • visited HCP 3 months to 1 yr before death
  • girls more likely to have ideation and attempt, boys more likely to die
  • native american/alaskan native and hispanic youth have higher suicide-related fatalities and attempts
215
Q

therapeutic relationships in personality disorders

A
  • nurse must be accessible no matter what maladaptive social response patient is experiencing
  • physically present with patient for interaction opportunities
  • show genuine interst in patient, try to understand by clarifying meanings, validating perceptions
    • support behavior change
  • be empathic with focus on appropriate boundaries of relationship
  • maintain patient safety
  • facilitate patient participation in care
  • select least restrictive intervention
  • help patient assume responsibility for own actions
216
Q

sleep and the value of exercise

A
  • physically fit people adapt better to changes in work, sleep, life schedule
  • exercise promotes sleep quality and duration
  • combined with bright light, elevates mood and alleviates depresseive S/Sx
  • daily exercise promotes transition from day work to evening and night work by promoting phase delays in circadian rhythm
217
Q

mindfulness overview

A

temporarys tate of non-judgmental, non-reactive, present-centered attention and awareness that is cultivated during awareness and attention practice

enduring traits that can be described as dispositional pattern of cognition, emotion, behavioral tendency

  • meditation
  • intervention in therapy
  • antidote to mind wandering and time travel
218
Q

mindfulness traits

A
  • act with awareness
  • less reactive
  • nonjugdmental
  • development of ability to label and escribe with words the internal world
  • self-observation
219
Q

mindful moments

A
  • nonconceptual
  • nonverbal
  • present-centered
  • nonjudgmental
  • participatory
  • liberating
220
Q

core of mindfulness

A
  • awareness of awarness
  • paying attention to intention
  • awakened presence
  • equanimity
  • curiosity
221
Q

the pause

A
  • temporal pause from habitual automatic thoughts and responses
  • redirects attitude of awareness of present experience with acceptance and compassion
  • allows for awarness of changing vibrations of self and other
  • enhances depth of attention, concentration, spaciousness in relationship
222
Q

ways to be present

A
  • physical - “being there”: acts of care, tasks, technical interventions
  • psychological - “being with”: communication, listening, empathy
  • therapeutic - mindful attentiveness, attunement, resonance
  • awakened presence - embodied understanding of and interaction with things that are in the world
223
Q

the breath

A
  • object of awareness for mindfulness practices
  • boundary between involuntary and voluntary, automatic and effortful
  • interface between internal and external
  • rhythm is repeated pattern where in-breath is followed by out-breath
  • rhythm r/t to nervous sytem fxns and integration
224
Q

forms of the mind

A
  • spacious awarness
  • concentrated awarness
  • both forms are characteristics of conditioned phenomenon of consciousness
  • pure awareness is an experience
225
Q

spacious awarness

A

diffuse attention in present moment

expanisve with infinite space

226
Q

concentrated awareness

A

focus of attention on object without distraction of other stimuli

227
Q

mindfulness meditation

A

3 types:

  • focused attention (FA): concentrative practice
  • insight/open monitoring (OM): receptive practice
  • loving, kindness, compassion: quality of attidue/emotion of tenderness, soothing, comfort, ease, care, connection
228
Q

objects of awareness

A
  • sensations, thoughts, feelings in “me”
  • words, body, language, mood of the “other”
  • flow of relationship, felt sense of connection or distance
229
Q

mentalizing

A

constructing biographical and autobiographical narrative

making inferences about mental states

reflecting on meaning of mental states

230
Q

overlap

A
  • decentering
  • awareness of mental states as representational
  • nonjugmental
  • acceptance
  • compassion
  • curiosity
231
Q

mindfulness definition

A

attentiveness to mental states in self and others

bare attention

present-centered

232
Q

components of compassion

A
  • distress-sensitive
  • sympathy
  • distress-tolerance
  • empathy
  • non-judgment
  • care for well-being of others
  • create opportunities for growth and change with warmth
233
Q

mindfulness in practice

A
  • presence with awareness is critical in listening empathically and responding appropriately to others
  • establishes rapport - worless experience of mindful attentiveness
  • if one person is mindful, regulatory capacity of state is present for interpersonal system
  • promotes well-being in body, mind, relationships
  • therapeutic experiences that move an individual toward well-being promote integration
234
Q

mindfulness experience

A
  • reduces biases through specific forms of mental training that develop self-awareness
  • increases ability to effectively manage or aler one’s responses and impulses
  • enhances development of positive relationship between self and other that transcends self-focused needs
  • increases prosocial characteristics
235
Q

clinical applications of mindfulness

A
  • mindfulness-based stress reduction
  • dialectical behavior therapy
  • midnfulness-based cognitive therapy for depression
  • acceptance and commitment therapy
  • third-wave cognitive-behavioral therapies
  • change r/t thought, feelings, impulses
  • terminology overlapping mentalizing
    • defusion, decentering, nonidentification
  • stress reduction, anxiety, depression, BPD, substance abuse, eating disorders, psychosis
236
Q

mindfulness conceptual overlaps

A
237
Q

how mindfulness works

A
  • attention regulation
  • body awareness
  • emotional regulation
  • reappraisal
  • exposure
  • flexible sense of self
238
Q

neurocognitive mechanisms of mindfulness

A
  • intention and motivation
  • attention and emotion regulation
  • extinctio and reconsolidation
  • prosociality
  • nonattchment
  • decentering
239
Q

(mindless) vs mindful practice

A
  • experiential avoidance
  • cognitive fusion and projection into self conceptualization
  • repertoire narrowing from personal narratives, old scripts, roles
  • too much talk, not enough of action
  • reinforcing avoidance
  • insensitivty
  • failure to link acceptance with values
240
Q

mindless vs (mindful) practice

A
  • fully present
  • open to emotional content
  • defused from judgment
  • in touch with core values
  • faciliate relationships qualities of warmth, resonance, openness, authenticity
  • allows focus of mind and attention on internal world of another
    • sparking sense of being “felt”
241
Q

MAP

A

mindfulness awarness practice

  • breath meditaiton
  • mediation
  • body/mind work
  • intention with everyday activities
  • loving kindness meditation
  • insight dialogue
  • concentration
  • open monitoring
  • equanimity
  • presence
  • loving kindness/compasion
242
Q

mindfulness clinical training

A
  • paying attention
  • affect tolerance, emotional regulation, fearlessness
  • practicing acceptance
  • empathy and compassion
  • equanimity and humility
  • learning to see
  • letting go and starting again
  • epxosing narcissistic needs
  • overcoming infatuation with theory/techniques
243
Q

mindfulness training practices

A
  • what brings you away
  • being with discomfort
  • breathing together
  • embracing emotions that arise in therapy
  • not worrying about me
  • finding our profesional shadow
  • beginner’s mind
  • three objects of awareness
244
Q

G.R.A.C.E.

A
  • Gathering your attention
  • Recall your intention
  • Attune to yourself, body, heart, mind
  • Consider what will serve patient/colleague
  • Enacting and ending

Psychiatric Nursing (2 decks)

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