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Psychiatric Nursing > FINAL EXAM > Flashcards

FINAL EXAM Flashcards

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1
Q

Autism Spectrum Disorders

A

Deficits in social relatedness and relationships

  • Stereotypical repetitive speech
  • Obsessive focus on specific objects
  • Over adherence to routines or rituals
  • Hyper- or hypo-reactivity to sensory input
  • Extreme resistance to change
  • Appears in early childhood
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2
Q

ASD assessment

A

developement delays, communication, sensory stim, relationships within family abuse, intellectual ability

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3
Q

asd diagnosis

A

lack of coordination head banging

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4
Q

asd diagnosis

A

lack of coordination head banging

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5
Q

asd outcomes

A

reframe from outburst, talk through it

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6
Q

ASD implementation and interventions

A

provide structure, consistency, reward system

  • psychological interventions
  • psychobiological interventions

physical occupational speech therapy

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7
Q

autism develops…..

A

in early childhood

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8
Q

ADHD

A

Inappropriate degree of

  • Inattention
  • Impulsiveness
  • Hyperactivity
  • commonly seen in school
  • temper outburst
  • low self esteem
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9
Q

adhd assessment, diagnosis

A

Assessment

  • Level of physical activity, attention span, talkativeness
  • Social skills
  • Comorbidity: learning disorder, disregulation, impulsive

Diagnosis: low self esteem, anxiety

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10
Q

meds for adhd

A

ridiline aderal

increase pay attention, less impulsive, less distracted

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11
Q

communication disorders

A

deficit in language skills acquisition that impairment in academic, achievement, socialization, or self worth

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12
Q

what are the Intellectual Development Disorders

A

Intellectual functioning
Social functioning
Daily functioning

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13
Q

intellectual development disorder severity

A

can be mild to extremely severe

- begin in childhood

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14
Q

intellectual functioning

A

deficit in reading problem solving

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15
Q

social functioning

A

impaired communication and language regulating emotion

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16
Q

daily functioning

A

daily life affected

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17
Q

sterotypic movement disorder

A

Repetitive, purposeless movements for 4 weeks or more

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18
Q

tourette’s disorder

A

multiple motor ticks for 1y can be brought on by stress

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19
Q

depersonalization

A

unreal
loss of idenity
arm not part of body

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20
Q

derealization

A

environment has changed

“everything tiny”

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21
Q

Hallucinations

A
  • Auditory: voices and sounds
  • Visual: spots, animals, people
  • Olfactory: smell something not there
  • Gustatory: taste something not there
  • Tactile: begs crawling on them
  • Command: need interventions, voices telling them to hurt them/someone
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22
Q

Illusions

A

spiders crawling on wall, black dots

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23
Q

delusions

A

fulse beliefs, held despite a lack of evidence to support them

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24
Q

disadvantange of first gen

A

Extrapyramidal side effects (EPS)

  • Anticholinergic (ACh) side effects
  • Tardive dyskinesia
  • Weight gain, sexual dysfunction, endocrine disturbances
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25
Q

first gen

A

 Haloperidol (Haldol)
 Loxapine (Loxitane)
 Chlorpromazine (Thorazine)
 Fluphenazine (Prolixin)

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26
Q

xanax…..

A

severe anxiety

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27
Q

theraptuic statements for soemone hearing voices

A

ik it must be very scary for you but i don’t hear voices

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28
Q

acute dystonia

A

The client experiences severe spasms of tongue, neck, face, or back. This is a crisis situation, which requires rapid treatment

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29
Q

parkinsonism

A

Signs and symptoms include bradykinesia, rigidity, shuffling gait, drooling and tremors.

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30
Q

akathisia

A

The client is unable to stand still or sit, and is continually pacing and agitated.

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31
Q

tardive dyskinesia (TD

A

Late extrapyramidal symptoms (EPS)
 Manifestations include involuntary movements of the tongue and face, such as lip-smacking, which cause speech and /or eating disturbances.
 TD may also include involuntary movements of arms, legs, or trunk

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32
Q

Neuroleptic Malignant Syndrome

A

Symptoms include sudden high-grade fever, blood pressure fluctuations, dysrhythmias, muscle rigidity, and change in LOC developing into coma

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33
Q

Anticholinergic effects

A 
	Dry mouth
	Blurred vision
	Photophobia
	Urinary hesitancy/retention
	Constipation
	Tachycardia
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34
Q

positive symptoms of schizo

A
  • hallucinations
  • delusions
  • disorganized speech
  • bizarre behavior (talking to self)
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35
Q

negative symptoms

A
  • blunt affect
  • no expression
  • alogia- the poverty of thoughts
  • avolition- lack of motivation
  • anhedonia- lack of pleasure
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36
Q

alogia

A

the poverty of thoughts

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37
Q

avolition

A

lack of motivation

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38
Q

anhedonia

A

lack of pleasure

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39
Q

medications that cause tardive dyskinesia

A

1st gen meds

 Haloperidol (Haldol)
 Loxapine (Loxitane)
 Chlorpromazine (Thorazine)
 Fluphenazine (Prolixin)

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40
Q

treatment for tardive dyskinesia

A

 Manifestations may occur months to years after the start of therapy.
 Administer the lowest dosage possible to control symptoms.
 Use the AIMS test to screen for the presence of EPS

deutetrabenazine and valbenazine

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41
Q

planning manic phase

A
  • Managing medications
  • decreasing physical activity
  • increasing food and fluid intake
  • ensuring at least 4 to 6 hours of sleep per night
  • intervening so that self-care needs are met
  • Seclusion, restraint, or electroconvulsive therapy (ECT) may be considered during the acute phase.
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42
Q

manic episodes implementation

A
  • Hospitalization for acute mania (bipolar I disorder)
  • Communicating challenges and strategies
  • be direct with limits
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43
Q

risk for sicude with bipolar

A

watch for s/s

hospitalize them

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44
Q

bipolar 1 disorder

A
  • Most severe form
  • Highest mortality rate of the three
  • At least 1 manic episode
  • big shifts
  • admitted for severe mania
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45
Q

ithium therapeutic level

maintenance blood level

A

Therapeutic blood level: 0.8 to 1.4 mEq/L

Maintenance blood level: 0.4 to 1.3 mEq/L

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46
Q

lithium toxic level

A

Toxic blood level: 1.5 mEq/L and above

  • need blood test every 5d
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47
Q

<1.5 side effects

A 
nausea
vomiting
diarrhea
thirst 
polyuria
lethargy 
sedation 
fien hand tremors
renal toxicity 
goiter
hypothyroidism
48
Q

1.5-2.0 lithim early s/s of toxicity

A 
gastro upset
coarse hand tremors
confusion 
hyperiiritability  of muscles 
electroencephalography changes
sedation 
incoordination
49
Q

2.0-2.5 advanced s/s of lithium toxicity

A 
ataxia
giddiness
serious electroenciphalographic changes
blurred vision 
clonic movements 
large output of diluted urine 
seizure
stupor
severe hypotension 
coma 
death
50
Q

> 2.5 severe toxicity lithium

A

convulsion
oliguria
death

51
Q

planning during depressive phase

A
  • Reduction of depressive symptoms
  • restoration of psychosocial and work function
  • hospitalization may be required
  • medication or biological treatments
  • prevention of relapse
  • prevention of further episodes of depression
52
Q

bipolar 1 vs bipolar 2

A

1:

  • Most severe form
  • Highest mortality rate of the three
  • At least 1 manic episode
  • big shifts
  • admiited for severe mania

2:

  • at least 1 hypomanic episode- less severe scale
  • at least 1 major depressive episode
  • productive at work, trying to do a lot of things at once
53
Q

s/s of suicide ideation

A
  • Verbal and nonverbal clues
  • Overt statements: direct
  • Covert statements: more settle signs “soon everything will be fine”
  • Lethality of suicide plan: how successful
  • Self assessment: guilt, sad, fustrated, debrief
54
Q

depressive disorder: Selective serotonin reuptake inhibitors SSRIs

A

First-line therapy
Rare risk of serotonin syndrome

Fluoxetine (Prozac)
Citalopram (Celexa)
Escitalopram oxalate (Lexapro)
Paroxetine (Paxil)
Sertraline (Zoloft)
55
Q

depressive disorder plan of care

A

Planning

Geared toward

  • Patient’s phase oif depression
  • Particular symptoms
  • Patient’s personal goals
56
Q

priority intervention for a pt. that is depressed

A

check if they are suicidal

57
Q

vegetative depression interventions

A

use encouragement

58
Q

MAOI dietary restriction

A
  • Tyramine-rich foods can lead to hypertensive crisis.
  • Clients will most likely experience headache, nausea, increased heart rate, and increased blood pressure.
  • Provide client with instructions regarding foods and beverages to be avoided. - These include aged cheese, pepperoni, salami, avocados, figs, bananas, smoked fish, protein dietary supplements, soups, soy sauce, red wine
59
Q

assessment findings for depression

A

Five (or more) of the following in 2-week period

  • Weight loss and appetite changes
  • Sleep disturbances
  • Fatigue
  • Worthlessness or guilt
  • Loss of ability to concentrate
  • Recurrent thoughts of death

PLUS—at least one symptom is also either
Depressed mood or
Anhedonia

  • depression underrecognized in kids
  • old adults not considered normal of aging
  • comorbidities
60
Q

mild anxiety

A

Everyday problem-solving leverage
Grasps more information effectively
- tense, bitting nails, shaking legs

61
Q

moderate anxiety

A

Selective inattention

  • Clear thinking hampered
  • Problem solving not optimal
  • Sympathetic nervous system symptoms begin
  • heart racing, tension, rr increase, sweat, symmatic symptoms present due to anxiety to physical, belly aches, diarrhea,
62
Q

severe anxiety

A
  • Perceptual field greatly reduced
  • Difficulty concentrating on environment
  • Confused and automatic behavior
  • Somatic symptoms increase: headache, nausea, insonmina
  • concentration inpared
  • difficulty problem solving, elevated hr
63
Q

panic

A
  • Markedly disturbed behavior—running, shouting, screaming, pacing
  • Unable to process reality; impulsivity
  • cant breath, hallucinated, withdrawn
64
Q

Obsessive-compulsive disorder when does it occur and what does it involve

A

symptoms occur on a daily basis and may involve issues of sexuality, violence, contamination, illness, or death

65
Q

plan of care for anxiety

A

Sound physical and neurological exam
- Determine source of anxiety (primary vs. secondary)
- Determine current level of anxiety
- Assess for potential self-harm
- Complete psychosocial assessment
+Ask patient about causes they can identify

66
Q

discarge planning for anxiety

A
  • Self-monitors intensity; uses reduction techniques; maintains role performance
  • Identifies ineffective and effective patterns; asks for assistance and information; modifies as needed
  • help to find ways to manage it
67
Q

obsessions

A

Thoughts, impulses, or images that persist and recur, so that they cannot be dismissed from the mind
- “I’m a bad person”

68
Q

compulsions

A

Ritualistic behaviors an individual feels driven to perform in an attempt to reduce anxiety

69
Q

post traumatic stress disorder

A
  • Re-experiencing of the trauma: fearful, anxious, shame, guilt, nightmares, explosive
  • Avoidance of stimuli associated with trauma
  • Persistent symptoms of increased arousal
  • Alterations in mood
    + want them in presence
    + identify what real vs not
70
Q

depersonalization

A
  • cut off from self
  • robot
  • not intube
  • outside observer
  • out of body experience
71
Q

derealization

A
  • cut off from world
  • in dream
  • objects feel bigger/smaller
  • sounds overwhelming
72
Q

post-traumatic stress disorder diagnosis

A

Post trauma syndrome
- symptoms over a month impaired function, anxiety

Complicated grieving
- morning the situation

73
Q

Dissociative Identity Disorder

A
  • Presence of two or more distinct personality states
  • protect from traumatic event
  • moral compas irratic

Each alternate personality (alter) has own pattern of

  • Perceiving
  • Relating to and
  • Thinking about the self and environment
  • History: how long, short or long term memory, injuries (concussion, seizure)
  • Moods
  • Impact on patient and family
  • Suicide risk
  • Self-assessment
74
Q

acute stress disorder vs ptsd

A

acute stress last 3 days after 1 month becomes ptsd

75
Q

somatization

A

Expression of stress through physical symptoms that are often manifestations of psychological and emotional distress

76
Q

somatization symptoms expressed

A

place of anxiety, depression, or irritability

77
Q

illness anxiety disorder

A

extreme worry of fear about having an illess refer to physcologist

78
Q

conversation disorder

A

functional: neurological symtpoms in the absent of any nerological disease pt. blindeness assist them

79
Q

nursing diagnosis for somatic disorder

A
  • infecctive coping
  • anxiety
  • risk for loneliness
  • powerlessness, hopelessness
  • social isolation
  • pain
  • altered family processes
  • risk for suicide
80
Q

anorexia acute care

A
  • *** Suicidal ideation first
  • Psychosocial interventions: no approved meds specifically, prozack is helpful for ocd behaviors
  • Pharmacological interventions
  • Integrative medicine: accupuncture, massage, herbal treatments
  • Health teaching and health promotion
  • Safety and teamwork
81
Q

Anoreixa safety and teamwork

A

weight respiration program

  • not above 90%may stop treatment
  • coping and probelm solving
  • normalize eating specific habit
  • schedule weights
  • family go to bathroom
82
Q

anorexia nursing diagnosis

A

***Imbalanced nutrition
Decreased cardiac output
Risk for injury (electrolyte imbalance)
Risk for imbalanced fluid volume

disturbed body image, ineffective coping, chronic low self-esteem, and powerlessness.

83
Q

s/s of anorexia

A

cold extremities, fatigue, languo: downey hair, hypokalemia, NA decr, yellow skin, amenorhea, low weight

84
Q

restrciton anorexia

A

not had recurrent pinge and purg in last 3 months

85
Q

binge and purg anorexia

A

binge and purg or laxatives, vomiting, diretics in 3m

86
Q

binge eating s/s

A

obese and overwight

  • GI issues: bloating, heartburn, vomiting
  • treatment done on an out pt. basis
87
Q

binge eating nursing diagnsis

A

Imbalanced nutrition: more than body requirements

  • Other nursing diagnoses are similar to bulimia nervosa and include disturbed body image, ineffective coping, anxiety, chronic low self-esteem, powerlessness, and social isolation
88
Q

binge eating acute care

A 
Psychosocial interventions
Pharmacological interventions
Surgical interventions: bariatric surgery (for obesity)
Health teaching and health promotion
Teamwork and safety
89
Q

bulimia outcomes

A

Electrolytes in balance; adequate cardiac output; satisfaction with body image; effective coping; verbalizes confidence; makes informed life decisions; expresses independent decision making; willingness to call others for assistance; develops sense of belonging

  • interupt cycles of binge
  • treatment working n coping skills
  • meal plan
  • relaxation tecniques
  • healthy diet
90
Q

communication with a withdrawing pt.

A

empathetic communication

91
Q

alc withdrawl

A

8-10 hr after a drink

  • quits after prolonged use
  • hears psychotics voices, spiders, delerium, tremors, increased hr, sweating, fevers, anxious, hullicinations
  • 12-24 hr withdrawal seizures start
  • medical emergency
  • librium and ativan taper for 72 hours
  • 72 hours watch window
92
Q

serious withdrawl

A
  • sucide
  • seizures
  • depression
    (valium can help)
93
Q

clondrine, methadone, buprenorephine

A

used to treat opioid withdrawl symptoms (check on pt. every 4 hr)

94
Q

nalazone

A

opioid toxcity

95
Q

Confabulation

A

creation of stories in place of missing memories to maintain self-esteem

96
Q

delirium

A 
Disturbance in attention
Abrupt onset with periods of lucidity
Disorganized thinking
Poor executive functioning
Disorientation
Anxiety and agitation
Poor recall
Delusions and hallucinations (usually visual)
  • caused by medical
  • resolves by treatment
97
Q

what is affected in delerium

A

Cognitive and perceptual disturbances

  • Illusions: paperclip = big
  • Hallucinations: visual- reaching out to something

Physical needs
Moods and physical behaviors: confusion, disoriented
Self assessment

98
Q

delirium planning

A
  • Ensure necessary aids and supportive home team
  • Visual cues in the environment for orientation
  • Continuity of care providers
99
Q

delerium implementation

A
  • Prevent physical harm due to confusion, aggression, or fluid and electrolyte imbalance.
  • Minimize use of restraints (increases confusion)
  • Perform comprehensive nursing assessment to aid in identifying cause.
  • Assist with proper health management to eradicate underlying cause.
  • Use supportive measures to relieve distress
100
Q

community support

A
  • Transportation services
  • Supervision and care when the primary caregiver is out of the home
  • Referrals to day care centers (9-5)
  • Information on support groups in the community
  • Meals on Wheels: provide meals
  • Information on respite and residential services (drop off for weekend)
  • Telephone numbers for help lines
  • Home health services
101
Q

dementia interventions

A

Person-centered care approach
Health teaching and health promotion
Referral to community supports
Integrative therapy

Pharmacological interventions

  • ariept moderate to mild
  • namenda moderate to severe
  • namzarix moderate to severe
101
Q

dementia interventions

A

Person-centered care approach
Health teaching and health promotion
Referral to community supports
Integrative therapy

Pharmacological interventions

  • ariept moderate to mild
  • namenda moderate to severe
  • namzarix moderate to severe
102
Q

plan of care for dependent personality disorder

A
  • help address current stressors
  • set limits that dont make the pt. feel punished
  • be aware of strong countertransferance
  • use therapeutic relationships as a testing ground for assertiveness training

treatment:
- psychotherapy is treatment of choice

103
Q

narcissistic personality disorder characteristics

A
  • Feelings of entitlement, exaggerated self importance
  • Lack of empathy; tendency to exploit others
  • Weak self-esteem and hypersensitivity to criticism
  • Constant need for admiration
  • Less functional impairment than other personality disorders
  • irrigant know it all, stems from insecurities, look for compliments
104
Q

Schizotypal PersonalityDisorder

A
  • Severe social and interpersonal deficits
  • Anxiety in social situations
  • Rambling conversation
  • Paranoia, suspiciousness, anxiety, distrust
  • Brief, intermittent episodes of hallucination or delusion
  • Can be made aware of their own odd beliefs
  • May be vulnerable to involvement with cults or unusual religious/occult groups
  • odd, hard time being social, don’t blend well, strange, magical thinking, strange beliefs, affect inappropriate, hallucinations, delusions
  • they know symptoms are not normal
105
Q

Borderline PersonalityDisorder setting limits

A 
Provide clear and consistent boundaries
Use clear, straightforward communication
Calmly review therapeutic goals
Teamwork and safety
Respond matter-of-factly to superficial self-injuries
106
Q

characteristics of obsessive compulsive disorder

A
  • rigidity, inflexible standrds for others and self
  • constant rehearsal of social responses
  • excessive goal seeking that is self defeating or relationships defeating
  • strict standards interfere with project completion
  • unhealthy focus on perfection
107
Q

Antisocial PersonalityDisorder planning and implementation

A
  • Boundaries, consistency, support, and limits
  • Realistic choices
  • Teamwork and safety (prime)
  • Therapeutic communication
  • Pharmacological interventions (mood stabilizers)
  • rarely stick to long term relationships
108
Q

mandated reported

A

must report abuse if you dont you can have licenses taken away

109
Q

cycle of violence

A

Tension-building stage
Acute battering stage
Honeymoon stage

110
Q

Tension-building stage

A

minor incidence happens

  • verbal abuse, pushing
  • person is fearful
111
Q

Acute battering stage

A
  • external events trigger it, or perpretrator

- emotional state

112
Q

Honeymoon stage

A

everything calms down
- apologizes, shows remorse, says they’ll never do it again

cycle starts again, gets worse, victim has low self esteem or fear

113
Q

neglect

A

failure to provide physical, emotional, educational needs

114
Q

types of abuse

A 
Physical abuse
Sexual abuse
Emotional abuse
Neglect
Economic abus

Psychiatric Nursing (22 decks)

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