FINAL EXAM Flashcards
Autism Spectrum Disorders
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
ASD assessment
developement delays, communication, sensory stim, relationships within family abuse, intellectual ability
asd diagnosis
lack of coordination head banging
asd diagnosis
lack of coordination head banging
asd outcomes
reframe from outburst, talk through it
ASD implementation and interventions
provide structure, consistency, reward system
- psychological interventions
- psychobiological interventions
physical occupational speech therapy
autism develops…..
in early childhood
ADHD
Inappropriate degree of
- Inattention
- Impulsiveness
- Hyperactivity
- commonly seen in school
- temper outburst
- low self esteem
adhd assessment, diagnosis
Assessment
- Level of physical activity, attention span, talkativeness
- Social skills
- Comorbidity: learning disorder, disregulation, impulsive
Diagnosis: low self esteem, anxiety
meds for adhd
ridiline aderal
increase pay attention, less impulsive, less distracted
communication disorders
deficit in language skills acquisition that impairment in academic, achievement, socialization, or self worth
what are the Intellectual Development Disorders
Intellectual functioning
Social functioning
Daily functioning
intellectual development disorder severity
can be mild to extremely severe
- begin in childhood
intellectual functioning
deficit in reading problem solving
social functioning
impaired communication and language regulating emotion
daily functioning
daily life affected
sterotypic movement disorder
Repetitive, purposeless movements for 4 weeks or more
tourette’s disorder
multiple motor ticks for 1y can be brought on by stress
depersonalization
unreal
loss of idenity
arm not part of body
derealization
environment has changed
“everything tiny”
Hallucinations
- 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
Illusions
spiders crawling on wall, black dots
delusions
fulse beliefs, held despite a lack of evidence to support them
disadvantange of first gen
Extrapyramidal side effects (EPS)
- Anticholinergic (ACh) side effects
- Tardive dyskinesia
- Weight gain, sexual dysfunction, endocrine disturbances
first gen
Haloperidol (Haldol)
Loxapine (Loxitane)
Chlorpromazine (Thorazine)
Fluphenazine (Prolixin)
xanax…..
severe anxiety
theraptuic statements for soemone hearing voices
ik it must be very scary for you but i don’t hear voices
acute dystonia
The client experiences severe spasms of tongue, neck, face, or back. This is a crisis situation, which requires rapid treatment
parkinsonism
Signs and symptoms include bradykinesia, rigidity, shuffling gait, drooling and tremors.
akathisia
The client is unable to stand still or sit, and is continually pacing and agitated.
tardive dyskinesia (TD
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
Neuroleptic Malignant Syndrome
Symptoms include sudden high-grade fever, blood pressure fluctuations, dysrhythmias, muscle rigidity, and change in LOC developing into coma
Anticholinergic effects
Dry mouth Blurred vision Photophobia Urinary hesitancy/retention Constipation Tachycardia
positive symptoms of schizo
- hallucinations
- delusions
- disorganized speech
- bizarre behavior (talking to self)
negative symptoms
- blunt affect
- no expression
- alogia- the poverty of thoughts
- avolition- lack of motivation
- anhedonia- lack of pleasure
alogia
the poverty of thoughts
avolition
lack of motivation
anhedonia
lack of pleasure
medications that cause tardive dyskinesia
1st gen meds
Haloperidol (Haldol)
Loxapine (Loxitane)
Chlorpromazine (Thorazine)
Fluphenazine (Prolixin)
treatment for tardive dyskinesia
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
planning manic phase
- 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.
manic episodes implementation
- Hospitalization for acute mania (bipolar I disorder)
- Communicating challenges and strategies
- be direct with limits
risk for sicude with bipolar
watch for s/s
hospitalize them
bipolar 1 disorder
- Most severe form
- Highest mortality rate of the three
- At least 1 manic episode
- big shifts
- admitted for severe mania
ithium therapeutic level
maintenance blood level
Therapeutic blood level: 0.8 to 1.4 mEq/L
Maintenance blood level: 0.4 to 1.3 mEq/L
lithium toxic level
Toxic blood level: 1.5 mEq/L and above
- need blood test every 5d
<1.5 side effects
nausea vomiting diarrhea thirst polyuria lethargy sedation fien hand tremors renal toxicity goiter hypothyroidism
1.5-2.0 lithim early s/s of toxicity
gastro upset coarse hand tremors confusion hyperiiritability of muscles electroencephalography changes sedation incoordination
2.0-2.5 advanced s/s of lithium toxicity
ataxia giddiness serious electroenciphalographic changes blurred vision clonic movements large output of diluted urine seizure stupor severe hypotension coma death
> 2.5 severe toxicity lithium
convulsion
oliguria
death
planning during depressive phase
- 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
bipolar 1 vs bipolar 2
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
s/s of suicide ideation
- 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
depressive disorder: Selective serotonin reuptake inhibitors SSRIs
First-line therapy
Rare risk of serotonin syndrome
Fluoxetine (Prozac) Citalopram (Celexa) Escitalopram oxalate (Lexapro) Paroxetine (Paxil) Sertraline (Zoloft)
depressive disorder plan of care
Planning
Geared toward
- Patient’s phase oif depression
- Particular symptoms
- Patient’s personal goals
priority intervention for a pt. that is depressed
check if they are suicidal
vegetative depression interventions
use encouragement
MAOI dietary restriction
- 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
assessment findings for depression
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
mild anxiety
Everyday problem-solving leverage
Grasps more information effectively
- tense, bitting nails, shaking legs
moderate anxiety
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,
severe anxiety
- 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
panic
- Markedly disturbed behavior—running, shouting, screaming, pacing
- Unable to process reality; impulsivity
- cant breath, hallucinated, withdrawn
Obsessive-compulsive disorder when does it occur and what does it involve
symptoms occur on a daily basis and may involve issues of sexuality, violence, contamination, illness, or death
plan of care for anxiety
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
discarge planning for anxiety
- 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
obsessions
Thoughts, impulses, or images that persist and recur, so that they cannot be dismissed from the mind
- “I’m a bad person”
compulsions
Ritualistic behaviors an individual feels driven to perform in an attempt to reduce anxiety
post traumatic stress disorder
- 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
depersonalization
- cut off from self
- robot
- not intube
- outside observer
- out of body experience
derealization
- cut off from world
- in dream
- objects feel bigger/smaller
- sounds overwhelming
post-traumatic stress disorder diagnosis
Post trauma syndrome
- symptoms over a month impaired function, anxiety
Complicated grieving
- morning the situation
Dissociative Identity Disorder
- 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
acute stress disorder vs ptsd
acute stress last 3 days after 1 month becomes ptsd
somatization
Expression of stress through physical symptoms that are often manifestations of psychological and emotional distress
somatization symptoms expressed
place of anxiety, depression, or irritability
illness anxiety disorder
extreme worry of fear about having an illess refer to physcologist
conversation disorder
functional: neurological symtpoms in the absent of any nerological disease pt. blindeness assist them
nursing diagnosis for somatic disorder
- infecctive coping
- anxiety
- risk for loneliness
- powerlessness, hopelessness
- social isolation
- pain
- altered family processes
- risk for suicide
anorexia acute care
- *** 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
Anoreixa safety and teamwork
weight respiration program
- not above 90%may stop treatment
- coping and probelm solving
- normalize eating specific habit
- schedule weights
- family go to bathroom
anorexia nursing diagnosis
***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.
s/s of anorexia
cold extremities, fatigue, languo: downey hair, hypokalemia, NA decr, yellow skin, amenorhea, low weight
restrciton anorexia
not had recurrent pinge and purg in last 3 months
binge and purg anorexia
binge and purg or laxatives, vomiting, diretics in 3m
binge eating s/s
obese and overwight
- GI issues: bloating, heartburn, vomiting
- treatment done on an out pt. basis
binge eating nursing diagnsis
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
binge eating acute care
Psychosocial interventions Pharmacological interventions Surgical interventions: bariatric surgery (for obesity) Health teaching and health promotion Teamwork and safety
bulimia outcomes
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
communication with a withdrawing pt.
empathetic communication
alc withdrawl
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
serious withdrawl
- sucide
- seizures
- depression
(valium can help)
clondrine, methadone, buprenorephine
used to treat opioid withdrawl symptoms (check on pt. every 4 hr)
nalazone
opioid toxcity
Confabulation
creation of stories in place of missing memories to maintain self-esteem
delirium
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
what is affected in delerium
Cognitive and perceptual disturbances
- Illusions: paperclip = big
- Hallucinations: visual- reaching out to something
Physical needs
Moods and physical behaviors: confusion, disoriented
Self assessment
delirium planning
- Ensure necessary aids and supportive home team
- Visual cues in the environment for orientation
- Continuity of care providers
delerium implementation
- 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
community support
- 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
dementia interventions
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
dementia interventions
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
plan of care for dependent personality disorder
- 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
narcissistic personality disorder characteristics
- 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
Schizotypal PersonalityDisorder
- 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
Borderline PersonalityDisorder setting limits
Provide clear and consistent boundaries Use clear, straightforward communication Calmly review therapeutic goals Teamwork and safety Respond matter-of-factly to superficial self-injuries
characteristics of obsessive compulsive disorder
- 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
Antisocial PersonalityDisorder planning and implementation
- Boundaries, consistency, support, and limits
- Realistic choices
- Teamwork and safety (prime)
- Therapeutic communication
- Pharmacological interventions (mood stabilizers)
- rarely stick to long term relationships
mandated reported
must report abuse if you dont you can have licenses taken away
cycle of violence
Tension-building stage
Acute battering stage
Honeymoon stage
Tension-building stage
minor incidence happens
- verbal abuse, pushing
- person is fearful
Acute battering stage
- external events trigger it, or perpretrator
- emotional state
Honeymoon stage
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
neglect
failure to provide physical, emotional, educational needs
types of abuse
Physical abuse Sexual abuse Emotional abuse Neglect Economic abus
