final exam Flashcards
ADHD:
-the most common disorder of
childhood, results in poor academic
performance, strained family dynamics
and/or rejection by peers
-Behavioral interventions
– Parental education/support
– Special Education assistance may also be
needed to reach academic benchmarks
Autism:
-includes a continuum approach to
developmental disorders, which are characterized by severe impairment of reciprocal social interaction skills, communication deviance, and restricted stereotyped behavioral patterns
-do not relate to peers or
parents, lack spontaneous enjoyment, and
cannot engage in play or make-believe with toys.
-autism is often treated with behavioral
approaches. Months or years of treatment may be needed before a positive outcome is seen
Lithium therapeutic vs. toxic ranges:
-therapeutic: 0.8-1.2
-1.2 - 1.5 – lethargy, slurred speech, muscle weakness, thirst, polyuria
-1.5 - 2.0 – above reactions plus ECG changes
-2.0 - 2.5 – ataxia, clonic movements, hyperreflexia, seizures
->2.5 – multiorgan toxicity, significant risk of death
Nursing considerations: Slowly crosses the blood brain barrier, crosses the placenta, enters breast milk, monitor sodium level: low sodium = risk for toxicity
neurologic side effects that can be treated with anticholinergic medications (diphenhydramine) are called EPS and include:
acute dystonia, akathisia, pseudoparksonism
resilience:
term for having healthy responses to stressful circumstances or risky situations is
torts (intentional and unintentional)
wrongful act, resulting in injury, loss, or damage
-unintentional: negligence, malpractice
-intentional: assault, battery, false imprisonment
negliegence:
is an unintentional tort causing harm through failure to act
malpractice
is negligence by health professionals in cases where they have a duty to the client that is breached, causing injury or damage to the client
assault:
act of intentionally or recklessly causing someone to fear immediate and unlawful violence, assault doesn’t require physical contact
battery:
act of intentionally or recklessly inflicting unlawful force or physical contact on someone
deontological principles:
-autonomy: right to self-determination,
independence
-beneficence: duty to benefit others or promote good
-nonmaleficence: requirement to do no harm
-justice: fairness
-veracity: honesty, truthfulness
-fidelity: obligation to honor commitments and contracts
revolving door:
a cycle of frequent psychiatric hospitalizations and discharges
breach of confidentiality-when is it acceptable to breach confidentiality in mental health
-what should you say when someone asks about a patient: ‘i cant confirm or deny the existence of that patient’
-breach confidentiality when patient is deemed to be a danger to themselves or others, abuse
-HIPAA, health insurance portability and accountability act
-each individual is entitled to have all identifying information that a provider maintains or knows about him remain confidential, HIPAA, if patient is proved to be a threat, report
Freud’s assumption?
all human behavior is cased and can be explained, psychosexual development, five stages of development:
-oral - 18-24 months
-anal 18-36 months
-phallic/oedipal 3-5 years
-latency 5-11 years
-genital 11-13 years
therapeutic communication techniques and how to use and identify.
sympathy: feeling of concern for someone who is experiencing something difficult (pity)
empathy: ability to understand and share another persona feelings (im on your side of help)
therapeutic nurse client relationships goals
-Establish a working relationship
-Identify patients most important concerns: assess patient’s perceptions
-Assess the client’s perception of the problem as it unfolds
-Facilitate the client’s expression of emotions
-Teach the client/family necessary self-care skills
-Recognize the clients needs
therapeutic communication (appropriate responses)
Accepting, broad openings, exploring, general leads, making observations, presenting reality, reflecting, and restating, eye contact, up right, open space, 3-6 feet
non therapeutic communication
Advising, challenging, defending, disagreeing, disapproving, reassuring, rejecting, requesting an explanation- using why? fidgeting, slouching, crossing arms
professional responses to inappropriate comments or questions from patients
“I understand you may be feeling frustrated, but please refrain from making comments like that as they are not appropriate for this setting,” or “Let’s keep our conversation focused on your medical care.” do not tell patient they are being rude, be direct and firm with what you say
roles of nurses:
-teacher: methods of coping skills, solving problems, medications, self care, community and family resources
-caregiver: physical nursing care
-advocate: acting on clients behalf when they cannot do so (privacy and dignity)
-parent-surrogate: childlike behavior set clear and firm limits
therapeutic responses to maintain professional boundaries
-focus on client needs, experiences, feelings, ideas, goal oriented
-pre-interaction: explore own feelings, fantasies, and fears, analyze own professional strengths and limits, gather data about patient, plan first meeting
-orientation: why patient sought help, establish trust, communication, acceptance, contract, goals with patient
-working: start doing goals, overcome resistance behaviors
-termination: reality of separation, renew progress, explore feelings of anger
transference vs. countertransference
transference: what the patient feels towards the nurse
countertransference: what the nurse feels towards the patient
neurotransmitters and which mental disorders they affect:
-dopamine: the “feel good” neurotransmitter
thought to be increased in people with schizophrenia, excitatory transmitter
-norepinephrine: is associated with “fight or flight”, excitatory transmitter
-GABA: “calming” neurotransmitter and may be decreased in depression and anxiety, inhibitory transmitter
-serotonin: sleep, mood, memory neurotransmitter can be decreased in depression and anxiety, inhibitory transmitter
Carper’s Patterns of Knowing
four patterns:
-empirical (derived from nursing science)
-personal (from life experience)
-ethical (from moral nursing knowledge)
-aesthetic (from art of nursing)
5 phases of aggression:
1) triggering: an event or circumstances in the environment initiates the clients response, which is often anger or hostility
2) escalation: clients responses represent escalating behaviors that indicate movement toward a loss of control
3) crisis: during a period of emotional and physical crisis, client loses control
4) recovery: client regains physical and emotional control
5) postcrisis: client attempts reconciliation with others and returns to the level of functioning before the aggressive incident and its antecedents
what is aggression and some characteristics of aggression?
-hostility = verbal aggression, usually when feeling
threatened or powerless
-physical aggression: attack on or injury to another person; destruction of property
-both to harm or punish another person or force into compliance
-clenched jaw, pacing, clenched fists, raised voices, irritability
the cycle of violence:
1) honeymoon stage: apologetic, respectful, attentive, promises, improved communication, helpful, gift giving/compliments, spends time
2) tension stage: insults, threats, sarcasm, jealousy, accusations, fault finding, controlling actions, quick mood changes, emotional distance
3) explosion stage: intimidating body language, keeps them from leaving, throwing things, slamming doors, silent treatment, name calling, swearing, yelling
cluster a personality disorders: odd or eccentric behaviors “accusatory”
-paranoid personality disorder
-schizoid personality disorder
-schizotypal personality disorder
may have trouble forming close relationships and may have odd or cold traits that can lead to criticism from others
cluster b personality disorder: erratic or dramatic behaviors “wild”
-antisocial personality disorder
-borderline personality disorder
-histrionic personality disorder
-narcissistic personality disorder
dramatic, impulsive, and emotional behaviors and thoughts
cluster c personality disorder: anxious or fearful behaviors “worried”
-obsessive personality disorder: compulsive
-avoidant personality disorder: cowardly
-dependent personality disorder: clingy
cause persistent and harmful patterns of behavior and thinking, affecting how individuals perceive themselves and interact with others
nursing interventions for personality disorders
be cautious and avoid patient attempts to use manipulation or splitting
techniques, use clear communication, set limits, boundaries, and realistic goals, deal with frustration: patients change slowly yet “look” like they are capable
of better behavior, work effectively as part of team; consistency is essential
difference between factitious disorder and illness anxiety disorder
-factitious: characterized by physical symptoms that are feigned or self inflicted for the sole purpose of drawing attention to oneself and gaining emotional benefits of assuming the sick role
Munchausen Syndrome and Munchausen Syndrome by Proxy (imposed on someone else so they can be a hero or get sympathy from people)
hyperchondriasis: defined as the preoccupation with the fear that one has or will contract a serious and possibility life threatening disease, clients often misinterpret bodily sensations or functions
5 stages of grief
1) denial: avoidance, confusion, elation, shock
2) anger: frustration, irritation, anxiety
3) bargaining: overwhelmed, helplessness, hostility
4) depression: struggling to find meaning, reaching out to others, telling ones story
5) acceptance: exploring options, new plans, moving on
types of grief
-complicated: person void of emotion; grieving for prolonged periods; expressions of grief seem disproportionate to event, usually sudden deaths, multiple deaths, suicide or murder
-uncomplicated: this is also known as normal grieving, a grief process that involves a range of emotions and behaviors that are common after a loss
-disenfranchised: grief over loss that is not or cannot be openly acknowledged, mourned publicly, or supported socially, like a nurse losing their patient
PTSD:
disorder in which a person has difficulty recovering after experiencing or witnessing a terrifying event
eating disorders:
-anorexia nervosa: refusal or inability to maintain minimal normal body weight, intense fear of gaining weight or becoming fat, significantly disturbed perception of body shape or size, steadfast inability or refusal to acknowledge seriousness of problem or even that one exists, anorexia starves on purpose, very thin, some may use laxatives
-bulimia nervosa: recurrent episodes of binge eating (secretive); compensatory behaviors to avoid weight gain (purging, use of laxatives, diuretics, enemas, emetics,
fasting, excessive exercise), recognition of behavior as pathologic; feelings of guilt, shame, remorse, contempt, usually normal weigh, bulimia binge eating followed by purging, average weight, heavy meals followed by purging, guilt
-purging: making self throw up
-anorexia: eat too little
-bulimia: eat too chaotically
-obesity: eat too much
major depressive disorder
changes in eating habits → weight gain or loss, hypersomnia or insomnia, impaired concentration, decision making, or
problem solving, worthlessness, hopelessness, despair, guilt, thoughts of death/suicide, overwhelming fatigue, negative thinking, anhedonia, at least 2 weeks
suicide risk factors
deliberate non-suicidal behaviors
intended to cause self-harm, family history, may be seen as an acceptable behavior, previous attempts Feelings of
hopelessness, isolation, barriers to
accessing mental health treatment, history of alcohol or substance use disorders
bipolar 1 disorder: manic depressive disorder
will experience a full manic episode
excessive cheerfulness or elevation in mood, extreme mood fluctuations from mania to depression, manic episodes begin suddenly, last from a few weeks to several months, manic episodes-pressured speech, sleeplessness, impulsiveness, grandiose
bipolar 2 disorder
will experience only a hypomanic episode (a period that’s less severe than a full manic episode), the “up” moods never reach full blown mania
-hypomania: period of milder expansive or irritable mood, milder symptom of mania
nursing interventions for client experiencing mania:
provide a safe environment, meet physiological needs, therapeutic
communication, promote appropriate behaviors, manage medications, educate client and family
schizophrenia:
positive symptoms: delusions, hallucinations, grossly disorganized thinking, speech, and behavior
negative symptoms: flat affect, lack of volition (making a decision), social withdrawal, low energy, anhedonia (lack of interest)
therapeutic communication with client experiencing delusions or hallucinations
-assess and intervene to maintain safety – suicide, violence, physiological stability
-establish trusting relationship with patient and family
-recognize suspicious and paranoid behaviors by the client as part of the illness, -fear of the hostile or aggressive patient,
-frustration with client for not adhering to medication regimen,
-you are not expected to have all of
the answers and solutions
types of delusions:
-persecutory Delusions: The person feels he or she is being plotted or discriminated against, spied on, threatened, attacked or
deliberately victimized. This is the most common form of psychotic delusion.
-grandiose Delusions: The person believes he or she has enormously superior characteristics or is a person of great power or fame.
-delusions of reference: Also common, these symptoms occur when a person attaches special personal meaning to television broadcasts, music, or newspaper articles- they may believe
television sets are talking to them or that people are sending thoughts to them.
-somatic delusions: unrealistic beliefs about their own health or
bodily functions.
risk factors for alcoholism:
how can we help prevent alcoholism?
-early age of alcohol starts at 12-14 years old
-biologic factors: kids of alcoholic parents are at higher risk for developing alcoholism
-children of alcoholics are 4x more likely to develop it (inconsistent behaviors, poor role modeling, lack of nurturing, maladaptive coping skills)
-prevent: going to groups, therapy, knowing your triggers
Disulfiram (Antabuse) patient teachings
should never take place until the patient has abstained from alcohol for at least 12 hours, should avoid alcohol and alcohol-containing products for at least 14 days after discontinuing disulfiram, as there are reports of disulfiram-alcohol reactions within 2 weeks of discontinuation
priority when suspecting nurse diverting drugs:
characteristics: isolates from others, eats alone, avoid staff events, unexplained disappearances, shows up on days off, volunteers for extra shifts, and hold narcotic keys, spills or waste narcotics, chaotic home life, refuses to comply, implausible excuses for behavior
handling waste: must have a documented witness, document as soon as u make a mistake, MAR, document pain score, report any discrepancies, suspected diversion, inapporiate access
differences in dementia and delirium:
do we care for patients with these
disorders?
delirium: a mental state in which you are confused, disoriented, and not able to think or remember clearly. It usually starts suddenly
dementia: the loss of cognitive functioning — thinking, remembering, and reasoning — to such an extent that it interferes with a person’s daily life and activities, slow
differences between dementia and delirium
dementia is gradual, long, LOC is unaffected, worsens as life goes on, memory is impaired, pt looks healthy, common disturbances
delirium is fast, brief, LOC fluctuates during the day, speech incoherent, hallucinations common, pt looks sick, memory infected
motivational learning:
O: open ended questions
A: affirmations
R: reflections
S: summarizing
stigma:
1 in 4 people get treated for their mental health, refers to the negative attitudes, beliefs, and stereotypes that people hold towards individuals experiencing mental health conditions
phases of therapeutic relationship:
-pre-interaction: explore own feelings, fantasies, and fears, analyze own professional strengths and limits, gather data about patient, plan first meeting
-orientation: why patient sought help, establish trust, communication, acceptance, contract, goals with patient
-working: start doing goals, overcome resistance behaviors
-termination: reality of separation, renew progress, explore feelings of anger
generalized anxiety disorder is defined as?
causes people to experience excessive and persistent worry about everyday things
obsessive compulsive disorder is defined as?
-obsessions = recurrent, persistent, intrusive, and unwanted thoughts, images, or impulses
-compulsions = ritualistic or repetitive behaviors or mental acts that a person carries out continuously in an attempt to neutralize anxiety
what is PTSD defined as?
post traumatic stress disorder, disturbing patterns of behavior demonstrated by someone following a major trauma
beginning at least 3 months after the event or even months or years later
what is mild/moderate, up to 3 months, 6 months after end of stressor duration for symptoms disorder called?
adjustment disorder
what is severe, few days to maximum 4 weeks, maximum one month duration for symptoms disorder called?
acute distress disorder
what is severe, sometimes years, >1 month duration for symptoms disorder called?
PTSD
different dissociative disorders:
dissociative amnesia disorder: what is sudden memory loss cause by an event
depersonalization disorder: whats is a person feels detachment from ones mind or body
dissociative fugue disorder: what is forgetting personal info and taking on a new identity and including moving, but forget fugue state when it ends
dissociative identity disorder: what is the existence of two or more distinct personalities within a distinct individual
grounding:
technique reminds the patient that they
are in the present and are safe, can be used for anxiety and PTSD
signs of physical abuse:
unexplained cuts, abrasions, bruising or swelling, unexplained burns or scalds, cigarette burns, rope burns or marks on arms, legs, neck, torso, unexplained fractures, strains or sprains; dislocation of limbs, bite marks, dental injuries, ear or eye injuries
levels of anxiety:
-mild: special attention; increased sensory stimulation; motivational
-moderate: feeling something is definitely wrong; nervousness/agitation; difficulty concentrating; able to be redirected, learning is still able
-severe: trouble thinking and reasoning; tightened muscles; increased vital signs; restless, irritable, angry
-panic: fight, flight, or freeze response; increased vital signs; enlarged pupils; cognitive processes focusing on defense
OCD characteristics:
-excoriation: skin picking
-trichotillomania: hair-pulling
-onychophagia: chronic nail-biting
-BDD(body dysmorphia): a preoccupation with an imagined or slight defect in physical appearance
-hoarding
-kleptomania: compulsive stealing
-oniomania: compulsive buying
-body identity integrity disorder
antipsychotics medication side effects:
electrocardiogram (ECG) changes-
prolong QT interval
neuroleptic malignant syndrome (NMS)
agranulocytosis-severe low white blood
count
extrapyramidal symptoms (EPS)
-pseudoparkinsonism
-akathisia-state of agitation, distress
and restlessness
-dystonia-muscles contract
involuntarily
-tardive dyskinesia-movements appear in the eyes, lips, tongue and jaw
weight gain
somatic symptom illness:
-conversion disorder: involves unexplained, usually sudden deficits in sensory or motor function (blindness, paralysis), client is usually indifferent or shows a lack of distress to the functional loss
- pain disorder: client complaints of physical pain that is not relieved by pain medications, greatly affected by psychological factors in terms of onset, severity, exacerbation, and maintenance
-hyperchondriasis: defined as the preoccupation with the fear that one has or will contract a serious and possibility life threatening disease, clients often misinterpret bodily sensations or functions
-somatic symptom disorder: when a person has a significant focus on physical symptoms, such as pain, weakness or shortness of breath, to a level that results in major distress and/or problems functioning
malingering:
feigning (or pretending to be affected by) physical symptoms for some external gain such as avoiding work
disordered speech patterns: for schizophrenia
-tangential: the person’s ideas are only loosely connected to the topic, i.e. there are “loose associations” between expressed ideas and one thought or statement does not logically follow the other
-neologisms: the person makes up new words that have meaning only to them
-circumstantial: provides unnecessary detail but does return to the point
-preservation: adherence to a single idea or topic, and verbal repetition of the sentence phrase or word even when attempts are made to change the topic
-word salad: the person’s language can become so disordered as to be incomprehensible, a senseless jumble of words
-flight of ideas: the person’s ideas rapidly shift from one subject to another and are not related at all, however he or she believes the incoherent statements make perfect sense
Conduct disorder:
-is the most common disruptive behavior disorder and is characterized by aggression to people and animals, destruction of property, deceitfulness and theft, and serious violation of rules, Callous and unemotional traits
-Decreasing violent behavior
– Increasing compliance
– Improving coping skills and self-esteem
– Promoting social interactions
– Education and support of the parent
Oppositional Defiant Disorder:
-conduct disorder may be diagnosed with antisocial personality disorder as adults, involves and enduring pattern of uncooperative, defiant, disobedient, and hostile behavior toward authority figures that exceeds the periodic negative behaviors that are usually seen in adolescence
-do not associate their behaviors with
consequences of those behaviors
-management training is based on
behavioral principles of decreasing
reinforcing attention for negative behaviors, rewarding positive behaviors and setting consistent expectations and consequences
-Treatment—parent
management training
models of behavioral
interventions
Intermittent Explosive Disorder
-sudden, intense, and out-of-proportion anger outbursts
-Repeated episodes of impulsive,
aggressive, violent behavior; angry
verbal outbursts
-May physically injure others and self
-May feel guilty after outbursts; this
does not prevent future outbursts
-Most common in adolescence and
adulthood
-serotonin imbalance
limit setting
a technique used to establish boundaries and expectations for acceptable behavior, and to communicate the consequences of breaking those rules
treatment for disruptive behavioral disorders
Stimulants like methylphenidate (Ritalin)
and amphetamine compounds such as
Adderall.
– Atomoxetine (Strattera) – THE ONLY NON-
STIMULANT MEDICATION THAT HAS
BEEN SPECIFICALLY DEVELOPED AND
TESTED BY THE USDA FOR THE
TREATMENT OF ADHD.
gender dysmorphia:
a condition that describes a person’s distress or discomfort when their gender identity differs from their assigned sex at birth
different effects:
blunted effect: restricted range of emotional feeling, tone, or mood
flat effect: absence of any facial expression that would indicate emotions or mood
flumazenil:
helps overdose on benzo, No, flumazenil does not have effects like benzodiazepines (benzos); instead, it acts as an antagonist to benzodiazepines, meaning it actively reverses the effects of benzodiazepines by blocking their receptors in the brain, making it the specific antidote for benzodiazepine overdose
