Final Exam Blueprint Flashcards
Most common complications of late stage NCD
-contractures, cannot move, cannot eat, cannot swallow, atrophy, cannot talk
Can clients with late stage NCD hear and see the outside world
yes
Nursing considerations for client in late stage NCD
-safety!
-learn how to effectively communicate with them
Expected MRI/CT findings for Alzheimer’s disease
-sulci begin to unfold
-changes to hippocampus (memory)
-changes to cerebral cortex
-amyloid-beta plaques, tau neurofibrillary tangles, neuronal damage
Area of the brain associated with impaired visuospatial skills
parietal lobes?
Opioid intoxication interventions
-safety is main priority (may need 1 on 1 observation)
-low stimuli environment
-monitor clients RR, BP and other VS
Symptoms of opioid intoxication
slurred speech, impaired memory, small pupils, decreased respirations, decreased LOC
What is the antidote for severe opioid intoxication
naloxone
What is disulfiram used for
maintaining abstinence from alcohol
Patient teaching for disulfiram
-avoid contact with any forms of alcohol (mouthwash, cough syrup, aftershave, hand sanitizer)
-wear a medical alert bracelet
-participate in a self-help program
-potential for acetylaldehyde syndrome (if alcohol is consumed)
Symptoms of acetaldehyde syndrome
N/V, sweating, palpitations, hypotension, respirator depression, cardiovascular suppression, seizures ,death
Recovery success in drug treatment
First 24 hours of alcohol withdrawal priority intervention
-begin treatment so we do not have tremens delirium
-seizure precautions
What medications treat alcohol withdrawal
benzodiazepines, anticonvulsants
Symptoms of alcohol delirium
hallucinations, severe disorientation, severe hypertension, cardiac dysrhythmias, delirium
What type of drug is risperidone
atypical antipsychotic
What type of disorders does risperidone treat
psychotic disorders (schizophrenia, delusional disorder, schizoaffective disorder)
-treats negative symptoms (5 A’s)
What are the 5 A’s?
-affect (blunted)
-alogia (poverty of thought or speech)
-anergia (lack of energy)
-anhedonia (lack of pleasure or joy)
-avolition (lack of motivation)
client education for risperidone
-report indications of metabolic syndrome (increased thirst, urination, appetite)
-monitor blood pressure and HR for orthostatic hypotension
-increase fiber, fluids, exercise (anticholinergic teaching)
-monitor for EPS symptoms
-sexual dysfunction can occur
-monitor for amenorrhea, galactorrhea, and gynecomastia
-avoid smoking
-avoid high and low temps
-avoid alcohol and OTC meds
-sunblock and protective clothing
Should respiridone be used in clients with dementia
no
We should tell those on risperidone to avoid
-drinking alcohol
-becoming pregnant/breastfeeding
What are the EPS symptoms clients on risperidone should monitor for
tardive dyskinesia, acute dystonia, Parkinsonism, dystonia, akathisia
What is tangentiality a symptom of
psychotic disorder
What is tangentiality
veering away from the topic of discussion and demonstrates difficulty In maintaining focus and attention
“Tangential thinking involves abrupt changes in subject matter that are unrelated to the initial topic”
What is meant by ‘prodromal symptoms’
early signs of a disease
Prodromal symptoms of schizophrenia
-depression, social withdrawal, cognitive impairment, OCD behaviors
When may ECT be utilized
depressive disorders, mania, schizophrenia
Nursing interventions before ECT
-CBC, urinalysis, ECG, X-ray
-maintain NPO status
Nursing interventions during ECT
-succhinylcholine given (prevent seizures)
-monitor airway and administer oxygen
- monitor patient has bite block during seizure
Nursing interventions following ECT
-monitor HR, BP, and RR q 15 min for first hour
-position patient on side
-stay with patient until they are awake
-assess patient for memory loss or decreased cardiovascular functioning
What factors increase a client’s risk for suicide
widows, sex (women attempt more, more men die by suicide), financial strain, previous suicide attempt, family member die by suicide, diagnosed mental illness, being a minority, veterans, disabled, certain occupations (physicians, law enforcement officers, dentists, insurance agents)
A client is more at risk for suicide if their plan is
-more detailed, availability of the plan to be carried out, more lethal
Risk to a client once antidepressants take effect
suicidal ideation
Lithium carbonate is used to treat what class of disorders
bipolar disorders
lithium carbonate dietary education
maintain a diet adequate in sodium, drink 1.5-3L of water a day
Most common comorbid disorder found in children before being diagnosed with bipolar disorder
ADHD
what are signs and symptoms of ADHD
short attention span, irritability, hyperactivity, accelerated speech, talk a lot
What is the cognitive theory of fear
What is the therapeutic technique of flooding
involves exposing the client to a great deal of an undesirable stimulus in an to turn off the anxiety resposne
the flooding therapeutic technique is useful for clients who have
phobias
which neurotransmitter causes hyperarousal and anxiety
GABA
What are the two most common phobia disorders
agoraphobia, SAD (social anxiety disorder)
What is agoraphobia
fear of not being able to escape
What is social anxiety disorder
excessive fear someone may do something embarrassing/be judged/ negatively evaluated by others
What is a crisis precipitated by normal life changes
crisis of anticipated life transitions
example of a crisis precipitated by normal life changes
JT’s wife had a baby and quit her job. JT is having to work extra shifts
Identify maladaptive responses to stress
adjustment disorder , self-harm, anger, substance abuse, withdrawal
Function of self-help groups in trauma care
group experiences, with or without a professional facilitator. members of the group exchange advice, share coping strategies, and support one another
How do members benefit from self-help groups
hope is derived from knowing that others have survived from similar traumas
the focus of crisis care in a client with stress/trauma
assessing for suicidal behavior, maintaining client safety, restore adaptive functioning and promote personal growth,
Which repressed emotion creates somatic and dissociative disorders
severe anxiety
Which somatic and dissociative disorder is more prevalent in adolescents
conversion disorder
What is the typical onset of DID
childhood, although the disorder may not be recognized until late adolescence or early adulthood
goals for anorexia nervosa
-improved self-body image
-gradual weight increases
-small, frequent meals
-use of self-care activities
-attending individual or group therapy
Bulimia nervosa assessment
-normal to slightly elevated bodyweight
-BMI 18.5-30
-Russels sign (callouses)
-low HR, BP, and body temp
-enlargement of parotid glands
-dental erosions
-hypokalemia
Which disorders are strongly correlated to eating disorders
depression, personality disorders, substance use disorder, anxiety
Borderline personality disorder
-always in a state of crisis
-frequent mood swings and changes in behacior
-affect = extreme intensity
-generate chaos , especially in interpersonal relationships
-inappropriate outbursts of anger
What are some diagnostic criteria a patient must have to be diagnosed with BPD
-unstable self image
-self damaging or impulse behavior
-inappropriate anger
-recurrent SI, threats, or mutilation
-frantic effort to avoid abandonment
-unstable interpersonal relationships
Common patterns of interaction with BPD
-clinging and distancing
-splitting (pitting staff against each other)
-self destructive behavior
-impulsivity (safety risk to themselves, staff, milieu)
What is defensive coping
similar to acting out
Defensive coping interventions
-explain acceptable vs unacceptable behaviors
-explain consequences of violation of limits
-be consistent with enforcing limits
-clear, concise, concrete
-specific rules and regulations for the environment
Avoidant personality disorder
-awkward and uncomfortable in social situations
-perceived as timid, withdrawn
-sensitive, touchy, evasive
-speech is slow and constrained, frequently hesitate
-view others as critical/betraying/humiating
Which avoidant personality disorder, do they desire close relationships?
yes
Histrionic personality disorder
-colorful, dramatic, excitable
-require constant affirmation and acceptance
-engage in seductive, flirtatious behaviot
-manipulative behavior to be the center of attention
-easily influenced
-fleeting and superficial relationships… provocative and sexua l
Obsessive compulsive personality disorder
-serious and formal demeanor
-overly discipled, perfectionistic, preoccupied with rules
-conscious of social ranking
-inflexible and rigid
-difficulty expressing emotions
-concerned with organization, efficiency, and procedure
Dependent personality disorder
-lack of self-confidence, apparent in posture/voice/mannerisms
-passive and acquiscent to desires of others
-overly generous and thoughtful
-discouragement, dejection, and pessimism in silence BUT appears to see the world through ‘rose tinted glasses’
paranoid personality disorder
-on guard, hypervigilant, ready for threat
-appear tense and irritable
-avoids other people
-do not accept responsibility for behaviors
-envois of success
-overly sensitive and misinterpret environmental clues
Most common symptoms of personality disorders
-impairment in interpersonal relationship functions
-dysfunctions in thoughts, mood/affect, impulse control
Antisocial personality disorder
-disregard and violation of rights of other (since age 15)
-failure to respect lawful behavior
-deceitfulness, lying
-impulsivity, failure to plan
-reckless disregard for the safety of others
-lacks remorse
-repeated fights/assaults
-failure to sustain consistent work
What makes up someone’s personality
emotional and behavioral characteristics that are particular to a specific person
-remains someone stable ad predictable over time
How do personality disorders develop
when there is a deviation in what is expected, behaviors go maladaptive, leads to distresses in life
How is our personality developed
hereditary, temperament, experiential learning, social interaction
Cluster A personality disorders will see behavior described as
odd, eccentric
Which personality disorders are cluster A ?
cluster B personality disorders will see behavior described as
dramatic, emotional, erratic
Which personality disorders are cluster B?
Symptoms of antisocial personality disorder we may see in children
abuse to other people or animals
Antisocial personality disorder is more common in men or women
men
Borderline personality disorder is more common in men or whomen
women
Nursing interventions for self-mutilation
-frequent and close observation
-seek staff with experience
-care for wounds in a matter-of-fact manner
-encourage discussions about feeling
-act as a role model
-remove dangerous objects
-redirect with physical outlets
-ensure sufficient staff is available
Schizoid personality disorder nursing diagnosis
Characteristics of shizoid personality disorder
-profound defect in ability to form personal relationships
-eccentric, isolated, lonely
-lifelong pattern of social withdrawal
-engage in solitary activities/ be with animals
-work ion isolation and are unsociable, no desire for emotional ties
-unable to experience pleasure
Factors impeding accurate assessment in children and adolescents
-language development. Children may not have language or cognitive skills to describe what is happening
-Children demonstrate a wide variety of normal
-difficult to distinguish if behavior indicates an emotional problem.
What questions should we ask during assessment with a child?
ask everything about the birth and pregnancy. Ask about any complications that might of occurred for mom or baby
What puts babies at higher risks for mental health disorders?
nutrition in womb and out, pre-mature birth, If mom used substances or alcohol while pregnant
What is intellectual Developmental Disorder?
onset of deficits and impairments during the developmental period of infancy or childhood
What four areas are effected by IDD?
What are some characterisitcis of IDD?
impaired ability to maintain personal independence and social responsibility
What areas are impaired with IDD?
daily living, social participation, and the need for ongoing support at school
Pediatric PTSD
caused by experiancing, witnessingm or learning about something traumatic.
Pediatric PTSD can lead to what kind of disorder?
conduct disorder
Characterisitcs of Children with PTSD
What is an event that can cause a trigger an obsession with death and could cause PTSD in children?
funerals
Difference between Ped conduct disorder and Intermittent Explosive disorder?
conduct: destructive and harm things with no remorse
Explosive: harm but has remorse about it, more common in males 13-21
Why do we normally not perscribe medicine for kids under 8 for mental health disorders?
There are black box warning for SI on anti-depressants, so we want to try therapy first
