Final Exam Review Flashcards
What is empirical knowing?
derived from nursing science
What is personal knowing?
derived from personal experience
What is ethical knowing?
derived from moral nursing knowledge
What is aesthetic knowing?
derived from art of nursing practice
How long is intimate distance?
0-18 inches
How long is personal distance?
18-36 inches
How long is social distance?
4-12 feet
How long is public distance/
12-25 feet
What are the 4 D’s of mental disorders?
deviant, distressing, dysfunction, dangerous
What % of people in the U.S. live w mental illness?
20%
How many current psychiatric disorders in the DSM-5?
157
Notable psychoanalysts/
sigmund freud, carl jung
What is the biggest belief of pyschoanalysis?
Most of our behaviors are driven by unconscious forces. These unconscious forces are often in conflict with each other.
What is the id?
pleasure principle
What is the ego?
reality principle
What is the superego?
moral principle
What are three important therapy techniques for psychoanalysis theory?
free association, dream analysis, inkblot test
Who are notable behavioralists?
john watson, bf skinner
What is the key concept of behavioralism?
contend psychological problems are caused by having learned maladaptive responses. Fortunately, these behaviors can be unlearned.
What are therapy techniques for behavioralism?
operant conditioning, token economies, extinction, modeling, systemic desensitization, relaxation techniques, and aversion therapy
Who are notable cognitive behaviorist?
albert ellis, aaron beck
What is the idea of cbt?
“Men are not disturbed by things, but by the views which they take of them and CBT theorists also emphasize the link between thoughts, behaviors, and emotions. Many clients wish to change their emotions (e.g,. anxiety or depression). But it’s difficult to change emotions. However, if you change your thoughts or behaviors, you can indirectly change your emotions.1
What are therapy techniques for cbt?
education, socratic questioning, assertiveness trainign
What is the ABCD method for cbt?
For example, suppose a friend walks by you but does not acknowledge you. That would be an activating event (A). You might believe that this person no longer likes you (B). The consequence of that belief might be that you feel worthless and depressed. That may cause you to withdraw and avoid others (C).
The therapist might ask you to dispute (D
Who are notable humanists?
carl rogers, abraham maslow
What is the key concept of humanism?
If the therapist can create the proper climate, the client will improve.
What are rogers’ therapeutic factors?
- Genuineness - Roger’s believed constructive change is likely to occur if you are real/transparent with the client.
- Unconditional positive regard - Rogers believed constructive change is likely to occur if you feel genuine caring/acceptance/prizing/love for the client.
- Empathy - Rogers believed constructive change is likely to occur if you can understand the inner world of the client (i.e., see the world through the client’s eyes).
What is “cortex” latin for?
bark
What is the frontal lobe and what mental disorders are associated with an impaired frontal lobe?
CEO of the brain, substance abuse disorder and ADHD
What does the limbic system control?
It controls learning, memory, emotions (fear, anger, pleasure), and basic drives (hunger and sex).
How many neurons are in the brain?
86 billion
What is dopamine used for in the brain?
regulate attention, concentration, pleasure, energy, motivation, mood, and muscle movements.
When is it helpful to increase dopamine levels?
depression or ADHD
What is norepi used for?
regulate mood, alertness, concentration, and energy
When is it helpful to increase norepi levels?
depression or ADHD
What does norepi activate?
fight or flight response
What can excessive amounts of norepi lead to?
anxiety and agitation
What is glutamate in the brain?
gas pedal
What is GABA?
brake pedal
What is acetylcholine?
regulate attention and memory
What are the three ways neurons can terminate a signal?
diffusion, enzymatic degradation, and reuptake
What is diffusion?
Once neurotransmitters enter the synapse, they will eventually float away into the surrounding cerebrospinal fluid, where they can no longer activate postsynaptic receptors.
What is enzymatic degradation?
The brain makes enzymes that break apart neurotransmitters. Of course, you can recognize such enzymes since they end with the letters ace. I like imagine these enzymes as little Pac-Men that enjoy chomping up neurotransmitters (instead of power pellets).
What is reuptake?
The presynaptic terminal has pumps that can suck neurotransmitters back inside the presynaptic terminal where they can be recycled for future use.
What is a hallucination?
sensory impressions without external stimuli (Hallucinating a monster is out to get them)
What is an illusion?
real stimuli misinterpreted (A real person but the client sees that person with a knife instead of just waving their hand)
What is a delusion?
false fixed belief “I am cleopatra”
What is the affect of a client with schizophrenia?
blunted, flattened, inappropriate, overresponsive, labile
Positive symptoms of schizo?
delusions, bizarre behavior, paranoia, hallucinations, disorganized speech, mutism (thought component)
Negative symptoms of schizo?
flat affect, inappropriate affect, poverty of thought, lack of energy, emotional ambivalence, inability to experience pleasure (emotional component)
Younger clients diagnosed with schizo earlier display?
poorer premorbid adjustment, more prominent negative signs, and greater cognitive impairment
What % of patients with schizo relapse within 1 year of an acute episode?
1/3 to 1/2
What are some etiological theories of schizo?
changes in basal ganglia activity, structural abnormalities, less brain tissue/cerebrospinal fluid, imbalance between neurotransmitter systems
What are genetic factor risks for schizo?
increased risk w a positive family history and first-degree relative diagnosed
What do the typical antipsychotics treat?
more effective for positive symptoms
What do the atypical antipsychotics treat?
both positive and negative as well as have fever extrapyramidal side effects
What are the effective goals of antipsychotics?
control symtoms (not cure), reduce anxiety, decrease hallucinations and delusions, increase ability to respond to other treatments
What are expected side effects of antipsychotics?
sedation, postural hypotension, sexual dysfunction, photosensitivity, allergic skin reactions, weight gain, anti cholinergic effects
What are the anticholinergic effects?
lowers BP, dry mouth, blurred vision, constipation, urinary retention, lower seizure threshhold
What are severe side effects of antipsychotics?
agranulocytosis, Extrapyramidal reactions, jaundice, tardive dyskinesia, NMS
What are expected outcomes for treatment of schizo?
safety, contact with reality, interaction w others in environment, express thoughts and feelings in safe manner, adhere to interventions
What are nursing interventions for schizo?
clarify client expectations and your expectations, assign same staff members, introduce to small group situations as tolerated, provide opportunities for success,
How to deal with altered thought processes in patients with schizo?
use simple, concrete language, clarify magical thinking, watch for ideas of reference, deal with delusions
What are the key issues to include when educating the family of someone with schizo?
medication continuation and follow-up, uncertainty of prognosis or recovery, coping with emotional upheaval, and self-care, proper nutrition, social skills, and medication management
What are risk factors for ptsd?
Lack of social support
Peri-trauma dissociation (dissociation during the event)
Previous psychiatric history
Personality factors
What are characteristics of ptsd?
Reexperiencing the trauma:
Dreams
Intrusive/recurrent thoughts
Avoidance
Negative cognition
Being on guard
What are expected outcomes for treatment of PTSD?
Remain physically safe
Distinguish ideas of self-harm vs acting
Demonstrate healthy, effective stress management
Display nondestructive expression of emotion
Develop and utilize social support system
What are interventions common for PTSD?`
Grounding techniques and Validation theory
(see Videbeck, p. 217)
Journaling
Distraction and relaxation techniques
Refer to client as “survivor”
Education to promote prevention and early intervention
What is mild anxiety categorized by?
Associated with the tension of everyday life
The person is alert, perceptual field is increased, learning is facilitated
Physiological responses are within normal limits
Affect is positive
What is moderate anxiety categorized by?
Focus is on immediate concerns
The perceptual field is narrowed
Low-level sympathetic nervous system arousal occurs (increased pulse and respirations)
Tension and fear are experienced
What is severe anxiety categorized by?
Focus is on specific details
Perceptual field is significantly reduced
Learning cannot occur
Sympathetic nervous system is aroused
Severe emotional distress is experienced
What is panic anxiety categorized by?
Dread and terror
Details are blown out of proportion
Personality is disorganized and unable to function
Physiological arousal interferes with motor activities
Overwhelming emotions cause regression to primitive or childlike behaviors
What are the most effective treatments for generalized anxiety disorder?
Buspirone and serotonin-norepinephrine reuptake inhibitor (SSRI) are the most effective treatments
What are nursing interventions for OCD?
therapeutic communication, SSRIs, second gen antipsychotics, behavioral therapy
What meds are used to help control EPs?
cogentin, artane, akineton
What are expected outcomes for treatment of panic disorder?
The client will be free from injury
The client will utilize effective coping mechanisms
The client will sleep at least 6 hours per night
What are expected outcomes for clients with OCD?
ocd symptoms no longer interfere with client’s ability to complete daily activities, willing to make change in behaviors, discuss feelings with others, spend less time performing rituals
What is most treatment for OCD?
outpatient
When are patients with OCD hospitalied?
when they are no longer able to complete ADLs
What is important for nurses to do for OCD patients with recovering?
first allow patient to do rituals but then decrease time allowed for rituals over treatment time
What are manifestations of trauma and stressor related disorders?
anxiety, insomnia, difficulty coping, grief
What is the difference between PTSD and and acute stress disorder?
ASD has symptoms that last 3 days up to one month, PTSD symptoms occur 3 months or more after trauma
What is depersonalization?
the client has a persistent or recurrent feeling of being detached from his or her mental processes or body or they have the sensation of being in a dream-like state in which the environment seems foggy or unreal
What is dissociative identity disorder?
the client displays 2 or more distinct identities or personality states that recurrently take control of his or her behavior and is accompanied by the inability to recall important personal information
What do DID patients usually have a history of?
abuse as a child
What are treatment options for PTSD?
individual therapy, group therapy (focus is on reassociation) and medications
What are expected outcomes for PTSD/traumatic disorders?
Remain physically safe
Distinguish ideas of self-harm vs acting
Demonstrate healthy, effective stress management
Display nondestructive expression of emotion
Develop and utilize social support system
What is the scale used to determine likelihood for violence?
Broset violence checklist
What are the stages of grief?
denial, anger, bargaining, anger, acceptance
What are mood-congruent factors?
Some clients with depression experience delusions that involve
strong feelings of guilt. They may believe they are responsible for someone’s death or a natural catastrophe.
Alternatively, they may believe they have a severe illness or that their body is “rotting.” Auditory
hallucinations can also occur.
What is bipolar I?
clients experience mania and ususally depression
What is bipolar II?
clients experience hypomania and depression
What are supported etiologies of bipolar disorder?
-stressful events in childhood
-first degree relatives w bipolar increases chances by 5-10%
-excessive dopamine and norepi levels, less dopamine even during mania
What are the 4 E’s of personality disorders/
Enduring, Externazation, Egosyntonic,early
What are the cluster A disorders?
paranoid, schizotypal, and schizoid
What are cluster B disorders?
borderline, histrionic, narcissistic, antisocial
What are the cluster C disorders?
avoidant, dependent, OCD
What are the most likely etiologies of antipersonality disorder?
difficult childhood, parental affection withheld, physical abuse and neglect
What is a common defense mechanism for borderline personality disorder?
splitting, along with intense fears of abandonment
Signs/symptoms of anorexia?
hypotension, bradycardia, lanugo, hypothermia
Laboratory findings in anorexia nervosa?
thrombocytopenia, hypokalemia, hypomagnesmia, anemia, leukopenia
Findings of bulemia?
russell’s sign, tachycardia, dental erosion, parotid gland enlargement
What are common treatment options for bulimia?
CBT, antidepressants next line if therapy does not work
What are laboratory findings in bulimia?
changes in fluid and electrolytes, metabolic alkalosis
What are effective treatments for anorexia?
CBT, psychoanalysis, Maudsley method of family therapy, nutritional rehab, pharmacotherapy is second line if no response to therapy
What are pharm interventions for anorexia?
second gen antipsychotics (olanzipine) help gain weight, SSRIs help with anxiety and depressive disorders
What are characteristics of somatic symptoms disorders?
symptoms indicate major illness, negative diagnostic tests, psychological factors exacerbate symptoms, clients do not control symptoms, usually do not seek mental health help
What is somatic symptom disorder?
is characterized by one or more physical symptoms that have no organic
basis.
What is conversion disorder?
involves unexplained, usually sudden deficits
in sensory or motor function (e.g., blindness, paralysis). These deficits suggest a neurologic disorder but are
associated with psychological factors. There is usually significant functional impairment. There may be an
attitude of la belle indifférence, a seeming lack of concern or distress, about the functional loss.
What is pain disorder?
has the primary physical symptom of pain, which is generally unrelieved by analgesics and
greatly affected by psychological factors in terms of onset, severity, exacerbation, and maintenance.
What is illness anxiety disorder?
is preoccupation with the fear that one has a
serious disease (disease conviction) or will get a serious disease (disease phobia). It is thought that clients
with this disorder misinterpret bodily sensations or functions.
What is malingering?
- Intentional production of false or grossly exaggerated symptoms
- It is motivated by external incentives or outcomes
- The person can stop the physical symptoms as soon as they get what they wanted
What is factitious disorder (munchausen syndrome)?
people inflict injury on themselves for attention
What is Munchausen syndrome by proxy?
Occurs when a person inflicts illness or injury on someone else to gain attention of medical personnel or be a
“hero” for saving the victim
What are psychosocial theories of somatic symtom disorder etiology?
internalization of stress anxiety, or frustration. inability to identify emotions (Alexythemia), primary and secondary gains
What are biological etiological theories for somatic symtom disorder?
differences in regulation, misinterpretation of stimuli thinking something is pathological
What are expected outcomes for somatic symptom disorders?
understand relationship between stress and symptoms, demonstrate healthier rest, nutrition, and activity rituals. alternate ways to deal with anxiety
What are important nursing skills to use when caring for clients with somatic symptom disorder?
- Building a trusting relationship
- Providing empathy and support
- Being sensitive to rather than
dismissive
What are perinatal implications for etiologies for ASD?
→ Women with asthma and allergies around the time of pregnancy have an increased risk of having a child with ASD
What is the treatment for tic disorders such as tourretts?
antipsychotics
what are characterisics of ADHD?
Fidgeting, noisy, disruptive, unable to
complete tasks, failure to follow
directions, blurting out answers, lost or
forgotten homework
What are identified outcomes for ADHD?
free of injury, no violating others’ boundaries, age-appropriate social skills, completing tasks without distraction, follow direction, managing symptoms
What are nursing interventions for ADHD?
ensure safety, improve role performance, simplify instructions, structure daily routine, LISTEN TO PARENTS’ FEELINGS AND FRUSTRATION
What are pharmacological interventions for ADHD?
Ritalin, Adderall (Stimulants), antidepressants for second-line
There is a high comorbidity between ADHD and what other disorders?
→ Substance use disorder
→ Antisocial behavior
→ Anxiety disorders
→ Mood disorders
What is most likely to produce the best long-term outcomes for patients with ADHD?
accurate diagnosis and appropriate interventiond
What is kleptomania?
impulsive, repetitive theft of items not
needed by the person
What is pyromania?
repeated, intentional fire-setting
What is ODD?
Characterized by a persistent pattern of angry mood and defiant behavior. Typically begins by age 8, not usually later than early adolescence
What are biological influences for etiology of ODD?
factors may be genes for metabolism of dopamine, serotonin, and
norepinephrine
What are family influence contributing to ODD?
- Strong-willed child and authoritarian parents
- Frustrated parent increases attempts to enforce authority
- Child reacts with anger and increases self-assertion
- Negative behavior is inadvertently rewarded
What are treatments for ODD?
Parents learn to ignore maladaptive behavior, Positive behaviors are rewarded with praise and reinforcers, Consistent consequences, Adolescent children benefit from interventions that use enhancement
of personal strengths, Older children may benefit from individual therapy in addition to
behavioral programs
What is intermittent explosive disorder?
Repeated episodes of impulsive, aggressive, violent behavior; angry verbal
outbursts. Most common in adolescent and adulthood
What are etiologies of IED?
childhood exposure to trauma, neglect, or maltreatment. neurotransmitter imbalances (serotonin, plasma trytophan depletion)
What are treatments for IED?
SSRIs, lithium and anticonvulsants, CBT, anger management, relaxation techniques, avoidance of alc and other substances (best outcome is usualyl combination of these treatments)
What are characteristics of conduct disorder?
Behavior in which the basic rights of others are violated, cannot adhere to age appropriate social norms or rules, physical aggression is common
What is mild conduct disorder?
some conduct problems that cause relatively minor harm to others (ex. Lying, truancy, shoplifting)
What is moderate conduct disorder?
conduct problems increase as does the amount of harm (ex. Vandalism, bullying, substance use, sexual promiscuity)
What is severe conduct disorder?
many conduct problems that cause considerable harm (ex. Forced sex, cruelty to animals, use of weapons, burglary, robbery)
What are clients with more severe personality disorders more likely to develop as adults?
antisocial personality disorder
What are symptoms for conduct disorder?
- Aggression to people and animals
- Property destruction
- Stealing, lying, truancy (violates curfew)
- Lacks feelings of guilt or remorse
- Substance use/sexual activity occurs earlier than expected for the peer group
- Low self-esteem (manifested by tough guy image)
- Low level of academic achievement
What are nursing interventions for conducts disorder?
limits set on unacceptable behaviors, decrease violence, increase treatment compliance, improve coping/self esteem, promote social interaction,
What is considered successful treatment outcomes for patients with conduct disorder?
client stops behaving in aggressive or illegal ways, attends school, follows directions at home. expect modest progress with some setbacks
What are predisposing factors/etiolgies for delirium?
serious medical, surgical, or neuro conditions, substance intoxication and withdrawal, medication-induced delirium.
What are characteristics of dementia?
aphasia (deterioration of language), apraxia (imparied motor function, but intact abilities), agnosia (inability to recognize name or objects that are familiar), disturbance in executive function (lost ability to think abstractly, plan, initiate, sequence, monitor, and stop complex behavior).
What are the hallmarks of mild dementia?
forgetfulness is the hallmark. It exceeds the normal, occasional forgetfulness experienced with aging
What is moderate dementia?
confusion is apparent, along with progressive memory loss. The person can no longer perform tasks but remains oriented to person and place.
What is severe dementia?
personality and emotional changes occur. The person may be delusional, wander at night, forget names of spouse and children, and requires assistance with ADLs
What are expected outcomes for patients with delirium?
– Be free from injury
– Demonstrate increased orientation, reality contact
– Return to optimal level of functioning
What are interventions for patients with delirium?
promote safety, face client when speaking, speak in short simple sentences, call client by name, refer to time of day, refer to expected activity
What are expected treatment outcomes for patients with dementia?
– Be free from injury
– Respond positively to memory cues
– Maintain an adequate balance of activity and rest
What are interventions for patients with dementia?
safety, sleep, proper nutrition, hygiene, activity, encourage following of usual routine, – Provide a wide variety of activities such as
– Music
– Dancing
– Pet therapy
– Plan activities that
– Reinforce the client’s identity
– Engages them in the business of living
– Tailor activities to the client’s interests and abilities
– Avoid routine group activities
– Clients often need the involvement of another person to:
– Sustain attention in the activity
– Enjoy it more fully
What are risk factors of dementia?
– Elevated levels of plasma homocysteine
What are measures to decrease risk of dementia?–
– Folate, vitamin B12 and betaine reduce
plasma homocysteine
– Regular participation in brain-stimulating
activities
– Leisure-time physical activity
– Large social network
What are the phases of schizo?
prodromal, active, residual
What entails in the prodromal phase?
withdrawn
What entails in active schizo?
delusions, hallucintions, disorganized speech,
What entails in residual schizo?
cognitive symptoms
What is the criteria for schizo diagnosis?
active schizo stages for at least 6 months
