HESI Review Flashcards
Milieu Therapy
Planned use of people, resources, and activities in the environment to assist in improving interpersonal skills, social functioning, and performing ADLs
Behavior Modification
Attempts to change ineffective or maladaptive behavioral patterns
Focuses on consequences of actions rather than peer pressure
Crisis Intervention
Directed at the resolution of an immediate crisis
Cognitive Therapy
Directed at replacing a client’s irrational beliefs and distorted attitudes
Electroconvulsive Therapy
Used with severely depressed clients who fail to respond to antidepressant medications and therapy
Anticholinergic (atropine sulfate) given 30 minutes prior to treatment
Have an emergency cart, suction, and oxygen ready
Displacement
Transference of feelings to another person or object
Projection
Attributing one’s own thoughts or impulses to another person
Reaction Formation
Development of conscious attitudes and behaviors that are the opposite of what is really felt
Repression
The involuntary exclusion of painful thoughts or memories
Sublimaiton
Substitution of an unacceptable feeling with a more socially accepted one
Suppression
Exclusion of feelings and ideas
Mild Anxiety
Increased levels of sensory awareness
Allows for logical thoughts
Associated with daily life and motivates learning
Moderate Anxiety
Motivates learning with assistance from others
Allows client to be attentive and able to focus, but not at an optimal level
Dulls perceptions of stimuli
Client is restless, has headaches, nausea, diarrhea, tachycardia
Severe Anxiety
Stimulates fight-or-flight
Stimuli input becomes disorganized
Impairs concentration and results in selective attention
Verbalization of emotional pain
Tremors, increased motor activity
Panic
Causes perceptions to be grossly distorted
Client feels overwhelmed
Anger and aggression
Requires immediate intervention
Generalized Anxiety Disorders
Unrealistic, excessive, or persistent anxiety and worry about two or more life circumstances
6 months or longer
Severe anxiety, motor tension, SOB, palpitations, on edge
Panic Disorders and Phobias
Discrete periods of intense fear or discomfort that are unexpected
Client recognizes fear is unrealistic but can’t help it
Autonomic hyperactivity, panic attacks, drug/alcohol use to cope
Obsessive-Compulsive Disorders
Repetitive thoughts (obsession) or irresistible impulses (compulsion)
Magical thinking, difficulty with interpersonal relationships, safety issues, recurring intrusive thoughts
Antianxiety Drugs
Benzodiazepines (epams)
Nonbenzodiazepines (Busipirone, Zolpidem, Ramelteon)
Benzodiazepines
Safer than sedative hypnotics
Administer at bedtime
Avoid alcohol
Gradually taper drug therapy
Short-term drug
Antidepressants
Tricyclic
MAOIs
SSRIs
Tricyclics
Amitryptiline, Desipramine, Imipramine
Anticholinergic effects
Administer at bedtime
Takes 2-6 weeks to achieve therapeutic effects
MAOIs
Isocarboxazid, Phenelzine sulfate
Depression, phobias, anxiety
May cause HTN crisis
Must not be used with tricyclics
Avoid tyramine (aged cheese, wine, beer, beef, chicken, chocolate)
SSRIs
Fluoxetine, Sertraline, Citalopram
Depression, anxiety, panic disorder, aggression, anorexia, OCD
Effective 2-4 weeks after treatment is initiated
Wait at least 14 days between discontinuing MAOI and starting Fluoxetine
Traumatic and Stressor Related Disorders
Anxiety level is proportional to perceived degree of threat
Shock, anger, panic, denial
Self-destructive behavior
Visible reminders of trauma
Antipsychotic Drugs
Phenothiazines
Nonphenothiazines
Phenothiazines
Chlorpromazine
Extrapyramidal symtpoms
May cause drowsiness, weightgain, photosensitivity
Used to control hallucinations, delusions, bizarre behavior
Nonphenothiazines
Haloperidol
Controls psychotic behavior with less sedation
Severe extrapyramidal symptoms
Somatic Symptom Disorder
Long history of health visits to HCPs for multiple somatic complaints
Most frequently pain, palpitations, or dizziness
Factitious Disorder
Deliberate exaggeration of symptoms for self gains
Munchausen Syndrome
Severe and chronic form of factitious disorder that may result in severe self-harm that requires treatment at the hospital
Factitious Disorder by Proxy
Occurs when a person foists deliberate fabricated symptoms onto another person
Munchausen Syndrome by Proxy
Occurs when a caregiver causes a child to require treatment for an injury stimulated by them
Malingering
Occurs when a client creates complaints for secondary gain (to obtain a disability check)
Dissociative Amnesia
Sudden temporary inability to recall extensive personal events
Occurs after traumatic event
Most common dissociative disorder
Dissociative Identity Disorder
Person assumes two or mote identities simultaneously
Emerges during stress
Depersonalization Disorder
Characterized by temporary loss of one’s reality and the ability to feel and express emotions
Expresses detachment with regard to surroundings
Schizotypal Personality
Has interpersonal deficits
Has eccentricities and odd beliefs
Is socially isolated
Antisocial Personality
Shows aggressive acting-out behavior pattern without remorse
Clever and manipulative
Lacks social conscience; immature and impulsive
Borderline Personality
Has disturbances regarding self-image
Shows impulsive, self-damaging behavior, makes suicidal gestures
Overly dependent
Self-critical, demanding, whiny, manipulative, argumentative, verbally abusive
Narcissistic Personality
Perceives self as all-powerful and important, is critical of others, arrogant
Needs attention and admiration
Exploits others, lacks empathy
Avoidant Personality
Socially inhibited, feels inadequate
Hypersensitive to negative criticism/rejection
Longs for relationships
Dependent Personality
Has unreasonable wishes/wants, expresses needs in a demanding manner while professing independence
Passive and does not accept responsibility
Low self-esteem
Obsessive-Compulsive Personality
Attempts to control self through the control of others or the environment
Shows inattention to new facts or viewpoints
Perfectionist, cold and rigid towards others
Preoccupied with efficiency and productivity
Anorexia Nervosa
Distorted body image and intense fear of becoming obese drive excessive dieting and exercise
Bulimia Nervosa
Eating disorder characterized by eating excessive amounts of food followed by self-induced purging
Mild Depression
Feelings of sadness
Difficulty concentrating and performing activities
Moderate Depression
Feelings of helplessness and powerlessness
Decreased energy
Sleep pattern disturbances
Appetite and weight changes
Slowed speech, thought, movement
Rumination on negative feelings
Severe Depression
Feelings of hopelessness, worthlessness, guilt, shame
Despair, flat affect, indecisiveness, suicidal thoughts
Nursing Interventions for Depression
Directly ask about self-harm
Do not give the client a choice about participating in activities
Observe for sudden elevation in mood (may indicate increased risk for suicide)
Encourage discussion of feelings
Sit in silence if client in nontalkative
Suicide Precautions
Previous suicide attempt
History of family suicide
Giving away possessions
Depressed –> happy
Evaluation of Suicidal Intent
Identify the method (the more lethal the method, the higher the probability that attempt is imminent)
Determine availability of method chosen
Mild Mania
Feeling of being on a high
Feelings of well-being
Minor alterations in habits
Moderate Mania
Grandiosity, talkativeness, pressured speech, impulsiveness, excessive spending, bizarre dress/grooming
Severe Mania
Extreme hyperactivity, flight of ideas, nonstop activity, talkativenss, easily distracted
Delusions of grandeur or persecution
Mood-Stabilizing Drugs
Lithium carbonate
Anticonvulsant Mood Stabilizers
Lithium Carbonate
Used for bipolar disorders
Assess electrolytes (Na+)
Keep salt usage consistent
Do not use with diuretics
Anticonvulsant Mood Stabilizers
Valproic Acid, Carbamazepine, Lamotrigine
Key Symptoms of Schizophrenia
Delusions Hallucinations Disorganized speech Disorganized behavior Negative symptoms
Catatonia
Stupor (decrease reaction to environment)
Rigidity (maintenance of a posture against efforts to be moved)
Posturing (waxy flexibility)
Negativism (resistance to instructions)
Excitement (severely agitated)
Schizophrenia
Characterized by thought disturbance, altered affect, withdrawal from reality, regressive behavior, difficulty with communication, and impaired interpersonal relationships
Alcohol Withdrawal Symptoms
Begin 4-6 hours after drinking, peaks in 48-72 hours
Delirium tremens may appear 12-36 hours after last drink
Tachycardia, tachypnea, diaphoresis, hand tremors, insomnia, NV, paranoia, grand mal seizures, hallucinations
Disulfiram
Treatment of alcoholism; aversion therapy
Causes NV, hypotension, headaches, rapid pulse and respirations, flushed face, confusion, chest pain, weakness
Opiate Withdrawal Symptoms
Dilated pupils, anxiety, diaphoresis, depression, fatigue, insomnia, tachycardia
Opiate Overdose Symptoms
Constricted pupils, respiratory depression, unconsciousness leading to coma, death
Antianxiety Drug Withdrawal Symptoms
Tremors, agitation, anxiety, abdominal cramps, NV, grand mal seizures
Antianxiety Drug Overdose Symptoms
Drowsiness, confusion, hypotension, convulsion, shock, coma, death
Delirium
Occurs in response to a specific stressor (infection, drug reaction, substance intoxication, electrolyte imbalance, head trauma)
Reversible if it is recognized by its sudden onset
Treatment is correction of causative disorder
Dementia
Cognitive impairments characterized by gradual, progressive onset; irreversible
Aphasia, apraxia, agnosia
Attention Deficit Hyperactivity Disorder (ADD/ADHD)
Disruptive behavior, excessive talking, underachievement, failure to follow instructions
Autism Spectrum Disorder
Causes problems in social skills, communication, repetitive behaviors and routines, emotional attachment
Conduct Disorder
Characterized by callous and unemotional interpersonal relationships
Significant impairment in social, educational, or occupational functioning
Physical fighting, running away, lying, stealing, animal cruelty, truancy, vandalism, alcohol/drugs
Oppositional Defiant Disorder
Characterized by behavior that causes significant problems at school, work, or home
Argumentativeness, blaming others, defying rules, obscene language, resentfulness, vindictiveness
