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semester 4 > mental health 1 > Flashcards

mental health 1 Flashcards

1
Q

Pica

A

Consistent eating of nonfood, nonnutritive substances for a month or more, usually early childhood, sometimes part of an intellectual disability. Can occur during pregnancy but not elevated to a diagnosis unless the severity poses medical risks.

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2
Q

Rumination Disorder

A

Undigested food being regurgitated – then re-chewed or re-swallowed or spit out. Can be fatal in infants. Teens might hide it with fake coughing.

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3
Q

Avoidant/Restrictive Food Disorder

A

Often due to sensory disgust of food characteristics and leads to failure to thrive. Not an eating disorder.

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4
Q

Anorexia Nervosa (AN)

A

Morbid fear of weight gain with failure to recognize low BMI, severity defined by BMI. Subtypes (1) Restricting type (2) Binge/Purge type

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5
Q

Bulimia Nervosa (BN)

A

Distress experienced: severe body dissatisfaction, severity defined by frequency of binge eating and compensatory behavior cycles.

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6
Q

Binge-Eating Disorder (BE)

A

Distress (self-disgust, guilt, embarrassment, depressed, physically uncomfortable) due to out of control binge-eating, severity defined by frequency of binge eating.

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7
Q

Anorexia Nervosa Severity Guide

A

Severity defined by BMI (FYI healthy body weight aprox. 18.5-25)
Mild: >/= 17kg/m2
Mod: 16 to 16.99
Severe: 15-15.99
Extreme: < 15

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8
Q

Restricting type AN

A

no binge-eating or purging, might fast or exercise excessively -not counted as “purge” behavior

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9
Q

Binge-eating/Purge type AN

A

some binge-eating or purging, example: self-induced vomiting after eating a small meal

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10
Q

Bulimia Nervosa Severity Guide

A

Mild: binge-eating with 1-3 episodes of compensatory behavior per week
Mod: binge-eating with 4-7 episodes
Severe: binge-eating with 8-13 episodes
Extreme: binge-eating with 14 or more episodes

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11
Q

Binge Eating Definition

A

consuming a large quantity (more than what most people would eat) of food over 2 hours or more

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12
Q

Compensatory behaviors

A

exercise, fasting, and purging (self-induced vomiting – most common, misuse: laxative/enemas, diuretics, thyroid hormone, omit needed insulin), some texts mix-up terms

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13
Q

Binge-Eating Disorder

A

No purging behavior, severity defined by frequency of binge-eating.
Mild: binge-eating 1-3 episodes per week
Mod: binge-eating 4-7 episodes
Severe: binge-eating 8-13 episodes
Extreme: binge-eating 14 or more episodes

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14
Q

Anorexia/Starvation S/S

A

Low efficacy for antidepressants due to lack of endocrine function/hormones/enzyme, and lack of tryptophan intake.
Osteopenia and osteoporosis from ↓ Calcium
Cold and weak from ↓ Thyroid function and decreased VS
Amenorrhea due to lack of hormones
Lanugo (theory – increase warmth)
Hypercarotenemia – orange hue to skin
Excessive exercise
Constipation
Watch for refeeding edema (increased heart rate ….)
EMERGENCIES Below 75% ideal body weight, rapid weight loss, Temp < 96.8, HR < 40, Systolic BP < 70 mm Hg

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15
Q

Purge Bulimia Nervosa

A

self-induced vomiting is most common, also use of laxatives, diuretics, ipecac, skipping insulin, and thyroid hormone abuse. Might use purge markers such as red smarties before binge

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16
Q

Russel’s sign

A

calluses on back of hand from teeth grazing hand during self-induced vomiting

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17
Q

Bulimia Nervosa s/s

A

Russel’s sign, enlarged parotid glands (from high serum amylase), dental caries (from acidic emesis)
Emergencies can include: Potassium < 3 mEq/L, severe dehydration, cardiac arrhythmias, metabolic alkalosis (from increased serum bicarbonate) r/t vomiting, metabolic acidosis (decreased serum bicarbonate) r/t laxatives
High comorbidity: 94% psychiatric issues, 30% substance abuse issues, self-injurious behavior and other impulsive behaviors

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18
Q

Cognitive Distortions s/s

A

Overgeneralizations - single negative event is equated with never ending negative situation: “no one will like me if I am fat.”
All-or-nothing thinking - also known as black or white thinking: “I can either have all the cake or none at all.”
Catastrophizing – exaggerating the importance of an event leading to an intolerable situation: “If I gain weight my life will be meaningless.”
Personalization - “Everyone is talking about how fat I am.”
Emotional reasoning – mixing up feelings with facts: “I feel puffed up so I know everyone sees me as gross and fat.”

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19
Q

Long Term Goals: Eating Disorders

A

AN: - Weight gain is the priority. Medical Hospitalization – restore 75% ideal body weight before discharge
Acute Inpatient psych/Eating Disorder Rehab Center – 85%
Partial Hospitalization/OP 90% or more

BN: Interrupting the binge-eating/purging cycles is the priority
Reduce binge/purge cycle

Unless the binge/purge BX causes a medical emergency that becomes the priority
In reality address both weight gain and interrupting the cycles

BE: Reducing the binge-eating episodes is the priority, may also be a bariatric patient

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20
Q

Therapeutic Relationship: Eating Disorders

A

do not blame the client
“Help rejecting” can elicit strong countertransference
The nurse’s own relationship with their body and with food needs to be healthy.
Be careful to NOT take a guard or parental approach even when the client is childlike in their behavior
Resistance to change is pervasive and strong, it is part of the illness
Express empathy

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21
Q

AN Interventions

A

Supervise meals- provide low stress environment while watching for food avoidance. Record how much was eaten.
Locked bathroom one hour after meals
Weigh client 3 times a week – gown only, in morning before breakfast after voiding (watch for water loading or hiding heavy items before weight-in
Monitoring VS
Groups and one-to-one talks with nurse: to challenge cognitive distortions, insight into vicious cycles in eating disorders, and providing education on healthy eating

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22
Q

BN Interventions

A

No exercise until binge/purge cycle is more controlled
Acknowledge strong emotions that surface when binge or purge behaviors are interrupted and help client to use healthy coping skills
Help the client make the connections between BN and avoiding life problems
Encourage discussion of the common distress is related to body shame or guilt over body size and shape (FYI – clients with binge eating DO experience distress over out of control binge eating)
Watch for hypokalemia
Watch for risk behaviors and substance abuse behaviors that are more common in individuals with BN versus AN

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23
Q

General Adaptation Syndrome

A

Alarm reaction stage
Fight, flight, or freeze response starts to prepare for defense
-Adrenal glands – epinephrine and norepinephrine
-Liver converts glycogen stores to glucose
Resistance stage
-blood shunted away from areas such as the GI system to lungs and heart to deliver more oxygen to muscles
Exhaustion stage
-Continual arousal of defense systems and emotions
-Body stores depleted
-Low resistance to disease

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24
Q

Mild Level of Anxiety

A

Mild - special attention:
Increased sensory stimulation
Motivational, increased learning, effective problem solving
“Butterflies”

25
Q

Moderate Level of Anxiety

A

Moderate - something definitely wrong:
Focus on one task only
Hard to make connections between concepts – hard to learn on own
Example – nursing students learning new skill anxiety with prompts
Increased pulse, dry mouth, speech rate and pitch, urination, irritation
Nurse able to redirect the patient

26
Q

Severe Level of Anxiety

A

Severe - trouble thinking and reasoning:
Reduced perceptual field
Can focus on one detail only or scattered details
Cannot complete tasks or respond to redirection
Tightened muscles, ↑ VS, N&V, restless, irritable, angry, crying, vertigo

27
Q

Panic Level of Anxiety

A

Panic: fight, flight, or freeze response:
Increased vital signs and behaviors, dilated pupils, bolting or freezing
Self-focused, cannot talk, cannot process stimuli, may not even see danger
Irrational, distorted perceptions, may experiencing hallucinations/delusions
May be suicidal

28
Q

Anxiety Defense Mechanisms

A

Compensation, conversion, denial, displacement, dissociation, identification, intellectualization, projection, rationalization, reaction formation, regression, repression, splitting, sublimation, suppression, undoing

29
Q

General Criteria for Mental Health Disorders

A

The symptoms cause clinical distress or significant inability/impairment to work, complete education, perform usual roles, socialize or function

  1. The symptoms are not due to substance use/withdrawal or other medical conditions – standard of practices:
    Rule out medical issues or physical issues
    Rule out other psychiatric issues that may better explain the signs and symptoms
30
Q

Separation Anxiety

A

Excessive distress when anticipating or experiencing separation
Excessive worry about losing significant other, accidents, kidnapping, refusal to sleep over or go out, nightmares, somatic issues

31
Q

Specific Phobic

A

Marked and out or proportion fear towards a situation or object, must be 6 months or more. Interferes with functions of daily life, avoids situation or object

32
Q

Social Anxiety

A

Similar to a specific phobia
Distress caused by possible scrutiny of others and social interactions

33
Q

Panic Disorder

A

Recurrent and unexpected panic “attacks” followed by (for at least a month)
Persistent worry of another attack OR avoidance of situations that might trigger an attack

34
Q

Agoraphobia

A

Similar to a specific phobia
Fear 2 of the following 5
Using public transportation
Open spaces
Enclosed spaces
Standing in a crowd or line
Being outside the home alone

35
Q

Generalized Anxiety Disorder (GAD)

A

Over half the time in the last 6 months:
Excessive anxiety and worry
and with 3 or more of the following
Restlessness/on edge
Easily fatigued
Decreased concentration
Increased irritability
Muscle tension
Sleep disturbance

36
Q

Obsessive-Compulsive Disorder (OCD)

A

Obsessions are unwanted, intrusive, repetitive thoughts or images. Thoughts lead to intense fear or distress
Compulsions are repetitive behaviors or alternative thoughts, used to decrease OR PREVENT the obsessive thoughts, fear, or distress
Experience one or both for at least an hour a day

37
Q

Body Dysmorphic

A

Preoccupied with a perceived physical body defect
Excessive observation, grooming, other BX targeting the “defect”
Example – excessively discussing the differences between their nose and your nose

38
Q

Hoarding

A

Cannot part with possessions regardless of actual value
Worries that they will need the item in the future
Clutter compromises use of home OR it is orderly but only due to helpers

39
Q

Trichotillomania

A

Recurrent pulling out of hair
Results in hair loss
Repeated attempts by patient to stop pulling out hair
Common areas: scalp, eyebrows, eyelids

40
Q

Excoriation

A

Skin picking resulting in lesions
Most common – face, arms, hands – using fingernails
Can pick healthy skin or skin with a irregularity

41
Q

Disruptive Mood Dysregulation DO

A

temper outbursts in younger folk

42
Q

Major Depressive DO

A

Includes MDD with seasonal pattern (old term “Seasonal Affective DO”)

43
Q

Persistent Depressive DO (Dysthymia)

A

milder depression than MDD

44
Q

Premenstrual Dysphoric DO

A

S/S week before menses, improves a few days after menses

45
Q

Bipolar I DO

A

has had mania or hospitalization or psychosis

46
Q

Bipolar II DO

A

less severe than Bipolar I DO (no psychosis, never mania, never need for hospitalization)

47
Q

Cyclothymic DO

A

less severe than Bipolar II

48
Q

Depression Assessment

A

Always assess if the client has:
SI, psychosis (hallucinations, delusions, disorganized brain), anxiety (50-60% will have anxiety)

49
Q

Comorbidity Concern: Bipolar and Depression

A

we do not want them to flip into a drug induced mania caused by using only an antidepressant, people with bipolar disorders need a mood stabilizer

50
Q

HAM-D 17 items to score

A

Depressed mood, Guilt feelings, suicide, insomnia (early, middle and late), work and activities, retardation - psychomotor, agitation, anxiety, somatic symptoms, sexual dysfunction, hypochondria, unintended weight loss, insight

51
Q

HAM-D Scoring

A

0 - 7 = Normal
8 - 13 = Mild Depression
14-18 = Moderate Depression
19 - 22 = Severe Depression
>23 = Very Severe Depression

52
Q

ECT “Electroconvulsive Therapy”

A

check BM
High efficacy for MDD
Highly regulated but relatively safe
Temporary memory loss is frequent
Done under general anesthesia, 3 x week for 12 treatments, then monthly

53
Q

Bipolar II DO bumped up to Bipolar I if the client

A

Has, or has had, full blown mania in their mood cycles for a period of a week or more
Has, or has had, periods of psychosis
Has, or has had, S&S severe enough to require acute psychiatric hospitalization

54
Q

Bipolar I High Risk Behaviors

A

spending sprees, bad business investments, indiscriminate sex, gambling, stealing

55
Q

Five Steps in the SAFE-T approach

A

Identify Risk Factors
Identify Protective Factors
Assess Suicidal Ideation (SI)
Determine Risk Level and Appropriate Interventions
Document

56
Q

Stages of Change and Addiction

A

Pre-contemplation (‘denial’)
Contemplation
Preparation
Action
Maintenance
Relapse
Assess the stage to focus on the best intervention for that stage

57
Q

Negative Symptoms Schizo

A

Affective blunting - minimal emotional response (but has feelings)
Avolition - decrease in motivation/initiative/spontaneity.
Alogia -decreased (old term: poverty) of speech and thought
Anergia - lack of energy
Anhedonia - lack or loss of pleasure in pleasurable activities
Anosognosia
NOT DENIAL(this is a symptom, not a defense mechanism or coping skill, and
usually leads to decreased interest in taking prescribed medication).
Anosognosia negatively correlates with and predicts prognosis.
Asociality - lack of interest in social interactions
Attention Impairment – not able to focus on important details

58
Q

Catatonia

A

Waxy flexibility – slow even resistance and then a possible “melt” when clinician moves pts limbs
Catalepsy – pt. maintains the position after the clinician has moved pt. limbs (even if it is against gravity)
Posturing (active) pt. demonstrates spontaneous posture and holds it, even if against gravity
Echopraxia (mimic movement of others)
Stereotypy (repetitive non-goal bx)
Mutism/Stupor (non-reactive)
Staring

semester 4 (11 decks)

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