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Third Semester > Mental Health Exam 3 > Flashcards

Mental Health Exam 3 Flashcards

1
Q

What is a common BMI for patient with anorexia nervosa?

A

15 or less (weigh less than 85% of expected weight)

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2
Q

What are some characteristics of a patient with anorexia nervosa?

A

voluntary refusal to eat, distorted body image, preoccupation with food, reduction in food intake, exercising extensively, self induced vomiting/ diarrhea (from laxatives), feeling “fat” when being noticeably underweight

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3
Q

What are the signs of a patient with anorexia needing healthcare?

A

BMI less than 15, amenorrhea, lanugo, hypothermia, bradycardia, hypotension, acrocyanosis, bone fractures, cold intolerance, abdominal bloating, yellowing of skin

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4
Q

What are signs of a patient with anorexia needing to be hospitalized?

A

30% below expected weight for height, dehydration, severe electrolyte imbalance, cardiac arrhythmia, bradycardia, hypothermia, hypotension, SI

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5
Q

What are labs for a patient with anorexia?

A

hypomagnesemia, hypophosphatemia, decreased estrogen/ testosterone

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6
Q

What is the medication of choice with anorexia?

A

fluoxetine

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7
Q

What does fluoxetine treat in patients with anorexia?

A

used to treat depression which is a sx of malnutrition

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8
Q

What appetite will fluoxetine decrease?

A

appetite for carbs

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9
Q

How long does it take for fluoxetine to become effective?

A

1-3 weeks, up to 2 months

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10
Q

What do you need to avoid doing on fluoxetine?

A

hazardous activities until adverse effects are known
some other adverse effects are sexual dysfunction, BBW for SI

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11
Q

What are cues for BMI bulimia nervosa?

A

18.5-30

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12
Q

What are characteristics of bullimia?

A

episodic, unrolled rapid ingestion of large quantities of food over a short period of time followed by inappropriate compensatory behaviors to rid excess calories

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13
Q

What are clinical presentations of bulimia nervosa?

A

Russels sign, parotid enlargement (salivary gland), dehydration and electrolyte imbalances, edema

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14
Q

What is Russels sign?

A

finger calluses

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15
Q

What will the oral cavity look like in a patient with bulimia?

A

erosion of tooth enamel, mouth ulcers, tears in gastric or esophageal mucosa

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16
Q

What are abnormal labs for bulimia?

A

hypokalemia, all electrolytes decrease, anemia, impaired liver function, BUN, decreased bone density, elevation or decrease in blood bicarb

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17
Q

What are cues for a patient with binge eating disorder?

A

BMI at or around 38

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18
Q

What are characteristics of binge eating disorder?

A

episodes of eating = binge followed by low self esteem followed by guilt and depression. usually an episode lasts for less than an hour

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19
Q

What are clinical presentations of binge eating disorder?

A

delayed gastric emptying, enlarged stomach capacity, decreased secretion of cholecystokinin, HgA1C 6.5 (diabetes)

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20
Q

What medication will you give to patients with binge eating disorder?

A

fluoxetine, high dose SSRI demonstrate weight loss

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21
Q

What eating disorder is topiramate and lisdexamfetamine?

A

binge eating disorder, reduce incidents of both binge eating and weight loss

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22
Q

What are nursing interventions for patients with anorexia?

A

collaborate with dietician to determine caloric and fluid requirements, monitor electrolytes, emaciated or unwilling pts will require NG tube, strict I&O, vitals, skin turgor, sit with client during meal time with a 30 min limit and observe for 1 hour after

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23
Q

What should you make sure you do with anorexic patients and scales?

A

weigh on the same scale each more after first void (dont let client see the scale)

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24
Q

Nursing interventions for a binge eating patient?

A

encourage a food diary, discuss feelings with eating, assist client to formulate a meal plan to eliminate calories while maintaining adequate nutrition, identify realistic goals, plan a progressive exercise program (walking)

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25
Therapeutic communication with patients who have eating disorders will include?
develop realistic perception of body image, assess feelings and attitudes about overeating and obesity, compare specific measurements of clients body with their perceived calculations, promote feelings of control through independent decision making, focus on strengths and past accomplishments
26
What is refeeding syndrome?
fluctuation of malnourishment and renourishments
27
What are the signs and symptoms of refeeding syndrome?
hypokalemia, AMS, cardiovascular collapse, cardiac arrhythmias, death
28
What are biological responses to stress?
fight or flight
29
What is adaptive responses to stress?
maintains the integrity of the individual; positive;healthy
30
What are examples of adaptive responses to stress?
running, yoga, exercise
31
What are maladaptive responses to stress?
disrupts the integrity of the individual; harmful; unhealthy
32
What are maladaptive responses to stress?
gambling, drinking, social withdrawal
33
What is acute stress disorder?
exposure to traumatic events causes anxiety, detachment and other manifestations about the event for at least 3 days, but no longer than. month
34
What are characteristics of acute stress disorder?
dissociative manifestations regarding the event (sense of unreality things are small and far away), can't remember a lot of the incident
35
What is PTSD?
Exposure to traumatic events cause anxiety, detachment, and other manifestations about the event for longer than 1 months following the vent. Manifestation can last for years
36
What are r/f PTSD?
severe traumatic distres, exposure to trauma during natural disaster, repeated exposure to trauma, living through traumatic event experience by a family member
37
What are characteristics of PTSD?
intrusive findings (memories, flashbacks), inability to concentrate on tasks, negative self image, recurring nightmares, memories are involuntary, flashbacks where the client feels they are recurring in the present, avoidance of reminders of traumatic events
38
What are PTSD nursing interventions?
consistent staffing assignments, friendly approach, respect opposite sex avoidance, keep promises, spend time, provide private environment, validate feelings, discuss coping strategies
39
Nursing interventions for PTSD patients and nightmares?
offer safety and security group techniques
40
What medicine is the first line drug for PTSD?
paroxetine , has the least severe side effects
41
What is the role of prazosin in PTSD?
reduces nightmares by eliminating all dreams
42
What do you do if a patient is sleepwalking?
Do NOT wake them up or put hands on them
43
What medication treats anxiety and is not addicting?
Buspirone, treats anxiety in PTSD patients
44
What are some risk factors for adjustment disorder?
Nursing school , being thrown into the hospital
45
What are some cues for an adjustment disorder?
months within the start of stressor, but no longer than 6 months (or when stressor ends) For nursing students, it didn’t hit until 2nd semester, and stops in summer impairment in social function symptoms are greater than expected reaction coping methods
46
How does trauma affect the hippocampus?
Loss of memory Loses volume and will be smaller than other peoples that do not have PTSD
47
Pt education for stress management includes..?
Awareness of factors that create stress (journaling) Use relaxation techniques (breathing, exercise) Meditation Communication, “talking out the problem” Problem solving Pets, and music
48
Biological responses to stress include..?
All vital signs are increased (bp, hr.) Eyes are dilated to see better All of the senses become heightened Peristalsis is delayed and absorption has stopped Blood sugar goes up for fuel
49
How can a patient recognize factors that increase stress?
journaling !!
50
What is the role of the thalamus in stress?
Thalamus is the key center for sensory information processing and transmission Key role in development in PTSD
51
What stops fight/flight?
GABA
52
What are characteristics of GAD?
persistent anxiety that occurs for day but no longer than 6 months
53
What are some symptoms of GAD?
muscle tension, restlessness, or feeling keyed up or on edge
54
What does GAD result in?
Often results in procrastination in behavior or decision making
55
What is the purpose of rituals in patients with OCD?
Compulsive rituals in OCD reduce anxiety and are therefore positively reinforced, just as avoidance responses in phobic disorders are reinforced by the relief of anxiety they afford.
56
Which is safer for a patient? Desensitization or flooding?
Desensitization
57
What is desensitization technique?
exposes a phobic stimulus in a stress free environment, done in least disturbing to most, may be executed in fantasy, reality or a combination of both
58
What is social anxiety disorder?
Marked fear/anxiety about being negatively evaluated in social situations, being observed, or performing in front of others
59
How long do symptoms persist with social anxiety disorder?
6 months
60
What is the role of the nurse in a therapeutic milieu?
validation
61
How does validation work in a therapeutic milieu?
active/empathetic listening to clients view of illness and concerns they have promoting autonomy Reinforce adaptive coping skills
62
What are some interventions for fight or flight syndrome?
defense mechanisms Intervene before anxiety becomes panic level Maintain at manageable level Verbalize a realistic perception of appearance and reflect positive body image Demonstrate adaptive strategies for coping with stressful situations Medication
63
What is agoraphobia?
Marked fear or anxiety for 6 months or more about 2 of the following: Using public transport Being in open spaces Being in enclosed places Standing in line or being in a crowd Being outside of the home alone
64
What are some patient teaching points for a benzodiazepine?
do not drink alcohol, take for a short amount of time due to a risk for dependence
65
What is the difference between obsession and compulsion?
Obsessions are unwanted, intrusive thoughts, images, or urges that trigger intensely distressing feelings. Compulsions are behaviors an individual engages in to attempt to get rid of the obsessions and/or decrease distress.
66
What are long term treatments for anxiety?
SSRI’s, fluoxetine Buspirone is not used for PRN and is therefore used for long term usage.
67
What are interventions for extreme anxiety?
Paper bag
68
What does mild anxiety look like?
heightened perception, increased awareness, increased alertness
69
How are patients affected with mild anxiety?
learning is enhanced, restlessness and irritability, may remain superficial with others, can cause pt to become motivated, not described as distressful
70
What does moderate anxiety feel like?
reduction in perceptual field, reduced alertness to environmental events
71
How are patients affected when experiencing moderate anxiety?
learning occurs but pt has a decreased attention span and ability to concentrate, tummy troubles, sweating, restless. pt feels discontent
72
What does severe anxiety look like ?
perception is greatness diminished only extraneous details are perceived. may not take notice of an event when attention is directed by another
73
How are patients affected when experience severe anxiety?
limitied attention span, can't concentrate, focus, or learn
74
What are the s/s of severe anxiety?
headache, N/D, hyperventilation, tachycardia, insomnia, palpitation. feelings of severe dread, total focus is on self and desire to relieve
75
What does panic anxiety look like?
unable to focus on one detail within the environment, misperceptions of the environment
76
How are patients affected when experience panic level anxiety?
unable to concentrate, learn, or comprehend simple instructions
77
What are the s/s of panic anxiety?
dilated pupils, labored breathing, tremors, sleeplessness, palpitations, diaphoresis, pallor, immobility, incoherence
78
What feelings does a patient with panic level anxiety experience?
sense of impending doom, bizarre behaviors like running screaming, hallucinations, delusions, extreme withdrawal to self
79
What are is defense mechanisms repression?
unconsciously putting unacceptable ideas, thoughts, and emotions out of awareness
80
What is an example of repression?
pt cannot recall abuse in early childhood but still has difficulty with anger, cognition and anxiety as a result from the trauma
81
What is depersonalization?
feeling that a person is observing ones own personality or body from a distance
82
What is derealization?
feeling that outside events are unreal or part of a dream, objects appear larger or smaller than they should, time moves slower than it should
83
What is dissociative fugue?
sudden, unexpected travel away from customary places or by wandering, can't recall personal identity and can even assume a new identity
84
What is an example of a dissociative fugue?
solider returns from war with no memory of who they are
85
What is dissociative amnesia ?
r/t traumatic or stressful events
86
What is localized dissosciative amnesia?
unable to recall all incidents, ex. a survivor of a car wreck who has no memory of the experience until 2 days later
87
What is selective dissociative amnesia?
only recall certain incidentsW
88
What is generalized dissociative amnesia?
total life history and identity
89
What are interventions for dissociative amnesia?
90
What does amobarbitol do?
retrieves lost memories in patients with dissociative amnesia
91
What does psychotherapy do in patients with dissociative amnesia?
adjusts to psychological impact
92
What does hypnosis do?
mobilizes memories
93
What does CBT do?
recall details
94
What are characteristics of DID?
2 or more personalities
95
What are interventions for conversion?
amobarbitol or lorazepam for historical trauma
96
What is conversion?
Responding to stress by unconsciously exhibiting physical manifestations. converting mental stress into somatic illness
97
What are client education points for conversion disorder?
stress management, alternative coping mechanism, verbalize feelings
98
What is illness anxiety disorder?
hypochondriac
99
What is somatic symptom disorder?
anxiety disorder and childhood trauma, no pathologic disorder, younger than 30
100
What is the difference between somatic symptom disorderand conversion disorder?
somatic symptom disorder is chronic worry about the symptoms they are presenting with, reject psychological diagnosis
101
What are characteristics of somatic symptom disorder?
frequent healthcare visits, vague or exaggerated symptoms, symptoms begin before 30
102
What do you need to do with somatic symptom disorder?
lab or diagnostics
103
What are interventions for a patient with somatic symptom disorder?
accept somatic manifestations as being real to the client, assess for SI, report new manifestations to provider, limit time to discuss somatic manifestations
104
What are some education points for somatic symptom disorder?
psychotherapy: develop healthy, adaptive behavior, move beyond somatization, manage lives more effectively, group therapy, CBT (symptoms related to stress and anxiety)
105
What are medications used for somatic symptom disorder?
SSRI for underlying depression, Benzodiazepines to treat anxiety
106
What does CBT stand for?
cognitive behavioral therapy
107
What is another way to say Factitious Disorder?
Munchausens
108
What are characteristics of Facticious disorder?
intentional feigning of physical or psychological symptoms; pretends to be ill to receive emotional care and support, may be a compulsive element that diminishes personal control, may aggravate existing symptoms, induce new ones, or inflict painful injuries to themselves
109
Interventions for factitious disorder?
communicate openly with health care team any suspicions of factitious disorder can help reduce medical costs and possible unnecessary treatments

Third Semester (5 decks)

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