Mental Health Final

Question 1

Chpt 8

Therapeutic Relationships are used for what?

Answer 1

—Therapeutic relationships exist to meet the needs of the patient:

Their needs / thoughts / feelings / goals

—Roles are clearly defined and professional boundaries are established and maintained

—Areas to be worked on are agreed on and outcomes are continually evaluated

Question 2

Social Relationships refer to what?

Answer 2

Primarily initiated for the purpose of friendship, socialization, enjoyment or to accomplish a task

—Social relationships exist for mutual gratification of the participants

Question 3

Transference

Answer 3

Sigmund Freud

Pt. unconsciously and inappropriately displaces (transferes) onto the RN feeling’s / behaviors r/t significant figures in their past (parents / siblings etc.)

i.e. “you remind me of…(mom / dad / sister)

Question 4

Chpt 8

Countertranferences

Answer 4

When the RN unconsciously and inappropriately displaces (transferes) onto the pt. feeling’s / behaviors r/t significant figures in their past (parents / siblings etc.)

Can be either a positive or negative response

Question 5

Chpt 8

RN’s tend to diviate from therapeutic relationsips when they are:

Answer 5

Bored - want to rescue the pt

overinvolved w/pt - overidentify w/pt

anger w/pt - feelins of hoplessness / helplessness

Question 6

Chpt 8

Peplau’s (1952)

Nursing - pt. relationship phases

Answer 6

1) PreOrientation Phase
2) Orientation Phase
3) Working Phase
4) Termination Phase

Question 7

Chpt 8

Peplau’s Orientation

Phase

Answer 7

• can last a few minutes or extend over a longer period
• is the initial interview
• Used to establish rapport (demonstate genuiness, empahty, & develope a postitive regard
• Set parameters
• discuss confidentiality

- **Plan for termination phase (pt needs to know) is 1st used here.

Question 8

Chpt 8

Peplau’s Working

Phase

Answer 8

RN & pt work together to Id / explore area’s that are causing problems in the pts life.

Key point. describing can often cause the pt. to reexperiencing old conflicts & can awaken high anxiety, anger etc

Question 9

Chpt 8

Peplau’s Termination

Phase

Answer 9

Final / intergal phase

Summation of goals / objectives that pt. can implement when discharged

Key point - if pt has unresolved feelins of abandonment / unwanted….this phase can awaken those feelings

Ask the pt…“How do you feel about…?

Question 10

Chpt 8

Factors that promote Pt. growth

Answer 10

1) Genuiness
2) Empathy (not sympathy)
3) Positive regard (respect 4)

Question 11

Chpt 8

Genuiness

Answer 11

what we display to the outside world for a person / pt is congruent (same) w/ our internal feelings

RN would use congruent communication strategies

*what we project is real

don’t hide behind rules / using staff or informal guidlines to explain our actions…show an ability to interact honestly w/pts.

Question 12

Chpt 8

Empathy

Answer 12

Empathy

The ability to understand a situation from the patient’s point of view

Empathy occurs when there is a deep understanding of the patient with the patient

Strongly associated with positive patient outcomes

Question 13

Chpt 8

Positive Regard Def

Answer 13

An attitude of deep and genuine caring for the patient that acknowledges his/her intrinsic dignity and worth and is not contaminated or diminished by judgments about the person’s attitudes, beliefs, thoughts, feelings, behaviors

Question 14

Chpt 9

Patient Centered

refers to…

Answer 14

refers to the Pt. as a full partner in his/her care - whose values, preferences, and needs are respected.

Question 15

Chpt 9

Factors that affect communications

Answer 15

1) Personal factors (ie. mood, level of education, cultural backgroud)

2) Environmental factors (noise, lack of privacy, uncomfortable chairs etc)

3) Relationship factors ( status…who is in charge, age, social standing)

Question 16

Chpt 9

Verbal vs. nonverbal communication

Answer 16

Words (verbal) equate to “content”

nonverbal (what we project) equates to “the process”

roughly 10% of all conversation is verbal & 90% is nonverbal (what we see)

when the content is congruent with the process - communication is said to be “healthy”

Question 17

Chpt 9

List 3 Therapeutic Communication techniques

Answer 17

1) Silence - is not the absence of communication, but a specific channel for transmitting / receiving messages.
2) Active Listening - carefully looking for both verbal and non-verbal cues to what is really meant.
3) Clarifying techniques

Question 18

Chpt 9

Types of communicatoin Q’s a nurse will use with a pt.

Answer 18

1) Open ended - encougage pts to share about experiences / perceptions
2) close ended - should use only during initial interviews to get specific details
3) Projective Q’s - “what if” (ie. #what if you had 3 wishes, what would they be”)
4) Presuppose - known as the “miricle Q” (ie. suppose you woke up today a millionaire and all your problems dissapeared. What would be diffent?)

Question 19

Chpt 9

Nontherapeutic Communicaiton

Answer 19

1) excessive q’s
2) giving approval or disapproval
3) Why q’s — implies judgement or wrong doing
4) Giving advise — rarely helpful

Question 20

Hesi Practise

Reframing def

Answer 20

is a technique that teaches clients to monitor their negative thoughts and replace them with ones that are more positive.

ie. by reminding a pt. complaining of a painful procedure that he had the same one the day before, this helps them refocus thier thoughs (reframing)

Question 21

Hesi Practise

Distraction def

Answer 21

focusing the clients attention on something other then what they are going through (ie. pain)

Question 22

Hesi Practise

Imagery def

Answer 22

uses mental imagaes to assist with relaxation

Question 23

Hesi Practise

Progressive relaxation def

Answer 23

strategy in which muscles are alternately tensed and then relaxed.

Question 24

Hesi Practise

Clarifying def

Answer 24

technique of restating a conversation with the pt.

helps examine the meaning of the pt. statement

helps the Rn in preventing making assumptions about a clients message

ie. what do you mean by…

Question 25

Hesi Practise

Offering Self

Answer 25

technique that allows the client to set the pace of a conversation. The RN is available, both physically and emotionally.

lets the client know you are there for them. helps build trust

Question 26

Hesi Practise

w/ depressed pts, what is the best assisstance a RN can give.

Answer 26

Exercise is the least expensive yet most available antidepressant on the market. Exersice increases neurotransmitters and endorphins, and decreases feelings of sadness.

W/ a depressed client…walk them around the unit. Don’t let them sit around all by themselves.

Socialize Socialize Socialize

Question 27

Hesi Practise

Regression def

Answer 27

resorting to an earlier, more comfortable level of functioning that is less demanding ahd has less responsibility.

Question 28

Hesi Practise

Confabulation def

Answer 28

is the filling of memory gaps with imaginary information in an attempt to distract others from observing an obvious deficit.

Question 29

Hesi Practise

Herorin withdraw s/s

Answer 29

symptons of heroin w/d include

cravings

muscle aches / tremors

severe abdominal cramps

chills / sweating / runny nose / watery eyes

Question 30

Hesi Practise

Cocaine withdrawal s/s

Answer 30

symptoms of cocaine w/d include:

severe cravings

depression / fatigue / irritability

vivid / unpleasant dreams

insomnia or hypersominia

Question 31

Hesi Practise

Cannabis withdrawal s/s

Answer 31

symptoms of cannabis w/d include:

irritability / anxiety / restlessness

decreased appetite or wieght loss

Question 32

Hesi Practise

Alcohol withdrawals s/s

Answer 32

early symptoms of alcohol w/d include:

irritability / anxiety

tremors

sweating

mild tachycradia

Question 33

Goals of a therapeutic Relationship

Answer 33

To promote healthy coping and adaptation

help clients examine personal issues and explore and evaluate the degree of change over time

Assist patient with their emotional and physical needs

Question 34

What are the Major Theories (3) in practise today?

Answer 34

1) Psychoanalytic Theory

2) Client-Centered Theory By Carl Rogers (** This is the professors favorite)

3) Cognitive-Behavioral Therapies

Question 35

Psychoanalytic Theory

Psychoanalysis makes you examine your life, retell your life. You have to confront the parts of yourself that are painful.”

who developed the theory & what are the 3 concepts of Self

Answer 35

• Originated by Sigmund Freud
• Key Concepts:

–The “Self” has 3 distinct parts

• Id (instincts; seek pleasure) - as a child does…I want at any cost
• Ego (rational adult self) - we start to become self aware…If i do this / this will happen. Is is worth it?
• Superego (internalized parents; conscience) - i.e a parent would say “if you do that…this will happen”

Question 36

Client-Centered Theory

who developed theory & what is the main tool used

Answer 36

•Originated by Carl Rogers

•Key Concepts

–Unconditional Positive Regard: Is the main tool of the therapist

–Every person has the potential to become fully functioning, moving toward increased awareness of self

Question 37

•Client-Centered Interventions / qualities of the therapist

Answer 37

•Genuineness, Warmth, Empathy, Respect

–Active listening, Reflection of feelings, Clarification, Being truly present for the client

It’s not about me, it’s about the patient (Pt. centered)

Question 38

What are some Clarifying techniques

Answer 38

paraphrasing - restating the pts. stmt. using dif words

Restating - mirroring their words

Reflecting - assisting the pts to better help them know their own thoughts

exploring - examining the situation to gain insight into important ideas.

Question 39

What is Therapeutic Use of Self

Answer 39

Involves learning to use your unique qualities in a genuine way to develop positive bonds with the client in order to help them grown & change

The nurse’s “self” is the “instrument” they use to deliver nursing care.

Question 40

What is the Johari Window

Answer 40

Key apsects

Open / Public - known to self and others

Hidden / Private - Known to Self but not Others

Blind / Unaware - known to Others but not Self

Unknown - Hidden from Self and Others

Question 41

What is Sympathy

Answer 41

Sympathy

involves projecting yourself into your patient’s situation and imagining what you would feel in that circumstance.

—Associated with feelings of pity and commiseration

Question 42

What is Empathy’s 2 step process

Answer 42

Step 1 Active Listening

Be fully present with the client—listen with all of your senses

Step 2 Empathic Responding

Communicate your understanding and acceptance of the patient by reflecting the patient’s feelings

—(“You feel X” or “You feel X because of Y.” )

Question 43

Who was the 1st pyschiatric nurse

Answer 43

Linda Richards

Question 44

Describe the “Id” phase of Freuds system

Answer 44

“Id” operaties on the pleasure principle, seeking immediate gratification of impluses.

Question 45

Describe the “ego” phase of Freuds system

Answer 45

The “ego” phase acts as a mediator of behavior and weighs the consequence of one’s action.

ie. Would be taking that toy, be worth getting in trouble?

Question 46

Describe the “superego” phase of Freuds system

Answer 46

The “superego” would oppose the impulsive behavior as “not nice”.

Question 47

Suicide def.

Answer 47

is the intentional act of killing oneself by any means.

hsty of attempts is best predictor of another attempt

Question 48

Parasuicide def.

Answer 48

A voluntary, failed attempt to kill oneself

Frequently called attempted suicide

Question 49

What are two key feelings that are important predicters of future suicide attempts

Answer 49

Hopelessness / helplessness

severity of depression.

Question 50

Theoretical foundations for understanding the suicidal client

Answer 50

Remember!

All behavior has meaning! All behavior, including suicidal behavior, represents an attempt to meet a need!

Question 51

What is Baumeister’s Escape Theory

Answer 51

it refers to the components of pts pyschi

• intense self-hatred
• intense desire to escape oneself

Question 52

What is the “Existential” Theory refer to

Answer 52

the inability to find meaning in suffering often contributes to suicide

Question 53

What is the “cognitive theory of suicide”

Becks Cognitive Triad

change, re-frame thoughts to curb depression.

Answer 53

Is a pt’s perspective about.

1) self
2) future
3) World

With a negative outlook in the center of all three views.

Question 54

What is

“Shneidman’s Cubic Model of Suicide”

Answer 54

It contains three factors:

Psyhchache - unbearable suffering of the mind

Press - Stressors that drive the person to suicide as a viable alternative

Perturbation - extream state of being upset

Question 55

What are the Assessment stages for the suicidal patient

Answer 55

Step 1: Set the Stage

Step 2:
Explore Suicidal Thoughts and Behaviors

Step 3: Evaluate Lethality

Question 56

Suicidal assessment

Step 1: Set the Stage

Answer 56

Establish rapport!

Promote trust

Convey accepting, non-judgmental attitude

Facilitate a supportive, collaborative approach to exploring the client’s problems

Question 57

Suicidal Assessment

Step 2:
Explore Suicidal Thoughts and Behaviors

Answer 57

Facilitate expression of feelings

Convey empathy by reflecting feelings: (“It sounds like you’re feeling hopeless.”)

** Verbalize the implied: (“When you say there’s no point in going on, I have to wonder, are you feeling like you want to kill yourself?”)

Normalize the patient’s experience: (“A lot of people in your situation might start wondering if there’s any point in living anymore.”)

Question 58

What is the difference btwn “overt” statements vs. “Covert” statements

Answer 58

Overt - Life isn’t worth living anymore (they are direct statements)

Covert - You won’t have to bother with me much longer (hidden statements)

Question 59

Watch for signs / clues that suggest suicidal intent

Answer 59

Giving away prized possessions

Putting affairs in order

Writing farewell notes

Buying a gun

Loss of interest in activities

Social withdrawal

Question 60

Ask the Q - be bold to a suicidal pt.

Answer 60

Have you ever wished you were dead (weren’t here)?

Have you ever thought about hurting or killing yourself?

Have you been feeling suicidal lately?

Question 61

What are some the demographic risk factors for suicidal pts.

Answer 61

ederly (w/terminal diagnoses)

younge adolesent white females

American Indians seem to have a higher rate.

Question 62

Suicidal Assessment

Step 3: Evaluate Lethality

Answer 62

Lethality refers to the probability that a person will successfully complete suicide

Determined by the seriousness of the person’s intent and likelihood that the planned method of death will succeed

Question 63

What are some ( 4 main )of the Lethality Assessment’s

Answer 63

How lethal is the proposed plan?

How accessible are the means?

What are the chances of rescue?

Is substance use a factor?

Question 64

What is the SAD PERSONS Scale

Answer 64

Sex Age Depression

Previous attempts

Ethanol abuse (alcahol)

Rational thinking loss (especially psychosis)

Social supports lacking

Organized plan No spouse Sickness

Score of 7 out of 10 warrants hospitalization

Question 65

What are the Goals for Hospitalization of suicidal patients

Answer 65

Prevent harm

Re-establish equilibrium

Restore hope

Enhance coping skills

Develop an outpatient support system

Develop a suicide prevention plan for discharge

Question 66

Always Observe for “Sudden Serenity” in suicidal patients - what does this mean

Answer 66

Distressed suicidal clients who suddenly become more peaceful and serene may have decided to kill themselves

Question 67

What are the two most prevelent Depressive Disorders

Answer 67

Major Depressive Disorder (MDD)

Dysthymic Disorder (DD)

Question 68

What is the Diagnostic Criteria for Major Depressive Disorder (MDD)

Answer 68

5 or more of the following symptoms for at least 2 weeks

• Depressed Mood
• feelings of guilt / worthlessness
• Anhedonia ( loss of interest in activities)
• Significant weight change
• Insomnia
• psychomotor agitation / retardation
• Anergia (fatigue or loss of energy
• Decreased concentration or indecisivness
• Recurrent thoughts of suicide or death

Question 69

Major Risk factors for Depression

Answer 69

Female / unmarried

low socioeconomic status

family hsty of depression

Alcohol / substance abuse

Post-partum

Negative life event - especially loss of loved one

Question 70

What is Dysthymic Disorder

Answer 70

2 or more of the following symptoms, along w/depressed mood are present most days over a 2 yr period of time

• decreased appetite
• insomnia or hypersomnia
• decreased self esteem
• feelings of helplessness or despair
• low energy or chronic fatigue
• Poor concentration and difficulty making decisions

Question 71

What are some of the theories regarding

depression

Answer 71

1) Neurobiological
2) Genetic Transmission
3) Diathesis-Stress Theory of Depression
4) Psychoanalytic Theory of Depression
5) Cognitive Theory of Depression
6) Learned Helplessness Model

Question 72

Explain the Diathesis-Stress

Theory of Depression

Answer 72

Individuals have a genetic predispostition (diathesis) for deprssion

This genetic vulnerability is activated by exposure to multiple stressors

Exposure to stressors early in life (abuse / death of parent prior to age 10) lead to lifelong risk for develpment of MDD

Question 73

What is the Learned Helpless Model

of depression

Answer 73

Person experiences stressful event preceived as uncontrollable.

extreme feelings of powerlessness, helplessness and apathy occur

loss of initiative and a feeling of futility

Question 74

What are some of the treatments for

depression

Answer 74

Psychotherapy

Pharmacotherapy

Electroconvulsive Therapy

Brain Stimulation

Exercise and Stress Management

Question 75

Name 4 Pharmacotherapies for

depression

Answer 75

Selective Serotonin Reuptake Inhibitors (SSRI)

Tricyclic Antidepressants (TCAs)

Monoamine Oxidase Inhibitors (MAOI’S)

St. John’s Wort

Question 76

Selective Serotonin Reuptake Inhibitors (SSRI)

FACTS

Answer 76

1st line therapy for most types of depression

effective in 1 to 3 weeks

low lethality risk

Should not take w/other depression medications -MAOI’S (discontinure all SSRI’s for 2 - 5 weeks before starting

Question 77

What are some of the S/E of SSRI’s

mnemonic

Answer 77

BAD SSRI

• increased body weight
• anxiety
• Dizziness

Serotonin Syndrome

Stimulation of the CNS

Reproductive issues / sexual dysfunction

insomnia

Question 78

Serotonin Syndrome is a potential toxic effect of SSRI’s - what are the signs

Answer 78

Rare - but life threatening - medical emergency

–Hyperactivity/restlessness

–Irrationality, mood swings, hostility

–Abdominal pain, diarrhea, bloating

–Elevated blood pressure

–Tachycardia / cardiovascular shock

–Fever / hyperpyrexia

–Confusion / delirium

–Myoclonus, incoordination, tonic rigidity

–Generalized seizures

–Apnea / death

Question 79

Tricyclic Antidepressants (TCAs)

FACTS

Answer 79

• Inhibit reuptake of serotonin and norepinephrine by the presynaptic neurons
• Full therapeutic response can take 4 to 8 weeks
• Potentially lethal in overdose or in

combination with MAOI’s

Question 80

Monoamine Oxidase Inhibitors (MAOI’S)

FACTS

Answer 80

• Inhibit MAOI’s, the enzyme that inactivates norepinephrine, serotonin, dopamine and tyramine
• Avoid foods containing tyramine (generally aged, fermented and pickled foods) and other pressor agents
• MAOIs should not be taken within 14 days of starting or discontinuing other antidepressant medications, including tricyclics, SSRIs, SNRIs and St. John’s Wort!

Question 81

Foods that contain

Tyramine

Answer 81

generally aged, fermented and pickled foods

avocados (especially if aged)

figs / bananas ( if overipe)

fermented meats

cured fish / dryed fish

all cheeses

foods (or drinks) w/yeast – beer / wine etc

Question 82

St. John’s Wort

FACTS

Answer 82

• May be effective in mild to moderate depression
• Should not be taken with other antidepressants or with tyramine-containing foods
• Can decrease digoxin levels 28%

Question 83

What are the three phases in treatment and recovery from major depression

Answer 83

1) acute phase
2) continuation phase
3) maintenance phase

Question 84

Describe the acute phase of major depression tx / recovery

Answer 84

• 6 to 12 weeks
• directed at reduction of depressive symptoms and restoration of psychsocial and work functions

Hospitalization may be initiated if severe

Question 85

Describe the continuation phase of major depression tx / recovery

Answer 85

• 4 to 9 months
• directed at prevention of relapse through pharmacotherapy, education & psychtherapy

Question 86

Describe the maintenance phase of major depression tx / recovery

Answer 86

• 1 year or more

treatment is directed at prevention of further episodes of depression

medication may be phased out.

Question 87

Anhedonia def.

Answer 87

loss of ability to experience joy or pleasure in previously plearsurable activities.

Question 88

What does the “recovery model” emphasize

Answer 88

healing is possible and attainable for individuals with mental illness including depression.,

Thourgh partnership with nurse where treatment goals are mutually developed based upon the pt.s personal needs.

Question 89

What is the PHQ - 9

Answer 89

Patient Health Questionaire - 9

0-4 none

5-9 mild

10-14 - moderate

15-19 moderately severe

20-27 servere

Question 90

What are “vegative signs” of depression

Answer 90

alterations in body processess necessary to support life and growth

• eating
• sleeping
• elimination
• sexual activity

Question 91

What are the four levels of

Anxiety

Answer 91

Mild Anxiety

Moderate Anxiety

Severe Anxiety

Panic

Question 92

Mild Anxiety def.

Answer 92

Occures in normal everyday living and allows an individual to perceive reality in sharp forcus

Question 93

Moderate Anxiety def.

Answer 93

as anxiety increases, person experiencing moderate anxiety sees, hears & grasps less informtion

often demonstrate “selective inattention”

Question 94

Severe Anxiety def.

Answer 94

perceptual field is greatly decreased. Person may be able to focus only on one detail or may have many scattered thoughts. Learning and problem solving not possible

Sense of impending doom

somatic symptoms include - headache, nausea, dizziness or insomnia

may have increased trembling / heart pounding

Question 95

Panic def.

Answer 95

is the most severe level of anxiety and results in markedly distrubed behavior.

Pt is unable to process what is going on & they may loss touch with reality.

Question 96

What is Separtion Anxiety Disorder

Answer 96

normal part of infant development - begins around 8 months through 18

Question 97

List some of the common “defense mechanisms” associated with anxiety

Answer 97

compensation - conversion - denial - displacement -

dissociation - indentification - projection - reaction -

regression - repression - splitting -

sublimation - suppression - undoing

Question 98

The defense mechanism

compensation is def. as

Answer 98

used to change perceived deficiencies by emphaszing strengths

Question 99

The defense mechanism

conversion is def. as

Answer 99

unconscious transformation of anxiety into a physical (somatic) symptom w/ no organic cuase

Question 100

The defense mechanism

denial is def. as

Answer 100

involves escaping unpleasant anxiety causing thought & feelings by ignoring thier existence

Question 101

The defense mechanism

displacement is def. as

Answer 101

transference of emotions associated w/ a particular person / place or thing with another object that is not threatening.

Question 102

The defense mechanism

Dissociation is def. as

Answer 102

is a disruption in consciousness, memory, identity that results in compartmentalizing unpleasant aspects of oneself

Question 103

The defense mechanism

identification is def. as

Answer 103

when you relate yourself to someone else

Question 104

The defense mechanism

projection is def. as

Answer 104

refers to unconscious rejection of unacceptable behaviors and placing them onto someone else.

is the hallmark of blaming, scapegoating, prejudicial thinking, and stigmatizing others.

Question 105

The defense mechanism

Sublimation is def. as

Answer 105

replacing an unacceptable behavior with one socially acceptable

Question 106

What is Agoraphobia

Answer 106

intense, excessive anxiety or fear about being in places or situation from which escape might be difficult.

Pt. will avoid these in an effort to control anxiety.

Question 107

Obsessive-complusive disorder is def. as

Answer 107

group of related disorders that all have obsessiv-complusive characteristics.

it exist along a continuum between obsessive-complusive behaviors — to the pathological end which is obsessive-complusive disorders, which obstruct thier very way of living.

Question 108

Obsessions are def. as

Answer 108

thoughts, implulses, or images that persist and recur, so that they cannot be dismissed from ones mind.

those experiencing these are often aware that these obsessions are senseless

Question 109

Compulsions are def. as

Answer 109

ritualistic behavirors (washing hands) that an individual feels driven to perform in an attempt to reduce anxiety.

Question 110

The Hamilton Rating Scale for Anxiety is on a scale

0 - none

1 - mild

2 - moderate

3 - disabling

4 - severely disabling

** What are the scoring ranges?

Answer 110

14-17 - mild anxiety

18-24 - moderate anxiety

25-30 - severe anxiety

Question 111

What is “cognitive restructuring”

Answer 111

refers to allowing the pt. (w/ your help) to test their automatic responses and then refocus / redraw them with more rational conclusions

Question 112

What is desesitization

Answer 112

involves gradual exposure to a feared object to redirect associated fear of it.

a behavioral therapy modality

Question 113

What is “flooding”

Answer 113

exposes the pt. to a large amount of an undesirable stimulus in an effort to extinguish the anxiety response.

a behavioral therapy modality

Question 114

The defense mechanism

Splitting is def. as

Answer 114

is the inability to integrate the positive and negative qualities of oneself or others into a cohesive image.

Question 115

What is “Altruism”

Answer 115

is a mechanism by which an individual deals with emotional conflict by meeting the needs of others and receiving gratification vicariously or from the responses of others

Question 116

The defense mechanism

Intellectualization is def. as

Answer 116

is a process in which events are analyzed based upon remote, cold facts w/o passion — rather than incorporating feelings / emotions into the process.

Question 117

The defense mechanism

Reaction formation is def. as

Answer 117

unconscious mechanism that keeps unacceptable feelings out of awarness by expressing the opposite behavior

ie. instead of ‘hating’ a rival, you would say you

admire them.

Question 118

The defense mechanism

Rationalization is def. as

Answer 118

involves uncounsciously making excuses for one’s behavior, idadequacies, or feelings by blaming others.

Question 119

What are the Fraud’s psychosexual development stages

Answer 119

Oral - age birth to 1 (thumb sucking)

Anal - age 1 - 3 (refusiing to use bathroom)

Phallic - age 3 - 5

Genital - age 13 - 20 years

Question 120

Describe Milieu therapy

Answer 120

based upon the idea that all members of the environment contribute to the planning and functioning of the setting.

Question 121

What is the def. of schema

Answer 121

Schemas are unique assumptions about ourselves, according to Beck’s theory

a negative schema is an emotional consequence with the end result of negative thinking process

Question 122

What is the def. of somatization

Answer 122

is the expression of psychological stress through physical symptoms

Question 123

What is the def. of “holistic approach” for

nursing

Answer 123

nursing care that addresses the multidimensional interplay of biological, psychological and sociocultural needs.

Question 124

List the five most common somatic disorders according to the American Psychiatric Association

Answer 124

1) Somatic symtpom disorder
2) Illness anxiety disorder (aka hypochondriais)
3) Coversion disorders (aka neurological disorders)
4) Pshychological factors affecting medical condition
5) Factitious disorders

Question 125

What is Somatic symtpom disorder

Answer 125

characterized by a combination of distressing symptoms and an excessive or maladaptive response w/o significant physical findings or diagnoses.

Question 126

What are the most common symptoms with Somatic symptom disorder

Answer 126

chest pain / fatigue / dizziness / headache

swelling / back pain / SOB / insomnia

abdominal pain / numbness

Question 127

What is Illness Anxiety Disorder

aka hypochondriasis

Answer 127

results in a misinterpretation of physical sensations as evidence of a serious illness

even normal bodily changes, such as a change in HR can be seen as red flags for serious illness

Question 128

What is conversion disorder

aka functional nurological disorder

Answer 128

manifest itself as nerological symptoms in the absence of neurological diagnosis

Question 129

What are some of the symptoms of Conversion disorders

Answer 129

paralysis / blindness / movement disorders

gait disorders / numbness / paresthesia (tingling or burning sensation)

loss of vision, hearing or even symptoms resembling epilepsy.

Question 130

List some (2) of the psychological factors affecting medical conditions

Answer 130

Major Depression disorder (MDD) & coronary heart disease

Stress & cancer

Question 131

What are “secondary gains”

Answer 131

those benifits derived from the symptoms alone

eg. in the sick role, a pts. are unable to perform usual household duties.

If a pt. derives benefits from the percieived symptoms, it will be very dificult to give them up.

Question 132

What is factitious disorder

aka Munchausen’s syndrome

Answer 132

unlike other somatic disorders…factitious disorders are consciously under the pts. control.

They fake ilness to get sympathy or some other benefit.

Question 133

What does factitous disorder imposed on another mean

aka Munchausen by proxy

Answer 133

it is when a caregiver deliberately fakes a pts. illness for their own benefits.

money from insurance - admiration from clinet or other staff etc.

Question 134

Def. Malingering

Answer 134

consciously motivated to deceive based upon the desire for gain

(money or getting out of someting)

Question 135

What is “la belle indifference”

Answer 135

When a pt. experiencing a somatic conversion disorders appears to be unconcerned about the symptom

eg. A woman suddenly finds she cannot see. She seems unconcerned about her symptom and tells her husband, “Don’t worry, dear. Things will all work out

Question 136

What is congitive behavioral therapy?

Answer 136

A therapy technique that attempts to change a patient’s thought processes and behaviors through problem-solving and conscious evaluation of beliefs about the self

Question 137

Nursing Interventions for GAD

Answer 137

• Identify source of anxiety
• Link pt’s behavior to feelings
• Introduce logic
• Teach coping skills

Question 138

Antidepressants (SSRIs) are the 1st line of defense in most anxiety & OCD related disorders.

The FDA has approved some SNRIs & TCAs for use with anxiety & OCD related disorders.

Answer 138

SSRIs:

• Lexapro (Escitalpram) for GAD
• Prozac (Fluoxetine) for OCD & Panic Disorder
• Luvox (Fluvoxamine) for OCD & SAD
• Paxil (Paroxetine) for GAD, OCD, PD, & SAD
• Zolfort (Sertraline) for OCD, PD & SAD
• Viibryd (Vilazondone) for GAD

SNRIs:

• Cymbalta (Duloxetine) for GAD
• Effexor (Venlafaxine) for GAD, PD & SAD

TCAs:

• Anafranil (Clomipramine) for OCD

Question 139

Antianxiety agents (Benzodiazepines) are often used to treat somatic & psychological symptoms of anxiety disorder

Answer 139

Benzodiazepines

• quick onset of action; used for acute treatment (prn)
• may be addictive; limit use to 2 - 3 wks
• monitor for sedation, ataxia & decreased cognition
• contraindicated in pregnancy
• absorption delayed by antacids
• i.e. Xanax (Alprazolam), Klonopin (Clonazepam), Valium (Diazepam), Ativan (Lorazapam)

Exception: Buspar (Buspirone) is long acting, not addictive; not for prn use

Question 140

What neurochemicals regulate anxiety?

Answer 140

1) Epinephrine
2) Norepinephrine
3) Dopamine
4) Serotonin
5) GABA

GABA is an inhibitory neurotransmitter & thus the focus of pharmacological therapy for anxiety symptoms.

Question 142

Schizophrenia def.

Answer 142

The most severe form of Schizphenia Spectrum

It is a potentially devastating brain disorder that affects a person’s thinking, language, emotions, social behavior, and ability to perceive reality accurately.

Question 143

What is Schizophenia Spectrum?

Answer 143

It, and other psychotic disorders are those that distrub the fundamental ability to deteremine what is real or what is not.

Question 144

All people who have Schizophrenia, have at least one of the following psychotic symptoms

Answer 144

hallucinatioins

delusions

and / or disorganized speech

Question 145

What is the epidemiology of Schizophrenia

(when does it normally occur)

Answer 145

usually presents in late teens / early twenties.

Question 146

What is early on-set Schizophrenia

Answer 146

(18 to 25) occurs more often in males

associated w/poor functioning before onset & more structural brain damage

Question 147

What is later on-set Schizophrenia

Answer 147

(25 to 35) more likely to be female

less structural brain damage

better outcomes

Question 148

What are some of the comorbidities associated w/ Schizophrenia

Answer 148

1) Substance abuse disorders - nearly 50% (sucide)
2) Nicotine dependence 70% - 90%
3) Anxiety, depression
4) Physical Health Illnesses

5) Polydipsia - can lead to fatal water intoxication (20% have insatiable thirst) may be due to medications

Question 149

What is the etiology of Schizophrenia

Answer 149

scientific consesus is that Schizophrenia occurs due to multiple inherited genetic abnormalities combined with nongenetic factors.

called the diathesis-stress model of Schizophrenia

Question 150

What are some of the genetic factors for Schizophrenia

Answer 150

Increased levels of dopamine (1st generations treat)

Increased levels of serotonin (2nd generation meds treat)

glutamate - which is a major neurotransmitter during neuronmaturation

Brain Structure Abnormalities - reduced volume of “grey matter” (temporal / frontal lobes) — more hallucinations.

Question 151

What are some of the psychological / environmental

factors associated w/ Schizophrenia

Answer 151

1) prenatal stressors (poor nutrition & hypoxia)
2) psychological stressors (stress w/ incr cortisol level which imped hypothalamic development)
3) environmental stressors (toxins, ie. solvent tetrochoroethylene in dry cleaning)

all increase chances w/ those vulnerable to Schizophrenia

Question 152

What are the Phases of Schizophrenia

Answer 152

Phase I - Acute

Phase II - Stabilization

Phase III - Maintenance

Question 153

Def. Phase I - Schizophrenia

Answer 153

Acute

onset or exacerbation of distruptive symptoms (ie. hallucinations, delusions, apathy w/draw)

w/ loss of functional abilities - increased care or hospitalization may be required.

Question 154

Def. Phase II - Schizophrenia

Answer 154

Stabilization

symptoms are diminishing, and there is movement towards one’s previous level of functioning (baseline)

Question 155

Def. Phase III - Schizophrenia

Answer 155

Maintenence

pt. is at or near baseline functioning

symptoms are absent or significantly decreased.

Question 156

What are the 4 main symptom groups of Schizophrenia

Answer 156

Positive symptoms

Negative symptoms

Affective Symptoms

Congnitive Symptoms

Question 157

What are postive symptoms of Schizophrenia

associated w/acute onset

Answer 157

The presence of something that is not normally present

hallucinations

delusions

disorganized speech

bizarre behavior

will generally respond to medication

Question 158

What are negative symptoms of Schizophrenia

Answer 158

absence of something that should be present

• Poverty of thought (interest in hygiene)
• Avolition (loss of motivation / energy or drive)
• Blunted affect (minimal emotional response)
• Alogia (poverty of speech)
• Anhedonia (loss of joy in something previously enjoyed)
• Anergia (lack of energy)

more presistent / crippling b/c they reduce motivation & limit social & vocational success

Question 159

What are cogntitive symptoms of Schizophrenia

Answer 159

often subtle changes in memory, behavior, attention or thinking

ie. impaired executive functioning (ability to set priorities or make decisions)

Question 160

What are affective symptoms of Schizophrenia

Answer 160

symptoms involving emotions and their expression

dysphoria (dissatisfaction w/ life)

suicidality

hopelessness

Question 161

Positive symptoms are broken down into

what four categories

Answer 161

alterations in

1) thought
2) speech
3) perception &
4) behavior

Question 162

Delusions are def. as

Answer 162

false fixed beliefs that cannot be corrected by reasoning. Pt will agree w/ RN about facts but disagree w/ interpretation.

75% of those w/ schizophrenia experience these

persecutory

gradiose or

those involving religious or hypochondriacal ideas

ex. I think; I believe; I interpret; My opinion

Question 163

What is “concrete thinking”

Answer 163

refers to the impaired ability to think abstractly

ie. When you ask a pt. what brought them to the hospital — they would say “ a cab”

Concreteness reduces one’s ability to understand and address abstract concepts such as love or the passage of time.

Question 164

What is “clang association”

Answer 164

choosing words based on their sound rather then their meaning

ie. rhyming “on the track… have a Big Mac”

Question 165

What is “word salad” (schizohasia)

Answer 165

jumbled words that are meaningless to the listener and possible to the speaker

ie. “red chair out town board”

Question 166

What are Neologisms?

Answer 166

made-up words that have meaning to the pt. but a different or nonexistent meaning to others

Question 167

What are Echolalia

Answer 167

pathological repeating of anothers words

ie. Nurse…Mary, come get your medication

Mary…come get your medication

Question 168

What is Depersonalizaiton

Answer 168

feeling that one is somehow different or unreal or has lost his / her identity

may feel body parts don’t belong to them.

Question 169

What is Derealization

Answer 169

a false perception that the environment has changed - surroundings seem strange and unfamilar

Question 170

Hallucinations vs. Illusions

both are perceptions

Answer 170

Hallucinations involve perceiving a sensory experience for which no external stimulus exist

Illusions are misperceptions or misinterpretations of a real experience (external stimulus); a false belief about a perception

ie. pts see the coat rack, but believes it is a bear

Question 171

What are the types of hallucinations

experienced by 60% of pts. with Schizophrenia

Answer 171

Auditory: hearing voices or sounds

Visual: seeing persons or things

Olfactory: smelling odors

Gustatory: experiencing taste

Tactile: feeling bodily sensations

ex. I see; I hear; I taste; I smell; I feel

Question 172

What are the worst types of hallucinations

Answer 172

Command hallucinations

those that direct pts to take action. voices may command the pt. to hurt themselves or others.

Question 173

What is “Catatonia”

Answer 173

pronounced decrease in the rate and amount of movement

Generally pts. may move little if at all

Question 174

What is Echopraxia

Answer 174

mimicking the movements of another

Question 175

What is Anosognosia

Answer 175

inability to realize they are ill (caused by the illness itself)

The resulting lack of insight can make assessment / treatment challenging.

Question 176

What does the “recovery model” stress

Answer 176

stresses hope, living a full and productive life, and eventually recovery rather than focusing on controlling symptoms and adapting to the disability

Question 177

What is the overall goal for the acute phase

Answer 177

patient safety and stabilization

Question 178

What goals does phase II (stabilization) focus on

Answer 178

helping the pt understand the illness and treatment, become stabilized on medications, and be able to control or cope with symptoms.

Question 179

What goals does phase III (maintenance) focus on

Answer 179

adhering to medication, preventing relapse, and achieving independence and a satisfactory quality of life.

Question 180

What is “waxy flexiblity”

Answer 180

the ability to hold distorted postures for extended periods of time.

Question 181

What are the prodromal signs of schizophrenia

Answer 181

they are the initial signs indicating that a pt. might be leading toward a schizophrenic break

Withdrawal

misinterpreting

poor concentration

preoccupation with religion

Question 182

What is associative looseness

Answer 182

refers to jumbled thoughts inchoherently expressed to the listener.

Question 183

What are some of the signs of a potential relapse in schizophrenia

Answer 183

feeling tense

difficultly concentrating

trouble sleeping

increased w/drawal

increased bizarre or magical thinking

Relapse can occur even w/ medication compliance

Question 184

Delusions may be bizarre or non-bizarre

Answer 184

Bizarre type are unreal and impossible beliefs

i. e. Pt believes body organs replaced in absence of scars
i. e. Pt believes they are another animal (not human)

Question 185

Non-bizarre types of delusions

Answer 185

• Delusions of control
• Ideas of reference
• Persecution
• Grandeur
• Somatic
• Erotomanic
• Jealousy

Question 186

Def. of control delusions

Answer 186

Believing that another person, group of people, or external force controls thoughts, feelings, impulses, or behavior

i.e. Pt covers his apartment walls w/ aluminum foil to block government efforts to control his thoughts

Question 187

Def. of ideas of reference

Answer 187

Giving personal significance to unrealated or trivial events; perceiving events as relating to you when they are not

i.e. Pt believes that birds sing when she walks down the street just for her.

Question 188

Def. of persecution delusions

Answer 188

Believing that one is being singled out for harm by others; this belief often takes the form of a plot by people in power.

i.e. Pt believes the Secret Service was planning to kill him by poisoning his food; therefore, he would eat only prepackaged food.

Question 189

Def. of grandeur delusions

Answer 189

Believing that one is a very powerful or important person

i.e. Pt believed he was a famous playwright and tennis pro

Question 190

Def. of somatic delusions

Answer 190

Believing that the body is changing in unusual ways (i.e. rotting inside)

i.e. Pt said his heart had stopped and was rotting away.

Question 191

Def. of erotomanic delusions

Answer 191

Believing that another person desires you romantically.

i.e. Although he barely knew her, Patti insisted that Eric would marry her if only his current wife would stop interfering.

Question 192

Def. of jealousy delusions

Answer 192

Believing that one’s mate is unfaithful

i.e. Pt wrongly accused her spouse of going out w other women. Her proof was that he twice came home from work late (even though his boss explained that everyone had worked late).

Question 193

Hierarchy of needs for psychosis intervention

Answer 193

Priorities will change depending on the situation and context (use critical thinking)

• Physical integrity
• Establishing trust
• Preventing inappropriate behavior
• Treating symptoms: hallucinations/delusions
• Enhancing compliance w/ treatment
• Reinforcing reality

Question 194

The Bipolar Spectrum

Answer 194

Bipolar disorder mood cycling:

Mania

Hypomania

Normal mood

Mild depression

Major depression

Question 195

Manic episode

mnemonic

Answer 195

MANIC EPISODE

Mood swings

Active, agressive behavior

Nothing is wrong (denial)

Impulsive, intrusive behavior

Can’t sit still, can’t stop talk

Euphoric mood

Poor judgement, provocative behavior

Increased sexual interest

Substance (stimulant) abuse

Omnipotent feelings

Decreased need for sleep

Endless energy

Question 196

Bipolar disorder medications

Answer 196

Lithium (used for mood stabilization)

Anticonvulsants (used for mood stabilizaiton)

• Depakote (valproate)
• Tegretol (carbamazepine)
• Lamictal (lamotrigine)

Antipsychotics (used for acute manic phase)

• Seroquel (quetiapine)
• Zyprexa (olanzapine)
• Geodon (ziprasidone)
• Ambilify (aripiprazole)
• Risperdal (resperidone)
• Haldol (haloperidol)

Question 197

Rapid stabilization of the manic pt

Answer 197

Antipsychotics & benzodiazapines

Typical “cocktail” given in psych ER:

Haldol 5 - 10 mg w/ Avtivan 2 mg

Question 198

Antidepressants and Mania

Answer 198

Use very cautiously w/ bipolar pts

All antidepressants induce mania in bipolar pts

If pt is bipolar, antidepressants should always be used in conjuction w/ a mood stabilizer.

Question 199

What are the 3 types of

bipolar disorder

Answer 199

Bipolar I

Bipolar II

Cyclothymic disorder

Question 200

Bipolar I disorder is def. as

Answer 200

mood disorder that is characterized by at least one-week long manic episode that results in excessive activity and energy

Question 201

The presence of three of the following behaviors constitues mania:

Answer 201

Extreme drive & energy

Inflated sence of self-importance

Drastically reduced sleep requirements

Excessive talking combined w/ pressured speech

Personal feeling of racing thoughts

Distraction by environmental events

Unusually obsessed with and overfocused on goals

Purposeless arousal and movement

Dangerous activities (ie. indiscriminate spending, reckless sexual encounters, or risky investments)

Question 202

Bipolar II disorder is def. as

Answer 202

low-level mania alternated with profound depression

this is called hypomania…unlike mania, psychosis is generally never present.

Question 203

Cyclothymic disorder is def. as

Answer 203

symptoms of hypomania alternate with symptoms of mild to moderate depression for at least two years in adults & one year in children.

Question 204

What are the 3 phases associated with bipolar disorders

Answer 204

Acute Phase

Continuation Phase

Maintenence Phase

Question 205

What is the primary outcome in the acute phase of bipolar disorders

Answer 205

The primary goal is

injury prevention

outcomes in the acute phase reflect both physiological and psychiatric issues

Question 206

the primary outcome in the continuation phase of bipolar disorders is:

Answer 206

can last for 4 - 9 months

overall outcome is relapse prevention, but consist of

Psycheducational classes for the pt. & family to:

a) understand the disease process

b) medication knowledge

c) knowledge of the early warning signs of replapse

Question 207

the primary outcome in the maintenence phase of bipolar disorder is:

Answer 207

continuing to focus of relapse prevention & limiting the severity and duration of future episodes.

Question 208

What is paranoia?

Answer 208

An unrealistic fear of harm

Question 209

What neurotransmitter is targeted by traditional antipsychotics?

Answer 209

Dopamine

Traditional antipsychotics block excessive dopamine, an excitatory neurotransmitter, so that symptoms r/t psychosis are reduced.

Question 210

What medication is used to provide immediate relief to a pt. experiencing a dystonic reaction?

Dystonic reactions are emergencies & require intervention (can be caused by antipsychotics)

Answer 210

Diphendhydramine (Benadryl) IM or IV

or

Benztropine (Cogentin) IM or IV

IV response is 5 mins; IM response is 15 - 20 mins

Other anticholingerics may be used

Question 211

What are common side effects of Haldol (Haloperidol)?

Answer 211

• Sedation
• Muscle stiffness
• Akathisia
• alters effectiveness of exogenous insulin

Antipsychotics often produce sedation & EPS effects (i.e. stiffness, gait disturbance). The pt might describe the medication as making them feel like a “robot”.

Question 212

Personality disorders characteristic’s

defined

Answer 212

Pts with personailty disorders are inflexible & deomonstrate maladaptive responses to stress

• they are unable to develop true intimacy with others
• unable to develop trusting relationships.

“Impaired soical interaction”

Question 213

What are the 10 Personality disorders according to the American Psychiatric Association (APA)

Answer 213

1) Avoidant 2) Antisocial
3) Borderline 4) Dependent
5) Histrionic 6) Narsicistic
7) Paranoid 8) Obsessive-complusive
9) Shizioid 10) Schizotypical

Question 214

Paranoid personality disorder

Answer 214

characterized by a longstanding distrust & suspiciousness of others based on the belief (unsupported by evidence) that others want to exploit, harm, or deceive them.

• difficult to treat b/c they distrust everyone
• have a need for space & reassurance
• are hypervigilant

Projection is the dominant defense mechanism; they blame others for their shortcomings.

Question 215

Schizoid personality disorder

Answer 215

exhibits a poor ability to function in their lives…Relationships are particularly affected due to their prominent feature of emotional detachment.

need for soical isolation

Individuals do not seek out or enjoy close relationships. They are reclusive, avoidant, and uncooperative. They do not do well with resocialization.

Question 216

Schizotypal personality disorder

Answer 216

more common in men then women.

It is the 1st of the schizophrenia spectrum.

severe social and interpersonal deficits.

These individuals experience extreme anxiety in social settings & conversations tend to ramble w/ lengthy, unclear & overly detailed content.

eccentricity, odd or unusual beliefs (magical thinking)

prefer periods of solitude

Question 217

Histrionic personality disorder

Answer 217

characterized by emotinal attention-seeking behaviors & melodramatic, including self-centeredness, low frustration tolerance, & excessive emotionality

demonstrates poor verbal boundaries

• In general, those with this disorder do not believe they need psychiatric help.
• flirtatious - overly intense attachment w/ the opposite sex; provocative.
• Psychotherapy is the txmt of choice.

Question 218

Narcissistic personality disorder

Answer 218

comes across as arrogant & w/ an inflated view of thier own self-importance (grandiose self-importance).

needs constant admiration

lack of empathy for others

pathological traits include: antagonism, represented by grandiosity and attention-seeking behaviors.

txmt includes cognitive-behavioral therapy, family & group therapy.

Question 219

Avoidant personality disorder

Answer 219

main traits are low self-esteem associated w/ feelings of inferiority compared to peers.

timid, socially uncomfortable

they tend to avoid engaging in new or unfamilar activities involving new people d/t fear of criticism or rejection

Question 220

Dependent personality disorder

Answer 220

people with this disorder have a high need to be taken care of, which can lead to patterns of submissiveness with fears of separation & abandonment by others.

urgently seek relationships

have a constant need for reassurance

lack self-confidence

Psychotherapy is the txmt of choice

Question 221

Obsessive-Complusive personality disorder

Answer 221

the most prevalent disorder in the general community - associated w/ the highest burden of medical cost.

main traits include: rigidity & inflexible standards of self & others — along with persistence of goals long after they are necessary.

They will typically rehearse over & over for situations where they will deal with others.

perfectionists (interferes w/ task completion)

SSRI’s & prozac may help.

Question 222

Borderline personality disorder

Answer 222

has the central characteristic of instability in affect, identity, & relationships

desperately seek relationships to avoid feeling abandoned, but often drive others away with excessive demands, impulsive behavior, or uncontrolled anger.

chronic feelings of emptiness

assess for suicidal & self-mutilating behaviors, especially during times of stress…Risk for self-directed violence.

teach pt to identify triggers & positive coping

The frequent use of the defense of splitting strains personal relationships & creates turmoil in health care settings.

Question 223

Anti-social personatily disorder

Answer 223

most studied & researched personality disorder

• concerned with personal pleasure & power; does not conform to social norms

- characterized by decietfulness, impulsiveness, aggressiveness, disregard for others, lack of remorse, & manipulation.

usually presents w/ depression or because of the consequences of their behaviors, not because they care about the effects of their actions on others

Txmt w/one caregiver is preferred to avoid having the manipulative nature play one staff against another.

Question 224

What is Splitting

Answer 224

involves loving a person, then hating the person b/c the pt. is unable to recognize that an individual can have both positive and negative qualities.

black & white thinking

defense mechanism often used with BPD

Question 225

What is the MOST EFFECTIVE intervention for hallucinaitons?

Answer 225

Medications

RN-patient relationship

Reduce environmental stimuli

Increase internal stimuli (exercise) - tell the hallucinations to go away…listen to my voice or music

Question 226

Characteristics of psychotic thinking

Answer 226

• Limited ability to focus when lots of things are happening
• Concrete thought
• black/white thinking
• right/wrong judgments
• relationship w/ objects
• ambiguous boundaries btwn reality & fantasy
• ambiguous boundaries btwn self & others

Question 227

What is the HIGHEST PRIORITY intervention for delusional thinking?

Answer 227

• Reinforce reality for the pt.
• Establish a relationship or milieu that promotes trust
• Give meds on time (do not be late w/ prescribed meds)

Question 228

Psychosis key points

Answer 228

• psychosis is frightening to the pt - provide safety
• use kindness & respect
• pts experiencing psychosis NEED an anchor to reality

Question 229

Delusion vs. Illusion

Answer 229

A delusion (false belief) does not change w/ the use of logic.

An illusion (false belief about a perception) can often change once a person is given evidence that the belief is not true.

Question 230

Hallucinations are def as

Answer 230

Perceptions involving the senses (sight, sound, odor, taste or feeling on the skin)

The body’s ability to detect things in the environment that are not detected by others.

Question 231

Illusion is def as

Answer 231

A false belief about a perception

Based on a real perception (sight, sound, taste or feeling) that is misinterpreted

ex. the person actually sees something but believes they see something else

Question 232

Which medication is the drug of choice for safe alcohol w/drawals

Answer 232

Benxodiazepines

Question 233

Which medicaton is used in the treatment of both alcohol and opiod addiction

Answer 233

Naltrexone (ReVia) - it is an opiod antagonist that blocks the action of opiods & reduces alcohol cravings.

Question 234

What are the Cluster “A” personality disorders?

Cluster “A” = odd or eccentric

Answer 234

• Paranoid
• Schizoid
• Schizotypal

Question 235

What are the Cluster “B” personality disorders?

Cluster “B” = dramatic, emotional, erratic

Answer 235

• Antisocial
• Borderline
• Histrionic
• Narcissistic

Question 236

What are the Cluster “C” personality disorders?

Cluster “C” = anxious, fearful

Answer 236

• Avoidant
• Dependent
• Obsessive-Compulsive

Question 237

Tricyclic antidepressant (TCA)

side effects mnemonic

Answer 237

TCAS

Thrombocytopenia (low platelets)

Cardiac (arrythmia, MI, stroke)

Anticholinergic effects (tachycardia, urinary retention dry mouth, etc)

Seizures

Question 238

SSRI side effects mnemonic

Answer 238

BAD SSRI

Body wieght increase Seritonin Syndrome

Anxiety Stimulation of the CNS

Dizziness Reproductive dysfuntion

Insomnia

Question 239

MAOI side effects mnemonic

Answer 239

HAHA

Hypotension, orthostatic

Anticholinergic effects

Hypertensive crisis (avoid tyramine foods)

Anxiety, agitation, anorexia

Question 240

SNRI side effects mnemonic

Answer 240

BAD SNRI

Body wieght increase Suicidal thoughts

Anxiety Nausea / vomiting

Dizziness Reproductive dysfuntion

Insomnia

Question 241

Types of Antidepressants

Answer 241

• SSRIs
• SNRIs
• TCAs
• MAIOs

Question 242

Common SSRIs

Answer 242

Citalopram (Celexa)

Escitalopram (Lexapro)

Fluoxetine (Prozac)

Paroxetine (Paxil)

Sertraline (Zoloft)

Question 243

Common SNRIs

Answer 243

Duloxetine (Cymbalta)

Venlafaxine (Effexor)

Question 244

Common MAOIs

Answer 244

Phenelizine (Nardil)

Isocaroxzid (Marplan)

Tranylcyproine (Parnate)

Question 245

Common TCAs

Answer 245

Amitriptyline (Elavil)

Clomipramine (Anafranil) - risk for glacoma

Imipramine (Tofranil)

Question 246

SSRI info

Answer 246

First-line approach for trmt of depression

Increases Serotonin levels in brain

Uses: Major Depressive Disorder, anxiety disorders, panic disorders & OCD

Mood responds gradually (over 2 wks)

Do NOT STOP taking ABRUPTLY

Question 247

SNRI info

Answer 247

Increases Serotonin & Norepinephrine levels in brain

Treats both chronic neuropathic pain & depression

Question 248

TCA info

Answer 248

Boosts Norepinephrine

Uses: adjunctive therapy to treat chronic neuropathic pain & anxiety disorders; used only when other antidepressants fail or need to be boosted

SEs much more bothersome than SSRI class; results in nonadherence

Effects are slow to work

Do NOT stop taking abruptly

Question 249

MAOI info

Answer 249

Rarely used d/t danger they present when combined w/ certain pharmaceuticals & foods

Uses: _Atypical depressio_n (oversleeping & overeating); adjunctive med for anxiety disorders & bulemia

Monitor BP

AVOID tyramine, alcohol, & yeast

Do NOT take w/ oral decongestant

Dietary & med restrictions to stay in place 2 wks after MAIO stopped

Question 250

Serotonin Syndrome

Answer 250

Toxicity resulting from SSRI use w/ other meds that increases serotonin

Manifestions: HARM

Hyperthermia

Autonomic instability (delirium)

Rigidity

Myoclonus

• Be alert for sweating & diarrhea
• Late sign is apnea & death

Question 251

Serotonin Syndrome interventions

Answer 251

Stop SSRI

Administer serotonin-receptor blocker

Cooling blankets or meds to reduce fever

Benzodiazepines for seizures & muscle rigidity

Anticonvulsants for seizures

Ventillation support for apnea

Question 252

TCA overdose

Answer 252

TCA toxicity / overdose can be fatal

Signs associated w/ toxicity:

• altered LOC / delirium
• arrhythmias: VTach, VFib, prolonged QRS, QT & PR intervals
• vomiting
• fever
• coma
• hypoventilation from CNS depression

Question 253

Tyramine containing foods

Answer 253

Aged & fermented foods:

• All hard cheese (use caution w/ Italian & Mexican foods)
• pickled or smoked meats
• olives, pickles, sauerkraut
• soy sauce (avoid Asian foods)
• ripe alvocados

Question 254

MAOI toxicity

Answer 254

Toxicity can occur when MAOIs are combined w/ certain foods & medications resulting in Hypertensive Crisis & death

MAOIs prevent the break down of tyramine & certain meds; results in significant vasoconstriction

Question 255

Bupropion (Wellbutrin)

Answer 255

“Other” antidepressant

Boosts Norepinephrine & Dopamine

Only antipressant w/out unpleasant sexual SEs

Lowers seizure threshold

Not very effective w/ anxiety or pain

Effective in treating nicotine addiction & ADHD

Question 256

Anxiolytic info

Answer 256

2 types: Benzodiazipines & Non-benzodiazipines

Benzodiazepines:

• target GABA
• uses: sedative effect for anxiety; anticonvulsant effect for seizures (Klonopin); prevention of seizures induced by alcohol w/drawal (Librium)
• lead to physical & psychological dependence
• short term use only (1-2 wks)
• do NOT discontinue abruptly
• when combined w/ alcohol can result in overdose & death by respiratory suppression

Question 257

Common Anxiolytics

Answer 257

Benzodiazapines:

• Aloprazolam (Xanax)
• Lorazepam (Ativan)
• Chlordiazepoxide (Librium) - use for severe DTs
• Diazepam (Valium)
• Clonazepam (Klonopin) - effective anticonvulsant

Non-benzodiazapines:

• Buspirone (BuSpar)

Question 258

Buspirone (BuSpar)

Answer 258

Does not result in tolerace or addicition

Targets Serotonin & Dopamine

Does not have rapid onset of action

Takes up to 2 wks to be effective

Must be taken daily; not for PRN use

AVOID drinking grapefruit juice

Question 259

Acute Lithium Toxicity symptoms

mnemonic

Answer 259

CAN HAM SUCS

Confusion

An increase of urine & thirst

Nausea

Hand tremors (coarse)

Ataxia (uncoordinated arm & leg movements)

Muscle twitches

Seizures

Uncontrollable eye movements

Coma

Slurred speech

Question 260

3rd generation Atypical antipsychotics

Answer 260

• effective against both positive & negative symptoms of schizophrenia
• block dopamine & serotonin
• causes little / no weight gain
• causes no increase in glucose, cholesterol, or triglycerides

Good choice for pts w/ obesity &/or heart disease

Ex. Abilify (Aripiprazole)

Question 261

2nd generation Atypical antipsychotics

Answer 261

• targets both positive & negative symptoms of schizophrenia
• block dopamine & serotonin
• high incidence of significant weight gain, diabetes, & hyperlipidemia w/ use
• low incidence of tardive dyskinesia
• produces drowsiness (sedates w/o causing confusion; can use for severe anxiety instead of benzodiazapines)
• may cause constipation

Ex. Latuda (Lurasidone); Zyperxa (Olanzapine)

Question 262

Lithium info

Answer 262

• Lithium is a salt; regulated by body like sodium
• Be very alert for SUDDEN DROPS in sodium
• Lowering of dietary sodium intake, use of diuretics, excessive sweating or vomiting can have drastic effect on lithium; if Sodium goes DOWN, Lithium goes UP
• Narrow therapeutic index (0.6 - 1.2)
• 3 wks to reach therapeutic level; not for quick control of mania
• Teach strict adherence to dosing regimen
• Fluid intake 1-2qt/day & maintain normal salt intake

Question 263

Antimania meds (mood stabilizers)

Answer 263

Lithium

Anticonvulsants: treat/prevent mood episodes in Bipolar by slowing neuron firing & mood cycling

• Valproate / Valproic acid (Depakote)
• Carbamazepine (Tegretol)
• Lamotrigine (Lamictal) - risk of SJS (severe rash)
• Clonazepam (Klonopin) - anxiolytic/benzodiazepine effective for seizures

Depakote & Tegretol require blood levels to be monitored for therapeutic effect; periodic monitoring of liver enzymes & CBC

Question 264

Medications for treatment of Alcohol Abuse

Answer 264

Naltrexone hydrochloride (ReVia, Vivitrol)

Disulfiram (Antabuse)

• causes unpleasant effects when alcohol is consumed; negative reinforcer
• AVOID foods/products containing alcohol (cough syrup, mouthwash, cooking wine)
• extremely poor compliance; does not reduce alcohol cravings

Acamprosate (Campral)

• eliminated thru kidneys; pts w/ kidney disease at risk for adverse rxns
• eases discomfort of w/drawal & prevents cravings
• stimulates GABA

Question 265

Common Typical (1st generation) Antipsychotics

Answer 265

Chlorpromazine (Thorazine)

Fluphenazine (Prolixin)

Prochlorperazine (Compazine)

Haloperidol (Haldol)

Question 266

Common Atypical (2nd & 3rd generation) Antipsychotics

Answer 266

Aripiprazole (Abilify)

Clozapine** (Clozaril)** - risk of Agranulocytosis

Lurasidone (Latuda)

Olanzapine (Zyprexa) - significant wt gain

Quentiapine (Seroquel)

Risperidone** (Risperdal)**

Ziprasi_done_ (Geodon) - prolonged QT interval

Question 267

Typical (1st generation) Antipsychotic info

Answer 267

Reduce positive symptoms of psychosis

Blocks Dopamine

Uses: quick hallucination remission (delusions take longer to respond); out-of-control aggression; acute manic episodes

Safe, highly effective, very affordable

Poor compliance d/t bothersome SEs (i.e. EPS)

Question 268

Extrapyridamidal Side Effects (EPS)

Answer 268

movement disorders resulting from effects of antipsychotics on extrapyramidal motor system (primarily Typcial antipsychotics)

4 types of EPS reactions:

• acute dystonia
• pseudo-parkinsonism
• akathisia*
• tardive dyskinesia

*most common EPS

Question 269

Acute Dystonia

Answer 269

EPS rxn characterized by severe spasm of muscles of tongue, face, neck, or back

Torticollis (head turned & arched) & oculogyric crisis (upward deviation of eyes) occurs

rxn develops w/in 1st few wks of drug therapy; possibily w/in hrs of 1st dose

Requires rapid intervention if intense rxn

Anticholinergics used for initial trmt

Question 270

Psuedo-Parkinsonism

Answer 270

Mild EPS rxn characterized by bradykinesia, mask-like facies, drooling, tremor, rigidity, shuffling gait, cog wheeling, & stooped posture

Rxn develops w/in 1st month of drug therapy

Treat w/ central acting anticholinergics (i.e. benztropine (Cogentin), diphenhydramine)

Must AVOID use of Levadopa (promotes activation of dopamine; will induce psychosis)

Question 271

Akathisia

Answer 271

Serious & troublesome EPS rxn characterized by pacing & squirming (uncontrollable need to be in motion); profound sense of restlessness

Rxn develops w/in 1st 2 months of drug therapy

Most common reason for non-compliance w/ meds

Trmt is beta blockers & benzodiazapines (does not respond to anticholinergics)

Only “cure” is to stop taking antipsychotic

Question 272

Tardive Dyskinesia

Answer 272

Serious & troublesome EPS rxn characterized by abnormal muscle movements (i.e. slow, worm-like movements of the tongue, tongue flicking, lip smacking, pursing lips, grimacing)

Movements become constant; exhausting for the pt

Occurs late in antipsychotic drug therapy; 1 in 5 pts

Only trmt is to stop taking antipsychotic; maybe irreversible

Prevention is best approach; antipsychotics s/b used in lowest effective dose & for shortest time required; AIMS test every 3 mo. if long term use

Question 273

Acute Dystonic Reaction

Answer 273

Acute & dangerous EPS rxn

Acute dystonia that becomes life-threatening d/t involvement of the throat muscules

Inability to swallow & respiratory distress

Emergent use of anticholinergics necessary

Question 274

Neuroleptic Malignant Syndrome (NMS)

Answer 274

Acute & dangerous EPS rxn; life-threatening medical emergency; transfer to ICU

NMS symptoms: FEVER

• Fever, sudden & high (105⁰+)
• Encephalopathy
• Vital signs unstable (dysrhythmias, BP fluctations)
• Elevated enzymes (CK)
• Rigidity of muscles

Death can result from respiratory failure, cardiovascular collapse, or dysrhythmias

Tmt is immediate w/drawal of antipsychotic, supportive measures & drug therapy

Question 275

Side effects of antipsychotics

Answer 275

Fewer overall SEs w/ Atypical antipsychotics

iSHADE

impotence

Sedation, seizures (reduce seizure threshold)

Hypotension, orthostatic

Akathisia (inability to sit still)

Dermatological effects (risk of severe sun burn)

Extrapyramidal rxns (acute dystonias, rigidity, tremor, tachycardia)

Question 276

What is Anger

Answer 276

it is a secondary emotion usually triggered by another feeling

in response to some preceived threat or unmet need.

Question 277

Anger vs. aggression

Answer 277

anger is a feeling

where as

agression is a behvoior

agression becomes more likely when the angry, frustrated client feels ignored or discounted.

Question 278

Aggression defined

Answer 278

Aggression is a harsh physical or verbal action that reflects rage, hositility with the potential to cause harm or destruction to

Self

others

property

Agressive behavior violates the rights of others.

Question 279

What is the number one predictor of agressive behavior?

Answer 279

Past history of agressive behavior is the single best predictor of future behavior

increasing agitation is the most important predictor of imminent agression and violence.

Question 280

Signs of Increasing Agitation

Answer 280

• Restlessness, pacing, hyperactivity
• Rapid breathing
• Tensing of muscles
• Tight jaw/clenching teeth
• Shouting, cursing, making threats
• Verbal abuse
• Intense eye contact or avoidance of eye contact
• Clenched or raised fist
• Menacing posture
• Kicking or punching walls
• Picking up a weapon
• Throwing objects
• Stone silence

Question 281

Psychiatric Conditions
Associated with Aggression & Violence

Answer 281

• Dementia
• Delirium
• PTSD
• Bipolar Disorder
• Substance abuse
• Antisocial Personality Disorder
• Impulse-control disorders
• Delusional disorder, persecutory type
• Schizophrenia, paranoid type
• ADHD, conduct disorder and oppositional defiant disorders in children

Question 282

Medical Conditions
Associated with Aggression & Violence

Answer 282

• Chronic pain
• Neurological disorders
• traumatic brain injury, seizure disorder, neurosyphillis, HIV encephalopathy
• Endocrine disorders
• thyroid, parathyroid and adrenal hormone imbalances
• Metabolic disorders
• chronic renal failure, hepatic encephalopathy, hyponatremia, lupus
• Exogenous toxins
• inhaled solvents, alcohol, amphetamines, hallucinogens, heavy metals
• Vitamin deficiencies
• folate deficiency, Wernicke’s/Korsakoff’s encephalopathy

Question 283

Principles to Remember When Planning Care for the Potentially Violent Client

Answer 283

• Safety first!
• Protect yourself
• Maintain self-awareness and self-control
• Focus on prevention
• Always use the LEAST RESTRICTIVE intervention possible

Stop the Violence Before it Starts!

If it’s Predictable, it’s Preventable!

Question 284

How to protect yourself in violent situations

Answer 284

• Never see a potentially violent patient alone
• Maintain a safe, comfortable distance from the patient
• Avoid touching the client or invading his/her personal space
• Maintain a non-aggressive, neutral stance
• Be prepared to move quickly—Learn to scoot!
• Identify an “escape route” and do not allow the patient to block your exit path

Question 285

Use Therapeutic Communication Skills
to De-escalate the Situation

Answer 285

• Speak in a calm, caring manner
• Ensure that non-verbal messages are not defensive or provocative
• Slow your cadence and lower the volume of your voice if/when patient escalates. Watch your tone!
• Do not argue with the patient, shout, or belittle his feelings
• Use open ended questions to explore issues, then reflect/paraphrase
• Facilitate problem solving, but avoid telling the client what to do–unless limit setting becomes necessary

Question 286

Non-therapeutic responses

to the pt’s anger

Answer 286

• Avoiding
• Defensiveness
• Retaliating / Punishing
  
  • illegal, unprofessional, & unethical
  • monitor for countertransference & personal motives
• Threatening
  
  • unethical & unprofessional
• Condescension

Question 287

Set Limits When Necessary with an angry patient

Answer 287

Establish limits only when and where there is a clear need

Never set a limit you cannot enforce

Don’t use limit setting to threaten the patient

Establish reasonable and enforceable consequences or exceeding limits

Be consistent in enforcing limits

Question 288

What is “the SET” Communication Principles to Verbally De-escalate and Set Limits

Answer 288

•Support

•Remind client that you are an ally and you have his/her best interests in mind - (“I care about you and I want to help you.”)

•Empathy

•Convey to client that you understand and care about his/her feelings - (“I can see how frustrating and distressing this is for you.”)

•Truth

•Clearly state the limit and tell the patient what you want him/her to do - (“I won’t let you hurt yourself or anyone else. I need you to put the chair down now, please.”)

Question 289

If the violence continues to escalate

Answer 289

Assemble a Show of Force

Assign only one person to communicate with the patient - Continue to offer client opportunities to change behavior when possible -

Follow approved policies and procedures for doing a “takedown” if necessary

Question 290

When is Involuntary medication necessary?

Answer 290

• Requires “emergency declaration” by physician when ordered
• Danger to patient or others must be imminent
• Must document failure of less restrictive interventions
• No “prns” allowed for emergencies

•Considered a “chemical restraint”

Question 291

When can you use Seculusion or Restraints

Answer 291

Considered “last resort” interventions.

Seclusion is used when there is risk of danger to others.

Restraints are used when there is risk of danger to self.

NEVER used for punishment or staff convenience

Both require MD order, declared emergency due to imminent danger to patient or others and failure of less restrictive interventions

Question 292

Limits on seculsion or restraint

Answer 292

• One hour for children
• Two hours for adolescents
• Four hours for adults
• If longer use is indicated, intervention must be reordered
• Patients must be evaluated face to face by physician or specially trained nurse within one hour of initiation
• Patients in seclusion must be monitored at least q15 min.
• Patients in seclusion who have also received sedation must be monitored continuously
• Patients in restraints must be monitored continuously on 1:1 observation

Question 293

What is the type of documentation (how it should be completed) that is required when someone is placed in seculsion or restraints

Answer 293

• Behavioral Observations
• Interventions
• In the order they were done, least restrictive to most restrictive
• Patient’s responses to interventions
• Debriefing & patient’s response

•Patient education and response to education

Question 294

What is the #1 nursing diagnosis for violent patients

Answer 294

Risk for other-directed violence

Question 295

What is Validation therapy

Answer 295

meeting the patient “where he/she is at the moment — acknowledging the patients wishes

ex. Cognitivly impaired patient want to go home…you would say “So you want to go home?”

Validation does not redirect, reorient or probe

Question 296

What is the best medication to give a pt. thats agression continues to escalate?

Answer 296

Olanzapine (Zyprexa)

short acting antipsychotic useful in calming angry, aggrssive patients regardless of diagnosis.

Question 297

What is the 1st thing needed after an emergency seclusion?

Answer 297

Notify the health care provider to obtain a seclusion order.

This is a state law

Question 298

What are the stages/cycles of domestic violence and their definition

Walker’s 1993 cycle theory

Answer 298

Tension-building stage - characterized by minor incidents (pushing, shoving, and verbal abuse)…victim ignores or acepts the abuse for fear more will follow.

Acute battering state — abuser releases the built up tension by brutal beatings which result in injuries.

Honeymoon stage —characteized by kindness and loving behaviors, abuser is apologetic, remorseful and often give gifts to apologize — victim wants to believe the response and often agrees to drop any charges.

Question 299

What are components of a “plan of escape”

Answer 299

- keep a phone fully charged

• have number of nearest shelter
• secure a supply of medications for self & childrens

- Assemble birth certificates, SS card, and licenses

- Determine a code word to signal when it’s time to leave.

Question 300

Prevention of Abuse

pg. 546 book

Answer 300

Primary prevention - measures taken to prevent occurence of abuse

Secondary prevention - involves early intervention in abusive situations to minimize disabling or long term effects.

Tertiary prevention - often occures in mental health settings, involves facilatating healing and rehabilitation. .

Question 301

What is Engagement

Answer 301

“involve one’s attention and pledge to do something”

They are focused on the task at hand / in what they are doing (heart & soul)

Question 302

Healthcare Engagement

Answer 302

Actions individuals must take to obtain the greatest benefit from the health care services available to them.”

Behaviors of individuals relative to their health care that are critical and proximal to health outcomes, rather than the actions of professionals or policies of institutions.

Processes in which information and professional advice with own needs, preferences and abilities in order to prevent, manage and cure disease

Question 303

Consequences of Non-Engagement

Answer 303

• risk for poor health
• perform specific health behaviors
• without insurance
• education

Question 304

Complementary & Alternative Use

Answer 304

Non vitamin, non mineral supplements-18.9% in 2002 and unchanged from 2007 to 2012 (17.7%).

deep-breathing exercises were the second most commonly used complementary health approach in 2002 (11.6%), 2007 (12.7%), and 2012 (10.9%)

yoga, tai chi, and qi gong increased linearly over the three time points, beginning at 5.8% in 2002, 6.7% in 2007, and 10.1% in 2012

Question 305

What is Mindfulness Based Therapy

Answer 305

A randomized controlled trial of mindfulness-based cognitive therapy for bipolar disorder.

Question 306

Benefits of Vitamin B 12 & B 9

Answer 306

B12 -Cyanoboalamin

B9 folic acid

B 12 & B 9 - 60–74 years old with mild depressive symptoms in a RCT-no effect

B 12, B 9, & B 6 - Prevented depression post stroke (mean ages 45.8–76.6 years old).

Well – designed study showing benefit of l-methyfolate augmentation of antidepressant

Question 307

Benefits of Omega 3

Answer 307

Fish: salmon, almonds & walnuts.

The data support an antidepressant effect of Ω3.

Low levels of Ω3 in depression & suicidal patients.

Bipolar depressive symptoms may be improved by adjunctive use of omega-3.

Not effective in mania.

Question 308

Benefits of Ginkgo Biloba

Answer 308

Ginkgo biloba originates from the Maidenhair tree.

Neuroprotective

inhibits platelet activation

relaxes endothelium

inhibits cholinergic receptors

increases choline uptake in the hippocampus

antioxidant effects.

Small effect on cognitive decline in those already afflicted with certain types of dementia.

Question 309

Benefits of Lemon Grass

Answer 309

Effect of Lemongrass Aroma on Experimental Anxiety in Humans.

Question 310

Benefits of Lavender & Bergamot

Answer 310

Lavender and bergamot essential oils are antidepressants and relaxants,

Essential oils can be absorbed by inhalation into the olfactory pathway and from there to the brain. The scores on depression, anxiety, and stress decreased in the intervention group after the aromatherapy programme, but there was increased psychological distress in the control group. The results were consistent with those of previous studies, namely, that aromatherapy was able to relieve negative emotional symptoms

Question 311

Tenants of Spiritual Care

Answer 311

We have care for the beginning of families, new parents, and infants

We nurture mothers and fathers, children, and youth.

We offer wisdom and understanding concerning life’s stresses, anxieties, and challenges; we face together the realities of evil, suffering, and death.

We address the power of guilt, hopelessness, and despair; we mark our boundaries and limits; we create meaningful and shared narratives of the world and of our life journeys

We seek to name and contain what is toxic, and we foster food and drink that promote health and well-being.

We have care also for the experience of aging and the end of life

Question 312

Faith & Mental Illness

Answer 312

One in four persons sitting in our pews has a family member struggling with mental health issues

A majority of individuals with a mental health issue go first to a spiritual leader for help

Studies show that clergy are the least effective in providing appropriate support and referral information

Our faith communities can be a caring congregation for persons living with a mental illness and their family members

Question 313

Strategies for Caregivers

Answer 313

Support

Respite care

Mini-relaxations

Nutrition

Exercise

Sleep

Annual check up

Spiritual care

Stress management

Resilience

Question 314

Annual Self-care

Answer 314

Annual exam

Vitamin D - sunlight (get alot of it)

Eye exam

Dental exam

Blood pressure

Complete metabolic levels, complete blood count

Follow recommended treatments.

Question 315

What is VOLUNTARY ADMISSION

Answer 315

no procedure – patient signs self in and can sign self out with 24 hr letter.

Question 316

INVOLUNTARY ADMISSION steps

Answer 316

> 1) EMERGENCY DETENTION – using EITHER: a MIW (Mental ill warrent) OR an APOWW (apprehension by Police Officer without warrent)2) evaluation by 2 physicians to make sure legal criteria are met3) (2 possibilities) release persons who do not meet criteria OR retain person and ensure legal representation4) probable cause hearing – this results in the OPC5) (2 possibilities) patient does not contest, judge reviews documents and, if legal rules followed commit patient to 90 days. OR – patient contests the commitment and has choices – (with or without their own lawyer) present their own case before the judge alone OR ask for a jury trial.

IF patient has already served 90 days and STILL meets criteria – there is another trial to commit for a longer period.( EXTENDED MENTAL HEALTH SERVICES)

Question 317

Two ways to start commitment

Answer 317

1) Go to judge — issues a MIW (mental illness warrant)

2) Call the police — Determine danger — APPOW (Apprehension by Police Officer Without a Warrant)

Question 318

Comparison between

Voluntary & Involuntary committment

Answer 318

Voluntary

Patient signs a CONTRACT with facility allowing 24 hour hold before AMA release

Voluntary admission occurs when the client is willing to be admitted and agrees to comply with hospital and unit rules.

Involuntary

Allows State of TX to hold citizen, against pt will, until psychiatric care provider deems no longer meets criteria or 90 days, whichever comes first

(Patient may invoke habeas corpus) in an attempt to get released.

Question 319

Criteria for involuntary committment of

Mental Illness

Answer 319

1. Danger to Self

2. Danger to Others

3. Danger of deterioration of condition*

*Must be serious enough to cause substantial harm or death

Question 320

What landmark suit establishes the “Duty to Warn” in many states?

Answer 320

Tarasoff v. Regents of the University of California

Pt. admitted to Doc intended harm to an ex-girlfriend… – Doc told the authorities…

Pt still let go… - then killed the ex.

Question 321

What is delirium

Answer 321

Delirium is characterized by an abrupt onset of fluctuating levels of awareness, clouded consciousness, perceptual disturbances, and disturbed memory and orientation

Question 322

What is amnestic syndrome

Answer 322

Amnestic syndrome involves memory impairment without other cognitive problems.

Just lost ur memory

Question 323

What health problems are seen in

Dementia

Answer 323

Lewy body disease,

frontal-temporal lobar degeneration,

and Huntington’s disease.

Question 324

Dementia - cognitive deficits manifested in both

Answer 324

1) cognitive impairment
2) cognitive distrubances: ie.
a) aphasia
b) apraxia
c) agnosia

Question 325

What is Agnosia

Answer 325

Agnosia refers to the loss of sensory ability to recognize objects.

Question 326

What is Aphasia

Answer 326

Aphasia refers to the loss of language ability.

Question 327

What is Apraxia

Answer 327

Apraxia refers to the loss of purposeful movement

Question 328

What are the stages of Alzheimer’s disease

Answer 328

1) Preclinical Alzheimer’s disease

2) Mild cognitive decline

3) Moderately severe cognitive decline

4) Severe cognitive decline

Question 329

Mild cognitive decline in Alzheimer’s

Answer 329

Mild cognitive decline (early-stage) Alzheimer’s

can be diagnosed in some, but not all, individuals. Symptoms include misplacing items and misuse of words.

Question 330

Moderately severe cognitive decline in Alzheimer’s

Answer 330

In the moderately severe stage, deterioration is evident. Memory loss may include the inability to remember addresses or the date.

Activities such as driving may become hazardous, and frustration by the increasing difficulty of performing ordinary tasks may be experienced.

The individual has difficulty with clothing selection

Question 331

Severe cognitive decline in Alzheimer’s

Answer 331

personality changes may take place, and the patient needs extensive help with daily activities.

Question 332

What are some of the diagnostic findings for Alzheimer’s

Answer 332

apolipoprotein E (apoE) malfunction,

neurofibrillary tangles,

neuronal degeneration in the hippocampus,

and brain atrophy

Question 333

What is hyperorality

Answer 333

Hyperorality refers to placing objects in the mouth

Question 334

What is Confabulation

Answer 334

Confabulation refers to making up of stories or answers to questions by a person who does not remember.

It is a defensive tactic to protect self-esteem and prevent others from noticing memory loss.

Question 335

Four Key Concepts in the definition of a

Crisis Management

Answer 335

1) A Crisis is an Acute Time-Limited Phenomenon…a crisis will be resolved w/i 4-6 weeks after exposure to the stressor
2) A Crisis Results from Exposure to a Stressful Situation or Event
3) The Crisis Creates Emotional Distress…person in crisis feels anxious, overwhelmed and out of control
4) Existing Coping Skills Fail to Fix the Problem or Alleviate the Person’s Distress

Question 336

Types of Crisis

Answer 336

• Maturational Crisis…Occurs when a person arrives at a new and predictable stage of development where previously used coping strategies are no longer effective or appropriate
• Situational Crisis…critical life event from an external source. can change self - concept & esteem. (divorce, death of a loved one…job loss)
• Adventitious Crisis… uplanned accidental or deliberate event not part of every day life. (Ie natural disasters / wars / murder / child abuse). —
• Psychological first aid and crisis intervention are critical for persons of all ages after any adventitious crisis*

Question 337

The Evolution of a Crisis

Answer 337

• Phase I Person is exposed to a crisis event which triggers anxiety (robbery) - Anxiety stimulates the use of problem-solving strategies and defense mechanisms to decrease distress
• Phase II Previously used coping skills fail to alleviate the problem (overload) - coping strategies become increasingly maladaptive as emotional distress increases

Phase III - Every internal and external resource is mobilized to solve the problem and relieve distress - Automatic relief behaviors such as withdrawal and flight are mobilized

Phase IV - The individual’s condition deteriorates as tension mounts, and “desperate measures” may be considered to alleviate distress (Suicide?)

Question 338

What is Crisis Intervention?

Answer 338

A short-term helping process focused on resolution of the immediate problem through the use of personal, social and environmental resources

Crisis Intervention can be considered

“Psychological First Aid”

Question 339

General Principles of Crisis Intervention

Answer 339

Safety First - Determine Whether There is an Immediate Need for External Controls — All Clients in Crisis Should be Assessed for Suicidal and Homicidal Ideation (thoughts)

Stabilization is the Goal - Restoring equilibrium and returning the client to the pre-crisis level of functioning is the objective

Question 340

Basic Model for Crisis Intervention

Answer 340

Establish trust and develop rapport…Explore the patient’s feelings

Explore the problem…Find out what happened

Summarize both facts and feelings…“You feel x because of y.”

Focus on one problem…What does the patient want to change? What has to change in order for client to regain stability?

Explore resources and alternatives…Identify coping skills and resources

Develop plan of action…Consider contracting with client

Question 341

Terminating with the Client in Crisis

Answer 341

Review accomplishments and discuss ways in which adaptive coping skills can be used to deal with crises in the future

Question 342

Critical Incident Stress Debriefing

(CISD)

Answer 342

A group approach designed to help people who have been exposed to a crisis situation

Recent research suggests that it may not be as effective as once believed and may be harmful to

some people

Question 343

Assualt def.

Answer 343

an intentional threat designed to make the victim fearful: produces reasonable apprehension of harm.

Question 344

autonomy def.

Answer 344

Autonomy is the right to self-determination, that is, to make one’s own decisions.

(e.g. acknowledging the pts right to refuse medicine promotes autonomy)

Question 345

battery def.

Answer 345

Battery is an intentional tort in which one individual violates the rights of another through touching without consent.

Question 346

competency def.

Answer 346

is the capacity to understand the consequences of one’s decision’s

Pt.s are considered legally competent until they have been declared incompetent through a formal legal proceeding.

Question 347

confidentiality def.

Answer 347

confidentiality of care and treatment remains an important right to all patients.

discussion or consultation involving a patient should be conducted discreetly and only w/individuals who have a NEED TO KNOW

Can only be released by the pt.’s written consent

The duty to warn a person whose life has been threatened by a psychiatric patient overrides the patient’s right to confidentiality.

Question 348

When does confidentiality end

Answer 348

Confidentiality extends to death and beyond. Nurses should never disclose information after the death of a client that they would have kept confidential while the client was alive.

Question 349

duty to warn

Answer 349

1974

Tarasoff v. Regents of the University of California..was a case in which the Supreme Court of California held that mental health professionals have a duty to protect individuals who are being threatened with bodily harm by a patient.

It is the health care professional’s duty to warn or notify an intended victim after a threat of harm has been made. Informing a potential victim of a threat is a legal responsibility of the health care professional.

Question 350

false imprisonment def.

Answer 350

False imprisonment involves holding a competent person against his or her will.

Actual force is not a requirement for false imprisonment.

The individual needs only to be placed in fear of imprisonment by someone who has the ability to carry out the threat.

Question 351

involuntary admission def.

Answer 351

is admission to a facility w/o the patients consent.

generally necessary when a person is in need of psychiatrict treatment, presents a danger to self or others, or is unable to meet his / her own basic needs.

Pts. can be kept involuntarily for up to 90 days, w/interim court apprearances. After that a panel reviews their cases.

Question 352

least restrictive environment def.

Answer 352

writ of habeas corpus and the least restrictive alternative doctrine are two of the most important concepts applicable to civil commitment cases.

Least restrictive mandates that the least drastic means be taken to achieve a specific purpose

ex. if someone is being treated for depression only on an outpatient basis….then hospitalization would be too restrictive and unnecessarily disruptive.

Question 353

malpractice def.

Answer 353

malpractice is an act or omission to act that breaches the duty of due care and results in or is responsible for a persons injuries.

Question 354

negligence def.

Answer 354

is the failure to use ORDINARY care in any professional or personal situation when you had a duty to do so.

ex. duty to drive safely…if you don’t and cause an accident, you could be changed with negligence.

Question 355

patient rights def.

Answer 355

Pt.s right have been modified over time, but the following are some of the basic patient rights: pg 101 - 106

• Right to treatment
• Right to refuse treatment
• Right to informed consent
• Rights regarding involuntary admission and advance psychiatric directives
• Rights regarding restraint and seclusion
• Right regarding Confidentiality

Question 356

privileged communication def.

Answer 356

is that information / communication obtained between a patient / provider.

Question 357

right to privacy def.

Answer 357

is legally protected by HIPAA (Health Insurance Protability and Accountability Act)

Release of information without patient authorization violates the patient’s right to privacy.

Question 358

right to refuse treatment def.

Answer 358

Pts. may w/hold consent or withdrew constent to take medication at any time.

Commintment to a hospital facility does not mean they are forced to take medications….they retain their right to refuse treatment.

THE ONLY circumstance where medication will be forced is an emergency to prevent harm to self or others.

Question 359

right to treatment def.

Answer 359

Federal Statute 1964 - Hospitalization of the Mentally ill

All public hospitals are required to provide medical and psychiatric care to all persons admitted to a public facility.

O’Conner v. Donaldson (1975)

Court ruling that State cannot confine a non-dangerous individual who is able to survive in freedom by themself or w/help of family.

Question 360

restraint def.

Answer 360

a restraint can be any device, equipment or material that prevents or reduces movement of the pt.s arms/legs or head.

restraints can also be chemical or even one individual holding another (Therapeutic hold).

Question 361

What are the characterisitc’s of a time out

Answer 361

Time-out is designed so that staff can be consistent in their interventions.

Time-out may require going to a designated room or sitting on the periphery of an activity until the child gains self-control

Question 362

Seclusion vs Timeout

Answer 362

Seclusion - confining a pt alone & preventing the pt from leaving. Should be used only when pt demonstrates violence / self-distructive behavior that jepardizes the safety of others or the pt

Timeout - pt chooses to spend time alone in a specific area for a certain amt of time. Pt can leave the area at any point.

Question 363

What are the five elements required to prove negligence?

Answer 363

1) duty

2) breach of duty

3) cause in fact

4) proximate cause

5) there were actual damages.

Question 364

Etiological risk factors for child/adolscent mental illness

Answer 364

Biological factors: Genetic & Neurobiological

• Resilience, intelligence & supportive environment aid in avoiding development of mental disorders

Psychological factors: Temperament; fit w/ parents is crucial to development. Resilience

Environmental factors: Dependent on family; witness violence; neglect / sexual abuse; bullying

Cultural factors: Expectations; stigma follows throughout lifespan

Question 365

Risk factors that presents the highest chance for a child to develop a psychiatric disorder

Answer 365

Having a parent with a substance abuse problem has been designated an adverse psychosocial condition that increases the risk of a child developing a psychiatric condition.

Having a family history of schizophrenia presents a risk, but an alcoholic parent in the family offers a greater risk.

Question 366

Resilience def.

Answer 366

The ability to adapt & cope

Helps people to face tragedies, loss, trauma, & severe stress

Question 367

Factors that increase resilience in children/adolscents

Answer 367

Child’s inborn strengths

Child’s success in handling stress in the environment

Question 368

Temperament def.

Answer 368

The style of behavior a child habitually uses to cope w/ the demands & expectations of the environment

Question 369

Characteristics of a mentally

healthy child/adolscent

Answer 369

• Trusts others & sees his/her world as being safe & supportive
• Correctly interprets reality; makes accurate perceptions of the environment & one’s ability to influence thru actions (i.e. self-determination)
• Behaves in developmentally appropriate way; doesn’t violate social norms
• Has a positive, realistic self-concept & developing identity
• Adapts to & copes w/ anxiety & stress using age appropriate behavior
• Can learn/master developmental tasks & new situations
• Expresses self spontaneously & creatively
• Develops & maintains satisfying relationships

Question 370

Pervasive def.

Question 371

Behavioral characteristics of children with

Pervasive Developmental Disorder

(Autism, Aspergers, PDD NOS)

Answer 371

Autism is primarily biogenetic

Question 372

What is IDD

Answer 372

IDD is characterized by severe deficits in three major areas of functioning: intellectual, social, and managing daily life. Specific learning disorder is diagnosed when a child demonstrates persistent difficulty in the acquisition of reading (dyslexia), mathematics (dyscalculia), and/or written expression (dysgraphia) and their performance is well below the expected performance of their peers.

Question 373

Behavioral characteristics of children with

Tourette’s Disorder

Answer 373

A motor (neurodevelopment) disorder

Motor & verbal tics appearing between age 2 & 7

Tics change in location, frequency & severity over time

Tics cause marked distress, significant impairment in social & occupational functioning, & low self-esteem

Disorder is permanent; periods of remission may occur

Symptoms often diminish in adolescence & may disappear by early adulthood

Familial pattern in 90% of cases

Often co-exists w/ depression, OCD, & ADHD

Treated w/ antipyschotic meds: Hadol & Orap

Question 374

Behavioral characteristics of children with

Attention Deficit / Hyperactivity Disorder

Answer 374

Inattention

Impulsive

Hyperactive

Symptoms present before age 7

Symptoms must be present at home & school

Low frustration tolerance, temper outbursts

Poor school performance

Primarily biogenetic

Question 375

Medication class most commonly

prescribed for ADHD

& med side effects

Answer 375

Stimulants

Methyphenidate (Ritalin)

s/e…The most common side effects are gastrointestinal disturbances, reduced appetite, weight loss, urinary retention, dizziness, fatigue, and insomnia

Weight loss has the potential to interfere with the child’s growth and development.

Question 376

Nursing interventions for child

w/ADHD

Answer 376

“reduce loneliness and increase self-esteem.”

Because of their disruptive behaviors, children with ADHD often receive negative feedback from parents, teachers, and peers, leading to self-esteem disturbance. These behaviors also cause peers to avoid the child with ADHD, leaving the child with ADHD vulnerable to loneliness.

Question 377

Milieu characteristics for

children/adolscents with

ADHD and/or Disruptive Behavior Disorders

Answer 377

manage the milieu with structure and limit setting

Question 378

Behavioral characteristics of children with

Separation Anxiety Disorder

Answer 378

Developmentally inappropriate levels of concern over being away from a significant other

May also be a fear that something horrible will happen to the other person resulting in permanent separation

Anxiety is so intense it distracts the pt from their norm activities, causes sleep disturbances & nightmares, is often manifested in GI disturbance & headaches

Question 379

Conduct Disorder def.

Answer 379

Persistant pattern of behavior in which the rights of others are violated

Age appropriate societal norms/rules are disregarded

Question 380

Behavioral characteristics of children with

Conduct Disorder

Answer 380

Disruptive/impulsive control behavior disorder thought to be caused by parenting

Cruel bahvior to animals 1st then people

Violates rights & disregards norms (truancy before age 13, alcohol &/or heavy drug abuse, running away)

Aggressive & destructive (vandalism)

Deceitfulness

Pyromania and/or Kleptomania

Poor peer relationships; may be precursor to antisocial personality disorder

Meds for aggression, impulsivity & mood: Risperdal, Zyprexa, Seroquel, Geodon, & Abilify

Question 381

Psychosocial risk factors that

predispose children/adolscents

to Conduct Disorder

Answer 381

ADHD

Oppositional child behaviors

Parental rejection

Inconsistent parenting w/ harsh discipline

Early institutional living

Chaotic home life

Large family size

Absent or alcoholic father

Antisocial & drug-dependent family members

Association w/ delinquent peers

Question 382

Prevention strategies for

Conduct Disorder

Question 383

Behavioral characteristics of children with

Oppositional Defiant Disorder (ODD)

Answer 383

Disruptive behavior disorder thought to be caused by parenting

Angry & irritable; temper tantrums past usual age

Defiant & vindictive

Disregard for authority

Deliberately annoys & blames

Distructive (usually short of criminal)

Difficulty w/ home, school, peers

Not age limited but usually seen in preteens

Meds. not generally indicated but must treat comorbidity

Question 384

Disruptive Mood Dysregulation disorder

Answer 384

Frequent temper tantrums (verbal / behavioral outbursts) out of proportion to the situation & not developmentally age appropriate

Persistent irritable mood btwn outbursts

Dx given to children btwn ages 6 - 18 w/ no other medical/mental health dxs accounting for tempertantrums (i.e. autism)

Question 385

Disruptive mood management

Answer 385

Time-out

Quiet Room

Question 386

Behavioral characteristics of children with

Mood Disorders

(depression & bipolar disorder)

Answer 386

Core symptoms of depression in children/adolscents are same as for adults: sadness & anhedonia

Frequently assoc w/ anxiety & anger

Symptoms display differently in children/adolscents.

• very young children cry
• school age children are withdrawn
• teens become irritable in response to feeling sad / hopeless

Generally, depressed children/adolscents display increased irritability, negativity, isolation, & w/drawl along w/ loss of energy.

Younger children may suddenly refuse to go to school.

Adolscents may engage in substance abuse or sexual promiscuity & become preoccupied w/ death or suicide.

Bipolar is more severe if starts in childhood/teens.

Youth w/ bipolar have more frequent mood switches, more mixed emotions, are sick more often, & have greater suicide attempts.

Question 387

General interventions for children/adolscents

Answer 387

Family therapy

• specifical goals defined for ea family member

Group therapy - used for breavement, physical abuse, substance use, dating, or chronic illness (diabetes)

• young child: play therapy
• school-aged child: combines play, learning skills, & talking about activity; aids w/ social skills
• adolscent: popular media event/personality used as basis for discussion

Behavioral therapy

• behavior modification
• rewards desired behaviors to reduce maladaptive behaviors
• use least restrictive intervention

Cognitive-Behavioral therapy (CBT)

• negative/self-defeating thoughts are replaced by more realistic & accurate appraisals
• results in improved functioning

Question 388

Nursing interventions to alter behavior in

children/adolscents with mental illness

Answer 388

Physical problems have higher priority than mind/behavior problems

Parent training (positive parenting)

Behavioral therapies

Milieu therapy

Psychopharmacology

Question 389

Teaching for parents of

children/adolscents with

mental illness

Answer 389

Predict & prevent

Act EARLY to stop escalation

Provide safety

Causes & prevention of non-genetic types of disorders

Parental expectations of behaviors

Behavioral control of socially unacceptable behaviors

Question 390

Psychoactive medications for

children/adolscents

Answer 390

Stimulants excite neurons responsible for focus

Question 391

Mental Health Assessment differences

for children vs. adults

Answer 391

Who is interviewed?

How is interview conducted?

Data collected:

Question 392

Parent teaching for managing

child’s behavior at home

Answer 392

• Behavior modification - use it RIGHT or NOT AT ALL
• Rewards occur ALL THE TIME but to effect change you MUST PLAN
• Punishment is not allowed
• Extinction - ignoring / not reacting to behavior will prevent the “reward”

*RNs don’t have time or relationship to use extinction

Question 393

What is Acculturation

Answer 393

is learning the beliefs, values, and practices of a new cultural setting, which sometimes takes several generations

Question 394

What is enculturation

Answer 394

is a process where members of a group are introduced to the culture’s worldview, beliefs, values, and practices

Question 395

What is a highly valued approach in Western Cultures, but not other cultures.

Answer 395

Directly confronting problems is a highly valued approach in the American culture but not part of many other cultures in which harmony and restraint are valued

American nurses sometimes mistakenly think that all patients should take direct action.

Question 396

What are some of the approaches valued by other cultures but not America?

Answer 396

Present orientation, interdependence, and a flexible perception of time are not valued in Western culture

These views are more predominant in other cultures

Question 397

What is valued in Hispanic Cultures

Answer 397

Hispanic individuals usually value relationship behaviors.

Their needs are for learning through verbal communication rather than reading and for having time to chat before approaching the task.

Many people from Central American cultures express distress in somatic terms

Question 398

To provide culturally competent care,

Answer 398

identify strategies that fit within the cultural context of the patient

RN’s should understand that Western biomedicine is one of several established healing systems

Question 399

How do Asian Americans express psychological distress

Answer 399

Asian Americans commonly express psychological distress as a physical problem.

The patient may believe psychological problems are caused by a physical imbalance.

The patient will probably respond best to a therapist who is perceived as giving.

Question 400

Communication techniques effective for Native American pt.s

Answer 400

Soft voice; break eye contact occasionally; general leads and reflective techniques.

Native American culture stresses living in harmony with nature. Cooperative, sharing styles rather than competitive or intrusive approaches are preferred;

thus, the more passive style described would be best received.

Question 401

W/an Asian pt. with mental illness, what type of intervention best fits this culture?

Answer 401

The Asian community values the family in caring for each other.

The Asian community uses traditional medicines and healers, including herbs for mental symptoms.

The Asian community describes illness in somatic terms.

The Asian community attaches a stigma to mental illness, so interfacing with the community would not be appealing

Question 402

What is the Western, biomedical prespective on health and illness?

Answer 402

The Western biomedical perspective holds the belief that sick people should be as independent and self-reliant as possible.

Self-care is encouraged; one gets better by “getting up and getting going.”

An ability to function at a high level is valued.

Question 403

What is Wind Illness?

Answer 403

Wind illness is a culture-bound syndrome found in the Chinese and Vietnamese population.

It is characterized by a fear of cold, wind, or drafts. It is treated by keeping very warm and avoiding foods, drinks, and herbs that are cold.

Warm broth would be most in sync with the patient’s culture and provide the most comfort.

Question 404

What is Culutral competence?

Answer 404

Cultural competence is dependent on understanding the beliefs and values of members of a different culture.

A nurse who works with an individual or group of a culture different from his or her own must be open to learning about the culture.

Question 405

Amoung different Cultures – are there difference in metabolic pharmacokinetics of pshychotrophic drugs?

Answer 405

YES

Cytochrome enzyme systems,

which vary among different cultural groups, influence the rate of metabolism of psychoactive drugs

Question 406

What is a Culture-bound syndrome

Answer 406

Culture-bound syndromes occur in specific sociocultural contexts and are easily recognized by people in those cultures.

A syndrome recognized in parts of Southeast Asia is running amok, in which a person (usually a male) runs around engaging in furious, almost indiscriminate violent behavior.

Question 407

Know the following Culture-Bound Syndromes & the pts. heritage

Answer 407

Culture-Bound Syndromeheritage

• Ataque de nervios Latin American
• Ghost Sickness Navajo
• Hwa-byung Korean
• Susto Latin American
• Wind Illness Chinese

Question 408

In the course of providing best psychiatric care for a client, the nurse must place greatest reliance on

Answer 408

Legal principles are fundamental to nursing practice. They supersede all other principles, standards, and judgments.

Question 409

What is the concept of Justice

Answer 409

fair distribution of care, which includes treatment with the least restrictive methods

Question 410

What is the concept of Beneficence

Answer 410

. Beneficence means promoting the good of others

Question 411

What is the concept of Fidelity

Answer 411

Fidelity is the observance of loyalty and commitment to the patient.

Fidelity refers to being “true” or faithful to one’s obligations to the client. Client abandonment would be a violation of fidelity.

Question 412

Tort

Answer 412

A tort is a civil wrong against a person that violates his or her rights.

ex. Giving unnecessary medication for the convenience of staff controls behavior in a manner similar to secluding a patient; thus, false imprisonment is a possible charge.

Question 413

What is the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

Answer 413

The DSM-5 classifies disorders people have rather than people themselves

Question 414

“What is the most prevalent mental disorder in the United States?”

Answer 414

The 12-month prevalence for Alzheimer’s disease is 10% for persons older than 65 and 50% for persons older than 85.

Question 415

What is Clinical epidemiology?

Answer 415

A broad field that addresses studies of the natural history (or what happens if there is no treatment & the problem is left to run its course) of an illness, studies of diagnostic screening tests, & observational/experimental studies of interventions used to treat people w/ the illness or symptoms.

Question 416

What does Prevalence refer to?

Answer 416

The number of new cases

Question 417

What does Incidence refer to?

Answer 417

The number of new cases of mental disorders in a healthy population within a given period.

Question 418

What areas of care are promoted by QSEN

Answer 418

The key areas of care promoted by QSEN are patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics.

Question 419

Faith / Religion & stress - immune systems

Answer 419

Studies have shown a positive correlation between spiritual practices and enhanced immune system function and sense of well-being

Question 420

Eating disorder facts

Answer 420

• Complex medical/psychiatric illness
• Disease of control (pt can control eating)
• Anorexia is 3rd most common chronic illness
• Genetic, biological, behavioral, social, & psychological factors
• Develop over time
• Occurs across all socioeconomic & age groups
• Bulimia is life-threatening; highest mortality rate of all mental illnesses
• Causes are multifactoral
• Global issue

Question 421

Body image in eating disorders

Answer 421

Perception is never reality

A distorted body image is DELUSIONAL

& will not chg w/ reasoning

(no nursing interventions will work)

Question 422

Anorexia Nervosa characteristics

Answer 422

Restricted calories w/ significantly low BMI

Low body wt (

Intense fear of gaining wt

Distorted body image

Extreme focus on shape / wt

Amenorrhea

Denial of illness (secretive)

Question 423

Types of Anorexia Nervosa

Answer 423

2 types:

• Restricting - no consistent bulimic features
• Binge-Eating - primarily restriction, some bulimic behaviors

Question 424

Anorexic issues

Answer 424

• How can I appear perfect?
• What is this feeling?
• When I eat, I feel sick.
• No energy
• No sleep (not just insomnia)
• No peristalsis
• No appetite (not the same as hunger)
• No control
• No future
• I HATE being me
• Nobody can love ME the way I am

Question 425

Personality traits of pt

w/ Anorexia Nervosa

Answer 425

Perfectionism

Obsessive thoughts & actions r/t food

Intense feelings of shame

People pleasing

Need to have complete control over their therapy

Question 426

Thoughts & behaviors assoc.

w/ Anorexia Nervosa

Answer 426

• Terror of gaining wt; repeated re-weighting of self
• Preoccupation w/ thoughts of food
• View of self as fat even when emaciated
• Peculiar handling of food; cutting into mini bites
• Food portioning (eats sm amts of certain foods)
• Pushing pieces of food around plate
• Poss. development of rigorous exercise regimen / hyperactivity
• Poss. self-induced vomiting, misuse of laxatives/diuretics
• Cognition so distrubed that pt judges self-worth by his/her wt

Question 427

Physical presentation of

Anorexia Nervosa

Answer 427

• Low body wt r/t caloric restriction / excessive exercise
• Amenorrhea d/t low wt
• Lanugo & thin, brittle hair d/t starvation
• Cold extremities/cold intolerance/hypothermia d/t starvation
• Peripheral edema d/t hypoalbuminemia & refeeding
• Muscle weakening/letheragy d/t starvation & electrolyte imbalance
• Constipation d/t starvation
• Cardio abnormalities (hypotension, bradycardia, HF) d/t starvation & dehydration
• Impaired renal function , low urine output, increased urine concentration d/t dehydration
• Hypokalemia d/t starvation
• Decreased bone density
• Dry skin d/t dehydration

Question 428

Psychological presentation of

Anorexia Nervosa

Answer 428

• Disturbed body image
  
  • excessive self-monitoring
  • describes self as fat despite emaciation
• Ineffective coping
  
  • destructive behavior toward self
  • poor concentration
  • inability to meet role expectations
  • inadequate problem solving
• Chronic low self-esteem
  
  • rejects positive feedback about self
  • reports feelings of shame
  • lack of eye contact
  • passive
  • indecisive behavior
• Powerlessness

Question 429

Anorexia Nervosa assessment

Answer 429

Eating habits

History of dieting

Methods used to achieve wt control (restricting, purgeing, exercising)

Value attached to a specific shape & wt

Interpersonal & social functioning

Mental status & physiological parameters

Question 430

Anorexia complications

Answer 430

Hormonal chgs

Cardiac issues (leaky heart valves, orthostatic pulse & BP chgs, prolonged QT, ST-T wave abnormalities) & arrhythmias

Edema (ankle & periorbital)

Electrolyte imbalances (lead to fatigue, weakness, letheragy)

Infertility

Bone density loss (osteoporosis)

Anemia

Neuro problems (peripheral neuropathy)

Death

Question 431

What is Refeeding?

Answer 431

Refeeding resulting in too-rapid weight gain & can overwhelm the heart, resulting in cardiovascular collapse.

Deadly complication of treatment involving metabolic alteration in serum electrolytes, vitamin defciencies, & sodium retention.

Focused assessment is a necessity to ensure the patient’s physiological integrity.

Question 432

Bulimia Nervosa characteristics

Answer 432

Cycle of bingeing/purging (1x per wk x 3 mo)

Feeling out of control

Compensatory behaviors (self-induced vomiting, excessive exercising, fasting, laxative/diuretic misuse)

Usually normal body wt

Self-image largely influenced by body image

Question 433

Types of Bulimia Nervosa

Answer 433

2 types:

• Purging - self induced vomiting or laxative/diuretic misuse
• Non-Purging - excessive exercising or fasting

Question 434

Bulimic issues

Answer 434

• How can I appear perfect?
• What is this feeling?
• I eat to fill the void.
  
  • lack of emotion / emotional pain drives binge
• I rid myself of food to get rid of the tension.
• I HATE being this way. MAKE it STOP.
• Nobody can love ME the way I am.

Question 435

Thoughts & behaviors assoc.

w/ Bulimia Nervosa

Answer 435

• Binge eating behavior
• Often self-induced vomiting (or laxative/diuretic use) after bingeing
• Hx of anorexia nervosa in 1/4 - 1/3 of pts
• Depressive signs & symptoms
• Problems w/:
  
  • interpersonal relationships
  • self-concept
  • impulsive behaviors
• Increase levels of anxiety & compulsivity
• Poss. chemical dependency
• Poss. impulsive stealing
• Family relationships usually chaotic & lack nurturing
• Life reflects instability & troublesome interpersonal relationships

Question 436

Physical presentation of

Bulimia Nervosa

Answer 436

• Normal to slightly low wt r/t excessive caloric intake w/ purgeing or excessive exercise
• Dental caries & tooth erosion r/t vomiting
• Puffy cheeks / parotid swelling (enlarged salivary glands) d/t increased serum amylase levels
• Gastric dilation / rupture r/t binge eating
• Callused, ulcered, or scarred knuckles r/t vomiting
• Swollen hands / feet (peripheral edema) d/t rebound fluid (seen w/ diuretic use)
• Weakness & fatigue d/t electrolyte imbalances
• Menstrual irregularities
• Abdmonial pain
• Sore throat

Question 437

Psychological presentation

of Bulimia Nervosa

Answer 437

• Disturbed body image
  
  • obsession w/ body
  • denial of problems
  • dissatisfaction w/ appearance
• Ineffective coping
  
  • obsessed w/ food
  • substance abuse
  • impulsive responses to problems
  • misuse of laxatives/diuretics/enemas
  • fasting
  • inadequate problem solving
• Chronic low self-esteem
  
  • feelings of shame / guilt
  • views self as unable to deal w/ events
  • excessive seeking of reassurance
• Powerlessness
  
  • loss of control w/ binge/purge cycle
• Social isolation
  
  • absence of supportive significant other(s)
  • hides eating behaviors from others
  • reports feelign alone

Question 438

Bulimia Nervosa assessment

Answer 438

Are you satisfied w/ your eating habits?

Do you ever eat in secret?

Question 439

Bulimia complications

Answer 439

Tooth erosion, cavities, gum disease

Water retention / abd bloating

Low serum potassium

Irregular menstrual cycles

Swallowing problems & esophagus damage (perforation)

Salivary gland hypertrophy

Petechiae

Hematemesis

Question 440

Priority interventions for Bulimia Nervosa

Answer 440

• Change dysfunctional eating behavoirs
• Prevent use of dysfunctional compensation
  
  • monitor bathroom use after meals
  • ensure pt doesn’t purge or exercise w/o staff knowledge
• Maintain physical integrity
• Boost self-esteem

Question 441

What is the priority information that a nurse should provide for a pt. w/ binge-purge bulimia

Answer 441

How to recognize hypokalemia

Hypokalemia results from potassium loss associated w/ vomiting. Physiological integrity can be maintained if the pt can self-diagnose potassium deficiency & adjust the diet or seek medical assistance.

Self-monitoring of daily food & fluid intake is not useful if the pt purges.

Question 442

Binge Eating Disorder

(BED)

Answer 442

Recurring episodes (>/= 1x wk x 3 mo)

Feeling of shame, guilt, embarrassment & disgust

NO use of compensatory behavoirs

Common SE is obesity

Question 443

Psychological presentation

w/ BED

Answer 443

• Disturbed body image
  
  • embarassment d/t wt gain
  • fear of negative rxn by others
  • attempts to hide wt gain
  • body dissatisfaction
• Ineffective coping
  
  • eats as coping method
  • absence of other/more effective coping methods
  • eats when full
• Anxiety
  
  • feelings of discomfort/dread
  • feelings of inadequacy
  • focused on self
  • increased wariness
  • irritability
• Chronic low self-esteem
  
  • feelings of shame/guilt
  • views self as unable to deal w/ events
• Powerlessness
  
  • loss of control of eating
• Social isolation
  
  • absence of supportive significant other(s)
  • eats normally in presence of others
  • hides eating behaviors
  • reports feeling alone

Question 444

Avoidant/Restrictive Food Intake Disorder

(ARFID)

Answer 444

Individual restricts food intake & experiences significant associated physological / psychosocial problems but doesn’t met criteria for any other eating disorder.

• difficulty digesting certain foods
• avoids certain colors / textures of foods
• eats only very small portions / no appetite
• afraid to eat after freightening episode of choking / vomiting

Significantly low BMI; dependent on enteral feeding or experiencing nutritional deficiencies

No distortion of body image

Symptoms show up in infancy / childhood

Question 445

PICA

Answer 445

Ingestion of non-nutritive substances past toddlerhood

Varies w/ age & availability

Occurs in pregnancy, children, iron deficient adults, & institutionalized persons

Not culturally sanctioned

Not part of any other mental illness

Psych comorbidities: IDD, Austism, OCD, Schizophrenia, Trichotillomania (if hair ingested)

Question 446

Rumination Disorder

Answer 446

Repeated regurgitation of food

Regurgitate, re-chew, spit out or re-swallow

No GI or medical reason

Behavior is volitional (done willingly)

Occurs in secret

Not part of other mental illness/eating disorder

Psych comorbidities: IDD & generalized anxiety disorder

Question 447

Psychiatric comorbidity

of eating disorders

(co-existing psych & physical disorders)

Answer 447

Depression

Anxiety (r/t food)

OCD

Substance abuse

Personality disorders

Bipolar

Obesity

Question 448

Assessment in eating disorders

Daily physical assessments needed

Answer 448

Height, weight (blind wts), & muscle mass

Electrolytes

Cardiac function

Bradycardia, orthostatic hypotension

Amenorrhea

Mood changes

Use of enemas, laxatives, diuretics, diet pills

Dental caries, sore throat, calloused fingers

Cold intolerance

Hair loss

I & O

Question 449

Treatment goals for eating disorders

Answer 449

Refeed

Stabilize wt

Resolve cognitive distortions

Normalize eating

Treat comorbidities

Improve family relationships

Understand importance of balanced nutrition

Develop age-appropriate identity

Question 450

Treatment Team

Answer 450

Psychiatrist

Psychologist

RN

Dietician

Social Worker (family therapist)

Milieu therapist (PCT)

Art / Music / Recreational therapists

Question 451

Treatment of eating disorders

Answer 451

• Restore pt to healthy wt
  
  • wt gain of 0.2 kg/day (slow & steady)
  • food intake must be increased slowly to prevent stressing heart
• Treat psych issues r/t eating disorder
• Reduce / eliminate behaviors or thoughts that lead to disordered eating; prevent relapse
  
  • Control issues: do NOT agrue over wt; emphasize HEALTH not wt.; avoid coerision
• Behavior modification can help decrease manipulative behavior (CBT)

Question 452

Interventions for eating disorders

Answer 452

Medications:

• Prozac (fluoxetine) or Zoloft (sertraline)
• Zyprexa (olanzapine) - antipsychotic helps w/ distored thoughts

Psychotherapy (group & individual)

Behavior modification

• promote behaviors that contribute to wt gain
• limit wt-loss behaviors

Monitoring

• physiological parameters (vitals, electrolytes)
• wt routinely
• daily caloric intake & fluid I&Os
• restrict food to scheduled, pre-served meals/snacks
• observe during & after meals/snacks
• accompany to bathroom designated observation times; limit time spent in bathroom if not observed
• limit physical activity

Support

• use behavioral contracting w/ pt to elicit desired wt gain
• reinforce wt gain & behaviors that promote it
• assist pt to develop self-esteem compatible w/ healthy body wt

Promote increased independence

• allow opportunity to make choices about eating & exercise as wt gain progresses

Remove anger / anxiety from eating situation (keep conversations light)

Well-balanced meals & adaquate calories (meal plans)

Be a role model

Question 453

Priority milieu interventions

for pts w/ eating disorders

Answer 453

• Support restorative wt gain & normalization of eating patterns
• Close supervision of pt’s eating
• Prevention of exercise & purging
• Strict adherence to menus
• Observe pt during/after meals to prevent throwing away food or purging
• Monitor all trips to the bathroom
• Structured mealtimes (not flexible)
• Regularly scheduled weighing
• Privileges correlated w/ wt gain & trmt plan compliance

Question 454

Medication issues

with eating disorders

Answer 454

• TCAs & SSRI - prevent relapse in Bulimia
• Zyprexa - used to control anxiety; tends to cause wt gain
• Antianxiolytic agents are contraindicated
• Wellbutrin contraindicated in Bulimics
• MAOIs are not indicated
• Beta Blockers are contraindicated

Question 455

Physical criteria for hospitalization

with eating disorders

Answer 455

• Wt loss > 30% over 6 mo. (severe malnutrition
• Rapid decline in wt
• Inability to gain wt w/ outpt trmt
• Physiologic instability
  
  • Severe hypothermia d/t loss of sub-Q tissue or dehydration (body temp oC or 96.8^oF)
  • Bradycardia (HR)
  • Hypotension (systolic )
• Electrolyte imbalances not corrected by oral supplmentation
  
  • hypokalemia
  • hyponatremia
  • hypophosphatemia
• Cardiac dysrhythmias

Question 456

Psychiatric criteria for hospitalization

with eating disorders

Answer 456

• Suicidal ideation or severely out of control, self-mutilating behaviors
• Out of control use of laxatives, emetics, diuretics, or street drugs
• Failure to comply w/ trmt contract
• Severe depression
• Acute psychosis
• Family crisis or dysfunction

*pt must be physiologically stable to come to psych unit

Question 457

What is Stimming

Answer 457

autism

repetitive movements or sounds…self soothing

Question 458

What is the CAGE questionaire

Answer 458

CAGE

C (have you ever felt that you should CUT down?)

A (have people ANNOYED you by criticizing you)

G (have you every felt GUILTY about our drinking?)

E (have you ever had an EYE OPENING moment in the morning?)