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Spring 2016 Semester > Mental Health N4615 Module 1 > Flashcards

Mental Health N4615 Module 1 Flashcards

1
Q

Chpt 8

Therapeutic Relationships are used for what?

A

—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

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2
Q

Goals of a therapeutic Relationship

A

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

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3
Q

Social Relationships refer to what?

A

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

—Social relationships exist for mutual gratification of the participants

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4
Q

Transference

A

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)

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5
Q

Chpt 8

Countertranferences

A

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

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6
Q

Chpt 8

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

A

Bored - want to rescue the pt

overinvolved w/pt - overidentify w/pt

anger w/pt - feelins of hoplessness / helplessness

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7
Q

Chpt 8

Peplau’s (1952)

Nursing - pt. relationship phases

A

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

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8
Q

Chpt 8

Peplau’s Orientation

Phase

A
  • 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.

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9
Q

Chpt 8

Peplau’s Working

Phase

A

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

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10
Q

Chpt 8

Peplau’s Termination

Phase

A

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…?

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11
Q

Chpt 8

Factors that promote Pt. growth

A

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

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12
Q

Chpt 8

Genuiness

A

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.

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13
Q

Chpt 8

Empathy

A

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

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14
Q

What is Empathy’s 2 step process

A

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.” )

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15
Q

What is Sympathy

A

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

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16
Q

Chpt 8

Positive Regard Def

A

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

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17
Q

Chpt 9

Patient Centered

refers to…

A

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

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18
Q

Chpt 9

Factors that affect communications

A

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)

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19
Q

Chpt 9

Verbal vs. nonverbal communication

A

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”

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20
Q

Chpt 9

List 3 Therapeutic Communication techniques

A

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

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21
Q

What are some Clarifying techniques

A

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.

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22
Q

Chpt 9

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

A

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?)

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23
Q

Chpt 9

Nontherapeutic Communicaiton

A

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

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24
Q

Hesi Practise

Reframing def

A

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)

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25
Q

Hesi Practise

Distraction def

A

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

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26
Q

Hesi Practise

Imagery def

A

uses mental imagaes to assist with relaxation

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27
Q

Hesi Practise

Progressive relaxation def

A

strategy in which muscles are alternately tensed and then relaxed.

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28
Q

Hesi Practise

Clarifying def

A

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…

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29
Q

Hesi Practise

Offering Self

A

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

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30
Q

Hesi Practise

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

A

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

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31
Q

Hesi Practise

Regression def

A

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

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32
Q

What are the Fraud’s psychosexual development stages

A

Oral - age birth to 1 (thumb sucking)

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

Phallic - age 3 - 5

Genital - age 13 - 20 years

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33
Q

Hesi Practise

Confabulation def

A

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

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34
Q

Hesi Practise

Herorin withdraw s/s

A

symptons of heroin w/d include

cravings

muscle aches / tremors

severe abdominal cramps

chills / sweating / runny nose / watery eyes

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35
Q

Hesi Practise

Cocaine withdrawal s/s

A

symptoms of cocaine w/d include:

severe cravings

depression / fatigue / irritability

vivid / unpleasant dreams

insomnia or hypersominia

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36
Q

Hesi Practise

Cannabis withdrawal s/s

A

symptoms of cannabis w/d include:

irritability / anxiety / restlessness

decreased appetite or wieght loss

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37
Q

Hesi Practise

Alcohol withdrawals s/s

A

early symptoms of alcohol w/d include:

irritability / anxiety

tremors

sweating

mild tachycradia

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38
Q

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

A

1) Psychoanalytic Theory

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

3) Cognitive-Behavioral Therapies

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39
Q

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

A
  • 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”
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40
Q

Describe the “Id” phase of Freuds system

A

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

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41
Q

Describe the “ego” phase of Freuds system

A

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?

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42
Q

Describe the “superego” phase of Freuds system

A

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

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43
Q

Client-Centered Theory

who developed theory & what is the main tool used

A

•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

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44
Q

•Client-Centered Interventions / qualities of the therapist

A

•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)

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45
Q

What is Therapeutic Use of Self

A

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.

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46
Q

What is the Johari Window

A

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

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47
Q

Who was the 1st pyschiatric nurse

A

Linda Richards

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48
Q

Suicide def.

A

is the intentional act of killing oneself by any means.

hsty of attempts is best predictor of another attempt

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49
Q

Parasuicide def.

A

A voluntary, failed attempt to kill oneself

Frequently called attempted suicide

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50
Q

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

A

Hopelessness / helplessness

severity of depression.

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51
Q

Theoretical foundations for understanding the suicidal client

A

Remember!

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

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52
Q

What is Baumeister’s Escape Theory

A

it refers to the components of pts pyschi

  • intense self-hatred
  • intense desire to escape oneself
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53
Q

What is the “Existential” Theory refer to

A

the inability to find meaning in suffering often contributes to suicide

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54
Q

What is the “cognitive theory of suicide”

Becks Cognitive Triad

A

Is a pt’s perspective about.

1) self
2) future
3) World

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

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55
Q

What is

“Shneidman’s Cubic Model of Suicide”

A

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

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56
Q

What are the Assessment stages for the suicidal patient

A

Step 1: Set the Stage

Step 2:
Explore Suicidal Thoughts and Behaviors

Step 3: Evaluate Lethality

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57
Q

Suicidal assessment

Step 1: Set the Stage

A

Establish rapport!

Promote trust

Convey accepting, non-judgmental attitude

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

58
Q

Suicidal Assessment

Step 2:
Explore Suicidal Thoughts and Behaviors

A

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.”)

59
Q

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

A

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

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

60
Q

Watch for signs / clues that suggest suicidal intent

A

Giving away prized possessions

Putting affairs in order

Writing farewell notes

Buying a gun

Loss of interest in activities

Social withdrawal

61
Q

Ask the Q - be bold to a suicidal pt.

A

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?

62
Q

What are some the demographic risk factors for suicidal pts.

A

ederly (w/terminal diagnoses)

younge adolesent white females

American Indians seem to have a higher rate.

63
Q

Suicidal Assessment

Step 3: Evaluate Lethality

A

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

64
Q

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

A

How lethal is the proposed plan?

How accessible are the means?

What are the chances of rescue?

Is substance use a factor?

65
Q

What is the SAD PERSONS Scale

A

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

66
Q

What are the Goals for Hospitalization of suicidal patients

A

Prevent harm

Re-establish equilibrium

Restore hope

Enhance coping skills

Develop an outpatient support system

Develop a suicide prevention plan for discharge

67
Q

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

A

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

68
Q

What are the two most prevelent Depressive Disorders

A

Major Depressive Disorder (MDD)

Dysthymic Disorder (DD)

69
Q

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

A

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
70
Q

Major Risk factors for Depression

A

Female / unmarried

low socioeconomic status

family hsty of depression

Alcohol / substance abuse

Post-partum

Negative life event - especially loss of loved one

71
Q

What is Dysthymic Disorder

A

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
72
Q

What are some of the theories regarding

depression

A

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

73
Q

Explain the Diathesis-Stress

Theory of Depression

A

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

74
Q

What is the Learned Helpless Model

of depression

A

Person experiences stressful event preceived as uncontrollable.

extreme feelings of powerlessness, helplessness and apathy occur

loss of initiative and a feeling of futility

75
Q

What are some of the treatments for

depression

A

Psychotherapy

Pharmacotherapy

Electroconvulsive Therapy

Brain Stimulation

Exercise and Stress Management

76
Q

Name 4 Pharmacotherapies for

depression

A

Selective Serotonin Reuptake Inhibitors (SSRI)

Tricyclic Antidepressants (TCAs)

Monoamine Oxidase Inhibitors (MAOI’S)

St. John’s Wort

77
Q

Selective Serotonin Reuptake Inhibitors (SSRI)

FACTS

A

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

78
Q

What are some of the S/E of SSRI’s

mnemonic

A

BAD SSRI

  • increased body weight
  • anxiety
  • Dizziness

Serotonin Syndrome

Stimulation of the CNS

Reproductive issues / sexual dysfunction

insomnia

79
Q

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

A

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

80
Q

Tricyclic Antidepressants (TCAs)

FACTS

A
  • 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

81
Q

Monoamine Oxidase Inhibitors (MAOI’S)

FACTS

A
  • 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!
82
Q

Foods that contain

Tyramine

A

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

83
Q

St. John’s Wort

FACTS

A
  • 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%
84
Q

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

A

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

85
Q

Describe the acute phase of major depression tx / recovery

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

Hospitalization may be initiated if severe

86
Q

Describe the continuation phase of major depression tx / recovery

A
  • 4 to 9 months
  • directed at prevention of relapse through pharmacotherapy, education & psychtherapy
87
Q

Describe the maintenance phase of major depression tx / recovery

A
  • 1 year or more

treatment is directed at prevention of further episodes of depression

medication may be phased out.

88
Q

Anhedonia def.

A

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

89
Q

What does the “recovery model” emphasize

A

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.

90
Q

What is the PHQ - 9

A

Patient Health Questionaire - 9

0-4 none

5-9 mild

10-14 - moderate

15-19 moderately severe

20-27 servere

91
Q

What are “vegative signs” of depression

A

alterations in body processess necessary to support life and growth

  • eating
  • sleeping
  • elimination
  • sexual activity
92
Q

What are the four levels of

Anxiety

A

Mild Anxiety

Moderate Anxiety

Severe Anxiety

Panic

93
Q

Mild Anxiety def.

A

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

94
Q

Moderate Anxiety def.

A

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

often demonstrate “selective inattention”

95
Q

Severe Anxiety def.

A

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

96
Q

Panic def.

A

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.

97
Q

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

A

compensation - conversion - denial - displacement -

dissociation - indentification - projection - reaction -

regression - repression - splitting -

sublimation - suppression - undoing

98
Q

The defense mechanism

compensation is def. as

A

used to change perceived deficiencies by emphaszing strengths

99
Q

The defense mechanism

conversion is def. as

A

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

100
Q

The defense mechanism

denial is def. as

A

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

101
Q

The defense mechanism

displacement is def. as

A

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

102
Q

The defense mechanism

Dissociation is def. as

A

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

103
Q

The defense mechanism

identification is def. as

A

when you relate yourself to someone else

104
Q

The defense mechanism

Intellectualization is def. as

A

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

105
Q

The defense mechanism

projection is def. as

A

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

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

106
Q

The defense mechanism

Reaction formation is def. as

A

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.

107
Q

The defense mechanism

Rationalization is def. as

A

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

108
Q

The defense mechanism

Sublimation is def. as

A

replacing an unacceptable behavior with one socially acceptable

109
Q

The defense mechanism

Splitting is def. as

A

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

110
Q

What is “Altruism”

A

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

111
Q

What is Separtion Anxiety Disorder

A

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

112
Q

What is Agoraphobia

A

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.

113
Q

Obsessive-complusive disorder is def. as

A

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.

114
Q

Obsessions are def. as

A

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

115
Q

Compulsions are def. as

A

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

116
Q

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?

A

14-17 - mild anxiety

18-24 - moderate anxiety

25-30 - severe anxiety

117
Q

What is “cognitive restructuring”

A

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

118
Q

What is desesitization

A

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

a behavioral therapy modality

119
Q

What is “flooding”

A

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

a behavioral therapy modality

120
Q

Describe Milieu therapy

A

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

121
Q

What is the def. of schema

A

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

122
Q

What is the def. of somatization

A

is the expression of psychological stress through physical symptoms

123
Q

What is the def. of “holistic approach” for

nursing

A

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

124
Q

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

A

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

125
Q

What is Somatic symtpom disorder

A

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

126
Q

What are the most common symptoms with Somatic symptom disorder

A

chest pain / fatigue / dizziness / headache

swelling / back pain / SOB / insomnia

abdominal pain / numbness

127
Q

What is Illness Anxiety Disorder

aka hypochondriasis

A

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

128
Q

What is conversion disorder

aka functional nurological disorder

A

manifest itself as nerological symptoms in the absence of neurological diagnosis

129
Q

What are some of the symptoms of Conversion disorders

A

paralysis / blindness / movement disorders

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

loss of vision, hearing or even symptoms resembling epilepsy.

130
Q

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

A

Major Depression disorder (MDD) & coronary heart disease

Stress & cancer

131
Q

What are “secondary gains”

A

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.

132
Q

What is factitious disorder

aka Munchausen’s syndrome

A

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

They fake ilness to get sympathy or some other benefit.

133
Q

What does factitous disorder imposed on another mean

aka Munchausen by proxy

A

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

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

134
Q

Def. Malingering

A

consciously motivated to deceive based upon the desire for gain

(money or getting out of someting)

135
Q

What is “la belle indifference”

A

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

136
Q

What is congitive behavioral therapy?

A

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

137
Q

Nursing Interventions for GAD

A
  • Identify source of anxiety
  • Link pt’s behavior to feelings
  • Introduce logic
  • Teach coping skills
138
Q

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.

A

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
139
Q

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

A

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

140
Q

What neurochemicals regulate anxiety?

A

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

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

141
Q
A

Spring 2016 Semester (7 decks)

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