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Term 4 > Mental Health Test 2 > Flashcards

Mental Health Test 2 Flashcards

1
Q

Describe the symptoms of bipolar disorder

A

Manic phase:

  • labile mood with euphoria
  • agitation and irritability
  • restlessness
  • flight of ideas
  • grandiose view
  • impulsivity
  • demanding and manipulative behavior
  • decreased attention span
  • poor judgment
  • attention seeker
  • social impairment
  • decreased sleep
  • neglect of ADLs
  • denial iof illness

Depressive phase:

  • flat, blunted
  • tearfulness, crying
  • lack of energy
  • anhedonia
  • physical pain reports
  • can’t concentrate
  • self destructive
  • decrease hygiene
  • loss of appetite
  • psychomotor retardation
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2
Q

Define akathisia and avolition

A

akathisia: extreme inability to sit or stand still
avolaiton: lack of motivation in activities and hygiene

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3
Q

List three (3) possible questions for the client who is suicidal.

A

do you have a plan

are you thinking about suicide

are you thinking about hurting yourself

have you experienced a recent change in your mood

do you feel that is not worth living ?

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4
Q

list the s/s of major depression

A
  • depressed m mood
  • difficulty sleeping or excessive
  • indecisivness
  • decreased ability to concentrate
  • suicidal ideation
  • increase or decrease in motor activity
  • inability to feel pressure
  • increase or decrease in weight of more than 5% of total body weight over one month
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5
Q

list expected findings in the client with panic disorder

A
  • Palpitations
  • SOB
  • Choking or smothering sensation
  • Chest pain
  • Nausea
  • Feelings of depersonalization
  • Fear of dying or insanity
  • Chills or hot flashes
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6
Q

list the expected findings in individuals with PTSD

A
  • recurrent, intrusive recollection of the event
  • dreams or images
  • reliving through flashbacks, illusions or hallucinations
  • increased arousal
  • irritability
  • difficulty with concentration
  • sleep disturbances
  • avoidance of stimuli
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7
Q

List the expected findings in the client with borderline personality disorder.

A 
instability
lack of self esteem
fear of abandonment
strong dependency needs
splitting behaviors
manipulation and impulsivness
often tries self mutilation
maybe suicidal
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8
Q

Compare and contrast catatonic schizophrenia, paranoid schizophrenia, and disorganized schizophrenia.

A

Catatonic schizophrenia: abnormal motor movement

Paranoid Schizophrenia: suspicion towards others

Disorganized schizophrenia: withdrawal from society and very inappropriate behaviors.

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9
Q

discuss the reason the client with OCD has repetitive behaviors

A

to decrease anxiety

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10
Q

List a serious complication of alcohol withdrawal

A

cardiac dysrhythmias

severe disorientation
psychotic symptoms
HTN
delirium
seizures
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11
Q

discuss nursing interventions for the client having a panic disorder

A
  • Structured interview to keep the client focused
  • Provide safety and comfort as client during panic attack is unable to problem solve and focus
  • Use relaxation techniques
  • Stay with the patient during panic attacks. Use short, simple directions.
  • Establish and maintain a trusting relationship by listening to the client; displaying warmth, answering questions directly, offering unconditional acceptance; being available and respecting the client’s use of personal space.
  • Maintain calmness in your approach
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12
Q

discuss one possible cause of schizophrenia

A

birth and pregnancy complications

lack of o2

exposure to toxins

malnutrition

father over 55

viral infections

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13
Q

liste expected findings in the client with anxiety disorder

A
  • restlessness
  • muscle tension
  • avoidance of stressful activities or events
  • increased time and effort required to prepare for stressful activities
  • seeks repeated reassurance
  • fatigue
  • problems with concentration
  • irritability
  • sleep disturbances
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14
Q

Discuss the effects of marijuana use on the body

A

euphoria
seduction
hallucinations
decreased n/v

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15
Q

define schizophrenia

A

psychotic disorders that affect thinking, behavior, emotions and the inability to perceive reality.

typical onset is early 20’s

dx: PET scans, CT scans, MRI

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16
Q

how does the nurse determine the difference between a client with suicidal idealations and one who is actively suicidal

A

Suicidal ideations- occurs when the client is having thoughts about committing suicide

Actively suicidal- Is currently a harm to self and has their mind set that they want to commit suicide.

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17
Q

Discuss disorganized-type schizophrenia

A

withdrawal from society and very inappropriate behaviors such as poor hygiene

seen more in homeless population

common s/s: loose associations, bizarre mannerisms,

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18
Q

List the signs and symptoms of opioid withdrawal

A 
sweating
rhinorrhea
tremors
irritability
severe weakness
diarrhea
fever
insomnia
pupil dilation
n/v
pain in bones
muscle spasms
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19
Q

Discuss the treatment and desired outcomes for the client who is a poly-substance abuser.

A

Treatment begins with a thorough assessment of each patient’s drug use, treatment history, family dynamics, and medical and legal history. The multidisciplinary team of clinical professionals then creates an individualized treatment plan geared toward the specific needs and goals of the patient. Through education, life skills training and intensive therapy, Wellness Resource Center helps patients with polysubstance dependence develop coping strategies and life skills that will help them end their addiction to all addictive substances and more effectively manage any mental health disorders.

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20
Q

List five (5) symptoms of alcohol withdrawal delirium (delirium tremens).

A

severe disorientation

psychotic symptoms

severe HTN

cardiac dysrhythmias

delirium

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21
Q

Discuss the CAGE screening test for alcoholism

A

acronym with four questions:

  1. Have you ever felt you should CUT down on your drinking?
  2. Have people ANNOYED you by criticizing your drinking?
  3. Have you ever felt bad or GUILTY about your drinking?
  4. Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (EYE OPENER)
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22
Q

Discuss the nurse’s priority of care during the alcohol detoxification period.

A

SAFETY

nurse must be aware of possibility

monitor respiratory distress

monitor cardiac dysrhythmias and HTN

implement seizure precautions

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23
Q

Discuss dependent personality disorder

A

belongs to cluster C. anxious or fearful traits, insecurity and inadequacy

Characterized by extreme dependency in a close relationship with an urgent search to find a replacement when one relationship ends- most frequently seen personality disorder. Characteristics include- Indecisiveness, clinginess, possessiveness, requiring reassurance, fear of aloneness.

24
Q

Give three examples of therapeutic responses for the client experiencing hallucinations

A
  • Ask the client directly about hallucinations. The nurse should not argue or agree with the client’s view of the situation, but may offer a comment, such as, “I don’t hear anything, but you seem to be feeling frightened”
  • Do not argue but focus on the client’s feelings and possibly reasonable explanations such as. “I can’t imagine the President of the US would have a reason to kill a citizen, but it must be frightening for you to imagine that”
  • Attempt to focus conversations on reality based subjects
25
Q

list expected findings in the client with OCD:

obsessions:
compulsions:
compulsions s/s:

A

obsessions: recurrent, intrusive thought or belief that the person cannot ignore
compulsions: repetitive behavior or mental act that the person feels driven to perform, sometimes constantly

compulsions s/s: hand washing, cleaning, counting, praying

26
Q

Discuss Wernicke’s encephalopathy and Korsakoff’s syndrome.

A

Wernicke’s encephalopathy- An important cause of acute or subacute delirium, Wernicke encephalopathy (WE) is a neurological disorder induced by thiamine, vitamin B1, deficiency.WE is the most important encephalopathy due to a single vitamin deficiency.WE presents with the classic triad of ocular findings, cerebellar dysfunction, and confusion

Korsakoff’s syndrome- Korsakoff syndrome is a chronic memory disorder caused by severe deficiency of thiamine (vitamin B-1). Korsakoff syndrome is most commonly caused by alcohol misuse, but certain other conditions also can cause the syndrome

27
Q

Discuss nursing interventions for the client with suicidal ideation

A

constant supervision

document location, mood, quoted statements and behavior q15mins

remove all sharp tools

plastic utensils only

check environment for hazards

always check hands

do not assign to private room. keep door open.

ensure client swallows all meds

restrict visitors who might be harmful

therapeutic relationship

28
Q

List expected findings in the client with schizophrenia

A

positive:

  • hallucinations
  • delusions
  • disorganized speech
  • bizarre behavior

negative:

  • blunted/flat affect
  • alogia
  • avolition
  • anhedonia
  • anergia
29
Q

Identify five risk factors for depression in a client.

A 
family history
female in postpartum
medical illness
poor social support
unmarried
comorbid substance use
30
Q

Discuss conversion disorder

A
  • sudden loss of neurological function, usually at a time of severe stress, that cannot be explained fully by a physical disorder.
  • Behaviors are necessary for the client to cope.
  • 1 or more symptoms of loss of voluntary motor or sensory function.
  • No evidence that symptoms is feigned or intentionally produced
  • Loss of function is not due to medical illness and is not a culturally expected behavioral response
  • The onset of symptoms is linked to a socially or psychologically stressful event
  • The client may display a lack of concern about the debilitating symptoms
  • S/S- inability to walk, weakness, impaired coordination or balance, paralysis of an arm or a leg, loss of sensation in a body part
  • May have stimulated convulsions, blindness, deafness; do not focus on symptoms (reinforces behavior)
31
Q

Compare and contrast bulimia and anorexia nervosa

A

Anorexia:
• Clients are preoccupied with food and the rituals of eating, along with a voluntary refusal to eat.
• Client exhibits morbid fear of obesity and a refusal to maintain minimally normal body weight (less than 85% of expected weight) in the absence of a physical cause.
• Most often occurs in females with onset between ages 12-18.
• Two types- restricting type and binge-eating/purging type
• In females, accompanied by amenorrhea for at least 3 consecutive cycles
Common lab findings-
• Hypokalemia
• Anemia and leukopenia
• Elevated liver enzymes
• Elevated cholesterol
• Abnormal thyroid function tests
• Elevated carotene (causes yellow skin)
• Decreased bone density
Manifestations-
• Hypotension with possible orthostatic hypotension
• Decreased pulse and body temperature
• Fine, downy hair (lanugo) on the face and back
• Jaundiced skin
• Mottled, cool extremities
• Poor skin turgor
• Enlargement of parotid glands
• If client is purging, dental erosion and caries
• Irregular HR, HF, cardiomyopathy
• Peripheral edema
• Muscle weakness
• Constipation
• Excessive use of laxatives and diuretics

Bulimia:
• Clients recurrently eating large quantities of food over a short period of time (binge eating) which can be followed by inappropriate compensatory behaviors, such as self induced vomiting to rid the body of excess calories.
• Most clients maintain a weight within normal range or slightly higher
• Occurs mostly in females between the ages of 18-26
• Two types- purging and non purging
Common lab findings-
• Hypokalemia
• Hyponatremia
• Hypochloremia
• The type and extent of electrolyte imbalance may depend on method used when purging such as vomiting, laxative use or diuretic use
Manifestations-
• Hypotension with possible orthostatic hypotension
• Decreased pulse and body temperature
• Enlargement of parotid glands
• If client is purging, dental erosion and caries
• Irregular HR, HF, cardiomyopathy
• Peripheral edema
• Muscle weakness
• Constipation
• Excessive use of laxatives and diuretics

32
Q

Define dissociative disorder and psychotic disorder.

A

Dissociative identity disorder- Characterized by two or more identities or personalities that alternatively take over the person’s behavior. Formerly known as multiple personality disorder. Some causes are overwhelming stress, lack of nurturing and sexual or physical abuse.

Psychotic disorders: Disorders that affect thinking, heavier, emotions and the ability to perceive reality. Presence of hallucinations, delusions or disorganized speech.

33
Q

What are pseudo-neurologic symptoms? Give an example

A

involved in somatization disorder.

examples: blindness, inability to walk, speak or move

34
Q

List nursing interventions for the client with anti-social personality disorder

A

set limits and be consistent

milieu therapy

resources fro crisis services

35
Q

Define anti-social personality disorder. What difficulties does this client have?

A

Cluster B category. Disregard for others with exploitation; repeated unlawful actions, deceit, sexual acting out, failure to accept personal responsibility, maladaptive coping, low tolerance for frustration, violence. For example- Frank has just been arrested for the 5th time. He is accused of vehicular manslaughter and driving while intoxicated. He has no remorse for the 3 year old he killed in the car crash.

36
Q

Define catatonic schizophrenia

A

abnormal motor movement

withdrawn stage: psychomotor retardation, waxy flexibility, extreme self care needs

excited stages: constant movement, unusual posturing, incoherent speech, self care needs, danger to self

37
Q

discuss panic disorder

A

the client experiences recurrent panic attack with episodes typically lasting 15-30 minutes.

The client may experience behavior changes and/or persistent worries about when the next attack will occur. The client may experience agoraphobia due to a fear of being in places where previous panic attacks occurred. For example- if pervious attacks occurred while driving, client may stop driving.

38
Q

How early after cessation of alcohol intake might the nurse expect to see signs of withdrawal?

A

4-12 hours. peak after 24-48 hours

39
Q

discuss OCD

A

Persistent thoughts or urges that the client attempts to suppress through compulsive or obsessive behaviors. Obsessions or compulsions are time consuming and result in impaired social and occupational functioning. Client has intrusive thoughts of unrealistic obsessions and tries to control these thoughts with compulsive behaviors such as repetitive cleaning or wash hands. Clients who engage in constant ritualistic behaviors may have difficulty meeting self care needs. If rituals include constant handwashing or cleaning, skin damage and infection may occur if behaviors do no decrease. Goal- decrease behaviors.

40
Q

discuss (generalized) anxiety disorder

A

In GAD, client exhibits uncontrollable, excessive worry for more than 3 months. GAD causes significant impairment in one or more areas of functioning, such as work related duties.

occurs:

  • more in women
  • genetic and neurobiological link
  • exposure to traumatic events can precipitate them
  • adverse effects of meds can cause
41
Q

List two important nursing interventions for the client with bipolar disorder that is suffering with mania.

A

focus on safety and maintaining physical health

use a calm, matter of fact approach

42
Q

Define the following terms: devaluation, splitting, derealization, and empathy

A

Devaluation: attributing exaggeratedly negative qualities to the self or others

Derealization: perception tha environment has changed

Empathy: the ability to understand and share the feelings of another

Splitting: inability to incorporate positive and negative aspects of self into a shoe image and is commonly associated with bordering personality disorder

43
Q

discuss the priority interventions for a client with personality disorder

A
  • safety #1
  • developing a therapeutic relationship is often challenging due to client distrust or hostility
  • use firm yet supportive approach and consistent care to hep build the therapeutic relationship
  • set limits when working with client who is manipulative or acts out
  • assertiveness training and modeling
  • the nurse should respect schizoid personality disorder patients, who tend to isolate themselves
  • maintain boundaries with histrionic personality disorder clients who tend to be flirtatious.
44
Q

List 3 toxic effects of opioids; List the signs and symptoms of opioid intoxication

A 
slurred speech
impaired memory
pupillary change
decrease Resp
decreased LOC
45
Q

What is the only effective treatment for alcohol addiction?

A

abstinence

46
Q

discuss nursing care of the client who has attempted suicide

A
  • One on one constant supervision
  • the client’s location, mood, quoted statements and behavior every 15 minutes
  • Remove all glass, metal silverware, electric cords, vases, belts, shoelaces, metal nail files, tweezers, matches, razors, perfume, shampoo and plastic bags from the client’s room
  • Allow the client to use plastic utensils only
  • Check the environment for possible hazards
  • During observation periods, always check the client’s hands, especially if they are hidden from sight
  • Do not assign to private room. Always keep door open
  • Ensure client swallows all meds
  • Restrict all visitors from bringing possibly harmful items to the client
  • Therapeutic relationship
47
Q

What type of seizures might the alcoholic patient have

A

tonic-clonic

48
Q

Discuss the assessment of the client admitted to a detoxification unit for alcohol addiction.

A

type of substance or addictive behavior

amount used

age at onset

changes in work/school performance

changes in use patterns

periods of abstinence

previous withdrawal manifestation

date of last substance use or addictive behavior

review of symptoms

49
Q

discuss the cause of PTSD

A

When the client is exposed to an event or experience that threatens severe injury or death to the client or others. It causes intense fear, horror, flashbacks, feelings of detachment and foreboding, restricted affect and impairment for longer than 1 month after the event. Manifestations can last for years.

50
Q

Discuss the stages of alcohol withdrawal.

A

Stage 1: autonomic hyperactivity- elevated vitals. anxiety and sleep issues, diaphoresis, nausea. hand tremors are a sign. 12-18 hours after last drink.

Stage 2: Neuronal excitation- severe tremors, panic, insomnia, increased agitation. hallucinations. paranoia. 24-36 hours.

Stage 3: Sensory-perceptual disturbance- severe toxic state. seizures. medications emergency. 3-4 days after last drink

51
Q

List four (4) possible symptoms that may cause you to suspect a client is suffering from mania.

A

agitation and irritability
restlessness

restlessness

flight of ideas

decreased sleep

52
Q

List six (6) signs and symptoms of bulimia.

A

hypotension
decreased pulse
enlarged parotid glands

dental erosion
cardiomyopathy
peripheral edema
muscle weakness
constipation
excessive use of laxatives
53
Q

Describe the function of Alcoholics Anonymous (AA).

A

Fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism. The only requirement for membership is a desire to stop drinking. Helps people who have stopped drinking remain sober.

54
Q

Define and compare rationalization, denial, suppression, and compensation.

A

Denial: pretending the truth is n to reality to manage the anxiety of acknowledging what is real

Rationalization: creating reasonable and acceptable explanations for unacceptable behavior

Suppression: voluntarily denying unpleasant thoughts and feelings

Compensation: covering up a real or perceived weakness by emphasizing a trait one considers more desirable

55
Q

Compare and contrast: hallucinations, illusions, delusions of grandeur, and paranoid delusions.

A

Hallucinations: sensory perceptions that do not have any apparentent external stimuli. hearing voices or seeing things

Illusions: deceptive appearance or impression, a false idea or belief

Delusions: alterations in thought, false fixed beliefs that cannot be corrected by reasoning and are usually bizarre

Paranoid Gradeur: believes they are powerful like God

Paranoid Delusions: the fixed, false belief that one is being harmed or persecuted by a particular person or group of people, such as being hunted by the FBI

56
Q

Which interventions should the nurse implement for the client with catatonic schizophrenia

A
  • Identify personal feelings and responses to the client
  • Assess the client’s use of drugs, alcohol, caffeine and other substances
  • Assess the client’s family or other support system
  • Assess the client’s symptoms and behavior
  • Determine whether the client is a risk for self or other directed violence
  • Provide a structured safe environment in order to decrease anxiety and to distract the client from constant thinking about hallucinations
  • Promote therapeutic communication to decrease anxiety, decrease defensive patterns and encourage participation in the milieu
  • Establish a trusting relationship with the client
  • Encourage the development of social skills and friendships
  • Encourage participation in group work and psychotherapy
  • Do not dwell on symptoms after assessing them
  • Attempt to focus conversations on reality based subjects
  • Identify symptom triggers such as loud noises
  • Be genuine and empathetic
  • Encourage med complicance
  • Promote self care by modeling and teaching self care activities

Term 4 (8 decks)

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