Mental Health Test 2 Flashcards
Describe the symptoms of bipolar disorder
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
Define akathisia and avolition
akathisia: extreme inability to sit or stand still
avolaiton: lack of motivation in activities and hygiene
List three (3) possible questions for the client who is suicidal.
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 ?
list the s/s of major depression
- 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
list expected findings in the client with panic disorder
- Palpitations
- SOB
- Choking or smothering sensation
- Chest pain
- Nausea
- Feelings of depersonalization
- Fear of dying or insanity
- Chills or hot flashes
list the expected findings in individuals with PTSD
- 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
List the expected findings in the client with borderline personality disorder.
instability lack of self esteem fear of abandonment strong dependency needs splitting behaviors manipulation and impulsivness often tries self mutilation maybe suicidal
Compare and contrast catatonic schizophrenia, paranoid schizophrenia, and disorganized schizophrenia.
Catatonic schizophrenia: abnormal motor movement
Paranoid Schizophrenia: suspicion towards others
Disorganized schizophrenia: withdrawal from society and very inappropriate behaviors.
discuss the reason the client with OCD has repetitive behaviors
to decrease anxiety
List a serious complication of alcohol withdrawal
cardiac dysrhythmias
severe disorientation psychotic symptoms HTN delirium seizures
discuss nursing interventions for the client having a panic disorder
- 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
discuss one possible cause of schizophrenia
birth and pregnancy complications
lack of o2
exposure to toxins
malnutrition
father over 55
viral infections
liste expected findings in the client with anxiety disorder
- 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
Discuss the effects of marijuana use on the body
euphoria
seduction
hallucinations
decreased n/v
define schizophrenia
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
how does the nurse determine the difference between a client with suicidal idealations and one who is actively suicidal
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.
Discuss disorganized-type schizophrenia
withdrawal from society and very inappropriate behaviors such as poor hygiene
seen more in homeless population
common s/s: loose associations, bizarre mannerisms,
List the signs and symptoms of opioid withdrawal
sweating rhinorrhea tremors irritability severe weakness diarrhea fever insomnia pupil dilation n/v pain in bones muscle spasms
Discuss the treatment and desired outcomes for the client who is a poly-substance abuser.
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.
List five (5) symptoms of alcohol withdrawal delirium (delirium tremens).
severe disorientation
psychotic symptoms
severe HTN
cardiac dysrhythmias
delirium
Discuss the CAGE screening test for alcoholism
acronym with four questions:
- Have you ever felt you should CUT down on your drinking?
- Have people ANNOYED you by criticizing your drinking?
- Have you ever felt bad or GUILTY about your drinking?
- Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (EYE OPENER)
Discuss the nurse’s priority of care during the alcohol detoxification period.
SAFETY
nurse must be aware of possibility
monitor respiratory distress
monitor cardiac dysrhythmias and HTN
implement seizure precautions
Discuss dependent personality disorder
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.
Give three examples of therapeutic responses for the client experiencing hallucinations
- 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
list expected findings in the client with OCD:
obsessions:
compulsions:
compulsions s/s:
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
Discuss Wernicke’s encephalopathy and Korsakoff’s syndrome.
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
Discuss nursing interventions for the client with suicidal ideation
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
List expected findings in the client with schizophrenia
positive:
- hallucinations
- delusions
- disorganized speech
- bizarre behavior
negative:
- blunted/flat affect
- alogia
- avolition
- anhedonia
- anergia
Identify five risk factors for depression in a client.
family history female in postpartum medical illness poor social support unmarried comorbid substance use
Discuss conversion disorder
- 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)
Compare and contrast bulimia and anorexia nervosa
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
Define dissociative disorder and psychotic disorder.
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.
What are pseudo-neurologic symptoms? Give an example
involved in somatization disorder.
examples: blindness, inability to walk, speak or move
List nursing interventions for the client with anti-social personality disorder
set limits and be consistent
milieu therapy
resources fro crisis services
Define anti-social personality disorder. What difficulties does this client have?
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.
Define catatonic schizophrenia
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
discuss panic disorder
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.
How early after cessation of alcohol intake might the nurse expect to see signs of withdrawal?
4-12 hours. peak after 24-48 hours
discuss OCD
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.
discuss (generalized) anxiety disorder
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
List two important nursing interventions for the client with bipolar disorder that is suffering with mania.
focus on safety and maintaining physical health
use a calm, matter of fact approach
Define the following terms: devaluation, splitting, derealization, and empathy
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
discuss the priority interventions for a client with personality disorder
- 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.
List 3 toxic effects of opioids; List the signs and symptoms of opioid intoxication
slurred speech impaired memory pupillary change decrease Resp decreased LOC
What is the only effective treatment for alcohol addiction?
abstinence
discuss nursing care of the client who has attempted suicide
- 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
What type of seizures might the alcoholic patient have
tonic-clonic
Discuss the assessment of the client admitted to a detoxification unit for alcohol addiction.
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
discuss the cause of PTSD
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.
Discuss the stages of alcohol withdrawal.
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
List four (4) possible symptoms that may cause you to suspect a client is suffering from mania.
agitation and irritability
restlessness
restlessness
flight of ideas
decreased sleep
List six (6) signs and symptoms of bulimia.
hypotension
decreased pulse
enlarged parotid glands
dental erosion cardiomyopathy peripheral edema muscle weakness constipation excessive use of laxatives
Describe the function of Alcoholics Anonymous (AA).
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.
Define and compare rationalization, denial, suppression, and compensation.
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
Compare and contrast: hallucinations, illusions, delusions of grandeur, and paranoid delusions.
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
Which interventions should the nurse implement for the client with catatonic schizophrenia
- 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
