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BSN: 4th Quarter > MH EXAM #4 > Flashcards

MH EXAM #4 Flashcards

1
Q

Specific disorders

A

– Dissociative amnesia
– Dissociative fugue
– Dissociative identity disorder
– Depersonalization disorder

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2
Q
  1. A client has avoidant personality d/o. Which of the following statements is expected from the client?
A

“I’m scared that you’re going to leave me.”

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3
Q
  1. Which of the following statements by the newly licensed RN indicates an understanding of personality d/o?
A

“I should practice limit-setting to help prevent client manipulation.”

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4
Q
  1. Which of the following is an expected finding of a client w/ bulimia nervosa? SATA.
    Amenorrhea
    Yellowing of the skin
    HYPOK+
    Presence of lanugo on the face
    Slightly elevated body weight
A

HYPOKALEMIA
Slightly elevated body weight (b/c of the purging)

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5
Q
  1. Which of the following questions should the RN include in the assessment of anorexia? SATA.
    A. “What is your relationship like w/ your family?”
    B. “Why do you want to lose weight?”
    C. “Would you describe your current eating habits?”
    D. “At what weight do you believe you will look better?”
    E. “Can you discuss your feelings about your appearance?
A

A. “What is your relationship like w/ your family?”
C. “Would you describe your current eating habits?”
E. “Can you discuss your feelings about your appearance?

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6
Q
  1. “The RN on the vending shift is always nice! Yo usare the meanest RN ever!” The RN should recognized which defense?
A

Splitting

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7
Q

Bulimia Nervosa lab results

A

Decreased: Na+, K+, thyroid hormone
Increased: pancreatic enzymes

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8
Q

Manifestations of bulimia nervosa

A

— swelling of salivary glands
— gastric dilation (r/t binge-purge behaviors)

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9
Q

Manifestations of anorexia nervosa

A

— socially withdrawn/isolated
— patches of hair loss on the scalp (r/t malnutrition)
—

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10
Q

A RN invites a client on the eating d/o unit to a special morning activity as a reward for consuming all their breakfast. The RN should ID this an example of which of the following treatment models?
A. CBT
B. Humanistic therapy
C. Behavioral therapy
D. Interpersonal therapy

A

C. Behavioral therapy
RATIONALE: The use of reinforcements and a reward system to encourage tx-enhancing behaviors

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11
Q

Different types of therapies

A

CBT— ID’ing + restructuring distorted thoughts in effort to improve emotional status and perceptions about self, world, and the future
Humanistic— focuses on human potential, free will, and self-actualization; emphasizes genuineness, empathy, and nonjudgmental approach and NOT using rewards
Behavioral— use of reinforcement + a reward system to encourage tx-enhancing behaviors
Interpersonal— improving interpersonal interactions + satisfaction w/ social relationships

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12
Q

Cluster A Personality Disorders

A

think PaSS
— Paranoid
— Schizoid
— Schizotypal

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13
Q

Cluster A diagnostic

A

Manifest as odd + eccentric

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14
Q

Cluster B diagnostic

A

Manifest as dramatic + erratic

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15
Q

Cluster B Personality disorders

A

think BANHed
— Borderline
— Antisocial
— Narcissistic
— Histrionic

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16
Q

Cluster C diagnostic

A

Manifest as anxious + fearful

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17
Q

Cluster C Personality Disorders

A

think DOA

— Dependent
— Obsessive-Compulsive
— Avoidant

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18
Q

RF + Subj/Obj Data for Personality D/Os

A

Risk Factors: Usually have comorbid substance use disorders, and history of nonviolent and violent crimes, including sex offenses.
______
Psychosocial influences- such as childhood abuse or trauma, and developmental factors with a direct link to parenting.
_________
Subjective/Objective Data- include the following below.
Inflexibility/maladaptive responses to stress
Compulsiveness and lack of social restraint
Inability to emotionally connect in social and professional relationships
Tendency to provoke interpersonal conflict
Ability to merge personal boundaries with others

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19
Q

Patient care for cluster A

A

approach client in a gentle, interested, nonintrusive manner. Respect client’s needs for distance and privacy. Be cognizant of own non-verbal cues, as a client may perceive others as threatening.

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20
Q

Patient care for Cluster B

A

remain patient in response to emotional erratic, aggressive behavior. Provide a consistent and structured milieu to avoid manipulation and power struggles. Protect client from self-harm. Implement suicide precautions. Encourage direct communication and nurse serves as a role-model of healthy behaviors. Facilitate clients to recognize dichotomous thinking( perception that self and/or others are perceived as all good or all bad).

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21
Q

Patient care for Cluster C

A

Address avoidance behaviors related to losses and any secondary gain. Provide problem solving and assertiveness training to increase self-confidence and independence. Facilitate clients to recognize any impairment or distress related to the need for perfection and control. Encourage clients to acknowledge and discuss a sense of inadequacy and/or fear of rejection.

22
Q

Treatment for Personality disorders

A

Psychopharmacology:
Psychosis- low dose atypical and typical antipsychotic agents.
Depression- antidepressants may be given.
Benzodiazepines and buspirone (Buspar( used to alleviate anxiety
Obsessions/compulsions can be alleviated with SSRIs
Impulse control- mood stabilizers such as lithium, antiepileptics, and antipsychotics such as haloperidol, and olanzapine.
Asocial behavior: related to depression such as risperidone(Risperdal), quetiapine(Seroquel), and olanzapine (Zyprexa).

23
Q

Treatment cont’d for Personality d/os

A

Individual and group therapy- based on client’s willingness to participate, client’s level of function, and specific psychosocial needs.
Self-help groups- provide a safe and trusting environment where clients can receive feedback from peers and facilitator(s), share effective coping skills amongst the group, and increase self-awareness
Cognitive behavioral therapy(CBT)-Action-oriented form of therapy; supports successful treatment for BPD, relapse for prevention of depression, and behaviors such as anger issues, suicide, social anxiety, and OCD.
Impulse-control training- is designed to support client safety by decreasing the risk for suicide or self-mutilation, identifies triggers and patterns related to self-destructive behaviors, and identifies alternative coping strategies.

24
Q

Distinguish personality d/o + cluster

A
25
Q

Anorexia Nervosa Manifestations

A

Clients preoccupied with food and the rituals of eating, along with a voluntary refusal to eat.
Fear of being obese and will refuse to maintain a normal body weight (usually <85%) of expected normal body weight in the absence of a physical cause.
Occurs mostly in females adolescent to young adulthood

26
Q

Bulimia nervosa manifestations

A

Clients eat large quantities of food over a short period of time(binging), which may be followed by inappropriate compensatory behaviors, such as self-induced vomiting(purging) to rid the body of excess calories.
Usually maintain a weight within a normal range or slightly higher.
Occurs mostly in females. Onset is females 15 to 18 or between 18 and 26 years of age

27
Q

2 types of Anorexia Nervosa

A

1) Restricting type- restricting food intake and does not binge or purge; maintain weight or a little less
2) Binge-eating/purging type- engages in binge eating or purging

28
Q

2 types of Bulimia Nervosa

A

1) Two types
Purging type- client used self-induced vomiting, laxatives, diuretics, and or enemas
2) Non-purging type- compensate binge eating through other means such as exercising and the use of laxatives, diuretics, and/or enemas.

29
Q

Binge Eating disorder characteristics

A

Clients recurrently eat large quantities of food over a short period of time without the use of compensatory behaviors associated with bulimia nervosa.
Affects men and women of all ages, but is most common in adults age 46 to 55.
The weight gain associated with binge eating disorders increases the risk for other disorders, including type 2 diabetes, hypertension, and cancer. Other comorbidities are depression, personality disorders, anxiety, and substance use.
Increased mortality rate and high suicide rates. Treatment focuses on normalizing eating patterns and addressing health issues.

30
Q

Subjective assessment data for Eating disorders

A

client’s perception, eating habits, dieting, methods of weight control, value attached to weight control, interpersonal and social functioning, difficulty with impulsivity and compulsivity, family dynamics.

31
Q

Objective assessment data for Eating disorders

A

Mental status, vital signs, weight, skin, hair, and nails, head, neck, mouth, and throat; cardiovascular system, musculoskeletal system, and gastrointestinal system. It is critical nursing assessment includes knowing expectations regarding the above. Review page 165 in ATI book.

32
Q

Binge Eating d/o Objective assessment
P. 165 ATI book

A

Mental status:
Overgeneralizations- other girls don’t like me because I am fat; all or nothing such as if I eat desert, I will gain 50 pounds.
Catastrophizing- my life is over if I gain weight.
Personalization- when I walk in the hospital, everyone is looking at me. Terrified of gaining weight, has high interest in preparing food but wont eat, client perception is they will get fat from eating, low self esteem, impulsivity and difficulty with interpersonal relationships, may exhibit need for intense physical regimen. May have guilt from binge eating behaviors.
Vital signs- low blood pressure with possible orthostatic hypotension, decreased pulse and body temperature or hypertension for those with binge eating.
Weight- those with anorexia nervosa have a body weight less than 85% of expected normal weight, Thise with bulimia maintain a weigth that is within the normal range or slightly higher. Clients with binge eating disorders are typically overweight or obese.
Skin, hair, and nails- those with anorexia nervosa may have fine, downy hair(lanugo) on the face and back; yelloed skin; mottles, cool extremities, and poor skin turgor.
Head, neck, mouth, and throat- enlargement of the parotid glans (bulmia nervosa) dental erosion and caries(ourging).
Cardiovascualr- irregular heart rae (dysrhythmias) heart failure, cardiomyopathy, peripheral edema
Muscle weakness
GI- constipation, self-induced vomiting and excessive use of laxatives or enemas/diuretics.

33
Q

Obj data for Eating disorders

ATI p. 167-168

A

Hypokalemia(vomiting); dehydration (sodium retention and potassium excretion). Anemia and leukopenia with lymphocytosis. Possible impaired liver function (increased enzyme levels). Possible elevated cholesterol, abnormal thyroid function tests, elevated carotene levels( skin appears yellow), decreased bone density (possible osteoporosis) abnormal glucose level, ECG changes.
Must focus on electrolyte imbalances associated with bulimia nervosa which depend on purging method (laxatives, diuretics, vomiting): Hypokalemia, hyponatremia, hypochloremia.
Screening tools: Eating Disorders Inventory, Body Attitude Test, Diagnostic Survey for Eating Disorders, and Eating Attitudes Test.

34
Q

Best medication for someone with binge-eating disorder?

A

Fluoxetine (SSRI)

35
Q

RN Care for eating d/o patients

A

Medications- remind client medications may take up to 1 to 3 weeks to work for initial response and 2 months for maximal response. Instruct to avoid hazardous activities and if sexual dysfunction occurs and is tolerable.
Teamwork/collaboration- a registered dietitician is needed for nutritional guidance and support. Consistency among staff is important.
Discharge-develop a maintenance plan related to weight management; encourage follow-up treatment in an outpatient setting, support group, individual and family therapy.
Complications- refeeding syndrome is the potentially fatal complication that can occur when fluids, electrolytes, and carbohydrates are introduced to a severly malnourished client. Nurse must consult with the provider and dietitian to develop a controlled rate of nutritional support during initial treatment. Monitor serum electrolytes, and administer fluid replacement as ordered.
Cardiac dysrhythmias, severe bradycardia, and hypotension- nurse place the client on cardiac monitoring, monitor vital signs frequently, report changes in the clients condition to the provider.

36
Q

How to ensure compassionate care for transgender patients

A
  • Apologize when a mistake is made
  • Cease from gossiping about patients
  • Do not ask about gender confirmation surgery
  • Do not ask about genitalia unless it relates to care
  • Do not ask a transgender patient what their “real” name is
  • Do not insist the patient use the name on the medical record
  • Most of all, check your personal biases
37
Q

Types of Dissociative

A
38
Q

RN assessment for dissociative d/os

A

A. History: recounts of trauma, and/or severe stress; extent of dissociation or amnestic symptoms varies widely with different dissociative disorders
B. Include physical symptoms: May report symptoms of depression or anxiety, headaches common with DID
C. Mental status examination
Appearance: facial expressions and mannerisms may vary widely within one session or appearance may vary widely from day to day (DID)
Mood: anxious, depressed; some clients have little mood change !
Memory: amnesia for events (variable extent)
4. Perception: feelings of detachment from self or environment, feeling of physical change in body !
5. Insight: impaired, unaware of memory impairment

39
Q

Types of defense mechanisms for dissociative d/os

A

— Dissociation is a defense mechanism in which experiences are blocked off from consciousness, so that affect, behavior, identity, memories, and/or thoughts are not integrated
— Repression is a defense mechanism in which thoughts and feelings are kept from consciousness

40
Q

Dissociative amnesia

A

a dissociative disorder in which the client cannot remember important personal information that cannot be accounted for by ordinary forgetfulness

41
Q

Dissociative fugue

A

a dissociative disorder characterized by suddenly wandering away or taking a trip away from one’s usual place, accompanied by amnesia for some or all of the past

42
Q

Dissociative identity disorder (DID)

A

Formerly known as split-personality disorder
a dissociative disorder characterized by two or more distinct personalities or identities (alters) in an individual person

43
Q

Depersonalization disorder

A

Experiences recurrent alterations in self-perception; feeling a sense of unrealness
— e.g. “detached from my body” or “being in a dream”

44
Q

Types of amnesia in dissociative d/os

A
  1. a. Localized amnesia: short time period (hours) after a disturbing event
    b. Selective amnesia: amnesia for some, but not all, events
    c. Generalized amnesia: amnesia for whole lifetime of experiences (very rare)
    d. Continuous amnesia: forgets successive events as they occur
45
Q

Dissociative amnesia manifestations

A

Suddenly unable to recall memories
2. Not ordinary forgetfulness
3. Able to recall other information, learn, and function coherently
4. Most common during wars and natural disasters
5. Primary gain: symbolic resolution of unconscious conflict that decreases anxiety and keeps the conflict from awareness
6. Secondary gain: receipt of extra support and caring when experiencing an illness
7. Usually terminates abruptly
8. Special interventions: Survivor support groups; Gradual reconstruction of events through talking and listening/reading of others’ accounts of the trauma

46
Q

Dissociative fugue manifestations

A
  1. Travels from usual environment
  2. Unable to recall important aspects of identity and assumes new identity
    a. Old and new identities do not alternate
    b. Incomplete new identity
    c. Does not know information is forgotten
  3. Usually lasts from hours to days, rarely months; considerable confusion when returns to pre-fugue state
  4. Often is a response to psychological stressors (war, family, marital) !
  5. Once the client has returned to pre-fugue state, he or she has no memory for events during the fugue
  6. Special interventions: hypnosis, drug-facilitated interviews, support groups
47
Q

What is DID?

A
  1. Client has two or more alters (separate, distinct identities or “personalities”)
    a. An alter is a personality state or identity that recurrently takes over the behavior of a person with DID
    b. Each alter has relatively enduring pattern of perceiving, relating to, and thinking about itself and the environment
    c. Formerly known as multiple personality disorder (MPD)
48
Q

DID manifestations

A

Personalities with different influences and power over one another
a. May represent different ages, genders
b. Alters each have different physiological responses and disorders (one alter may be myopic, while another is not)
c. Communicate with one another through “executive” alter
d. Some alters share “co-consciousness,” aware of each other’s experience and behavior, while others are only aware of own existence
e. “Switching” occurs by dissociating from one alter to another
f. Number of personalities range from 2 to over 100, with 50% of clients having more than 10 personalities
g. Host personality: primary identity that holds the person’s name
h. The host personality is typically unaware of the alters (the anxiety-provoking aspects of personality), but the alters are typically aware of the host personality

49
Q

Other DID manifestations

A
  1. “Loses time” when alternate personality is present for a period of time
    a. Usually client is unable to give full account of childhood (few memories) because of dissociation
    b. May appear forgetful and is often accused of lying !
  2. Mental status variations
    a. Marked variation in appearance from time to time
    b. Blinking, eye rolls, headaches, covering or hiding the face, and twitches may occur when “switching” from one alter to another
    c. Marked variation in speech for brief periods of time
    d. Impaired insight, usually unaware of alters
    e. May appear anxious or depressed
  3. Associated with severe physical or sexual abuse during childhood
    a. Many posttrauma symptoms (nightmares, flashbacks, hypervigilance)
    b. Self-mutilation, suicidal, or aggressive behavior
50
Q

Interventions for DID

A

a. No-harm contract and environmental safety if client is suicidal or is self- mutilating
b. Meeting and recognizing alters and their unique experiences and needs
c. “Mapping” personality system, noting characteristics of alters and co-consciousness
d. Creation of emotionally safe environment for all alters
e. Individual therapy with therapist skilled in working through trauma leading to integration (moving together of aspects of all identities)
f. Development of new coping skills for integrated client and for clients who choose not to integrate so that dissociation is either not necessary or is under control
g. Family therapy with partners and children to help client avoid dissociation, deal with hostile personalities, understand therapy process, and to confirm experience with client’s behavior
h. Hypnosis or drug-facilitated interviews; use is controversial because of the possibility of remembering “too much, too soon” and being overwhelmed with anxiety
i. Issue: the therapist’s “creating” memories and alters by his or her verbal and non-verbal behavior in suggestible client

51
Q

Depersonalization d/o manifestations

A

1.Experiences recurrent alterations in self-perception
a. Depersonalization: feeling of detachment or separation from one’s self, as if in a dreamlike state
b. Client describes self as “detached from my body” or “being in a dream”
c. Feels strange or unreal
d. Able to function during the experience
2. Client may report distress about experiences and become depressed and anxious
a. Often fears being “crazy”
b. May be accompanied by derealization, which is the feeling that the external world is unreal or strange
3. Precipitated by stress and anxiety
4. Most common in teenagers and young adults
5. Special interventions: Problem solving to reduce stress in general, Stress-management techniques; “Grounding” or focus on external environment

52
Q

Pseudocyesis
Triazolam

A

BSN: 4th Quarter (10 decks)

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