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PNRS 252 Mental Health Nursing II > Midterm 1 > Flashcards

Midterm 1 Flashcards

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1
Q

Atypical Antipsychotics - Metabolic Syndrome Signs

A

**High fasting blood glucose: ** > 5.6

Hypertension:
>130/85

Abdominal obesity:
Waist to hip ratio (M >0.90; W > 0.85)
Waist circumference (M >102; W; 88)

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2
Q

Constellation (>3) of coronary artery disease risk factors. Metabolic syndrome signs

A

Abdominal obesity (Waist circumference M >102cm; W > 88cm)

Hypertension

Glucose intolerance/resistance (fasting glucose 100mg/dL)

Elevated triglycerides (150)

Low HDL (>40 males, >50 females)

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3
Q

CASE Approach

A

Chronological Assessment of Suicide Events

• Presenting suicidal events (how?)
•Recent suicide events (2 months)
•Past suicide events
•Immediate suicide events (now; what’s next?)

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4
Q

CASE Validity Techniques

A

Behaviour incident
Shame attenuation
Gentle assumption
Symptom amplification
Denial of the specific
Normalization

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5
Q

Behavioural Incident

A

What did they do? Ask questions about concrete behavioural fact

Example: “can you walk me through what happened the night you almost attempted suicide?”
..”what did you do next?” .. “what did you feel next?”

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6
Q

Shame Attenuation

A

Showing sincerity and wanting to understand rationalizations that shape how individuals perceive their reality.

Inquires about behaviours that individuals may be hesitant to discuss because of shame and guilt.

Enforces a stance for unconditional positive regard.

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7
Q

Symptom Amplification

A

How often/how intensely?

Example: “I only have a couple of drinks” - Clarify what “a couple” is for the client

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8
Q

Denial of the specific

A

When individuals deny generic questions.

Example:
Clinician: have you made any preparations for suicide?
Pt: No
Clinician: Have you written a will?
Pt: No
Clinician: Have you written a suicide note?
Pt: Well, yes, but only on my phone. I haven’t printed it or anything

Many people who say “no” to a general question will say “yes” when the question is asked about specifics

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9
Q

Functional vs Encapsulated vs Chaotic families

A

Functional: No preexisting family conflict or psychopathology. Suicide due to chronic physical illness

Encapsulated: Psychopathology and conflict generally observed only in deceased, not other family members

Chaotic: Clear evidence of psychopathology in multiple family members

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10
Q

Recovery-focused approach

A

Includes building relationships that fosters hope, empowerment, self-determination, and responsibility. Values address:

•Family engagement
•Respect and dignity
•Choice
•Determination
•Independence
•Family caregiver needs and sustainability

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11
Q

Ethical Considerations in nursing care

A

Competence

Privileged communication: Privilege provides relief from having to disclose info in court

Confidentiality:

Advocacy

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12
Q

Calgary Family Assessment Model Components

A

Developmental

Structural

Functional

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13
Q

Tidal Model

A

Theoretical model that recognizes individuals are in a constant state of change while negotiating their relationship with intrinsic and extrinsic influences and that growth and development occur through changes that follow patterns

Relevant to care of older adults in psych

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14
Q

Clinical Recovery vs Personal Recovery

A

Clinical Recovery: Reduction or removal of symptoms

Personal Recovery: Belief that even if they live with an illness, their life will continue and they will find a way to live well. Focus on strength/resources

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15
Q

4 R’s of trauma informed care

A
  1. Recognize your biases
  2. Regulation
  3. Relate (make a connection)
  4. Reason
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16
Q

First generation (typical)
vs
Second generation (atypical)

A

First gen: Significant neurological side effects such as EPS, dystonia(involuntary muscle contractions), neuroleptic malignant syndrome (life-threatening; fever, altered LOC, muscle rigidity)

Second gen: Metabolic syndrome. Still has neuro risks but lower risk

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17
Q

Extrapyramidal Symptoms (EPS)

A

Effects motor control and coordination.

•Tardive dyskinesia

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18
Q

Neuroleptic Malignant Syndrome

A

Life-threatening

fever
altered mental status
muscle rigidity
autonomic dysfunction

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19
Q

Dystonia

A

Neurological movement disorder. Involuntary contractions that cause slow repetitive movements or abnormal postures that can be painful

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20
Q

Waist / hip to waist ratio for obesity

A

Men:
Waist >102cm
Hip-to-waist >0.90cm

Women:
Waist >88cm
Hip-to-waist >0.85cm

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21
Q

Acute Stress Disorder

A

Symptoms appear 2-4 wks after event, resolve by 4 wks

Display of 3 dissociative symptoms during or after traumatic event and within month of experiencing trauma

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22
Q

PTSD

A

When psychological behavioural reactions persist over a month of an event

Flashbacks, nightmares, intrusive thoughts

Avoidance of situations/environments

Interventions:
CBT
Exposure
Group therapy
EMDR
Neurosequential therapeutics
Somatic centred approaches
meds

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23
Q

Perry’s Neurosequential Model of Therapeutics

A

NMT is a developmentally sensitive, neurobiology-informed approach to clinical problem solving. It’s not a specific technique or intervention.

Used for children but can be effective with adults.

Inverted triangle.
From bottom to top:

Brainstem -> Midbrain -> Limbic -> Cortical

Brainstem: Interoception (internal) and external input from world. HR, fight/flight.

Midbrain: arousal/sleep/appetite/movement

Limbic: Emotional response, memory, reward, bonding

Cortical: Creativity, empathy, self-control, values, language, time

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24
Q

Positive relationships develop when:

A

The nurse establishes credibility (knowledgeable)

The focus is on the immediate intervention need of the family

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25
Q

Challenges for families

A

Difficulty in access related to limited capacity

Poor information sharing between provider, consumer and carer

Carers not always included in decisions

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26
Q

Community treatment orders (CTOs)

A

Provide a legal framework that requires adherence to treatment in order to avoid treatment in restrictive environments such as inpatient units

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27
Q

Recovery Oriented Practice: How?

A

Focus on strengths

Belief in potential for growth

Hope

Understand that recovery is individualized process

Being supported by others

Develop connections to community and natural supports

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28
Q

Psychosocial Rehabilitation

A

Promotes personal recovery, successful community integration and satisfactory quality of life for persons who have mental illness

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29
Q

Phase I, Phase II and Phase II recovery outcomes

A

Phase I
(Acute) safety and medical stabilization

Phase II
(Stabilization) Adhere to treatment and self care

Phase III
(Maintenance) Building on success. Living more individually with more satisfaction. Prevent relapse

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30
Q

Recovery vs Rehabilitation

A

Rehabilitation
Focuses on managing deficits and helping them learn to live with illness

Recovery
•Focuses on achieving goals of patients choosing
•Collaborative, client-centred
•Focus is on person and future

31
Q

Trauma Informed Care Principles

A

Trauma awareness/understanding

Cultural competence

Promote Safety/Stability

Compassion and dependability

Collaboration and empowerment

Belief in Resilience and recovery

32
Q

PTSD Risk Factors

A

Biological:
•Hypothalamic-pituitary Adrenal Axis
•Deficits in arousal and sleep regulating systems
•Endogenous opioid system problems

Psychological:
•Mood disorders
•Anxiety disorders

33
Q

Considerations for children with PTSD

A

Less likely to show distress. Express emotions through play

34
Q

Sequential Engaging & processing

A

Builds off neurosequential model.

Remember the upside down triangle. Bottom to top: Brainstem, midbrain, limbic, cortical.

Sequential engaging and processing
Midbrain: Regulate
Limbic: Relate
Cortical: Reason and reflect

35
Q

Post Traumatic Growth

A

Growth happens are a result of the struggle to find a new normal through emotional and cognitive processing. NOT because of the direct result of trauma

•Life appreciation
•Closer relationships
•Setting new goals and letting go of old ones
•Increased personal strengths
•Having a greater connection

36
Q

Allostasis

A

Stress.

The adaptive processes that maintain homeostasis through the production of mediators such as adrenalin, cortisol and other chemical messengers.

37
Q

Depersonalization vs Derealization

A

Depersonalization
A state in which one’s thoughts and feelings seem unreal or not to belong to oneself, or in which one loses all sense of identity.

Derealization
A mental state where you feel detached from your surroundings. People and objects around you may seem unreal.

38
Q

Fear conditioning

A

The pairing of an initially neutral stimulus with a fear eliciting stimulus

39
Q

Paresthesia

A

pins and needles sensation

40
Q

Each “type” of anxiety disorder has symptoms clustered in 4 areas. What are those 4 areas?

A

Physical response

Thoughts

Emotions

Behaviours

41
Q

Agoraphobia

A

Excessive anxiety or fear about being in places or situations in which escape might be difficult or embarrassing

42
Q

Generalized Anxiety Disorder

A

Physical response: dizziness, itching, choking feeling, GI changes, blurred vision, nausea, vomiting, increased HR

Thoughts: automatic negative thoughts, catastrophizing, excessive worry

Emotions: Agitation, sadness, guilt

Behaviours: Avoidance, procrastination

43
Q

Pharmacotherapy for anxiety

A

SSRI/SNRI are first line for long-term Tx

Benzodiazepines
Hypnotics
OTC

SSRI: Zoloft
SNRI: Effexor

Non-benzodiazepines: Buspirone (good for anxiety, not panic). Displaces digoxin, a med used for irregular HR

Zolpidem (sleep)

Hypnotics: Zopiclone (increase GABA activity), Temazepam

OTC: Antihistamines, melatonin

44
Q

Benzodiazepine Side Effects

A

CNS depression
Autonomic effects
Paradoxical reactions

45
Q

Panic disorder most closely associated with addiction to what?

A

Alcohol

46
Q

GAD closely associated with addiction to what substances?

A

Cannabis, etc. Less commonly alcohol

47
Q

Trauma Resiliency Model

A

The model is a brief, effective, body-based crisis response intervention that takes advantage of the body‘s natural propensity to self regulate, using the biological stabilization skills of tracking internal sensations of well-being

48
Q

Exclusion

A

Major health problem globally

Impacts all populations, community, individuals

Carries mental health consequences on a mass scale, ranging from mild depression to suicide

49
Q

Social Exclusion

A

Lack of or denial of resources, rights, and goods/services and inability to participate in normal activities available to the majority of people in a society, whether in economic, social, cultural, or political areas

50
Q

Delirium tremens

A

Most severe form of ethanol withdrawal, manifested by altered mental status (global confusion) and sympathetic overdrive (autonomic hyperactivity), which can progress to cardiovascular collapse

51
Q

Motivational Interviewing

A
52
Q

What is the most preventable cause of death globally?

A

Tobacco/Nicotine use

53
Q

Biologic Theories in Addiction

A

Interplay between stressors in the environment and genes (epigenetics). Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, and the environment and individuals life experiences

54
Q

Psychological Theories in Addiction

A

The contribution of psychological and psychiatric factors that reflect the individuals preferences, experiences, or problems

55
Q

Social Theories in Addiction

A

Substance availability, legislation, and other health policies. Culture is another factor influencing addiction prevalence rates

56
Q

Spiritual Theories in Addiction

A

The relationship between an individual snd the sacred

57
Q

Substance Use Disorder: Medical Model Approach

A

Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences

58
Q

Substance Use Disorder: sociological Perspective

A

Looks at social influences; economic, homelessness, health inequities..

59
Q

What are the 4 overarching Criteria of Substance Use Disorder?

A

•Impaired control (4)

•Social Impairment (3)

•Riskier use (2)

•Pharmacological Criteria (2)

60
Q

Substance-Induced disorders

A

Intoxication, withdrawal, and other substance/medication-induced mental disorders (psychosis, anxiety, etc), caused by the effects of substances

61
Q

Impacts of substance use disorder

A

Relationships

Economical

Public health (eg. opioid crisis)

62
Q

Substance Withdrawal

A

Development of a substance-specific maladaptive behavioural change that is due to the cessation, or reduction, of heavy and prolonged substance use

Can be life threatening or just uncomfortable

63
Q

Substance/medication-induced mental disorders

A

Challenges that develop when people who did not have mental health challenges before using now do

64
Q

What is a standard drink?

A

341 ml (12 oz) bottle of regular beer

65
Q

What is a standard drink?

A

341 ml (12 oz) bottle of regular beer

1.5 oz of 80-proof spirits

5 oz wine

66
Q

Alcohol Use Disorder

A

A problematic pattern of alcohol use leading to clinically significant impairment or distress, manifested by at least two of the following occurring within a 12 month period:

  1. Alcohol is often taken in larger amounts over a longer period than was intended
  2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use
67
Q

CAGE Questionnaire

A
68
Q

COWS

A

Clinical Opiate Withdrawal Scale

69
Q

CIWA

A

Clinical Institute Withdrawal Assessment for Alcohol

70
Q

SUD assessment includes:

A

Standard use assessment

Comprehensive physical assessment

Collateral information assessment

71
Q

Which substance are older adults more often hospitalized for?

A

Opioids

72
Q

Family Assessment Components

A

Structural: Who, what connections, context

Developmental: Life cycle events/sequence

Functional: Detail behaviour toward eachother

73
Q

4 Pillars of Substance Use Strategy

A

Prevention
Encourages people to make healthy choices, provide opportunities for people to reduce likelihood of substance use (affordable housing, employment training, jobs)

Treatment
Access to services, outpatient services, Opioid dependency program, residential treatment

Enforcement
Non criminalization, improving safety, community engagement

Harm Reduction

74
Q

Pragmatism

A

Recognize that substance use is inevitable in society

PNRS 252 Mental Health Nursing II (1 decks)

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