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Nursing 301 > Midterm #2 > Flashcards

Midterm #2 Flashcards

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1
Q

What is continuum of care?

A

integrated system of care

*involves services & integrating mechanisms that guide people over time

physical/mental/social services with all levels of intensity

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2
Q

3 major forces driving continuum of care

A

1) Decreased length of hospital stay
2) Movement towards more home care/community care e.g. increased family involvement in care
3) Regionalization

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3
Q

2 goals of continuum of care

A

to provide seamless care from hospital to home
(pt/family educated on what to expect)

to maintain quality/continuity of patient care in different environments

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4
Q

what is seamless care

A

is a smooth and safe transition of a patient from the hospital to the home.

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5
Q

what is continuity of patient care?

A

personalized, continuous care that begins at point of entry into HC system until problems/needs resolved

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6
Q

how to ensure continuity of patient care

A

interpersonal/interdisciplinary practice
collaboration/communication
focus on patient/family

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7
Q

Regionalization history

A

emerged in 1993 in New Directions for Health BC

1996: downsized from 20 to 11
2002: downsized to 6 (5 geographical, 1 provincial)

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8
Q

5 goals of regionalization

A

to integrate continuum of care concept

looks at unique health needs of each community

to promote collaboration/communication between agencies

to ensure patient-centered care via interdisciplinary teams

to reduce agency centeredness (decreasing cost/resource waste)

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9
Q

How many stages are in discharge planning for nurses?

When does it begin?

A

4 stages

Begins upon admission

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10
Q

Stage 1

A

The nurses role at first point of contact with hospital:

Involves:
admission assessment
full dimensional: home environment, social supports, preferences
getting to know patient

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11
Q

Stage 2

A

Nurse as the patient advocate

Involves:
other HCP (referrals, family conference)
initial d/c date is decided

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12
Q

Stage 3

A

Getting ready to go home

Nurse contacts community team

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13
Q

Stage 4

A

Transition back home or to another facility

Involves other services: home health, patient, family, PT, OT etc.

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14
Q

5 components of an effective discharge

A

1) occurs in stages
2) Inter-professional collaboration
3) Good timing and receipt of information
4) Clear communication (pt, family, PT, community resources)
5) “Close the loop” and “fill in the picture”

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15
Q

5 Barriers to discharge planning

A 
Time
Cost
Lack of motivation
Patient being overwhelmed 
Communication barriers
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16
Q

3 benefits to discharge planning for the patient/HCP

A

patient:
Improved quality of care -> improved outcome
Decreased hospital stays
Improved pt/family fears/anxiety

HCP:
Increased awareness of resources
Decreased frustration
More efficient use of professional time

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17
Q

4 key objectives to delivery of home care*

A

1) Provide the support necessary for clients to remain in their own homes
2) Provide at-home services to clients who would otherwise require admission to hospital
3) Provide assisted living and residential care services to clients who can no longer be effectively supported in their own homes
4) Provide End of Life Care

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18
Q

Home health philosophy

2 points

A

promote well-being, dignity, independence of both pt. & family

to offer support (not replace) and complement care provided by clients/families/community services

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19
Q

4 Principles guiding home care philosophy

A

Ensure informed decision making

Clients have right to make own care decisions including right to ‘live at risk’

Care will *supplement/complement but NOT replace client’s efforts to care for self *

HHC services will promote the well-being, dignity and independence of clients

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20
Q

3 triggers for home health:

A

D/C from hospital r/t acute event i.e. CVA

Worsening of chronic health condition requiring more care than available in home setting

Person with ongoing difficult health issues finding it more and more difficult to care for themselves at home.

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21
Q

Who can make a referral for home care

A 
Clients
Family
Physicians
Concerned neighbours/friends
The hospital

All referrals go through HHC office Intake nurse

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22
Q

Home health intake process

Community vs. Hospital

A

Within Community:
All referral sent to HHC office intake nurse

Nurse screen referral & prioritizes it (1-3)

Nurse forwards referral to appropriate discipline

Within Hospital:
In hospital referalls made online

The Hospital Liaison Nurse will respond to discharge planning needs that arise

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23
Q

Home health professionals involve..

A

Case Managers

Liaison Nurse ( formerly known as Hospital Case Managers)

Home Care Nurses(RNs & LPNs)

Social Worker/Palliative Social Worker

Rehabilitation Therapists (OT/PT)

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24
Q

5 steps to case management?

A
  1. comprehensive assessment- I.D. strengths/weaknesses
  2. develop individualized care plan
  3. arrange various services
  4. monitor ongoing client needs
  5. re-assess/review care plan
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25
Q

purpose of long-term care

A

to assist adults with chronic health related issues to maintain optimal level of independent functioning

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26
Q

3 common health care resources that case managers use

A

Respite/Respite Beds

Community Health Workers

Residential Care

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27
Q

3 common community resources that case managers use

A

Family/friend support & other support groups

Life Line

Shopping Programs

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28
Q

7 functions of home care RNs

A

*Coordinate care

Assess
Teach
Support/counsel

Direct Care
Referrals

End of Life Care

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29
Q

home care LPN functions

A

Simple dressings

DOTs ( e.g..medication management, catheter care, eye drops, ostomy care)

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30
Q

What do rehab therapists do?

A

Includes OT and PT

Assesses:
safety in home 
equipment needs
mobility/adaptive aids
falls prevention
post surgical therapy
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31
Q

What do social workers do?

A

Assisting with complex care needs of clients including:

financial assistance
housing issues
drug and alcohol issues
abuse issues

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32
Q

Criteria for costs of home health

A

Which program they are on
i.e. if the client is palliative they receive 6 months free service.

If the client is coming out of hospital they will likely get 2 weeks free

If the client is to receive services for an extended time then the charge is based on a financial assessment which will be made by HHC Case Manager.

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33
Q

Who is eligible to receive home care servies?

A
  • Canadian Citizen/landed immigrant status
  • BC residency
  • Require care following D/C from hospital, care at home rather than hospital, or care because of a terminal illness
  • Have a local doctor

We do not serve:
Persons whose primary handicap is developmental disability.

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34
Q

Who is eligible for subsidized services? (financial support)

A

Under 19 years of age

Lived in BC for 3 months

Canadian citizen or permanent resident status*

Unable to function independently d/t chronicity or terminal illness

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35
Q

what are DOT’s?

A

Delegation of tasks

DOT’s are often for medication management, catheter care, eye drops, ostomy care

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36
Q

What is cognition?

“PR-JIM”

A

Cognition refers to a system of interrelated abilities that allows us to be aware of ourselves/our surroundings

 Perception 
 Reasoning
 Judgment
 Intuition
 Memory
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37
Q

Types of cognitive disorders

A

Dementia
Delirium
Depression

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38
Q

What are amnestic disorders?

A

memory impairment not related to cognitive disorders
e.g. exposure to environmental toxins
substance abuse
head trauma

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39
Q

What is delirium?

A

An acute cognitive impairment

reversible

symptoms may differ

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40
Q

3 causes of delirium?

A

Medical conditions: acute crisis, Infections, F&E imbalances, hypoxia/ischemia

Medications & substances (surgical sedatives)

Elderly (65-75)

Unknown factors

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41
Q

4 types of delirium

A

hypoactive/mild (Lethargic/depressed, fatigued/drowsiness- highest mortality rate)

hypoactive/severe (more intense symptoms)

hyperactive (Psychomotor agitation, aroused/restless)

Mixed

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42
Q

Delirium interventions

A

Bed alarm
one-to-one
“soft” restraints (e.g. pelvic restraints, wrist constraints)

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43
Q

What is dementia

A

Global, chronic cognitive impairment

irreversible & progressive

Symptoms are the same no matter what the cause

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44
Q

5 types of dementia

A 
Alzheimer’s
 vascular dementia
 dementias 2o to medical condition
 dementias 2o to substance uses
 dementias with mixed / unknown causes

*different dementias effect different areas of brain

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45
Q

Causes of dementia

A

anything that damages brain cells- depends on type of dementia

Multiple theories (plaques, tangles, cell death, genetics)

not a disease- but can occur as a result of diseases (CVA, Parkinson’s, head trauma)

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46
Q

Hippocampus function

A

formation of memories (long-term)

shrinks in dementia

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47
Q

Parietal lobe function

A

sensation & sensory processing

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48
Q

Occipital lobe function

A

visual reception and interpretation

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49
Q

Cerebellum function

A

movement

muscle coord

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50
Q

Temporal lobe function

A

Language
Learning
Short-term memory

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51
Q

Frontal lobe function

A

Thought processing
Language output

Programming of activities
Prioritization
Personality
Bheaviour

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52
Q

Difference between delirium/dementia/depression

A

** see chart

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53
Q

6 Risk factors for delirium

A

Age
Admission to new facility
pre-existing dementia

poly-pharmacy
changes in vitals
pain

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54
Q

Diagnostics for delirium

A

Note cognitive changes
review patient history
assessment

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55
Q

S&S of delirium

A

changes in:
A&O, focus, speech, language, memory

insomnia
social changes
fluctuating symptoms throughout the day.

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56
Q

3 priorities for delirium

A

Elimination or correction of underlying causes

Symptomatic measures e.g. treat cause of Delirium such as UTI

Supportive measures e.g. bring patient by nurses station

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57
Q

Interventions for delirium:

physiological/psych/social

A

physiological: assessment, labs, meds, safety checks, avoid anticholinergics
psychological: MSE, reduce stimuli, non pharmacological comfort measures e.g. pets, warm blankets
social: family roles, social supports, providing information

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58
Q

Why avoid anticholinergics with delirium

A

further depresses the CNS

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59
Q

Delirium prognosis

A

Reversible if treated

Often causes lasting complications e.g. higher risk of developing dementia

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60
Q

Risk factors for dementia

A

Age (65+)
genetics

Down’s syndrome/Parkinsons
Cardiac disease
Head trauma

lower socioeconomic status
lifestyle factors
exposure to viruses/environmental toxins

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61
Q

5 Diagnostics for Dementia

A

Aphasia: alterations in language/speech

Agnosia: failure to recognize/identify objects

Apraxia: impaired motor activity

Disturbance of executive functioning - Ability to think abstractly, plan, initiate, stop inappropriate behaviour

Significant decline in normal functioning

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62
Q

4 priorities with dementia

A

Delay cognitive decline
Attend to physical needs
Protect from harm
Support family members

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63
Q

Interventions for dementia

psych/physical/social

A

Physiological interventions:
Promote self-care, monitor activity, nutrition, bowel/bladder, sleep/wake cycle, PRN meds

Psychological interventions:
Validation, tools for memory enhancement (pictures, whiteboard),

Social interventions: encourage participation, alter environment, home visits, create a home-style atmosphere

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64
Q

Alzheimers

4 points

A

memory/ADL impairments

effects all areas of brain

more common in women

the younger the age, the more rapid/severe

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65
Q 
Vascular dementia
(3 points)
A

Symptoms dependent on area effected
Executive functioning goes early

Cerebrovascular lesions

Sudden onset & step wise progression

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66
Q

What medical conditions often result in dementia

A

AIDS
syphillis

Parkisons
Huntingdons

head trauma
hydrocephalus
meningitis

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67
Q

Substance induced dementia causes

A

drugs, alcohol, environmental toxins, Korsakoff’s

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68
Q

Types of mixed dementia

A

Lewy body, frontotemporal lobe dementia

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69
Q

What does cognitive assessments involve?

A 
MMSE
A&O (person,place,time)
Attention span
Speech
Appearance (appropriateness)

Ask family questions
Compare to baseline/chart
How well they attend to ADL’s
Spatial recognition (unable to find front door)

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70
Q

What is poverty?

A

Material/social deprivation d/t political/public policies re: distribution of resources in the community

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71
Q

4 types of poverty

A

Absolute:
no resources to meet basic biological/physical needs

Relative:
standards/resources below average person

Low income cut-off line (LICO):
majority of income is spent on basic needs, strained compared to other average families

Core need:
Household falling below 1 or more standards: adequacy, suitability, affordability.
*Use 50% or more of TOTAL household income for rent
e.g. pay rent/bills or feed children

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72
Q

What does homelessness result in?

A

powerlessness
hopelessness
vulnerability
decreased resiliency

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73
Q

continuum of homelessness

A

from inadequate housing, to living in shelters, to absolute homelessness

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74
Q

Two categories of homelessness

A

Absolute (primary)

Relative (secondary)

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75
Q

What is absolute homelessness

A

Totally without shelter of any kind

Basic needs totally unmet

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76
Q

What is relative homelessness

A

Does not meet basic needs as defined by UN

protection from elements
secure/personal safety
Safe water/sanitation
access to employment/education/health care
affordable
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77
Q

4 types of homelessness

A

Chronic: long-term, engage in substance abuse, psychiatric problems

Periodic: temporary, leave home when tensions/pressures become intense

Temporary: result of crises from situational transition

At risk: too much of household income going to rent

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78
Q

Causes of homelessness

A

1) structural factors
2) personal factors

** see powerpoint for more specific

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79
Q

Structural factors resulting in homelessness

A

social safety-net cutbacks:
e.g. government policies/programs cut back on disability, EI

broader macro-economic & societal factors:
e.g. globalization, changed social contract, less job security, less affordable housing available

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80
Q

Personal factors resulting in homelessness

A

Morals (deserving poor vs. undeserving poor)…

leading to various discourses*

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81
Q

What are discourses

A

the way which society chooses to make sense of phenomenon

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82
Q

Types of discourses r/t homelessness

A

Neo-liberal

Conservatism

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83
Q

Neo-liberal discourses

A

Believe that government/state interferes with the operation of market/economy to provide benefits r/t welfare

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84
Q

Neo-liberal discourse history

A

1990- federal public policy changes
Chretien government withdrawal funding/involvement with affordable housing initiatives, more funding put towards business/trade

as a result increase in homelessness

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85
Q

Neo-conservatism discourse

A

Similar to neo-liberal discourse but adds moral tone by attributing blame to those who are poor (Campbell-BC, Klein-Alberta)

people living in poverty are responsible for themselves

other provinces express this more subtly via decreasing funding/not raising minimum wage

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86
Q

What does neo-conservative discourses result in

A

poor bashing
blaming the poor –> ostracism
disrespectful treatment

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87
Q

Types of discourses related to poverty

A 
Moral underclass (MUD)
Social Integrationist (SID)
Redistributionist (RED)
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88
Q

MUD

A

believes that the underclass or socially excluded individuals are culturally different from mainstream

Impacts public policies re:
social assistance
minimum wage
EI eligibility 
resulting in: difficult living conditions for those who rely on these services, "poor bashing" - stigmatization- adding psychological/social insult to the exisiting difficulties, become more dependent
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89
Q

SID

A

Believe in coercing non-working individuals into paid-labour
e.g. punitive workfare initiative programs across Canada

Hides issues of inequality of paid workers
e.g. ignores gender issues (men being paid more)

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90
Q

RED

A

Believe that poverty is caused by social exclusion

Believes that poverty can be reduced through benefit increases

Values un-paid work, and aims to increase power/resources

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91
Q

5 poverty/homeless theories

A 
By choice/personality theory
Social disengagement/disaffiliation theory
Social disconnection theory
Housing/poverty theory
Poverty as social issue theory
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92
Q

3 social factors r/t poverty/homelessness

A

often are the breaking point resulting in homelessness

1) severe addiction/mental illness
2) Youth “aging out of care”
3) Family violence/social breakdown (women/youth)

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93
Q

What is a “harm reduction” approach

A

attempts to decrease the harms of illegal drugs

involves safety promotion, death/disability prevention, treating all individuals with respect/dignity/non-judgemental

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94
Q

What is insite

A

the only legal supervised drug injection site in North America

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95
Q

4 purposes of insite

A
  • improve health of drug users: prevent overdose, drug transmission
  • reduce harms associated with illegal drugs: discarded needles, crime
  • increase access to social/health services by IV drug users
  • reduce social/legal/incarceration costs associated with drug use
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96
Q

4 roles of outreach nurses

A

build relationship
primary nursing care
education
partnership & referrals to health/social systems

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97
Q

Examples of micro, meso, macro collaboration

A

READ ARTICLE (Insite)

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98
Q

Common homeless populations

A

adults
youth

sex-trade workers/MSWM
mentally ill
aboriginals
single parents (women & children)

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99
Q

5 common homeless health issues adults

A

psych episodes (as a result of medication lapses, chaotic lifestyle)

Infections- upper resp., TB

Impaired skin integrity: wound, abscess, cellulitis (as a result of poor injection technique, IV substance abuse etc.)

Scabies/lice/bed bugs

Malnutrition/dehydration/dental

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100
Q

3 common health issues in homeless youth

A

STD’s/HIV/HCV

anxiety/fear/insomnia

depression/suicidal ideation

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101
Q

4 health issues in homeless sex trade workers

A

STD’s/HIV/AIDS

unwanted pregnancies/unsafe abortions

GU infections/GI diseases

Risk-taking lifestyle

Rape

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102
Q

5 health issues in homeless men who have sex with men

A

STD’s/HIV/AIDS

GI infections

Trauma: rape

Addiction

Discrimination/stigma

103
Q

5 health issues in homeless single parent mothers

A

stress-anxiety-depression-insomnia

fear of children being taken away

self neglect–>malnutrition/dehydration

partner abuse

negative coping- substance abuse

104
Q

5 health issues is homeless children

A

upper respiratory infections (2x more)

Skin disorders/infestations (4x more)

GI/GU problems (4x more)

Ear infections (2x more)

malnutrition- poor hygeine (dental issues)- emotional disorders

105
Q

5 health issues in homeless aboriginals

A
  • alcoholism/drug use
  • lung cancer (second hand smoke)
  • chronic wounds to lower legs/feet
  • Trauma/rape/violent beatings
  • STD’s
106
Q

5 common traumas treated in ER

A 
Rape/IPA
Assault
Lacerations/contusions
MVA
Overdoses
107
Q

negative factors impacting health of homeless people

A

increased morbidity rates in all dimensions -> leading to premature death

exposure to infection/diseases
stress-> triggering genetic disposition to diseases;
malnutrition-> chronic conditions
increased trauma/violence
poor living conditions
aggravated mental illness
substance abuse
108
Q

Barriers to accessing health care

A

poverty (no fixed address)

no tax assessment- no care card (marginalization)

multiple diagnoses: mental illness/addiction

lack of transportation/fare

negative stereotyping/disrespect

fear of being caught for illegal activities

109
Q

what is fear?

A

a cognitive response to a specific object that a person can identify

involves cognitive appraisal of a threatening stimuli

110
Q

What does fear lead to

A

anxiety

111
Q

What is anxiety

A 
subjective feeling of:
uneasiness
tension
apprehension
dread

results from external threat to ones integrity

112
Q

function of anxiety

A

to warn of potential threat/conflict/danger

113
Q

main difference between anxiety/fear

A

anxiety has no identifiable object/cause, very subjective

114
Q

Stages of anxiety

A

mild
moderate
severe
panic

115
Q

Mild anxiety

A

Vitals stable -few physiological responses

Still able to focus- thoughts are controlled

Feel relatively relaxed/safe

116
Q

Moderate anxiety

e.g. writing a paper

A

Vitals elevate slightly - more muscle tension

More focused, optimal state for problem-solving

Feelings of readiness/challenge, learn new skills, energized

117
Q

Severe anxiety

A

Fight or flight response- physiological responses (increased BP, increased BG, decreased blood flow to gut etc.)

Focus greatly narrowed - problem-solving is difficult, selective attention

Feel overwhelmed, detached, distortion of time, activity can increase (restlessness) or decrease

118
Q

Panic anxiety

A

fight or flight continues until sympathetic nervous system activated and body reaches exhaustion:
BP drops, pale, disoriented
lack coord, limited sensation/perception, don’t respond to stimuli

No focus, unable to problem solve, unrealistic, dissociation can occur

Feel helpless/angry/scared, may be extremely active or drawn

119
Q

4 types of anxiety

ST-SF

A

Signal
Trait
State
Free-floating

120
Q

What is signal anxiety

A

when a trigger is identified

e.g. balloon

121
Q

What is trait anxiety

A

function of personality structure

e.g. “being an anxious person”

122
Q

what is state anxiety

A

occurs in conflicting/stressful situations

123
Q

What is free-floating anxiety

A

not associated with any idea or event

e.g. unsure of cause, wake up and just have feeling

124
Q

5 types of anxiety disorders

A 
Generalized Anxiety Disorder
Panic disorder
Phobias
PTSD & Acute Stress Disorder
OCD
125
Q

population

A

more common in women

late adolescents- mid 30’s

126
Q

Generalized anxiety disorder

A

Excessive anxiety and worry that occurs more days than not

127
Q

Generalized anxiety disorder criteria

A

● At least 6 months of duration

● Presence of 3 of the following:
restlessness- edginess- irritability
muscle tension- sleep disturbance
fatigue- poor concentration

● Anxiety and worry that interfere with normal social and occupational functioning

128
Q

Generalized anxiety disorder sx

A
  • Difficult to control symptoms, lots of physical symptoms: chest pain, SOB, GI symptoms, migraines
  • Make sure that it is not a result of substance abuse
129
Q

What are panic attacks

A

A physical symptom of anxiety - not a psychiatric illness

Period of intense fear, discomfort, dread or doom

130
Q

onset of panic attacks

A

abrupt, peaks in 10 mins

131
Q

interventions for panic attacks

A

prevention

132
Q

panic attack sx

A 
has at least 4:
Racing heart-palpitations-chest pain
hot flashes- sweating - trembling 
pain- nausea- dizziness- SOB
Fear of losing control, feelings of impending doom/death, trembling, depersonalization
133
Q

Criteria for panic disorder

A
  • reoccuring/unexpected panic attacks
  • followed by:
    concern for additional attacks
    worry about implications of the attack
    change in behaviour
134
Q

Agoraphobia

A

anxiety about being somewhere where escape is difficult- avoid situations as a result

e.g. fear of open spaces/closed in spaces

135
Q

What are specific phobias?

A

Fear of the presence/anticipation of a specific object/situation

exposure provokes anxiety/panic attack in attempt to avoid exposure

Recognize fear is excessive/unreasonable

136
Q

Social phobia

A

Fear of social/performance situations that expose individual to scrutiny

Avoid these situations

only maintain relationships with familiar people

137
Q

social phobia tx

A

psychotherapy

SSRI

138
Q

Symptoms of PTSD

A

Symptoms present for >1month and impairs function

Symptoms are reoccurant (nightmares)
Heightened arousal (irritation/anger outbursts)
Avoid situations
139
Q

Acute stress disorder

symptoms

A

Experience three symptoms of dissociation: numbing, detachment, dazed, derealization, depersonalization, dissociative amnesia

The symptoms of dissociation prevent the individual from adaptively coping with the trauma

140
Q

what is dissociation

A

subjective sense of numbing/detachment

reduced awareness of surroundings

141
Q

Differences between acute stress disorder and PTSD

A

Acute stress disorder:
Short-term (2-30 days)
Unable to pursue everyday tasks
experience dissociation

142
Q

obsession vs. compulsion

A

Obsession:
unwanted thoughts/impulses/images that cause anxiety

cannot be ignored-interferes with functioning

Compulsion:

  • repetitive behaviours that the person feels driven to do in response to the obsession*
    e. g. little girl washing hands repetitively

● Treated with behavioural therapy or medications (SSRIs, TCAs), suppress the thoughts

143
Q

OCD tx

A

behavioural therapy
meds: SSRI, TCA
suppress thoughts

144
Q

Nursing diagnoses for anxiety

A

Ineffective coping
Self-care deficit
Social isolation
Spiritual distress

145
Q

Anxiety interventions

A
  • Promote coping mechanisms/focus on strengths
  • DB
  • PRN medications
  • Warm blanket
  • Provide support
  • Create a trusting/therapeutic relationship
  • Sleep-wake patterns
  • Decrease caffeine/stimulants
  • Assertiveness
146
Q

Common anxiety meds

A 
● Benzodiazepines
Lorazepam, Clonazepam, Diazepam
- highly addictive
- increasing tolerance
- quick acting- onset/duration short

● SSRIs/SNRIs
Fluoxetine, Paroxetine, Sertraline, Venlafaxine
- onset 2 weeks
- may require PRN benzo in meantime

● TCAs
Clomipramine

● Other
Beta-blockers, Buspirone, Tegretol

147
Q 
Clozapine
class
action
onset/peak/duration
adverse effects
considerations
A

antipsychotic used with schizo/bipolar

action: binds to dopamine receptors in the CNS, blocks anticholinergic/apha-adrenergic activity
onset: unknown, peak:one week, duration: 4-12h

adverse effects: agranulocytosis (decreased WBC), neuroleptic malignant syndrome

Considerations:
- requires weekly monitoring every week for first 6 months
(standing/lying BP, vitals, sore throat, extra salivia, dizziness, nausea)
- use as last resort

148
Q

What is metabolic monitoring

A
  • see handout in adobe
149
Q

What is an personality disorder

A

Axis II

pattern of inner experience/behavior that deviates markedly from expectations of culture

150
Q

how is pattern of personality disorder recognized

A

Through cognition:

affect
interpersonal functioning
impulse control

151
Q

types of disorders

A

Axis I- state disorders (short-term, associated with trauma)
Axis II- trait disorders (long-term, personality disorders)

152
Q

Onset/duration/characteristics of personality disorders

A

onset: early (childhood-adolescent)
duration: long
characteristics: inflexible, pervasive, leads to distress/functional impairment

153
Q

Causes of personality disorders

A

psychological

genetics: twins
neurochemical: serotonin levels/lack of opioid receptors

154
Q

psychological factors

A

Freud: a result of unsuccessful completion of 5 psychosexual stages of development

object relations: improves ability to relate to others as personality develops, if unable to relate relationship to object then unable to develop healthy relationships
e.g. teddy bear and mom

155
Q

Types of personality disorders

A

Cluster A
Cluster B
Cluster C

156
Q

Cluster A personality disorders

A

odd & eccentric

paranoid personality disorder
schizoid personality disorder
schizotypal personality disorder

157
Q

Cluster B personality disorders

A

dramatic & erratic

Antisocial
Borderline
Histrionic
Narcissistic

158
Q

Cluster C personality disorders

A

anxious & fearful

dependent
avoidant
OCD

159
Q

S&S of cluster A

A

difficulty relating to others
isolation
unusual ideas/perceptions

160
Q

paranoid personality disorder

A

suspicious
difficulty with relationships- critical with others
difficulty expressing emotions

161
Q

schizoid personality disorder

A

no desire for relationships

may seem cold/flat affect

162
Q

schizoidtypal personality disorder

A

magical thinking
unusual perceptions/experiences
social anxiety

163
Q

Nursing interventions for cluster A

A 
build rapport/trust
be non-judgmental & accepting
reflect on situation
slow intro to social situations
role model
164
Q

Cluster B S&S

A

dramatic approach to situations
difficulty maintaining relationships
impulsive
highly emotional

165
Q

antisocial personality disorder

A

infancy-like behavior
crime & lack of remorse
aggressive
charming but manipulative

166
Q

borderline personality disorder

A

fear of abandonment*
boredom/emptiness
unstable affect
splitting

167
Q

histrionic personality disorder

A

draw attention to self
excessive emotions-rapid/shallow
over intimate

168
Q

Narcissistic personality disorder

A

self-absorbed
put self higher and will exploit others to make self look/feel better
grandiose

169
Q

nursing actions for Cluster B

A

identify primary nurse to avoid splitting

clear & concise communication

set mutual goals

set boundaries

170
Q

Cluster C S&S

A

social inhibition

internalize blame & emotions

171
Q

dependent personality disorder

A

no coping mechanisms

will use nurse/family member as coping mechanism

172
Q

OCD

A

inflexible
perfectionist
cannot delegate tasks
fear of loss of control

173
Q

avoidant personality disorder

A

isolation
big fear of rejection
fear of crowds/social situations

174
Q

Treament for personality disorders

A 
Team approach (know primary nurse)
Art/music
OT/recreation
Individual reflection
Family
175
Q

What is milieu

A

getting involved with everyday tasks, routine, maintain consistency

176
Q

3 common meds for personality disorders

A

Benzos (calm patient)
Antidepressants (monitor serotonin levels)
Anticonvulsants (stabilize mood)

177
Q

cons of pharmacological tx

A

risk for poly-pharmacy
risk of substance abuse
risk of overdose
risk for dependency

178
Q

Discharge planning for personality disorders

A
  • safety
  • arrange follow-up appointments
  • acute sx management
  • educations re: meds
  • connect with resources
179
Q

Bipolar onset

A

late teens- early 20’s

180
Q

Depression onset

A

mid 30’s

181
Q

Depression population

A

greater in caucasians, hispanics, lower socioeconomic groups

more often in women

182
Q

Bipolar population

A

occurs more often in higher socioeconomic groups

183
Q

What is a mood disorder?

A

often a comorbidity

a stress response to illness
a physiologic response to patho
“ “ to medication

184
Q

What does mood disorders involve

A

bipolar

depression

185
Q

two types of depression

A

Major depressive disorder

Dysthymic disorder

186
Q

What is major depressive disorder

A

aka unipolar depression
episodic
5 sx present most of the day, every day, for at least 2 weeks

187
Q

MDD sx

A

sx occur from result of disorder, not from substance/medical conditions/grief&loss

  • depressed mood
  • anhedonia (lack of interest in activity)
lack of energy
lack of concentration
low self-esteem
hopelessness
SI, suicide plan, attempt
ETC.
188
Q

What is dysthymic disorder

A

chronic
low-level depression

depressed mood & at least 2 symptoms most of the day, nearly every day, for 2 years

189
Q

dysthymic disorder sx

A

lack of appetite/overeating
insomnia/hypersomnia

hopelessness
low self-esteem

low energy
poor concentration
anger/irritability

190
Q

Depression medications

A

TCA
Monoamine oxidase inhibitors
SSRI

191
Q

what do TCA’s do

A

block neuronal uptake of norepinephrine & serotonin

serotonin: contribute to well being/happiness
norepinephrine: concentration

192
Q

what to MAOIs do

A

inhibits MAO-A in nerves

increasing amount of norepinephrine/serotonin available for release

193
Q

what do SSRI’s do

A

inhibit serotonin reuptake

intensify transmission at serotogenic synapses

194
Q

When do bipolar disorders occur

A

when experience episodes of depression and mania/hypomania

195
Q

types of bipolar

A

I- one or more manic episodes or mixed episodes

II- a clinical course of major depressive disorder followed by hypomania

196
Q

what is a manic episode

A

persistent, elevated, irritable mood for one week, with at least 3 sx

197
Q

manic sx

A

inflated self-esteem
chatty

decreased sleep
flight of ideas
distractability

goal directed activity
high-risk activities

198
Q

what is hypomania

A

persistent, elevated, expansive irritable mood for 4 days, with at least 3 sx

199
Q

what is clyclothymic disorder

A

2 years of hypomania/depressive periods without fulfilling criteria for an episode of mania/hypomania/MDD

200
Q

Bipolar meds

A 
Mood stabilizers (lithium)
anticonvlusants
201
Q

how does lithium work

A

has a positive charge

202
Q

how do anticonvulsants work

A

controls symptoms in acute manic episodes

prevention for recurrent episodes of depression/mania

203
Q

what is a crises

A

subjective response to a stressful experience

comprises stability/ability to cope/function

204
Q

Venette’s 4 defining characteristics of crisis

A
  • Specific, unexpected, non-routine
  • creates perception of threat
  • creates uncertainty
  • process of transformation: old system no longer working, need to change
205
Q

5 components of a crisis (Rogers)

A

1) a hazardous/traumatic event
2) a vulnerable state
3) a precipitating (causative) factor
4) an active crisis state
5) a resolution of crisis

206
Q

5 types of crises

A

external (situational): from events/circumstances in environment

internal (subjective)

phase-of-life (maturational): occurs during natural growth/development

disasters (adventitious)

psychiatric emergencies: sudden/serious psychological disturbance

207
Q

5 risk factors for crises

A
  • Experience multiple bio-psychosocial stressors
    e. g. losses, unexpected transitions, unresolved problems, trauma
  • Lack of resiliency/poor coping mechanisms
  • Lack of social supports
  • Chronicity
  • Intensity of exposure
208
Q

4 phases of crises development

Caplan

A

Phase 1:

  • Exposure to stressor
  • Anxiety triggered
  • Use of previous coping/problem solving mechanisms

Phase 2:

  • Previous coping/problem-solving mechanisms fail
  • Stressors persist & feelings of discomfort

Phase 3:

  • Use internal/external resources to alleviate discomfort
  • Fails- and anxiety escalates to panic
  • May use new problem solving mechanisms - leading to resolution

Phase 4:

  • if not resolved, major disorganization
  • breaking point, cognitive function declines, emotions are unstable, irrational behavior, aggressive, self-harm
209
Q

5 elements of crises that influence responses

A

1) predictability
2) duration
3) intensity
4) control
5) self-concept

210
Q

5 barriers to crisis resolution

A

failure to learn from experience

mental issues

sociocultural considerations

secondary gain (external motivators e.g. missing work, obtain financial compensation)

therapist-patient boundary issues

211
Q

what are crises interventions?

A

short-term/action-oriented/strategic interventions

focus on solving immediate holisit issues that result from crises

212
Q

3 goals of crises intervention

A

to alleviate acute distress
restore independency
prevent psychological trauma

213
Q

balancing factors for crises (for equilibrium)

A

have a realistic perception of event
social supports
coping mechanisms

if these factors not present disequilibrium continues and crises will continue

214
Q

5 steps in crises intervention

A

1) assess individual & problem
2) plan therapeutic intervention
3) implement intervention
4) evaluation of resolution of crisis
5) anticipatory planning

215
Q

step 1) assess individual & problem

A

gather hx/risk assessment

focused assessment of presenting problem

analyze problem: determine pre-crisis level of functioning/coping, assess support system, establish desired outcome

216
Q

step 2) plan therapeutic intervention

A

select appropriate interventions that:

have a time limit
focus on strengths
uses past successful coping skills & new ones
uses social supports

217
Q

step 3) intervention

A
  • reality oriented
  • establish relationship
  • gain understanding of crises/cause/problem
  • discuss feelings & validate
  • encourage lengthy responses
  • explore coping mechanisms
  • identify social supports/ social resources
218
Q

step 4) evaluation of crises resolution & step 5) anticipatory planning

A
  • client summarizes changes/effectiveness of intervention
  • states realistic plans for future
  • reviews how this experience will help in the future
  • referrals
  • plan for similar experiences in the future
219
Q

Roberts crises intervention model

A

crises assessment

establish rapport/relationship

identify major problems

deal with feelings/emotions

create/explore alternatives

action plan

follow up

220
Q

3 main components of PTSD

A

re-experience of traumatic event:
dreams, acting/feeling, certain triggers result in distress

avoidance:
detachment, apathy, cannot recall events associated with event

hyperarousal:
insomnia, anger, lack of concentration, exaggerated startle response

221
Q

PTSD risks

A 
lack of support
lack of early tx/access to services
shame/guilt/self-doubt
other life stressors
underlying diseases
222
Q

what does schizo do

A

distorts senses/cognition & disturbs thoughts/thought processes

difficult to determine what is real/what isn’t

223
Q

onset of schizo

A

men: late teens- early 20s
women: late 20s early 30s

occurs equally in men/women

224
Q

cause of shiczo

A

biochemistry- excess dopamin

cerebral blood flow- entire brain “lit up” with schizo- unable to focus

molecular biology- increased ventricle size, loss of brain matter

genetic

225
Q

what can alleviate/aggravate symtpoms

A

aggravates:
stress
drugs

alleviates:
nutrtion- vitamins/omega3 protects brain

226
Q

What is schizo

A

a brain disease with specific symptoms d/t psychical & biochemical changes in brain

impacts thoughts/cognition

227
Q

schizo tx

A

medications

228
Q

schizo sx types

A

positive
negative
cognitive
depressive

229
Q

positive sx

A

hallucinations/ delusions
bizarre behaviour/ agitation
disorganization

230
Q

negative sx

A

lack of interest/motivation
lack of emotional activity (blunted affect)
impaired social skills
impaired concentration

231
Q

cognitive sx

A 
impaired:
memory
attention
focus
executive functioning

*associated with negative sx- apathy

232
Q

depressive sx

A

anxiety/irritability
dysphoria (anguish)
suicide

233
Q

perceptual disturbances in schizo

A

hallucinations/delusions
tangentiality (irrevelant responses)
poverty of thought (lack of thought)
loose association (unfocused)

234
Q

Criteria for schizo

A

sx for at least 6 months

1 month includes 2 active-phase sx

235
Q

active phase sx

A

hallucinations
delusions
disorginized behaviour
disorganized speech

236
Q

5 types of schizo

A

paranoid
disorganized

catatonic
undifferentiated

residual

237
Q

paranoid schizo

sx/tx

A

sx:
delusions: believe someone is out to get them, grandiose

auditory hallucinations

intense/rigid/controlled interactions

tx:
respond well to medication

238
Q

disorganized schizo

sx/prognosis

A 
sx:
regress & act like child/silly
disorganized speech/clanging/senseless laughter
grimacing/rocking/sexual behaviours
poor grooming/ADL's
social withdrawal

prognosis: poor d/t early permorbid hx

239
Q

catatonic schizo
sx
prognosis

A 
intense psychomotor disturbance 
immobile, waxy flexibility
echopraxia (act like others), echolalia (repeat words of others), grimacing
fluctation between extremes
delusions in withdrawn state

prognosis: fair

240
Q

undifferentiated schizo

sx/onset/prognosis

A

psychotic manifestations are extreme
delusions/hallucinations/bizarre behaviour/disorientation/incoherence
fantasy content

onset: acute
prognosis: poor

241
Q

residual schizo
cause:
sx:
prognosis:

A

results from at least one acute episode
free from positive sx but still has negative
may persist for years

unfocused
illogical thinking
blunted behaviour
social withdrawal
eccentric behaviour

prognosis: varies/unpredictable

242
Q

4 warning signs of psychosis

A

mood: suspicious, depressed, anxiety, mood swings, irritability
thoughts: odd ideas, vague, lack of focus/recall
physical: insomnia, appetite, loss of energy
behaviour: lack of activity, social isolation, decreased work/school performance

243
Q

population of psychosis

A

equal in men women

onset usually late teens-young adults

244
Q

risks for psychosis

A 
genetics
drugs
abuse
trauma
stressful life events
failure to achieve developmental milestones
245
Q

how does psychosis and cannabis relate

A

will create a poorer prognosis/functional outcome

increases risk of relapse

earlier age of onset

246
Q

interventions that promote recovery from psychosis

A 
stable living situation
strong social support
safe environment
goal oriented
understanding & insight
247
Q

tx of psychosis

A 
meds
relapse prevention
education
stress management
self management
lifestyle choices
social/life skills
family support/therapy/education
248
Q 
Quietapine (seroquel)
class
action
duration
adverse effects
A

mood stabilizer

antagonist for dopamine/serotonin

onset/peak unknown, duration 8-12h

adverse effects: neuroleptic malignant syndrome, cognitive impairment

249
Q

Benztropine

class

A

antiparkinsons agent
treats extrapyramidal side effects

action: blocks cholinergic activity in CNS which is partiall responsible for sx, restores balnace of neurotransmitters

250
Q

what causes extrapyramidal S&S

A

blockage of dopamine or depletion of basal ganglia

251
Q

what does dopamine do

A

ans and other animals. Some of its notable functions are in:

movement
memory
pleasurable reward
behavior and cognition
attention
inhibition of prolactin production
sleep
mood
learning

too little: parkinsons movement symptoms (rigidity, lack of coord, unable to stop movements)

too much: schizo symptoms

252
Q

Fluphenazine Decanoate
class:
action:
onset:

A

class: antipsychotic
action: reduces dopamine in certain areas of brain
onset- 48-96 h

253
Q

Olonzapine
class
indications
action

A

class: antipsychotic, mood stabilizer
for acute agitiation d/t schizo

action: antagonizes dopamine and serotonin in CNS

254
Q

Antiprazole
class
indications
action

A

antipsychotic, mood stabilizer
for schizo/agitation
decreases dopamine/serotonin activity

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