NSG 150 Psychiatric Nursing Final Exam Flashcards
Consistent w/verbal and nonverbal, shows open, honest, sincere need for trust
Genuineness
Respect/acceptance “no judgment”
Positive regard
Ability to see from patient view and communicate this understanding
Empathy
Responsible/dependable follow through w/promises
Trustworthiness
Simple words; speak at their level
Clarity
Be accountable for outcome
Responsibility
Express thoughts/feelings comfortable/confident, positive/honest, open manor, respect self and others. “Good eye contact” “I” statements
Assertiveness
Define Mental health
successful performance of mental functions, resulting in the ability to engage in productive activities, enjoy fulfilling relationships, & change or cope w/ adversity. Mental health provides people w/ the capacity for rational thinking, communication skills, learning, emotional growth, resilience, & self-esteem.
Describe the DSM-IV-TR and the Multi-axial System
Diagnostic & Statistical Manuel of Mental Disorders [DSM-IV-TR(4th edition, text revision)]-Is a manual that classifies mental disorders; focuses on research & clinical observations when constructing diagnostic categories for a discrete mental disorder. The DSM-IV-TR is a Multi-axial System by requiring judgments to be made on each of the 5 axes, forces the diagnostician to consider a broad range of info.
Specific Client Rights
o Client consent o Communication o Freedom from harm o Dignity & Respect o Confidentiality o Participation in plan of care
Involuntary admission
72 hour hold by Doctor with 2nd to reevaluate w/in a few hrs. usually a psychiatrist.
EPS (Extra Pyramidal Side Effects)
Parkinson like symptoms S/E from Antipsychotic medications
acute contractions of tongue, neck, & back.
Acute Dystonic reactions
motor inner driven restlessness (eg., tapping foot incessantly, rocking backward in chair, shifting weight from side to side.)
Akathisia
(face) protruding & rolling tongue, blowing, smacking, licking, spastic distortion; (Limbs) rapid, purposeless & irregular movements, (Trunk) dramatic hip jerks & rocking.
Tardive Dyskinesia
Drugs that reduce anxiety through effects on limbic system
Antianxiety /Anxiolytic
Benzodiazepines
Valium, Klonopin, & Xanax, bind to specific receptors adjacent to the GABA receptors.
Very addictive, short term only, no alcohol, taper off to avoid w/drawl (Grandmal seizures) not good for person w/suicide risk. S/E fatigue, sedation, mouth dryness. Avoid St. Johns Wort
What is Benzo
Nardil, Parnate avoid: Aged cheese, deli meat, chocolate, liver, avocados. Tyramine, can lead to hypertensive crisis
What are MAOIs
Antidepressants (SSRIs)
Prozac, Zoloft, Paxil - sexual dysfunction, weight gain, sedation , agitation
Antidepressants (SSRNI - Atypical)
Welbutrin, Cymbalta, Effexor – Headache, dry mouth, seizures, suppress the appetite (don’t give to small people) (TCAs - Tricyclics) Elavil, Tofranil - postural orthostatic hypotension, sedation
Antipsychotics (1st gen/typical)
(Haldol, Thorazine, Stelazine) Treats only Positive symptoms. S/E include EPS, anticholinergic, orthostatic hypotension, causes Neuroleptic Malignant Syndrome, fever, elevated Bp. Treat w/Benadryl (antihistamine)
Antipsychotics (2nd gen/atypical)
Zyprexa, Risperdal, Abilify, Clozaril - decreased EPS symptoms (less or no), works on Positive and Negative symptoms. Zyprexa causes increased weight, (Clozaril- agranulocytosis check WBC, temp and flu like symptoms)
Anticholinergic SEs (Dementia)
Aricept, Exelon, Razadyne – Don’t cure or improve, slow progression. S/E dry mouth, constipation, blurred vision, urinary retention, dry mucous membranes. Less destruction of acetylcholine which equals more available. Namenda – new drug that block effects of excess glutamate for moderate to severe.
Mood Stabilizers
Treat Bipolar (Lithium) S/E Arrhythmias, tremor, polyuria, therapeutic levels and toxic levels are close (monitor their blood). Antiepileptic – Tegretol, Depakote – S/E Sedation and agranulocytosis (WBC).
Complimentary Alternative Therapy for stress
- Yoga
- Mindfulness based (Mind is present and in the moment, not dwelling on negative shit)
- Hypnosis
- Prayer
- Art, Music, Dance
- Orthomolecular (Vitamin Therapy)
- Acupuncture
- Massage
- Energy Reiki/TT (Therapeutic Touch)
- TMS (Trans magnetic Stimulation) (Copper Bracelets)
- Biofeedback (Using a V/S machine to control BP)
- Exercise and Herbs
A Holistic Model of Stress
Initial Alarm Reaction Stress: Fight or Flight
Fight-or-Fight Response (Walter cannon)
The body’s way of preparing for a situation that an individual perceives as a threat to survival.
Steps
- Threat message is conveyed to the hypothalamus
- Pituitary begins mobilizing the release of ACTH as well as activating hormones for the adrenal medulla – Adrenal medulla pumps adrenaline, noradrenaline, and other catecholamine’s into the bloodstream, resulting in: Increase in HR and BP
Acute and Long-Term Effects: General Adaptation Theory Hans Selye (expanded Cannon’s theory of stress with GAS - General Adaptation Syndrome (GAS)
Occurs in two stages
- ) An initial adaptive (fight or flight) response in the alarm or acute stress phase
- ) The eventual maladaptive responses to prolonged stress
- The body reacts in the same manner regardless of whether the stress is a real threat or perceived as a
threat. And regardless of whether physical, psychological, or social.
Emotional conflicts and stressors are dealt with by meeting the needs of others
• The person receives gratification either vicariously or from the response of others
Defense Mechanism - Altruism
An unconscious process of substituting constructive an socially acceptable activity for strong impulses that are not acceptable in their original form
• Rechanneling of intolerable or socially unacceptable impulses or behaviors into activities that are personally or socially acceptable.
Defense Mechanism ➢ Sublimation
An individual may deal with emotional conflicts or stressors by emphasizing the amusing or ironic aspects of the conflict or stressor
Defense Mechanism ➢ Humor
Conscious denial of a disturbing situation or feeling
• Voluntary rejection of unacceptable thoughts or feelings from conscious awareness.
Defense Mechanism ➢ Suppression
The involuntary exclusion of emotionally painful material or unpleasant or unwanted experiences from awareness.
Defense Mechanism ➢ Repression
Unconscious shifting of feelings such as hostility or anxiety from one idea, person, or object to another.
Defense Mechanism ➢ Displacement
Unacceptable feelings or behaviors are kept from awareness by demonstration of the opposite behavior, attitude, or feeling of what one would normally show in a given situation.
Defense Mechanism ➢ Reaction Formation (overcompensation)
Transforming anxiety on an unconscious level into a physical symptom that has no organic cause (Functions as an attention getter or as an excuse)
Defense Mechanism ➢ Somatization
Makes up for an act or communication (Giving a gift to undo an argument
or Compulsive hand washing (cleansing oneself of the act)
Defense Mechanism ➢ Undoing
Justification of one’s illogical or unreasonable ideas, actions, or feelings to maintain self-respect, prevents guilt feelings, or obtains social approval.
Defense Mechanism ➢ Rationalization
Separation and detachment of a strong emotionally charged conflict from one’s consciousness.
• A disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment
• Male victim of carjacking exhibits symptoms of traumatic amnesia the next day.
• Splitting off a group of thoughts or activities from the main portion of the consciousness.
Defense Mechanism ➢ Dissociation
Occurs when emotional conflict or stressors are dealt with by attributing negative qualities to self or others
• When evaluating another the individual appears good by contrast
Defense Mechanism ➢ Devaluation
Unconscious attempt to identify with personality traits or actions of another to preserve one’s self-esteem or to reach a specific goal.
• Many female teenagers buy clothing and try to dress like their favorite idol.
• A teenager mimics the behaviors of his favorite coach.
• Unconsciously modeling one’s self after another person or group
➢ Idealization
Unconscious assignment of unacceptable thoughts or characteristics of self to others.
➢ Projection
Unconscious refusal to face thoughts, feelings, wishes, needs, or reality factors that are intolerable.
➢ Denial
Retreat to past developmental stage to meet basic needs.
➢ Regression
Use of a specific behavior to make up for a real or imagined inability or deficiency, thus maintaining self-respect or self-esteem.
➢ Compensation
Unconscious expression of a mental conflict as a physical symptom to relieve tension or anxiety.
➢ Conversion
an anxiety disorder characterized by chronic anxiety, exaggerated worry and tension, even when there is little or nothing to provoke it.
Panic Disorder- Panic disorder is an anxiety disorder and is characterized by unexpected and repeated episodes of intense fear accompanied by physical symptoms that may include chest pain, heart palpitations, shortness of breath, dizziness, or abdominal distress.
GAD- Generalized Anxiety Disorder, GAD
A specific phobia is an intense fear of something that poses little or no actual danger.
Phobias
an anxiety disorder and is characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). Repetitive behaviors such as hand washing, counting, checking, or cleaning are often performed with the hope of preventing obsessive thoughts or making them go away. Performing these so-called “rituals,” however, provides only temporary relief, and not performing them markedly increases anxiety.
Obsessive-Compulsive disorder (OCD)
an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that may trigger PTSD include violent personal assaults, natural or human-caused disasters, accidents, or military combat.
Posttraumatic Stress Disorder (PTSD)
a chronic condition in which there are numerous physical complaints. These complaints can last for years, and result in substantial impairment. The physical symptoms are caused by psychological problems, and no underlying physical problem can be identified.
Somatization disorder
A disorder is a psychiatric condition in which emotional distress or unconscious conflict are expressed through physical symptoms.
Conversion disorder
a belief that real or imagined physical symptoms are signs of a serious illness, despite medical reassurance and other evidence to the contrary.
Hypochondriasis
is characterized by an excessive preoccupation with a real or imagined defect in your physical appearance.
Body dysmorphic disorder
A persistent and chronic pain at one or more sites in which psychological factors are thought to play a role.
Pain Disorder
involving a disturbance of identity in which two or more separate and distinct personality states (or identities) control the individual’s behavior at different times. When under the control of one identity, the person is usually unable to remember some of the events that occurred while other personalities were in control. The different identities, referred to as alters, may exhibit differences in speech, mannerisms, attitudes, thoughts, and gender orientation. The alters may even differ in “physical” properties such as allergies, right-or-left handedness, or the need for eyeglass prescriptions. These differences between alters are often quite striking.
Dissociative Disorders- Dissociative Identity Disorder (DID), previously referred to as multiple personality disorder (MPD),
Dyssomnias
Abnormalities in amount, quality or timing of sleep
* Insomnia, narcolepsy/hypersomnia, breathing related (sleep apnea), circadian rhythms (shift work, jet leg). Insomnia can lead to day time sleepiness, day time dysfunction.
Parasomnias
Abnormal behavior or events occurring in association with sleep. (sleep walking/talking)
Assessing for sleep disorders
Sleep history (objective/subjective), sleep diary, EEG/EMG/sleep labs, physical/psychological stressors.
Interventions for sleep disorders
Meds (sleeping pills), sleep diary, quiet comfortable environment, no caffeine, no
Nicotine, no sugar, refer to sleep disorder specialist as needed.
2.4 Part 1 Episode of depression only
Unipolar/Major Depressive Disorder
Episodes of depression and mania or hypomania
Bipolar Disorder
Emotional or behavior problems related to a specific stressor (Transient)
- Goes away once stressor is removed.
Adjustment Disorder
Chronic depression syndrome, low level, ongoing, pessimistic, chronic fatigue,
Doom and gloom.
Dysthymia
Depressed mood, Anhedonia (lack of pleasure), wt. loss/gain, insomnia,
Anergia (loss of energy, fatigue), feelings of worthlessness or guilt, decreased concentration.
Depression
How do you assess for a mood disorder?
Assess for suicide, (after meds, increase risk of suicide due to more energy),
Sad Person Scale (suicide risk test)
What are some interventions for mood disorder?
Psychotherapy, behavioral, cognitive, group, meds, ECT, safety first
Mood disorder Drugs: MAOIs
Nardil, Parnate avoid: Aged cheese, deli meat, chocolate, liver, avocados. Tyramine, can lead to hypertensive crisis
Mood disorder Drugs: Antidepressants- (SSRIs)
Prozac, Zoloft, Paxil - sexual dysfunction, weight gain, sedation , agitation
Mood disorder drugs: (SSRNI - Atypical)
Welbutrin, Cymbalta, Effexor – Headache, dry mouth, seizures, suppress the appetite (don’t give to small people) (TCAs - Tricyclics) Elavil, Tofranil - postural orthostatic hypotension, sedation
Suicide:
Assessment:
Highest risk time for suicide is when coming out of depression newly on meds, assess the potential by questioning patient or when they say, “Life isn’t worth living”, Find out if they have a plan or any prior attempts, and then assess the lethality (details, proposed method, availability of means) (Do they have a gun available and a plan).
Suicide: Interventions:
Suicide Precautions: Secure Room (lock windows, break proof glass/mirrors), no cords (belts, phone, extensions, curtains, equipment), No matches, razors, plastic flat wear, frequent observation/1:1, communicate to staff, monitor and restrict visitors.
5 sub-types of Schizophrenia: Less neurologic and cognitive impairment and a better prognosis for the individual. They respond better to meds. During the acute phase of the disorder the afflicted person is extremely ill and symptoms often make the person a danger to self and others. They have delusions (grandiose ones) with consistent theme (can generate anxiety, anger, violent behavior). They also have auditory hallucinations. Interaction with others rigid, intense, controlled environment, no touching.
Paranoid Schizophrenia
5 sub-types of Schizophrenia: Early dangerous onset and silly, childish affect. Severe disintegration of the personality characterizes this form. Severe disorganized in speech (word salad: communication includes both real and imaginary words, no logical order), odd behavior. Socially withdrawn, bad sexual behaviors, poor personal hygiene (grooming) and prognosis is poor.
Disorganized Schizophrenia
5 sub-types of Schizophrenia: Has a predominant feature, intense psychomotor disturbance. Takes form of stupor (psycho-motor retardation) or excitement. Manifestations include posturing, immobility, catatepsy (waxy flexibility), mutism, and negativism. Patient requires the most nursing care due to life threatening vegetative state. Can see and hear during catatonic state and there is danger for malnutrition.
Catatonic Schizophrenia
5 sub-types of Schizophrenia: Poor prominent symptoms but still some negative. It may continue for years with or without exacerbations.
Residual Schizophrenia
5 sub-types of Schizophrenia: Chronic prognosis. They have extreme delusions with a poor prognosis.
Undifferentiated Schizophrenia
s a closely related disorder of schizophrenia, but the onset of illness generally occurs later in life. The disorder presents with severe mood swings of either mania or depression and also w/some of the psychotic symptoms. Most of the time, mania or depression coexists with the psychotic symptoms, must be 2 week period in which there are only psychotic episodes. Can’t diagnose right away, you have to review over time. Clients have a better prognosis then schizophrenia but less + prognosis than depression. It’s a lifelong disorder. Symptoms worsen during time of stress resulting in hospitalization. Treated with psychotherapy, meds, and skills training.
Schizoaffective
Bleuler’s Signs of Schizophrenia (the 4 “A’s” of schizophrenia)
- Affect- flat, blunt. Inappropriate or bizarre (feeling)
- Associative looseness- haphazard, confused thinking causing illogical, jumbled speech & reasoning ability (speech)
- Autism- pt. lives in their own world; delusions, hallucinations, neologisms (thinking)
- Ambivalence-leads to inability to make decisions due to conflicting feelings (behavior)
NSG Interventions for Schizophrenia
- Safety (self & others)/Redirect
- Support
- Education
- Limit setting/reduce stimulation
- Medication treatment
- Milieu Therapy
- Activities
- Health promotion
- Directive communication
- Treatment of other health issues
- Individual therapy
- Family therapy
Antipsychotics for Schizo- (1st gen/typical)
(Haldol, Thorazine, Prolixin, Stelazine) Treats only Positive symptoms. S/E include EPS, anticholinergic, orthostatic hypotension, causes Neuroleptic Malignant Syndrome, fever, elevated BP. Treat w/Benadryl (antihistamine) (HALDOL and PROLIXIN come in injectable forms – (IM long acting D) Haldol-D or Prolixin-D (Deconate)).
Antipsychotics for Schizo- (2nd gen/atypical)
Zyprexa, Risperdal, Abilify, Clozaril - decreased EPS symptoms (less or no), works on Positive and Negative symptoms.
Zyprexa
Antipsychotics (2nd gen/atypical) causes increased weight,
Clozaril
Antipsychotics (2nd gen/atypical) agranulocytosis, check WBC, temp and flu like symptoms
Seroquel
Antipsychotics (2nd gen/atypical) Sedating and overused.
Risperdal
Antipsychotics (2nd gen/atypical) Also has an IM long acting injectable (Risperdal-C (Consta))
Geodon
Antipsychotics (2nd gen/atypical) Monitor for cardiac problems, depressed
Abilify
Antipsychotics (2nd gen/atypical) Is also a crossover drug for bipolar.
Motor movement - masklike faces, stiff & stooped posture, shuffling gait, drooping, tremor, & “pill rolling”
Pseudo parkinsonism
acute contractions of tongue, neck, & back. (GIVE IM Cogentin)
Acute Dystonic reactions
Increased temp (103), muscle rigidity (lead pipe), rapid breathing, mute, altered consciousness, increased CPK, excessive salivation. (GIVE Benadryl)
Neuroleptic malignant syndrome
motor inner driven restlessness (eg., tapping foot incessantly, rocking backward in chair, shifting weight from side to side.)
Akathisia
(face) protruding & rolling tongue, blowing, smacking, licking, spastic distortion; (Limbs) rapid, purposeless & irregular movements, (Trunk) dramatic hip jerks & rocking. (LATER ONSET)
Tardive Dyskinesia
o Haldol (fast acting; D is long lasting)
o Thorazine
o Prolixin (D is long lasting)
o Navane
Typical Antipsychotics- Treats positive symptoms ONLY with more troubling side effects
o Clozaril (not 1st line, watch WBC) o Risperdal o Zyprexa o Seroquel o Zisprasidone o Abilify (lil or no weight gain)
Atypical Antipsychotics- (newer gen) Treats BOTH positive & negative symptoms, may decrease anxiety & depression, decreases suicidal behavior.
Antiparkinsonian Drugs-
used to treat extra pyramidal syndrome (EPS); usually give before symptoms occur. * Cogentin & *Artane
Atypical Side Effects:
Weight gain, sexual dysfunction, glucose deregulation, (Clozaril- agranulocytosis)
words made up with special meaning
Neologisms
