- Developed by Ellis. - The goal is to eliminate negative thoughts that are illogical. - The illogical thoughts are things like, I SHOULD always be nice or I MUST be the best. - Ellis said negative thoughts are an ABC event. - REBT is about seeing the glass as half full. - It focuses more on the present than the past

- Developed by Beck. - Neo-freudian. - The way people feel is determined by the thoughts they have about the world. - The thoughts people have are called schemas. - Rapid, unthinking responses based on schemas are called automatic thoughts or cognitive distortions. - Cognitive distortions are irrational; CBT identifies these distortions, reality tests them, and corrects the distortion

- Personality is not about inner thoughts, it’s just about learned behaviors. - Behaviorism was originally thought of by Watson. - Watson did the experiment with little albert. --Operant conditioning was developed by Skinner.

- Sullivan believed that personality is behaviors that can be seen in interpersonal relationships. - Sullivan said that the purpose of all behavior is to get needs met through interpersonal interactions and to decrease anxiety. - Sullivan coined the term security operations to describe measures the individual employs to reduce anxiety and enhance security. All of the person’s security operations combined are called the self-system.

NUR 304 Flashcards by Richard smith

Therapeutic Use of self

the ability to intentionally use one’s personality to build a relationship and form nursing interventions.

How well did you know this?

Not at all

Perfectly

Mental health- A state of well-being in which each individual is able to realize his own potential, cope with normal stress, work productively, and

make a contribution to society

How well did you know this?

Not at all

Perfectly

Mental illness

all mental disorders with definable diagnoses

How well did you know this?

Not at all

Perfectly

DSM –V- the official guideline for diagnosing psychiatric disorders. It also provides

epidemiological statistics

How well did you know this?

Not at all

Perfectly

DSM –V organization

child disorders are listed first in the chapter, and adults are listed later. Also, disorders that are related (eating disorder and elimination disorder) are usually bunched together.

How well did you know this?

Not at all

Perfectly

ICD-10 Includes all diseases. Divides mental illness into 2 main categories, which are

psychosis and neurosis

How well did you know this?

Not at all

Perfectly

Maslow’s Hierarchy

Physical
Safety 
Love
Esteem (achievement and praise)
Self-actualization
Self-Transcendence

How well did you know this?

Not at all

Perfectly

cognitive theory includes

rational-emotive behavior therapy (REBT) and Cognitive-Behavioral Therapy

How well did you know this?

Not at all

Perfectly

REBT

Developed by Ellis.
The goal is to eliminate negative thoughts that are illogical.
The illogical thoughts are things like, I SHOULD always be nice or I MUST be the best.
Ellis said negative thoughts are an ABC event.
REBT is about seeing the glass as half full.
It focuses more on the present than the past

How well did you know this?

Not at all

Perfectly

CBT

Developed by Beck.
Neo-freudian.
The way people feel is determined by the thoughts they have about the world.
The thoughts people have are called schemas.
Rapid, unthinking responses based on schemas are called automatic thoughts or cognitive distortions.
Cognitive distortions are irrational; CBT identifies these distortions, reality tests them, and corrects the distortion

How well did you know this?

Not at all

Perfectly

Ego

reality tester. Leader.

How well did you know this?

Not at all

Perfectly

Superego

strict morality. Super christian

How well did you know this?

Not at all

Perfectly

Psychoanalytic- came up with

transference and countertransference

How well did you know this?

Not at all

Perfectly

Behavioral theory

Personality is not about inner thoughts, it’s just about learned behaviors.
Behaviorism was originally thought of by Watson.
Watson did the experiment with little albert. –Operant conditioning was developed by Skinner.

How well did you know this?

Not at all

Perfectly

Behavior therapy works best on

specific problems, like a phobia of snakes

How well did you know this?

Not at all

Perfectly

There are 5 kinds of behavior therapy:

modeling, OC, desens, aversion therapy, biofeedback

How well did you know this?

Not at all

Perfectly

Interpersonal

Sullivan believed that personality is behaviors that can be seen in interpersonal relationships.
Sullivan said that the purpose of all behavior is to get needs met through interpersonal interactions and to decrease anxiety.
Sullivan coined the term security operations to describe measures the individual employs to reduce anxiety and enhance security. All of the person’s security operations combined are called the self-system.

How well did you know this?

Not at all

Perfectly

Peplau

Influenced the shift from what nurses do TO patients to what nurses do WITH patients.

Emphasized keeping the nurse’s needs out of the picture.

Described 4 levels of anxiety (mild, moderate, severe, panic)

How well did you know this?

Not at all

Perfectly

Lithium adverse effects

tremor
ataxia
confusion
convulsions
NVD
arrhythmia
polyuria
polydipsia
edema
goiter
hypothyroidism

How well did you know this?

Not at all

Perfectly

Lithium TI

.8 to 1.5

How well did you know this?

Not at all

Perfectly

Lithium contraindication

pregnancy

below age 12

How well did you know this?

Not at all

Perfectly

Lithium drink…

plenty of water

How well did you know this?

Not at all

Perfectly

Lithium, older adults are

more sensitive to it

How well did you know this?

Not at all

Perfectly

Lithium, diet

don’t change the amount of salt you eat

How well did you know this?

Not at all

Perfectly

Lithium patient instructions

take with food to avoid GI problems

Clozaril

- Atypical antipsychotic - Blocks DA, ACH, NE, and histamine - Emotional quieting and reduced movement - Antiemetic - Alter temp - Increases prolactin - HAS ANTICHOLINERGIC EFFECTS (dry mouth, urine retention, constipation) - Orthostatic hypo - Causes sedation (because it's antihistamine)

TCA general info

- Anticholinergic effects - Antihistamine effects - Takes 2-3 weeks to work - Can cause arrhythmia - Very severe interaction with MAO - Also interacts with barbis

TCA SE

dizzy ortho sedation risk of suicide

TCA toxic effects

cardiac coma seizure delirium

SSRI has no

anticholinergic effects

SSRI SE

insomnia nervous tinnitus weight loss followed by gain

MAOI

- irreversibly inactivate MAO to increase amine levels - reduce REM sleep - enhances effects of anesthesia, sedatives, narcotics, and TCAs

MAOI toxic effects

- liver - don't take it within 2-3 weeks of taking TCA - agitation, cardiac, convulsions

Criteria for admission: harm to self, harm to others or

unable to care for self

Even if the patient is involuntarily admitted, they have the right to refuse

meds

Informal admission

similar to a regular hospital admission, there’s no formal application.

Voluntary admission

- patients formally requests in writing to be admitted. - If the person is a minor, the guardian may be allowed to apply on their behalf. - They can ask to leave, however if their condition is really bad it may be forced to stay

Temporary admission

- used for people so confused that they can’t make a decision or people so ill that they need to be admitted right away. - Usually they can only be held under temporary admin for 15 days

Long-term involuntary admission doesn’t always require a

judicial hearing beforehand, but usually the patient can have a hearing at a later point

Tort

A civil wrong for which money damages may be collected by the injured party (plaintiff) from the responsible party (the defendant)

Intentional tort

Willful or intentional acts that violate another person’s rights or property

Intentional tort examples

``` ➢ Assault ➢ Battery ➢ False imprisonment ➢ Invasion of privacy ➢ Defamation of character (slander or libel) ```

Unintentional tort example

negligence

Cause in fact

if it was not for what the nurse did, would this injury have occurred?

Proximate cause

aka legal cause, may be evaluated by figuring out what caused the harm

Accepting

Doesn’t necessarily communicate agreement, but it’s nonjudgemental

Giving recognition

Indicates awareness of change and personal efforts. Does not imply good or bad

Restating

Repeats the main idea expressed. It’s different from paraphrasing because it repeats so of the exact same words the patient used

Example of Reflecting

You sound as if you’ve had many hard times.

Projective questions

Asking a “what if” question

Presupposition question

What if you woke up and this problem went away? What would your life be like?

Alarm (acute) stress level

Characterized by sympathetic response, corticosteroids, endorphins. It’s very brief and intense.

Resistance stage of stress

Aka adaptation phase. It’s the time of sustained and optimal stress resistance. Normally stressors are overcome here, but if not you can fall into the exhaustion stage.

Exhaustion stage of stress

Resources are depleted and you can no longer combat the stress.

Mild anxiety

Normal amount. | The person perceives more information and can better problem solve.

Moderate anxiety

``` Perception decreases. The person has selective attention. Problem solving can occur, but it’s not optimal. Sympathetic nervous system kicks in. May have tremors and shaky voice. ```

Severe anxiety

- Unable to problem solve. | - Behavior is automatic and aimed at reducing stress.

Panic

May lose touch with reality. | Hallucinate.

Indicates that the nurse has heard and has followed the trend of though; e.g. “I follow what you said.” “Yes” “Uh Huh”.

Accepting – giving indication of reception

Not only words are important but the facial expression, the tone of voice and inflection, and the posture of the nurse.

Accepting

To greet the patient by name, to note efforts the patient has made, to indicate awareness of change “Good morning Mr. M.”

Giving Recognition

“I’ll sit with you awhile.”

Offering self

By calling patient’s attention to what is happening to him, the nurse seeks to encourage the patient’s noticing for himself so that he can do the describing

Making observations

“Tell me whether my understanding of it agrees with yours.”

Seeking consensual validation

PATIENT: “I’m dead.” NURSE: “Are you suggesting that you feel lifeless or is it that life seems without meaning?”

Attempting to translate into feelings

“Perhaps you and I can discuss and discover what produces your anxiety.”

suggesting collaboration

Paraphrasing: restating another’s message more briefly and in your own words; lets another know

you are actively seeking understanding of what they are saying

help person be aware of inconsistencies in his/her feelings, attitudes, beliefs, or behaviors

confrontation

Diathesis

biological predisposition

Stress (in terms of the diathesis-stress model)

Environmental stress or trauma

Diathesis-Stress Model

Most accepted explanation for mental illness Combination of genetic vulnerability and negative environmental stressors

New Freedom Commission on Mental Health

created to conduct a study of the U.S. mental health service delivery system and make recommendations based on its findings.

Incidence

the of new cases popping up

Prevalence

how many people have the condition at the a given time

Sullivan’s Interpersonal Theory: Purpose of all behavior is to get needs met through interpersonal interactions and to reduce or avoid

anxiety

5 Foundations of Peplau’s theory

``` Participant observer Mutuality Respect for the patient Unconditional acceptance Empathy ```

The art of nursing and science

Peplau

Peplau's theory aims to

improve patient’s ability to think and function

Theory: Dynamic interplay between individuals and the environment

Cognitive

Theory: Thoughts come before feelings and actions

Cognitive

Cognitive theory: Thoughts about the world and our place in it are based on our own unique perspectives, which

may or may not be based on reality

Theory: Test distorted beliefs and change way of thinking; reduce symptoms

CBT (Beck)

Theory: Recognize thoughts that are not accurate

REBT (Ellis)

Theory: Emphasis on human potential and the patient’s strengths

Maslow

Theory: Consider other influences that play a role in the development and treatment of mental disorders Social, environmental, cultural, economic

Biological

Theory: Focus on Qualities of a therapeutic relationship Understanding patient’s perspective Communicating to facilitate recovery

Biological

Neuropeptides

Long-term changes in cells

Neurotrophic factors

Proteins and gases that influence growth, shape, etc of neurons

Brain: Basic drives and link between thought and emotion and function of internal organs

Hypothalamus

Brain: Processing center for sensory information

brain stem

Structured imaging techniques

CT and MRI

Functional imaging techniques

PET and SPECT

special X-ray tests that produce cross-sectional images of the body using X-rays and a computer

PET

Positron emission tomography uses a radioactive substance called a tracer to look for disease in the body

SPECT

Single photon emission computed tomography uses a radioactive substance and a special camera to create 3-D pictures

Benzos

Pams and lams

Melatonin receptor agonists

Ramelteon Doxepin Buspirone

TCA examples

Nortriptyline Amitriptyline Imipramine

SSRI examples

Fluoxetine Paroxetine Citalopram Escitalopram

SNRI examples

Venlafaxine Desvenlafaxine Duloxetine

Serotonin-norepinephrine disinhibitors (SNDIs) example

Mirtazapine

MAOIs examples

Isocarboxazid Phenelzine Selegiline Tranylcypromine

Anticonvulsant drugs

``` Valproate Carbamazepine Lamotrigine Gabapentin Topiramate Oxcarbazepine ```

First-generation, conventional, typical of standard antipsychotic drugs strongly block

DA attachment (antagonistic)

First-generation, conventional, typical of standard antipsychotic drugs also block (besides DA)

ACH NE Histamine

First-Generation (Conventional) Antipsychotic Drugs main side effects

Weight gain | Sedation

Second-Generation (Atypical) Antipsychotic Drugs block

DA and Serotonin

Second-Generation (Atypical) Antipsychotic Drugs examples

``` Clozapine (Clozaril) Risperidone Quetiapine Olanzapine Ziprasidone ```

Third-GenerationAntipsychotic Drug

Aripiprazole (Abilify) | Dopamine stabilizer

Drugs For Alzheimer's disease

Tacrine | Donepezil

Herbal Medicine- major concerns:

Potential long-term effects: Nerve damage Kidney damage Liver damage

If a person has decreased circulating levels of GABA, which health problem would be expected?

Anxiety

Thorazine

typical antipsyc Primarily used for schizo. Also does bipolar, attention deficit hyperactivity disorder, nausea and vomiting, anxiety before surgery, and hiccups

Cultural ____: Examine beliefs, values, and practices of own culture

Cultural awareness

Cultural ____: Recognize that during a cultural encounter, three cultures are intersecting

Cultural awareness

Cultural ____: Learn by attending cultural events and programs

Cultural knowledge

Cultural ____: Deter nurses from stereotyping Help nurses gain confidence in cross-cultural interactions Help nurses avoid or reduce cultural pain

Cultural encounters

Cultural ____: Ability to perform a cultural assessment in a sensitive way

Cultural skill

Cultural ____: Use professional medical interpreter to ensure meaningful communication

Cultural skill

Cultural ____: Genuine concern for patient’s welfare Patience, consideration, and empathy

Cultural desire

Ethics

study of philosophical beliefs about what is considered right or wrong in a society

Bioethics

Used in relation to ethical dilemmas surrounding health care

Justice

Distribute resources or care equally

Fidelity

Maintaining loyalty and commitment; doing no wrong to a patient

Writ of habeas corpus

You must get a court order to hold someone

Example of unintentional tort (besides negligence)

malpractice

Five Elements to Prove Negligence

``` Duty Breach of duty Cause in fact Proximate cause Damages ```

which phase: Evaluate problems and goals

Working

Hans Selye came up with the

General Adaptation Syndrome

Distress and Eustress were coined by

Lazarus

Neurotransmitter Stress Responses: serotonin production becomes

more active

Neurotransmitter Stress Responses: Increased serotonin may impair

the brain's ability to use serotonin

Lifetime prevalence of schizophrenia is __% worldwide

schizo has no differences related to

Race Social status Culture

Schizo Comorbidity

Substance abuse disorders Anxiety, depression, and suicide Physical health or illness Polydipsia

The neurobiological contribution to schizo is the ___ theory

DA theory

Psychological and environmental factors causing schizo

Prenatal stressors Psychological stressors Environmental stressors

3 Phases of Schizophrenia

Acute, Stabilization, Maintenance

Concrete thinking

Inability to think abstractly

Neologisms

made up word

Echolalia

meaningless repetition of another person's spoken words

Alogia

can't speak

Depersonalization

These thoughts in my head are someone else's

Derealization

my surroundings aren't real

Echopraxia

imitate someone's movements

For schizo patients, it is crucial to assess for

depression

1st gen antipsycs are ___ antagonists

advantage of 1st gen antipsycs

cheaper

disadvantages of 1st gen antipsycs

- Anticholinergic side effects - Tardive dyskinesia - Weight gain, sexual dysfunction, endocrine disturbances

disadvantage of 2nd gen antipsycs

significant weight gain

3rd gen antipsycs are DA system

stabilizers

Advantages of 3rd gen antipsycs

Improves positive and negative symptoms and cognitive function Little risk of EPS or tardive dyskinesia

Potentially Dangerous Responses to Antipsychotics

Anticholinergic toxicity Neuroleptic malignant syndrome (NMS) Agranulocytosis

Lifetime prevalence of bipolar disorder in the United States is

5.1%

Bipolar I – more common in

males

Cyclothymia – usually begins in

adolescence or early adulthood

In the Maintenance phase of bipolar, the only planned intervention is to

prevent relapse (everything else is acute phase of continuation phase. That phase is before Maintenance phase)

Lithium Therapeutic blood level:

0.8 to 1.4

Lithium Maintenance blood level:

0.4 to 1.3

Advanced Practice Interventions for bipolar

CBT | interpersonal and social rhythm therapy

Major Depressive Disorder: Persistently depressed mood lasting a minimum of

2 weeks

Disruptive mood dysregulation disorder

disorder in children, characterized by persistently irritable or angry mood

Dysthymic disorder

mild but long term depression

Premenstrual dysphoric

severe, sometimes disabling extension of premenstrual syndrome (PMS)

Leading cause of disability

Major Depressive Disorder

3 phases of Major Depressive Disorder

acute, continuation, maintenance

Other Treatments for Depression

``` Electroconvulsive therapy (ECT) Transcranial magnetic stimulation Vagus nerve stimulation Deep brain stimulation Light therapy ```

Fear

Reaction to specific danger

Adjustment disorder is precipitated by

a stressful event

The theory specifies two functionally distinct branches of the vagus, or tenth cranial nerve. The branches of the vagal nerve serve different evolutionary stress responses in mammals: the more primitive branch elicits immobilization behaviors (e.g., feigning death), whereas the more evolved branch is linked to social communication and self-soothing behaviors.

Polyvagal theory

Individuals respond to stress with severe interruption of consciousness

Dissociative Disorders

A disorder characterized by the presence of two or more distinct personality states

Dissociative identity disorder

Without significant physical findings and medical diagnosis Suffering is authentic High level of functional impairment

Somatic Symptom Disorder

Misinterpretation of physical sensations Overconcerned for health and preoccupied with symptoms Extreme worry and fear Course of illness chronic and relapsing

Illness Anxiety Disorder

Presence of deficits in voluntary motor or sensory functions Common symptoms—paralysis, blindness, movement and gait disorders, numbness, paresthesias, loss of vision or hearing, or episodes resembling epilepsy “La belle indifférence” versus distress

conversion disorder

Artificially, deliberately, and dramatically fabricate symptoms or self-inflict injury Goal of assuming a sick role

Factitious Disorders

Examples of Factitious Disorders

Self-directed Other-directed Malingering

3 eating/elimination disorders

Anorexia nervosa Bulimia nervosa Binge eating disorder

Pica

eating dirt etc

an eating disorder in which a person -- usually an infant or young child -- brings back up and re-chews partially digested food

Rumination disorder

Enuresis

wet the bed

Encopresis

shit the bed

cataplexy

strong emotion or laughter causes a person to suffer sudden physical collapse though remaining conscious

hypnagogic hallucinations

auditory

Irresistible attacks of refreshing sleep, cataplexy, sleep paralysis, and hypnagogic hallucinations

Narcolepsy/Hypocretin Deficiency

Treatment—lifestyle modifications and long-acting stimulant medication

Narcolepsy/Hypocretin Deficiency

Circadian Rhythm Sleep Disorder, Treatment:

aggressive lifestyle management strategies aimed at adapting to or modifying the required sleep schedule

Difficulty with sleep initiation Sleep maintenance Early awakening

Insomnia

Insomnia: symptoms last for

at least 3 months (and occur 3 times a week)

``` Angry and irritable mood Defiant and vindictive behavior Experience Social difficulties Conflicts with authority figures Academic problems ```

Oppositional Defiant Disorder

``` Inability to control aggressive impulses Adults 18 years or older Leads to problems with Interpersonal relationships Occupational difficulties Criminal difficulties ```

Intermittent Explosive Disorder

Behavior is usually abnormally aggressive | Rights of others are violated and societal norms or rules are disregarded

Conduct Disorder

therapy designed to help people change patterns of behavior that are not helpful, such as self-harm, suicidal thinking, and substance abuse.[1] This approach works towards helping people increase their emotional and cognitive regulation by learning about the triggers that lead to reactive states

Dialectical behavioral therapy

teaching parents positive reinforcement methods

Parent management training (PMT)

an intensive, family-focused and community-based treatment program for chronically violent youth

Multisystemic therapy (MST)

Delirium is a medical

emergency

1. Acute onset and fluctuating course 2. Reduced ability to direct, focus, shift, and sustain attention 3. Disorganized thinking 4. Disturbance of consciousness

Delirium

Delirium diagnoses: Risk for injury Acute confusion Risk for ___ __ __

deficient fluid volume

Dementia does not show change in

consciousness

inability to interpret sensations and hence to recognize things

Agnosia

Difficulty with skilled movements

Apraxia

cant talk

Aphasia

People with ____ personality disorder are often described as odd or eccentric and usually have few, if any, close relationships

Schizotypal Personality Disorder

A disorder characterized by social discomfort and avoidance of interpersonal contact.

avoidant personality disorder

personality disorder that is characterized by a pervasive psychological dependence on other people.

dependent disorder

Antisocial, obsessive-compulsive, and schizotypal personality disorders occur most frequently in

men

Types of Crisis: New developmental stage is reached Old coping skills no longer effective Leads to increased tension and anxiety

Maturational

``` Types of Crisis: Arise from events that are Extraordinary External Often unanticipated ```

Situational

``` Types of Crisis: Unplanned and accidental Natural disaster National disaster Crime of violence ```

Adventitious

In the hospital, violence is most frequent in

Psychiatric units Emergency departments Geriatric units

Cycle of Violence

Tension-building stage Acute battering stage Honeymoon stage

Therapeutic use of self: studies show that relationships established by therapeutic use of self

improve treatment outcomes