NUR 304 Flashcards
Therapeutic Use of self
the ability to intentionally use one’s personality to build a relationship and form nursing interventions.
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
Mental illness
all mental disorders with definable diagnoses
DSM –V- the official guideline for diagnosing psychiatric disorders. It also provides
epidemiological statistics
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.
ICD-10 Includes all diseases. Divides mental illness into 2 main categories, which are
psychosis and neurosis
Maslow’s Hierarchy
Physical Safety Love Esteem (achievement and praise) Self-actualization Self-Transcendence
cognitive theory includes
rational-emotive behavior therapy (REBT) and Cognitive-Behavioral Therapy
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
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
Ego
reality tester. Leader.
Superego
strict morality. Super christian
Psychoanalytic- came up with
transference and countertransference
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.
Behavior therapy works best on
specific problems, like a phobia of snakes
There are 5 kinds of behavior therapy:
modeling, OC, desens, aversion therapy, biofeedback
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.
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)
Lithium adverse effects
tremor ataxia confusion convulsions NVD arrhythmia polyuria polydipsia edema goiter hypothyroidism
Lithium TI
.8 to 1.5
Lithium contraindication
pregnancy
below age 12
Lithium drink…
plenty of water
Lithium, older adults are
more sensitive to it
Lithium, diet
don’t change the amount of salt you eat
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
CT
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
1%
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
DA
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
- Acute onset and fluctuating course
- Reduced ability to direct, focus, shift, and sustain attention
- Disorganized thinking
- 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
