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Psychiatry > Psych Exam 2 > Flashcards

Psych Exam 2 Flashcards

WARNING: topics include suicide, mood disorders, intimate partner violence and abuse, and more

1
Q

What type of anti-psychotics target positive symptoms?

A

Conventional (first-generation)

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2
Q

What type of anti-psychotics target positive and negative symptoms?

A

Atypical (second-generation)

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3
Q

How do anti-psychotic medications work against schizophrenia?

A

Alleviate the symptoms but do not cure the underlying psychotic processes

Can return with medication noncompliance

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4
Q

What are some reactions of anti-psychotic medications?

A

Anti-cholinergic effects
Orthostasis
Lowered seizure threshold

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5
Q

What is schizophrenia and what does it affect?

A

Brain disorders affecting thinking, language, emotions, social behavior ability to perceive reality accurately

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6
Q

Psychosis

A

Symptom; refers to a total inability to recognize reality
not a diagnosis

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7
Q

Ongoing psychosis

A

Never fully recovering

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8
Q

Episodes of psychotic symptoms

A

Alternating episodes of relatively complete recover

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9
Q

Long-term course of psychosis

A

Intensity diminishes with age and the disease becomes less disruptive

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10
Q

What are the co-morbidities of schizophrenia?

A

Substance abuse disorders
Anxiety
Depression
Suicide
Physical health illness
Polydipsia

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11
Q

What factors may play a role in the etiology of schizophrenia?

A

Genetic
Brain structure abnormalities (less brain tissue and CSF)
Neurobiological theories (elevated dopamine, serotonin, and glutamate)
Immunovirologic factors

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12
Q

What are the psychological and environmental factors which play a role in the etiology of schizophrenia?

A

Prenatal stress
Psychological stressors
Environmental stressors

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13
Q

What can be seen in imaging results of patients with schizophrenia?

A

Enlarged ventricles
Smaller brains
Less grey matter
Less brain mass
Higher density of dopamine receptors

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14
Q

What five items are included in the DSM for schizophrenia?

A

Delusions
Hallucinations
Disorganized speech
Grossly disorganized or catatonic behavior
Negative symptoms

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15
Q

What are examples of positive (hard) symptoms found in schizophrenia?

A

Delusions, hallucinations, hyper-vigilance

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16
Q

What are the examples of negative (soft) symptoms of schizophrenia?

A

Flat effect, lack of volition, inattention

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17
Q

What are alterations in thinking in schizophrenia?

A

Impaired reality testing
Delusions
Concrete thinking

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18
Q

What are alterations in speech in schizophrenia?

A

Associative looseness
Neologisms
Clang association
Word salad
Echolalia
Echopraxia

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19
Q

What are alterations in perception in schizophrenia?

A

Depersonalization
Hallucinations
Illusions
Command hallucinations
Derealization

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20
Q

What are alterations in behavior in schizophrenia?

A

Bizarre behavior
Extreme motor agitation
Stereotyped behaviors
Waxy flexibility
Stupor
Negativism
Automatic obedience

Impulse control resulting in agitated behaviors

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21
Q

What are therapeutic strategies for communicating with patients with schizophrenia?

A

Lower anxiety
Decrease defensive patterns
Encourage participation in therapy and social events
Raise feelings of self-worth
Increase medication compliance

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22
Q

Tardive dyskinesia

A

irreversble

Seen more in long-term usage of conventional anti-psychotics
Involuntary rhythmic stereotyped movements of trunk and extremities
Symptoms increase with anxiety and tension

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23
Q

Extrapyramidial syndrome

A

Reversible and can be treated with anti-cholinergics
Characterized by: pseudoparkinsonism,acute dystonia, and akathesia

Treatment: anti-parkinsonian drugs and lowered doses

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24
Q

What falls under pseudoparkinsonism?

A

Stiffness/rigidity, tremors, drooling, pill rolling, mask-like experience, thick tongue, cog wheeling

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25
Q

What falls under acute dystonia?

A

Irregular, involuntary abnormal positioning of the neck, head, arms, legs, and trunk
Oculogyrc crisis

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26
Q

Akathesia

A

Motor restlessness

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27
Q

What is the purpose of antipsychotic medications?

A

Alleviate symptoms of schizophrenia (not a cure)

symptoms will return if discontinued

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28
Q

What are common reactions with antipsychotic medications?

A

Anticholinergic effects
Orthostasis
Lowered seizure threshold

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29
Q

What do conventional (first-generation) antipsychotics target?

A

Positive symptoms

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30
Q

What do atypical (second-generation) antipsychotics target?

A

Positive and negative symptoms

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31
Q

Why are atypicals often preferred compared to conventional antipsychotics?

A

Fewer side effects and target more symptoms

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32
Q

What are some examples of conventional antipsychotic medication?

A

Thiothixene [Navane]
Fluphenazine [Prolixin]
Haloperidol [Haldol]
Pirozide [Orap]
Loxaine [Loxitane]
Molidone [Moban]
Perphenazine [Trilafon]
Chlorpromazine [Thorazine]
Thioriadizine [Mellaril]

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33
Q

What are some examples of atypical antipsychotic medications?

A

Aripiprazole [Abilify]
Clozapine [Clozaril]
Olanzapine [Zyprexa]
Paliperidone [Invega]
Quetiapine [Seroquel]
Risperidone [Risperdal]
Ziprasidone [Geodon]

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34
Q

What six antipsychotic medications are available in the form of depot injections?

A

Fluphenazine
Haloperidol
Risperidone
Paliperidone
Olanzapine
Aripiprazole

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35
Q

What is metabolic syndrome characterized by?

A

Hyperglycemia, dyslipidemia, and abdominal obesity

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36
Q

What labs should you look at in metabolic syndrome? Interventions?

A

CBC, serum glucose level, lipid panel, liver function, vision tests

Need baseline bloodwork and regular monitoring; check family history of metabolic disorders

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37
Q

What drugs seem to have the highest risk with metabolic syndrome?

A

Clozaril and Zyprexia

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38
Q

What are the side effects and adverse reactions of antipsychotics seen more in first-generation medications?

A

Extrapyramidal symptoms (EPS) and tardive dyskinesia (TD)

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39
Q

What are the side effects and adverse reactions of antipsychotics seen more in second-generation medications?

A

Metabolic syndrome

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40
Q

What is neuroleptic malignant syndrome?

A

fatal

Usually occurs suddenly and symptoms can be mistaken for an illness of other side effects

Altered consciousness (confusion and irritability)

Muscle rigidity and abnormal blood work

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41
Q

Should medication continue to be administered, or should it be held in a patient experiencing neuroleptic malignant syndrome?

A

Hold medication

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42
Q

What is a fairly common adverse reaction to Clozapine [Clozaril] in patients?

A

Agranulocytosis

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43
Q

What is agranulocytosis?

A

Bone marrow is unable to produce sufficient amounts of WBCs which leads to fever, malaise, sore throat, and leukopenia

Interventions: regular bloodwork (WBCs over 3500)

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44
Q

_____ are administered for severe depression.

A

Antidepressants

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45
Q

_____ and other _____ _____ reduce aggressive behaviors.
Hint: medications

A

Lithium
Mood stabilizers

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46
Q

_____ _____ improves positive and negative symptoms.

A

Benzodiazepine augmentation
OR atypical second gen anti-psychotics

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47
Q

_____ decreases anxiety, agitation, and possibly psychosis.

A

Clonazepam

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48
Q

According to evidence-based psychosocial therapies, family needs to be included in:

A

Psychologic strategies aimed at reducing psychotic symptoms
Teaching patient and family about illness
Recognizing effect of stress
Identifying support sources
Medication groups for patients and family

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49
Q

Schizoaffective disorder

A

Diagnosed when a client is severely ill and has a mixture of psychotic and mood symptoms
These symptoms can occur simultaneously or alternating

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50
Q

Schizophreniform disorder

A

The client exhibits an acute, reactive psychosis for less than 6 months necessary to meet the diagnostic criteria for schizophrenia

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51
Q

Catatonia

A

Characterized by marked psychomotor disturbance, either excessive motor activity or virtual immobility and motionlessness

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52
Q

Delusional disorder

A

The client has one or more non-bizarre delusions (believable)

Delusions may be persecutory, erotomanic, grandiose, jealous, or somatic in content

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53
Q

Brief psychotic disorder

A

The client experiences the sudden onset of at least one psychotic symptom which last from one day to one month

Symptoms include delusions, hallucinations, or disorganized speech or behavior

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54
Q

Shared psychotic disorder (folie à deux)

A

Two people share the same delusion after one begins to mimic the delusions of the other

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55
Q

Schizotypal personality disorder

A

This involves odd, eccentric behaviors - includes transient psychotic symptoms

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56
Q

Dysthymic disorder

A

A chronic, persistent mood disturbance characterized by symptoms such as insomnia, loss of appetite, decreased energy, low self-esteem, difficulty concentrating, and feelings of sadness and hopelessness

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57
Q

Disruptive mood regulation disorder

A

A persistent angry or irritable mood, punctuated by severe, recurrent temper outbursts that are not keeping with the provocation or situation

Begins before the age of 10

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58
Q

Cyclothymic disorder

A

Characterized by mild mood swings between hypomania and depression without loss of social or occupational functioning

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59
Q

Substance-induced depressive or bipolar disorder

A

Characterized by a significant disturbance in mood that is a direct physiological consequence of ingested substances such as alcohol, other drugs, or toxins

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60
Q

Seasonal affective disorder (SAD) - winter depression or fall onset

A

Increased sleep, appetite, and carbohydrate cravings
Weight gain, interpersonal conflict, irritability, and heaviness in the extremities beginning in late autumn and abating in spring and summer

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61
Q

Seasonal affective disorder (SAD) - spring onset

A

Less common

Symptoms of insomnia, weight loss, and poor appetite lasting from late spring or early summer until the fall

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62
Q

Postpartum or “maternity” blues

A

Mild, predictable mood disturbance occurring in the first several days after delivery of a baby

Symptoms include labile mood and affect, crying spells, sadness, insomnia, and anxiety

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63
Q

Postpartum depression

A

Symptoms are consistent with those of depression with onset within 4 weeks of delivery

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64
Q

Postpartum psychosis

A

A severe and debilitating psychiatric illness, with acute onset in the days following childbirth

Symptoms begin with fatigue, sadness, emotional lability, poor memory, and confusion
Progresses to delusions, hallucinations, poor insights and judgment, and loss of contact with reality

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65
Q

Premenstrual dysphoric disorder

A

A severe form of premenstrual syndrome

Defined as a recurrent, moderate psychological and physical symptoms that occur during the week before menses and resolving with menstruation

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66
Q

Non-suicidal self-injury

A

Involves deliberate, intentional cutting, burning, scraping, hitting, or interference with wound healing

Some report reasons of alleviation of negative emotions, self-punishment, seeking attention, or escaping a situation or responsibility

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67
Q

What populations are more likely to experience depression?

A

Living below the poverty level
Co-occurring chronic medical problems
Frequently accompanies other psychiatric disorders

68
Q

What are the four etiological theories of mood disorders?

A

Genetic theory
Biochemical theory
Psychosocial theories
Cognitive theory

69
Q

What two neurotransmitters involved in depression?

A

Serotonin and norepinephrine

70
Q

What three things are involved in Beck’s cognitive triad?

A
  1. negative, self-depreciating view of self
  2. pessimistic view of the world
  3. belief that negative reinforcement will continue
71
Q

List risk factors for mood disorders?

A

Prior episodes of depression
Family history of depressive disorders
Prior suicide attempts
Female
Age of onset prior to age 40
Post partum
Medical comorbidity
Lack of social support
Stressful life events
Substance abuse
Certain medications
Co-morbid psychiatric conditions

72
Q

How long can an untreated depressive episode last for major depressive disorder?

A

Weeks, months, or years

Most clear in about 6 months

73
Q

What are some key symptoms of major depressive disorder?

A

Depressed mood, anhedonia, changes in appetite, changes in sleep, psychomotor agitation, fatigue, feelings of worthlessness or excessive guilt, decreased cognitive ability, morbid thinking or suicidal ideation

74
Q

What assessment are noted for major depressive disorder? What are the expected findings?

A

History
General appearance and motor behavior (psychomotor agitation, latency of response)
Mood and affect (anhedonia)
Thought process and content (rumination, thoughts of suicide)
Sensorium and intellectual processes (impaired memory)
Judgment and insight (impaired judgment)
Self-concept (feelings of worthlessness)
Roles and relationships (severity directly proportional to difficulty)
Physiological and self-care considerations
Depression rating scales

75
Q

What are examples of rating scales used for major depressive disorder?

A

Hamilton rating scale
Zung self-rating scale
Beck depression inventory

76
Q

What are nursing priorities and interventions common for major depressive disorder?

A

Free from self-injury
Independently carry out activities of daily living
Balance of rest, sleep, and activity
Evaluate self-attributes realistically
Socializing
Return to occupation or school activities
Medication compliance
Verbalize symptoms of recurrence

77
Q

What types of medications are available for depression?

A

SSRI
Atypicals
Tricyclic
MAOI

78
Q

Selective serotonin reuptake inhibitors (SSRIs)

A

Block the neuronal uptake of serotonin by inhibiting the uptake of serotonin in the nerve terminal

Therapeutic response: 2-8 weeks

must monitor for suicidality in the first few weeks

79
Q

What are common side effects of SSRIs?

A

Dizziness, drowsiness, headache, GI

80
Q

List SSRIs.

A

Fluoxetine [Prozac]
Sertraline [Zoloft]
Paroxetine [Paxil]
Citalopram [Celexa]
Escitalopram [Lexapro]
Vortioxetine [Trintellix]

81
Q

What side effect should be reported to a physician when using SSRIs?

A

Sexual dysfunction

82
Q

Serotonin and noradrenaline reuptake inhibitors (SNRIs)

A

Increases serotonin and norepinephrine
Side effects include fewer anticholinergic effects that tricyclic agents and nausea/vomiting

83
Q

What are examples of atypical SNRIs?

A

Venlafaxine [Effexor]
Duloxetine [Cymbalta]
Desvenlaxafine [Pristiq]

84
Q

Serotonin and noradrenaline disinhibitors (SNDIs)

A

Increase serotonin and norepinephrine
Has anti-anxiety, antidepressant, and anti-emetic effects
Side effects include sedation and weight gain

85
Q

What are examples of atypical SNDIs?

A

Mirtazapine [Remeron]

86
Q

What are examples of other atypical antidepressants?

A

Bupropion [Wellbutrin, Zyban]
Nefazodone [Serzone]
Vilazodone [Viibryd]

87
Q

Tricyclic antidepressants (TCAs)

A

Neurotransmitter effects
Contraindications - MI, hepatic history

88
Q

What are examples of TCAs?

A

Amitriptyline [Elavil]
Amoxapine [Asendin]
Doxepin [Sinequan]
Imipramine [Tofranil]
Desipramine [Norpramin]
Nortriptyline [Pamelor]

89
Q

Monoamine oxidase inhibitors (MAOIs)

A

Responsible for breaking down the different types of neurotransmitters

Adverse and toxic effects - inhibits breakdown of excess tyramine in liver leading to hypertensive crisis, CVA, and death

Interactions: avoid OTC medications and foods containing tyramines

Contraindications: must be off of these for at least two weeks before starting another antidepressant

90
Q

What are examples of MAOIs?

A

Isocarboxazid [Marplan]
Phenelzine [Nardil]
Tranylcypromine [Parnate]

91
Q

Serotonin syndrome

A

Due to central and peripheral serotonin hyper stimulation

Symptoms: confusion, delirium, agitation, irritability, incoordination tremor, seizures, fever, diaphoresis, nausea and vomiting, diarrhea, abdominal pain, hypo or hypertension, tachycardia, severe respiratory depression, coma

Treatment: discontinue the medication and/or treat the symptoms

92
Q

Electroconvulsive therapy (ECT)

A

Electrodes are applied to a patient’s head through which electrical impulses are sent to the brain
It is believed that these impulses alter and correct the brain’s chemistry to fix imbalances

93
Q

Interpersonal therapy

A

Relationship difficulties

94
Q

Behavior therapy

A

Positive reinforcement of interactions

95
Q

Cognitive therapy

A

Focus on cognitive distortions

96
Q

Absolute, dichotomous thinking

A

Tendency to view everything in polar categories

97
Q

Arbitrary inference

A

Drawing a specific conclusion without sufficient evidence

98
Q

Specific abstraction

A

Focusing on a single detail while ignoring other, more significant aspects of the experience

99
Q

Overgeneralization

A

Forming conclusions based on too little or too narrow experience

100
Q

Magnification and minimization

A

Overvaluing or undervaluing the significance of a particular event

101
Q

Personalization

A

Tendency to self-reference external events without basis

102
Q

What symptoms are common in children with depression?

A

Persistent sadness
Withdrawal
Irritable, anhedonia
Low self-esteem
Excessive guilt
Sleep disturbances
Running away behaviors
Appetite changes
Somatic/physical complaints
Change or difficulty in school performance
Preoccupation with death

103
Q

What are depressive symptoms common in adolescence?

A

Fluctuations between apathy and talkativeness
Anger/rage, sarcasm, verbally attacking
Overreaction to criticism
Guilt
Feels unable to satisfy ideals
Low self-esteem
Loss of confidence
Feelings of hopelessness and helplessness
Intense ambivalence between dependence and independence
Feelings of emptiness in life
Restlessness/agitation
Pessimism about the future
Death wishes
Rebellious
Sleep disturbances
Appetite changes and weight changes

104
Q

Fact: depression in older adults is often underdiagnosed and misdiagnosed.

A

Check on them and make them feel as if they have a purpose. Please.

105
Q

Bipolar mixed

A

Cycles alternate between periods of mania, normal mood, depression, normal mood, mania, and so forth

106
Q

Bipolar type I

A

Manic episodes with at least one depressive episode

107
Q

Bipolar type II

A

Recurrent depressive episodes with at least one hypomanic episode

108
Q

What is the diagnostic criteria for Bipolar I?

A

Current or recent major depressive episode
Previous manic episode or mixed

Mood episodes not to to schizoaffective disorder or similar

109
Q

What is the diagnostic criteria for Bipolar II?

A

Current or history of major depressive episodes
Current or history hypomanic episodes
Symptoms cause significant distress as well as impairment in social, occupational, or other important areas of functioning
Current episode meets appropriate criteria for hypomania or depression

No history of manic episode or mixed episode
Mood symptoms not due to schizoaffective disorder or similar

110
Q

Hypomania

A

Mood falling between normal euphoria and mania

Characterized by optimism, pressure of speech and activity and a decreased need for sleep; increased creativity; poor judgment and irritability
Able to function socially, academically, and occupationally although their behavior is different from their baseline

111
Q

Manic episode

A

Mood persistently and abnormally elevated, expansive or irritable for at least 1 week
Inflated self-esteem or grandiosity
Decrease need for sleep
Increased talking or increased pressure to keep talking
Flight of ideas or subjective feelings of “racing thoughts”
Easily distractible
Increased goal directed activity or psychomotor agitation
Excessive over involvement in pleasurable activities usually associated with a high potential for painful consequences

May be preoccupied with religious, sexual, financial, political or persecutory thoughts that can develop into a delusional system-psychotic symptoms
Mood occurring with at least three other symptoms
Symptoms not related to a medical condition or substance use

112
Q

What are some appropriate strategies for manic patients?

A

Display a firm, calm approach
Express short, concise explanations or statements
Remain neutral
Maintain consistency
Conduct frequent staff meetings to agree on approach and limit setting
Hear and act upon legitimate complaints
Firmly redirect energy

113
Q

What are key components of milieu therapy with patients in acute phase of mania?

A

Teamwork and collaboration

114
Q

What are assessment findings for someone experiencing bipolar disorders?

A

History
General appearance and motor behavior
Communication
Mood and affect (euphoria, grandiosity)
Thought process and content (circumstantiality, tangentiality)
Sensorium and intellectual processes (disoriented to time)
Judgment and insight
Self-concept (exaggerated self-esteem)
Roles and relationships

115
Q

What expected outcomes are our biggest concerns when working with a patient experiencing bipolar disorders?

A

No injury to self or others
Balance of rest, sleep, and activity
Socially appropriate behavior

116
Q

What interventions are important for patients experiencing bipolar disorders?

A

Providing for safety
Meeting physiological needs
Providing therapeutic communication
Promoting appropriate behaviors
Managing medications
Providing client and family teaching

117
Q

What type of medications are available for bipolar disorders?

A

Lithium (0.5-1.5)
Anticonvulsants
Antipsychotics

118
Q

Lithium [Eskalith, Lithobid]

A

Stabilizes depression and mania
Narrows the therapeutic index
Has a potential for toxicity

Absorbed in the GI tract; 80% excreted by kidneys

119
Q

What are toxic symptoms of lithium?

A

Nausea and vomiting, diarrhea, drowsiness, slurred speech, agitation, coarse tremors, muscle spasms, blurred vision, stupor, coma, convulsions, death

no antidote - may try dialysis

120
Q

Valproate [Depakote/Depakene]

A

Very effective in managing impulsive aggression

121
Q

What are examples of anticonvulsants?

A

Carbamazepine [Tegretol]
Divalproex [Depakote]
Gabapentin [Neurontin]
Lamotrigine [Lamictal]
Topiramate [Topamax]
Oxcarbazepine [Trileptal]

122
Q

What should you monitor for when a patient is taking lamotrogine [Lamictal]?

A

Rash - may indicate Stevens-Johnson syndrome

123
Q

Suicide or completed suicide

A

Intentional ending of one’s own life

124
Q

Suicide attempts

A

Willful, self-inflicted, life-threatening attempts that have not led to death

125
Q

Suicidal ideation

A

A person thinking of self-harm

ask them directly if they are thinking of killing themselves

126
Q

Physician-assisted suicide (PAS)

A

For terminally ill patients
Operated under strict guidelines

127
Q

What types of cues will a person provide when they are thinking of or planning to attempt suicide?

A

Verbal cues
Behavioral cues
Situational cues

128
Q

What medications may contribute to suicidal ideation?

A

Antihypertensives, benzodiazepines, calcium-channel blockers, corticosteroids, hormonal medications, pain medications

129
Q

Traumatic brain injury (TBI)

A

Refers to trauma to the head that affects brain functioning

130
Q

What groups are at high risk for suicide?

A

People with a previous suicide attempt
Family member who has committed suicide
People with psychiatric disorders
People with substance abuse
Divorced, separated, widowed, unemployed, socially isolated
People with gambling problems
People who have command hallucinations
People experience grandiose thinking
People with poor impulse control

131
Q

What are assessment markers for suicide in children?

A

Children or teenagers who lost a parent to suicide are three times more likely to commit suicide
Childhood maltreatment
Problematic family relations
History of bullying or victimization
Family history of suicide
Socioeconomic problems
Parental psychopathologic problems
Peer problems
Legal and/or discipline problems

132
Q

What are the risk factors for suicide in adolescents and young adults?

A

substance abuse, aggression, disruptive behaviors, depression, and social isolation
Frequent episodes of running away
Frequent expressions of rage and problems with parents
Family loss, instability, and withdrawal
Perception of failure
Expression of suicidal thoughts when sad or bored
Difficulty dealing with sexual orientation
Unplanned pregnancy

133
Q

What are risk factors for suicide in older adults?

A

Social isolation, solitary living arrangements, widowhood, lack of financial resources, poor health, and hopelessness

134
Q

What are behavioral cues of suicide in people considering it?

A

Giving away prized possessions
Writing farewell notes
Making out a will
Putting personal affairs in order
Global insomnia
Exhibiting sudden or unexpected improvement in mood after being depressed and withdrawn
Neglecting personal hygiene

135
Q

What questions are asked (or should be) to patients presenting with suicidal thoughts or plans?

A

Passive death wish
Suicidal ideation
Suicidal intent
Suicidal threat
Suicidal gesture
Suicidal attempt

136
Q

What should be assessed if a history of suicide attempts exists?

A

Intent
Lethality
Injury

137
Q

What interventions are important for patients experiencing suicide?

A

Provide a safe environment
Document the patient’s activity (every 15 minutes)
Maintain accurate records of nurse and physician actions
Place the patient on either suicide precaution or suicide observation
Construct a verbal or written no-suicide contract
Encourage the patient to talk about their feelings and alternatives

138
Q

What are protective factors that can be implemented for patients experiencing suicide?

A

Family and community support
Effective and appropriate clinical care for mental, physical, and substance abuse disorders
Restricted access to highly lethal methods of suicide
Cultural and religious beliefs that discourage suicide
Acquisition of problem-solving skills, conflict resolution, and nonviolent management of disputes
Cognitive-behavioral therapy

139
Q

Intimate partner violence

A

Defined as a pattern of assault and course of behaviors that may include physical injury, psychologic abuse, sexual assault, progressive social isolation, stalking, deprivation, intimidation, and threats between current or former partners of an intimate relationship OF ANY KIND

140
Q

Abuse

A

A repetitive pattern of behaviors to maintain power and control over an intimate partner

141
Q

What are warning signs (red flags) of intimate partner violence?

A

Telling partner they never do anything right
Showing jealousy of partner’s friends and time spent away
Keeping partner or discouraging them from seeing friends or family
Embarrassing or shaming partner with put downs
Controlling every penny spent in the household
Taking partner’s money or refusing to give them money for expenses
Preventing partner from making your own decisions
Telling partner they are a bad parent or threatening to harm or take away their children
Preventing partner from working or attending school
Destroying partner’s property or threatening to hurt or kill their pets
Intimidating with weapons
Pressuring partner to be intimate when they don’t want to

142
Q

What does the cycle of violence look like?

A

Tension building phase
Acting out
Honeymoon

143
Q

What are the characteristics of intimate partner violence?

A

Denial and blame
Emotional abuse
Control through isolation
Control through intimidation
Control through economic abuse
Control through power

144
Q

What can be found in people experiencing battered woman syndrome? This can be seen in anybody who is a victim, not just women.

A

PTSD symptoms
Learned helplessness
Self-destructive coping responses to violence

145
Q

What can be done to help someone leave an abusive relationship?

A

Come up with a plan
Keep location and plan a secret
never tell the abuser that the person is leaving

146
Q

What questions should be asked to someone who you suspect may be experiencing intimate partner violence?

A

Within the last year, have you been hit, slapped, kicked or otherwise physically hurt by someone?

If pregnant, since the pregnancy began, have you been hit, slapped, kicked, or otherwise physically hurt by someone?

Within the last year, has anyone forced you to have sexual activities?

Are you afraid of your partner or anyone else?

Is there a partner from a previous relationship who is making you feel unsafe now?

147
Q

What interventions can be done for someone experiencing intimate partner violence?

A

Let them know help is available

Give them specific information about resources

Document the battering with accurate medical records

Acknowledge them experiences in a supportive manner

Respect them right to make their own decisions

148
Q

What is included in a rape assessment?

A

Determine if life threatening and/or acute issues

History of incident (may need to review several times) Documentation is crucial

Chain of evidence (who handles-how obtained)

Hopefully victim hasn’t bathed

Assess skin, look for signs of physical force

Rape kit in all ER’s

Items in paper bag

Referrals

149
Q

What is included in the nurse’s role when it comes to intimate partner violence?

A

Screen for intimate partner violence

Conduct initial assessment in private

Screen using direct questions – need to ask won’t usually volunteer

If violence is identified – make sure person knows they are not alone and that they do not deserve to be treated in this way

Stress confidentiality

Assess immediate safety

Ask to consult an advocate

Report situation to physician

If necessary, let security know

150
Q

What does the word violence encompass?

A

Domestic violence
Family violence
Intimate partner violence

151
Q

What are indicators for family violence?

A

Recurrent emergency department (ED) visits for injuries attributed to being “accident prone”

Presenting problems reflecting signs of high anxiety and chronic stress

Stress-related conditions

152
Q

How does the social learning theory apply to domestic violence?

A

Relies on role modeling, identification, and human interaction

153
Q

What are the societal and cultural factors of domestic violence?

A

Poverty or unemployment
Communities with inadequate resources
Overcrowding
Social isolation of families

154
Q

Patriarchal theory

A

Male dominance in our political and economic structure enforces the differential status of men and women

155
Q

What are psychologic factors in domestic violence?

A

Personality traits
Substance abuse
“loss of control” according to some abusers
Low self-esteem
Poor problem-solving skills
History of impulsive behavior
Hypersensitivity
Narcissism

156
Q

What are the types of child abuse?

A

Neglect
Physical
Sexual
Emotional

157
Q

What are common signs of abuse?

A

Verbal complaints of beatings and/or parent’s significant other doing things when parent not home
Arrives early and leaves late, doesn’t want to go home
Compliant, shy, withdrawn, passive, and uncommunicative
Nervous, hyperactive, aggressive, disruptive, and destructive
Unexplained injury, hair missing, burns or bruises
Injury not adequately explained
Goes to bathroom with difficulty
Inadequately dressed for inclement weather
Clothing is soiled, tattered, too small
Dirty, odorous, poor dental, hair falling out, lice
Thin, emaciated, tired
Unusually fearful of other children and adults
Has been given inappropriate food, drink or drugs

158
Q

What are signs of abusive parents?

A

Shows little concern for child’s problems
Takes an unusual amount of time to seek health care for child
Does not adequately explain an injury
Gives different explanations for the same injury
Complains about irrelevant problems unrelated to the injury
Blames a third party
Reluctant to share information about the child
Uses alcohol or drugs
Has no friends or relatives to turn to in crises
Very strict disciplinarians
Were abused as children
Goes to different doctors and clinics
Antagonistic and hostile

159
Q

Infant whiplash syndrome

A

Shaken baby syndrome
Potentially life threatening
Serious injury
Often due to adults becoming frustrated and angry

160
Q

Shaken baby syndrome

A

It is: abusive head trauma, closed head injury, blunt force trauma to the head, non-accidental head injury

Happens when: someone forcefully shakes a baby, uncontrolled head rotation, brain violently moves back and forth in the skull, ruptured blood vessels, nerves, and tearing of brain tissue, bruising and bleeding in the brain

161
Q

What are the signs of shaken baby syndrome?

A

Bruising from being grabbed firmly
Major head injury (cerebral edema, subdural hematoma)
Blindness due to retinal hemorrhage
Cerebral palsy
Cognitive impairment
Death

162
Q

Kimberlin West Act2002 Florida Law

A

Requires hospitals, birthing centers or home birth providers to give new parents informational brochures about the danger of shaken babies

Department of health must prepare and provide these brochures

Training sessions to teach nurses to talk to new parents about Shaken Baby Syndrome

163
Q

What are actions the nurse does when assessing a child who has been a victim of family violence?

A

Reassure children that they did not do anything wrong.
Experience should be nonthreatening and supportive. Interview should not resemble trial or inquisition.
Children may express experiences through playing out the incident with dolls or drawings.
Do not suggest answers.
Do not promise that everything is confidential (abuse must be reported).
Do not react with shock to anything; do not force a child to undress or be examined.

164
Q

What are interventions the nurse can perform for a child experiencing family violence?

A

Gently confirm abuse and treat the problem
May not come right out and confess the abuse
Provide very safe atmosphere
Assure they will be protected
Reframe that parents need guidance and help
Educate about how many children go through this
Play therapy
Family therapy
Group therapy for all

165
Q

What are the types of abuse against elders?

A

Physical
Emotional
Financial
Neglect
Sexual abuse
Self-neglect

166
Q

What are warning signs common in elder abuse?

A

Bruises, pressure marks, broken bones, abrasions and burns
Unexplained withdrawal from normal activities, sudden change in alertness, unusual depression
Bruises around the breasts or genital area
Sudden changes in financial status
Decubitus ulcers, poor hygiene unusual weight loss
Belittling, threats by caregivers
Strained and tense relationships with caregivers

167
Q

Who is more at risk for elder abuse?

A

People with dementia or cognitive impairment
Long term domestic violence
Personal problems of abusers/caregivers
Social isolation

Psychiatry (2 decks)

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