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psych final review Flashcards

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1
Q

therapeutic alliance

A

a professional bond, play role in pts wel being,

no judgement, pts centered needs, short and long term

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2
Q

Factors that influence communication

A

external factors, relationship, context of message, attitude, knowledge level

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3
Q

facilitators

A

silence, ative listening, support reassurance, sharing obervation, open ended statements, info giving, interpretation, restating, reflecting, clarifying, confronting, summarizing, voicing doubt,

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4
Q

blockers

A

why questions, changing topic, defensive responses, excessive questioning, closed questions, false reassurance, giving advice, showing approval, stereotyping, minimizing, belittling, disagreeing, judging, challenging

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5
Q

nonverbal

A

93% of all communication, involves al 5 senses and should be congruent with verbal comminiation, includes appearance, body language

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6
Q

levels of prevention

A

primary (before problem exists)
secondary ( treatment of symptoms)
Tertiary (keep from getting sick again)

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7
Q

Levels of Practice

A

RN-PMH (basic- requires a bachelors degree)

APRN-PMH ( advanced- requires a masters or doctoral degree)

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8
Q

Interventions of APRN-PMH

A

psychotherapy, prescriptive authority and treatment, consultation

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9
Q

Standards of practice

A

developed by ANA, APNA, ISPMH,- describes professional activities that the nurse performs during the steps of nursing process ADPIE

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10
Q

Settings of practice

A

mental health units, emergency department, intensive care units, med surg unit, school, correctional facility, community center, homeless shelter, private practice.

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11
Q

Cultural influences

A

cultures differ in how they define mental illness, cure and care vary in different cultures, things that also differ in cultures: personal space, touch, time orientation, biologic, physical variations, communication, eye contact, and social organization.

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12
Q

Stigma as an obstacle for mentally ill

A

stigma buts an negative mark on persons image or reputation, increases misunderstanding, causes alienation, and alters funding for the disease

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13
Q

DSM IV

A

metnal disorders are formally identified and classified based on specific criteria for diagnosis. Cultural biases in the DSM can lead to misdiagnosis. Strength of the DSM IV is it gives us consistency

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14
Q

Axis I

A

psychiatric dx

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15
Q

Axis II

A

personality disorder or mental retardation

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16
Q

Axis III

A

Medical dx

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17
Q

Axis IV

A

psychosocial stressor

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18
Q

Axis V

A

GAF score (numerical number to assess patient functioning and possible prognosis 1-100, 1-10 indicates severe danger or possible suicide, patient with severe mental illness will be in the 30’s

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19
Q

Patients rights, basic rights

A

retain civil rights, right to vote, manage financial matters, enter a contractual relationship, assert constitutional rights, seek advice of attorney, right to send and receive unopened mail, wear own clothes, receive visitors and keep and use personal possessions and access to a phone. Also have right to be informed about potential risks, benefits and reasonable alternatives before given consent for any therapy, surgery or TX, including medication. Nurses need to disclose serious side effects. For non-speaking English patients they have right to have rights in their own language or presented via qualified interpreter.

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20
Q

Restraints

A

used to contain out of control behavior , implemented only when less restrictive alternatives to ensure safety don’t work, restraints can be deadly, so strict hospital protocol must always be followed, protocol usually includes 15 min checks then complete reevaluation of status in 1 hour

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21
Q

Duty to warn/ Tarasoff

A

responsibility of treating health professinal to notify and warn an inteded and identifiable victim

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22
Q

duty to report

A

suspected abuse neglect and exploitation of children, elderly, and dependent adults

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23
Q

criteria for involuntary admission

A

18 years old and observed the behavior. harm to self, harm to others, or unable to care for self. A petition for hospitalization and clinical certificate is filled out. After brought t inpatient unit, a second mental health professional usually psychiatrist has to make examination and fill out a second clinical certificate. This procedure protects rights of individuals. Within 5 days, excluding weekends and holidays a probable cause hearing ahs tot take place to continue the persons hospitalization. Standard is called “clear and convincing evidence” as standard of proof…NOT ‘beyond a reasonable doubt”. Who can commit? ONLY a JUDGE`

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24
Q

Intent to terminate

A

filed 72 buisnes hours for hospital to document and pursue involuntary commitment if deemed. The 72 hours gives the doctor right to decide fist if patient could be released

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25
Q

Rescind

A

Everything stops. Patient can fill out another form for intent to terminate and process starts again

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26
Q

Cerebellum

A

motor coordination and balance -cognition

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27
Q

Brainstem

A

regulation of respiration and heart rate

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28
Q

Basal Nuclei (ganglia)

A

associated with complex motor function

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29
Q

Synapse

A

space between neurons

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30
Q

Receptor

A

binding site for neurotransmitters

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31
Q

Neuron

A

cells that conduct electrical impulses

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32
Q

Frontal lobe

A

thought processes, largest lobe, motor functions, insight and judgement/abstraction, decision making (executive functions)

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33
Q

parietal lobe

A

sensory and motor, interprets sensory information, right and left orientation

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34
Q

temporal lobe

A

auditory, connects with limbic system/ allows expression of emotions/sexual, aggression, motivation, memory

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35
Q

Limbic system

A

instincts primitive drives, sexual arousal, fear, aggression, and other emotions.

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36
Q

Amygdala

A

modulates emotional states, responses to events

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37
Q

thalamus

A

relays sensory info except smell, filters incoming info regarding emotions

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38
Q

hypothalamus

A

regulates basic human functions-sleep, temp, hunger, sex

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39
Q

hippocampus

A

controls learning and recall

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40
Q

occipital lobe

A

vision, interprets visual images to brain, involved in language formation

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41
Q

Dopamine increase

A

schizophrenia

42
Q

Serotonin decreased

A

depression

43
Q

Norepinephrine decreased

A

depression

44
Q

GABA decreased

A

anxiety

45
Q

Acetylcholine decreased

A

Alzheimer

46
Q

Internal locus of control

A

a person feels they have control events rather than letting events control them

47
Q

External locus of control

A

views task completion as having to do with circumstances beyond there control, such as luck and the influence of external forces

48
Q

GAS Alarm stage

A

physical reaction to stressor “fight or flight”

49
Q

GAS Resistance stage

A

body stabilizes and returns to normal homeostasis

50
Q

GAS Exhaustion stage

A

the individuals body does not adapt and the stressor continues to be prominent. if this stage continues can result in death

51
Q

Mindfulness-Based Stress Reduction

A

meditation, breathing exercises, concentration

52
Q

Stop-Divert, and Reframe Method

A

recognize and need to interrupt a pattern of negative self-talk that is increasing your stress and anxiety.

53
Q

Interventions for Anxiety

A

maintain safety, assess own level of anxiety, limiting CNS stimulants, have client do more anxiety-reducing methods, help client to use past coping methods, help identify support persons, assist in gaining control of overwhelming feelings and impulses through verbal interactions, less noisy environment

54
Q

Stages of anxiety

A

Mild stage- facilitates learning, creativity, and personal growth. Occasional movement into the moderate stage is an adaptive mechanism to cope with pleasant or unpleasant situations. Moderate and Severe can be either acute or chronic. With severe anxiety the person focuses energy on reducing the discomfort or anxiety rather than on coping with the environment. Panic level anxiety the person is disorganized, with increased motor activity, a distorted visual perceptual field, a loss of rational thought, and a decreased ability to relate to others

55
Q

Panic disorder

A

recent or unexpected panic attacks are present and there is concern about addition attacks. The attacks are not related to direct effects of substance and are not the result of a GMC.

56
Q

Panic with agoraphobic symtoms

A

anxiety about being in areas from which it is difficult to escape or where no assistance is available, such as in a crowd, on a bridge, or in a subway train

57
Q

Panic Attack

A

sudden, spontaneous episodes that are accompanied by symptoms such as racing heart, palpitations, dizziness, dyspnea, and feeling that death is imminent. Happens with panic disorder, social phobia, simple phobia, and PTSD.

58
Q

Social Anxiety Disorder

A

overwhelming fear of being in a social situation or having to interact with many people at once. Great concern that people are criticizing them and they worry about acting in a manner that will be humiliating or embarrassing. Usually this situation is avoided all together or it is endured with anxiety.

59
Q

PSTD

A

an individuals reaction to a traumatic event like war, rape, disasters, accidents and the grieving process.

60
Q

Acute Stress Disorder

A

the individual experiences at least three symptoms indicating dissociation. Longer than one month means PTSD

61
Q

GAD

A

person experiences excessive anxiety and worry that impedes the persons ability to maintain normal function. Last for at least 6 months and occurs mor e days that not. Person describes feeling restless or on edge, being easily fatigued, and having difficulties with concentration, irritability, muscle tension and sleep disturbances

62
Q

Buspar

A

effective for treatment of generalized anxiety disorder, but it does not appear to be effective for panic disorder. Major disadvantages is tis longer onset, usually 2-4 weeks. It is not addivtive and is used for long term use.

63
Q

OCD

A

obsessions are recurrent persistent thoughts that are intrusive to the individual and that cause a marked increase in anxiety.

64
Q

Humor consciously

A

assists the person with management of everyday stressors

65
Q

Suppression Consciously

A

Avoid thinking about problem areas

66
Q

Sublimation

A

channeling bad thoughts and feelings like aggression into acceptable behaviors

67
Q

displacement

A

transferring feeling or response toward one person onto another less threatening person or object.

68
Q

Dissociation

A

person feels detached from his or her surroundings

69
Q

Repression

A

unintentionally pushing back disturbing thoughts, desires, or experiences from the conscious mind

70
Q

Devaluation

A

Attributing negative qualities to self or others

71
Q

Denial

A

Refusing to acknowledge painful reality or subjective experience that other identify

72
Q

Projection

A

Attributing strong conflicting feelings for faults to another person

73
Q

Splitting of the self-image or of the image of others

A

viewing self, other, and situations as being either all good or all bad

74
Q

Insomnia

A

person has trouble falling asleep or in maintaining sleep

75
Q

Narcolepsy

A

sudden onset of brief sleep attacks that last 10 to 20 minutes

76
Q

Breathing related

A

narrowing or obstruction of the upper airway leads to loud snoring or apnea

77
Q

Circadian Rhythm

A

jet-lag, shift work change, irregular sleep schedules

78
Q

Nightmare

A

takes place during REM period late in sleep cycle

79
Q

Sleep Terror

A

arousal during NREM sleep. Typical person awakens during the early part of the night, and the awakening is usually caused by extreme anxiety or panic. Usually not able to recall

80
Q

Sleepwalking

A

takes place in deep NREM sleep, not able to recall

81
Q

LithiumLithotabs, Eskalith, Lithobid

A

mood stabilizer 1-2 weeks to reach therapeutic level. TOXICITY can be fatal. 0.5 -1.2 mEq/l. Causes fine hand tremor and thirst. Advanced toxicity include mental confusion, coarse hand tremors, and persistent GI upset.

82
Q

Tricyclics Amitriptyline HCL (Elavil), Imipramine (Tofranil)

A

oldest of the anti depressants. Block reuptake of norepinephrine and to a lesser extent serotonin. take up to 6 weeks to work. Side effects include sedation, orthostatic hypotension, anticholinergic effects. 8x the dose can be lethal monitor for suicide and only a limited amount at one time. Not to be used with ST. JOHNS WART or SAM-e increase risk of serotonin syndrome

83
Q

SSRI-Fluoxetine (Prozac), Sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), andescitalopram (Lexapro)

A

Antidepressant that allows more serotonin to be available by blocking the reuptake, works quicker than most antidepressants. They do not block cholinergic and alpha adrenergic receptors. Used for Anxiety disorders, OCD, panic, PTSD, and phobias. Side effects include possible toxic levels with grapefruits and juice, sexual dysfunction, and insomnia. Use with caffeine increases agitation, use with alcohol increases sedation, and effectiveness is decreased with cigarette smoking.

84
Q

SSNRI’s/NovelDrug names- bupropion (Wellbutrin), Trazodone (Desyrel), venlafaxine (Effexor)

A

antidepressants- increase available norepinephrine and serotonin and dopamine. Side effects are same as SSRI’s including weight gain, nausea, dizziness, insomnia.

85
Q

Monoamine Oxidase Inhibitor Agents (MAOI’S)- Drug names- Tranylcypromine (Parnate), Pheneizine (Nardil), Isocarboxazid (Marplan), selegilinetransdermal patch (Emsam)

A

These medications are used for those who are unresponsive to other drugs. Mao is an enzyme that destroys neurotransmitters. These drugs inhibit the enzyme so the neurotransmitters are not destroyed. These drugs are most dangerous because they cause you to be allergic to tyramine (know foods that contain tyramine). Can cause hypertensive crisis, avoid tyramine, and other medications including SSRI’s (MAOI’s should not be used within 14 days of SSRI’s).

86
Q

Anticonvulsants• Carbamazepine (Tegretal) and Valporic Acid (Depakote) - Do not use with MAOI’s (cause fatal reactions), Ginkgo and quinine increase anticonvulsant action, grapefruits and grapefruit juice may increase the absorption and blood concentration of Tegretal.
• Gabapentin (Neurontin) Lamotrigine (Lamicatal) - Ginkgo increases anticonvulsant effects, and ginseng and santonica decrease their effects. Gabapentin has been found to be ineffective for treatment of bipolar disorders

A

Used as mood stabilizers to replace lithium and also when clients don’t respond to lithium. Abrupt withdrawal may cause seizures

87
Q

Most at Risk of Suicide

A

Within 24 hours of admission, pending discharge, when client states that they feel better due to medication yet the medication onset has not begun yet, significant anniversary of event, previous attempts, social isolation or lack there of, recent losses, medical problems and soldiers returning from the war

88
Q

Premorbid schizophrenia

A

contributing factors

89
Q

Prodromal schizophrenia

A

one month to one year before diagnosis; they may be talking to self, problems in school, isolated from family, get into trouble, substance abuse, not seeing friends, hide from everyone in room or other areas, poor hygiene.

90
Q

Acute phase schizophrenia

A

when the psychosis begins (hallucinations, illisions) there is usually a need for inpatient treatment, Individuals experience florid positive symptoms and negative, They areunable to perform self-care activities.

91
Q

Maintenance (recover)phase schizophrenia

A

out-patient treatment and occurs 6-18 months after acute phase. Symptoms present but less severe than in acute. By 5-10 years after onset, most clients have a leveling off of their illness and functioning. They are generally able to care for self with some supervision.

92
Q

Stable Phase schizophrenia

A

the time in which symptoms are in remission, although some symptoms may persist or remain present in milder forms ( residual symtoms). Some people are able to live independently in the community during this time

93
Q

Antipsychotics typicals

A

(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)).

94
Q

Antipsychotics atypicals

A

(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)
Seroquel – Sedating and overused.
Risperdal – Also has an IM long acting injectable (Risperdal-C (Consta))
Geodon – Monitor for cardiac problems, depressed
Abilify – Is also a crossover drug for bipolar.

95
Q

Pseudo Parkinsonism

A

Motor movement - masklike faces, stiff & stooped posture, shuffling
gait, drooping, tremor, & “pill rolling”

96
Q

Acute Dystonic reactions-

A

(A’Duh) acute contractions of tongue, neck, & back. (GIVE IM

Cogentin)

97
Q

Neuroleptic malignant syndrome

A

– Increased temp (103), muscle rigidity (lead pipe), rapid breathing, mute, altered consciousness, increased CPK, excessive salivation. (GIVE Benadryl)

98
Q

Akathisia-

A

motor inner driven restlessness (eg., tapping foot incessantly, rocking backward in
chair, shifting weight from side to side.)

99
Q

Tardive Dyskinesia-

A

(face) protruding & rolling tongue, blowing, smacking, licking, spastic distortion; (Limbs) rapid, purposeless & irregular movements, (Trunk) dramatic hip jerks & rocking. (LATER ONSET)

100
Q

Typical Antipsychotics-

A

Treats positive symptoms ONLY with more troubling side effects
Haldol (fast acting; D is long lasting)
Thorazine
Prolixin (D is long lasting)
Navane
Typical SEs: EPSs, anticholinergic, sedative, Neuroleptic Malignant Syndrome

101
Q

Atypical Antipsychotics

A 
- Treats BOTH positive & negative symptoms, may decrease anxiety & depression, decreases suicidal behavior.
Clozaril (not 1st line, watch WBC)
Risperdal
Zyprexa
Seroquel
Zisprasidone
Abilify (lil or no weight gain)
Atypical SEs: Weight gain, sexual dysfunction, glucose deregulation, (Clozaril- agranulocytosis)
102
Q

Antiparkinsonian Drugs-

A

used to treat extra pyramidal syndrome (EPS); usually give before
symptoms occur. * Cogentin & *Artane

psych final (2 decks)

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