psych final review Flashcards
therapeutic alliance
a professional bond, play role in pts wel being,
no judgement, pts centered needs, short and long term
Factors that influence communication
external factors, relationship, context of message, attitude, knowledge level
facilitators
silence, ative listening, support reassurance, sharing obervation, open ended statements, info giving, interpretation, restating, reflecting, clarifying, confronting, summarizing, voicing doubt,
blockers
why questions, changing topic, defensive responses, excessive questioning, closed questions, false reassurance, giving advice, showing approval, stereotyping, minimizing, belittling, disagreeing, judging, challenging
nonverbal
93% of all communication, involves al 5 senses and should be congruent with verbal comminiation, includes appearance, body language
levels of prevention
primary (before problem exists)
secondary ( treatment of symptoms)
Tertiary (keep from getting sick again)
Levels of Practice
RN-PMH (basic- requires a bachelors degree)
APRN-PMH ( advanced- requires a masters or doctoral degree)
Interventions of APRN-PMH
psychotherapy, prescriptive authority and treatment, consultation
Standards of practice
developed by ANA, APNA, ISPMH,- describes professional activities that the nurse performs during the steps of nursing process ADPIE
Settings of practice
mental health units, emergency department, intensive care units, med surg unit, school, correctional facility, community center, homeless shelter, private practice.
Cultural influences
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.
Stigma as an obstacle for mentally ill
stigma buts an negative mark on persons image or reputation, increases misunderstanding, causes alienation, and alters funding for the disease
DSM IV
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
Axis I
psychiatric dx
Axis II
personality disorder or mental retardation
Axis III
Medical dx
Axis IV
psychosocial stressor
Axis V
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
Patients rights, basic rights
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.
Restraints
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
Duty to warn/ Tarasoff
responsibility of treating health professinal to notify and warn an inteded and identifiable victim
duty to report
suspected abuse neglect and exploitation of children, elderly, and dependent adults
criteria for involuntary admission
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`
Intent to terminate
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
Rescind
Everything stops. Patient can fill out another form for intent to terminate and process starts again
Cerebellum
motor coordination and balance -cognition
Brainstem
regulation of respiration and heart rate
Basal Nuclei (ganglia)
associated with complex motor function
Synapse
space between neurons
Receptor
binding site for neurotransmitters
Neuron
cells that conduct electrical impulses
Frontal lobe
thought processes, largest lobe, motor functions, insight and judgement/abstraction, decision making (executive functions)
parietal lobe
sensory and motor, interprets sensory information, right and left orientation
temporal lobe
auditory, connects with limbic system/ allows expression of emotions/sexual, aggression, motivation, memory
Limbic system
instincts primitive drives, sexual arousal, fear, aggression, and other emotions.
Amygdala
modulates emotional states, responses to events
thalamus
relays sensory info except smell, filters incoming info regarding emotions
hypothalamus
regulates basic human functions-sleep, temp, hunger, sex
hippocampus
controls learning and recall
occipital lobe
vision, interprets visual images to brain, involved in language formation
Dopamine increase
schizophrenia
Serotonin decreased
depression
Norepinephrine decreased
depression
GABA decreased
anxiety
Acetylcholine decreased
Alzheimer
Internal locus of control
a person feels they have control events rather than letting events control them
External locus of control
views task completion as having to do with circumstances beyond there control, such as luck and the influence of external forces
GAS Alarm stage
physical reaction to stressor “fight or flight”
GAS Resistance stage
body stabilizes and returns to normal homeostasis
GAS Exhaustion stage
the individuals body does not adapt and the stressor continues to be prominent. if this stage continues can result in death
Mindfulness-Based Stress Reduction
meditation, breathing exercises, concentration
Stop-Divert, and Reframe Method
recognize and need to interrupt a pattern of negative self-talk that is increasing your stress and anxiety.
Interventions for Anxiety
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
Stages of anxiety
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
Panic disorder
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.
Panic with agoraphobic symtoms
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
Panic Attack
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.
Social Anxiety Disorder
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.
PSTD
an individuals reaction to a traumatic event like war, rape, disasters, accidents and the grieving process.
Acute Stress Disorder
the individual experiences at least three symptoms indicating dissociation. Longer than one month means PTSD
GAD
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
Buspar
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.
OCD
obsessions are recurrent persistent thoughts that are intrusive to the individual and that cause a marked increase in anxiety.
Humor consciously
assists the person with management of everyday stressors
Suppression Consciously
Avoid thinking about problem areas
Sublimation
channeling bad thoughts and feelings like aggression into acceptable behaviors
displacement
transferring feeling or response toward one person onto another less threatening person or object.
Dissociation
person feels detached from his or her surroundings
Repression
unintentionally pushing back disturbing thoughts, desires, or experiences from the conscious mind
Devaluation
Attributing negative qualities to self or others
Denial
Refusing to acknowledge painful reality or subjective experience that other identify
Projection
Attributing strong conflicting feelings for faults to another person
Splitting of the self-image or of the image of others
viewing self, other, and situations as being either all good or all bad
Insomnia
person has trouble falling asleep or in maintaining sleep
Narcolepsy
sudden onset of brief sleep attacks that last 10 to 20 minutes
Breathing related
narrowing or obstruction of the upper airway leads to loud snoring or apnea
Circadian Rhythm
jet-lag, shift work change, irregular sleep schedules
Nightmare
takes place during REM period late in sleep cycle
Sleep Terror
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
Sleepwalking
takes place in deep NREM sleep, not able to recall
LithiumLithotabs, Eskalith, Lithobid
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.
Tricyclics Amitriptyline HCL (Elavil), Imipramine (Tofranil)
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
SSRI-Fluoxetine (Prozac), Sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), andescitalopram (Lexapro)
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.
SSNRI’s/NovelDrug names- bupropion (Wellbutrin), Trazodone (Desyrel), venlafaxine (Effexor)
antidepressants- increase available norepinephrine and serotonin and dopamine. Side effects are same as SSRI’s including weight gain, nausea, dizziness, insomnia.
Monoamine Oxidase Inhibitor Agents (MAOI’S)- Drug names- Tranylcypromine (Parnate), Pheneizine (Nardil), Isocarboxazid (Marplan), selegilinetransdermal patch (Emsam)
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).
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
Used as mood stabilizers to replace lithium and also when clients don’t respond to lithium. Abrupt withdrawal may cause seizures
Most at Risk of Suicide
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
Premorbid schizophrenia
contributing factors
Prodromal schizophrenia
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.
Acute phase schizophrenia
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.
Maintenance (recover)phase schizophrenia
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.
Stable Phase schizophrenia
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
Antipsychotics typicals
(1st gen/typical) (Haldol, Thorazine, Prolixin, Stelazine) Treats only Positive symptoms. S/E include EPS, anticholinergic, orthostatic hypotension, causes Neuroleptic
Malignant Syndrome, fever, elevated BP. Treat w/Benadryl (antihistamine) (HALDOL and
PROLIXIN come in injectable forms – (IM long acting D) Haldol-D or Prolixin-D (Deconate)).
Antipsychotics atypicals
(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.
Pseudo Parkinsonism
Motor movement - masklike faces, stiff & stooped posture, shuffling
gait, drooping, tremor, & “pill rolling”
Acute Dystonic reactions-
(A’Duh) acute contractions of tongue, neck, & back. (GIVE IM
Cogentin)
Neuroleptic malignant syndrome
– Increased temp (103), muscle rigidity (lead pipe), rapid breathing, mute, altered consciousness, increased CPK, excessive salivation. (GIVE Benadryl)
Akathisia-
motor inner driven restlessness (eg., tapping foot incessantly, rocking backward in
chair, shifting weight from side to side.)
Tardive Dyskinesia-
(face) protruding & rolling tongue, blowing, smacking, licking, spastic distortion; (Limbs) rapid, purposeless & irregular movements, (Trunk) dramatic hip jerks & rocking. (LATER ONSET)
Typical Antipsychotics-
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
Atypical Antipsychotics
- 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)
Antiparkinsonian Drugs-
used to treat extra pyramidal syndrome (EPS); usually give before
symptoms occur. * Cogentin & *Artane
