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COMPREHENSIVE PHASE > Psychiatric Nursing > Flashcards

Psychiatric Nursing Flashcards

1
Q

“I’ll sit with for a while.”

A

Offering self

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2
Q

(observe for non-verbal clues)

A

Silence

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3
Q

“How are you feeling today?”
“Is there something you’d like to talk about?”
“Tell me what you are thinking?”

A

Broad opening

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4
Q

“Tell me more….”/ “Tell me what happened”

A

Exploring

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5
Q

“Go on.” / “And after that?

A

General Lead

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6
Q

CLIENT: “I can’t sleep. I stay awake all night.”
NURSE: “You have difficulty sleeping

A

Restating

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7
Q

CLIENT: “I’m feeling sick inside.”
NURSE: “What do you mean by ‘feeling sick inside?”

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

A

Clarifying

Consensual validation

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8
Q

CLIENT: “I’m way out in the ocean.”
NURSE: “You seem to feel lonely.

A

Translating into feelings

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9
Q

CLIENT: “Life is hard. I just want to put an end to everything.”

NURSE: “You seem to be having a difficult time, are you planning to harm yourself?”

A

Verbalizing the implied

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10
Q

CLIENT: “Do you think I should tell my dad?”

NURSE: “What do you think would work best?”

A

Reflecting

INDEPENDENT DECICION MAKING

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11
Q

“I know it isn’t easy, but you can do it.”
“It would be difficult at first, but you’ll get through it.

A

Supportive confrontation

ACKNOWLEDGE
client’s feelings.

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12
Q

-Not allowed to agree and disagree
-Do not give opinion to the patient
-All feelings are valid

-Acknowledge
-Give Recognition
-Do not give compliment

A

Therapeutic Communication

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13
Q

statements of acknowledgements

A

I can see…
You seem…
It seems…
You sound…
It sounds…
It must be…

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14
Q

CARES

A

Clarify (what do you mean? are you saying this/that?)

Acknowledge

Restate ; Reflect

Explore

Sit ; Silence

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15
Q

[NON THERAPEUTIC]

“Just have a positive attitude.”

A

Stereotyping

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16
Q

[NON THERAPEUTIC]
“Everybody gets down in the dump.”

A

Belittling

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17
Q

[NON THERAPEUTIC]
“Everything will be alright.”

A

Reassuring

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18
Q

[NON THERAPEUTIC]
“Why did you do that?”

A

Requesting an
explanation

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19
Q

focusing on feelings of patient

A

Empathy

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20
Q

focusing on own (RN) feelings

A

sympathy

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21
Q

[Disturbances in PERCEPTION]

-misinterpretation of EXTERNAL stimulus

A

Illusion

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22
Q

[Disturbances in PERCEPTION]

-misinterpretation of SENSORY stimulus

A

Hallucination

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23
Q

Hallucination seen in marijuana use

A

Visual (psychedelics)

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24
Q

Hallucination seen in alcohol withdrawal

A

Tactile (formication)

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25
Q

Hallucination seen in post traumatic stress disorder

A

Olfactory (phantosmia)

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26
Q

Hallucination seen in epilepsy [aura of seizure]

A

Gustatory (spontaneous dysgeusia)

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27
Q

Hallucination seen in paranoid schizophrenia

A

Auditory (command auditory)

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28
Q

Management for Hallucination

A

(HARDER)

Hallucination must be recognized

Assess the content (don’t ask them to describe!)

Reality presentation

Divert the attention

Engage in reality-based activity

Reintegrate with the milieu

*TALK BACK to the voices – “practice saying GO AWAY!

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29
Q

examples of reality based activity for a pt with hallucinations

A

Gardening, household chores, arts and crafts, exercises

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30
Q

mixing of senses (hears the color, sees the sound, tastes the words)

A

Synesthesia

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31
Q

[Disturbances in THOUGHT]

  • false belief
A

Delusion

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32
Q

[Disturbances in THOUGHT]

-giving meaning to events or actions of others

A

Ideas of Reference / Referential delusion

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33
Q

false belief that he/she has superiority or invulnerability

A

Delusion of Grandiose

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34
Q

false belief that “to be harmed by others”

A

Persecutory Delusion

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35
Q

false belief that bodily functions are abnormal

A

Somatic Delusion

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36
Q

false belief that a part of the body is missing

A

Nihilistic Delusion

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37
Q

false belief that a person is in love with her/him.

A

Erotomanic Delusion

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38
Q

Management for Delusion

A

(CAVE)
Clarification the meaning

Acknowledge the feelings, but NOT the DELUSION

Voice doubt, but DO NOT CHALLENGE

Engage in reality-based activities

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39
Q

[Disturbances in THOUGHT]

-fullness of detail, still does answer the question

A

Circumstantiality

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40
Q

[Disturbances in THOUGHT]

  • lack of focus, did not answer the question
A

Tangentiality

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41
Q

[Disturbances in THOUGHT]

  • fragmented ideas
    -walang konek
A

Looseness of Association (derailment)

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42
Q

[Disturbances in THOUGHT]

  • rapid speech, jumping from one topic to another
    -medyo may konek
A

Flight of Ideas

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43
Q

[UNUSUAL SPEECH PATTERNS]
– coining of new words

A

Neologisms

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44
Q

[UNUSUAL SPEECH PATTERNS]
– word salad, mixing of words without rhyme

A

Schizophasia

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45
Q

[UNUSUAL SPEECH PATTERNS]
– rhyming of words

A

Clang associations

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46
Q

[UNUSUAL SPEECH PATTERNS]
– repeating the words of others

A

Echolalia

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47
Q

[UNUSUAL SPEECH PATTERNS]
-repeating own words (fast and decreasing audibility)

A

Palilalia

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48
Q

[UNUSUAL SPEECH PATTERNS]
- repeating phrases

A

Verbigeration

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49
Q

[UNUSUAL SPEECH PATTERNS]
-use of flowery words

A

Stilted language

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50
Q

[UNUSUAL SPEECH PATTERNS]
-adherence to a single topic

A

Perseveration

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51
Q

internal / loob
e.g. Happy

A

mOOd

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52
Q

external
e.g. smiling

A

affEct

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53
Q

[Disturbance in AFFECT]

  • no emotion response (Withdrawn)
A

Flat Affect

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54
Q

[Disturbance in AFFECT]

  • minimal emotional response (Major Depression)
A

Blunt Affect

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55
Q

[Disturbance in AFFECT]

  • emotions are opposite to the context of the situation (Schizophrenia)
A

Inappropriate Affect

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56
Q

[Disturbance in AFFECT]

  • single emotional response (Paranoid)
A

Restrictive Affect

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57
Q

[Disturbance in AFFECT]

-sudden shift of emotions (Bipolar disorder)

A

La bile Affect

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58
Q

[Disturbances in MEMORY]
- loss of memory

A

Amnesia

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59
Q

inability to recall memories formed before a traumatic event (Reminiscence therapy)

A

Retrograde Amnesia

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60
Q

inability to make new memories after a traumatic event (Reorient the client)

A

Anterograde Amnesia

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61
Q

making stories that are not true to fill the gap between memory loss

A

Confabulation

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62
Q

[Psychosis vs Neurosis]

  • Has Contact with reality
A

Neurosis

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63
Q

[True or False]

  • Schizophrenia is curable.
A

FALSE. It is only manageable.

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64
Q

[True or False]

  • Schizophrenia is hereditary and contagious.
A

FALSE. It is hereditary but not contagious.

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65
Q

[SCHIZOPHRENIA]

2 or more of the following for at least __________.
- Hallucinations
- Delusions
- Disorganized speech
- Disorganized behavior
- Negative symptoms

A

1 month

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66
Q

4As of Schizophrenia

A

Autism – indifference
Ambivalence – 2 opposing feelings
Associative looseness
Abnormal affect

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67
Q

BIOLOGIC THEORY OF SCHIZOPHRENIA

A

Genetics: 1 parent (15%);
2 parents (35%)

Neuroanatomy: less CSF and brain tissue

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68
Q

Social Causation Hypothesis of Schizophrenia

A

↑risk (low income)
diet (malnourished)
lack of access to healthcare, recreation

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69
Q

[SCHIZOPHRENIA]

Neurochemistry: _______

A

Increased DOPAMINE AND SEROTONIN

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70
Q

psychosis (<1 month)

A

Brief Psychotic Disorder

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71
Q

psychosis (1 – 6 months)

A

Schizophreniform

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72
Q
  • 2 people sharing similar delusion
A

Shared Psychotic Disorder (Folie à Deux)

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73
Q

Hallucinations, Delusions, and other disturbances in thought and perception

A

POSITIVE Signs of Schizophrenia

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74
Q

lack of relationships

A

Asociality

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75
Q

lack of motivation

A

Avolition

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76
Q

lack of pleasure

A

Anhedonia

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77
Q

lack of speech

A

Alogia

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78
Q

waxy flexibility, stupor and mutism

A

Absence of movement (catatonia)

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79
Q

Flat, blunt, inappropriate la bile

A

Abnormal affect

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80
Q

another term for ANTIPSYCHOTICS

A

NEUROLEPTICS

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81
Q

1st Generation ANTIPSYCHOTICS

Mode of action:
Indication:

A

1st Generation ANTIPSYCHOTICS

-decreases DOPAMINE
-to manage (+) signs

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82
Q

2nd Generation ANTIPSYCHOTICS

Mode of action:
Indication:

A

-decreases DOPAMINE AND SEROTONIN
-to manage (+) (-) but more on (-)signs

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83
Q

another term for 1st Generation Antipsychotics/Neuroleptics

A

Conventional / Typical Antipsychotics

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84
Q

another term for 2nd Generation Antipsychotics/Neuroleptics

A

Atypical Antipsychotics

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85
Q

Chlorpromazine
Thioridazine
Fluphenazine
Haloperidol (Haldol)

A

1st Generation / Conventional / Typical Antipsychotics

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86
Q

Olanzapine Risperidone
Quetiapine Ziprasidone
Clozapine Lurasidone

A

2nd Generation / Atypical Antipsychotics

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87
Q

Antipsychotic that is contraindicated to ELDERLY (>65y/o)

A

1st Generation / Conventional / Typical Antipsychotics

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88
Q

side effect of 1st Generation / Conventional / Typical Antipsychotics

A

Pseudoparkinsonism
(due to decreased dopamine)

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89
Q

safest Antipsychotic drug for elderly

A

2nd Generation: Clozapine!

  • least likely to develop pseudoparkinsonism
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90
Q

High potency 1st generation antipyschotic drug that can be immediately given to eliminate hallucinations

A

Haloperidol (Haldol)

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91
Q

1st Generation / Typical Antipsychotic drug that is an exception to the rule, as it ends with -pine and -done. ( which is for 2nd gen rule)

A

1st Gen: (LoMo)
Loxapine
Molindone

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92
Q

3rd Generation Antipsychotics / Dopamine System Stabilizer (DSS)

Mode of action:
Advantage:

A
  • regulates dopamine receptors
    -less side effects
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93
Q

Aripiprazole
Brexpiprazole

A

3rd Generation Antipsychotics / Dopamine System Stabilizer (DSS)

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94
Q

Indication: NON – COMPLIANCE

Common cause: side effects; memory problem

A

Long Term Injection / DECANOATE

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95
Q

Previous term for Long Term Injection

A

Depot Therapy

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96
Q

when and how is the decanoate / LTIs given?

A

Intramuscularly, 1-2x / month

  • prolong effect so does not need daily
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97
Q

pleasure hormone

A

dopamine

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98
Q

happy hormone

A

serotonin

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99
Q

SIDE EFFECTS OF ANTIPSYCHOTICS

A

[CAT DOG PAWS]

Constipation – increase fluid, fiber in the diet
Agranulocytosis – Monitor WBC, report any signs of infection (fever, sore throat)
Tooth decay – sugarless hard candy or gum

Dry mouth – sugarless hard candy or gum to stimulation salivation
Orthostatic hypotension – change position gradually
Galactorrhea – use cotton underwear

Photosensitivity – avoid direct sunlight, use umbrella and sunglasses, apply SPF 25 lotion
Arrhythmias – immediately report abnormal heart beat
Weight gain – lessen intake of sugary food and beverages
Sedation – avoid driving and operating machineries

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100
Q

Extra Pyramidal Syndrome

A

[DAP]
Dystonia
Akathisia
Pseudoparkinsonism

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101
Q

Neuroleptic Malignant Syndrome

A

Hyperthermia
Hypertension
Muscle spasms

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102
Q

Extra Pyramidal Syndrome Nursing Action

A

Notify the physician, DO NOT discontinue!

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103
Q

Neuroleptic Malignant Syndrome Nursing Action

A

Discontinue the Medication

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104
Q

Neuroleptic Malignant Syndrome Prevention

A

Hydrate the patient

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105
Q

Tardive Dyskinesia

A

Tongue protrusion
Teeth grinding
Lip Smacking

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106
Q

Tardive Dyskinesia Nursing Action

A

Notify the physician

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107
Q

Tardive Dyskinesia Prevention

A

Start with the lowest dose

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108
Q

Complementary and Alternative Therapy: [S/E Antipsychotics]

A

✓ Ketogenic diet, Omega-3 fatty acids, Vitamin D, Sulforaphane

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109
Q

Neurochemistry on MAJOR DEPRESSIVE DISORDER

A

Decreased DOPAMINE, SEROTONIN, and NOREPINEPHRINE

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110
Q

at least 5 of the following symptoms of Major Depressive Disorder

A

[DIWAGAS]

Difficulty thinking
Insomnia/Hypersomnia
Weight loss/gain (5%)
Anhedonia
Guilt feeling
Anergia
Suicidal thoughts

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111
Q

Defense Mechanism of MAJOR DEPRESSIVE DISORDER /Depression

A

Introjection

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112
Q

[MAJOR DEPRESSIVE DISORDER]

Impairs educational, social, and occupational functioning in at least ___ weeks

A

2 weeks

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113
Q

Hallmark Sign of MAJOR DEPRESSIVE DISORDER /Depression

A

Hopelessness, Helplessness,

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114
Q

Initial sign of Major Depressive Disorder

A

Sleeplessness

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115
Q

Best time to take Antidepressants

A

Morning with meals (some may cause insomnia)

Principle: at the same time each day

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116
Q

Effectivity of Antidepressants

A

after 2-4 weeks
-increase suicide precaution

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117
Q

TO PREVENT RELAPSE:
Continue taking antidepressants for _______.

A

6mos - 2 yrs
- even the client feels better

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118
Q

Wash-out period for antidepressants to prevent hyperstimulation, increasing serotonin

A

Wash-out period: 5-6 weeks

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119
Q

SEROTONIN SYNDROME

A

[DEAD CHART]

Diaphoresis
Elevated temperature
Anxiety
Diarrhea

Clonus
Hypertension
Agitation
Restlessness
Tachycardia

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120
Q

last resort, when medications are ineffective, acute suicidal crisis

A

Electroconvulsive Therapy

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121
Q

Contraindication for Electroconvulsive Therapy

A

presence of metals (jewelries, pacemaker, hip prothesis)

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122
Q

pre-medication for ECT

A

[SAM]
Succinylcholine (muscle relaxant)
Atropine Sulfate (Anti-cholinergic)
Methohexital (Anesthesia)

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123
Q

Duration of seizure for ECT

A

30-60 seconds

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124
Q

Nursing intervention before ECT

A

-NPO post midnight
-clean oil from the head
-Discontinue anticonvulsant
- Insert bite guard

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125
Q

Nursing intervention after ECT

A

Priority: Assess the respiratory status

-turn the client to the side
-reorient the patient

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126
Q

5 Types of Antidepressants

A

-MONOAMINE OXIDASE INHIBITOR (MAOI)

-TRICYCLIC ANTIDEPRESSANTS (TCA)

-SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRI)

  • SEROTONIN NOREPINEPHRINE REUPTAKE INHIBITORS (SNRI)

-ATYPICAL ANTIDEPRESSANTS

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127
Q

tyramine rich foods (CI: MAOIs)

A

Frozen, Fermented, Pickled, Preserved, and Overripe Fruit
-old foods
-aged cheese (parmesan, cheddar)

safe cheese: cottage cheese,
cream cheese, ricotta

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128
Q

What to avoid when taking MAOIs?

A

Avoid tyramine rich foods

if mixed with MAOIs = Hypertensive crisis
= (+) occipital headache

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129
Q

[PAMANA] [TIP]
PArnate Tranylcipromine
MArplan Isocarboxacid
NArdil Phenelzine

SELegiline (Eldepryl)

A

MAOIs = money

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130
Q

TOFRAnil ImiPRAMINE
ANAfranil ClomiPRAMINE
ELAvil AmiTRYPTILINE
Pamelor NorTRYPTILINE
- Sinequan Doxepine

A

TRICYCLIC ANTIDEPRESSANTS (TCA)

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131
Q

most FATAL antidepressant

A

TRICYCLIC ANTIDEPRESSANTS (TCA) because can cause arrythmia

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132
Q

Side effect of TCA

A

Adrenergic stimulation
(ASA = dry)

Arrhythmia: Tachycardia, Bradycardia (toxicity)

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133
Q

ZOLOFT (sertraline)
PAXIL (paroxetine)
LUVOX (fluvoxamine)
PROZAC (fluoxetine)
LEXARPO (escitalopram)
Celexa (Citalopram)

A

SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRI)

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134
Q

Fastest antidepressants

Safest antidepressants
- less suicide
-less side effect
-nausea
-gastrointestinal upset
-dizziness
-sexual dysfunction

A

SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRI)

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135
Q

Side effect of SSRI

A

Gastrointestinal upset (nausea)

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136
Q

3 Side effect of SNRI

A

Increase Blood Sugar
Increase Intraocular Pressure
Increase Cardiac Rate

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137
Q

CYMBALTA (Duloxetine)
EFFEXOR (Venlafaxine)

A

SEROTONIN NOREPINEPHRINE REUPTAKE INHIBITORS (SNRI)

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138
Q

What is the priority nursing intervention for ATYPICAL ANTIDEPRESSANTS ?

A

monitor AST, ALT

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139
Q

BUPROPION (Wellbutrin)
TRAZODONE

A

ATYPICAL ANTIDEPRESSANTS

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140
Q

HERB FOR DEPRESSION

A

St. John’s wort

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141
Q

Neurotransmitter: increase DOPAMINE, SEROTONIN, and NOREPINEPHRINE

A

BIPOLAR DISORDER

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142
Q

Psychosocial Factors: Type A personality (Competitive, Perfectionist, Goal-oriented)

Sociocultural Factors: Upper Class

A

BIPOLAR DISORDER

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143
Q

Defense Mechanism for Bipolar Disorder

A

Reaction Formation, Projection

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144
Q

MANIC PHASE: ____ or more of the following
✓ FLIGHT OF IDEAS
✓ Inflated self-esteem or grandiosity
✓ Decreased need for sleep
✓ Increased talkativeness
✓ Distracted easily
✓ Increase in goal-directed activity
✓ Engaging in risky activities

A

3 or more

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145
Q

manic phase manifestations last for more than 1 week

A

mania

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146
Q

manic phase manifestations last for only 4 days

A

Hypomania

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147
Q

Manic episodes with or without major depression

A

Bipolar I

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148
Q

alternating periods of depressed mood and hypomania for 2 yrs

A

CYCLOTHYMIA

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149
Q

Major depression with hypomanic episodes

A

Bipolar II

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150
Q

persistent mild depression for 2 yrs

A

DYSTHYMIA

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151
Q

CarboLITH LITHothab
EskaLITH LITHobid
LITHane

A

ANTIMANIC MEDICATION
-Lith - para sa Makulit

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152
Q

DRUG OF CHOICE - Antimanic

A

Lithium Carbonate
Valproic acid

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153
Q

ANTIMANIC MEDICATION

Mechanism:
Onset: __weeks
Peak: __ hours

A

ANTIMANIC MEDICATION

Mechanism: to stabilize the mood
Onset: 3 weeks
Peak: 3 hours

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154
Q

Lithium Carbonate Therapeutic Level

A

0.6-1.2 meq/L

max: until 1.5 meq/L

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155
Q

if serum lithium level >3 meq/L =

A

DIALYSIS

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156
Q

When to obtain specimen in serum lithium level?

A
  1. before breakfast
  2. 8 hours after last dose
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157
Q

Common side effects of Lithium Carbonate

A

FINE TREMORS

Polyuria
Hypothyroidism

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158
Q

Drug at bedside if lithium toxicity occur

A

Mannitol (osmotic diuretic)

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159
Q

electrolyte imbalance where lithium toxicity may occur

A

Hyponatremia

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160
Q

Lab test important for Antimanic Medication such as Lithum Carbonate

A

BUN (renal function)

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161
Q

if no antipsychotic, antimanic,
antidepressant = Give_____

A

Anticonvulsant Medications:

Carbamazepine (Tegretol)
Divalproex (Depakote)
Gabapentin (Neurontin)
Pregabalin (Lyrica)
Lamotrigine (Lamictal) – ADHD

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162
Q

after giving Anticonvulsant medication, you see a rash. What is the priority intervention?

A

RASH, Report MD!

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163
Q

PERSONALITY DISORDERS

Age of diagnosis:

Age of Improvement:

A

PERSONALITY DISORDERS

Age of diagnosis: Adolescent
Age of Improvement: 40 – 50 years old

164
Q

ODD / ECCENTRIC / MAD

165
Q

EMOTIONAL / ERRATIC / BAD

166
Q

FEARFUL / ANXIOUS / SAD

167
Q

Cluster __
- suspicious

A

Cluster A
Paranoid

168
Q

Cluster ___
- social isolation and indifference
- hard time forming relationship

A

Cluster A
Schizoid

169
Q

Cluster ___
- superstitious, magical thinkers
-“lucky charm”

A

Cluster A
Schizotypal

170
Q

EMOTIONAL / ERRATIC / BAD

171
Q

Cluster ___
-unpredictable mood, clings to relationship, unstable relationship

A

Cluster B
Borderline

172
Q

Cluster ___
- law breakers, no regard for right or wrong

A

Cluster B
Antisocial

173
Q

Cluster ___
- attention seekers, dramatic and theatrical

A

Cluster B
Histrionic

174
Q

Cluster ___
-self-entitlement, denies weakness and failure

175
Q

Cluster ___
Narcissistic

176
Q

FEARFUL / ANXIOUS / SAD

177
Q

Cluster ___
-avoids responsibilities and social interactions

A

Cluster C
Avoidant

178
Q

Cluster ___
- extreme submissiveness (depends on others for decision making)

A

Cluster C
Dependent

178
Q

Cluster ___
-extreme neatness and perfectionism

A

Cluster C
Obsessive compulsive

178
Q

Management for Personality Disorders

A

Behavioral therapy (Role Playing)

179
Q

Eating Disorder Goal

A

!!!To manage anxiety: impose rigid rules + regulations

180
Q

Diagnostic criteria: more than ___ months

  1. Intense fear of gaining weight
  2. Body weight less than ___ % of the ideal
  3. Food intake restriction
  4. Distorted body image
  5. Amenorrhea
A

Anorexia Nervosa

180
Q

Diagnostic criteria:
1. Recurrent BINGE eating
2. Distress regarding binge eating (GUILT)
3. Compensatory behaviors (PURGING)

A

Bulimia Nervosa

181
Q

Once a week for 3 months purging

A

(+) Binge Purge Syndrome

182
Q

MEDICAL TREATMENT for EATING DISORDER

A

Selective Serotonin Reuptake Inhibitors

182
Q

decrease GAMMA AMINO BUTYRIC ACID

183
Q

DECREASED SEROTONIN AND NOREPINEPHRINE

A

EATING DISORDERS

184
Q

teeth markings or scarring on the knuckles

A

Russel’s sign

185
Q

Distortion of facts, unjustifiable excuse

-Man says he beats his wife because she does not listen
to him

A

Rationalization

186
Q

-acknowledging the facts but not the emotions
-Person shows no emotional expression when discussing
serious car accident

A

Intellectualization

187
Q

– replacing unattained goals with by one that is more attainable

Woman who would like to have her own children opens
a day care center

A

Substitution

188
Q

overachieve in another area to
compensate for failure

Nurse with low self-esteem working double shifts so
that her supervisor will like her

A

Compensation

189
Q
  • rechanneling of unacceptable impulses to acceptable once
  • Person who has quit smoking sucks on hard candy when
    the urge to smoke arises
A

Sublimation

190
Q
  • categorizing people as either good or bad

Seeing all people without mustache as all feminine

191
Q

unconscious forgetting with disintegration of personality, consciousness, memory, identity, and emotion.

A

Dissociation

192
Q

Formerly known as MULTIPLE PERSONALITY DISORDER

A

DISSOCIATIVE IDENTITY DISORDER

193
Q

different identity in a different environment

A

DISSOCIATIVE FUGUE (Psychogenic fugue)

194
Q

– unconscious forgetting

Woman has no memory of the mugging she suffered
yesterday

A

Repression

195
Q

conscious forgetting

Student decides not to think about a parent’s illness to
study for a tests

A

Suppression

195
Q

Exhibiting acceptable behavior to make up for
or negate unacceptable behavior

Person who cheats on a spouse brings the spouse a
bouquet of roses

196
Q

Acting the opposite of what one
thinks or feels

Person who despises the boss tells everyone what a
great boss she is

A

Reaction Formation

197
Q

Acting the opposite of what one
thinks or feels

Person who despises the boss tells everyone what a
great boss she is

A

Reaction Formation

198
Q

– ventilation of intense feelings toward persons less threatening

Person who is mad at the boss yells at his or her spouse

A

Displacement

199
Q

unconscious blaming of unacceptable
inclinations or thoughts on an external object

An unfaithful husband suspects his wife of infidelity

A

Projection

200
Q

accepting another person’s attitude beliefs, and values as one’s own (conforms feelings for approval)

“ginaya mo, ayaw mo”

Person who dislikes guns becomes an avid hunter, just
like a best friend

A

Introjection

201
Q

-imitating or emulating others while searching for identity

“ginaya mo, gusto mo”

Nursing student becoming a critical care nurse because
this is the specialty of an instructor she admires

A

Identification

202
Q

return to early stage of development

Man pouts like a 4-year-old if he is not the center of his
girlfriend’s attention

A

Regression

203
Q

– failure to admit the reality of a situation
-Diabetic person eating chocolate candy

204
Q

Pleasure seeker, needs immediate gratification

204
Q

Balancer – REALITY

205
Q

Moral conscience, guilt

206
Q

When coping mechanism are ineffective that results to disequilibrium.

206
Q

to protect the feeling brought about own ego

A

ego defense mechanism

207
Q

Freud Structural Theory of Personality on people with obsessive compulsive disorder, anorexia nervosa

208
Q

Freud Structural Theory of Personality on people that are antisocial, borderline

208
Q

When coping mechanism are ineffective that results to disequilibrium.

209
Q

caused by unexpected event (Loss of a job / starting a new job, Death of a loved one)

A

Situational

210
Q

caused by natural catastrophe (earthquake, fire, tornado)

A

Adventitious / Social

211
Q

– caused by expected events (menarche, marriage, pregnancy, retirement)

A

Maturational / Developmental

212
Q

Focus or Therapy on Crisis

A

Here and Now (GESTALT THERAPY)
- immediate problem, feelings, and solutions

213
Q

CRISIS

Initial assessment:

Factors to consider:

A

Initial assessment: Precipitating event

Factors to consider:
Perception
Support system
Coping mechanism

214
Q

Age of group for Anorexia Nervosa

215
Q

Age of group for Bulimia Nervosa

A

18-22 y/o (stress)

216
Q

Anorexia Nervosa

___ loss of appetite
___ refusal to talk about food
___ lack of knowledge about food

___ counting calories
___ compulsive exercising
___ ritualistic food behaviors
___ preoccupation with food related activities

___ RECOGNIZES the problem

A

X loss of appetite
X refusal to talk about food
X lack of knowledge about food

/ counting calories
/ compulsive exercising
/ ritualistic food behaviors
/ preoccupation with food related activities

X RECOGNIZES the problem

216
Q

Complications of Anorexia Nervosa

A

Alopecia, Anemia, Lanugo

217
Q

Priority nursing diagnosis for Eating Disorder

A
  1. Electrolyte imbalance
  2. Altered Nutrition
218
Q

Eating Disorder

____ Body Image Disturbance
_____ Altered Body Image

A

/ Body Image Disturbance (Perception problem)

X Altered Body Image
(if there is an actual deformity in the body natanggal or nasira or kinabit; e.g. amputation, mastectomy, burns, colostomy)

219
Q

INTERVENTIONS for Eating Disorder

A
  • Plan meals with the client
  • Set time limit during meals
  • Supervise client after eating
  • LIMIT TIME ON SOCIAL MEDIA
220
Q

[LEVELS OF ANXIETY]

Increased alertness, learning is effective

Gastrointestinal butterflies

A

Mild Anxiety
-Acknowledgement
-Verbalization

221
Q

[LEVELS OF ANXIETY]

Selective attention, narrowed perception

Can be redirected

Gastrointestinal upset

Diarrhea
Urinary Frequency

A

Moderate Anxiety

PARASYMPATHETIC
(ParaTae, ParaIhi)

-Redirect
-Refocus
-ORAL anxiolytics

222
Q

[LEVELS OF ANXIETY]

Cannot complete task, cannot solve problem

Cannot be redirected

Nausea, vomiting, diarrhea

Physiologic symptoms (chest pain, tachycardia)

A

Severe Anxiety

-IM anxiolytics

223
Q

[LEVELS OF ANXIETY]

Delusions and Hallucinations
Violence and Suicide

A

Panic Anxiety

-Take Control
Restraint if needed

224
Q

GENERALIZED ANXIETY DISORDER

3 or more of the symptoms for more than ___________.

224
Q

repetitive thoughts

225
Q

repetitive actions (RITUALS)

A

Compulsion

226
Q

Defense Mechanism of OCD

226
Q

Management for OCD

A

Management:
1. Allow the patient to perform the ritual
2. Adjust the schedule of the patient
3. Gradually limit the ritual
4. COGNITIVE BEHAVIORAL Therapy (challenge negative thinking)

227
Q

fear of interacting with strangers

A

Social Phobia

227
Q

irrational fear

A

PHOBIC DISORDER

227
Q

fear of enclosed spaces

A

Claustrophobia

228
Q

fear of inescapable places such as open areas - football field, market, park

A

Agoraphobia

229
Q

fear of hospitals

A

Nosocomephobia

230
Q

fear of death

A

Thanatophobia

231
Q

Defense Mechanism of Phobic Disorder

A

Displacement and avoidance

232
Q

sudden exposure to maximum stimulus

233
Q

emotional blindness
not able to determine/ not express

A

alexithymia

233
Q

gradual exposure to the feared object

A

Systematic Desensitization

1st step: Let the client think and talk about the feared object

234
Q

(+) Physical symptoms
(+) Excessive worry

A

Complex Somatic Symptom Disorder (CSS)

235
Q

DOCTOR SHOPPING

A

Illness Anxiety Disorder (Hypochondriasis)

236
Q

(-) Physical symptoms
(+) Excessive worry

A

Illness Anxiety Disorder (Hypochondriasis)

237
Q

(+) Physical symptoms
(-) Excessive worry

A

Functional Neurologic Disorder (Conversion Disorder)

238
Q

LA BELLE INDIFFERENCE

A

Functional Neurologic Disorder (Conversion Disorder)

239
Q

nabulag ako pero okay lng kasi hindi na ko makakapag exam

A

LA BELLE INDIFFERENCE

Functional Neurologic Disorder (Conversion Disorder)

241
Q

Primary Gain on SOMATOFORM DISORDERS

A

Relief of anxiety or guilt

242
Q

Nursing interventions on SOMATOFORM DISORDERS

A

Rule out any possible organic of physiologic cause

Attend to physical complaints

Consistent care giver must be provided

Encourage verbalization of feeling

242
Q

Secondary Gain on SOMATOFORM DISORDERS

242
Q

Cause: Rape, War, Natural calamities

A

POST TRAUMATIC STRESS DISORDER (PTSD)

242
Q

PTSD Manifestations:
Hypervigilance, Flashback, Avoidance, Dissociation, Detachment > 1 month

More than __ years old:

A

more than 6 yrs old

243
Q

PTSD Manifestations:
Repetitive play and re-enactment

Less than ___ years old:

A

Less than 6 years old:

243
Q

Psychotherapy

A

Adaptive closure therapy (empty chair technique)

BREATHING technique

Catharsis – releasing repressed emotions thru art and music

Debriefing – client is asked about their emotional reaction to an incident

Exposure therapy – confronting trauma associated thoughts rather than avoiding

244
Q

out of the body experience

A

Depersonalization

244
Q

Medical Management for PTSD

A

Selective Serotonin Reuptake Inhibitors

245
Q

out of the world experience

A

Derealization

246
Q

Primary Management for DEPERSONALIZATION / DEREALIZATION DISORDER

A

Talk Therapy

247
Q

substance use that result in maladaptive behavior

A

Intoxication

247
Q

use of a drug that is inconsistent with medical or social norms

248
Q

need for a higher dose to produce the same effect

249
Q

physical or mental symptoms occurs when a person stops the use of the substance

A

Withdrawal

250
Q

unsuccessful attempts to stop using the substance

A

Dependence

251
Q

2 Contributing factor of Substance Abuse Disorders

A

Genetics and Family Dynamics

252
Q

downers to escape reality

253
Q

Commonly abused narcotics

A

Opiods
Codeine, Tramadol, Oxycodone, Morphine, Meperidine, Fentanyl

254
Q

weakest opiod narcotic

255
Q

strongest opiod narcotic

255
Q

Hypotension
Bradycardia
Bradypnea
Pupil CONSTRICTION

A

Signs of Abuse

255
Q

Sign of Overdose of narcotics

A

PINPOINT pupil

256
Q

Detoxification drug for Narcotic

A

Methadone (low potent opiod)

-does not interfere with function, productivity

257
Q

process of safe withdrawal

A

Detoxification

258
Q

Antidote for Narcotic Overdose

A

Naloxone (Narcan) /
Naltrexone (ReVia)

259
Q

Early signs of withdrawal of narcotics

A

Lacrimation, Diaphoresis, Rhinorrhea, Yawning

260
Q

Late signs of withdrawal of narcotics

A

Vomiting and Diarrhea

261
Q

Downers = Dryness

A

stop=Withdrawal = Wetness

262
Q

Management for overdose of Barbiturate

A

Activated charcoal

262
Q

sedative-hypnotics to cause sedation

A

BARBITURATE

262
Q

Commonly abused barbiturates:

A

-barbitals (phenobarbital, methohexital, thiopental) -anesthesia

263
Q

Signs of Withdrawal of Barbiturate

A

Anxiety and Seizure

263
Q

Sign of abuse for Barbiturate

A

same with narcotics

Hypotension
Bradycardia
Bradypnea
Pupil CONSTRICTION

264
Q

Uppers to cause euphoria

264
Q

Signs of abuse of Stimulants

A

Hypertension
Tachycardia
Tachypnea
Pupil DILATION

265
Q

Commonly abused stimulants

A

CoMet

COCAINE
METHAMPHETAMINE HCl (shabu)

266
Q

Sign of abuse of METHAMPHETAMINE

A

DILAT
Di makatulog
Di makakain

Decreased appetite, insomnia
: stained and rotting teeth

266
Q

Sign of abuse for COCAINE

A

Excoriated nostrils, nosebleeds

267
Q

Sign of withdrawal of METHAMPHETAMINE

A

HALLUCINATIONS

“lost his job” = no money
hindi nakatira = crime

268
Q

Sign of withdrawal for COCAINE

A

BIPOLAR CYCLING

(high -> stop -> depression = suicide)

269
Q

Medical Management for STIMULANTS

A

Bromocriptine (Parlodel) – decreases cravings

270
Q

to cause hallucinations

A

HALLUCINOGENS

271
Q

Most commonly abused hallucinogens:

A

Cannabis Sativa (Marijuana)

Lysergic Acid Diethylamide (LSD) – Synesthesia

Phencyclidine (PCP) – violence

Ecstasy – aggression

272
Q

Blood shot eyes (increased blood flow to eyeballs)

A

Cannabis Sativa (Marijuana)

272
Q

Active ingredient in Marijuana

A

Tetrahydrocannabinol

273
Q

type of hallucinations in Marijuana

A

Visual hallucinations

274
Q

weight gain, food trip, laugh trip

A

Cannabis Sativa (Marijuana)

275
Q

Detectability (urine)
Marijuana

276
Q

Detectability (urine)
Methamphetamine

277
Q

Detectability (urine)
Cocaine

278
Q

Shabu, cocaine, marijuana Hair follicles

279
Q

Effects of alcohol:

280
Q

common side effect of DISULFIRAM ANTABUSE (for alcoholism)

280
Q

Defense mechanism of Alcoholism

280
Q

to stop alcoholism / to maintain sobriety

A

AVERSION THERAPY
-pair a behavior with unpleasant stimulus

281
Q

Drug used for Alcoholism

A

DISULFIRAM ANTABUSE

282
Q

DISULFIRAM + ALCOHOL =

A

severe adverse reaction (headache, abdominal pain, vomiting, palpitation)

283
Q

What to assess in Alcoholism

A

TIME OF THE LAST ALCOHOL INTAKE
-wait for 8 hours (to eliminate last intake of alcohol in the body)

283
Q

Contraindication for Alcoholism

A

Anything with alcohol (Mouthwash, cough suppressants, perfume etc)

284
Q

Alcohol Large amount (Sedative) = Decrease vital signs

A

Alcohol Stop/ Withdrawal = increased Vital signs

285
Q

ALCOHOL WITHDRAWAL (6-12 hours)

286
Q

ALCOHOL WITHDRAWAL (48-72 hours):

A

Stage 3: Delirium Tremens (seizures and hallucinations)

286
Q

ALCOHOL WITHDRAWAL (12-48 hours)

287
Q

To decrease cravings to alcohol –

A

Acamprosate (Campral)

288
Q

To block the effect of alcohol

A

Naloxone / Naltrexone

289
Q

No. of participants in group therapy

290
Q

norming

290
Q

storming

291
Q

Stages of Group therapy

A

Forming, Norming (rules), Storming (sharing)

292
Q

Group therapy
Leader:
Decision Maker:

A

Leader: Stable patient
Decision Maker: All members

292
Q

Most important element in Group therapy

A

Motivation

292
Q

Formation of Group Therapy

A

Circular formation

293
Q

Tool in Group therapy

A

Cut, Annoy, Guilt, Eye opener (Cage)

-stop, angry, regrets, realization

294
Q

kinokonsinti

A

CODEPENDENCY

295
Q

Support Groups

Alcoholic anonymous:
Al-Anon:
Alateen :
Rainbow Recovery :

A

Support Groups

Alcoholic anonymous: alcoholic
Al-Anon: spouse
Alateen : children
Rainbow Recovery : LGBTQIA

295
Q

pinagtatakpan

296
Q

Alcoholism – causes THIAMINE DEFICIENCY (Vitamin B1)

A

WERNICKE – KORSAKOFF’s SYNDROME

297
Q

Acute
Short-term
Reversible

[ACO]
Ataxia
Confusion
Ophthalmoplegia

A

Wernicke’s

298
Q

Chronic
Long-term
Irreversible

[CHA]
Confabulation
Hallucination
Amnesia

A

Korsakoff’s

298
Q

Management for WERNICKE – KORSAKOFF’s SYNDROME

A

Thiamine-Rich diet

-Coordinate with DIETICIAN

299
Q

rich in thiamin (Vit B1) foods

A
  1. lean pork chops
  2. fish (salmon)
  3. Flax seeds
  4. Navy Beans
  5. green peas
  6. Firm tofu
  7. brown rice
  8. acorn squash
  9. asparagus
  10. mussels
300
Q

Delirium: Sudden Onset

A

Dementia: Gradual Onset

301
Q

Delirium: Alcohol withdrawal

A

Dementia: Alzheimer’s disease

302
Q

Delirium: Temporary Disorientation

A

Dementia: Permanent Disorientation

303
Q

Delirium: Hours to days

A

Dementia: Lifetime

304
Q

Delirium: altered LOC

A

Dementia: normal LOC

305
Q

Delirium: altered attention span

A

Dementia: normal attention span

305
Q

Delirium: Impairment of neuron

A

Dementia: Death of neurons

306
Q

Delirium: Reversible Prognosis

A

Dementia: Irreversible Prognosis

307
Q

Delirium: Temporary Memory Loss

A

Dementia: Permanent Memory Loss

308
Q

addiction + severe mental illness

A

Dual Diagnosis

309
Q

Aloof, alone, catatonic (have the tendency to hold their breath)

A

WITHDRAWN CLIENT

310
Q

Engage in highly structured, scheduled activities

A

depressed clients

310
Q

approach to DEPRESSED CLIENT

A

Kind Firmness (SOME)

Silence
Offering Self
Motivate – remind client of time when she or he felt better and was successful

310
Q

approach to WITHDRAWN CLIENT

A

Active Friendliness

  1. Activity – Achievable, and non-competitive activities
    >watering the plants
    >folding linens
    >arranging table
  2. Accompany – Offering self
  3. Appraise – NO material rewards
311
Q

approach for SUICIDAL CLIENT

A

DIRECT CONFRONTATION APPROACH

Clarify the client’s statement
Confront the client directly
Consider the plan, method, and lethality (How? When? Where?)
Confiscate dangerous objects
Contract of Safety: “I will not harm myself intentionally or accidentally with the next 24 hours”

312
Q

signs of suicidal clients

A

[GCASH]

Giving of valuables
Cancelling of appointments
Apologetic
Sudden cheerfulness and increase in energy
Homicidal and suicidal thoughts

315
Q

Most Common Time of Suicide

A

Early morning, Monday, During endorsement

316
Q

Most Common Method of Suicide

316
Q

Most Common Place of Suicide

317
Q

Gender and age of Suicide

A

Males (20-24)
Female (15-19)

more common: Male
4 males: 1 female

318
Q

Civil Status for Suicide

319
Q

Important factor to consider for suicidal client

A

Substance Abuse!!!

320
Q

Constant Observation: ___________

A

Irregular observation

best answer: 1 on 1 supervision

alternative: frequent monitoring every 15 mins

320
Q

What is the priority:

a. suicidal history
b. suicidal thoughts
c. suicidal ideation (plan)

A

priority: with means readily available!

c. suicidal ideation (plan)

321
Q

not suicide but will do dangerous activities

A

“passive suicidal”

322
Q

approach to Paranoid client

A

Passive Friendliness

-(keep doors open/ be available for pt to approach you)

323
Q

[DISARM]

Develop trust

Involve the client in planning

SEALED CONTAINER (for food and medicine)

Avoid staring, whispering, and giggling

Respect personal space (not less than 4ft) / 3-6ft

Maintain professional tone (use simple, direct, concise words)

A

Passive Friendliness

324
Q

“May lason yan, di ko kakainin”

a. Martha was prepared by the hosp chef
b. food given is same with other pts
c. the food is not poisoned, eat it when you get hungry

A

c. the food is not poisoned, eat it when you get hungry

325
Q

approach to MANIC / MANIPULATIVE client

A

Matter-of-Fact Approach

326
Q

Point out unaccepted behavior, and inform client of what is expected

(Calm, non-threatening, non-punitive, directive tone of voice)

A

Matter-of-fact Approach
(SET FIRM LIMITS)

326
Q

“Maria, its not time for lunch. Go back to your room.

“Maria shouting and cursing is not allowed in the building. It’s not yet time to eat. Go back to your room.”

A

Matter-of-Fact Approach

326
Q

Activity for Manic/Manipulative Pts

A

Non-competitive, Solitary, Gross Motor Activities

327
Q

Room for Manic/Manipulative Pts

A

Private Room

328
Q

[MANIC PTS]

a. running
b. walking

A

b. walking

328
Q

[MANIC PTS]

a. watching TV
b. reading newspaper
c. listening to radio
d. writing a journal / drawing

A

d. writing a journal / drawing

329
Q

Diet for Manic/ Manipulative Pts

A

high calorie, fingerfood

330
Q

Verbally abusive

A

AGGRESSIVE CLIENT

330
Q

Diet for Manic/ Manipulative Pts

  1. a. fruit salad
    b. banana
  2. a. spaghetti
    b. cheeseburger
  3. a. tinola
    b. french fries
  4. a. potato chips
    b. milk shake
A
  1. b. banana

2.b. cheeseburger

  1. b. french fries
  2. b. milk shake (high calorie, healthier)
331
Q

Visibility of 4 – 6 staff members

A

SHOW OF FORCE

Note: Only 1 RN is allowed to communicate with the patient

332
Q

Physically violent

A

ASSAULTIVE CLIENT

333
Q

Decrease Stimulation – turn of television, let other clients leave the room

Deescalate – Encourage expression of feelings, promote ASSERTIVE COMMUNICATION

Directive approach – calm, non-threatening

A

AGGRESSIVE CLIENT (Verbally abusive)

334
Q

Goal of Management for ASSAULTIVE CLIENT (Physically violent)

A

To strengthen patient’s impulse control

335
Q

RESTRAINTS PRINCIPLE

A

Principle: Least to Most restrictive

336
Q

Room for Seclusion

A

lockable and observable from the outside

337
Q

RESTORATIVE, NOT PUNITIVE to help client regain self-control

338
Q

SECLUSION

Monitoring:
Environment:

A

Monitoring: one-on-one monitoring on the first hour

Environment: less stimulated environment (no visitors and phone calls allowed)

339
Q

If pt has schizo, ayaw niya itake due to side effects, wag pilitin. They can think clearly at the time

A

Principle: if client admitted in mental facility -they can still refuse treatment but loses it if they are a threat to themselves or to other people! And they cannot go out without doctor’s order.

340
Q

is the doctor’s order needed for application of restraints?

A

NOT REQUIRED! BUT must be obtained within 1 hour

MORE CORRECT: according to hospital policy/agency protocol!!!

341
Q

Proper Application of Restraints:

  • ____ staff members required
  • Adequate circulation must be ensured every ____ mins
  • Anchor on a stable part of the bed:
A
  • 6 to 8 staff members required
  • Adequate circulation must be ensured every 15 mins
  • Anchor on a stable part of the bed: Bed Frame
342
Q

is the doctor’s order required for the removal of restraints?

A

YES. Required doctor’s order for the removal of restraints

343
Q

how many RN needed for removal of restraints?

344
Q

Temporary removal of restraints

A

alternately, one at a time,
for 10 minutes every 2 hours

345
Q

Permanent removal of restraints

A

alternately one at a time

346
Q

how to tie restraints

A

QUICK-RELEASE KNOT /
“Half-bow tie”

347
Q

Most Important Element of Nurse-Patient Relationship

A

ACCEPTANCE

347
Q

Elements of a contract of Professional Relationship

A

-Time, duration, and venue of sessions

  • Termination and criteria for termination
  • Nurse’s and patient’s responsibilities
  • Participants
347
Q

Purpose of Nurse-Patient Relationship

A

To help client develop new and effective coping mechanisms

348
Q

Phases of Nurse Patient Relationship

A

(POWT)

PRE – ORIENTATION
ORIENTATION
WORKING
TERMINATION

349
Q

Nurse’s Responsibility: Read the patient’s chart

Problem: Reluctance of the nurse

Goal: Self – awareness / INTROSPECTION

A

PRE – ORIENTATION

349
Q

Nurse’s Responsibility: Formulate Nursing Diagnosis

Problem: Resistance of the patient

Goal: Establish TRUST / Build RAPPORT

A

ORIENTATION

350
Q

Nurse’s Responsibility: Promote the client’s insight

Problem: EMOTIONAL ATTACHMENT

Goal: RN (explore); Patient (verbalize)

350
Q

Patient to Nurse

A

Transference

351
Q

Nurse to Patient

A

Countertransference

-laging nasa counter - nurse

352
Q

BQ: Which of the ff emphasizes on the concept of countertransference?

A

When the nurse provides personal contact details to the pt.

353
Q

Nursing responsibility:
Determine client’s feelings about the end of the relationship

Problem: Separation Anxiety

Prevention: Constantly remind patient about the contract

Intervention: Encourage verbalization of feelings

Goal: Evaluate effectives of intervention

A

TERMINATION

354
Q

Intervention for Transference and Countertransference

A

Intervention:
▪ Remind the patient about the contract

COMPREHENSIVE PHASE (8 decks)

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