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Nursing Practice 5 > Psychiatric Nursing Part 2 (Pdf) > Flashcards

Psychiatric Nursing Part 2 (Pdf) Flashcards

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1
Q

regulates the internal organs and responsible for vital
functions such as regulation of blood gases and the maintenance of BP

A

BRAINSTEM

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2
Q

hunger, thirst and sex.
- thought & emotions

A

Hypothalamus

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3
Q

allows human to sleep and carry out conscious mental activity

A

RAS reticular Activating System

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4
Q

crucial role in emotional status and psychological
function (norepinephrine, serotonin, dopamine

A

Limbic system –

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5
Q

CEREBELLUM

A

Coordinated muscle energy & activity
🞂 Maintenance of equilibrium
🞂 Coordinates contraction

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6
Q

responsible for mental activities and a conscious sense
of being. Also responsible for language and the ability to communicate

A

CEREBRUM

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7
Q

responsible for conscious sensation and the
initiation of movement

A

Cerebral cortex

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8
Q

Parietal cortex

A

touch

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9
Q

Temporal

A

Sound

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10
Q

Occipital

A

Vision

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11
Q

Frontal

A

Initiation of Skeletal muscle contraction

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12
Q

responsible for thoughts, goal-oriented
oriented behavior & inhibition
- Seat of Personality

A

Prefrontal cortex

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13
Q

– regulation of movements

A

Basal ganglia

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14
Q

emotions, learning, memory
and basic drives

A

Amygdala and hippocampus

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15
Q

is present at the postsynaptic membrane and
destroys acetylcholine shortly after it attaches to nicotinic or muscarinic
receptors on the postsynaptic cell.

A

Acetylcholinesterase

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16
Q

monoamine transmitters norepinephrine, dopamine, and serotonin are all
inactivated in this manner by the enzyme,

A

monoamine oxidase.

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17
Q

involved fine muscle movements,
Decision making
Stimulate hypothalamus and release hormone

A

Dopamine

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18
Q

Decrease Dopamine

A

Parkinsons
Depression

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19
Q

Increase dopamine

A

Schizo
Mania

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20
Q

Decrease norephi

A

Depression

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21
Q

Increase norepi

A

Schizo
Anxiety
Mania

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22
Q

Role in sleep regulation, hunger, mood, and pain perception

Aggression and sexual behavior

A

Serotonin

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23
Q

Decrease serotonin

A

Depression

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24
Q

Increase serotonin

A

Anxiety

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25
Q

reduces aggression, excitation and anxiety

A

y-aminobutyric acid (GABA)

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26
Q

Decrease GABA

A

Anxiety
Schizo
Huntingtons

Inc - Anxiety

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27
Q

Excitatory, role in learning and memory

A

Glutamate

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28
Q

Decrease glutamate

A

Psychomimetic state resembles schizo

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29
Q

Increase glutamte

A

Improved cognitive performance in behavioral task

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30
Q

Decrease acteylcholine

A

Azheimer
Huntingtons
Parkinsons

Inc - Depression

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31
Q

Antidepressant and anti anxiety

Reinforces memory

A

Substance P

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32
Q

a specific channel for transmitting and
receiving messages

A

The use of silence

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33
Q

– self-awareness of one’s feelings

A

Genuineness

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34
Q

one understands the ideas expressed

A

Empathy

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35
Q

5 concepts of empathy

A

Human trait
◦ Professional state
◦ communication process
◦ caring process
◦ special relationship

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36
Q

ability to view another person as being
worthy of caring about & as someone who has strength & achievement
potential

A

Positive regard

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37
Q

consistently encourage
client to use their resources helps minimize the client’s feeling of
helplessness & dependency & also validates their potential for change

A

Helping client develop resources –

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38
Q

– the process whereby a person unconsciously
& inappropriately displaces onto individuals in his/her current life t

A

Transference

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39
Q

the tendency of the nurse to displace
onto the client feelings related to people in the nurse’s past

A

Countertransference

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40
Q

Common countertransference reaction

A

Boredom (indifference)
2. Rescue

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41
Q

to establish a client database & assess own feelings
regarding the client

A

PREORIENTATION PHASE

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42
Q

develop mutual trust, establish role of the nurse as
significant other to the client

A

ORIENTATION PHASE

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43
Q

Goal: identify & address client’s problem

A

WORKING PHASE
◦ Goal: identify & address cl

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44
Q

intervention designed to prevent clients from
harming themselves or others

A

Limit setting

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45
Q

Goal: assist client to review what was learned and to transfer
learning interaction with others

A

TERMINATION PHASE

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46
Q

Interaction with client behaviors
🞂 Violent behavior

A

Stay out of striking distance

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47
Q

Hallucinations

A

Provide reality but acknowledge behavior
◦ Assess the hallucination based on content of the messages

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48
Q

Delusions

A

Clarify the meaning of the delusions then ignore

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49
Q

Conflicting values

A

Help client examine the effects or outcomes of their beliefs on
their lives, relationship, and happiness

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50
Q

Severe anxiety & incoherent speech

A

Spend frequent, brief time with patients, offer support, and
build trust

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51
Q

Provide limit setting
◦ Help client express their needs directly to others

A

Manipulation

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52
Q

Crying

A

Unless a form of manipulation, allow client to cry
◦ Provide privacy
◦ Be quiet and unobtrusive

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53
Q

Sexual innuendos or inappropriate touch

A

◦ Remind client these actions are inappropriate

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54
Q

Denial & lack of cooperation

A

Reality testing & supportive confrontation with denial

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55
Q

Depressed affect, apathy, & psychomotor retardation

A

Patience, frequent contact, and empathy
◦ Encourage hygiene, proper nutrition and gradual increase in
activities
◦ Postponed major decisions until emotions have subsided

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56
Q

Suspiciousness

A

Communicate clearly, simply, and congruently.
◦ Clarify misinterpretation
◦ Provide simple rationale or explanations for rules, activities,
occurrences, noises and requests

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57
Q

Hyperactivity

A

Patient should be in a quiet area, with minimal auditory &
visual stimulation
◦ Remain calm, speak slowly and softly & respect patient’s
personal space

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58
Q

Nurses must be open and clear
◦ State action that they cannot meet patient’s need
◦ Limit setting

A

Transference & countertransference

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59
Q

Consists of treatment by means of control modification of the
client’s environment to promote positive experiences

A

Milieu Management

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60
Q

Friendly, warm, trusting, secure, supportive, comforting
atmosphere throughout the uni

A

Characteristics of milieu therapy

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61
Q

Elements of Milieu therapy

SSNLB

A

Safety
Structure
Norms
Limit settings
Balance

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62
Q

should be set on acting-out behavior
◦ Reinforces the norms of making rules & expectations clear &
encourage the milieu therapy concept—responsibility to self

A

Limit settings –

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63
Q

Group of conditions in which the affected person experiences
persistent anxiety that the person cannot dismiss and that interferes with
daily activities

A

ANXIETY DISORDERS

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64
Q

Characterized by excessive chronic anxiety or worry & might concern everyday events

A

GENERAL ANXIETY DISORDER

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65
Q

restlessness. Fatigue, poor concentration, irritability, muscle tension, sleep disturbance, physical symptoms (dry mouth, upset stomach)

A

GENERAL ANXIETY DISORDER

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66
Q

Milieu mgt: for GAD

A

Recreational activities
● Relaxation exercises, meditation & biofeedback
● CBT
● Therapeutic touch & acupressure

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67
Q

recurrent panic attack & are worried about having more attacks

A

PANIC DISORDERS

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68
Q

eelings of terror that function is suspended, perceptual field is severely limited & misinterpretation of reality

A

Panic disorder with agoraphobia

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69
Q

intense, excessive anxiety or fear about being in places or situations from which escape might be difficult or embarrassing or in which help might not be available if panic attack occurs

A

Agoraphobia

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70
Q

Psychotherapeutic mgt: Reduce immediate anxiety

A

Stay physically close to patient use simple sentences, firm voice, remove to smaller quiet room to minimize stimuli

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71
Q

Psychopharmacology Panic disorder without agoraphobia

A

SSRI
● Benzodiazepine (clonazepam, lorazepam) – immediate effect

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72
Q

persistent thoughts, impulses, images or desires that maybe trivial or morbid

A

Obsession

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73
Q

repetitive stereotyped behavior that are performed in a particular manner in response to an obsession

A

Compulsion

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74
Q

Etiology OCD

A

genetic, increase brain activity in the frontal lobe & basal ganglia, serotonin dysregulation

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75
Q

NPR for OCD

A

Accept rituals permissively
Avoid criticism or punishment, making demands, showing

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76
Q

Psychopharmacology OCD

A

Antidepressant:
o Clomipromine (anafranil)
● SSRI – fluoxetine (Prozac), setraline (Zoloft), fluovoxamine (Luvox) & paroxetine (Plaxil)

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77
Q

Milieu mgt for OCD

A

Relaxation exercises & stress mgt.
● Recreational or social skills
● CBT, problem-solving & communication or assertive training groups

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78
Q

Intense, irrational, persistent fear responses to an external object activity or situation

A

PHOBIC DISORDERS

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79
Q

response to experience anxiety & is characterized by a persistent fear of specific places or things

A

Phobia

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80
Q

fear of being in public or open spaces places or situations in which escape might be difficult or help might not be available

A

Agoraphobia with history of panic disorders

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81
Q

fear of being humiliated, scnrutinized, or embarrassed in public

A

Social phobia

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82
Q

fear of a specific object or situation that is not either of the above

A

Specific phobia

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83
Q

NPR for Phobias

A

Accept patient & their fears with a non-critical attitude
● Provide & involve patient in activities that do not increase anxiety but increase involvement, rather that promote avoidance
● Help client with physical safety and comfort
● Help patient recognize that their behavior is a method of avoiding anxiety

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84
Q

Psychoparma for SSRI for Phobia

A

to reduce anxiety & depression & block panic attacks, if present

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85
Q

Milieu mgt for Phobia

A

Assertive training & goal-setting groups
● Social skills group to help redevelop social skills and decrease avoidance
● Behavior therapy – systemic desensitization, flooding, exposure, and self-exposure

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86
Q

Develop after exposure to a clearly identifiable traumatic event that threatens the self, others, resources, and/or sense of control or hope

A

ACUTE STRESS DISORDER & POST TRAUMATIC STRESS DISORDERS

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87
Q

symptoms occur within 1 month of extreme stressor; includes dissociative symptoms (depersonalization, emotional detachment., dazed appearance, amnesia

A

ACUTE STRESS SYNDROME

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88
Q

severe traumatic event that is not an ordinary occurrence e.g.. Rape, fire, flood, earthquake, tornado, bombing, plane crash, war, torture, kidnapping

A

POST STRESS DISORDER

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89
Q

4 diagnostic criteria for PTSD

A
  1. Dissociative symptoms & numbing
  2. Reexperiencing the trauma & intrusive memories – hallucinations
  3. Arousal symptoms
  4. Other symptoms
    ● Anxiety or panic attack
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90
Q

grief, depression, suicidal ideation or attempts, impulsive self-destructive behavior, anxiety-relate disorders & substance abuse

A

PTSD

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91
Q

Psychotherapeutic mgt: prevent or minimize the symptoms
1. NPR: for PTSD

A

DEVELOP TRUST

Nurse needs to be non-judgmental honest, emphatic, and supportive
● Teach dynamics of ASD & PTSD
● Exposure therapy & systematic desensitization
● Expressive therapy (art, music, poetry) – facilitate externalizing painful emotions that are difficult to verbalize
● Crisis counselling –

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92
Q

Psychopharma for PTSD

A

● Benzodiazepine (clonazepam, lorazepam) – to reduce level of anxiety and fear. Help with sleep disturbance
● Clonidine & propanolol – diminish the peripheral autonomic response associated with fear, anxiety & nightmare
● Lithium carbonate – prescribed to patients experiencing explosive outburst
● SSRI (paroxetine, setraline, fluoxetine) – decrease repetitive behaviors, disturbing images & somatic states
● TCA – depression, adehonia & sleep disturbances ● Antipsychotic (respirodone) – psychotic thinking

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93
Q

Milieu mgt for PTSD

A

Social activities
● Recreational & exercise program ● Group therapy

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94
Q

Characterized by the presence of physiologic complaints or symptoms, ● which are not under voluntary control & no demonstrable organic finding ● and physiologic bases

A

F. SOMATOFORM DISORDERS 1. NPR:

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95
Q

Conversion of mental states or experiences into bodily symptoms associated with anxiety
◦ Recurrent, frequent & multiple somatic complaints for several years without physiologic cause

A

Types: 1. Somatization disorder

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96
Q

Associated with psychological factors like severe pain in one or more of anatomical sites that causes significant distress or impairment in functioning
◦ Pain is exaggerated or out of proportion

A

Pain disorder

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97
Q

Worried & belief that they have serious disorders base on the misinterpretation of bodily signs & sensation for at least 6 months
◦ Preoccupation persists despite appropriate medical tests & reassurances

A

Hypochrondiasis

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98
Q

Individual is preoccupied with an imagined defect in appearance which are usually facial flaws.
◦ Dermatologist & plastic surgeon is often consulted
◦ May also exhibit obsessive compulsive traits & depressive syndrome

A
  1. Body dysmorphic disorder
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99
Q

NPR for Somatoforms

A

Use matter-of-fact caring approach
Encourage patient to verbalize & describe feeling

Use positive reinforcement & set limits
Do not push awareness of or insight into conflicts or problems

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100
Q

Milieu for Somatoform

A

Relaxation exercises meditation and CBT
● Family therapy

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101
Q

disturbances in the normally well-integrated continuum of consciousness, memory, identity, and perception

A

G. DISSOCIATIVE DISORDER

102
Q

the removal from conscious awareness of painful feelings, memories, thoughts, or aspects of identity

A

Dissociation

103
Q

Defense mechanism of Dissociative

A

repression

104
Q

Cause of Dissociative

A

Inability to recall important personal information usually of a traumatic or stressful nature
● The disorder is often associated with exposure to traumatic event common during disaster and wartim

105
Q

Types of dissociative disorders

A
  1. Dissociative amnesia
  2. Dissocialise fugue – sudden, unexpected travel away from
  3. Depersonalization disorder – involves an altered sense of
  4. Dissociative identity disorder – existence of 2 or more
106
Q

Sudden inability recall important information of one or more episodes not associated with organic disorders usually of a traumatic or stressful nature

A
  1. Dissociative amnesia
107
Q

sudden, unexpected travel away from home or some other location with the assumption of a new identity or a confusion about one’s identity

A

Dissocialise fugue

108
Q

involves an altered sense of self, so that the individual feel unreal or strange or believe that danger is not happening to then or to someone else

A

Depersonalization disorder

109
Q

existence of 2 or more identities or personalities that take control of the person’s behavior with its own patterns of relating, perceiving, and thinking

A

Dissociative identity disorder

110
Q

The person or host us unaware of the other personalities, but the other alters might be aware of each other to varying degrees
◦ Defense mechanism:?

A
  1. Dissociative identity disorder –

Repression

111
Q

NPR for Dissociative

A

Ensure client safety
Provide nondemanding, simple routine
Confirm identity of client and orientation to time & place

112
Q

Milieu for Dissociativew

A

Individual therapy
● Task-oriented group activities

● OT and art therapy ● Cognitive therapy ● Self-help groups

113
Q

Childhood & Adolescent psychiatric disorders

Social

A

◦ Social & environment – severe marital discord, low socioeconomic status, large family & overcrowding, parental criminality maternal psychiatric disorder, traumatic life event, sexual/physical abuse

114
Q

alterations of neurotransmitters (decrease in norephhinephrine & serotonin

A

Biochemical in children

115
Q

Characterized by impairment in social interaction, communication and restricted repertoire of activity & interest c. Usually first observed before 3 years of age

A

a. Autistic disorder

116
Q
  1. Pervasive development disorders
A

a. Autistic disorder
a. Asperger’s disorders –
Attention deficit/hyperactivity disorder

117
Q

Characterized by impairment in social interaction, communication and restricted repertoire of activity & interest c. Usually first observed before 3 years of age

A

a. Autistic disorder

118
Q

Symptoms of Autism

A

Impairment in communication & imaginative activity ● Impairment in social interaction
● Markedly restricted, stereotypical patterns of behavior, interest and activities

119
Q

a severe developmental disorder
characterized by major difficulties in social interaction & restricts & unusual interest & behavior

A

Aspergers Disorder

120
Q

Symptoms of Aspergers

A

Use monotone speech and rigid language
● They cannot understand jokes and are taken advantage easily ● Inability to show empathy to others but want to meet people & make friends

121
Q

characterized by inattention, impulsiveness, and overactivity in school 9before 7 years

A

b. Attention deficit/hyperactivity disorder – characterized by

122
Q

Characteristics of ADHD

A

Inattention
❖ Difficulty paying attention in tasks or play
❖ Does not seem to listen, follow through or finish tasks

123
Q

Nursing Diagnoses for ADHD

A

Risk for injury
● Impaired social interaction
● Ineffective individual
● Risk for violence for self-directed or directed to others

124
Q

ADHD intervention

A

Talk to client about safe & unsafe behavior – use clear, honest straightforward communication
● Assess the frequency & severity of accidents
● Provide supervision for potentially dangerous

125
Q

nduring pattern of disobedience, argumentative, explosive angry outburst, low frustration tolerance, and a tendency to blame others for quarrels or accidents

A

Oppositional defiant disorder

126
Q

Recurrent pattern of negativistic, disobedient, hostile , defiant behavior towards authority figures with serious violation of basic rights of others

A

Oppositional defiant disorder

127
Q

characterized by persistent pattern of behavior in which the rights of opthers and age-appropriate societal norms or rules are violated

A

Conduct disorder

128
Q

Predisposing in Conduct Dx

A

ADHD, oppositional child behaviors, parental rejection, inconsistent parenting with harsh discipline, early institutional living, frequent shifting of parental figures,

129
Q

excessively anxious when
separated from or anticipating a separation from their home or parental figures

A

Separation anxiety disorders

130
Q

Characteristics Separation anxiety disorders

A

Excessive distress
Excessive worries
Fear of being home alone
Refusal to sleep unless near a parental figure
Refusal to attend school

131
Q

Nursing interventions for sepanx

A

Assess the quality of the relationship between child & parents

Accept regression but give emotional support

132
Q

Psychopharma for sepanx

A

antihistamines, anxiolytics and antidepressants

133
Q

sum total of the person’s distinctive character, behavior, attitudes, the way one carries himself , the way one communicate

A

Personality

134
Q

enduring pattern of inner experience & behavior that deviates markedly from the expectation of the individual’s culture, is pervasive & inflexible, has an onset in adolescence or early adulthood, is stable over time, & lead to distress or impairment “ (APA, 2000)

A

Personality disorder

135
Q

(ODD, ECCENTRIC)

A

CLUSTER A DISORDERS

136
Q

CLUSTER A DISORDERS (ODD, ECCENTRIC)

A

a. Paranoid personality disorder
b. Schizoid personality disorder
b. Schizotypal personality disorder

137
Q

Individuals with this disorder lacks personal & social relationship. They are detached from others & withdraws from interaction – hypersensitive
● Introverted since childhood, rarely have close friends

A

Schizoid personality disorder

138
Q

Defense mechanism Schizoid personality disorder

A

INTELLECTUALIZATION

139
Q

Avoid in Schizoid

A

Avoid being too “nice” or “friendly” 2. Do not try to increase socialization

140
Q

Individuals with this disorder may have behavior similar to those of someone with schizophrenia, however psychotic episode are infrequent & less severe

A

Schizotypal personality disorder

141
Q

Has __________ appearance and shows evidence of magical thinking or perceptual distortion that are not clear delusions or hallucination

A

Schizotypal personality disorder : Eccentric

142
Q

Symptoms of schizoid

A

Ideas of reference
2. With magical thinking/odd beliefs leading to interpersonal difficulties
3. Problems in thinking, communicating and perceiving
4. Has eccentric appearance and shows evidence of magical thinking or perceptual distortion that are not clear delusions or

143
Q

CLUSTER B CRITERIA (DRAMATIC, EMOTIONAL, ERRATIC)

A

a. Antisocial personality disorder
c. Borderline personality disorders
c. Narcissistic personal disorder
Histrionic personality disorder

144
Q

Has consistent disregard for others with exploitation & repeated unlawful actions.

A

a. Antisocial personality disorder

145
Q

Charming, intellectual and smooth talkers
● They repeatedly neglect responsibilities, tell lies and perform destructive or illegal acts, without developing any insight into predictable consequences
● Hostile, unable to follow rules
● Diagnose before age 15 as conduct disorder

A

a. Antisocial personality disorder

146
Q

Criteria for Antisocial PD
LIAR

A

Lack of Guilt
Irresponsible
Aggressive behavior
Recklessness

147
Q

Be firm, steadfast and consistent in dealing with patient’s
behavior and reinforcing rules & policies

A

Nx int for Antisocial PD

148
Q

Characterized by impulsiveness, unpredictable, unstable moods
● Desperately seek relationship to avoid feeling abandoned
● Chronic sense of boredom
● Overspending, promiscuity, overeating
● Problems with identity & self-image

A

Borderline personality disorders

149
Q

Defense mech of Borderline

A

Projection

150
Q

Inadequate regulation of serotonin & dopamine & other transmitters
● Parents may cling to the child and prevent autonomy, individual or parent withdraws support & attention making the child confuse

A

Etiology of Borderline PD

151
Q

Nursing int for Borderline

A

Set realistic goals, use clear action word
● Be aware of manipulative behaviors
● Provide clear & consistent boundaries & limits

152
Q

Individuals with this disorder display grandiosity about his performance and achievement
● Arrogant, extrovert

A

c. Narcissistic personal disorder

153
Q

Defense mech of c. Narcissistic personal disorder

A

Rationalization

154
Q

Individual with this disorder are characterized by excessive emotional attention seeking behavior and are dramatic and ego-centric ● Seductive, flamboyant and shallow – use speech to impress others

A

Histrionic personality disorder

155
Q

Nursing int for Histrionic personality disorder

A

Understand seductive behavior as a response to distress
● Keep communication & interaction professional, despite temptation to collude with the client in a flirtatious & misleading manner ● Encourage & model the use of concrete & descriptive rather that vague & impressionistic language

156
Q
  1. CLUSTER C DISORDERS (ANXIOUS, FEARFUL)
A

a. Dependent personality disorder
b. Avoidant personality disorder
c. Obsessive-compulsive personality disorder
1. MAJOR DEPRESSIVE DISORDER (MDD)

157
Q

For Dependent PD

A

Increase responsibility for self in daily livings ● Be assertive
● Encourage client to verbalize feeling
● Be aware of countertranference

158
Q

These clients are timid, socially uncomfortable, with self care and withdrawn
● Social inhibition and avoidance of all situation that require interpersonal contact

A

b. Avoidant personality disorder

159
Q

Nx int for Avoidant PD

A

Be friendly, gentle, reassuring approach
● Help client to confront fears gradually
● Support & direct client in accomplishing short-term goals ● Relaxation techniques

160
Q

Perfectionist and inflexible
● Overly strict & often set standards for themselves that are too high
● Preoccupied with details, rules, trivial and procedures
● Difficult to express emotions or warmth

A

c. Obsessive-compulsive personality disorder

161
Q

Defense mechanism: c. Obsessive-compulsive personality disorder

A

intellectualization, rationalization, reaction-formation

162
Q

extreme change in mood that presents problems in daily functioning

A

Mood disorders

163
Q

Characterized by 1 or more major depressive episodes, which are defined as at least 2 weeks by depressive mood or less of interest accompanied by at least 4 additional symptoms of depression

A
  1. MAJOR DEPRESSIVE DISORDER (MDD)
164
Q

Signs of MDD

A

Depressed mood most of the day
b. Anhedonia
c. Significant weight loss or gain (5% wt. in month)
d. Insomia or hypersomia (2 hrs in 1 month)

165
Q

MOOD DISORDERS ◦ Characteristics

A

Disregards grooming, cleanliness & personal appearance
b. Stooped posture & dejected facial expression
c. Dishevelled, downcast, lacking eye contact & tearful
d. Agitated

166
Q

occurs in younger population
● Increase appetite or wt. gain, hypersomnia, leaden paralysis &
extreme sensitivity to interpersonal rejection

A

Atypical depression –

167
Q

older adults
Anhedonia
Depression worse in AM
Wt loss anorexia

A

Melancholic depression

168
Q

psychomotor attraction including immobility, excessive motor activities, mutism, echolalia or echopraxia inappropriate posturing

A

Catatonic features

169
Q

mood disturbance that occurs during the first ___ days post partum

A

Postpartum depression 30 days

170
Q

Delusion of guilt, delusions of deserved punishment, somatic delusions, nihilistic delusion, & delusion of poverty

A

Psychotic depression – delusions & hallucination

171
Q

occur in conjunction with a seasonal change

A

Seasonal affective disorder (SAD

172
Q

Establish trust
● Nonjudgmental & friendly approach
● Use silence & stay with patient
● Avoid challenging or testing the client
● Do not argue
● Divert patient’s attention

A

Nx guideline for SAD

173
Q

Patient is depressive mood for at least 2 years ▪ With poor appetite or over-eating
▪ Insomia or hypersomia
▪ Low energy or fatigue

A

DYSTHMIC DISORDER

174
Q

Difference betweeen MDD and DD

A

Duration and Severity

175
Q

Behavior – always on the go, increase sexual drive
Thought – flight of ideas, inflated self-esteem
Affect – feeling of happiness, confidence

A

Mild elation or hypomaniac (4 days)

176
Q

Intensified symptoms
Mood disturbance & lability
Enthusiastic & intrusive
Hyperactivity
◦ Flight of ideas ●

A

Acute manic episodes

177
Q

state of extreme excitement
◦ Disorientation, incoherence
◦ Visual or olfactory hallucination
◦ Exhaustion, dehydration, injury even death

A

Delirium

178
Q

elevated, expansive or irritable mood

A

Manic episodes

179
Q

less, severe level of impairment

A

Hypomanic episodes

180
Q

hypersomia, hyperphagia, wt. gain, leaden paralysis, little energy

A

Depressive episodes

181
Q

🞂 Basic syndromes of bipolar disorders

MHD

A

Manic
Hypomanic
Depressive

182
Q

experiences swings between manic episodes and major depression

A

Bipolar I disorder

183
Q

characterized by 1 or more depressive episodes accompanied by at least one hypomanic episodes

A

Bipolar I disorder

184
Q

a swing between a hypomanic and depressive symptoms

A

Cyclothymic disorders

185
Q

Disturbance of speech, social, interpersonal & occupational relationship, activity & appearance
● Speech – rapid, pressured, loud, easily distracted
● Altered social, interpersonal & occupational relationship

A

● Objective behavior

186
Q

NX for Manic disorders

A

Limit – setting
Reinforcement of reality
Respond to legitimate complaints
Redirect patient into more healthy activities Provide for can be eaten easily
Assess amount of sleep & rest

187
Q

Milieu mgt. Manic

A

Safety
Consistency among staff
Reduction of environmental stimuli

188
Q

Limit their intake or refuse to eat but do not lose their appetite
◦ Perfectionist & introvert with self-esteem & peer relationship problems
◦ Clinical manifestation/behaviors
Restricters Vomiters-purgers

A

🞂 ANOREXIA NERVOSA

189
Q

Amenorrhea
◦ Hypotension, bradycardia, hyponatremia
◦ Dry skin with lanugo
◦ Delayed gastric emptying
◦ Slow peristalsis—-constipation
◦ Dehaydration

A

🞂 ANOREXIA NERVOSA

190
Q

Etiology of 🞂 ANOREXIA NERVOSA

A

A culture of thinness, relational orientation of women
● Genetic component
● Family environment
● Odd eating habits & emphasis on appearance
● Rejection of food & wt. loss as a positive reinforcement
● Childhood sexual abuse
● Regression to a prepubertal state

191
Q

Intermittent binge period and periods of restrictive eating
◦ Loss of control over eating
◦ Anxious & feeling of weakness – before eating while binging
◦ Angry & agitated or depressed

A

BULIMIA NERVOSA

192
Q

Bulimia Nervosa charac

A

Secretive about behavior ● Binge eating
● F/E abnormalities
● Use of laxatives
● Use of ipecac syrup
● Menstrual irregularities
● Dental carries
● Russel’s sign
● Loss of control over eating

193
Q

EATING DISORDERS
◦ Psychotherapeutic mgt

A

Medical stabilization
● Wt. restoration –
● Help patient reestablish appropriate eating behavior
● Elevate self-esteem
● Medical treatment – IV lines & feeding tubes
◦ Nursing guidelines
● Convey warmth & sincerity
● Listen emphatically
● Be honest

194
Q

Psychopharmacology for eating dx

A

Anxiolytics
● Atypical antipsychotics
● Antidepressants - SSRI

195
Q

mental disorder characterized by disturdance in thought & sensory perception & deterioration in psychosocial functioning

A

Schizophrenia

196
Q

delusions, any prominent hallucinations, disorganized speech or disorganized catatonic behavior

A

Psychotic

197
Q

SCHIZOPHRENIA
🞂 Precipitating factors
1. Emotional - marital problem
2. Somatic – pregnancy, physical illness 3. May be none
🞂

4 A’s (Eugene Bleuler)

A

Affect
Associative looseness
Autism
Ambivalence

198
Q

outward manifestation of a person’s feelings & emotion – flat, blunted, inappropriate bizarre affect

A

Affect

199
Q

haphazard & confused thinking manifested in jumbled & illogical speech & reasoning

A

Associative looseness

200
Q

hinking that is not bound to reality but reflects the private perceptual world of the individual – delusions, hallucination, neologism

A

Autism

201
Q

simultaneously holding 2 opposing emotions, attitudes, ideas, or wishes towards the same person situation or object

A

Ambivalence

202
Q

🞂 Phases of schizophrenia Acute

A

period of florid positive symptoms as well as negative symptoms

203
Q

Phases of Schizo: Maintenance

A

period when acute symptoms decrease in severity

204
Q

patient is might still experience hallucination & delusions but not as severe nor as disabling as they were during the acute phase

A

Stabilization phase in Schizio

205
Q

Common symptoms of schizophrenia

A

Delusions
Hallucinations
Illusions
Depersonalization
Affective flattening
Ambivalenve

206
Q

false fixed beliefs that cannot be corrected by reasoning

A

Delusions

207
Q

sensory perception for which no external stimulus exist

A

Hallucinations

208
Q

feeling of the individual that the self has been changed or altered

A

Depersonalization

209
Q

🞂 Common delusions in schizophrenia

A

Delusions of Reference
Somatic delusions
Grandiose
Nihilistic delusions
Delusions of Influence

210
Q

everything that is occurring in the environment has significance to oneself

A

Delusions of reference

211
Q

false belief that one is being singles
out for harm by others – someone is platting against him/her

A

Delusion of persecution

212
Q

appearance or functioning of one’s body
is altered

A

Somatic delusion –

213
Q

false belief that one is a very powerful ◦ & important person

A

Grandiose delusion

214
Q

I am dead”

A

Nihilistic delusion

215
Q

one is controlled by others or outside
force

A

Delusions of influence

216
Q

alse belief that one’s mate in unfaithful; may have so-called proof

A

Jealousy

217
Q

🞂 Symptoms of loose association

A

Neologism
2. Echolalia
3. Word salad
4. Clang association

218
Q

3 broad clinical symptoms

A

Positive
Negative
Disorganized symps

219
Q

Reflects the presence of overt psychotic or distorted behavior

A
  1. Positive symptoms
220
Q

reflect a dimunition or loss of normal function

A

Negative symptoms

221
Q

presence of confused thinking, incoherent or disorganized speech & disorganized behavior

A

Disorganized symptoms

222
Q

Onset of positive symptoms is generally acute
🞂 Sx: delusions, excitement, feelings of persecution, grandiosity, hallucination, hostility, ideas of reference, illusions, insomia

A

Type I schizophrenia

223
Q

Type II schizophrenia

A

Slow onset of negative symptoms aused by viral infxn & abnormalities in cholecystokinin
🞂 Sx: dimunition or loss og normal function, anergia, anhedonia, alogia, avolition, blunted affect or affective flattening,

224
Q

Experience persecutory or grandiose delusion & auditory hallucination

A

SCHIZOPHRENIA SUBTYPES
1. PARANOID TYPE

225
Q

psychomotor disturbances
◦ Motoric immobility, waxy flexibility or stupor
◦ Excitement (excessive motor activity)

A

CATATONIC TYPE

226
Q

most severe prognosis, disintegration of personality & is withdrawn, disorganized speech, disorganized behavior, flat or inappropriate affect

A

DISORGANIZED TYPE

227
Q

characterized by atypical symptoms that do not meet the criteria for other subtypes

A

UNDIFFERENTIATED TYPE

228
Q

Continuing evidence of negative symptoms without characteristic symptoms of schizophrenia
🞂 SCHIZOPHRENIA

A
  1. RESIDUAL TYPE
229
Q

Psychopharmacology of Schiz

A

Stabilize acute symptoms
◦ Maintain therapeutic plasma levels ◦ Typical antipsycotics
● Haloperidol (Haldol)
● Chlorpromazine (Thorazine)
● Thiothixene (Navane)
◦ Atypical antipsychotics
● Clozapine (Clozaril)
● Respirodone (Respiradol)
● Olanzopine (Zyprexa)

230
Q

🞂 Milieu mgt.

A

For disruptive patients:
● Set limits
● Frequently observe escalating patients to intervene
● Modify the environment to minimize objects that can be used as weapons
● Be careful in stating what the staff will do if a patient acts out
● When using restraints, provide for safety by evaluating the patient’s status of hydration, nutrition, elimination, & circulation

231
Q

SCHIZOPHRENIA For withdrawn patients:

A

unless patient can hear what is being said
● Do not touch suspicious patients without warning ● Be consistent in activities
● Maintain eye contact
◦ For patient with impaired communication:
● Be patient & do not pressure patient to make sense
● Do not place patient in group activities that would frustrate them, damage self-esteem, or over-tax their abilities

232
Q

◦ For disorganized patients:

A

Remove disorganized patient to a less stimulating environment
● Provide a calm environment
● Provide safe & relatively simple activities for these patients

233
Q

🞂 Nursing guidelines for Schizo

A

Build a therapeutic alliance with patient
◦ Be calm
◦ Accept patient
◦ Keep promises
◦ Be honest
◦ Do not reinforce hallucinations or delusions ◦ Do not touch patient without warning
◦ Reinforce positive behaviors
◦ Avoid competitive activities

234
Q

Uninterruptive period of illness during which at some point the patient experiences a MDD, manic or mixed episodes along with the negative symptoms of schizophrenia

A

Schizoaffective Disorder

235
Q

Patient exhibits features of schizopohrenia for more than 1 month but fewer that 6 months

A
  1. Schizophreniform disorder
236
Q

Onset of at least 1 or more positive symptoms of psychosis
◦ Occur at least 1 day to less that an month then full recovery

A

Brief psychotic disorder

237
Q

due to a general medical condition
◦ Presence of prominent hallucination or delusion determined as resulting from the direct physiologic effect of a specific medical condition

A

Psychotic disorder

238
Q

It is an overwhelming reaction to a threatening situation in which an individual’s usual problem-solving skills and coping responses are inadequate for maintaining psychological equilibrium

A

CRISIS

239
Q

Crisis is time limited and is usually resolve one way or another in a brief period

A

4-6 weeks

240
Q

occurs from transition from one stage of maturation to another in the life cycle

A

Developmental crisi

241
Q

occurs to a sudden, unexpected event in an individual life. These events is all about experiences of loss.

A

Situational crisis

242
Q

occurs in response to severe trauma or natural disaster. These crisis can affect individuals, communities and even nation

A

Adventitious crisis

243
Q

individual has emotional equilibrium

A

Pre-Crisis period

244
Q

ndividual has the subjective experience of being upset, failure of usual coping mechanism, symptoms are expereinced

A

Crisis period –

245
Q

resolution of crisis

A

Post-Crisis period

246
Q

confusion, difficulty concentrating,
racing thoughts, inability to make decisions

A

Cognitive symptoms

247
Q

disorganization, impulsive, angry
outburst, withdrawal from social interaction

A

Behavioral symptoms

248
Q

anxiety, anger, guilt, sadness, depression, paranoia, suspicion, helplessness, powerlessness

A

Emotional symptoms

249
Q

the goal of crisis intervention is to return the individual to pre-crisis level of functioning
🞂 Emphasis is on strengthening and supporting healthy aspects of individual’s functioning

A

Principles of crisis intervention

250
Q

Establishes rapport and communities hope and optimism 🞂 Assumes an active, directive role if necessary
🞂 Make suggestions and offer alternatives

A

Role of crisis intervention worker includes:

Nursing Practice 5 (3 decks)

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