Test 3 Flashcards
Personality
The totality of emotional and behavioral characteristics that are particular to a specific person and remain somewhat stable and predictable over time.
Personality traits are
Characteristics with which an individual is born with or develops early in life and influence the way a person perceives and relates to the environment and are stable over time.
When do personality disorders occur?
When personality traits become rigid and inflexible and contribute to maladaptive patterns of behaviors impairing function.
What are the tx for personality disorders 4 and how they help
interpersonal psychotherapy
Milieu or group-antisocial personality disorder mostly. helps get feedback from peers.
cognitive behavioral therapy- behavioral strategies give reinforcement for positive change. and help client recognize and correct distorted and irrational thinking patterns.
psychopharmacology
What are eating disorders influenced by? 2
Society and culture
body image
Is a subjective concept of ones physical appearance based on personal perception of self and the reaction of others
Normal BMI obesity BMI
20-24.9 is normal
30 or greater is obese
S/s of dehydration
orthostatic hypotn, tachy, elevated Na.
what temp is hypothermia
below 96.8
heart related issues with eating disorders that we need to monitor for 3
k below 3
dysrhythmias
brady
What is the number one goal for eating disorder patient
Positive relationship with self
What are the two groups that substance related disorders are composed of? examples?
Substance use disorders-addiction
Substance induced disorders- a disorder that manifests itself with use of drugs
Substance intoxication 3
Under the influence of something
reversible
impaired function/judgement
Addiction 2
The need is so strong it generates distress physical or psychological
compulsive or chronic dependence
One thing to remember about withdrawal
Can have with or without substances on board.
Addiction 2
The loss of control over substance consumption.
Continued substance use despite associated problems that interfere with obligations.
What makes up a substance abuse disorder? 3
Interpersonal problems, Hazards, cravings
Alcohol induced disorders GI 3
Esophageal varices, esophagitis, gastritis
Alcohol induced disorders CNS plus one
Psychosis, wernicke’s encephalopathy (Thiamine deficiency) wet brain, Korsakoffs psychosis, pancreantitis
What is korsakoff psychosis 4 things
Confusion, loss of recent memory, confabulation, seen in conjunction with wernickes
How do we treat wernickes and korsakoff?
Thiamine replacement B1
What assessment do you do with alcohol that measures if there is an unhealthy relationship with alcohol 2
CAGE Cut, annoyed, guity, eye opener
and MAST- Michigan alcoholism screening test
What assessment information do we need to know about alcohol and why?
BE SPECIFIC. Quantity, duration, frequency, binge, withdrawal, seizures?
What assessment information do we need to know about alcohol and why? 6
BE SPECIFIC. Quantity, duration, frequency, binge, withdrawal, seizures?
So we can understand when they are going to withdrawal and how bad it might be
what are the four age related changes related to alcohol?
Decreased hepatic blood flow, insufficiency of liver enzymes, poly pharm, non-alzheimers dementia .
What is the CIWA-Ar and 3 things about it
clinical institute withdrawal assessment alcohol scale.
objective and subjective, documents severity, use same tool to see progress
When do signs of withdrawal start and what are they?
4-12 hours after last drink
tachycardia, HTN, diaphoresis, high bp, seizures, tremors, N/V
What meds do we use for alcohol w/d? 3
Benzos, anticonvulsants, thiamnine
Name one benzo for alcohol w/d
Chloridiazepoxide
One concern we have for alcohol w/d
onset?
s/s-4
Delirium tremens
onset- 2-3 days
s/s difficulty with attention, disorganized thinking, perceptual disturbances, sig restlessness
What drugs do we use for alcohol addiction treatment? and how they help
Disulfiram- negative reinforcement- they feel sick
Naltrexone- stop cravings given po or IM-30 days works on opiate receptors to induce feelings of pleasure.
Symptoms of opioid intox
Pupillary constriction, drowsiness, slurred speech, impatient in attention or memory.
What is the triad of opioid toxicity?
Pinpoint pupils, respiratory depression, decreased level of consciousness
Assessment for ops 5 and what does it indicate?
quantity, duration, frequency, method, withdrawal?
withdrawal
Symptoms of acute opioid w/d 11
dysphoria, tachy, mm aches, N/V, pupil dilation, ab cramping, diarrhea, fever, irritability, insomnia, low BP
one thing to remember about op w/d
Symptoms get worse before they get better.
What meds do we use for op withdrawal 4 and one scoring
Ib/ace- watch out for hep, loperamide-anti di, ondanserton- zofran, electrolytes-push fluids!
COWS- Clinical opiate withdrawal score
What does methadone do?
and 2 things about it
Long acting full op agonist
can’t just stop
need to be with a clinic
What does naloxone do? and one thing
Partial op agonist- like a tickle
can get at pharm
how do stimulants work? 3
stimulate norepi, epi, and dopamine
Tell about the crash after stimulants 6
Fatigue, cramps, depression, h/a nightmares, withdrawal can last days,
Caffeine and nicotine w/d s/s
C-HA/dysphoria
N-Anxiety, irritability, restlessness, decreased heart rate
Explain the branches of government
Executive branch- president
legislative-congress
judical-court
three types of laws
Statutory law- congress making the law
common law or judicial- courts
admin or executive law- board of nursing rules but they are laws
What is self determination
We have the right to do what we want
What do we do when someone refuses treatment? 4Ri
Find out why?
education
involve family
use resources
Right to least restrictive treatment example
Therapy in a room all the way up to restraints.
What age can someone admit them self into psych care?
and one thing about it
15 they are given a hearing
what are the other names for emergency hold?
M-I 27-10
What is a short cert? 4 things about it
It is a hold that someone can be on that lasts up to 3 months at this point the doctor needs to fill out paperwork and send into the court and that person can get representation. there has to be a psych disorder and the treatment has to be a solution. They have to have been advised but refused voluntary hold
Right to refuse medication
first…and?
We have to make a reasonable attempt for them to take it voluntarily and document it. Then emergency treatment for 72 hours.
need to document behaviors (not diagnosis) after 72 hours another clinician needs to step in. with two doctors we can give meds for an additional 7 days. then we can get a court date (have to have to go past 10 days) but we are allowed to tapper meds.
This is 3 24 hour sets at a time and is up to the doctor to make that call.
duty to third party 2 things
threat and an identifiable person
What is competency? and when is it lost?
Ability of a person to understand and participate in care. when someone goes to court.
What is guardian vs conservatorship and when is it used?
G- allowed to make decisions for someone
C-money
when competency is lost in court
What is a tort? What are the intentional torts? 4
when can we do this?
Civil law it means someone can sue
Assault, battery, false imprisonment, Invasion of privacy
When it is for the patient’s benefit when they are a danger to themselves and other in emergency situation
What is malpractice? what makes it up
Professional negligence unintentional tort ( remember it is a tort)
Duty, breech of duty, causation, damages
What does having a duty mean?
That you have a relationship with someone
Other duties 3
Intervene and report
abandonment
documentation
Policies and duty
a bad policy is not a good enough excuse you need to change the policy
When can you be relieved of duty to a patient
when you hand off to someone of equal education
Discharge conditional vs unconditional
unconditional is absolute relationship is severed
What is elopement
When a patient disappears
What is AMA
against medical advice- tx is beneficial but can’t hold
complete while competent guide when not
Psych advanced directive
Seclusion 4
when they are a danger to themselves and others
when they are put in a room and not allowed to leave
when less restrictive methods have been used and documented
only ordered by a licensed physician or psychologist
when do we not need to have other measures put in place before restraints? And what do we need to do?
When other techniques are unsafe, if the patient is combative, assaultive, or self destructive
Document justification
Four things about restraints and we
Clear explanation, the procedure, desired effect, and circumstances under which it will be terminated.
DOCUMENT all of these
when do we need an order for restraints? and one more thing
If it goes beyond 1 hr. and not ordered as needed
What happens if someone is restrained for longer than 4 hours?
If they have not been seen by a doctor in the last 24 hours- they require a face to face evaluation. with a new written order
if they have- they have to be seen in 14 hours with a new written order
we need a new one every 24 hours
if restraint is in excess of 24 hours then an admin director will review
What do we need to document with restraints?
Their behaviors and nature of danger
what we did to control behavior
termination- what they need to do
notification to doctor
24 hour exam and restraints
not seen in 24 hours- need to be if longer than four hours
seen in 24 hours- seen in 14 hours
and that is good for 24 hours
how to put someone in restraints
Supine, four one arm down 30 deg make sure you have the right people
What about verbal orders for restraints
verbal is ok if followed by a written order.
Anorexia physical signs 6
Hypothermia, bradycardia, hypotension, edema, lanugo, metabolic changes
