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Test 3 important Flashcards

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1
Q

When do personality disorders occur?

A

When personality traits become rigid and inflexible and contribute to maladaptive patterns of behaviors impairing function.

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2
Q

What are the tx for personality disorders 4 and how they help

A

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

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3
Q

What are eating disorders influenced by? 2

A

Society and culture

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4
Q

body image

A

Is a subjective concept of ones physical appearance based on personal perception of self and the reaction of others

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5
Q

Normal BMI obesity BMI

A

20-24.5 is normal

30 or greater is obese

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6
Q

S/s of dehydration

A

orthostatic hypotn, tachy, elevated Na.

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7
Q

what temp is hypothermia

A

below 96.8

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8
Q

heart related issues with eating disorders that we need to monitor for 3

A

k below 3
dysrhythmias
brady

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9
Q

What is the number one goal for eating disorder patient

A

Positive relationship with self

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10
Q

What are the two groups that substance related disorders are composed of? examples?

A

Substance use disorders-addiction

Substance induced disorders- a disorder that manifests itself with use of drugs

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11
Q

Substance intoxication 3

A

Under the influence of something
reversible
impaired function/judgement

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12
Q

Addiction 2

A

The need is so strong it generates distress physical or psychological
compulsive or chronic dependence

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13
Q

One thing to remember about withdrawal

A

Can have with or without substances on board.

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14
Q

Addiction 2

A

The loss of control over substance consumption.

Continued substance use despite associated problems that interfere with obligations.

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15
Q

What makes up a substance abuse disorder? 3

A

Interpersonal problems, Hazards, cravings

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16
Q

Alcohol induced disorders GI 3

A

Esophageal varices, esophagitis, gastritis

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17
Q

Alcohol induced disorders CNS plus one

A

Psychosis, wernicke’s encephalopathy (Thiamine deficiency) wet brain, Korsakoffs psychosis, pancreantitis

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18
Q

What is korsakoff psychosis 4 things

A

Confusion, loss of recent memory, confabulation, seen in conjunction with wernickes

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19
Q

How do we treat wernickes and korsakoff?

A

Thiamine replacement B1

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20
Q

What assessment do you do with alcohol that measures if there is an unhealthy relationship with alcohol 2

A

CAGE Cut, annoyed, guity, eye opener

and MAST- Michigan alcoholism screening test

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21
Q

What assessment information do we need to know about alcohol and why?

A

BE SPECIFIC. Quantity, duration, frequency, binge, withdrawal, seizures?

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22
Q

What assessment information do we need to know about alcohol and why? 6

A

BE SPECIFIC. Quantity, duration, frequency, binge, withdrawal, seizures?
So we can understand when they are going to withdrawal and how bad it might be

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23
Q

what are the four age related changes related to alcohol?

A

Decreased hepatic blood flow, insufficiency of liver enzymes, poly pharm, non-alzheimers dementia .

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24
Q

What is the CIWA-Ar and 3 things about it

A

clinical institute withdrawal assessment alcohol scale.

objective and subjective, documents severity, use same tool to see progress

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25
Q

When do signs of withdrawal start and what are they?

A

4-12 hours after last drink

tachycardia, HTN, diaphoresis, high bp, seizures, tremors, N/V

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26
Q

What meds do we use for alcohol w/d? 3

A

Benzos, anticonvulsants, thiamnine

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27
Q

Name one benzo for alcohol w/d

A

Chloridiazepoxide

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28
Q

One concern we have for alcohol w/d
onset?
s/s-4

A

Delirium tremens
onset- 2-3 days
s/s difficulty with attention, disorganized thinking, perceptual disturbances, sig restlessness

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29
Q

What drugs do we use for alcohol addiction treatment? and how they help

A

Disulfiram- negative reinforcement- they feel sick

Naltrexone- stop cravings given po or IM-30 days works on opiate receptors to induce feelings of pleasure.

30
Q

Symptoms of opioid intox

A

Pupillary constriction, drowsiness, slurred speech, impatient in attention or memory.

31
Q

What is the triad of opioid toxicity?

A

Pinpoint pupils, respiratory depression, decreased level of consciousness

32
Q

Assessment for ops 5 and what does it indicate?

A

quantity, duration, frequency, method, withdrawal?

withdrawal

33
Q

Symptoms of acute opioid w/d 11

A

dysphoria, tachy, mm aches, N/V, pupil dilation, ab cramping, diarrhea, fever, irritability, insomnia, low BP

34
Q

one thing to remember about op w/d

A

Symptoms get worse before they get better.

35
Q

What meds do we use for op withdrawal 4 and one scoring

A

Ib/ace- watch out for hep, loperamide-anti di, ondanserton- zofran, electrolytes-push fluids!
COWS- Clinical opiate withdrawal score

36
Q

What does methadone do?

and 2 things about it

A

Long acting full op agonist
can’t just stop
need to be with a clinic

37
Q

What does naloxone do? and one thing

A

Partial op agonist- like a tickle

can get at pharm

38
Q

how do stimulants work? 3

A

stimulate norepi, epi, and dopamine

39
Q

Tell about the crash after stimulants 6

A

Fatigue, cramps, depression, h/a nightmares, withdrawal can last days,

40
Q

Caffeine and nicotine w/d s/s

A

C-HA/dysphoria

N-Anxiety, irritability, restlessness, decreased heart rate

41
Q

Explain the branches of government

A

Executive branch- president
legislative-congress
judical-court

42
Q

three types of laws

A

Statutory law- congress making the law
common law or judicial- courts
admin or executive law- board of nursing rules but they are laws

43
Q

What is self determination

A

We have the right to do what we want

44
Q

What do we do when someone refuses treatment? 4Ri

A

Find out why?
education
involve family
use resources

45
Q

Right to least restrictive treatment example

A

Therapy in a room all the way up to restraints.

46
Q

What age can someone admit them self into psych care?

and one thing about it

A

15 they are given a hearing

47
Q

what are the other names for emergency hold?

A

M-I 27-10

48
Q

What is a short cert? 4 things about it

A

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

49
Q

Right to refuse medication

first…and?

A

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.

50
Q

duty to third party 2 things

A

threat and an identifiable person

51
Q

What is competency? and when is it lost?

A

Ability of a person to understand and participate in care. when someone goes to court.

52
Q

What is guardian vs conservatorship and when is it used?

A

G- allowed to make decisions for someone
C-money
when competency is lost in court

53
Q

What is a tort? What are the intentional torts? 4

when can we do this?

A

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

54
Q

What is malpractice? what makes it up

A

Professional negligence unintentional tort ( remember it is a tort)
Duty, breech of duty, causation, damages

55
Q

What does having a duty mean?

A

That you have a relationship with someone

56
Q

Other duties 3

A

Intervene and report
abandonment
documentation

57
Q

Policies and duty

A

a bad policy is not a good enough excuse you need to change the policy

58
Q

When can you be relieved of duty to a patient

A

when you hand off to someone of equal education

59
Q

Discharge conditional vs unconditional

A

unconditional is absolute relationship is severed

60
Q

What is elopement

A

When a patient disappears

61
Q

What is AMA

A

against medical advice- tx is beneficial but can’t hold

62
Q

complete while competent guide when not

A

Psych advanced directive

63
Q

Seclusion 4

A

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

64
Q

Four things about restraints and we

A

Clear explanation, the procedure, desired effect, and circumstances under which it will be terminated.
DOCUMENT all of these

65
Q

when do we not need to have other measures put in place before restraints? And what do we need to do?

A

When other techniques are unsafe, if the patient is combative, assaultive, or self destructive
Document justification

66
Q

when do we need an order for restraints? and one more thing

A

If it goes beyond 1 hr. and not ordered as needed

67
Q

What happens if someone is restrained for longer than 4 hours?

A

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

68
Q

24 hour exam and restraints

A

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

69
Q

how to put someone in restraints

A

Supine, four one arm down 30 deg make sure you have the right people

70
Q

What do we need to document with restraints?

A

Their behaviors and nature of danger
what we did to control behavior
termination- what they need to do
notification to doctor

71
Q

What about verbal orders for restraints

A

verbal is ok if followed by a written order.

Psych (7 decks)

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