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theory exam 1 Flashcards

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1
Q

actual (problem that is present) or potential (at risk for)
o Actual: powerlessness, social anxiety
o Potential: suicidal, self harm
• Explanation of the diagnostic and statistical manual (DSM-5)
• Use of the DSM-5 in the mental health delivery system

A

nursing diagnosis in the nursing process

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2
Q

o Patient notices how you at and reminds them of something from their past

A

transference in therapeutic relationship

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3
Q
  • Nurse is reminded of something by the patient

* Seek clinical supervision to maintain objectivity

A

counter transference in therapeutic relationship

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4
Q
  1. initial
  2. working
  3. termination
A

phases of therapeutic relationships

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5
Q

maybe we can compromise

• Rational part of our personality

A

Ego
Psychoanalytic Theory of Freud
Theories of personal development

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6
Q

want to do that now
• Concerned with instant gratification of basic physical needs/urges
• Unconsciously
• Take ice cream from stranger for itself – doesn’t care that it’s rude

A

Id
Psychoanalytic Theory of Freud
Theories of personal development

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7
Q

it’s not right to do that
• Concerned with rules and morals
• Like our conscious

A

Superego
Psychoanalytic Theory of Freud
Theories of personal development

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8
Q

– Trust vs Mistrust – find hope – infancy (0-1 ½ )
– Autonomy vs Shame – find will – early childhood (1 ½ - 3)
– Initiative vs Guilt – find purpose – play age (3-5)
– Industry vs Inferiority – find competency – school age (5-12)
– Ego identify vs Role confusion – find fidelity – adolescence (12-18)
– Intimacy vs. Isolation – fine love – young adult (18-40)
– Generativity vs Stagnation – find care – adult (40-65)
– Ego integrity vs Despair – find wisdom – maturity (65+)

A

eriksons psychosocial stages

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9
Q

a. Tension with day to day stressors/events

b. Sharpens your senses

A

mild anxiety

anxiety levels of Peplau

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10
Q

a. Attention span and concentration decrease. Increase in muscle tension/restlessness

A

moderate anxiety

anxiety levels of Peplau

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11
Q

a. Perception is diminished. Get headaches, palpitations

A

severe anxiety

anxiety levels of Peplau

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12
Q

panic attack

A

panic anxiety

anxiety levels of Peplau

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13
Q
  1. Denial
  2. Anger
  3. Bargaining
  4. Depression
  5. Acceptance
A

5 stages of grief of Kubler-Ross

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14
Q
  • Suppression – purposely try to block it out
  • Repression – involuntary blocking it out
  • Rationalization – make your own reason to justify your doings
  • reaction formation – you’re afraid but put yourself out there to do that thing
  • Regression – going backwards
  • Denial – refuse to acknowledge the real situation
  • Displacement – putting feelings onto someone else
  • Undoing – purposefully doing opposite of action to cancel it out
  • Projection – pass blame on someone else
  • Sublimation – rechanneling impulses that aren’t acceptable into activities that are tolerable
  • Intellectualization – attempt to avoid expressing emotions associated with a stressful situation
  • Identification – try to identify with someone you admire
A

function of defense mechanisms/coping mechanisms for stress

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15
Q

elevated or expansive irritable mood where motor activity comes frenzy and excessive
a. Abnormal elevated mood for one week, large increase in activity/energy, decrease need for sleep (3 hours or less), overly talkative, fight of ideas, money sprees, hypersexual activity, thought process is extreme goal driven

A

mania

5 levels of bipolar disorder

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16
Q

last 4 days and not as extreme as mania

a. Increase in activity, decrease need for sleep, etc

A

hypomania

5 levels of bipolar disorder

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17
Q

fluctuations in your everyday mood – baseline mood

A

eurthymia

5 levels of bipolar disorder

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18
Q

neurosis where you go though a loss of contact of reality

a. Depressed mood, weight loss, insomnia, poor appetite, low energy

A

dysthymia/depression

5 levels of bipolar disorder

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19
Q

depression neurosis that impairs social ability

a. See suicidal thoughts/attempts, no self esteem, hopelessness, helplessness and worthlessness

A

major depression

5 levels of bipolar disorder

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20
Q
  • Clinical course with 1 or more manic episodes—manic episode or history of manic episode required to make Bipolar I Disorder diagnosis
  • Manic episode may have been preceded by and may be followed by hypomanic or major depressive episodes
  • “Mixed episodes”—include both manic and major depression symptoms
A

bipolar 1 disorder

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21
Q
  • Characterized by a clinical course of recurring mood episodes consisting of one or more major depressive episode
  • The major depressive episode must last at least 2 weeks, and the hypomanic episode must last at least 4 days to meet the diagnostic criteria
A

bipolar 2 disorder

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22
Q

• Characterized by 1 or more major depressive episodes without history of manic, mixed or hypomanic episodes
• Severe depression symptoms present during same 2-week period and represent a change from previous level of functioning
o Depressed mood, weight loss, fatigue, suicidal thoughts/attempts
• Depressed mood and/or loss of interest or pleasure in addition to other symptoms of severe depression

A

Major depression disorder

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23
Q

• Protect individuals in manic phase of illness from their ambitious buying, entertaining, business schemes
• Protect from risk for injury due to poor judgment and hyperactivity
o Decrease risk for injury by reducing stimuli
• Attend to nutritional, hydration, and sleep deficit needs
• Set necessary behavioral limits
• Monitor response to medications

A

nursing interventions for manic S/S

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24
Q
  • Assume that individuals who have major depression are potentially suicidal
  • Assess suicide potential and intervene
  • Ask directly regarding suicidal thoughts/plans
  • Place on suicide precautions with 10-15 minute checks or constant 1:1 observation
  • Maintain environmental safety and vigilance
  • Provide supportive measures if vegetative signs of depression are present
A

nursing interventions for depression

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25
Q
  • ECT is believed to increase levels of norepinephrine and serotonin, resulting in decrease in depression
  • Treatment modality for depressed individuals, especially if acutely suicidal or not responding to antidepressant medications
  • Memory loss and temporary confusion post ECT
  • Medications used prior to and during ECT
  • Contraindications
  • Nursing care pre-ECT and post-ECT
A

electroconvulsive therapy

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26
Q
  • Procedure used to treat depression by targeting certain cells in the brain
  • Involves use of short pulses of magnetic energy to stimulate nerve cells in the brain, similar to the electrical activity observed with ECT
  • Unlike ECT, the electrical waves generated by TMS do not result in generalized seizure activity
A

transcranial magnetic stimulation

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27
Q

history of suicide/experiencing violence/abuse, lack of support system, risky behaviors, bullied, stigma to getting help, talks about dying, change in personality/sleeping/eating, feelings of loss of contro

A

warning signs of suicide in children

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28
Q
  • Instill sense of hope in the future while acknowledging the individual’s current pain and despair
  • Values and attitudes of nurse influence assessment and interventions
  • Provide safe, secure environment
  • Institute suicide precautions per policy
  • Establish therapeutic relationship with patient
  • Verbalize care and concern for patient
  • Promote problem-solving and decision-making
  • Goal: person will talk about but not act upon suicidal feelings/plans
  • Hospitalize if person is at significant risk to attempt suicide
A

intervention strategies for suicidal individual

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29
Q
  1. Individual treatment needs: Provides each patient with sufficient space/privacy, allow communal dining/activities (alone time/group time)
  2. Self governance/community meetings: Encourage group, but don’t force them come
  3. Progressive levels of responsibility: Accountable for missing group/participating – promotes achievement but know regression may occur
  4. Variety of meaningful activities: Groups go along with what there is more of like depression, abuse
  5. Links with patient’s family
  6. Links with the community: Involving treatment with family, helps complete therapy and discharge process
  7. Effective working relationships among staff
  8. Humanistic staff: See better outcomes/positive attitude if working together
A

8 elements of therapeutic milieu

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30
Q

• Organization of patients therapeutic external environment can cary as patient demonstrates that he/she is more able to make decisions, behave responsibily and tolerate stress

A

how mileu is manages

31
Q
  • Nurse creates, manages, maintains, and coordinates the milieu 24/7
  • Includes traditional structured nursing responsibilities
  • Includes unstructured aspect, referred to as the therapeutic use of self
A

role of nurse in therapeutic milieu

32
Q
  • Using interpersonal relationships to help patients learn to trust, to acquire self confidence and self esteem, and to progress from dependence to independence
  • Using all milieu activities to help patients learn interpersonal skills
  • Identifying illness-maintaining patterns of interaction and avoid reaffirming them
  • Encouraging patients to try out health-promoting behaviors
  • Affirming and strengthening patient’s adaptive or successful interactions
  • Communicating what is expected of patient and what is permitted
  • Informing patient about what is happening, what is going to happen, and why
A

therapeutic use of self

33
Q
  • Helps individual gain empowerment and allow them to control their care decisions
  • STEPS ON PAGE 323-325
A

recovery model

34
Q

o Helps patient develop a tool box (tools, strategy, coping skills to manage S/S: journal, music, exercise),
o daily maintenance (what needs to be done to reach level),
o triggers
o early warning signs
o things are breaking down/getting worse (identify that situation has worsen and they need to seek health – have headaches, hallucinations, bizarre behaviors),
o crisis planning (caregiver steps in to help because they are no longer able to)
o Step process where a person is able to monitor/manage distressing symptoms in daily life
o Steps on pages 323

A

wellness recovery action plan (WRAP)

35
Q

o Focus on persons self determination in recovery

A

psychological recovery model

36
Q
  1. Hope
  2. Empowerment – focus on strengths and the things you can do
  3. Self responsibility
  4. Connection
  5. Meaningful life
A

5 components of recovery

37
Q
  • How one thinks determine how one feels/behaves
  • Goals: series of 5 steps – find evidence to support thoughts, substituted realistic behaviors for biased and help learn to identify/alter dysfunctional beliefs
A

cognitive therapy :aaron beck

38
Q

• Arbitrary Inference – patient comes to conclusions without evidence/facts to support it
o Sent wedding gift and didn’t receive thank you so assumed they didn’t like the gift
• Overgeneralization – sweeping conclusions – all or nothing
o Man submitted article and didn’t get accepted – believes no journal will accept his work
• Dichotomous Thinking – views situations in black in white, all/nothing, good/bad
o Man writes article, editor asked him to rewrite parts of it, man thinks he’s a bad write

A

Automatic thoughts

39
Q

• Selective Abstraction – conclusion based on selected portion of evidence – usually negative
o Perfectionists – student has 3.98 GPA, gets accepted to everything, but is mad she didn’t receive a 4.0
• Magnification – exaggerating negative significance of events
o Woman overhears friend is having a party, she wasn’t invited, assumes she doesn’t like her
• Minimization – undervaluing positive significance of event
o Grandma calls daughter, says she’s sorry she cant but will call her, grandma feels unloved even though she’s calling her but cannot attend

A

automatic thoughts

40
Q

• Catastrophic Thinking – always thinking the worst ill occur without thinking of possibility of a positive outcome
o 1st day of job, asked to write a letter, came back with an error, she thinks she will be fired
• Personalization – person takes complete responsibility for everything without think of contributing factors
o Man is selling product and talked with her for 2 hours and she said no, so he thinks he’s a awful salesman’s even though she really doesn’t have the money

A

automatic thoughts

41
Q
  • Didactic/educational aspect – therapists giving educations/informational/homework
  • Purpose: to help patient become their own therapists – gain knowledge through assignments
  • Cognitive techniques – recognizing/modifying cognitive errors (automatic thoughts) and core beliefs (schemas)
  • Behavioral intervention – helps clients learn more adaptive behaviors
A

techniques of cognitive therapy

42
Q

• Recognizing and then modifying automatic thoughts by:
o looking at other alternatives
o Allow patient to see other possibilities
• examining evidence for and against the automatic thought
o Helping patient find facts to support automatic thought (positive or negative)
• Decatastrophizing – helping patient examine validity of their automatic thought, also helping them cope adaptively moving beyond the crisis
• Recognizing and then modifying automatic thoughts by:
• reattribution of adverse events to circumstances outside self
o Many patients blame themselves for adverse – changing it from internal to external
• using the “Daily Record of Dysfunctional Thoughts” DRDT
o Log where patients rate automatic thoughts, rate intensity and formulate resolutions
• cognitive rehearsal – uses mental imagery to uncover positive thoughts

A

cognitive techniques used in cognitive therapy

43
Q
  • Behavioral rehearsal – use of role play to rehearse situation and modify maladaptive behavior
  • Task assignments – 1 task is broken down to subtasks and each subtask is given a goal – then work to accomplish each subtask one at a time
  • Distraction – use this to redirect patient thinning/divert negative thoughts
  • Relaxation exercises – helping them relax/think through thinks
  • Social skills training – train social skills to redirect automatic thoughts
  • Thought stopping techniques – use this in cognitive therapy to help patient stop automatic thought – spell out the word stop, and it changes their thought process
A

behavioral interventions for cognitive therapy

44
Q

substance use disorder definition

A

addition to substance

45
Q

substance induced disorder definition

A

intoxication, withdrawal, other substance/med induced mental disorder

46
Q
  • Impaired control – needing larger amounts to receive desire effect
  • Social impairment
  • Risky use – amount could be hazardous to patients health
  • Tolerance – need more to reach desire effect
  • Withdrawal
A

substance use disorder - 1st cateogry

47
Q 
•	Detects alcohol use disorder
o	Have you felt you should CUT down
o	Have you felt ANNOYED by criticism
o	Have you felt GUILTY
o	Have you taken a drink 1st thing in the morning (EYE-OPENER) to steady nerves
A

CAGE questionnaire

48
Q

• Intoxication—problematic behavioral, psychological and cognitive changes
o Mood, impaired judgment, occurs shortly after use of substance
• Withdrawal—behavioral, physiological and cognitive changes
o Start after abruptly stopping or decreasing it tremendously
• Substance/Medication-Induced Mental Disorders—mental disorder associated with substance intoxication or withdrawal
o Occur within 1st month or dose

A

substance induced disorder

49
Q
  • Pre-alcoholic – use to relieve stress
  • Early alcoholic phase – hiding, trying to keep use secretive – consists of black outs,
  • Crucial phase – person has loss control of alcohol use and they contemplate if they should risk losing everything – know problem is there and what they could lose but cannot stop
  • Chronic phase – feeling helping, pity, suicidal thoughts/attempts, life threatening physical conditions WERNICKE-KORSAKOFF: related to thymine deficiency
A

alcohol use disorder

50
Q
  • Recent ingestion of alcohol: BAL 100-200
  • Clinically significant problematic behavior or psychological changes that developed during, or shortly after, alcohol use
  • Signs and symptoms, e.g. slurred speech, unsteady gait, nystagmus, impaired attention or memory
  • Stupor or coma can occur
A

alcohol intoxication

51
Q
  • Occurs after stopping or greatly reducing alcohol use following a period of heavy and prolonged use
  • Signs and symptoms, e.g. increased blood pressure and pulse, sweating, hand tremor, insomnia, nausea or vomiting, transient hallucinations or illusions, psychomotor agitation, anxiety, generalized tonic-clonic seizures
  • Can start 4-12 hours after last drink – especially if someone is used to blacking out then waking up and starting that cycle again
A

alcohol withdrawal

52
Q
  • A patient who meets the criteria for both alcohol withdrawal and delirium is considered to have Withdrawal Delirium (Delirium Tremens)
  • Criteria for Delirium: Decreased attention and awareness; Disturbance in attention, awareness, memory, orientation, language, visuospatial ability, perception, or all of these abilities that is a change from the normal level for the individual and fluctuates in severity during the day
  • DTs are the most severe form of alcohol withdrawal
A

alcohol withdrawal delirium (DELIRIUM TREMENS) (DT)

53
Q
  • Occur after stopping or reduction in prolonged, heavy drinking—can occur a week to 10 days after cessation of drinking
  • DTs are a medical emergency requiring vigorous treatment
  • Major treatment goals for Alcohol Withdrawal Delirium are to control agitation, decrease the risk of seizures, and decrease the risk of injury and death
  • Supportive care includes reorienting to person, place and time; providing reassurance; frequent monitoring of vital signs; and ensuring adequate hydration
A

alcohol withdrawal delirium (DELIRIUM TREMENS) (DT) 2

54
Q

more and more alcohol is needed to achieve the desired effect

A

physical tolerance

55
Q

ability to mask the effects of alcohol – walk a straight line, not slur words, function reasonably normally

A

behavioral tolerance

56
Q
  • Goal: The individual with the alcohol problem assumes full responsibility for decision to use alcohol
  • Medications may include use of Thiamine, Multivitamins, Anxiolytics, Anticonvulsants
  • Antabuse— a medication occasionally used as adverse conditioning treatment
  • Take this med when they’re in process of recovery so they don’t drink – any drink of alcohol = nasty GI symptoms
A

treatment of alcohol problems

57
Q
  • Scores on the CIWA-Ar range from 0 to 67
  • Scores lower than 8 indicate mild withdrawal symptoms that rarely require use of medications
  • Scores of 8-15 indicate moderate withdrawal symptoms likely to respond to modest doses of benzodiazepines
  • Scores higher than 15 indicate severe syndromes that require close monitoring to avoid seizures and alcohol withdrawal delirium
A

clinical institute withdrawal assessment of alcohol scale

58
Q
  • Important to be aware of feelings related to Alcoholism and Drug Abuse
  • Keep in mind that all substance dependent persons suffer from a negative self concept
  • Avoid reinforcing this negative self concept through non-therapeutic treatment of chemically dependent individuals
A

nurses responses to alcoholism/drug abuse*

59
Q
  • Enabler
  • Hero – child that tries to bring positive attention through school and take away the negative attention
  • Scapegoat – troublemaker in school – get attention away from alcoholic
  • Lost Child – isolated, keep to themselves due to embarrassment
  • Mascot – tries to bring light to a negative situation
A

impact on family

60
Q

• 2 or more S/S for the past 6 months
o Positive: delusions, hallucinations, disorganized speech, grossly disorganized behavior (inappropriate dress)
 Positively there when you don’t want them to be, behaviors there when they should be – adding on S/S on a normal level
o Negative: anhedonia (showing lack of pleasure), apathy, poverty of speech
 Taking away normal behaviors – lack of interest there
• Disturbance in thinking, feeling and social relations

A

schizophrenia

61
Q

o Presence of the schizo S/S (previous slide) for less than 6 months. (1 day-6 months)

A

brief psychotic disorder

62
Q

o 1 month-6 months:

A

schizophreniform disorder

63
Q

o S/S of schizophrenia, but affect that resembles mood disorder (bipolar, depressed/manic episode)
o Affect determines what diagnosis will be when admitted to hospital

A

schizoaffective disorder

64
Q

o Presence of delusions for at least 1 month and doesn’t include any hallucinations or bizarre behaviors
 Erotomaniac: thinking someone is in love with them, like a celebrity
 Grandiose: patient believes they have inflated worth, powder, or knowledge
 jealous: believe their partner is unfaithful
 persecutory: one is being evilly treated – someone is plotting against them
 somatic: belief they have a medical condition
 mixed: no certain theme, a cluster of delusions

A

delusional disorder *

65
Q

o Present with mutism, repetitive movements, agitation, echolalia (mimicking of sound/repeat what they hear) and echopraxia (repetitive copying of movements, see someone stretching so they copy it)

A

catatonia

66
Q

false, fixed, personal belief

A

delusion

67
Q

o Auditory – most common in terms of a voice
 Dog barking, sounds, music, command (telling them to hurt themselves or others)
o Visual – see images of people, shadows, flashes of light
o Tactile – feel something is crawling under their skin
o Gustatory – tastes something, usually unpleasant
o Olfactory – any sort of smell

A

hallucinations *

68
Q

o Essential features: inattention, impulsiveness, hyperactivity
o Manifestations: distractibility, excitability, impulsivity, and excessive physical activity
 Motor activity: fast talking, no control over actions/thoughts
 Overlook their mistakes by rushing through things, don’t check over work
 Difficulty with long lectures/long periods of time, following instructions
 Appear not to be listening when spoken to
 Blurt out answers, interrupting
o Cause: genetic and environmental factors
 High lead levels, diet considerations (food dyes), sugar
o Nursing interventions
 Decrease environmental stimuli, setting clear limits while protecting from injury (hyperactivity), improving social interaction and self esteem, completing task expectations

A

attention deficit hyperactivity disorder

69
Q

o Characterized by a pattern of behavior in which a child:
o violates the basic rights of others
o violates major age-appropriate societal norms or rules, such as aggression to people or animals, destruction of property, theft, etc.
o Manifested by antisocial behavior in the form of physical aggression and violence against another person; violation of the rights of others; stealing, lying and truancy; use of illegal substances; sexual permissiveness; projecting blame; anger control and school performance problems
o Nursing intervention:
 Protecting others from patient’s physical aggression
 Improving social interaction and self esteem
 Holding patient accountable for behavior
 Recognizing behaviors that precede onset of aggression and intervening before violence occurs

A

conduct disorder

70
Q

o Characterized by a pattern of negativistic, hostile, and defiant behavior without the more serious violations of the basic rights of others that are seen in Conduct Disorder
o Oppositional attitude usually directed at home, but may not be evident at school or the community
o Nursing interventions
 Peer pressure (why do you talk to your mom that way), use of B. Mod plan, help set realistic goals, limit manipulative behavior

A

oppositional defiance disorder ODD

71
Q 
o	I.Q. 70 or lower
o	Deficits in adaptive functioning
o	Causes--many predisposing factors
	Medical conditions, meningitis, autism
o	Nursing interventions
	Working 1 task at a time to get self care, social interaction, group activities, risk for injury, 
o	Nursing involvement with family
o	Behavior modification
A

intellectual disability

72
Q

o Physiological changes that occur secondary to extreme weight loss: amenorrhea, lanugo hair, hypotension, bradycardia, hypothermia, constipation, polyuria, and electrolyte imbalances that may be life threatening
o treatment approaches:
 Behavior modification to restore weight and nutritional status
 STG: Patient will cooperate with nutritionally sound re-feeding program resulting in a weight gain of 2 pounds/week, more is too hard on CV system
 Psychotherapy to deal with unresolved psychological problems

A

anorexia

73
Q

o Family characteristics–families may be disorganized, in conflict and characterized by confusing sex role expectations for women
o Behaviors of bulimic–enormous grocery bills and many cavities (acid from throw up)
o Physiologic complications
 Dehydration, electrolyte imbalance, erosion of tooth enamel, increase work load on heart or lungs
o Treatment:
 Out-patient psychotherapy which may involve an eating disorder program
 Sit with patient 1/2 hour after meals if purging history
 May need to treat concurrent substance abuse problem along with treatment of bulimia

A

bulimia

psych pharm (4 decks)

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