Week 6-Exam 2 Flashcards
Stress occurs when we are forced to __________ to changes
adapt
Holmes-Rahe’s life illustrates the cumulative ________ of stress
nature
Selye’s GAS stages include:
1.
2.
3.
Alarm stage
Resistance stage
Exhaustion stage
The fight or flight response is activated in what stage?
alarm
The individual uses the fight or flight response to adapt to the stressor to prevent which next stage?
resistance stage
Physical problems and mental disorders occur in what stage?
exhaustion
When responding to a tragedy, its important to remember the following:
1.
2.
3.
4.
- be aware of physical needs and limitations
- Provide emotional support to each other
- debrief after the incident
- utilize available counseling resources.
Trauma patients often have difficulty ____________ and feel ___________ from others
concentrating, detached
If symptoms are present for less than one month, the diagnosis is _________ stress disorder.
acute
When trauma symptoms last longer than a month, the diagnosis is _________
PTSD
Children experiencing PTSD commonly present with ____________
regression
________ percent of people will experience trauma, but not many develop PTSD
50-60
The lifetime prevalence of PTSD is __________?
6-9%
Which trauma is more likely to lead to PTSD?
Intentional or non-intentional
intentional trauma
_________ are more likely to develop PTSD
men
Trauma treatments include:
1.
2.
3.
4.
5.
- CBT techniques (socratic questioning and exposure)
- cognitive processing therapy
- eye movement desensitization and reprocessing (EMDR)
- mindful based stress reduction
- guided imagery (visualize peaceful scene)
The first line of medications for trauma is __________
Paroxetine, sertraline, venlafaxine, mirtazapine
antidepressants (SSRIs, SNRIs)
_____________ receptor blockers can help with PTSD -related sleep disturbances
alpha- adrenergic
given the high prevalence of substance abuse and PTSD, ____________ are usually avoided
benzodiazepines
Assigning the ________ nurse will help build a trusting relationship with PTSD clients
same
Be sensitive to the issue of _______ for a client who has experienced rape
gender
PTSD: Ask ___________ before touching the client
permission
PTSD: Reassure the client that he or she is ________
safe
PTSD: Reassure the client that feelings of _______ are normal
grief
PTSD: Assess clients for ________ ideation
suicidal
PTSD: Use ________ listening skills if a client expresses feelings of guilt
active
PTSD: teach clients to avoid ____________ and __________
alcohol, caffeine
Anxiety disorders are characterized by excessive amounts of anxiety that ____________________
disrupt functioning
what level of anxiety sharpness the senses, increases motivation and productivity, and allows instruction?
mild anxiety
what level of anxiety decreases the perceptual field, alertness, and concentration, but increases muscle tension?
moderate anxiety
What level of anxiety causes the perceptual field, and concentration to be severely diminished. Clients lose situational awareness and have impaired functioning. Physical symptoms are very prominent.
severe anxiety
What level of anxiety causes a person to be unable to focus on a single detail in the environment. Clients may lose contact with reality and experience hallucinations or delusions
panic anxiety
________ disorders are the most common category of mental illness
anxiety
Most anxiety disorders are more common in ____________
women
Behavioral theory illustrates the __________ cycle that causes anxiety disorders.
avoidance
physical changes in the brain’s circuitry will further reinforce the avoidance cycle used in anxiety. It becomes ___________
hardwired
CBT emphasizes the role of _____________ distortions in producing anxious feelings
cognitive
Panic attacks occur suddenly and __________________________ (i.e., they are not associated with any particular situations or triggers). These attacks are usually brief (minutes).
unpredictably
“Panic Disorder feels like being in a cage with a _________, except that there is no ________” (Frances, 2013, p. 61). Clients can feel sheer terror, be out of breath, and have a racing heartbeat.
tiger, tiger
Panic disorder can sometimes lead to ______________________.
agoraphobia
The lifetime prevalence of panic disorder is ________ percent.
4.7
Anxiety is twice as common in __________
women
Panic treatment CBT technique:
1.
2.
3.
4.
5.
- self-monitoring,
- breathing retraining
- muscle relaxation
- cognitive restructuring (ABCD method)
- exposure therapy.
Common panic disorder medications include __________ (SSRIs, SNRIs, TCAs) and _______________.
antidepressants, benzodiazepines
Using ____________ for panic disorder is best at achieving a rapid effect but aren’t the best long term option
Benzodiazepine
Panic disorder intervention: Stay with the client and offer _____________. Don’t leave a client who is experiencing severe or panic anxiety alone.
reassurance
PD intervention: Anxiety is contagious; remain ________. Use a matter-of-fact approach.
calm
PD intervention:
Use ____________ words and phrases. During intense anxiety, clients are unable to focus and are unable to comprehend complicated speech.
simple
PD intervention:
Reduce environmental ______________ (e.g., decrease the number of people in the room, turn the TV off, dim the lighting).
stimuli
Hyperventilation can be treated by having the client breathe into a small paper bag. This helps the client retain more ____________ ______________, relieving many of the panic attack symptoms. Don’t do this, however, if the client has coronary artery disease, asthma, or COPD.
Administer prescribed fast-acting PRN anxiolytic medication (e.g., a benzodiazepine).
When the client is calm and receptive to learning, _________ teaching on ways to halt anxiety attacks (e.g., relaxation techniques, deep breathing exercises, meditation, exercise).
carbon dioxide,
reinforce
Clients with social anxiety disorder have an excessive __________ they might say or do something embarrassing
fear
Social anxiety disorder is more severe than normal ________ ; it causes significant distress and _________ functioning
shyness, impairs
The lifetime prevalence of social anxiety disorder is ___________%. It is slightly more common in __________. The average age of onset is mid-teens.
5-12%, women
Social anxiety treatment: Effective CBT techniques include _________ desensitization and _________ restructuring.
systemic, cognitive
common social anxiety disorder meds are __________ and ________
antidepressants, benzodiazepines
(benzodiazepines achieve rapid effect, but aren’t best long term)
Clients with social anxiety disorder sometimes use ______________ as a “social lubricant.” Self-medication, however, can easily lead to a ____________ use disorder. Prescribed and monitored treatments (e.g., SSRIs) are safer and more effective.
alcohol, substance
Clients with generalized anxiety disorders experience ongoing, excessive worrying about ________________ issues
everyday
GAD cause significant _________.
distress
In GAD __________, _______, ________ symptoms are often present.
cognitive, mood, physical
GAD is more severe than the normal, occasional worrying everyone experiences. GAD is excessive, disruptive, and enduring (i.e., greater than ______ months).
6
The lifetime prevalence of GAD is _________%. It is twice as common in ________ . The average age of onset is later than most anxiety disorders. Preclinical symptoms usually develop before age _____, but the full syndrome does not emerge until later.
5-12, women, 20 yrs
GAD psychotherapy and medicine is the same as the other anxiety disorders.
Effective CBT techniques include self-monitoring, relaxation training, cognitive restructuring (ABCD method), and exposure therapy.
Common medications include antidepressants (SSRIs, SNRIs), buspirone, and benzodiazepines. Benzodiazepines are best at achieving a rapid effect but aren’t the best long-term option.
GAD intervention: Anxiety is ____________________; maintain a calm demeanor.
contagious
Don’t leave clients who are in distress. ________ with them.
Be careful not to stigmatize clients with anxiety disorders. You may find yourself thinking, “Why don’t they knock it off?” “Why won’t they focus on something else?” Be patient and gracious. Remember, thoughts and emotions are byproducts of the brain. The brain is an organ and sometimes organs don’t function properly.
Stay
Clients with OCD have both __________ and _________
obsessions, compulsions
_______________ are intrusive thoughts or images that provoke anxiety. For example, a client might be frequently bothered by the thought, “There are germs everywhere. I can easily catch the stomach flu and become unimaginably sick.”
obsessions
_____________ are acts clients perform (physical or mental) to neutralize the anxiety or distress produced by the obsession. Sometimes clients believe the compulsion will help prevent the obsession from occurring.
compulsions
Most clients have good ______________ about their OCD (i.e., it is egodystonic). They would love to stop or control their behaviors.
insight
The lifetime prevalence of OCD is _______%. It is slightly more common in ________. The average age of onset is 19.5 years. Men, however, tend to have an _______ age of onset than women.
2.3,
women,
earlier
OCD treatment: A key CBT technique is ________________ prevention (ERP) therapy.
exposure and response
OCD meds commonly used are ____________
antidepressants (SSRI, TCAs)
OCD intervention:
In the early stages of treatment, allow sufficient ________ for the client to perform rituals. Preventing a client from performing a ritual could lead to panic anxiety, damage thenurse-client relationship, and interfere with treatment. ⭐
time
OCD intervention:As the client becomes involved in other activities, develops healthy coping mechanisms, etc., gradually ____________ the amount of time available for rituals.
reduce
OCD intervention:
Avoid ___________ attitudes and criticizing the client’s rituals.
Provide a __________ schedule of activities.
judgmental, structured
Body dysmorphic clients experience exaggerated concerns about real or imagined physical __________ (e.g., skin, hair, nose, stomach, hips, buttocks, breasts). Clients may spend an inordinate amount of time in front of mirrors, scrutinizing self. Alternatively, some clients may avoid mirrors.
flaws
The lifetime prevalence of body dysmorphic disorder is around _____%. It is slightly more common in _________. The average age of onset is _______ years. Onset is typically gradual.
2,
women,
17
Body dysmorphic treatment:
Effective CBT techniques include ________ restructuring (ABCD method) and _________ interviewing.
cognitive, motivational
Body dysmorphic meds is _____________
antidepressants (SSRIs, SNRIs)
BD interventions: Encourage the _______________ of fears and anxiety. Invite clients to participate in activities that promote positive feelings about themselves that are not based on physical appearance.
verbalization
BD intervention:
Be sensitive to the presence of comorbidities. About 90% of people with body dysmorphic disorder also have major ____________________. Around 70% have an ______________ disorder (usually OCD). Approximately 30% have had a psychotic disorder.
depression, anxiety
The most likely event to trigger PTSD is ____________
rape
Grief is the painful emotional response to the ________ of something or someone significant.
loss
Kubler Ross Model of Grief
Initially, clients may have difficulty accepting that the loss has really occurred. _________ is a common first reaction.
denial
Clients who are grieving often experience strong feelings of _________. They may express anger toward themselves, others, or even the lost person.
anger
During grief, clients may attempt to strike a deal with God or some higher power for an alternative plan. For example, a person may plead, “If you will let me live to see my daughter’s wedding, I’ll accept my cancer diagnosis.” is called _____________
bargaining
Of course, clients that are grieving will experience intense feelings of sadness, sorrow, and loss called _____________
depression
Eventually, most clients come to _________ the loss. They utilize coping strategies and become less preoccupied with it. That’s not to say they no longer feel the loss or still grieve; they still have ups and downs. But they’ve found new ways to stay connected to the loss as they continue life.
accept (acceptance)
Which grief is it?
Clients experience the stages of grief (denial, anger, bargaining, etc.).
Somatic complaints are common (e.g., headaches, nausea, fatigue, sleep difficulties).
Some authors say that clients usually achieve some degree of acceptance within six months. Keep in mind, each situation is unique and there is no set time limit for grieving. Remember, anger is a normal emotion during grief.
normal grief
________________ occurs when a client experiences the stages of grief before the loss occurs
anticipatory grief
___________________ occurs when the grief response may be inhibited, exaggerated, or prolonged.
Complicated or maladaptive grief
A helpful way to distinguish normal grief from maladaptive grief is that the latter is often accompanied by feelings of worthlessness or low-self esteem
_____________________ occurs when an individual experiences too many losses at too rapid of a pace. Older adults are especially prone to experiencing this.
bereavement overload
Hicks (2001) gives four recommendations on how to help people that are suffering.
1.
2.
3.
4.
1.Don’t speak; be present
2. listen
3. take action
4. express compassion and care
Mood disorders occur when these states are prolonged and cause ____________________.
impairment (dysfunction)
Clients with major depressive disorder have a depressed mood or loss of interest in pleasurable activities called ____________
anhedonia
Melancholic features - This is a severe version of depression in which a client’s mood is extremely ________ and unremitting. Even extremely positive news will not temporarily lift the client’s spirits. Clients often experience early morning awakenings and loss of appetite. Suicidal ideation is common.
dark
Some clients with depression experience delusions that involve strong feelings of guilt. They may believe they are responsible for someone’s death or a natural catastrophe is called _________________.
mood congruent psychotic features
_______________ is a form of depression that reoccurs seasonally (usually ____________). Light therapy is an effective treatment.
seasonal pattern, wintertime
______________ is a subtype of depression is associated with pregnancy. Some of these clients will develop psychotic features.
peripartum
depression is often called the _____________ of mental disorders
common cold
The lifetime prevalence of depression is about ______%. It’s nearly twice as common in __________.
17, women
A common problem is relapsing. The chance of relapsing after one episode is ______%. After two episodes, the relapse rate is ______%.
50, 80
Cognitive-behavioral theorists note that depressed clients have a similar pattern of thinking: negative beliefs about the __________, ____________________, and the ____________. In addition, depressed clients exhibit several cognitive distortions
world, themselves, future
Depression may be related to deficiencies of ___________, ____________, and _____________ in the brain. We also know that depression is sometimes caused by a general __________ condition (e.g., hypothyroidism) or medication use
serotonin norepinephrine, dopamine.
medical
Effective psychotherapy for depression includes ________ and ______________.
CBT, group therapy
Antidepressants (SSRIs, SNRIs, TCAs, MAOIs) are commonly used for depression. __________ are usually the first-line agents since their side effects are milder.
SSRIs
Electroconvulsive therapy (ECT) is an effective option for clients who are extremely ________________ or have failed numerous other treatments. The evidence supporting ECT for these clients is strong.
suicidal
_______________________ (TMS) is another option. TMS, as the name suggests, is a procedure in which strong magnetic pulses are sent through the skull into the brain—usually the left prefrontal cortex
transcranial magnetic stimulation
Depression intervention:
____________ is always the top priority. Depressed clients might be suicidal. Assess for suicidal ideation often and monitor closely.
safety
Depression intervention:
Clients who are depressed may take longer than expected to respond to questions or to speak. An important therapeutic communication strategy is to allow sufficient _______ for such clients. In other words, learn to slow down and be comfortable with brief periods of silence. ⭐
time
Depression intervention:
Explain that antidepressants can take up to four __________ to begin working.
weeks
Clients with mania seem to have endless energy, are always moving about, and may feel little or no need for sleep. They are high on life. Their thoughts race (____________ of ideas) and their speech is “__________________.”
flight, pressured
Clients in the mania phase of bipolar disorder experience psychotic delusions (usually __________________) and hallucinations (usually ________________) may also occur. Manic episodes usually end with a crash into a deep depression.
grandiose, auditory
_____________ is a less severe version of mania. Clients experience an elevated mood, enhanced creativity, increased energy, and may act intrusively. Hypomania by itself does not cause significant _______________.
hypomania, impairment
______________ - These clients experience mania (and usually depression).
bipolar 1
__________________ - These clients experience hypomania and depression.
bipolar 2
Clients who experience four or more mood episodes in a 12-month period are classified as “__________ cyclers.”
rapid
Bipolar disorder has a strong ______________ basis.
genetic
Having a first-degree relative with bipolar disorder increases a person’s lifetime risk to ___________%.
5-10
____________ and _____________ can help clients with bipolar disorder learn coping skills and improve medication adherence.
CBT, group psychoeducation
Common medications for bipolar disorder include ______________, anticonvulsants (valproate, lamotrigine, carbamazepine), and second generation antipsychotics (e.g., aripiprazole, clozapine, ziprasidone). ____________ are often ineffective and sometimes precipitate mania.
lithium, antidepressants
__________ can help clients with extreme manic behavior or who are having difficulty achieving symptom control
ECT
Bipolar disorder interventions:
- Decrease environmental ______________ (e.g., low lighting, low noise, fewer people) when clients are manic. Do not, however, isolate a client.
- Assess for suicidal and __________________ thoughts.
- Remove all dangerous objects when clients are agitated, confused, or suicidal.
- Assess for illicit drug use. Substances can increase the risk of harm and make medication management more difficult.
- Maintain a calm demeanor and tone of speech. Remember that anxiety can be contagious.
- Set ____________ on dangerous and manipulative behaviors. Clearly describe what is expected. Explain the consequences if limits are broken. Ensure the entire team is enforcing the same limits. Give immediate feedback when limits are broken. Don’t argue, bargain, try to reason, or become emotional with the client. Provide positive reinforcement for non-manipulative behaviors.
- Listen to and act on legitimate complaints.
- Avoid __________ struggles; don’t become emotional.
- Provide outlets for physical energy (e.g., exercise, punching bag).
- Clients experiencing mania have increased caloric needs and may have difficulty sitting down to eat meals. Monitor nutritional status. Provide frequent high-protein, high-calorie, ________________ foods and drinks. ⭐
- Promote good sleep hygiene and limit caffeine use during manic episodes. Remember to provide frequent rest periods during the day too. ⭐
- stimuli
- homicidal
- limits
- power
- portable
More than 90% of people who kill themselves have a diagnosable mental illness. Mood disorders and __________________ abuse are the most common.
substance
Males have the highest rate of suicide, but women have more ________________.
attempts
The highest suicide risk _________ now is 45- to 64-year-olds.
group
____________ are the highest risk group. American Indians are the second highest risk group.
whites
The following items increase a client’s risk of committing suicide.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
- age
- gender
- ethnicity/race
- marital status
- socioeconomic status
- occupation
- religion
- family history
- military
- previous attempts
The IS PATH WARM mnemonic can help you recognize imminent warning signs.
ideation
substance
purposelessness
anger
trapped
hopelessness
withdrawing
anxiety
recklessness
mood shifts
A helpful way to raise an uncomfortable topic like suicide is to use the ______________________ technique. For example, “Sometimes when clients are going through intense emotional pain, they have thoughts about killing themselves. Have you had any thoughts like that?”
normalizing
Pay attention to _____________ (also called “covert”) statements (e.g., “I don’t have anything worth living for anymore.” Or “I wish I could fall asleep and never wake up.”). Assess for suicidal ideation when you hear statements like these. ⭐
indirect
Be alert to the warning signs (i.e., IS PATH WARM). Remember, a lethal plan that a client has the means to carry out is a major warning sign. If a client has __________________ the plan, the risk is even greater.
rehearsed
Ensure that clients are not “________________” medications. Clients may save these pills to attempt an overdose.
cheeking
A sudden ____________ in a client’s mood can indicate the client intends to commit suicide in the near future. ⭐
improvement
______________ - ECT is a very effective treatment for ____________ depression. Other indications include bipolar disorder (depression and mania), schizophrenia (especially with catatonic features), and schizoaffective disorder
efficaciousness, severe
In the vast majority of ECT cases, clients give informed consent. In cases where a client is too ill or lacks the capacity to consent, the provider must seek a __________ order.
court
In ECT clients are given a short-acting ____________ (e.g., propofol) to render them unconscious during the procedure. In addition, a paralytic
anesthetic
A standard treatment course is __2__ or __3______ treatments per week for a total of six to _______ treatments. Unfortunately, relapse is common.
12
ECT is one of the safest procedures performed under general anesthesia. It can even be performed on clients who are ________________
pregnant
ECT adverse effects:
1.
2.
3.
4.
- headache
- elevated vitals (seizures temporarily elevate vitals)
- memory loss ⭐
- Miscellaneous (dental and tongue injuries, muscle soreness, nausea, and aspiration)
ECT interventions:
1.Assess the client and family’s understanding of ECT. Help correct any misconceptions.
2.Know your medications. An ______________________________ (atropine or glycopyrrolate) is given before the procedure to dry up secretions and prevent a seizure-induced vagal response.
3.____________ is your top priority when clients have been under anesthesia.
- Monitor vital signs and mental status before and after the procedure. If a client has a history of ________________________, make sure it is under control.
- Maintain the client’s ____ until recovery is fully completed.
- Stay with the client. Reorient the client to time and place. Explain what has occurred. Provide reassurance
- anticholinergic
- airway
- hypertension
- IV
