Behavioral/Psychosocial 4% Flashcards
(39 cards)
1
Q
Adventitious Crises
A
- Follow accidental or uncommon events leading to major environmental changes
- Ie. Natural disasters
2
Q
ANTICHOLINERGIC AGENTS
A
- Blocks the parasympathetic nervous system
- Stimulates the sympathetic nervous system
Includes:
- atropine
3
Q
Anxiety
A
- Anxiety is a vague uneasiness accompanied by tension and helplessness
- Patients often cannot pinpoint a cause for anxiety
- Anxiety disorder = presence of anxiety for at least 6 months
- Both short-term and long-term methods of treatment
4
Q
Most commonly prescribed anxiolytics used in the critical care setting?
A
- Benzodiazepines
- Cause sedation and some degree of amnesia
- Less likely than other agents to cause significant side effects
- Ex. diazepam, lorazepam, alprazolam
5
Q
Assault
A
- Specific type of threat
- To threaten a patient with bodily harm
6
Q
Battery
A
- Unlawful use of force
- Requires the actual use of force rather than just threatening to use force
7
Q
Death and Dying Process
A
- Shock and Disbelief
- Denial
8
Q
Delirium
A
- Acute organic mental syndrome with potentially reversible impairment of consciousness and cognitive function that fluctuates in severity
- Types:
- Mixed: hyperactive and hypoactive, most common
- Hypoactive: second most common
- Hyperactive: lease common
- May result in agitation
- Delirium has increase in 6 month mortality and severity of delirium predicts mortality rate
9
Q
Delusion
A
- Perception that has no actual external stimulus
- Common during alcohol withdrawal syndrome
10
Q
Denial
A
- Inability to face reality
11
Q
Release of Epinephrine in Stressful Situation causes what?
A
- Oxygen consumption increases
- Glucose is mobilized
- Blood vessels are constricted
- Increase in heart rate, contractility, and conductivity
- Vasoconstriction
- Bronchodilation
- Pupil dilation
- Stimulation of glycogenolysis and gluconeogenesis to mobilize glucose
- Redistribution of blood flow from nonessential to essential organs (Heart & Brain)
12
Q
What is epinephrine?
A
- Neurotransmitter for the sympathetic nervous system
13
Q
Illusion
A
- Misperception or misinterpretation of an actual external stimulus
- Common during alcohol withdrawal syndrome
14
Q
Malpractice
A
- Professional negligence that results in injury to the patient
15
Q
Mania
A
- Distinguished from psychosis by absence of hallucinations
16
Q
Mania & Anticonvulsants
A
- Anticonvulsants are used to improve mood stability in patients
17
Q
Maturational crises
A
- Arise as a result of growth and development and involve changes in self-concept and roles
18
Q
Post-Traumatic Stress Disorder (PTSD
A
- Arises from traumatic events
- Produces anxiety due to repeated stressful memories and intrusive thoughts about the experience
- Causes physiologic reactivity and re-experiencing related to previous experiences
19
Q
Psychosis (psychotic episode) S/S
A
Classic signs:
- Bizarre behavior
- Disorganized thoughts
- Presence of delusions
- Disorganized thoughts
- Hallucinations
20
Q
Effective Communication Technique for Patients with Psychosis
A
Keep sentences short and simple
- Patients with psychosis
- Aberrant speech patterns
- Grossly disorganized behavior
- Will not be able to track long and complex sentences
- “Out of touch with reality”
21
Q
BETA-BLOCKERS
ß-BLOCKERS
A
- ß-blockers inhibit the stimulation of the ß receptors
- May be given to patients with history of bipolar disorder.
- Block catecholamine effects
- Inhibits ß1 stimulation, which will lower the patient’s heart rate
- Used after myocardial infarction to decrease the effects of catecholamines on the myocardium and decrease the oxygen requirements of the myocardium
includes
- metoprolol
22
Q
Sensory Overload
A
- Overload of non-meaningful stimuli
- Interventions:
- Darkening the room (especially at bedtime)
- Decreasing the volume of noises (including the beeping of the cardiac monitor)
- Avoiding unnecessary conversation (chitchat)
- Family visitation should not be limited because it is a meaningful stimulus
- Possible to have sensory overload and sensory deprivation simultaneously
23
Q
Situational Crises
A
- Follows an external event or experience and the associated losses and changes
- Ie. Life-threatening illness in a loved one
24
Q
Suicide Attempt Assessment Priorities
A
- Injury
- Intent
- Lethality
Evaluate Intent, Plan, and Ability
25
Sympathetic Nervous System Stimulation
* Hyperventilation
* Increased musle tension
* Palpitations
* Reduced oral and gastrointestinal secretions
26
When is denial after a myocardial infarction most beneficial?
Denial during the first 72 hours limits catecholamine release and decreases myocardial oxygen demand and ectopy potential.
27
Significant Risks for Delirium
* Preexisting dementia
* History of hypertension
* History of alcoholism (2-3 drinks or more per day)
* High severity of illness at admission
* Coma - primary neurological, sedative induced, multifactorial
* Benzodiazepine drugs
28
Lesser RIsk for Delirium
* Age
* Pain
* Restraints
* Tubes and lines
* Sensory deprivation or overload
29
Delirium Assessment Tools
1. Confusion assessment method for the ICU (CAM-ICU)
2. Intensive care delirium screening checklist (ICDSC)
30
Delirium Prevention - ABCDE Bundle
A: Awakening
B: Breathing trials
C: Communication and collaboration
D: Delirium monitoring/management
E: Early progressive mobility and exercise
31
Dementia
* Neurocognitive disorder
* Affects brain's ability to think, reason, and remember clearly
* Most common affect areas: memory, visual-spatial, language, attention, and problem solving
* Most common form is Alzheimer's disease
* Vascular brain disease/stroke another form
32
Tricyclic Antidepressents
* Use declined with availability of SSRIs
* Includes:
* amitriptyline
* nortriptyline
* imipramine
* clomipramine
* desipramine
* Adverse effects:
* highly lethal in overdose (tachycardia, hypotension, fatal arrhythmias)
* vertigo
* dry mouth, dental caries
* urinary retention
* constipation
* orthostatic hypotension
* prolonged QT
33
Selective Serotonin Reuptake Inhibitors (SSRIs)
* First-line pharmacological therapy for depression
* Abnormalities in brain serotonin activity have been implicated in many emotional and behavioral disorders (mood disorders, obsessive-compuslive disorder, aggresive behaviors)
* Block action of presynaptic serotonin reuptake pump, increasing amount of serotonin available in synapse and increasing postsynaptic serotonin receptor occupancy
* Well tolerated
* QDay administration
* Fewer adverse effects than tricyclic antidepressants
* Adverse effects:
* Dose dependent, most subside after 1-2 weeks or dose reduction
* headache, abdominal pain, nausea, diarrhea, sleep changes, jitteriness, agitation
* less common - diaphoresis, akathisia (restlessness and inability to sit still), bruising, changes in sexual functioning
* can induce a manic or hypomanic episode
* potential for increased suicidality
* inhibit metabolism of meds - antiarrhythmics, benzodiazepines, warfarin, tricyclics, neuroleptics
34
Suicide
* 33,000 suicides annually / 11th leading cause of death
* 4 men : 1 woman, women attempt 2x as men, men \> 65yo greater risk
* Suicide behavior continuum:
* Ideation - contemplation without action
* Gesture - nonlethal action
* Attempt - potentially lethal
* Suicide - 30% successful on 1st try
35
Suicide Nursing Interventions
* Establish SAFE environment
* 1:1 observation
* Explain precautions to patient
* Comprehensive documentation
* Safety measures
* remove hazards from room (sharp or hazardous objects, personal items)
* contraband check
* paper/plastic food service
* do not allow visitors to leave anything with patient
* make sure patient swallows medications
* move near nurses' station
36
Alcohol Withdrawal
* minor, initial signs (first 6 - 3 hours without alcohol)
* tremulousness
* mild anxiety
* headache
* diaphoresis
* palpitations
* anorexia
* GI upset
* seizures may occur during first 48 hours
* "alcoholic hallucinosis" (after 12-48 hours without alcohol
* visual, auditory, and/or tactile hallucinations
* Delirium tremens (DTs) (may occur 48-96 hours without alcohol with delirium, agitation, tachycardia, hypertension, fever, diaphoresis
37
Alcohol Withdrawal Treatment
* DT prevention with oral benzodiazepines such as lorazepam (Ativan), diazepam (Valium), or chlordiazepoxide (Librium)
* Benzos enhance effect of neurotransmitter GABA, resulting in sedative, hypnotic, anxiolytic, anticonvulsant, and muscle relaxant properties
* Symptom-triggered treatment with valid tool (CIWA-Ar)
* Phenobarbital for refractory DTs
* Restore fluid volume (Glucose and thiamine to prevent Wernicke's encephalopathy and Korsakoff syndrome
* Multivitamins with folate
* Correct potassium, magnesium, and phosphate deficiencies
38
Wernicke's Encephalopathy
* Gait disturbances
* Nystagmus
* Eye muscle paralysis
39
Korsakoff Syndrome
* Decreased spontaneity
* Amnesia
* Denial of memory loss by making up facts
