Exam 1 Flashcards
(136 cards)
1
Q
Kantianism
A
It’s not about consequences or end results that makes an action right or wrong.
-motive is what matters
-Denotology = Duty
Ex: A nurse saying that they are ethically making this choice because it is morally right and my duty to do so.
2
Q
Utilitarianism
A
Determines what is right and wrong by focusing on outcomes.
- consequences are what matters
- consequentialism = consequences
3
Q
Defense Mechanisms
A
- Sublimation - Rationalization
- Identification - Compensation
- Denial - Displacement
- intellectualization - Introjection
- Isolation - projection
- Reaction Formation - Regression
- Repression - Suppression
- Undoing
4
Q
Sublimation
A
Rechanneling of impulses that are personally or socially unacceptable into activities that are constructive.
Ex: Mother whose son died in a drunk driver accident channels her anger and energy into becoming president of the Mothers against drunk drivers.
5
Q
Rationalization
A
Attempting to make excuses or logical reason’s to justify unacceptable feelings or behaviors.
Ex: Telling rehab nurse the reason you drink is because of your bad marriage and bad job.
6
Q
Identification
A
An attempt to increase self-worth by acquiring certain characteristics of an individual one admires.
Ex: When someone requires rehab for a long period of time, and decides to become a physical therapist as a result of their experience.
7
Q
Compensation
A
Covering up a real or perceived weakness by emphasizing a trait one considers more desirable
Ex: A physically disabled boy is unable to play football so he compensates by becoming a great scholar
8
Q
Denial
A
Refusing to believe or even perceive painful realities
Ex: a woman drinks alcohol every day, can’t stop, and does not acknowledge that she has a problem
9
Q
Displacement
A
The transfer of feelings from one target to another that is considered less threatening or that is neutral.
Ex: a client is angry at his doctor, and does not express it; but becomes verbally aggressive with nurse
10
Q
Intellectualization
A
An attempt to avoid expressing actual emotions associated with a stressful situation by using the intellectual processes of logic, reasoning, and analysis
Ex: Susan’s husband is being transferred to a new job to a city far from her parents. she hides anxiety by explaining to her parents the advantages associated with the move.
11
Q
Introjection
A
Integrating the beliefs and values of another individual into one’s own ego structure
Ex: Children integrate their parents value system into the process of conscience formation. a child says to a friend, don’t cheat, its wrong.
12
Q
Isolation
A
Separating a thought or memory from the feeling, tone, or emotion associated with it
Ex: a young woman describes being attacked and raped without showing any emotion
13
Q
Projection
A
Attributing feelings or impulses unacceptable to one’s self to another person
Ex: person feels strong attraction to her track coach, and tells her friend “he is coming on to me”
14
Q
Reaction Formation
A
Preventing unacceptable or undesirable thoughts/ behaviors from being expressed by exaggerating opposite thoughts or types of behaviors
Ex: Jana hates nursing but she attended nursing school to make her parents happy, during career day she speaks to prospective students about the excellence of nursing as a career
15
Q
Regression
A
Responding to stress by retreating to an earlier level of development and the comfort measures associated with that level of functioning
Ex: When a 2 year old Jay is hospitalized for tonsillitis, he will drink only from a bottle, although his mother says he has been drinking from a cup for 6 months
16
Q
Repression
A
Involuntarily pushing unpleasant feelings out of one’s mind
Ex: A trauma victim is unable to remember anything about the traumatic event
17
Q
Suppression
A
The voluntary blocking of unpleasant feelings and experiences from ones awareness
Ex: someone saying “I don’t want to think about that now. I’ll think about that tomorrow”
18
Q
Undoing
A
Symbolically negating or canceling out an experience that one finds intolerable
Ex: Joe is nervous about his new job and yells at his wife. On the way home he stops and buys her flowers
19
Q
Mental illness
A
Maladaptive responses to stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are incompatible with the individuals social, occupational, and or physical functioning
-some are affected, not all are.
20
Q
Ethical egoism
A
Ethical position that moral agents ought to do what is in their own self-interest. The decision may not be what’s best for anyone else involved. but consideration is only for the individual making the decision
21
Q
Autonomy
A
The right or condition of self-government
22
Q
Beneficence
A
Addresses the idea that the nurses action is for the best of the patient
23
Q
Nonmaleficence
A
To do no harm
24
Q
Justice
A
Fairness
25
Veracity
To remain truthful with the patient no matter what the outcome is
26
False Imprisonment
Restraining an individual or restricting an individual's freedom
27
Voluntary commitment
Admitting oneself to a mental health institution
28
Involuntary commitment
Legal process by which a person is confined in a psychiatric hospital because of a treatable mental disorder, against his or her wishes.
29
Milieu therapy
Psychotherapy in which the patient's social environment is controlled or manipulated with a view to preventing self-destructive behavior.
30
Antidepressants
```
A class of psychotropic medications used for the treatment of depression
side effects: nausea, increased appetite, weight gain, fatigue, drowsiness
```
31
Anticonvulsants
Used in the treatment of bipolar disorder and borderline personality disorder;
drugs used to treat mania and depression
side effects: Dizziness, Drowsiness, Fatigue, Nausea, Tremor, Rash, Weight gain
32
Antipsychotic drugs
Medications that are used to treat schizophrenia and related psychotic disorders
side effects: Dizziness or blurry vision, Drowsiness, Sexual challenges, weight gain
33
Anxiolytics
Drugs that reduce anxiety
| side effects: Drowsiness, Sedation, Confusion, Dependence and withdrawal symptoms
34
Stimulants
Drugs that speed up the central nervous system
side effects: Loss of appetite
Increased wakefulness and physical activity
Improved attention
Increased sexual desire and performance
35
Mood stabilizers
```
Drugs used to control mood swings in patients with bipolar mood disorders
side effects: Nausea
Diarrhea
Dizziness
Muscle weakness
```
36
Dimensions of recovery
Health: make a informative healthy choice
Home: safe place
Purpose: like school, or a job
Community: social life for support
37
Negligence
Failure to exercise the care that a reasonably prudent person would exercise in like circumstances.
38
Battery
Unlawful touching of another person without consent
39
Assault
Threat or attempt to injure
40
Compassion
Sympathetic pity and concern for the sufferings or misfortunes of others.
"the victims should be treated with compassion"
41
Empathy
the ability to understand and share the feelings of another
42
Pre-interaction phase
- occurs before meeting the patient
- prepping & looking at patients report
- examining our own feelings about working with a particular patient
43
Orientation phase
- creating an environment for establishing trust and rapport
- identifying pt. strengths & limitations
- developing a plan of action
44
Working phase
-continuously evaluating progress toward goals
45
Termination phase
- the mutually agreed on goal was met
| - pt is being discharged
46
Rapport
mutual understanding and harmony
47
Trust
belief someone is reliable
48
Respect
someone or something is good & valuable and important
49
Genuineness'
quality of being what someone says you are; authentic
50
Touch is appropriate when
providing care & asked permission
51
As a nurse you can show the patient that you care without touching by
-by meeting the needs of the pt
52
Non-verbal communication
- body movement and posture
- facial expressions
- vocal cues/paralanguage
53
Pre-existing conditions that affect communication
- values, attitudes, beliefs
- culture or religion
- social status
- gender
- age or developmental level
- environment
54
Non-verbal communication
Communicating without the use of words. can be through
- physical appearance & dress
- body movement and posture
- touch
- facial expressions
- eye behavior
- vocal cues/paralanguage
55
Therapeutic Communication Techniques
Active Listening
Open-ended Questions
Clarifying
Summarizing
56
Active Listening
Shows clients that they have your undivided attention
Builds trust
Promotes honesty
57
Open-ended questions
Used initially to encourage clients to tell their story in their own way. Ask questions in a language that a client can understand
58
Clarifying
Questioning clients about specific details in greater depth or directing them toward relevant parts of the history.
59
Summarizing
Validates the accuracy of the story.
60
Other types of therapeutic communication
-silence -accepting
-giving recognition -offering self
-giving broad openings -offering general leads
-placing events in time & sequence
-making observations
-encouraging description of perception
-encouraging comparison -restating
-reflecting -focusing
-exploring -clarifying & validating
-presenting reality -voicing doubt
-translating words into feelings
-formulation a plan of action -encouraging comparison
-restating -reflecting
-focusing -exploring
-clarifying & validating -presenting reality
-voicing doubt -translating words into
feelings
-formulation a plan of action
61
Non-therapeutic communication
-giving false reassurance -rejecting
-approving or disapproving -agreeing or
disagreeing
-giving advice -probing
-defending -requesting an
explanation
-indicating existence of external source of power
-belittling expressed feelings -stereotyped comments
-denial -interpreting
-introducing an unrelated topic
62
To be a active listener
- use paraphrasing -actively nodding
| - asking questions -using zero judgement
63
Body language (SOLER)
```
S-sit square, face the pt
O-open posture
L-lean forward
E-eye contact
R-relax
```
64
When giving feedback to a patient
- be specific
- ensure it is well timed
- be descriptive and objective
- be aware of your non verbals
- give information, not advice
- focus on behavior that the client can change; do not focus on the client
65
Milieu
is a patient's environment; setting
66
Suicidal ideation
thinking about suicide, usually with serious emotional and intellectual impact
-a range of wishes of death
67
Self-injurious behavior
Causing injury or mutilation of
| oneself, such as head banging, self biting
68
Passive death wish
They are suicidal but they don't have a plan
--Idea of wanting to die but not actually causing it (wish to die in their sleep, want to get into a car accident, but not cause it)
69
What is a crisis
a sudden event in one's life, during which usual coping mechanisms cannot resolve the problem; disturbs homeostasis
70
Interventions before restraints and seclusion
- prevention: want to prevent, develop a plan in place to prevent this
- de escalation: reduce the intensity
- reduction to stimuli: remove pt from that area, dim the lights, eliminate noise, have a contact patient
71
Restraints
to physically restrict voluntary movement or use chemicals to revise/restrict resident behavior
- nurses can do, but must get MD order right away (must be evaluated by MD within one hour)
- verbal orders for these must be renewed every 4 hours for adults ages 18 and older, every 2 hours for children 9-17 & every hour for children younger than 9 years old
- pts. must be continuously monitored in person by staff, after first hour a person in seclusion must be monitored through simultaneous audio and video equipment.
- every 15 mins after put in restraint's pt must be assessed for injury, nutrition, hydration, circulation, vital signs, hygiene and elimination, comfort, and readiness for discontinuation of restraints
72
Pre-interaction examples
- explore own feelings, fantasies, and fears
- analyze own professional strengths limitations
- gather data about patient when possible
- plan for first meeting with pt.
73
Orientation phase examples
- determine why patient sought help
- establish trust, acceptance & open communication
- mutually formulate a contract
- explore patient's thoughts, feelings, and actions
- identify patients' problems
- define goals with the patient
74
Working phase example
- explore relevant stressors
- promote pts. development of insight and use of constructive coping mechanism
- overcome resistance behaviors
75
Termination phase examples
- establish reality of separation
- review progress of therapy and attainment of goals
- mutually explore feelings of rejection, loss, sadness, and anger and related behaviors
76
Auditory hallucinations
hearing voices, noises, music, or sounds that are not actually real
77
Tactile hallucinations
when someone experiences some perception related to touch when it is not really there
-like feeling bugs crawling on you
78
Visual hallucinations
seeing objects, people, or things that do not actually exist
79
Delusions
false beliefs held by a person who refuses to accept evidence of their falseness
80
Psychosis
A mental disorder characterized by the loss of contact with reality.
81
Antipsychotic main side effect
EPS-->see thick tongue, pinwheel movement & muscle stiffness
| -give Cogentin or Benadryl will dry it up
82
Schizophrenia
a group of severe disorders characterized by disorganized and delusional thinking, disturbed perceptions, and inappropriate emotions and actions
- multiple potential causes
- not one single treatment
- at risk for suicide: 20-40% of people with this attempt suicide
83
Phases of Schizophrenia
1. premorbid
2. prodromal
3. active
4. residual
84
Premorbid phase
are signs that occur before there is clear evidence of illness & may include distinctive personality traits or behaviors
- being shy or withdrawal
- poor relationships
- doing poorly in school
- antisocial behaviors
85
Prodromal phase
these symptoms are more clearly manifest as signs of developing this illness. Begins with change from premorbid functioning and extends until onset of frank psychotic symptoms. Shows signs of significant deterioration in function
-depression, social withdrawal, cognitive impairment, and can develop obsessive compulsive disorder
86
Active psychotic phase
acute episodes of pronounced symptoms
| -delusions, hallucinations, disorganized speech, negative symptoms
87
Residual phase
A phase of schizophrenia usually after the active phase involving peculiar thoughts and behaviors similar to the prodromal phase.
88
Predisposing factors
Biological: genetics, biochemical, physiological
Environmental: sociocultural, stressful life events, cannabis & genetic vulnerability
89
Genetic factors of schizophrenia
relatives of individuals with this have a increased probability of developing the disease like
- 1% are at risk for developing just in general
- siblings have a 10% if one sibling has it
- if parent has, 5-6% of their baby developing it
90
Biochemical factors include
Dopamine, NE, Serotonin, GABA, Glutamate
91
Physiological factors for schizophrenia include
viral infection, anatomical abnormalities, electrophysiology, and physical conditions like Huntington disease, strokes, etc...
92
Catatonia
refers to a significant motor disturbance that may range from stupor (no motor activity) to excessive motor activity and agitation
93
Delusions (schizophrenia)
false beliefs that are irrational and that the individual maintains as true despite evidence to the contrary.
94
Persecutory delusions
- most common
- the belief that someone is harming or attempting to harm the person
- for example like being plotted against, poisoned, or drugged.
- also called paranoid delusions
95
Grandiose delusions
individuals are convinced they have special powers, talents, or abilities, or may believe they are a famous person.
-Of a religious nature they may believe that are actually Jesus Christ
96
Delusions of reference
the belief that common elements in the environment are directed toward the individual.
-for example: an individual is laughing and they think they must be laughing at them but with additional information there is other explanations for their laughter
97
Delusions of control or influence
individual believes certain objects or persons have control over his or her behavior
98
Somatic delusions
individual has a false idea about the functioning of his or her body
99
Nihilistic delusions
believe that the self, part of the self, others, or the world is nonexistent
100
Erotomaniac delusions
when an individual believes falsely that another person is in love with him or her
-famous people are normally the target of these delusions
101
Jealous delusion
the belief that the person's sexual partner is unfaithful
102
Mixed delusions
delusions are prominent, but no single theme is predominant
103
Catatonia stupor
stop responding to their environment, remaining motionless and silent for long stretches of time
104
Catatonia: Catalepsy
patient adopts positions that they are put in
105
Catatonia: Mutism
not speaking
106
Catatonia: negativism
resistance to instructions
107
Catatonia posturing
assuming awkward, bizarre positions for long periods of time
108
Catatonia
| Mannerism
carrying out odd, exaggerated actions
109
catatonia: agitation
not influenced by external stimuli
110
Catatonia
| Stereotypy
repetitive, abnormally frequent, non goal directed movements
111
Catatonia: grimacing
keeping a fixed expression
112
Catatonia: echolalia
mimicking another's speech
113
Catatonia: echopraxia
mimicking another's movements
114
Positive symptoms of schizophrenia
any change in behavior or thoughts
- Delusions -Religiosity
- paranoia -magical thinking
- associate looseness -neologisms
- concrete thinking -word salad
- circumstantiality -Tangentially
- mutism -preservation
- hallucinations -illusions
- echolalia -echopraxia
- identification and imitation -depersonalization
115
Loose associations
A common thinking disturbance in schizophrenia, characterized by rapid shifts from one topic of conversation to another.
-positive symptom
116
Neologisms
person invents new words
| -positive symptom
117
Clang associations
the stringing together of words that rhyme but have no other apparent link
-positive symptom
118
Word salad
a group of words that are put together randomly
| -positive symptom
119
Circumstantiality
Speech that is delayed in reaching the point and contains excessive or irrelevant details
-positive symptom
120
Tangentiality
veering away from the topic of discussion and difficulty maintaining focus and attention
-positive symptom
121
Perseveration
persistent repetition of the same word or idea in response to different questions
-positive symptom
122
Depersonalization
feelings of detachment from one's mental processes or body
| -positive symptom
123
With positive symptoms if we catch our patient in these
we can help and turn them around
124
Hallucinations
false sensory experiences, such as seeing or hearing something that isn't really there
-positive symptoms
125
Negative symptoms of schizophrenia
people appear to be withdrawn from the world around them. Take no interest in everyday social life & appear emotionless & flat.
-inappropriate effect -bland/flat affect
-apathy -cannot initiate goal-
directed activities
-emotionally ambivalent -decreased hygiene
-impaired social isolation -isolation
-anosogonsia -anergia
-waxy flexibility -posturing
-pacing/rocking -anhedonia
-regression -with these symptoms it is harder to treat our patients
126
Anosognosia
A condition in which a person with an illness seems unaware of the existence of his or her illness.
-negative symptom
127
Anergia
lack of energy
| -negative symptom
128
Anhedonia
inability to experience pleasure
| -negative symptom
129
Catatonia: waxy flexibility
allows body parts to be placed in bizarre or uncomfortable positions, negative symptom
130
Treatment modalities
Psychological: individual psychotherapy, group therapy, behavior therapy, social skills training
social: family therapy, assertive community treatment, RAISE (recovery after an initial schizophrenia episode)
organic: psychopharmacology
131
Psychopharmacology
types of antipsychotics: Typical , Atypical
132
Typical Antipsychotics
work by blocking dopamine (first generation; conventional)
- Chlorpromazine
- Thioridazine
- Prolizine
- Compazine
- Haloperidol (B52 which has Benadryl, Haldol, and Ativan)
- doesn't not do well with serotonin
- works well with improving positive symptoms but not with negative symptoms
133
Atypical antipsychotics
block strongly with serotonin, vary between the noriepi and setacolin
- they are the first line drugs and prevent episodes. (second generation; new drugs)
- improve positive and negative symptoms
- Aripiprazole (Abilify)
- Olanzapine (Zyprexa)
- Risperidone (Risperdal)
- Cariprazine (Vraylor) and Ziprasidone, clozapine, and paliperidone
- Seroquel
- weight gain is a huge side effect for antipsychotics
134
Education on antipsychotics
- do not abruptly stop taking the med
- use sunblock
- use caution when operating a car
- change positions slowly
- interventions for dry mouth
- talk to HCP before taking OTC med
- Talk to HCP if pregnant or planning to become pregnant
- avoid alcohol
- report side effects of meds
135
Side effects of antipsychotics
- Anticholinergic effects: means that everything gets really dry; dry mouth & weight gain
- Nausea; GI upset
- headache, dizziness
- Skin rash
- Sedation
- blurred vision
- Orthostatic hypotension: BP drops & HR goes up
- Prolonged QT waves
- Photosensitivity
- Hormonal effects
- ECG changes
- Hypersalivation
- Hyperglycemia/diabetes
- Increased risk of mortality in elderly clients with dementia
- Reduction in seizure threshold
- Agranulocytosis
- Extrapyramidal symptoms
- Neuroleptic malignant syndrome
EPS side effects:
-pseudo parkinsonism: tremor, shuffling gait, drooling, rigidity) occurs most often in woman, elderly, and dehydrated patients.
- Akinesia: absence or impairment of involuntary movement
- Akathisia: inner restlessness
- Dystonia: medical 911, involuntary spasms in the face, arms, legs, and neck
- Oculogyric crisis: eyes roll back in head, medical 911
- -> treat with IV or IM cogentine
- Tardive Dyskinesia (TD): huge side affect, respective, involuntary, purposeful movement like lip smacking, eye rolling but not life threatening
- MNS: dopamine completely blocked, can be fatal if we give MAOIs with this, used to treat severe depression
136
Treatment for catatonia
benzodiazepines (like Ativan) , Electrotherapy
