Exam 1 (Lecture 3, 4, 5, 6) Flashcards by Johannah Crumpton

**What are the seven patient factors that are barriers to eliciting patient concerns?

Time
Embarrassment
Language barrier
Intimidated
Deaf (Sensory barriers)
Trust
Mental handicaps

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**What are the 8 provider factors that are barriers to eliciting patient concerns?

Time
Hypocrisy
Provider bias/prejudice
Cultural differences
“Frequent fliers”
Keeping your composure
Personal or emotional conflicts
Patient being inattentive

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What are the two portions of the HPI, are the _____ and _____

patient centered and clinician centered

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What are some nonverbal sources of communication that often fall in the patient centered HPI?

nonverbal cues
physical characteristics
autonomic changes
accoutrements (clothing, jewelry, makeup)
environment
self

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The empathy skill NURS, what does it stand for?

Naming
Understanding
Respecting
Supporting

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**What is one important question that needs to be asked during the social context of the HPI?

Does it affect your ADLs?

Job function
Daily activities
Hobbies
Family

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In the patient education section, what are some key points to cover?

Assessment of patient understanding
Communication at patient level
Tailor your education for each patient:
Self-management education

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What are some benefits of shared decision making?

More likely to feel secure in the healthcare setting
Stronger commitment to recover
Improved perception of the quality of care
Better self-efficacy and patient responsibility for their outcomes
Improved self-management
Better adherence to care plans
Strengthens provider-patient bond

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What are some disadvantages of shared decision making?

Patient may not desire to make decisions or feel comfortable making decisions
Patient misunderstanding may lead to incorrect decisions
Possible association with increased costs and services in hospitalized patients

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**What are some patient factors that are barriers to ending the visit?

Failure to comprehend education
Continuous questions
Casual conversation
New complaint at end of encounter
Family members

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**What are some provider factors that are barriers to ending the visit?

Poor flow of patient encounter
Lack of proper communication with patient
Failure to “enforce” the end of the visit
Casual conversation

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Name some skills that define someone as a “good communicator”

Effectively listens to others
Understands and uses nonverbal communication appropriately
Manages stress well
Emotionally aware of others
Effective verbal expression of thoughts

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What is the “fast food” rule?

Whoever is the “hungriest” gets to talk first
Repeat their message sincerely
Remember mirroring!

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Oftentimes what does an incomplete history equal ?

incomplete data to make decisions

A lot of times, this leads to costly and UNNECESSARY testing!

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What are some common patient reasons as to why they did not adhere to the care plan?

disagreed with treatment
cost
instructions were too difficult to understand
went against their personal beliefs
did not understand

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Name some factors that affect patient satisfaction

expectations
communication
control
decision-making
time spent with patient
clinical team
referrals
continuity of care
dignity

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What is the root cause in the majority of malpractice causes?

poor communication

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What is a quick summary of the biopsychosocial model? Who was it proposed by?

Interrelation of biological, psychological, and social factors that all contribute to the presence or absence of disease

George Engel

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Hereditary (Genetics)
Anatomic
Molecular
Gender
Age
Ethnicity

All fall under what Biopsychosocial Factors category?

Biological

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Temperament
Personality
Motivation
Emotion
Attention
Cognition

All fall under what Biopsychosocial Factors category?

Psychological

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Family
Society
Culture
Environment
Spiritual
Economic

All fall under what Biopsychosocial Factors category?

Social

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What is the the triple overlap of the Biopsychosocial model?

mental health

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What are the 5 core values of the provider-patient relationship?

attentiveness
support
partnership
respect
empathy

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Name some forms of nonverbal communication

kinesics (facial expression)
proxemic
paralanguage
autonomics
appearance

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____ are specific, deliberate movement

gestures

_____ are communication through touch

haptics

____ space around individual

proxemic

____ is nonverbal speech. Name some things it includes

paralanguage Pitch Tone Volume Speed Rhythm Emphasis

____ physiologic changes caused by autonomic nervous system

autonomic

____ Patient’s body is engaged, relaxed and in an open posture

Safe Pattern

_____ Patient’s body is engaged but has increased tension - response of “attack” or “retaliation” due to feeling unsafe

Fight Pattern

_____ Patient’s body is not engaged and has increased tension, as in preparing for "flight" - response of “guarding” or “pulling away” due to feeling unsafe

Flight Pattern

_____ - Patient’s body is not engaged; the person is overwhelmed with excessive input and is withdrawn, unable to mount a response

Withdrawal Pattern

Name 4 common body patterns found in a clinical setting

safe fight flight conservation-withdrawal

Define sexuality

Encompasses thoughts, feelings and behaviors connected with sexual gratification and reproduction

_____ individual with genetic, hormonal, and/or physical features of both male and female at once

intersex

we all start out _____ during the early stages of fetal life

anatomically female

______ Innate sense of feeling male, female, some combination of both male and female, neither, or an alternative such as third gender

gender identity

What does gender identity relate to ?

psychological aspects of behavior related to masculinity and femininity

____ how one presents one’s gender to others

gender expression

_____ discrepancy between assigned (biological) gender and gender identity

Gender discordance (dysphoria)

_____ Gender discordant people who make changes to their perceived gender and/or anatomic sex in order to conform with their gender identity

transsexual (older term is transgender)

____ a person whose gender identity, gender expression, and biological sex all align (e.g., man, masculine, and male)

cisgender

_____ a person who is not cisgender

transgender

_____ a person whose gender identity is neither masculine nor feminine, is some combination of both, or is fluid

Nonbinary/Genderqueer

What are the 4 steps in the sexual response sequence?

Desire Excitement Orgasm Resolution

What phase of the sexual response? _____ characterized by sexual fantasies and desire to have sexual activity

Phase 1: Desire

What phase of the sexual response? _____ brought on by psychological OR physiological stimulation OR combination subjective sense of pleasure

Phase 2: Excitement and arousal

What phase of the sexual response? _____ peaking of sexual pleasure; releasing of sexual tension; rhythmic contraction of perineal muscles and pelvic reproductive organs

Phase 3: orgasm

What phase of the sexual response? ____ disgorgement of blood from genitalia (detumescence); subjective sense of well-being and relaxation

Phase 4: Resolution

Name 3 hormones that lead to increased sexual desire

dopamine testosterone estrogen

_____ also increases vaginal lubrication, blood flow to female genitalia, and fullness/engorgement of female genitalia

Estrogen

Name 2 hormones that lead to decreased sexual desire

Serotonin and progesterone increased levels in the brain = decreased desire

sexual desire for males is commonly ____ stimuli sexual desire for females is commonly ___ stimuli

physical psychological

What is the sexual dysfunction that is associated with the desire phase?

hypoactive sexual desire disorder; sexual aversion disorder

What is the sexual dysfunction that is associated with the excitement phase?

female sexual arousal disorder; male erectile disorder

What is the sexual dysfunction that is associated with the orgasm phase?

orgasmic disorder, premature ejaculation

What is the sexual dysfunction that is associated with the resolution phase?

postcoital dysphoria, postcoital headache

Sexual dysfunction is frequently associated with _____

other psychiatric syndromes

______ Deficiency or absence of sexual fantasies, desire for sexual activity

Hypoactive sexual desire disorder

_____ characterized by an aversion to, and avoidance of, genital sexual contact

sexual aversion disorder

What are some treatment options for hypoactive sexual desire disorder and sexual aversion disorder?

therapy Serotonergic drugs - flibanserin (Addyi) Melanocortin agonists - bremelanotide (Vyleesi) Testosterone + estrogen

What is the serotonergic drug that is associated with hypoactive sexual desire disorder and sexual aversion disorder?

flibanserin (Addyi)

What is the melanocortin agonist drug that is associated with hypoactive sexual desire disorder and sexual aversion disorder?

bremelanotide (Vyleesi)

_____ dysfunction with lubrication-swelling response of sexual excitement, can be persistent or recurrent, partial or complete. What is the treatment

Female sexual arousal disorder consider therapy referral Testosterone Bupropion (Wellbutrin) : is associated with SSRI use Sildenafil (Viagra)

What are some factors that play a role in male erectile disorder?

Available sex partner History of consistent sexual activity Absence of vascular disease

If you have a young/middle aged male with ED what is the likely cause?

psych problem

What is important to determine in a male with ED?

can he get an erection some of the time (masturbation/morning)? or just with a specific partner? some of the time points to psych as the cause

What are some pelvic complaints that are associated with female orgasmic disorder?

Endometriosis, pelvic floor dysfunction, pelvic organ prolapse, uterine fibroids Childbirth or miscarriage/abortion Atrophy of genital tissues

What is the treatment for male orgasmic disorder? What is likely the cause?

therapy, dopamine agonists (experimental) Rigid, puritanical background Unconscious guilts History of abuse

How is premature ejaculation usually diagnosed?

man regularly ejaculates before or immediately after entering his partner

____ is the second most common complaint among men with sexual disorders

premature ejaculation

premature ejaculation can be helped by using the ________ or ____

squeeze technique consider an SSRI

_____ recurrent or persistent genital pain occurring in either men or women before, during, or after intercourse

Dyspareunia

_____ involuntary muscle constriction of the outer 1/3 of vagina. What is one helpful technique?

vaginismus Dilation: dilating vaginal opening with patient’s fingers or with graduated dilators (PT with pelvic subspecialty may help)

What pt population is vaginismus most common in?

highly educated women, high socioeconomic groups

Name some common causes of dysparenia in women

Inflammation, infection, or scarring of external genitalia Thinning of vaginal mucosa and/or reduced lubrication Endometriosis Leiomyomas (uterine fibroids) Chronic cystitis (UTIs, Interstitial cystitis)

Name some common causes of dysparenia in men

Peyronie’s Disease (abnormal fibrous penile tissue)

Name some psych medications that can affect sexual function

Antipsychotics → decrease dopamine Antidepressants (SSRIs, SNRIs, and TCAs) → increase serotonin Anti-anxiety agents → May improve sexual function in persons inhibited by anxiety, but certain agents may increase serotonin

Anticholinergics may produce ____ and ____ leading to sexual dysfuntion

dry mucous membranes and impotence

What is the criteria for diagnosing sexual dysfunction

Experience the disorder 75-100% of the time Have experienced the disorder for at least 6 months Have significant distress due to the disorder Not have another factor that could better explain symptoms (e.g. nonsexual mental disorders, relationship distress, etc.)

Female hypoactive desire dysfunction and Female arousal dysfunction merged into a single syndrome _____

Sexual interest/arousal disorder)

Dyspareunia and vaginismus were merged into a single syndrome called _____

Genitopelvic pain/penetration disorder

____ sexual arousal not associated with psychological desire. **What is it believed to be the root cause?

Persistent Genital Arousal Disorder Believed to be defect in sensory nerves

What is the treatment for Persistent Genital Arousal Disorder?

SSRIs, psychotherapy, topical or injected anesthetic agents

____ achievement of arousal by exposing genitalia to strangers

exhibitionism

_____ consists of recurrent cross-dressing in a heterosexual man

tranvestism

____ attaining arousal watching an unsuspecting person or people

voyeurism

____ inflicting pain upon the sexual object as a means of arousal

sexual sadism

_____ erotic pleasure being achieved by being humiliated, enslaved, or physically bound or restrained

Sexual masochism

_____ erotic fantasies and sexual urges or behavior involving non-living objects (i.e., female undergarments)

fetishism

_____ sexual arousal derived from touching or rubbing against a nonconsenting person

frotteurism

What is the treatment for paraphilias?

pharmacotherapy (if evidence for its use) and psychotherapy

What is a heterogenous fishbowl?

Central sub-group discusses the topic, while a larger outer group observes and offers silent support, varied points of view on an issue are all represented in the center group

What is a homogenous fishbowl?

Central sub-group discusses the topic, while a larger outer group observes and offers silent support everyone in a particular class/point of view sits in the center group and states their points first, then the groups change out for each point of view

What are good qualities in a good team leader?

Open communication/good communication Having good motives for being the leader Organized Seeing themselves as equal to others on the team, not better than others

What are some qualities of a good team participant?

Actually participate/willing to work Flexible Different/diverse backgrounds Involves others in decisions