Exam 2 Flashcards

1
Q

ACUTE STRESS DISORDER

A

DEFINITION/DESCRIPTION: can occur after the same kind of triggers as PTSD, which include experiencing a violent event or traumatic experience.
* resolution of sxs within 1 month*

PATHOHYSIOLOGICAL CHANGES:
ASSESSMENT:
NURSING DX:
OUTCOMES:
INTERVENTIONS:
-critical incident stress debriefing
-benzodiazepines 
-sedative-hypnotics ( for sleep)
-medications often used short term and in conjunction with other psychological treatments 
EVALUATION:
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

POST TRAUMATIC DISORDER

A

DEFINITION/DESCRIPTION: occurs in any individual who has exposure to a trauma severe enough to be outside of the range of normal human experience. experience sxs longer than one month

  • military personnel
  • childhood physical abuse, kidnapping, torture
  • sexual assault
  • natural disasters
  • diagnosis of severe illness
  • individuals extraordinary helplessness or powerlessness in the face of overwhelming circumstance*

PATHOHYSIOLOGICAL CHANGES:
-stress response of the hypothalamus-pituitary-adrenal cortex is abnormal in these individuals

  • more likely to have co-occurring conditions including osteoarthritis, diabetes, obesity, heart disease, elevated lipid levels, chronic pain, MDD

ASSESSMENT:

  • intrusive re-experiencing of initial trauma (flashbacks)
  • avoidance
  • persistent negative alterations in cognitions and mood)
  • alteration and arousal and activity ( irritability, angry outbursts, self-destructive behavior, exaggerated startle response, hyper-vigilance, sleep difficulties)
  • sxs often begin within a few months of initial trauma, if not treated within 1 year the likely hood of chronic sxs increase*

NURSING DX:

OUTCOMES:
- patient and others will remain safe
-TX for co-occuring conditions
-attend support groups
-expand social support network
-exhibit increase in restful sleep periods
- have fewer nightmares/flashbacks
-express decrease in irritability
-demonstrate effective anxiety reduction techniques ( cognitive and behavioral)
INTERVENTIONS:
- goals of treatment: solid social support, 
EVALUATION:
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

GENERALIZED ANXIETY DISORDER:

A

DEFINITION/DESCRIPTION: the patient exhibits uncontrollable, excessive worry for at least 6 months

  • GAD causes significant impairment in one or more areas of functioning such as work duties
  • SXS: restlessness, muscle tension, avoidance of stressful activities or events, increased time to prepare for possible stressful events, procrastination in decision making, seeks repeated reassurance
PATHOHYSIOLOGICAL CHANGES:
ASSESSMENT:
NURSING DX:
OUTCOMES:
INTERVENTIONS:
EVALUATION:
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

PANIC DISORDER

A

DEFINITION/DESCRIPTION: client experiences recurrent panic attacks

PATHOHYSIOLOGICAL CHANGES:
ASSESSMENT:
- attacks typically last 15-30 min
- FOUR or more of the following sxs present during an attack: palpitations, shortness of breath, choking or smothering sensation, chest pain, nausea, feelings of depersonalization, fear of dying or insanity, chills or hot flashes

-pt might experience behavior changes and/or persistent worries about when the next attack may occur

NURSING DX:
OUTCOMES:
INTERVENTIONS:
EVALUATION:

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

PHOBIAS

A

DEFINITION/DESCRIPTION:
- pt experiences irrational fear of a certain object or situation.

PATHOHYSIOLOGICAL CHANGES:
ASSESSMENT:
NURSING DX:
OUTCOMES:
INTERVENTIONS:
EVALUATION:
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

OBSESSIVE COMPULSIVE DISORDER

A

DEFINITION/DESCRIPTION:
-pt has intrusive thoughts of unrealistic obsessions and tried to control these thoughts with compulsive behaviors

PATHOHYSIOLOGICAL CHANGES:
ASSESSMENT:
NURSING DX:
OUTCOMES:
INTERVENTIONS:
EVALUATION:
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

SOMATOFORM DISORDERS

A

DEFINITION/DESCRIPTION: psychiatric disorder no organic basis for the physical SXS that are the chief complaints.

added risk factor if you have a co-occuring psychiatric disorders

PATHOHYSIOLOGICAL CHANGES:

Theory:
-amplified physiological response related to the brains inability to calm to central nervous system.

  • Cardiovascular
  • Musculoskeletal
  • Respiratory
  • GI/GU
  • Integumentary

ASSESSMENT:
- full health assessment to rule out physical illness with organic basis

NURSING DX:

  • ineffective individual
  • inadequate coping
  • family process
  • body image disturbance
  • chronic pain

OUTCOMES:

  • identifies interactions of mind and body
  • identifies the effects of stress on body
  • ** ASSUMES APPROPRIATE ROLES IN WORK/FAMILY/COMMUNITY**
  • Employs self help strategies

INTERVENTIONS:

  • SSRIs
  • Anti-anxiety- short term due to dependency
  • observe intensity and frequency of somatic sxs
  • reinforce patients strengths and problem solving abilities

EVALUATION:

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

SCHIZOPHRENIA

A

DEFINITION/DESCRIPTION:
Schizophrenia is characterized by delusions, hallucinations, disorganized speech and behavior, and other symptoms that cause social or occupational dysfunction. For a diagnosis, symptoms must have been present for six months and include at least one month of active symptoms.

  1. Cognitive Impairment
    - Bizarre Behaviors
  2. Sensory Perceptions
    • Hallucinations; Delusions
  3. Deterioration in psychosocial functioning

PATHOHYSIOLOGICAL CHANGES:

  • Structural Changes
  • Ventricular Enlargement
  • Decrease cerebral & intracranial size
  • Disordering of cells in hippocampus
  • Physical Conditions
  • Links with other neurological disorders
  • Alterations in neurotransmitter systems
  • Malfunction in transmission of information from one nerve cell across the synapses to postsynaptic receptors
  • Post mortem-^ dopamine receptors
  • Excess of dopamine & serotonin

ASSESSMENT:

Positive signs:
-hallucinations ( auditory, visual, olfactory (spices), gustatory ( metallic flavor), tactile

  • paranoia
  • delusions
  • though disorganization

Negative signs:

  • affective flattening ( no change in emotion/tone)
  • impoverish speech
  • apathy ( indifference)
  • avolition ( inability to persist in goal directed behaviors; bathing- lack of motivation)
  • alogia ( decreased fluency/content of speech)
  • ambivalence
  • anhedonia

Mood SXS:

  • dysphoria
  • anxiety
  • agitation
  • suicidality

Neuro-cognitive sxs:

  • distractibility
  • learning deficits
  • memory deficits
  • abstract thinking impairment

NURSING DX:

  • altered thought process
  • sensory/perceptual alterations
  • risk for violence
  • impaired communication
  • self-care deficits
  • intolerance to activity
  • social isolation
  • decisional conflict
  • sensory/perceptual
  • altered thought
  • altered emotional response
  • impaired home maintenance

OUTCOMES:

  • pt will recognize distortions of reality
  • demonstrate absence of violence, self harm
  • demonstrate reality-based thinking and behavior
  • maintain anxiety at manageable level
  • perform self-care activities independently
  • actively participate in unit activities
  • comply with meds
  • effective coping and problem solving
  • participate in discharge planning

INTERVENTIONS:
- psychotherapy ( group, individual, behavioral, support and family)

  • milieu therapy
  • somatic or ECT Therapy

-antipsychotic meds

  • Meet with patient each day for 30 minutes to establish trust and rapport.
  • Explore the voices with the patient when they are the most threatening & note the circumstances.
  • Provide noncompetitive/distracting activities that focus on the here and now
  • Explore possible actions that minimize or reduce the hallucinations

EVALUATION:

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

ANOREXIA NERVOSA

A

DEFINITION/DESCRIPTION: pts have intense irrational beliefs about their shape and wt, and engage in self-starvation, express intense fear of gaining weight, and have a disturbance in self-evaluation of weight and its importance

PATHOPHYSIOLOGICAL CHANGES:

  • amenorrhea in female pt’s (can lead to interference with age-appropriate development, which ppl assume to coordinate with the fear of sexual maturity)
  • significant compromise in every organ system of the body including - CV, GI, Endocrine, Derm, Hematological, Skeletal, and CNS
  • brain imaging studies show unusual activity in frontal, cingulate, temporal, parietal areas
  • serotonin pathways are abnormal –> key to anxiety responses, inhibition and distorted body image

ASSESSMENT:

  • avg age onset in early to middle adolescence
  • eating disorders are almost always comorbid with other psych illnesses
  • low self-esteem and self-doubts about personal worth
  • possible family infliction –> controlling, perfectionistic, achievement focused family
    • cachectic (severely underweight with muscle wasting)
  • lanugo (growth of fine, downy hair on face and back)
  • mottled, cool skin on extremities
  • low BP, bradycardia, and temp
  • BMI < 19
  • electrolyte imbalances (fatigue, weak, lethargy)
  • hypokalemic alkalosis (if vomiting or using laxatives/diuretics)

COGNITIVE DISTORTIONS:
- overgeneralization
“he didnt ask me out, it must be because im fat”
- all-or-nothing thinking
“if i allow myself to gain wt, ill blow up like a balloon”
- catastrophizing
“if i gain wt, my weekend will be ruined”
- personalization
“People wont like me unless im thin”
- emotional reasoning
“when i’, thin, i feel powerful”

NURSING DX:

  • restrictions of energy intake relative to requirements, leading to a signif low body wt in context of age, sex, development, and physical health
  • intense fear of gaining wt or becoming fat, or persistent behavior that interferes with wt gain, even tho V low wt
  • disturbed body image, persistent lack of recognition of the seriousness of low body wt

OUTCOMES: highest mortality rate of ANY mental illness

  • refrain from self-harm
  • normalize eating patterns as evidenced by eating 75% of 3 meals plus 2 snacks
  • achieve 85-90% of ideal body wt
  • demonstrate 2 new healthy eating habits
  • participate in treatment of associate psych symptoms (mood/self-esteem)

INTERVENTIONS:
- watch for refeeding syndrome (CV collapse)
- restore pt’s nutritional status (restoring wt within normal range)
- modify pt’s distorted eating behaviors
- help change distorted belief about wt loss and body image
- self-care activities
- milieu therapy (normalize eating patterns)
- Olanzapine, second-gen antipsychotic, increasingly being reported to positively affect wt gain and improve cognition and body image
EVALUATION:

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

BULIMIA NERVOSA

A

DEFINITION/DESCRIPTION: engage in repeated episodes of binge eating followed by inappropriate compensatory behaviors (vom, laxatives, diuretics, excessive exercise)

PATHOHYSIOLOGICAL CHANGES:

  • cardiac dysthymia
  • orthostatic changes in pulse/BP
  • electrolyte imbalance (hypOchloremia, hypoOkalemia, dehydration)
  • esophageal tears
  • Russell’s sign (knuckles)

ASSESSMENT:

  • binge eating
  • self-induced vomit
  • depressive signs and symptoms
  • increased anxiety and compulsivity
  • family may be chaotic and lack nurturing
    • medical stabilization
  • psych evaluation (comorbidity)
  • SI ?
  • ask for us or diuretics, vom, laxatives, diet pills, amphetamines, energy pills, skinny tea’s

NURSING DX:

  • recurrent episodes of binge eating (within 2 hour period, v large amount of food paired with sense of lack of control)
  • recurrent inappropriate compensatory behavior to prevent wt gain
  • binge eating and comp behavior occur at least once a week, for THREE months
  • self-evaluation is influenced by body shape and wt

OUTCOMES:

  • refrain from binge/purge
  • demonstrate at least 2 new skills for managing stress/anxiety/shame
  • obtain and maintain normal electrolyte balance
  • be free of self-directed harm
  • express feelings in a non-food-related way
  • name 2 personal strengths

INTERVENTIONS:

    • medical stabilization is FIRST PRIORITY (Fluid and Electrolyte, cardiac)
  • milieu therapy (observe during and after meals to prevent purging, normalize eating patterns, maintain appropriate amount of exercise)
  • CBT
  • fluoxetine = GOLD STANDARD in treating BN

EVALUATION:

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Relaxation training

A

used to control pain, tension and anxiety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Flooding

A

involves exposing a client to a great deal of undesirable stimulus in an attempt to turn off the anxiety response- useful for phobias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

modeling

A

allows a client to see a demonstration of appropriate behavior in a stressful situation, goal of therapy is that pt will imitate the behavior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Systematic desensitization

A

begins with mastering or relaxation techniques, then pt is exposed to increasing levels of anxiety-producing stimuli and uses relaxation to over-come the resulting anxiety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Types of Delusions

A

persecution: feeling threatening, others are hostile and trying to harm them

ideas of Reference: believe that all events are directly related to them

somatic: body altered from normal

Thought broadcasting: idea that unspoken thoughts can be heard

Thought insertion- beliefs of others being inserted into ones mind

Thought withdraw- thoughts being taken away by outside agency

Grandiose: exaggerated feeling of importance, power, knowledge or identity

Control/Influence: One’s actions or thoughts are controlled by external forces

jealousy-

Religiosity:

nihilistic: disbelief – everything is unreal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Types of Disorganized Speech

A
  • word salad- jumble of word, meaningless to listener and/or the speaker
  • loose association - flow one thought to the next with loos associations
  • clanging- meaningless rhyming

-echolalia- meaningless repetition of another person’s spoken words (mimicking) CATATONIA
echopraxia- mimicking of movements

  • Neologicsm: invented word (uniphrom)
  • Preservation: Inappropriate repetition of words or behaviors; abnormal compulsions (frontal lobe disorders)
  • Circumstantiality: unnecessary details and inappropriate thoughts
  • Tangentiality: detour from a topic that was logically progression but no return to the original topic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Schizoaffective disorder

A

presence of two disorders

-schizophrenia and Mood disorder (depression or bipolar)

  • delusions
  • hallucinations
  • disorganized speech
  • disorganized behavior
  • negative characteristics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Collaborative Management assessment

A
  • Chief complaint
  • onset
  • clinical manifestations
  • clients perceptions
  • suicidal ideation
  • previous hx of hospitalization
  • support system
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Psychopharmacology/antipsychotic meds

First Generation/Conventional/Typical

A

Dopamine antagonists

Target positive sxs

High Potency :

  • Haloperidol (Haldol)
  • Trifluoperazine (Stelazine)
  • Fluphenazine (Prolixin)

Medium Potency:

  • Loxapine (Loxitane)
  • Perphenazine (Trilafon)

Low Potency:

  • Chlorpromazine (Thorazine)
  • Thioridazine (Mellaril)

Adverse Effects:

Extrapyramidal Symptoms (EPSs)

  • Akathisia
  • Acute dystonia
  • Pseudoparkinsonism

-Tardive dyskinesia (TD)

-Neuroleptic malignant
syndrome (NMS)

  • anticholinergenic effects: dilated pupils, dry mouth, decreased sweating, slowed bowels and bladder

Antiadrenergic effects: orthostatic hypotension

  • lowered seizure threshold
  • photosensitivity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Psychopharmacology/antipsychotic meds

Second Generation/Atypical

A

Dopamine and serotonin antagonists

lessen the negative sxs

Adverse Effects:
Dystonia ( 1-2 days)
-Spasms of tongue and face

akathisia ( 1-6 wks) - restlessness

Tardive Dyskinesia ( late in treatment) - irregular, jerky muscle movements

  • continuous restlessness
  • slow arms and legs

Pseudoparkinsoniam ( 1-4 wks)
-muscle tremors, shuffling gait, drooling

21
Q

Psychopharmacology/antipsychotic meds

Second Generation/Atypical

A

Dopmaine & seratonin antagonists

block norepinephrine, histamine and acetylcholine

lessen the negative sxs
Target positive and negative sxs

Adverse Effects:
Dystonia ( 1-2 days)
-Spasms of tongue and face

akathisia ( 1-6 wks)
Tardive Dyskinesia ( late in treatment)
  • continuous restlessness
  • slow arms and legs

Pseudoparkinsoniam ( 1-4 wks)

-muscle tremors, shuffling gait, drooling

Common drugs
-clozapine
can cause agranulocytosis: monitor WBC weekly and then biweekly, monitor weight gain

-risperidone
(NMS, EPS, GI; obtain baseline vitals and ekg)

-paliperidone

-olanzapine
-quetiapine
( these two can cause drowsiness, EPS, weight gain, orthostatic hypotension)

  • ziprasidone
  • aripiprazole
22
Q

Neuroleptic Malignant Syndrome (NMS)

A

Rare but potentially fatal (Onset – within a week)

R/T Dehydration or high potency drugs (Haldol)

-Altered LOC
-Hyperpyrexia (Temp 101-103 F)
-Muscle rigidity
Autonomic hyperactivity
-Rhabdomyolitis : Myoglobinuria , Renal Failure

Treatment: Dantrolene (Dantrium) – skeletal muscle relaxant
Bromocriptine (Parlodel) – dopamine agonist

Do Not reinstitute antipsychotics for are least 2 weeks after complete resolution of NMS

23
Q

Clozapine

A

Use: Treat refractory Schizophrenia

Adverse Effects: Agranulocytosis

Weekly monitoring WBC count required 1st 6 months and; bi-weekly

If WBC’s fall below < 2000 cells/mm3 -Discontinue drug and; patient never receive drug again

24
Q

Maintenance Therapy

A

Depot injections of fluphenazine, haloperidol

effects last 2-4 weeks

25
Adjuncts to Antipsychotic Drug Therapy
Antidepressants are administered for severe depression. Lithium and other mood stabilizers reduce aggressive behavior. Benzodiazepine augmentation improves positive and negative symptoms. -Clonazepam (Klonopin) – Decreases anxiety, agitation, and possibly psychosis.
26
Nurse’s Role Related to Psychopharmacology
- Assess for side effects before and after administering and intervene early - Administer safely - Know nursing considerations - Promote education - Teach lifelong skills for community living. - Monitor quality-of-life issues. - Information on diet, exercise, antacids, smoking
27
Interventions for hallucinations
- Protect the client from injury - Share your observations with the client - Make frequent & brief remarks to interrupt the hallucinations - Avoid denying or arguing with the client about the hallucination - Administer antipsychotic drugs prn
28
fugue state
Dissociative fugue, formerly fugue state or psychogenic fugue, is a dissociative disorder and a rare psychiatric disorder characterized by reversible amnesia for personal identity, including the memories, personality, and other identifying characteristics of individuality. The state can last days, months or longer. Help by: providing grounding techniques such as stomping feet, clapping hands, touching physical oobjects
29
conversion disorder
is named so because it appears to convert a source of stress into a physical problem
30
depression and substance abuse among the sex's
Women are more likely than men to experience Depression; men are more likely than women to experience substance abuse.
31
Depersonalization
out of body experience, feeling like you floating above the ground
32
Derealization
stating that objects/ surrounding is far away or really small/ unreal
33
Amnesia
lack of memory for extended period of time
34
Eustress
beneficial stress - used to help people to develop skills needed to solve problems and meet personal goals
35
stressor
trigger
36
distress
damaging/detrimental- high and prolonged, chronic stress
37
EPS
Extra pyramidal SXS- Drug induced movement disorders
38
Beneficence
quality of doing good- charity, spending extra time to help calm and extremely anxious patient
39
autonomy
clients right to make their own decision, client must accept responsibility of consequences Recognizing a patients right to refuse treatment
40
Justice
fair and equal treatment for all
41
fidelity
Maintaining loyalty and commitment to the patient and doing no wrong to the patient
42
veracity
Honesty- the duty to communicate truthfully
43
involuntary vs voluntary admission
court ordered/ they brought themselves in
44
Restraints
physical or injectable - document - must be an order - all other avenues explored first - reevaluation of removal and new order every 24 hours
45
Tardive Dyskinesia (TD)
EPS of antipsychotic drugs - usually appears after prolonged treatment - serious, is not always reversible - involuntary tonic muscular spasms that typically involve the tongue, fingers, toes, neck, trunk or pelvis - fasciculations of the tongue, constant lip smacking. Can develop into uncontrollable lip biting, checking or sucking motions, an open mouth and lateral movements of the jaw.
46
Acute Dystonia
- common EPS of antipsychotic drugs - severe spasms of the muscles of the tongue, head and neck; upward fixed deviation of the eyes; severe back spasms the arch the trunk forward and thrust and head and lower limbs backward -
47
akathisia
- EPS of antipsychotic drugs | - internal restlessness and external restless pacing and fidgeting
48
pseudoparkinsonism
- EPS of antipsychotic drugs | - stiffening of muscular activity in the face, body, arms and legs