Exam 3 Flashcards
(85 cards)
1
Q
The painful emotional response to the loss of something or someone significant
A
Grief
2
Q
Clients experiencing a painful loss go through some predictable stages:
-Denial
-Anger
-Bargaining
-Depression
-Acceptance
A
Kubler-Ross Model of Grief
3
Q
Initially, clients may have difficulty accepting that the loss has really occurred. This is a common first reaction.
A
Denial
4
Q
Clients who are grieving often experience strong feelings of ____. They may express ____ toward self, others, or even the lost person.
A
Anger
5
Q
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.”
A
Bargaining
6
Q
Of course, clients that are grieving will experience intense feelings of sadness, sorrow, and loss.
A
Depression
7
Q
Eventually, most clients come to accept the loss. They utilize coping strategies and become less preoccupied with it. That’s not to say they no longer feel the loss of grieve. They still have ups and downs, but they’ve found new ways to stay connected to the loss as they continue life.
A
Acceptance
8
Q
Are the stages of grief set in stone? (Meaning, does everyone experience every stage?)
A
No, not everyone experiences every stage of grief. Also, it is possible that the stages are not experienced in the order they are listed.
9
Q
Clients experience the stages of grief. Somatic complaints are common. Some authors say that clients usually achieve some degree of acceptance by 6 months, but each situation is unique and there is no set time limit for grieving.
A
Normal grief
10
Q
Occurs when a client experiences the stages of grief before the loss occurs. Sometimes clients are not aware they are experiencing this type of grief since the loss has not yet occured.
A
Anticipatory grief
11
Q
Occurs when the grief response may be inhibited, exaggerated, or prolonged. A helpful way to distinguish this from normal grief is that this is often accompanied by feelings of worthlessness or low self-esteem.
A
Maladaptive grief
12
Q
Occurs when an individual experiences too many losses at too rapid of a pace. Older adults are especially prone to experiencing this.
A
Bereavement overload
13
Q
Two types of mood disorders
A
Depressive disorders and Bipolar disorders
14
Q
Depressive disorders
A
Major depressive disorder, Dysthymia, Premenstrual dysphoric disorder
15
Q
Bipolar disorders
A
Bipolar 1, Bipolar 2, Cyclothymia
16
Q
Clients have a depressed mood and/or loss of interest in pleasurable activities (anhedonia). Clients can feel extreme guilt and feelings of worthlessness. Sleep abnormalities are common. Appetite changes are common. Clients can be incredibly fatigued, making it difficult to get out of bed. Some clients experience psychomotor agitation and irritation. Suicidal thoughts and behaviors can occur.
A
Major Depressive disorder
17
Q
Depression subtype- This is a severe version of depression in which a client’s mood is extremely dark 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.
A
Melancholic features
18
Q
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. Alternatively, they may believe they have a severe illness or that their body is “rotting.” Auditory hallucinations can also occur.
A
Mood-congruent psychotic features
19
Q
This is a form of depression that reoccurs seasonally (usually winter). Light therapy is an effective treatment.
A
Seasonal patterns
20
Q
This subtype of depression is associated with pregnancy. Some of these clients will develop psychotic features.
A
Peripartum onset
21
Q
What are some psychological factors of depression?
A
-negative beliefs abut the world, themselves, and the future
-cognitive distortions such as all-or-nothing thinking, personalization, mind reading, and discounting positives.
22
Q
What are some biological factors of depression?
A
-Deficiencies of serotonin, norepinephrine, and dopamine in the brain
-A medical condition such as hypothyroidism
-Medication use (e.g. alcohol, beta blockers, steroids, withdrawing from a stimulant like cocaine or amphetamine)
23
Q
Effective treatment options for depression
A
-Psychotherapy (CBT, group therapy)
-Pharmacotherapy (antidepressants: SSRIs- first-line agents, SNRIs, TCAs, and MAOIs)
-Brain stimulation Therapies (Electroconvulsive therapy, Transcranial magnetic stimulation)
24
Q
An effective option for clients who are extremely suicidal or have failed numerous other treatments for depression
A
ECT (Electroconvulsive therapy)
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A procedure in which strong magnetic pulses are sent through the skull into the brain (usually the left prefrontal cortex). The evidence for this treatment for depression is not as strong as other options
TMS (Transcranial magnetic stimulation)
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Nursing interventions for depression
-SAFETY. Assess for suicidal ideation often and monitor closely.
-Convey empathy and unconditional positive regard
-Teach the stages of grief and explain that these are normal feelings
-Allow clients to express anger and don't take offence. Physical activity may also be a healthy outlet.
-Explain that crying is okay. Use silence; don't rush to change the subject
-Encourage clients to seek out spiritual support and a support group
-Teach clients with low self-esteem assertiveness techniques
-Explain that antidepressants can take up to 4 weeks to begin working
27
Clients with this disorder experience both sides of the mood scale. Mania- feel exuberant, confident, highly creative, endless energy, constantly moving about, little to no need for sleep, pressured speech, dangerous behaviors (drugs, risky sex, reckless spending), highly distractible. Agitated outbursts are common, psychotic delusions nd hallucinations may also occur. Mania usually ends with a crash into deep depression
Bipolar disorder
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A less severe version of mania. Clients experience an elevated mood, enhanced creativity, increased energy, and may act intrusively. this by itself does not cause significant impairment
Hypomania
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These clients experience mania (and usually depression)
Bipolar 1
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These clients experience hypomania and depression
Bipolar 2
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Clients that experience 4 or more mood episodes in a 12 month period
rapid cyclers
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What are some psychological factors for bipolar disorder?
Stressful life events in childhood seem to increase risk of developing bipolar disorder
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What are some biological factors for bipolar disorder?
-Strong genetic basis. Having a first-degree relative with bipolar disorder increases a person's lifetime risk to 5-10%
-Excessive levels of norepinephrine and dopamine as well as deficient levels of serotonin (even during mania) has been linked to this disorder
-Bipolar depression and regular depression are different in that antidepressants do not usually help with bipolar as it does with unipolar depression.
34
Effective treatment options for bipolar disorder
-Psychotherapy (CBT, group psychoeducation can help learn coping skills and improve medication adherence)
-Pharmacotherapy (essential to treating bipolar; common medications include lithium, anticonvulsants such as valproate, lamotrigine, and carbamazepine, as well as second generation antipsychotics such as aripiprazole, clozapine, and ziprasidone
-ECT
35
Nursing interventions for bipolar disorder
-Decrease environmental stimulation when clients are manic, but do NOT isolate a client
-Assess for suicidal and homicidal thoughts
-Remove all dangerous objects when clients are agitated, confused, or suicidal
-Assess for illicit drug use
-Set limits on dangerous and manipulative behaviors. Clearly describe expectations and consequences if limits are broken. Give immediate feedback when limits are broken and provide positive reinforcement for non-manipulative behaviors.
-Maintain a calm demeanor and tone of speech. Remember that anxiety can be contagious.
-Listen to and act on legitimate complaints
-Avoid power struggles; don't become emotional
-Provide outlets for physical energy
-Clients experiencing mania have increased caloric needs and may have difficulty sitting down during meals. Monitor nutritional status and provide high-protein, high-calorie, portable food and drinks
-Promote good sleep hygiene and limit caffeine use during manic episodes.
36
Long-term risk factors of suicide
-Age: highest risk group is 45-64 year-olds
-Gender: males have the highest rate of suicide, but women have more attempts
-Ethnicity/race: whites are the highest risk group, followed by American Indians
-Marital status: single, divorced, widowed, and LGBTQ+ individuals
-Socioeconomic status: the very poor and very rich
-Occupation: physicians, law enforcement officers, dentists, mechanics, lawyers, & insurance agents
-Religion: people who lack close religious affiliation
-Family history: having a family member who committed suicide
-Military: suicide rates among military personnel are higher than the general population
-Previous attempts: 50-80% of people who commit suicide have at least 1 previous attempt
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Imminent risk factors for suicide (IS PATH WARM mnemonic)
-Ideation: does client have a plan? The means to complete plan? How lethal is the plan? A lethal plan that a client has the means to carry out is a major warning sign
-Substance abuse: substances disinhibit people and interfere with judgement
-Purposelessness: does the client see no meaning or purpose for living?
-Anger: Is the client angry? One extra painful emotion can push a client over the edge
-Trapped: does the client believe there is no way out of his or her current predicament?
-Hopelessness: does the client see any other alternatives besides suicide to solve their problems?
-Withdrawing: is the client letting go, saying goodbye? This is not always obvious. Examples include sending flowers with a not, taking out a life insurance policy, getting finances in order, giving gifts, etc.
-Anxiety: is the client anxious? One extra painful emotion can push a client over the edge. Also, anxiety can cause insomnia-another risk factor
-Recklessness: is the client engaging in thoughtless, dangerous behaviors? This can be a sign they no longer value life.
-Mood shifts: is there a sudden change in the client's mood (positive or negative)? A sudden, positive shift could mean the client has decided to commit suicide.
38
Nursing interventions for suicide
-When assessing for ideation, be direct and matter-of-fact. Research shows assessing for ideation decreases risk of attempts
-A helpful way to raise an uncomfortable topic like this is to use the normalizing technique. (i.e. "sometimes when clients are going through intense emotional pain, they have thoughts about killing themselves. Have you had any thoughts like that?")
-Pay attention to indirect statements like "I don't have anything worth living for anymore." Assess for suicidal ideation when you hear these kind of statements
-Be alert to 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, and if they have rehearsed it, the risk is even greater
-If a client has suicidal thoughts, remove all potentially dangerous objects (shoe strings, glass, cords, belts, metal eating utensils, plastic bags, potential poisons, etc) and initiate one-on-one constant supervision (even when using the bathroom)
-Encourage the client to participate in establishing a detailed safety plan. ex: whom would they call if they started having a strong desire to carry out the plan?
-Ensure that clients are not "cheeking" medications. Clients may save these pills to attempt an overdose
-A sudden change in a client's mood can indicate the client intends to commit suicide in the near future
39
Electroconvulsive therapy (ECT) important considerations
-Efficaciousness: very effective treatment for severe depression. other indications include bipolar disorder, schizophrenia, and schizoaffective disorder
-Informed consent: In most cases, clients give informed consent. If a client is too ill or lacks the capacity to consent, the provider must seek a court order. The informed consent process is very detailed due to the controversy associated with ECT
-Anesthesia: clients are given a short-acting anesthetic (e.g. propofol) to render them unconscious during the procedure as well as a paralytic (e.g. succinylcholine) to prevent muscle contractions and injury. Clients are unconscious, feel no pain, and do not convulse like people imagine.
40
ECT treatment course and adverse effects
-Standard treatment course is 2-3 treatments per week for a total of 6-12 treatments. Relapse is common and many clients also receive maintenance ECT
-ECT is very safe and can even be performed on pregnant women, but can still produce adverse effects such as headache, elevated vitals, memory loss, aspiration, dental or tongue injuries, muscle soreness, and nausea. These effects are usually temporary, but can be permanent.
41
Nursing interventions for ECT
-Assess the client and family's understanding of ECT and help correct any misconceptions
-Know your medications. An anticholinergic (atropine or glycopyrrolate) is given before the procedure to dry up secretions and prevent a seizure-induced vagal response (i.e. bradycardia)
-Airway 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 hypertension, make sure it us under control
-Maintain the client's IV until recovery is fully complete
-Stay with the client. Reorient to time and place. Explain what has occurred. Provide reassurance.
42
Individuals with _______ have difficulty adapting to the needs of the moment. They rigidly stick to dysfunctional interaction styles. The inflexibility causes significant distress to themselves and others. These problems can cause them to ramp up maladaptive thoughts, emotions, and behaviors
Personality disorders
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Schneider's Four Es
-Early: the beginnings of the disorder were present early in life and became fully developed in adulthood.
-Enduring: personality disorders do not come and go. These maladaptive patterns are present in all situations and with all people
-Egosyntonic: clients have poor insight. They believe others are the source of their distress. If they seek treatment, it is usually for a comorbidity
-Externalization: clients with a personality disorder externalize their stress onto others; it's the people around them that feel uncomfortable
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Cluster A personality disorders- characterized by odd or eccentric behaviors
-Paranoid personality disorder
-Schizoid personality disorder
-Schizotypal personality disorder
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Cluster B personality disorders- characterized by dramatic, emotional, and erratic behaviors
-Antisocial personality disorder
-Borderline personality disorder
-Histrionic personality disorder
-Narcissistic personality disorder
46
Cluster C personality disorders- characterized by anxious emotions and behaviors
-Avoidant personality disorder
-Dependent personality disorder
-Obsessive-compulsive personality disorder
47
Clients are highly suspicious of others-even close companions. They stay on the alert lest someone try to sabotage them or take advantage. They are private and reveal little about themselves-someone could use personal information against them
paranoid personality disorder
48
Clients are reclusive and have very limited social interaction. They are not lonely or fearful of rejection. Rather, they have little interest in others. They prefer solitude. Others find them to be awkward and strange
schizoid personality disorder
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Clients have disorganized speech and behavior. They are odd and eccentric. They do not have hallucinations or delusions, but they may engage in magical thinking and experience illusions (e.g. UFO sightings)
Schizotypal personality disorder
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Clients are dramatic and love the spotlight. They usually dress seductively and can be very flirtatious. Relationships are intense, but shallow and short-lived.
Histrionic personality disorder
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Clients are very proud and outspoken about their talents and achievements. They are very preoccupied with themselves. Their interest in someone can be strong if they believe that person may help them get what they want. Just as quickly, their interest will vanish when that person is no longer needed. They are entitled.
narcissistic personality disorder
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Clients crave relationships but feel too awkward or inept to pursue them. They fear rejection so much, they find it easier to avoid new relationships. Their only relationships are with a few old friends.
Avoidant personality disorder
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Clients feel a desperate need to be cared for and nurtured by someone else. They are needy, unassertive, and overly submissive. They have few interests of their own and view the world through other people's eyes.
Dependent personality disorder
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Clients are overly concerned with rules, order, and routines. They are true perfectionists and have trouble delegating. They are inflexible in relationships; it's their way or the highway
Obsessive-compulsive personality disorder
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Clients had serious behavior problems starting in childhood. As they have grown up, they've maintained these selfish, ruthless, violent behaviors. They lie, cheat, steal, and destroy. "every man for himself" or "survival of the fittest" worldview. they are charming when trying to manipulate others, but a low tolerance for frustration. If kindness doesn't work, they quickly turn violent and aggressive. They are frequently incarcerated.
Antisocial personality disorder
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Psychosocial factors associated with antisocial personality disorder
-Clients tend to have difficult childhoods
-Parental affection was often withheld
-Many experienced physical abuse and neglect
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Biological factors associated with antisocial personality disorder
-There seems to be evidence of genetic risk factors and neurobiological abnormalities
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Effective treatments for antisocial personality disorder
-Psychotherapy: CBT may help those that are more mild, have good insight, and are motivated to change
-Pharmacotherapy: there are no medications to treat this disorder, but they can help with comorbid disorders. Medications with abuse potential should be avoided.
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Nursing interventions for antisocial personality disorder
-Don't allow yourself to have personal triggers. Monitor your thoughts and emotions and watch for countertransference
-Remember to convey unconditional positive regard and maintain the attitude that it is not the person, but their disorder that is unacceptable
-Observe the client's behavior frequently and remove dangerous objects from the environment
-Set clear limits on unacceptable and manipulative behavior. Remember to use a calm, matter of fact tone, clear, understandable terminology, and explain what the consequences are if limits are broken. Ensure consistency among staff in explaining and enforcing limits
-Give positive feedback when clients behave appropriately
-Clients often misuse the ego defense mechanism of displacement. Help clients realize this and recognize the real source of their anger
-Encourage clients to express their anger in healthy ways
-Ensure sufficient staff is available to present a "show of strength" if necessary. Remember to use the least restrictive means necessary.
60
Clients have intense fears of abandonment and cling tightly to relationships. They get angry when others don't meet their unrealistic expectations. These behaviors drive others away. Splitting is a common ego defense mechanism. They handle feelings of rejection by vilifying the person that offended them and imagine other friends or relatives saintly. This false caricature serves to highlight the misdeeds of the person who angered them and justify the clients' intense rage. They are emotionally unstable and depression, self-mutilation, and suicide are common. They have poor impulse control- substance abuse, gambling, promiscuity, and reckless driving are common
Borderline personality disorder
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psychosocial factors associated with BPD
Many clients experienced childhood trauma (e.g. physical or sexual abuse)
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Biological factors associated with BPD
Research suggests there are genetic and neurobiological risk factors
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Effective treatments for BPD
-Psychotherapy: dialectical behavioral therapy is the primary therapy for this disorder
-Pharmacotherapy: targeted at specific symptoms that accompany BPD. Antidepressants can help treat depression, antipsychotics and mood stabilizers can treat emotional instability, impulsivity, and aggression
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Nursing interventions for BPD
-Don't allow yourself to have personal triggers. Monitor your thoughts and emotions and watch out for countertransference
-Remember that clients who have BPD have strong fears of abandonment. They often exhibit clinging and distancing behaviors. Help these clients understand that you are available, but do not promote dependent, clinging behaviors. Consider rotating staff members.
-Splitting is a primary ego defense mechanism of clients with BPD. These clients tend to see people as either all good or all bad. Encourage the client with BPD to discuss those feelings directly with the staff member involved
-Encourage clients who engage in self-mutilating behaviors to seek out a team member if the urge returns. Remove dangerous objects and frequently monitor the client
-Encourage clients to verbalize painful emotions and provide physical outlets for strong emotions. Give positive reinforcement when clients express anger appropriately
-If self-mutilation occurs, do not reinforce the behavior by giving lots of sympathy or showing lots of interest in the wounds. Instead, matter-of-factly treat the wounds and encourage the client to discuss the emotions that preceded the self-injury. The goal is to help the client find better coping strategies next time the urge returns
-Assess for suicidal ideation.
65
If you drink coffee on a regular basis, your body adjusts and you won't get the same stimulatory effect. You'll need higher quantities of caffeine to receive the same initial effects. This phenomenon is called _______. Clients frequently develop a _________ to chemical substances. That does NOT mean they have an addicton.
Tolerance
66
Once your body gets used to a chemical substance, you may feel discomfort if you stop using them, This phenomenon is called ________. Clients frequently become ________ on chemical substances. That does NOT mean they have an addiction.
Dependence
67
When you abruptly stop using a medication you have a dependency to, you go through a _______ syndrome. These unpleasant symptoms are often opposite of the normal effects of the medication. For example, clients withdrawing from CNS depressants may feel overstimulated, nervous, and may even have a seizure.
Withdrawal
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_________ is a disease in which a person compulsively seeks out a drug and uses it despite the negative consequences it causes to the person and those around.
Addiction
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A common treatment strategy that removes the original substance and replaces it with a similar substance that will reduce the side effects of withdrawal. Some also make the abused substance not pleasurable.
Substitution therapy
70
If someone has another mental disorder along with substance abuse (that they use a substance to treat some symptoms of their other disorder), what is likely to happen when they quit abusing the substance?
Their other issue is likely to get worse, which will increase the urge to self-medicate, creating a cycle that is hard to break.
71
Why is including family members in a client's substance abuse recovery important?
Because while the client is encouraged to take full responsibility for their actions, dysfunctional family relationships tend to increase a client's drug abuse, so including family in the client's recovery gives an opportunity to work on those relationships
72
These increase alertness and energy. In excess, these medications can produce anxiety, paranoia, hallucinations, and seizures. They typically increase heart rate and blood pressure, dilate pupils, and suppress appetite. High doses activate the brain's reward circuitry and create a sense of euphoria
CNS stimulants
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These decrease alertness and energy, reduce anxiety and induce sleep (which is not always restorative because they disrupt the REM phase). High doses activate the brain's reward circuitry and create a sense of euphoria. These drugs reduce respiratory rate and blood pressure, which can cause respiratory failure that leads to death.
CNS depressants
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These induce altered states of consciousness. They are highly unpredictable in their effects, which is why some people experience bad trips (strong dysphoria). These usually have stimulatory effects.
Hallucinogens
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What increases the risk of developing a substance use disorder?
-genetics
-environmental influences (peer pressure)
-presence of other mental disorders
76
which neurotransmitter do illicit drugs utilize?
dopamine
77
What happens to the reward system when it adapts to overstimulation?
Neurons decrease their production of dopamine, then fewer dopamine receptors are produced, which means natural stimulation of the reward system is severely reduced.
78
What results from the decrease in stimulation of the reward system in substance abuse disorders?
The client no longer enjoys the drug, but needs it to function. They typically want to quit but feel trapped.
79
What is included in the broad diagnostic criteria of alcohol use disorder?
Clients that intermittently abuse alcohol in ways that cause clinically significant distress and clients who have become dependent on alcohol
80
How is alcohol use disorder described for clients that intermittently abuse alcohol?
They have not developed a significant tolerance for alcohol, do not experience a withdrawal syndrome, and are not strongly compelled to use it.
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How is alcohol use disorder described for clients that have become dependent on alcohol?
They need increasing amounts of alcohol to experience the same effects (tolerance). When they abstain from drinking, they experience painful physical and psychological effects (withdrawal). They feel a strong urge to drink, despite the devastation it is causing to their lives (compulsive use)
82
In lower amounts, alcohol depresses frontal lobe activity, causing euphoria, disinhibition, and impaired judgement. As blood levels rise, parietal lobe activity is depressed, causing impaired speech and motor function. Further drinking impairs the occipital lobe and cerebellum, causing impaired vision and problems with balance. Eventually the brainstem is affected and can cause coma and respiratory depression. What is this referring to?
Intoxication
83
What are the symptoms of alcohol withdrawal and how long does it take to begin after cessation?
It can begin within a few hours of cessation and can include hand tremors, nausea, vomiting, headache, malaise, autonomic activation, anxiety, insomnia, and irritability. Seizures and hallucinations can also be an issue.
84
What is Wernicke-Korsakoff Syndrome?
It is caused by poor intake of thiamine (vitamin B1); alcohol inhibits absorption of this essential nutrient. Wernicke's encephalopathy is characterized by abnormal eye movements, ataxia, confusion, and stupor (left untreated can cause death). Korsakoff's psychosis is characterized by an inability to convert short-term memory into long-term memory.
85
What are DTs?
Delerium Tremens (DTs) are developed 2-4 days after drinking cessation and are characterized by extreme confusion, hallucinations (visual), and autonomic activation. Electrolytes and blood gas abnormalities are common, but modern medical treatment has substantially reduced the mortality rate of DTs. Proper treatment has decreased the risk of death to less than 5%
