final Flashcards
(307 cards)
1
Q
abuse
A
deliberate mistreatment of a person
2
Q
subcategories of abuse
A
physical abuse
sexual abuse
psychological/emotional or verbal abuse
child abuse
elder abuse
3
Q
prof responsibilities related to abuse
A
public health act
adult guardianship trustee
public guardianship act
child, family, community service act
criminal code of canada
4
Q
why would you call the police if you suspect someone is at immediate risk (criminal code)
A
(criminal code)
- suspect crime has occurred, might occur, or someone is exhibiting behaviour indicating a lack of wellbeing and unpredictability
5
Q
for neglect/abuse, why would you call the adult guardianship act
A
- concerned that an adult is being abused, neglected, or is self neglecting and is unable to seek support and assistance due to (physical restraint, physical handicap limiting ability, an illness affecting ability to make decision)
6
Q
financial legal risk, why would you call public guardian and trustee
A
adult is not capable of managing financial and legal affairs & imminent risk to assets (under duress and going along with decisions they don’t agree with, financial mismanagement)
7
Q
vulnerable groups for abuse
A
- ppl with psych disorder
- LGBTQ2+
- ppl in care
- immigrants
- children & youth
- intimate partners
- older adults
- indigenous ppl
- ppl with disabilities
8
Q
why are women reluctant to identify their abuser
A
- fear retaliation against themselves or children
- may hold strong feelings toward partners or family members, despite abuse
9
Q
women abuse
A
domestic abuse, spousal abuse, or intimate partner abuse
10
Q
stalking/harassment
A
crime of intimidation, involved behaviour that occurs over a period of time, and which causes individuals distress or fear
11
Q
battering
A
repeated physical or sexual violence with the intent of coercive control
associated with anxiety, SI
12
Q
risk of violence increases w/ prego and can result in harm to unborn baby
A
true
13
Q
rape & sexual assault
A
any form of nonconsenting sexual activity, ranging from fondling to penetration
14
Q
risk factors for elder abuse
A
environmental risk (caregiver who is depressed, overwhelmed, burnt out)
inadequate economic resources
cognitive impairment
lack of empowerment
difficulties with ADLs
15
Q
types of abuse for older adults
A
physical, emotional, sexual, financial, neglect, over medicating, under medicating, restraining, secluding
16
Q
self neglect
A
Vulnerable adults who neglect themselves are unwilling or unable to do needed self-care. This can include such things as: Not eating enough food to the point of malnourishment. Wearing clothes that are filthy, torn, or not suited for the weather.
17
Q
sexual assault and age of consent
A
- 16 consent (kissing to intercourse)
- 18 years where sexual activity involves exploitative activity when it occurs in a relationship of authority, trust, or dependency
18
Q
exemptions for sexual assault and consent
A
Exceptions: Persons under16years can have consensual sex with someone close in age.
12-13year old (two-year age difference)
14-15year old (five-year age difference)
These exceptions only apply if the older person isnotin a position of authority or trust and there is no exploitation or dependency.
19
Q
consent is
A
voluntary agreement to engage in sexual activity or contact
absence of “no” does not mean “yes”
20
Q
consent is feeling
A
willing, certain, comfortable, sober, informed, respected
21
Q
consent is not feeling
A
pressured, confused, scared, drunk or high, ignored, disrespected
22
Q
is it the responsibility of the person initiating sexual activity to establish consent
A
YES
23
Q
cycle of abuse phases
A
- tension building
- violence erupts
- remorse ensues
24
Q
tension building phase
A
- minor incidents
- perp total control of victim (psych/emotional)
- isolates victim
- monitor victim activities
- degrades victim
25
violence erupts
- severe injury
- victim may incite violence as way to control mounting terror
- period of calm follows battering
26
remorse ensues
- perp becomes kind, loving - begging for forgiveness & promise to never inflict violence again
- tension builds; cycle repeats
27
why do people stay in abusive relationships
- economic/financial dependence
- societal, cultural, religious
- fear of retaliation, threats, harassment
- mental health problems (depression/PTSD)
- violence occurs once relationship established
- history of trauma & abuse
28
traumatic bonding
strong emotional ties between 2 people, one of whom intermittently abuses the other
29
biological effects of abuse
- mild injuries (bruises/abrasions of head, neck, face)
- severe injuries (multiple traumas, fractures, lacrations, loss of vision, hearing)
30
common mental health responses of biological effects of abuse
major depression, acute stress, PTSD, dissociative identity disorder
31
psychological effects of abuse
low self-esteem
guilt & shame
anger
problems with intimacy
revictimization
32
PTSD related symptoms
- hyperarousal & hypervigilance
- intrustive thoughts, flashbacks, memory impairment
- avoidance & numbing
- anhedonia
- dissociation
33
rpn role in identifying abuse
- assessment (what to look for)
- causes? (medical, environment)
- look at what to rule out first
- don't get hung up on diagnosis
- take all complaints of abuse seriously
- safety
- duty to report
- referrals
34
barriers to assessing for abuse include
perceived insufficient time
lack of understanding or knowledge
ensuring privacy of client
discomfort with asking questions about abuse
not knowing what to do once disclosure occurs
35
competent adults hvae the right to choose how they live, they can decline or refuse treatment, services, or resources despite living at risk (t/f)
true
36
rpn role with competent adults and abuse
- recognize potential victims
- report suspected abuse to social worker
- establish safety and trust
- assess for injuries, urgency of situation, abuse, neglect, self-neglect
- document your findings and interventions
- do not announce / no information client
- empower survivors
- collab approach
- respect client's choice, remain nonjudgemental
37
binge eating
episodes of uncontrolled eating of large amounts of food within discrete periods of time followed by feelings of guilt and purging behaviours
38
body dissatisfaction
belief that one's current body size differs from a highly valued ideal body size and deserves negative appraisal
39
dietary restraint
cognitive effort to restrict food intake for the purpose of weight loss or prevention of weight gain
40
interoceptive awareness
sensory response to emotional and visceral cues such as hunger
41
maturity fears
feeling overwhelmed by adult responsibilities (underlying issues for ppl with anorexia)
42
purging
compensatory behaviour to rid oneself of food already eating by means of self-induced vomiting or use of laxatives, enemas, diuretics
43
psych characteristics relating to eating disorders
- diff expressing anger
- low self-esteem
- body dissatisfaction
- powerlessness
- ineffectiveness
- obsessiveness
- compulsiveness
- non-assertiveness
- cognitive distortion
44
common eating disorder warning signs
- constant dieting
- rapid, unexplained weight loss
- obsession with calories, food, nutrition
- taking laxatives or diet pills
- going to bathroom right after meals
- eating alone, at night, or in secret
- hoarding high calorie food
45
anorexia nervosa
life threatening eating disorder characterized by refusal to maintain body weight appropriate for age, intense fear of gaining weight or becoming fat, a severely distorted body image, and refusal to acknowledge seriousness of weight loss
46
psychological characteristics specific to AN
- decreased interoceptive awareness
- sexuality conflict
- maturity fears
- ritualistic behaviours
- perfectionism
- dietary restraint
47
anorexia subtypes
restricting, binge eating/purging
48
restricting AN
restricting dietary intake
during current episode of AN, person does not binge or purge
49
binge eating/purging AN
during current episode of AN, the person engages in binge-eating and purging behaviours
50
whats the difference between BN & binge/purge AN
b/p AN person is severely under weight and has symptoms characteristics of AN in addition to b/p
51
MHA and eating disorders
pt only certified for MEDICAL reasons, otherwise voluntary on eating disorders unit or outpt
52
assessment for eating disorders
history
collateral
LABS
VS
insight/judgement
weight, appearance, lifestyle, triggers
recent changes?
MSE/ HTT
53
Labs for AN
low LH, FSH. T3, RBS
high GH, cortisol
anemia
thrombocytopenia
hypercholesterolemia
hypophosphatemia
electrolyte imbalance
54
reasons for admission for AN
medical = weight loss, physiological instability, severe dehydration
symptoms of starvation = electrolyte imbalance, syncope, seizures, HR < 40bpm, cardiac BMI < 16
psychiatric = SI, psychosis, OCD, family dysfunction, lack of improvement, decreased functioning
55
communication strategies for AN
- rapport/trust
- be direct
- be encouraging & supportive
- defuse shame, blame, guilt
- understand eating disorders as a coping mechanism against internal/external stressors
- collab TR
- use medical information to enhance motivation for change
56
interventions during hospital stay for AN
-monitor and record all intake
- start with low caloric intake
- monitor and adjust fluid, electrolyte, vitamin, mineral requirements based on labs
- supplemental enteral feeds when indicated
57
evaluation for AN
- closely monitor and evaluate outcomes of interventions
- full weight restoration is biggest factor for full recovery
- continued monitoring and assessment of symptoms following discharge to prevent or mitigate relapse
58
refeeding syndrome
due to metabolic and hormonal changes that occur due to aggressive nutritional rehabilitation
at risk with enteral or parenteral feeds
experience potentially fatal shifts of fluids & electrolytes
59
risk after refeeding (electrolyte imbalances)
hypophosphatemia, hypokalemia, hypomagnesemia
60
symptoms of hypophosphatemia
hypotension, seizures, anemia, resp distress
61
symptoms hypokalemia
delirium, resp distress, tetany, decreased DTRs
62
symptoms hypomagnesemia
seizures, anemia, gi symptoms, hypocalcemia
63
common symptoms of electrolyte imbalances
arrhythmias, neuromuscular disturbances, weakness, lethary, paresthesias
64
a surge of what causes electrolyte imbalances?
surge of insulin from hte increased ingested carbohydrates and an abrupt shift from fat to carbohydrate metabolism
65
preventing risk of refeeding
- start low and go slow when starting increased cal intake
- monitor pt presentation (VS, symotims, lab work)
- adjust fluid, electrolyte, vitamin based on lab work
- provide thiamine & multivitamin
66
BN
individual engages in recurrent epsiodes of binge eating and compensatory behaviour to avoid weight gain through purging methods such as self-induced vomiting or laxatives
67
psychological characteristics specific to BN
impulsivity, boundary problems, limit-setting difficulties, dietary restraints
68
binge purge cycle
dietary restraint <--> hunger <--> binge eating <--> shame, humiliation, failure <--> dieting/purging via vomiting etc
69
risk factors for BN
dieting tends to be predisposing factor of BN for vulnerable ppl
food/eating sometimes becomes a coping mechanism to deal with stress and negative emotions which can lead guilt/shame and worry about weight gain leading to binge/purge cycle
70
BN & hospitalization
dehydration, electrolyte imbalance, depression, SI
71
assessment BN
- assess eating patterns
- # of times/day binge/purge
- sleep pattern
- oral health
- exercise
- triggers
- dysfunctional behavioural & thought patterns
- knowledge gaps
- MSE, HTT, lab work
- risk assessment
72
priority care issues for BN
- comorbid conditions of depression, anxiety, substance misuse, BPD, risk for SI
risk for self harm
high levels of impulsivity (shop lifting, overspending)
73
assessing BN specific symptoms
- lack of control over eating
- secrecy surrounding eating
- eating unusually large amounts of food
- disappearance of food
- alternating between overeating and fasting
74
purging symptoms
- going to the bathroom after meals
- using laxatives, diuretics
- smell of vomit
- excessive exercising
75
concern for purging
- purging removes electrolytes
- low electrolytes cause cardiac arrhythmias
- cardiac arrhythmia can cause death
76
interventions for BN
- TR
- assertiveness, limit setting, boundaries
- discuss feelings & emotions
- trauma informed
- address distorted thinking with CBT
- encourage self monitoring to doc binge/purge cycle
- psychoeducation
- healthy sleep & coping patterns
- fluoxetine for symptom remission
77
psychoeducation checklist for BN
- psychopharm agents
- binge/purge cycle & effects on body
- nutrition & eating patterns
- hydration
- avoidance of cues
- cognitive distortions
- limit setting
- appropriate boundary setting
- assertiveness
- resources
- realistic goal setting
78
evaluation for BN
- early detection
- monitor behaviours & thinking patterns
- encourage self care & healthy lifestyle
- monitor comorbid conditions & symptoms
- watch for signs of relapse
- remain nonjudgemental & accepting
- encourage emotional regulation & healthy interpersonal connections
- provide resources
79
binge eating disorder
clinical eating disorder characterized by frequent consumption of very large amounts of food, coupled with feelings of being out of control, ashamed and disgusted by eating behaviour, and experiencing high body dissatisfaction
80
assessment for BED
- assess current binge eating patterns and triggers
- assess associated symptoms of gastric distress
- assess physical mobility, activity, and sleep patterns
- assess for cognitive distortions and knowledge gaps
- assess for symptoms of comorbid psych disorders like mood
- MSE & HTT
- risk assessment
81
priority care issues for BED
comorbid obesity, overweight, depression, anxiety can contribute to cardiac and other health crises
risk of type 2 diabetes is significant
82
behavioural symptoms of binge eating and compulsive overeating
- inability to stop eating or control what eating
- rapidly eating large amounts of food
- eating even when your full
- hiding or stockpiling food to eat later in secret
- eating normally around others, but gorging when ur alone
- eating continuously throughout the day, with no planned mealtimes
83
emotional symptomsof binge eating and compulsive overeating
- stress or tension that is only relieved by eating
- embarassment over how much eating
- feeling numb while binging
- never feeling satisfied
- feeling guilty, disgusted or depression after overeating
- desperation to control weight and eating
84
interventions for BED
- TR
- feelings & emotions
- trauma informed
- address distorted thinkning with CBT
- encourage to record intake, binges, and emotions
- pharm for weight loss treatment
- establishing healthy sleep and coping patterns
- psychoeducation
85
10 strategies for overcoming binge eating
- manage stress
- eat 3 meals a day + healthy snacks
- avoid temptation
- stop dieting
- exercise
- fight boredom
- get enough sleep
- listen to your body
- keep a food diary
- get support
86
pica
eating non-food, non-nutritive over period of month
87
rumination disorder
repeated regurgitation of food over period of 1 month
regurgitated food may be re-chewed, re-swallowed, or spit out
88
avoidant/restrictive food intake disorder
persistent failure to meet appropriate nutritional and/or energy needs associated with:
- sig weight loss
- sig nutritional deficiency
- dependence on enteral feeding or oral nutritional supplements
- marked interference with psychosocial functioning
89
purging disorder
recurrent purging behaviour to influence weight or shape
90
night eating syndrome
recurrent epiosdes of night eating, as manifested by eating after awakening from sleeo or by excessive food consumption after the evening mea;
91
personality
complex pattern of characteristics, largely outside the person's awareness, that compose the individuals distinct and enduring patterns of perceiving, feeling, thinking, coping, and behaving
emerges from hte complicated interaction of biological dispositions, psychological experiences, and environmental situations
92
personality traits
persistent patterns of perceiving, thinking, feeling, and behaving the shape the way in wihch a person responds to hte world
93
temperament
recognizable, distinctive, and relatively stable patterns of individual differences that are evident in early life
94
5 key traits of personality
openness to experience (O) = being imaginative and creative, inventive, open to unusual ideas, adventure, and nonconformity
conscientiousness (C) = responsible, careful or diligent
extraversion (E) = talkative, energetic, assertive, and outgoing
agreeableness (A) = ooperative, polite, kind, and friendly
neuroticism (N) = emotional instability, irritability, anxiety, self-doubt, depression, and other negative feelings
95
personality disorder
diagnosis when the perceptions, emotions, cognition, and behaviours of an individual substantially deviate from cultural expectations in a persistent and inflexible way, causing distress or impairment
96
contributing factors to personality disorder
genetic, epigenetic, neurobiological, trauma, stress, environment
97
common features of personality disorders
- impaired metacognition
- maladaptive emotional response
- impaired self-identity and interpersonal functioning
- impulsivity and destructive behaviours
98
cluster A
- odd, eccentric
includes: paranoid, schizoid, schizotypal
99
cluster B
dramatic, unpredictable
includes: antisocial, borderline, histrionic, narcissistic
100
cluster C
anxious, fearful
includes: avoidant, dependent, obsessive-compuslive
101
cluster A characteristics
- not see on ward
- tend to be socially isolative, with lack of social supports
- might simply be odd/eccentric
102
treatment for cluster A
- psychotherapy most effective to improve quality of life (can be diff to TR, careful to adapt to pt verbal/nonverbal)
- medications XX not effective
103
cluster B characteristics
- only hospitalizaed when in acute phase of disorder (crisis) or for co-existing medical/psych condition
- can be seen in acute inpt settings for brief interventions
104
antisocial
disregard for rights of others that begins in childhood/early adolescence
sneaky, impulsive, deceitful behaviours with no remorse
105
narcissistic
grandiosity with need for admiration and lack of empathy for others
preoccupied with competence, power, and prestige
often envious of others with a sense of entitlement and will exploit others to meet their needs
106
histrionic
excessive need for approval and desire to be the center of attention
often animated, dramatic, seductive, or flirtatious
feels relationships are closer than what they may be
107
borderline
poor self image/identity with an abnormal level of mood swings
chaotic and unbalanced in their interpersonal relationships with fear of abdondonment
will swing from worshipping someone to demonizing
high levels of impulsive behaviours
108
treatment for cluster B
- best = counselling & therapy (DBT), psychoeducation, healthy living
- consistent and supportive approach is important, boundaries, assertiveness, acceptance, and limit setting
- developing safety plans, preventing and treating self harm
109
characteristics of BPD
- affective instability
- identity disturbances
- unstable relationships
- cognitive dysfunction
- dysfunctional behaviours (impaired problem solving, impulsivity, self harm)
- risk SI
110
behavioural patterns in BPD
- emotional vulnerability
- self invalidation
- unrelenting crisis
- inhibited grieving
- active passivity
- apparent competence
111
psychoeducation checklist BPD
- manage medications
- regular sleep routines
- nutrition
- safety measures
- functional vs dysfunctional behaviours
- cognitive strategies
- structure and limit setting
- social relationships
- community resources
112
all or nothing thinking
tendency to see things in black&white categories, with no shades of grey
seen in extremes (very good/very bad)
113
overgeneralization
assumption that one error/problem means a lifetime of the same error/problems
"if i lose this job, i will never succeed in making a living"
114
mental filter
filtering out the good things that happen and retaining only the negative
115
magnification/minimization
over exaggeration of fears, imperfections, or errors
116
jumping to conclusions
concluding things that are not justified based on available evidence
(includes mindreading & fortune telling)
117
labelling
putting a negative label on yourself or others, a way to believe that no one can change
"my roommate is a slob, i have to tidy everything"
118
personalization and blame
making yourself feel responsible for things out of your control
119
should/must statements
thinking in terms of "should" and "must"
120
discounting the positive
refusing to credit the positive aspects of situations
121
emotional reasoning
believing something must be true becuase one "feels" it so strongly, ignoring any evidence to hte contrary
122
avoidant
avoids others and activities, fears rejection, feels inhibited and inept
123
dependent
passive, indecisive, fear loss of approval, difficulty doing things alone, fails to assume responsibility
124
obsessive-compulsive
perfectionist, controlling, inflexible, overconscientious, stubborn, miserly
125
treatment for cluster c
- treated in community, best group therapy
- cbt to deal with cognitive distortions, emotional reasoning, and personalization
- utilize strength-based approach
- take time to develop TR
- medications (anxiolytics & antidepressants)
126
overall treatment for personality disorders
- difficult to "treat" a personality
- medications CANT "cure" personality but can help treat other conditions that often accompany depression, anxiety
- counselling and skills to manage emotions
- CBT & DBT
127
sheas signal signs
observable behaviours and styles of interaction
128
sheas signal symptoms
clients reported complaints
129
assessment & management paranoid PD
prominent feature: distrust, suspicion
experience of illness: heightened sense of fear and vulnerability
problematic behvaiour in medical: fear clinician may cause harm, arugements, conflict
management strategy: provide clear explanations, empathic to fear, avoid direct challenge to paranoid ideation
130
assessment and management of schizoid
prom features: social detachment, emotional restriction
experience of illness: anxiety because of forced contact with others
prob behav in medical setting: delay seeking care, appear unappreciative
management strategy: prof stance, clear explanations, avoid over involvement in personal and social issues
131
assessment and management of schizotypal
prom features: odd beliefs, socially isolative
experience of illness: odd interpretation of illness, anxiety because of forced contact with others
prob bx in medical setting: delay seeking treatment, odd beliefs, odd behaviours
management strategy: prof stance, clear explanations, tolerate odd beliefs and behaviours, avoid over involvement in personal and social issues
132
assessment and management of antisocial
prom features: disregards rights of others
experience of illness: anger, entitlement masking fear
prob behaviour in medical setting: anger, impuslivity, deceit, manipulative bx
management: carefully investigate concerns and motives, communicate in clear and nonpunitive manner, set clearlimits
133
assessment and management of BPD
pro features: instability in interpersonal relationships, self image, and affects, marked impulsivity
experience of illness: terrifying fantasies about illness
prob bx in medical setting: fear of rejection and abandonment, self destructive acts, idealiztion and devaluation of clinican
managemnet: avoid excessive familiarity, schedule regular visits, provide clear explanations, tolerate angry outburst but set limits, maintain awareness of personal feelings
134
histrionic assessment and management
prom features: excessive attention-seeking behaviour, emotionality
experience of illness: threatened sense of attractiveness and self-esteem
prob bx: overly dramatic, attention seeking, inability to focus on facts and details, somatization
management: avoid excessive familiarity, show prof concern for feelings, emphasize objective issues
135
somatization
medical symptoms with no identifiable organic cause
136
narcissistic assessment and management
prom features: grandiosity, need for admiration, lack of empathy
experience of illness: anxiety caused by doubts of personal adequacy
prob bx: demanding, attitude of entitlement, denial of illness
management: validate concerns, give attention and factual responses to questions, channel pt's skills into dealing with illness
137
avoidant assessment and management
prom features: social inhibition d/t fear of rejection
experience of illness: heightened sense of inadequacy, low self esteem
prob bx: withholds information, avoids qting, disagrees with tx team
management: provide reassurance, validate concerns, encourage reporting of sx & concerns
138
dependent assessment and management
prom features: excessive need to be taken care of, submissive and clinging behaviour
experienceof illness: fear of abandonment, helplessness
prob bx: urgent demands for attention, prolongation of illness bx to obtain care
management: provide reassurance, schedule regular check ups, set realistic limits, enlist others to support pt, avoid rejection
139
obsessive compulsive assessment nad management
prom features: preoccupation with orderliness, perfection, control
experience of illness: fear of losing control of bodily function and emotions
prrob bx; fear of relinquishing control, excessive pting and attention to details, anger about disruption of routines
management strateguy: complete hx, provide explanations, do not overemphasize uncertainity, encourage participation in treamtent
140
psychotherapy
type of talk therapy with focus on helping client become aware of their thought patterns which is believed to allow the individual to have better control over them
141
psychoanalytic therapy
type of talk therapy with the focus on uncovering and resolving unconscious emotions and memories
142
psychoeducation
type of therapy with the focus on helping client understand their condition and ways in which they can be treated
143
common tx for paranoid
psychotherapy
144
commontx for schizoid
cbt, group therapy
145
common tx for schizotypal
psychotherapy, cbt, group therapy
146
common tx for antisocial
psychoanalytic, cbt
147
common tx for BPD
dbt, cbt, group, family, mindfulness and acceptance based treatments
148
common tx for histrionic
psychotherapy
149
common tx for narcissistic
psychotherapy
150
common tx for avoidant
psychoanalytic, cbt, group
151
common tx for dependent
psychotherapy, cbt, dbt, group
152
common tx for obsessive-compulsive
cbt
153
mindfulness
assists in disengaging the automatic pilot allowing the person to explore their thought patterns
154
5 core elements of mindfulness
attention (receptivity) & awareness (being deeply self-aware and self-monitoring)
present centeredness (being in the moment)
external events (the outer milieu’s impact on the mind and body)
cultivation (fostering of tranquility and insight)
ethical mindfulness (social awareness)
155
benefits of mindfulness
learn to accept yourself and experiences
experience peace and freedom
live life more fully
156
acceptance based tx
involves being aware and acknowledging your experiences
157
2 main things about acceptance based tx is
1 = acknowledge the feeling, experience
2 = identify ways to cope with said feeling or identify ways to change it
158
cognition
the mind
perception, thinking, language
159
emotions
how we react, feel, behave
160
3 components of emotions
physiological changes
subjective feelings
associated behaviour
161
cbt
psychotherapy focused on identifying, analyzing, and ultimately changing the habitually inflexible and begative cognitions about oneself, others, and the world that contributes to distress and problematic behaviours
162
cbt is effective for
depression & anxiety
163
cbt is used for PD but is not the 1st choice
true
164
10 principles of cbt
- evolving cb formulation of pt
- requires TR
- emphasizes collab & participation
- goal oriented & problem focused
- emphasizes present
- educative & emphasizes relapse prevention
- time limited
- structured
- teaches how to identify, evaluate, & respond to dysfunctional thoughts
- variety of techniques to change thinking, mood, behaviour
165
3 levels of cognition
core beliefs
intermediate beliefs
automatic thoughts
166
core beliefs
core knowledge structure that hold, organize, and interpret information about ones view of self, others, and the world
167
intermediate beliefs
attitudes, rules, or expectation, and assumptoms that influence one's perception, affect, and behaviour
168
automatic thoughts
the knee-jerk or initial and most superficialand accessible response
169
cognitive restructuring
cognitions (automatic thoughts, core beliefs) are identified, analyzed, and modified to effect positive change in mood and behaviour
170
dbt
combines numerous cognitive and behavioural strategies
requires pt to understand their disorder by actively participating in formulating tx goals by collecting data about their own behaviour, identifying tx targets in therapy, and work with the therapist in changing these behaviours
171
pre tx dbt
goals: orient dbt, identify goals, enhance motivation and commitment
interventions: individual dvt
172
stage 1 dbt
commitment, safety, stability
173
stage 1 dbt targets
life threatening bx
serious therapy interfering bx
severe quality of life interfering bx
174
stage 1 dbt interventions
individual dbt
skills training
phone coaching
175
stage 2 dbt
symptom reduction
176
stage 2 dbt targets
trauma
eating disorders
anxiety disorders
mood disorders
177
stage 2 dbt interventions
individual dbt
skill training
phone coaching
dbt consultation team
178
stage 3 dbt
regulating emotions through acceptance and change (REACH)
179
stage 3 dbt targets
low self esteem
relationship difficulties
difficulty with problem solving
inadequate quality of life
180
cognitive reframing
identifying and challenging situations or thoughts
181
self harm cycle
emotional suffering --> emotional overload --> panic --> self harm --> temp relief --> shame/grief
182
why do people self harm
- manage intense/uncomfortable feelings (release tension)
- communicate how one feels
- have control (obtain control over body, SH to feel normal)
- punish oneself
183
managing self-harming behaviours
- delay: wait for period of time before harming
- ride the wave: acknowledge urge, use distractions to redirect thoughts
- call support person
- call crisis line
- avoid drugs/alcohol
- grounding
- challenge thoughts: address thinking errors with CBT
- harm reduction
- PRNs
184
non-harmful ways to manage self harm
- write down feelings
- punch something soft
- scream into pillow
- go for walk
- play a sport
- bite into something spicy
- squeeze stress ball
- snap elastic band
185
interventions in hospital for SH
- rapport
- TIP
- MSE, safety, risk
- triggers, strengths, stressors
- explore alternative coping mechanisms
- safety planning
186
12 tips to provide support to help victims of abuse
- no judgements
- encourage conversations
- respond with patience, support
- keep things private
- be there regardless of excuses, rejection
- reassure them ths is not their fault
- do not assue the abuse is not that serious
- le t them make their own decisions
- provide practical support
- help them rebuild themselves
- do not mediate
- look after yourself
187
what types of assessments tools for abuse
- abuse assessment tool
- danger assessment tool
188
can you document abuse on your own judgement
NO, pt has to confirm abuse -- document findings
189
interventions for pt abuse
- safe environment
- treat injuries
- support clinet in verbalizing experiences
- assist the clinet in identifying their sterngths
- psychoeducation on coping
- education on self protection & when to get help
- refer to psychotherapy
- safety planning
190
clients must be ifnormed that there is increase risk of violence and homicide if abuser finds resources, safety plans, leaving bags
TRUE
191
encourage client to hide documents and store in a safe secure place
TRUE
192
things to bring when someone is leaving
money, keys, extra clothes, medicine, important documents, passports, unpaid bills, personal protective orders
193
services available for abuse
crisis line
kids help phone
ministry of children and family development
ACT adult abuse
194
sexual health
state of physical, emotional, mental and societal well being r/t sexuality, it is not merely the absence of disease, dysfunction
195
goals of sexual education
assist individuals to achieve positive outcomes (self esteem, respect, rewarding sexual relationships)
avoid negative outcomes (pregnancy, stds)
196
sexuality
central aspect of being human throughout life, and encompasses sex, gender identity and roles, sexual orientation, eroticism, pleasure
197
factors that can affect sexuality
- societal & cultural expectations
- family expecctations
- hx trauma
- stages of development
- support systems
- stressors and responsibilities
198
sexual orientation
who your attracted too
199
gender identity
personal sense of being male or female
200
sexuality intervention/health promotion
- provide sex education
- teaching self examination
- educating on responsible sexual behaviour
- providing privacy during intimate body care
- provide acceptance and respect to body, appearance, choice of dress, identity, name
201
gender diverse
gender roles & expression that do not match societal expectations
202
gender expresssion
how one outwardly shows gender through name, dress, voice
203
gender dysphoria
discomfort/distress that is caused by a discrepancy between a person's gender identity and that person's gender assigned at birth
204
in most children, gender dysphoria will resolve without intervention prior to or early in puberty
TRUE
205
goal of treatment for gender dysphoria
help the individual find the gender role and expression that they are comfortable with
206
treatment options for gender dysphoria
individual counselling
education & resource management
family & couple therapy
support groups
207
puberty blockers
supresses puberty to prevent development of secondary sex caracteristics
allows person & support system time to determine long-term plan
208
hormone therapy
individualized, based on hte pt goals, risk/benefit ratio, and medical
209
rpns play a supportive role in the process of working with gender dysphoria but are not considered experts and require additional education for formal interventions
TRUE
210
transaffirmative practices of nurses
- knowledge that sexual & gender diversity exists on continuum
- awareness of how one's attitude toward and knowledge of gender identity affects care
- understanding how stigma and discrimination affect the health
211
what to do if you make a mistake with pronouns etc
1. apologize briefly
2. use the correct term
3. move on
212
10 tips for trans inclusion
1. language
2. manners (do not discuss persons transgender status)
3. focus on what pt wants/asking for
4. policies
5. confront - safe space
6. paperwork - make sure inclusive
7. know & tell - asking about personal infrmation, share why you need to know beforehand
8. empower
9. be creative
10. advocate
213
ulcerative colitis
autoimmune disease
chronic inflammation & ulcers inner lining of colon & rectum
214
does ulcerative colitis affect small intestin
no
215
with UC, what develop & break through the submucosal layer
abscesses develop = ulceration = bleeding
216
symptoms of UC
- pain, cramping
- blood diarrhea
- bleeding from rectum
- anemia
- N & V
- bloating
- tender abdo
- no appetite
- fatigue
217
VS with UC
hypotensive, tachycardia
218
intestinal complications
hemorrhage
toxic megacolon
perforation
colon cancer
extra-intestinal complications (joints, skin, anemia) d/t autoimmune
219
toxic megacolon
dilation & paralysis of colon
220
perforation
bowel contents move into peritoneal space leading to septic shock
221
crohns disease
affect any part of digestive tract
inflammation occurs in patches = skip lesions (cobblestone appearance)
involves all layers of bowel
222
typical symptoms crohns
abdo pain
diarrhea
weight loss
fatigue
N & V
223
crohns complication
strictures = obstruction
- fistulas & abscesses
224
diagnosis of bowel complications
colonoscopy, scopes, barium enema, BW, CT
225
BW for bowel complications
hemoglobin, electrolyte (CP7) = potassium, sodium, WBC, CRP
226
nursing goals for bowel complications
- pain assessment
- VS = increased resps, tachycardia
- GI assessment
- stool chart
- monitor in/out
- NPO (let bowel rest) = IV fluids
- control & reduce inflammation (NSAIDs, corticosteroids)
- TR
227
what kind of diet to let bowels rest
low/no fibre
228
medications for bowel complications
NSAIDs
corticosteroids
immunosuppressants
antimicrobials (2nd infection)
immunomodulators
229
what does liver do
metabolism, detoxification, production of protein, bile production
230
acute liver failure
rapid deterioration of liver
231
causes of liver dysfunction
viral infections (hep B/C)
alcohol abuse
non-alcohol fatty liver disease (obesity)
autoimmune conditions
toxins & medications
232
cirrhosis
chronic inflammation of liver = scar tissue development
233
symptoms of liver dysfunction
- abdo edema & leg/feet
- jaundice
- purities
- pale "clay" stool
- encephalopathy
234
why does abdo & leg/feet edema happen with liver dysfunction
- decrease albumin
- cause distended, round, firm, dilated veins = pushing on diaphragm = SOB = fluid in vascular space
235
encephalopathy symptoms
lethargic
stupor
extremely confused
inappropriate behaviours
difficulty concentrating
changes in LOC
236
for encephalopathy, whats treatment with regards to liver dysfunction
lactulose (2-3 BM/day)
237
complications of liver dysfunction
- encephalopathy (increased ammonia levels)
- esophageal varices (dilated veins from portal HTN, risk of bleeding)
- ascites (accumulation of serous fluid in the peritoneal cavity d/t decrease albumin levels)
238
nursing managemnet for liver dysfunction
medications (rifaximin, lactulose, diuretics, beta blockers)
education (lifestyle changes)
monitoring (LOC, stool chart, weight, intake, CIWA)
bloodwork
239
pts need to avoid ASA, NSAIDs, sedatives with liver dysfunction
YES
240
blood work for liver dysfunction
albumin, ammonia, urea, clotting factors PTT & INR, CRP, LFT
241
pancreas
enzymes for digestion into small intestine to digest food
glucagon production
endocrine functions
242
inflammation of pancreas
potential necrosis
auto digestion & leakage of enzymes = swelling, pain, can go septic
243
pancreatitis
acute!!!
severe pain
244
causes of pacreatitis
alcohol misuse
gallstones
ERCP
fatty diet
245
how does alcohol misuse cause pancreatitis
chronic misuse --> acute pancreatitis --> chronic
more common younger men
246
gallstones & pancreatitis
thigns get stuck
women affected more
247
symptoms of pancreatitis
dull continuous pain (deep visceral pain)
N & V
elevated VS
pale, diaphoresis
248
assessment for pancreatitis
alcohol consumption
diet
distention
ins/out
medications? (tylenol mask fever, decrease pain)
249
interventions for pancreatitis
- CBG = hyperglycemia bc don't have insulin production
- decrease inflammation
- pain management
- NPO (let everything settle)
- antiemetics
- IV fluids
250
diagnostics for pancreatitis
- BW = lipase, amylase
- clinical presentation
- abdo ultrasound
- CT
251
thyroid role
body metabolism
regulation of temperature
growth/development
energy levels
thoughts/feelings
digestion
252
pituitary gland
thyroid stimulating hormone
253
hypothyroid
not enough hormones
everything is low & slow
254
common cause of hypothyroid
hashimotos
255
hashimotos
immune system attacks thyroid
cells become fibrous
256
medication for hashimotos
synthyroid = levothyroxine
257
symptoms of hypothyroid
- slow metabolism
- constipation
- muscle aches/joint pain
- men = low libido
- women = mensural irregularities
- brittle hair
- feel cold
258
BW for hypothyroid
not enough T4, high TSH
259
drugs to be careful with for hypothyroid
opioids, benzo
260
other causes of hypothyroid
decrease iodine
tumor
261
worst case scenario for hypothyroid
myxedema coma
hyperthermia
extreme drowsiness
everything starts shut down (bradycardia, low glucose, resp failure)
262
goiter
constant stimulation
protrusion of thyroid gland
263
hyperthyroid
too much thyroid hormones = everything on overdrive
264
msot comon cause hyperthyroid
graves
265
graves
protuding eyes
toxic goiter
266
symptoms of graves
- fast metabolism
- jittery
- anxious
- palpations
- hypermotility = bowels
- feel hot
- a fib
267
other causes of hyperthyroid
increase iodine
thyroiditis
268
BW for hyperthyroid
increase T4, decrease TSH (pituitary not active)
269
treatment for hyperthyroid
radioactive tx = destroy hyperactive cells = reduction in hormones
PTU or tapazole = decrease production of thyroid hormone
270
medications for hyperthyroid
beta blockers
271
worse case hyperthyroid
thyroid storm = multi system complications
272
TB is infectious disease caused by
mycobacterium tuberculosis & is reportable
273
TB spread by
airborne!
274
once TB inhaled
replicate slowly and spreads via lymphatic system
find favourable envrionments to grow = lobes
275
primary healing of lesion in TB
takes place by resolution, fibrosis, calcification & granulation tissue surroinding lesion become fibrous & form collagenous scar
276
ghon complex
calcified ghon complexes may be seen on chest xray
277
when TB lesion regresses and heals, infection..
enters latent period in which it may persist without producing symptoms
278
infected with TB but not have TB disease cannot spread to others
TRUE
279
reactivation of TB can occur
if hosts defence mechanisms become impaired (HIV)
280
clinical manifestations of TB
systemic = fatigue, malaise, anorexia, weight loss, low grade fevers, night sweats
pulmonary = cough & sputum, slight SOB
acute, sudden: high fever, chills, generalized flulike symptoms, pleuritic pain, productive cough
281
HIV infected pt with TB often has
atypical physical examinations & chest xray findings
282
where else can TB spread
bones, kidneys, lymph nodes
283
granulomas
inflammatory cells
284
does latent TB have symptoms
no immune response inactive
284
what do i need for a positive diangosis
tuberculin skin test = immune response demonstrated by hypersensitivity to test
xray
285
positive reaction of TB skin test occucrs
2-12 weeks
286
sputum test for TB (AFB)
3 times sputum collection in morning
287
NAA is a
rapid diagnositc test for TB
288
medication therapy for TB
min 8 months
TX consists of combo of 4+ meds
289
nursing care
- resp assessment
- sputum test
- TB skin test
- TB blood test
- VS
- chest xray
- education: wear mask, isolate until cleared, cover mouth when sneezing
290
patho of HIV
attacks immune system
enter WBC --> replicate --> destroy --> weakens immune --> opportunistic infection
291
what kind of cells are affected in HIV
CD4+
292
who is at risk of HIV
- IV drug users
- immunocomprised
- indigenous
- sex workers
- health care workers
293
what does transmission of HIV depend on
- blood & bodily fluids
- breast milk, vaginal fluids, semen, blood
294
most common tranmission HIV
semen & vaginal fluids
295
how quickly is HIV transmitted
few weeks begin to show symptoms
young people = flu like symptoms
296
characteristics of HIV transmission
- amount of virus in fluid
- frequency and duration = higher risk
- volume of fluid
- immune system
297
stages of HIV infection
- acute
- early chronic
- symptomatic HIV infection
- late AIDS
298
acute stage HIV
- initial
- increase amout of virus in blood
- flu like symptoms
299
early chronic stage HIV
prolonged period (10-12 years) of low HIV in blood
few symptoms
300
symptomatic HIV infection stage
- CD4+ count falls below 500
- night sweats, fever, weight loss
- no longer can fight infection
301
late stage HIV
- increased viral load
- decreased T cells (CD4 count less than 200)
- develop one opportunistic infection
302
can you transmit HIV to others without symptoms
yes, may not test + or show sx depending on immune system
303
opportunistic infections in HIV
neurological conditions
thrush
latent TB
304
tests for HIV
antibody test
self testing
EAI = detect HIV antigens and ABX
NAT = looks for actual virus in blood
305
nursing goals for HIV
ART
prep
education = medications
support
safe sex materials
306
