FINAL EXAM Flashcards
1
Q
Autism Spectrum Disorders
A
Deficits in social relatedness and relationships
- Stereotypical repetitive speech
- Obsessive focus on specific objects
- Over adherence to routines or rituals
- Hyper- or hypo-reactivity to sensory input
- Extreme resistance to change
- Appears in early childhood
2
Q
ASD assessment
A
developement delays, communication, sensory stim, relationships within family abuse, intellectual ability
3
Q
asd diagnosis
A
lack of coordination head banging
4
Q
asd diagnosis
A
lack of coordination head banging
5
Q
asd outcomes
A
reframe from outburst, talk through it
6
Q
ASD implementation and interventions
A
provide structure, consistency, reward system
- psychological interventions
- psychobiological interventions
physical occupational speech therapy
7
Q
autism develops…..
A
in early childhood
8
Q
ADHD
A
Inappropriate degree of
- Inattention
- Impulsiveness
- Hyperactivity
- commonly seen in school
- temper outburst
- low self esteem
9
Q
adhd assessment, diagnosis
A
Assessment
- Level of physical activity, attention span, talkativeness
- Social skills
- Comorbidity: learning disorder, disregulation, impulsive
Diagnosis: low self esteem, anxiety
10
Q
meds for adhd
A
ridiline aderal
increase pay attention, less impulsive, less distracted
11
Q
communication disorders
A
deficit in language skills acquisition that impairment in academic, achievement, socialization, or self worth
12
Q
what are the Intellectual Development Disorders
A
Intellectual functioning
Social functioning
Daily functioning
13
Q
intellectual development disorder severity
A
can be mild to extremely severe
- begin in childhood
14
Q
intellectual functioning
A
deficit in reading problem solving
15
Q
social functioning
A
impaired communication and language regulating emotion
16
Q
daily functioning
A
daily life affected
17
Q
sterotypic movement disorder
A
Repetitive, purposeless movements for 4 weeks or more
18
Q
tourette’s disorder
A
multiple motor ticks for 1y can be brought on by stress
19
Q
depersonalization
A
unreal
loss of idenity
arm not part of body
20
Q
derealization
A
environment has changed
“everything tiny”
21
Q
Hallucinations
A
- Auditory: voices and sounds
- Visual: spots, animals, people
- Olfactory: smell something not there
- Gustatory: taste something not there
- Tactile: begs crawling on them
- Command: need interventions, voices telling them to hurt them/someone
22
Q
Illusions
A
spiders crawling on wall, black dots
23
Q
delusions
A
fulse beliefs, held despite a lack of evidence to support them
24
Q
disadvantange of first gen
A
Extrapyramidal side effects (EPS)
- Anticholinergic (ACh) side effects
- Tardive dyskinesia
- Weight gain, sexual dysfunction, endocrine disturbances
25
first gen
Haloperidol (Haldol)
Loxapine (Loxitane)
Chlorpromazine (Thorazine)
Fluphenazine (Prolixin)
26
xanax.....
severe anxiety
27
theraptuic statements for soemone hearing voices
ik it must be very scary for you but i don't hear voices
28
acute dystonia
The client experiences severe spasms of tongue, neck, face, or back. This is a crisis situation, which requires rapid treatment
29
parkinsonism
Signs and symptoms include bradykinesia, rigidity, shuffling gait, drooling and tremors.
30
akathisia
The client is unable to stand still or sit, and is continually pacing and agitated.
31
tardive dyskinesia (TD
Late extrapyramidal symptoms (EPS)
Manifestations include involuntary movements of the tongue and face, such as lip-smacking, which cause speech and /or eating disturbances.
TD may also include involuntary movements of arms, legs, or trunk
32
Neuroleptic Malignant Syndrome
Symptoms include sudden high-grade fever, blood pressure fluctuations, dysrhythmias, muscle rigidity, and change in LOC developing into coma
33
Anticholinergic effects
```
Dry mouth
Blurred vision
Photophobia
Urinary hesitancy/retention
Constipation
Tachycardia
```
34
positive symptoms of schizo
- hallucinations
- delusions
- disorganized speech
- bizarre behavior (talking to self)
35
negative symptoms
- blunt affect
- no expression
- alogia- the poverty of thoughts
- avolition- lack of motivation
- anhedonia- lack of pleasure
36
alogia
the poverty of thoughts
37
avolition
lack of motivation
38
anhedonia
lack of pleasure
39
medications that cause tardive dyskinesia
1st gen meds
Haloperidol (Haldol)
Loxapine (Loxitane)
Chlorpromazine (Thorazine)
Fluphenazine (Prolixin)
40
treatment for tardive dyskinesia
Manifestations may occur months to years after the start of therapy.
Administer the lowest dosage possible to control symptoms.
Use the AIMS test to screen for the presence of EPS
deutetrabenazine and valbenazine
41
planning manic phase
- Managing medications
- decreasing physical activity
- increasing food and fluid intake
- ensuring at least 4 to 6 hours of sleep per night
- intervening so that self-care needs are met
- Seclusion, restraint, or electroconvulsive therapy (ECT) may be considered during the acute phase.
42
manic episodes implementation
- Hospitalization for acute mania (bipolar I disorder)
- Communicating challenges and strategies
- be direct with limits
43
risk for sicude with bipolar
watch for s/s
| hospitalize them
44
bipolar 1 disorder
- Most severe form
- Highest mortality rate of the three
- At least 1 manic episode
- big shifts
- admitted for severe mania
45
ithium therapeutic level
| maintenance blood level
Therapeutic blood level: 0.8 to 1.4 mEq/L
| Maintenance blood level: 0.4 to 1.3 mEq/L
46
lithium toxic level
Toxic blood level: 1.5 mEq/L and above
- need blood test every 5d
47
<1.5 side effects
```
nausea
vomiting
diarrhea
thirst
polyuria
lethargy
sedation
fien hand tremors
renal toxicity
goiter
hypothyroidism
```
48
1.5-2.0 lithim early s/s of toxicity
```
gastro upset
coarse hand tremors
confusion
hyperiiritability of muscles
electroencephalography changes
sedation
incoordination
```
49
2.0-2.5 advanced s/s of lithium toxicity
```
ataxia
giddiness
serious electroenciphalographic changes
blurred vision
clonic movements
large output of diluted urine
seizure
stupor
severe hypotension
coma
death
```
50
>2.5 severe toxicity lithium
convulsion
oliguria
death
51
planning during depressive phase
- Reduction of depressive symptoms
- restoration of psychosocial and work function
- hospitalization may be required
- medication or biological treatments
- prevention of relapse
- prevention of further episodes of depression
52
bipolar 1 vs bipolar 2
1:
- Most severe form
- Highest mortality rate of the three
- At least 1 manic episode
- big shifts
- admiited for severe mania
2:
- at least 1 hypomanic episode- less severe scale
- at least 1 major depressive episode
- productive at work, trying to do a lot of things at once
53
s/s of suicide ideation
- Verbal and nonverbal clues
- Overt statements: direct
- Covert statements: more settle signs "soon everything will be fine"
- Lethality of suicide plan: how successful
- Self assessment: guilt, sad, fustrated, debrief
54
depressive disorder: Selective serotonin reuptake inhibitors SSRIs
First-line therapy
Rare risk of serotonin syndrome
```
Fluoxetine (Prozac)
Citalopram (Celexa)
Escitalopram oxalate (Lexapro)
Paroxetine (Paxil)
Sertraline (Zoloft)
```
55
depressive disorder plan of care
Planning
Geared toward
- Patient’s phase oif depression
- Particular symptoms
- Patient’s personal goals
56
priority intervention for a pt. that is depressed
check if they are suicidal
57
vegetative depression interventions
use encouragement
58
MAOI dietary restriction
- Tyramine-rich foods can lead to hypertensive crisis.
- Clients will most likely experience headache, nausea, increased heart rate, and increased blood pressure.
- Provide client with instructions regarding foods and beverages to be avoided. - These include aged cheese, pepperoni, salami, avocados, figs, bananas, smoked fish, protein dietary supplements, soups, soy sauce, red wine
59
assessment findings for depression
Five (or more) of the following in 2-week period
- Weight loss and appetite changes
- Sleep disturbances
- Fatigue
- Worthlessness or guilt
- Loss of ability to concentrate
- Recurrent thoughts of death
PLUS—at least one symptom is also either
Depressed mood or
Anhedonia
- depression underrecognized in kids
- old adults not considered normal of aging
- comorbidities
60
mild anxiety
Everyday problem-solving leverage
Grasps more information effectively
- tense, bitting nails, shaking legs
61
moderate anxiety
Selective inattention
- Clear thinking hampered
- Problem solving not optimal
- Sympathetic nervous system symptoms begin
- heart racing, tension, rr increase, sweat, symmatic symptoms present due to anxiety to physical, belly aches, diarrhea,
62
severe anxiety
- Perceptual field greatly reduced
- Difficulty concentrating on environment
- Confused and automatic behavior
- Somatic symptoms increase: headache, nausea, insonmina
- concentration inpared
- difficulty problem solving, elevated hr
63
panic
- Markedly disturbed behavior—running, shouting, screaming, pacing
- Unable to process reality; impulsivity
- cant breath, hallucinated, withdrawn
64
Obsessive-compulsive disorder when does it occur and what does it involve
symptoms occur on a daily basis and may involve issues of sexuality, violence, contamination, illness, or death
65
plan of care for anxiety
Sound physical and neurological exam
- Determine source of anxiety (primary vs. secondary)
- Determine current level of anxiety
- Assess for potential self-harm
- Complete psychosocial assessment
+Ask patient about causes they can identify
66
discarge planning for anxiety
- Self-monitors intensity; uses reduction techniques; maintains role performance
- Identifies ineffective and effective patterns; asks for assistance and information; modifies as needed
- help to find ways to manage it
67
obsessions
Thoughts, impulses, or images that persist and recur, so that they cannot be dismissed from the mind
- "I'm a bad person"
68
compulsions
Ritualistic behaviors an individual feels driven to perform in an attempt to reduce anxiety
69
post traumatic stress disorder
- Re-experiencing of the trauma: fearful, anxious, shame, guilt, nightmares, explosive
- Avoidance of stimuli associated with trauma
- Persistent symptoms of increased arousal
- Alterations in mood
+ want them in presence
+ identify what real vs not
70
depersonalization
- cut off from self
- robot
- not intube
- outside observer
- out of body experience
71
derealization
- cut off from world
- in dream
- objects feel bigger/smaller
- sounds overwhelming
72
post-traumatic stress disorder diagnosis
Post trauma syndrome
- symptoms over a month impaired function, anxiety
Complicated grieving
- morning the situation
73
Dissociative Identity Disorder
- Presence of two or more distinct personality states
- protect from traumatic event
- moral compas irratic
Each alternate personality (alter) has own pattern of
- Perceiving
- Relating to and
- Thinking about the self and environment
- History: how long, short or long term memory, injuries (concussion, seizure)
- Moods
- Impact on patient and family
- Suicide risk
- Self-assessment
74
acute stress disorder vs ptsd
acute stress last 3 days after 1 month becomes ptsd
75
somatization
Expression of stress through physical symptoms that are often manifestations of psychological and emotional distress
76
somatization symptoms expressed
place of anxiety, depression, or irritability
77
illness anxiety disorder
extreme worry of fear about having an illess refer to physcologist
78
conversation disorder
functional: neurological symtpoms in the absent of any nerological disease pt. blindeness assist them
79
nursing diagnosis for somatic disorder
- infecctive coping
- anxiety
- risk for loneliness
- powerlessness, hopelessness
- social isolation
- pain
- altered family processes
- risk for suicide
80
anorexia acute care
- *** Suicidal ideation first
- Psychosocial interventions: no approved meds specifically, prozack is helpful for ocd behaviors
- Pharmacological interventions
- Integrative medicine: accupuncture, massage, herbal treatments
- Health teaching and health promotion
- Safety and teamwork
81
Anoreixa safety and teamwork
weight respiration program
- not above 90%may stop treatment
- coping and probelm solving
- normalize eating specific habit
- schedule weights
- family go to bathroom
82
anorexia nursing diagnosis
***Imbalanced nutrition
Decreased cardiac output
Risk for injury (electrolyte imbalance)
Risk for imbalanced fluid volume
disturbed body image, ineffective coping, chronic low self-esteem, and powerlessness.
83
s/s of anorexia
cold extremities, fatigue, languo: downey hair, hypokalemia, NA decr, yellow skin, amenorhea, low weight
84
restrciton anorexia
not had recurrent pinge and purg in last 3 months
85
binge and purg anorexia
binge and purg or laxatives, vomiting, diretics in 3m
86
binge eating s/s
obese and overwight
- GI issues: bloating, heartburn, vomiting
- treatment done on an out pt. basis
87
binge eating nursing diagnsis
Imbalanced nutrition: more than body requirements
- Other nursing diagnoses are similar to bulimia nervosa and include disturbed body image, ineffective coping, anxiety, chronic low self-esteem, powerlessness, and social isolation
88
binge eating acute care
```
Psychosocial interventions
Pharmacological interventions
Surgical interventions: bariatric surgery (for obesity)
Health teaching and health promotion
Teamwork and safety
```
89
bulimia outcomes
Electrolytes in balance; adequate cardiac output; satisfaction with body image; effective coping; verbalizes confidence; makes informed life decisions; expresses independent decision making; willingness to call others for assistance; develops sense of belonging
- interupt cycles of binge
- treatment working n coping skills
- meal plan
- relaxation tecniques
- healthy diet
90
communication with a withdrawing pt.
empathetic communication
91
alc withdrawl
8-10 hr after a drink
- quits after prolonged use
- hears psychotics voices, spiders, delerium, tremors, increased hr, sweating, fevers, anxious, hullicinations
- 12-24 hr withdrawal seizures start
- medical emergency
- librium and ativan taper for 72 hours
- 72 hours watch window
92
serious withdrawl
- sucide
- seizures
- depression
(valium can help)
93
clondrine, methadone, buprenorephine
used to treat opioid withdrawl symptoms (check on pt. every 4 hr)
94
nalazone
opioid toxcity
95
Confabulation
creation of stories in place of missing memories to maintain self-esteem
96
delirium
```
Disturbance in attention
Abrupt onset with periods of lucidity
Disorganized thinking
Poor executive functioning
Disorientation
Anxiety and agitation
Poor recall
Delusions and hallucinations (usually visual)
```
- caused by medical
- resolves by treatment
97
what is affected in delerium
Cognitive and perceptual disturbances
- Illusions: paperclip = big
- Hallucinations: visual- reaching out to something
Physical needs
Moods and physical behaviors: confusion, disoriented
Self assessment
98
delirium planning
- Ensure necessary aids and supportive home team
- Visual cues in the environment for orientation
- Continuity of care providers
99
delerium implementation
- Prevent physical harm due to confusion, aggression, or fluid and electrolyte imbalance.
- Minimize use of restraints (increases confusion)
- Perform comprehensive nursing assessment to aid in identifying cause.
- Assist with proper health management to eradicate underlying cause.
- Use supportive measures to relieve distress
100
community support
- Transportation services
- Supervision and care when the primary caregiver is out of the home
- Referrals to day care centers (9-5)
- Information on support groups in the community
- Meals on Wheels: provide meals
- Information on respite and residential services (drop off for weekend)
- Telephone numbers for help lines
- Home health services
101
dementia interventions
Person-centered care approach
Health teaching and health promotion
Referral to community supports
Integrative therapy
Pharmacological interventions
- ariept moderate to mild
- namenda moderate to severe
- namzarix moderate to severe
101
dementia interventions
Person-centered care approach
Health teaching and health promotion
Referral to community supports
Integrative therapy
Pharmacological interventions
- ariept moderate to mild
- namenda moderate to severe
- namzarix moderate to severe
102
plan of care for dependent personality disorder
- help address current stressors
- set limits that dont make the pt. feel punished
- be aware of strong countertransferance
- use therapeutic relationships as a testing ground for assertiveness training
treatment:
- psychotherapy is treatment of choice
103
narcissistic personality disorder characteristics
- Feelings of entitlement, exaggerated self importance
- Lack of empathy; tendency to exploit others
- Weak self-esteem and hypersensitivity to criticism
- Constant need for admiration
- Less functional impairment than other personality disorders
- irrigant know it all, stems from insecurities, look for compliments
104
Schizotypal PersonalityDisorder
- Severe social and interpersonal deficits
- Anxiety in social situations
- Rambling conversation
- Paranoia, suspiciousness, anxiety, distrust
- Brief, intermittent episodes of hallucination or delusion
- Can be made aware of their own odd beliefs
- May be vulnerable to involvement with cults or unusual religious/occult groups
- odd, hard time being social, don't blend well, strange, magical thinking, strange beliefs, affect inappropriate, hallucinations, delusions
- they know symptoms are not normal
105
Borderline PersonalityDisorder setting limits
```
Provide clear and consistent boundaries
Use clear, straightforward communication
Calmly review therapeutic goals
Teamwork and safety
Respond matter-of-factly to superficial self-injuries
```
106
characteristics of obsessive compulsive disorder
- rigidity, inflexible standrds for others and self
- constant rehearsal of social responses
- excessive goal seeking that is self defeating or relationships defeating
- strict standards interfere with project completion
- unhealthy focus on perfection
107
Antisocial PersonalityDisorder planning and implementation
- Boundaries, consistency, support, and limits
- Realistic choices
- Teamwork and safety (prime)
- Therapeutic communication
- Pharmacological interventions (mood stabilizers)
- rarely stick to long term relationships
108
mandated reported
must report abuse if you dont you can have licenses taken away
109
cycle of violence
Tension-building stage
Acute battering stage
Honeymoon stage
110
Tension-building stage
minor incidence happens
- verbal abuse, pushing
- person is fearful
111
Acute battering stage
- external events trigger it, or perpretrator
| - emotional state
112
Honeymoon stage
everything calms down
- apologizes, shows remorse, says they'll never do it again
cycle starts again, gets worse, victim has low self esteem or fear
113
neglect
failure to provide physical, emotional, educational needs
114
types of abuse
```
Physical abuse
Sexual abuse
Emotional abuse
Neglect
Economic abus
```
