Mental Health Flashcards
(256 cards)
1
Q
WHO describes mental health as…
A
a relative and ongoing state of well-being in which individuals realize their abilities, cope with the normal stresses of life, work productively, and contribute meaningfully to the community.
2
Q
Characteristics indicative on mental health include…
A
finding balance in all aspects of life - social, physical, spiritual, economic, and mental - and developing resilience, flexibility, and self-actualization.
3
Q
Mental disorder
A
the medical term for mental illness and is defined and diagnosed in Canada according to criteria specified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) by the American Psychiatric Association.
4
Q
Abuse
A
When directed toward another, includes acts of misuse, deceit, or exploitation; the wrong or improper use or action toward another individual that results in injury, damage, maltreatment, or corruption.
5
Q
Addiction
A
State of dependence or compulsive use. In relation to drug dependence, addiction incorporates the concepts of loss of control with respect to the use of a drug, taking the drug despite related problems and complications, and a tendency to relapse.
6
Q
Coping mechanism
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Method used to decrease anxiety.
7
Q
Crisis
A
Temporary state of disequilibrium in which an individual’s usual coping mechanisms or problem-solving methods fail. Crisis can result in personality growth or personality disorganization.
8
Q
Defense mechanism
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Coping mechanism used in an effort to protect the individual from feelings of anxiety. As anxiety increases and becomes overwhelming, the individual copes by using defense mechanisms to protect the ego and decrease anxiety.
9
Q
Milieu
A
Physical and social environment in which an individual lives. Milieu therapy focuses on positive physical and social environmental manipulation to produce positive change.
10
Q
Restraints (security devices)
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Physical restraints include any manual method or mechanical device, material or equipment that inhibits free movement. Chemical restraints include the administration of medications for the specific purpose of inhibiting a specific behaviour or movement.
11
Q
Seclusion
A
Placing a client alone in a specially designed room that protects the client and allows for close supervision. Seclusion is the last selected measure in a process of maximize safety to the client and others.
12
Q
Suicide
A
The ultimate act of self-destruction in which an individual purposefully ends his/her own life.
13
Q
Suicide attempt
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Any willful, self-inflicted, or life-threatening attempt by an individual that has not led to death.
14
Q
Principles of Nurse-Client Relationship
A
- Genuineness, respect, empathic understanding
- Cared for in a holistic way
- Consider cultural beliefs and values
- Appropriate limits and boundaries
- Honest and opening communication
- Using therapeutic technique to encourage client to express thoughts and feelings
- Confidentiality
- Assist to develop problem-solving abilities and coping mechanisms
15
Q
Phases of a therapeutic nurse-client relationship
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- Preinteraction phase (focus on own preconceived ideas, stereotypes, biases and values that may impinge on the relationship.
- Orientation or introductory phase (acceptance, trust and boundaries established; expectations and time frame identified; goals are defined; termination and separation of the relationship discussed with the time limit).
- Working phase (exploring, focusing, evaluation of pt’s concerns and problems; attitude of acceptance and active listening; encouraging independence in pt’s recovery).
- Termination or separation phase (evaluate progress and achievement of goals; identify responses related to separation- anger, return of symptoms, etc.; encourage pt to express feelings about termination; identify strengths and need for follow-up care; refer pt to community resources).
16
Q
Mental health is a lifelong process of…
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successful adaptation to changing internal and external environments.
17
Q
A mentally healthy individual is…
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in contact with reality, can relate to people and situations in their environment, and resolve conflicts within a problem-solving framework. Also has psychobiological resilience.
18
Q
Psychiatric illness is…
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the loss of the ability to respond to the internal and external environment in ways that are in harmony with oneself or expectations of society.
19
Q
Psychiatric illness is characterized by…
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thought or behaviour patterns that impair functioning and cause distress.
20
Q
Personality characteristics of psychiatric illness (7)
A
- Self-concept is distorted
- Perception of strengths and weaknesses is unrealistic
- Thoughts and perceptions may not be reality-based
- The ability to find meaning and purpose in life may be impaired
- Life direction and productivity may be disturbed
- Meeting one’s own needs may be problematic
- Excessive reliance or preoccupation on the thoughts, opinions, and actions of self or other may be present.
21
Q
Diagnostic and Statistical Manual of Mental Health Disorders (published by the American Psychiatric Association)
A
Provides guidelines for health care personnel for identifying and categorizing mental illness. There are diagnostic criteria for each mental health disorder.
22
Q
Dual diagnosis
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Refers to the client who has both a mental health disorder and a substance-related disorder.
23
Q
Types of Mental Heath Admissions
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- Voluntary admission
2. Involuntary admission
24
Q
Voluntary Admission
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When patient or their guardian seeks admission for care; free to sign out of the hospital; detaining voluntary pt against their will is false imprisonment.
25
Involuntary Admission
May be necessary when pt is mentally ill, is a danger to self or other, or in need of treatment/care.
When a person is admitted or detained involuntarily for treatment; still retains their right for informed consent and still able to refuse treatments unless a separate and specific treatment order is obtained from the court. An order from judge is required for involuntary admissions except in emergencies.
26
Types of release from hospital
1. Voluntarily
2. Against medical advice
3. With conditions (conditional release) -- still may be receiving treatment as outpatient; trial days to see if they can cope and manage independently.
27
Therapeutic Communication Techniques
```
Clarifying and validating
Encouraging formulating of a plan of action
Focusing and refocusing
Listening
Maintaining neutral responses
Maintaining silence
Provide acknowledgement and feedback
Providing nonverbal encouragement
Reflecting
Restating
Sharing perceptions
Summarizing
Using broad openings and open-ended questions
```
28
Nontherapeutic Communication Techniques
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Asking "why?"
Being defensive or challenging the client
Changing the subject
Giving advice or approval or disapproval
Making stereotypical comments
Making value judgements
Placing the client's feelings on hold
Providing false reassurance
```
29
Types of Defense Mechanisms
Compensation; Conversion;
Denial; Displacement; Dissociation;
Fantasy; Fixation;
Identification; Insulation; Intellectualization; Introjection; Isolation;
Projection;
Rationalization; Reaction Formation; Regression; Repression;
Sublimation; Substitution; Suppression; Symbolization;
Undoing
30
Compensation (Defense Mechanism)
Putting forth extra effort to achieve in areas where one has a real or imagined deficiency.
31
Conversion (Defense Mechanism)
Expression of emotional conflicts through physical symptoms.
32
Denial (Defense Mechanism)
Disowning consciously intolerable thoughts and impulses.
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Displacement (Defense Mechanism)
Feelings toward one person are directed to another who is less threatening, satisfying an impulse with a substitute object.
34
Dissociation (Defense Mechanism)
Blocking of an anxiety-provoking event or period of time from the conscious mind.
35
Fantasy (Defense Mechanism)
Gratification by imaginary achievements and wishful thinking.
36
Fixation (Defense Mechanism)
Never advancing to the next level of emotional development and organization; persistence in later life of interests and behaviour patterns appropriate to an earlier age.
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Identification (Defense Mechanism)
Unconscious attempt to change oneself to resemble an admired person.
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Insulation (Defense Mechanism)
Withdrawing into passivity and becoming inaccessible so as to avoid further threatening situations.
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Intellectualization (Defense Mechanism)
Excessive reasoning to avoid feelings; the thinking is disconnected from feelings, and situations are dealt with at a cognitive level.
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Introjection (Defense Mechanism)
Type of identification in which the individual incorporates the traits or values of another into themselves.
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Isolation (Defense Mechanism)
Response in which a person blocks feelings associated with an unpleasant experience.
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Projection (Defense Mechanism)
Transferring one's internal feelings, thoughts, and unacceptable ideas and traits to someone else.
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Rationalization (Defense Mechanism)
Attempt to make unacceptable feeling and behaviours acceptable by justifying the behaviour.
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Regression (Defense Mechanism)
Returning to an earlier developmental stage to express an impulse to deal with anxiety.
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Reaction Formation (Defense Mechanism)
Developing conscious attitudes and behaviours and acting out behaviours opposite to what one really feels.
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Repression (Defense Mechanism)
Unconscious process in which the client block undesirable and unacceptable thoughts through conscious expression.
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Sublimation (Defense Mechanism)
Replacement of an unacceptable need, attitude, or emotion with one more socially acceptable.
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Substitution (Defense Mechanism)
Replacement of a valued unacceptable object with an object more acceptable to the ego.
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Suppression (Defense Mechanism)
Conscious, deliberate forgetting of unacceptable or painful thoughts, ideas, and feelings.
50
Symbolization (Defense Mechanism)
Conscious use of an idea or object to represent another actual event or object; often the meaning is unclear because the symbol may be representative of something unconscious.
51
Undoing (Defense Mechanism)
Engaging in behaviour considered to be the opposite of a previous unacceptable behaviour, thought, or feeling.
52
Interpersonal Psychotherapy
A treatment modality that uses a therapeutic relationship to modify the client's feelings, attitudes, and behaviours.
Want to establish a contract, clarify roles and timeframe to help meet the client's goals.
53
Levels of psychotherapy (3)
1. Supportive therapy (allows pt to express feelings, explore alternatives, and make decisions in a safe/caring environment; may need for short or long time; no plan for new methods of coping, but reinforcing their existing coping mechanisms).
2. Reeducative therapy (learning new ways of perceiving/behaving; long time period; techniques: short term psychotherapy, reality therapy, cognitive restructuring, behaviour modification, develop coping skills).
3. Reconstructive therapy (make major changes; takes years; focus is on all aspects of their life; emotional and cognitive restructuring of self; positive outcomes include greater understanding of self/others; development of potential abilities.
54
Behavior Therapy
Approach that uses principle of skinerian (operant conditioning) or pavlovian (classical conditioning) behaviour therapy to bring about behavioural change.
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Operant conditioning
the manipulation of selected reinforcers to elicit and strengthen desired behaviour responses.
56
The reinforcer refers to the...
consequence of the behaviour, which is defined as anything that increases the occurrence of a behaviour.
57
Desensitization
a form of behavioural therapy whereby exposure to increasing increments of a feared stimulus is paired with increasing levels of relaxation, which helps reduce the intensity of fear to a more tolerable level.
58
Aversion therapy
form of behaviour therapy whereby negative reinforcement is used to change behaviour; a stimulus attractive to the client is pair with an unpleasant eve in hopes to endowing the stimulus with negative properties and dissuading the behaviour.
59
Modeling
is behavioural therapy whereby the therapist acts as a role model for specific identified behaviours so that the client learns through imitation.
60
Cognitive Therapy
Based on the principle that how individuals feel and behave is determined by how they think about the world and their place in it; their cognition is based on their attitudes or assumptions developed from previous experiences.
61
Transactional analysis
The 3 ego states of the individuals are examined. The goal is for the individual to communication from the proper ego states for the situation or response of others.
62
Rogerian therapy
Goal is to help express their feelings towards others during group session.
63
Gestalt therapy
emphasis on the "here and now"; emphasizes self-expression, self-exploration, and self-awareness.
64
Anxiety
A normal response to stress; A subjective experience that includes feelings of apprehension, uneasiness, uncertainty, or dread. Occurs when there is a misperceived threat or a threat to identity or self-esteem.
65
Types of Anxiety
1. Normal : a healthy type of anxiety
2. Acute : precipitated by imminent loss/change that threatens one's sense of security.
3. Chronic : Anxiety that persists as a characteristic response to daily activities.
66
Levels of Anxiety
1. Mild (tension of everyday life; alert; perceptual field is increased; can be motivating, produce growth).
2. Moderate (focus on imminent concerns; narrows perceptual fields; selective inattentiveness; learning and problem solving still occur).
3. Severe (feeling something bad will happen; significant narrowing of perceptual field; focus is on minute or scattered details; all behaviour aimed at realizing anxiety; learning and problem solving are impossible; needs direction to focus).
4. Panic (dread, terror, doom; disorganized; unable to communicate or function; increased motor activity; loss of rational thoughts with distorted perception; if prolonger can lead to exhaustion and death).
67
Interventions for Anxiety
Recognize the anxiety
Establish trust
Protect the client
Do not criticize coping mechanisms
Do no force into situations that provoke anxiety
Modify environment by setting limits or limiting interactions with others
Provide creative outlets
Monitor for signs of impending destructive behavior
Promote relaxation techniques (breathing, guided imagery)
Monitor vitals and administer antianxiety medications as prescribed
68
The immediate nursing action for a client with anxiety is to...
decrease stimuli in the environment and provide a calm and quiet environemnt.
69
Generalized Anxiety Disorder
is an unrealistic anxiety about everyday worries that persists over time and is not associated with another psychiatric or medical disorder.
70
Generalized Anxiety Disorder - Assessment findings
1. Restlessness and inability to relax
2. Episodes of trembling and shakiness
3. Chronic muscular tension
4. Dizziness
5. Inability to concentrate
6. Chronic fatigue and sleep problems
7. Inability to recognize connection between the anxiety and physical symptoms
8. Focused on the physical discomfort
71
Panic Disorder
produces a sudden onset of feelings of intense apprehension and dread; the cause usually cannot be identified; severe, recurrent, intermittent anxiety attacks last 5-30 minutes.
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Panic Disorder - Assessment findings
1.
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Phobias
Irrational fear of an object or situation that persists, although the person may recognize it as unreasonable. Associated with panic-level anxiety if object/situation is unavoidable. Defense mechanism commonly used are repression and displacement.
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Acrophobia
Fear of heights
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Agoraphobia
Fear of open spaces
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Astraphobia
Fear of electrical storms
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Claustrophobia
Fear of closed spaces
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Hematophobia
Fear of blood
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Hydrophobia
Fear of water
80
Monophobia
Fear of being alone
81
Mysophobia
Fear of dirt or germs
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Nyctophobia
Fear of darkness
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Pyrophobia
Fear of fires
84
Social phobia
Fear of situation where one might be embarrassed or criticized; fear of making a food of oneself.
85
Xenophobia
Fear of strangers
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Zoophobia
Fear of animals
87
Obsessive-Compulsive Disorder
Obsessions: preoccupation with persistently instructive thoughts and ideas.
Compulsion: the performance of rituals or repetitive behaviour to prevent some event, unacceptable thoughts and decrease anxiety.
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Compulsive behaviour patterns (behaviours or rituals)
Decrease the anxiety
The patterns are associated with the obsessive thoughts
The patterns neutralize the thought
During stressful times, the ritualistic behaviour increases
Deference mechanisms: repression, displacement, undoing.
89
Somatoform Disorders
Characterized by persistent worry or complaints regarding physical illness without supportive physical findings. Physical S&S increase with psychosocial stressors.
90
Conversion Disorder (a type of somatoform disorder)
The sudden onset of a physical symptom or a deficit suggesting loss of or altered body function related to psychological conflict or a neurological disorder. It is an expression of psychological conflict or need. No organic cause. The development of physical symptoms reduces anxiety.
Symptoms: blindness, deafness, paralysis, inability to talk.
91
Conversion Disorder - Assessment
1. Rule out physiological cause for symptoms/deficits
2. "La belle indifference" : unconcerned with symptoms
3. Physical limitation or disability
4. Feelings of guilt, anxiety, frustration
5. Low self-esteem
6. Unexpressed anger or conflict
7. Secondary gain
92
Hypochondriasis (a type of somatoform disorder)
Preoccupation with fears of having a serious disease; No evidence of physical illness exists; Significantly impairs social and occupational functioning.
93
Hypochondriasis - Assessment findings
```
Frequently somatic complaints
Complaints of fatigue and insomnia
Anxiety
Difficulty expressing feelings
Extensive use of home remedies or nonprescription medications
Repeatedly visiting a HCP
Secondary gains
```
94
Somatization Disorder (a type of somatoform disorder)
Has multiple physical complaints involving numerous body systems; Cause of complaints is presumed to be psychological.
Ex: pain; denial of emotional problems; signs of anxiety, fear, low self-esteem
95
Dissociative Disorder
A disruption in integrative functions of memory, consciousness, or identity. Is associated with exposure to an extremely traumatic event.
96
Dissociative identity disorder (DID) (formally called multiple personality disorder)
2 or more fully developed, distinct, and unique personalities exist within the client. The host is the primarily personality and the others are referred to a "alters". Alter personality may take full control over client and may/may not be aware of each other.
97
Dissociative identity disorder (DID) - Assessment findings
1. Client may have an inability to recall important information (unrelated to ordinary forgetfulness).
2. Transition from one personality to the other is related to stress or traumatic event and is sudden.
3. Used as a method of distancing and defending one's self from anxiety and traumatizing experiences.
98
Dissociative amnesia
Inability to recall important personal information because it provokes anxiety. Memory impairment may range from partial to almost complete.
99
Dissociative amnesia - Types
1. Localized: blocks out all memories about a specific period.
2. Selective: recalls some but not all memories about a specific period.
3. Generalized: has a loss of all memory about past life.
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Dissociative fugue
A client assumes a new identity in a new environment; may occur suddenly.
Client may drift from place to place; develops few social relationships; when the fugue phase lifts the client returns home and is unable t recall the fugue state.
101
Depersonalization Disorder
An altered self-perception in which one's own reality is temporarily lost or changed.
Assessment: feelings of detachment; Intact reality testing.
102
Bipolar Disorder
Characterized by episodes of mania and depression with periods of normal mood and activity in between.
103
Bipolar Disorder - Medication
- Lithium carbonate --> medication of choice**
- Valproic acid (Depakote) --> acute or maintenance
- Carbamazepine (Tegretol) --> acute or maintenance
- Lamotrigine (Lamictal) --> maintenance
- Antianxiety agents to manage psychomotor agitation characteristics of mania
- Atypical antipsychotic medication may be used for their sedative and mood stabilizing effects (Olanzapine, Aripiprazole, Risperidone)
104
Lithium Carbonate for Bipolar Disorder
Can be toxic and requires regular monitoring of serum lithium levels to help keep the medication's therapeutic index level appropriate. A stable intake of adequate dietary sodium and fluid (2-3 L daily) must be maintained to avoid toxicity.
105
Assessment findings for Mania - Bipolar Disorder
```
Becomes angry quickly
Delusional self-confidence
Pushing limits, manipulating, finding fault
Distracted by environmental stimuli
Extroverted personality
Flight of ideas
High and unstable affect
Decrease in appetite
Unlimited energy
Inability to sleep or eat due to involvement of more important things
Dress that is inappropriately bizarre
Pressured speech
Restlessness
Urgent motor activity
```
106
Bipolar I
Sustained mania with depressive episodes
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Bipolar II
At least one major depression episode with at least one hypomanic episode
108
Stressors for PTSD
natural disaster, terrorist attack, accident, rape/abuse, crime/violence
109
Assessment findings for Depression - Bipolar Disorder
```
Increased or decrease appetite
Decrease ADLs
Decreased emotion and physical activity
Easily fatigued
Inability to make decisions
Poor concentration
Introverted personality
Social isolation
Lack initiative and energy
Low self-esteem
Suicidal thinking
```
110
Depression
Affects feelings, thoughts and behaviours; Can occur after a loss or traumatic event; May be mild, moderate and severe; Treatment includes counseling, antidepressant medication and ECT.
111
Mild Depression
```
Lasts less than 2 weeks
Feeling sad, let down, disappointed
Mild alteration to sleep
Less alert
Irritability
Disinterested in spending time with others
Increase use of alcohol/drugs
Increase or decrease appetite
```
112
Moderate Depression
Persists over time
Experience a sense of change and often seeks help
Dejected, gloomy, low self-esteem, helplessness, powerlessness, intense anxiety and anger
Diurnal variation (may feel better at certain time of the day)
Rumination (persistent thinking/talking about particular subject)
Anorexia, weight loss, fatigue
Negative thinking and suicidal thoughts
Social withdrawal
113
Severe Depression
```
Intense and pervasive
Despair and hopelessness
Guilt and worthlessness
Flat affect
Unkempt appearance
Decreased speech
Self-destructive thoughts
Terminal insomnia
Diurnal variation
Delusion and hallucinations
```
114
Electroconvulsive Therapy (ECT)
An effective treatment for depression (not a cure); an electrical current is delivered though electrodes attached to the temples that cause a brief seizure within the brain.
115
ECT indications for use
- When antidepressant medications have no effect
- When there is a need for rapid definite response (ex. when suicidal)
- When extreme agitation or stupor present
- Major depressive and bipolar depressive disorder; Schizophrenia
116
Schizophrenia
A group of mental disorders characterized by psychotic features (hallucinations and delusions), disordered thought processes, and disrupted interpersonal relationships.
Disturbances in affect, mood, behaviour, and thought processes occur.
117
Schizophrenia - Physical Characteristics
Unkempt appearance
Body image distortions
May be preoccupied with somatic complaints
May neglect hygiene, eating, sleeping and elimination
118
Schizophrenia - Motor Activity Findings
Catatonic posturing (holding bizarre postures)
Catatonic excitement (moving excitedly with no stimuli)
Possible total immobilization
Inability to respond to command or only does same
Waxy flexibility
Repetitive or stereotyped movements
Motor activity increase (pacing)
119
Echolalia
Repeating the speech of another person
120
Echopraxia
Repeating the movement of another person
121
Waxy Flexibility
Having one's arms or legs placed in a certain position and holding the same position for hours
122
Schizophrenia - Emotional Characteristics
Mistrust
View the world as threatening and unsafe
Affect blunted, flat or inappropriate
123
Abnormal Thought Processes - Definition
Abnormal thought processes displayed by mentally ill client that occur as a result of a psychiatric disorder.
124
Abnormal Thought Processes - Types
1. Circumstantiality
2. Confabulation
3. Flight of Ideas
4. Looseness of Association
5. Neologisms
6. Though Blocking
7. Word Salad
125
Circumstantiality
Before getting to the point or answering a question, client gets caught up in countless details and explanations.
126
Confabulation
Filling a memory gap with detailed fantasy believed by the teller; the purpose of confabulation is to maintain self-esteem; seen in organic conditions such as Korsakoff's psychosis.
127
Flight of Ideas
Constant jumping between topics is rapid succession; seen in manic states.
128
Looseness of Association
Haphazard, illogical, and confused thinking and interrupted connections in thought; most seen in schizophrenic disorders.
129
Neologisms
Client makes up words that have meaning only for the individual; often part of a delusional system.
130
Delusions
A false belief held to be true, even when there is evidence to the contrary.
131
Loss of Reference - Delusion
client believes that certain events, situations, or interactions are related directly to self.
132
Delusions of Persecution
Client believes that they are being harassed, threatened, or persecuted by some powerful force.
133
Delusions of Grandeur
False belief that one is a powerful and important person.
134
Somatic Delusions
Client believes that their body is changing or responding in an unusual way, which has no basis in reality.
135
Illusions
May be brief experiences with a misinterpretation or misperception of reality.
136
Hallucinations
Sense perception (5 senses) for which no external stimuli exist.
137
Types of Schizophrenia
1. Catatonic Schizophrenia
2. Disorganized Schizophrenia
3. Paranoid Schizophrenia
4. Residual Schizophrenia
5. Undifferentiated Schizophrenia
138
Auditory Hallucinations
Hearing voices when none are present.
139
Gustatory Hallucinations
Experience taste in the absence of stimuli
140
Olfactory Hallucinations
Smelling smells that do not exist.
141
Tactile Hallucinations
Feeling touch sensations in the absence of stimuli
142
Visual Hallucinations
Seeing things that are no there.
143
Interventions: Active Hallucinations
1. Monitor for cues and assess content of hallucinations.
2. Intervene with one-on-one contact
3. Decrease stimuli; move pt to different areas.
4. respond verbally to anything real that they talk about.
5. avoid touching pt
6. encourage expressing feelings
7. during hallucination, attempt to engage the pt's attention through a concrete activity.
8. administer meds as n prescribed.
9. Safety first* ensure there is no commands to hurt self or others.
144
Interventions: Delusions
1. Interact based on reality
2. encourage to express feelings.
3. do not dispute or try to convince the pt that the delusions are false.
145
Paranoid Disorders
Is a concrete, pervasive delusional system characterized by persecutory and grandiose beliefs. Exhibits suspiciousness and mistrust of others.
146
Paranoid Disorders- Behaviours
```
Suspicious and mistrustful
Emotionally distant
Distortion of reality
Poor judgment
Delusions
Highly sensitive
Evasive
Concrete thinking
Hostile, aggressive
```
147
Types of Paranoid Disorders
1. Paranoid personality disorder
2. Paranoid-induced state
3. Paranoia
4. Paranoid Schizophrenia
148
Paranoid Personality Disorder (Characteristics)
Suspicious
Nonpsychotic
No hallucinations or delusions
No symptoms of schizophrenia
149
Paranoia-induced State (Characteristics)
Abrupt onset in response to stress; subsides when stress decreases
No hallucinations, but experiences paranoid delusions
May be sensitive and suspicious before delusions
No symptoms of schizophrenia
150
Paranoia (Characteristics)
```
Exhibits an organized delusional system
No hallucinations
Reserved and sensitive before onset
Psychotic state
No symptoms of schizophrenia
```
151
Paranoid schizophrenia (Characteristics)
Becomes cold, withdrawn, distrustful, resentful, argumentative before onset.
Bizarre, numerous and changeable delusions occur.
Persecutory hallucinations occur
Psychotic state ensues.
All symptoms of schizophrenia are present.
152
Personality Disorders
Includes various inflexible maladaptive behaviour patterns or traits that may impair functioning and relationships. Usually remain in touch with reality, but lack insight into their behaviours.
153
Personality Disorders (Characteristics)
- Poor impulse control
- Mood characteristics (abandonment, depression, rage, guilt, fear, emptiness)
- Impaired judgment (difficulty problem solving, inability to perceive the consequences of behaviour)
- Impaired self-perception
- Impaired thought process
- Impaired stimulus barrier
154
Cluster A personality disorder types
1. Schizoid
2. Schizotypal
3. Paranoid
155
Schizoid Personality Disorder (Characteristics)
Inability to form warm, close social relationships.
| Lack of interest in others; interest in solitary activities; indifferent; restricted expression of emotions.
156
Schizotypal Personality Disorder (Characteristics)
Display abnormal or highly unusual thoughts, perceptions, speech, and behaviour patterns.
Suspicious; Paranoia; Magical thinking; Relationship deficits.
157
Paranoid Personality Disorder (Characteristics)
Suspiciousness and mistrust of others (paranoia).
| Hostile; Rigid; Controlling; Distrusting
158
Cluster B personality disorder types
Include the overemotional, erratic types.
1. Histrionic
2. Narcissistic
3. Antisocial
4. Borderline
159
Histrionic Personality Disorder (Characteristics)
Overly dramatic and intensely expressive behaviour.
| Enjoys being center of attention; Easily bored; Concern with appearance; Sexually provocative.
160
Narcissistic Personality Disorder (Characteristics)
An increased sense of self-importance and preoccupation with fantasies and unlimited success.
Need admiration for accomplishments; overestimation of abilities and underestimation of contributions of others; lack of empathy.
161
Antisocial Personality Disorder (Characteristics)
Comprises a pattern of irresponsible and antisocial behaviour, selfishness, inability to maintain lasting relationships, poor sexual adjustment, failure to accept social norms and tendency toward irritability and aggressiveness.
162
Borderline Personality Disorder (Characteristics)
Instability in interpersonal relationships, unstable mood and self-image, and impulsive and unpredictable behaviour.
163
Cluster C personality disorder types
Include the anxious, fearful types.
1. Obsessive-compulsive personality
2. Avoidant
3. Dependent
164
Obsessive-Compulsive Personality Disorder (Characteristics)
Difficulty expressing warm and tender emotions, perfectionism, stubbornness, the need to control other, and a devotion to work.
165
Avoidant Personality Disorder (Characteristics)
Social withdrawal and extreme sensitivity to potential rejection.
Lack of social support; hypersensitive to reactions of others.
166
Dependent Personality Disorder (Characteristics)
Intense lack of self-confidence, low self-esteem, and inability to function independently.
167
General Interventions for a client with a Personality Disorder
Maintain safety against self-destruction;
Allow choices and be independent;
Provide consistency in response to behaviours;
Discuss consequences that will follow certain behaviours;
Set and maintain limits to decrease manipulation behaviours;
Encourage journal recording for emotions.
168
Dementia
A syndrome with progressive deterioration in intellectual functioning secondary to structural or functional changes.
169
The most common type of dementia is __.
Alzheimer's disease
170
Alzheimer's Disease
An irreversible form of senile dementia caused by nerve cell deterioration.
171
Stages and Major Characteristics of Alzheimer's Disease
```
Stage 1 (mild): forgetfulness
Stage 2 (moderate): confusion
Stage 3 (moderate-severe): ambulatory dementia
Stage 4 (late): end stage
```
172
Agnosia
Failure to recognize or identify familiar objects despite intact sensory function.
173
Amnesia
Loss of memory caused by brain degeneration.
174
Aphasia
Language disturbance in understanding and expressing spoken words.
175
Apraxia
Inability to perform motor activities, despite intact motor function.
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Bisexuality
Sexual attraction to and activity with both genders.
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Heterosexuality
Male-female sexual relationships.
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Homosexuality
Sexual attraction to a member of the same gender.
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Transvetisms
Obsession with wearing clothing of the opposite gender.
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Sexuality
One's sense of being a sexual individual; includes how one looks, behaves and related to others,
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Transsexualism
Feeling that one's gender is inappropriate and desiring to acquire sexual characteristics of the opposite gender.
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Exhibitionism
Sexual urges and fantasies that result in exposure of genitals to strangers to bring sexual gratification or arousal.
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Fetishism
Using nonliving objects for sexual gratification
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Pedophilia
Desiring sexual activity with a child younger than 13 years old.
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Sexual masochism
Sexual gratification that involves receiving pain.
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Sexual sadism
Sexual gratification that involves inflicting pain.
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Voyeurism
Sexual gratification through observing others disrobing or engaigng in sexual activity.
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Zoophilia
Intense sexual arousal or desire when rubbing against a nonconsenting person.
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Eating disorders are characterized by...
uncertain self-identification and grossly disturbed eating habits.
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Compulsive overeating
Bingelike overeating without purging; Release tension but doesn't produce pleasure; Aware eating patterns are abnormal and feels depressed after eating; Response to feelings by eating.
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Anorexia Nervosa
Onset often associated with stressful life event; Fears obesity; Body image is distorted is common; Can be life-threatening.
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Bulimia Nervosa
Indulges in eating binges followed by purging behaviours; Most clients remain within a normal weight range, but think their lives are dominated by the eating-related conflict.
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Interventions for clients with an Eating Disorder
1. Assess nutritional status and severity of medical problems.
2. Establish rapport with client.
3. Establish a contact concerning the nutritional plan for the day.
4. Identify precipitants to the eating disorder.
5. Encourage expression of feelings and feelings about their body.
6. Be accepting and nonjudgmental.
7. Work on exploring self-concept and identity.
8. Implement behaviour modification techniques.
9. Supervise during mealtimes and after; Monitor I&O.
10. Monitor for signs of physical complications r/t to eating disorders.
11. Weigh daily.
12. Monitor/restore electrolytes and fluids.
13. Assess and limit activity levels.
14. Medications (antidepressants)
15. Encourage psychotherapy and support groups.
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Substance abuse disorders cause...
behavioural and physiological changes.
195
Substance Dependence
Is a pattern of repeated use of a substance, which usually results in tolerance, withdrawal, and compulsive drug-taking behaviour.
Substance taken is large amounts and over longer period than intended. Daily activities resolve around the use of substance.
196
Substance tolerance
is the need for increased amount of the substance to achieve the desired effect.
197
Substance abuse
uses substances recurrently; recurrent, significant harmful consequences r/t to the use are experienced; Common to have legal issues.
198
Substance withdrawal
Physiological and substance-specific cognitive symptoms occur; Experiences a decrease in blood levels of a substance on which the individual is physiologically dependent.
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Factors to consider in a client with a substance-related disorder.
- Rebellion and peer group pressure in adolescence
- May be a coping mechanism to decrease pain/feeling
- Depression may precede or occur as a result
- Grief and loss may be associated
200
Codependency
refers to the presence of coexisting behaviours present in a significant other, which serves to enable the addict or alcoholic to continue the irresponsible patterns of use without experiencing consequences.
201
Alcohol Abuse
Is a CNS depressant affecting all body tissues.
202
Physical dependence is a...
biological need for alcohol to avoid physical withdrawal symptoms.
203
Psychological dependence refers to...
craving for the subjective effect of alcohol.
204
Compilations associated with Chronic Alcohol Use.
1. Vitamin Deficiencies (Vitamin B causing peripheral neuropathies; Thiamine causing Korsakoff's syndromes).
2. Alcohol-induces persistent amnesic disorder, causing sever memory problems.
3. Wernicke's encephalopathy, causing confusion, ataxia, and abnormal eye movements.
4. Hepatitis; cirrhosis of the liver.
5. Esophagitis and gastritis.
6. Pancreatitis.
7. Anemias.
8. Immune system dysfunctions.
9. Brain damage.
10. Peripheral neuropathy.
11. Cardiac disorders.
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What medication is commonly used for acute alcohol withdrawal?
Chlordiazepoxide (Librium)
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Disulfiram (Antabuse) Therapy
is an alcohol deterrent that may be prescribed for alcoholic dependence. The medication sensitizes the client to alcohol so that a disulfiram-alcohol reaction occurs if alcohol is ingested.
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CNS Depressants - Drug Dependency
Include alcohol, benzodiazepines, and barbiturates and act a a depressant, sedative, or hypnotic.
208
Intoxication for CNS Depressants (Symptoms)
- Drowsiness
- Hypotension
- Impairment of memory, attention, judgement, social or occupational functioning
- Incoordination and unsteady gait
- Irritability
- Slurred speech
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Overdose for CNA Depressants
If client is awake, vomiting is induced and charcoal is administered; If not aware, maintain airways and gastric lavage with activated charcoal are the priorities; seizure precautions.
Overdose can produce cardiovascular or respiratory depression, coma, shock, seizures and death.
210
What medication may be used for benzodiazepine overdose to reverse the effects?
IV Flumazenil (Romazicon)
211
CNS Stimulants - Drug Dependency
Include substances such as amphetamines, cocaine, and crack.
212
Intoxication for CNS Stimulants (Symptoms)
- Dilated pupils
- Euphoria
- Hypertension
- Impairment of judgment and social or occupational functioning
- Insomnia
- N&V
- paranoia, delusions, hallucinations
- potential violence
- tachycardia
213
Overdose for CNA Stimulants
Can produce respiratory distress, ataxia, hyperpyrexia, seizures, coma, stroke, MI, and death.
Is treated with antipsychotics and managements of associated effects.
214
CNA Depressant withdrawal is treated with...
barbiturate such as phenobarbital or a long-acting benzodiazepine.
215
CNA Stimulant withdrawal is treated with...
antidepressants, a dopamine agonist, or bromocriptine (Parlodel).
216
Opioids - Drug Dependency
Include opium, heroin, meperidine (Demerol), morphine sulfate, codeine sulfate, methadone (Dolophine), hydromorphone (Dilaudid), oxycodone (OxyContin), hydrocodone (Lortab), and fentanyl (Sublimaze).
217
Intoxication for Opioids (Symptoms)
```
Constricted pupils
Decreased respirations
Drowsiness
Euphoria
Hypotension
Impaired memory, attention, judgment
Psychomotor retardation
Slurred speech
```
218
Overdose for Opioids
Can produce respiratory depression, shock, coma, seizures, and death.
Treated with an opioid antagonist (naloxone)
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What medication assist in reducing the severity of sympathetic nervous system-generated withdrawal discomfort of Opioids?
Clonidine (Catapres)
220
Hallucinogens - Drug Dependency
Include lusergic acide diethylamide (LSD), mescaline (peyote), psilocybin (mushrooms), and phencyclidine (PCP).
221
Intoxication for Hallucinogens (Symptoms)
```
Agitation
Anxiety and depression
Blank state; Bizarre behaviour
Dilated pupils
Hallucinations
Elevated vital signs (BP)
Incoordination
Paranoia
Seizures
Tachycardia
Tremors
Muscular rigidity, jerking
```
222
Overdose effects of LSD, peyote, and psilocybin
Psychosis, brain damage, and death
223
Overdose effects of PCP
Psychosis, hypertensive crisis, hyperthermia, seizures, respiratory arrest
224
Treatment for LSD, peyote, psilocybin
Involves low environmental stimuli (speak slowly, clearly and in a low voice) and medications to treat anxiety.
225
Treatment for PCP
Possible gastric lavage (if alert); treatment to acidify the urine to assist to excreting the drug; interventions to treat behavioural disturbances, hyperthermia, hypertension, respiratory distress.
226
Inhalants - Drug Dependency
Include gases or liquids such as butane, paint thinner, paint and wax remover, airplane glue, nail polish remover, nitrous oxide.
227
Intoxication for Inhalants (Symptoms)
Enhancement of sexual pleasure
Euphoria
Excitation followed by drowsiness, lightheadedness, disinhibition, agitation
Giggling and laughter
228
Overdose effects of Inhalants
Can cause damage to the Nervous system and death.
229
Marijuana (Cannabis sativa) - Drug Dependency
Causes: euphoria, detachment, relaxation, talkativeness, slowed perception of time, anxiety, paranoia.
230
Other recreational and club drugs - Drug Dependency
Methylenedioxymethamphetamine (MDMA, ecstasy)
y-hydroxybutyrate (GHB)
Methamphetamine (crack, meth, crystal meth)
Ketamine (special K)
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Withdrawal Nursing Care
Obtain info about type of drug and amount consumed
Assess vital signs
Remove unnecessary object from environment
One-to-one supervision if necessary
Provide quiet, calm environment
Maintain client orientation
Use security devices if necessary
Provide physical needs
Provide food and fluids as tolerates
Administer medications as prescribed to decreased withdrawal symptoms
Collect blood and urine samples for drug screening
232
Crisis
Is a temporary state of severe emotional disorganization caused by failure of coping mechanisms and lack of support.
233
Phases of a Crisis
Phase 1: External precipitating event
Phase 2: Perception of threat; increase anxiety; may cope or resolve the crisis.
Phase 3: Failure of coping; increased disorganization; emergence of physical symptoms; relationship problems.
Phase 4: Mobilization of internal and external resources; goal is to return the client to at least a pre-crisis level of functioning.
234
Types of Crises
1. Maturational (R/t to developmental stages and role changes - marriage, birth of child, retirement)
2. Situational (external source, often unanticipated, life event that upsets their psychological equilibrium - loss/change of job, financial status, death of loved one)
3. Adventitious (r/t to crisis or event that is not part of everyday life, unplanned - flood, earthquake, assault, rape, murder, abuse)
235
Grief
A natural emotional response to loss that individuals must experience as they attempt to accept the loss. Usually involves moving through a series of stages to help resolve the grief.
236
Types of Grief
1. Normal grief (physical, emotional, cognitive, behavior reactions; can take months-years for resolution).
2. Anticipatory grief (occurs before the loss)
3. Disenfranchised grief (when a loss of a loved one is experience and cannot be acknowledged openly - society doesn't define the loss as a loss)
4. Dysfunctional grief (prolonged emotional instability, lack of progression to cope with the loss).
5. Grief in children is based on the developmental level of a child.
237
Stages of the Grief Response
Stage 1: Shock and Disbelief (numbness, difficulties with decision-making, emotional outbursts, denial, isolation).
Stage 2: Experiencing the Loss (ex. angry at the loved one who died or feelings of guilt about the death).
Stage 3: Reintegration (begins to reorganize their life and accepts the reality of the loss).
238
Loss
is the absence of something desired or previously thought to be available.
239
Moruning
is the outward and social expression of loss. May be dictated by cultural and religious beliefs.
240
Bereavement
includes the inner feelings and the outward reactions of the individual experiencing the loss. Includes grief and mourning.
241
Nurse's Role: Grief and Loss
Allow opportunities for fully informed choices.
Facilitate the grief process; assess grief and assist them to feel the loss and complete the tasks of the grief process.
Multidisciplinary team approach (physically, psychologically, socially, spiritually).
242
The nurse caring for a depressed client always considers the possibility of __.
suicide
243
High-risk groups for Suicide
```
Hx of previous suicide attempts
Family Hx of suicide attempts
Adolescents
Older adults
Disabled or terminally ill clients
Personality disorders
Dementia
Depressed or psychotic clients
Substance abusers
```
244
Anger
A feeling of annoyance that may be displaced onto an object or person.
Is used to avoid anxiety and gives a feeling of power in situations in which they feel out of control.
245
Violence
Physical force that is threatening to the safety of self and others.
246
Bullying
The abuse of power by an individual on another through repeated aggressive acts.
Can be in the form of physical, isolation, exclusion, verbal harm; it is both intentionally cruel and unprovoked.
247
Types of Violence
```
Physical violence
Sexual violence
Emotional violence
Physical Neglect
Developmental Neglect
Educational Neglect
Economic Exploitation
```
248
Physical Violence
Inflicting of physical pain or bodily harm.
249
Sexual Violence
Any form of sexual contact without consent.
250
Emotional Violence
Inflecting of mental anguish.
251
Physical Neglect
Failure to provide health care to prevent or treat physical or emotional illnesses.
252
Developmental Neglect
Failure to provide physical and cognitive stimulation needed to prevent developmental deficits.
253
Educational Neglect
Depriving a child of education.
254
Economic Exploitation
Illegal or improper exploitation of money, funds, or other resources for one's personal gain.
255
Latchkey Children
Children who do not have adult supervision before or after school hours; they are left to care for themselves during these times often when parent(s) work.
Interventions: encourage parent to teach child about self-care and self-help skills; assist to identify possible alternatives; inform about community resources B&A.
256
Actions to take when an Older Adult is Physically Abused
1. Assess and treat the wounds.
2. Ensure the victim is removed from the threatening environment.
3. Adhere to mandatory abuse reporting law.
4. Notify the caseworker of the situation.
5. Document the occurrence, findings, actions take, and the victim's response.
