Mental Health

Question 1

Inpatient Admission Criteria

Answer 1

1. clear risk of danger to self or others 2. dangerous decompensation of client under long-term treatment 3. failure of community based treatment with need for intensive treatment to prevent harmful consequences. 4. medical need- may or may not be associated with psychiatric treatment.

Question 2

Inpatient outcomes/goals

Answer 2

1. prevent harm to self and others 2. stabilize crisis and return to community 3. initiation or modification of medication. 4. brief and specific problem solving 5. Establishment of a plan for out-patient treatment.

Question 3

Mental Status Examination (MSE)

Answer 3

personal information; appearance; behavior; speech; affect and mood; thought; perceptual disturbances and cognition.

Question 4

cultural transference

Answer 4

the nurse’s reactions to a client that are based on the nurse’s unconscious needs, conflicts, problems, or views of the world.

Question 5

The HEADSSS Psychosocial Interview Technique

Answer 5

HOME environment (relations with parents and siblings) Education and employment (school performance) ACTIVITIES (sports, participation, after-school activities, peer relations) DRUG, alcohol or tobacco use SEXUALITY (whether the patient is sexually active, practices safe sex, uses contraception, or practices alternative sexual lifestyles) SUICIDE risk or symptoms of depression or other mental disorder SAVAGERY (violence or abuse in home environment or in neighborhood)

Question 6

The Institute of Medicine (IOM) and QSEN faculty have established mandates to prepare future nurses with the knowledge, skills, and attitudes (KSAs) necessary for achieving quality and safety they engage in the six competencies of nursing:

Answer 6

patient-centered care, teamwork, and collaboration, evidence-based practice (EBP), quality improvement (IQ), safety, and informatics.

Question 7

The primary source of assessment

Answer 7

is the patient. Secondary sources of information include family, neighbors, friends, police, and other members of the health team.

Question 8

Communication is a complex process. Berlo’s communication model has five parts:

Answer 8

stimulus, sender, message, medium, and receiver. Feedback is a vital component of the communication process for validating the accuracy of the sender’s message.

Question 9

Communication has two levels:

Answer 9

the content level (verbal) and the process level (nonverbal behavior). When content is congruent process, the communication is said to be healthy. When the verbal message is not reinforced by the communicator’s actions, the message is ambiguous; we call this a double-bind (or mixed) message.

Question 10

Cultural background (as well as individual differences) has a great deal to do with what nonverbal behavior means to different individuals.

Answer 10

The degree of eye contact and the use of touch are two nonverbal aspects that can be misunderstood by individuals of different cultures.

Question 11

Attending behaviors ( eye contact, body language, vocal qualities and verbal tracking)

Answer 11

are a key element in effective communication

Question 12

Cultural background (as well as individual values and beliefs) has a great deal to do with what nonverbal behavior means to different individuals.

Answer 12

The degree of eye contact and the use of touch are two nonverbal aspects that can be misunderstood by individuals of different cultures.

Question 13

Pharmacological, Biological & Integrative Therapies

Answer 13

• Administration of meds. -Nurse must know action, dose and adverse reactions, therapeutic blood levels. -Patient teaching -Observation of client response

Question 14

Milieu

Answer 14

• Specific structures activities that involves therapeutic communication, groups, and families. - communication and interpersonal feedback open and constructive: clear verbal messages, nonverbal messages congruent. - clients and staff responsible for own behavior.

Question 15

Milieu Examples

Answer 15

-morning goal setting meetings -evening goal review -community meetings -education -group therapy - The nurses “manage” the milieu.

Question 16

Therapeutic Communication

Answer 16

• Focus on client’s need. Not a social relationship -empathy -respect, non-judgemental - more effective than non-therapeutic communication techniques. - Communication is 10% Verbal and 90% nonverbal

Question 17

Crisis management 1

Answer 17

• Nurses anticipate, prevent, and manage emergencies and crises on the unit - depending on the diagnoses of the clients, must be prepared for varying physical crises

Question 18

crisis management 2

Answer 18

• Can lead to client violence -usually escalate through predictable stages - Nurse advocates for clients -Removes anyone not involved in the crisis from the area.

Question 19

Four key assessment areas

Answer 19

• Adequacy of housing and stability - income and source of income -family and support system -substance abuse history and current use - cultural characteristics are also important.

Question 20

Intervention Strategies

Answer 20

-Inpatient= stabilization defined by staff - Community = treatment foals and interventions negotiated

Question 21

Working Phase

Answer 21

• Promote problem-solving skills, self-esteem - Facilitate behavioral change -Overcome resistance behaviors - Evaluate problems and goals and redefine if necessary - Promote practice and expression of alternative behaviors -Can elicit intense emotions - Strong transference or counter-transference feelings may occur.

Question 22

beneficence

Answer 22

duty to act to benefit others

Question 23

autonomy

Answer 23

respecting rights of others to make decisions

Question 24

justice

Answer 24

duty to distribute resources equally

Question 25

Fidelity

Answer 25

maintaining loyalty and commitment to patient.

Question 26

veracity

Answer 26

duty to communicate truthfully

Question 27

voluntary admission

Answer 27

sought by the client or client's guardian have the right to demand discharge possible conversion to involuntary status

Question 28

involuntary admission

Answer 28

when presents danger to self/others unable to meet own basic needs commitment procedures (judicial, administrative, agency) (must be certified by multiple physicians to justify detention).

Question 29

The core concepts of patient- and family-centered care consists of

Answer 29

1. dignity and respect. 2. information sharing 3. patient and family participation. 4. the feeling of being heard and understood by patients.

Question 30

Goals in a therapeutic relationship include the following:

Answer 30

- facilitating communication of distressing thoughts and feelings - assisting patient with problem solving to help facilitate activities of daily living. - helping patients examine self-defeating behaviors and test alternatives. - promoting self-care and independence

Question 31

Within the context of a helping relationship, the following occur:

Answer 31

- The needs of the patient are identified and explored. - Alternative problem-solving approaches are taken. - New coping skills may develop. - Behavioral change is encouraged.

Question 32

narcissism

Answer 32

having to find weakness, helplessness, and/or disease in patient's to feel helpful, at the expense of recognizing and supporting patient's healthier, stronger, and more competent features.

Question 33

Transference

Answer 33

is the process whereby a person unconsciously and inappropriately displaces onto individuals in his or her current life those patterns of behavior and emotional reactions that originated in relation to significant figures in childhood.

Question 34

countertransferance

Answer 34

refers to the tendency of the nurse to displace onto the patient feelings related to people in his or her past.

Question 35

Values

Answer 35

are abstract standards and represent an ideal, either positive or negative.

Question 36

preorientation phase

Answer 36

preparing yourself professionally for the interaction Reading the chart Getting your mind around what the patient is facing Checking your own biases

Question 37

orientation phase

Answer 37

Start working on trust, develop rapport. Verbalize boundaries in a matter of fact, non judgmental way. Your purpose/function is explained. Goals are agreed upon, established. Start talking about what the end of the relationship will look like (time frame, etc) - an atmosphere is established in which rapport can grow. - the nurse's role is clarified, and the responsibilities of both the patient and the nurse are defined. - the contract containing the time, lace, date and duration of the meetings is discussed. - confidentiality is discussed and assumed. - the terms of termination are introduced (these are also discussed throughout the orientation phase and beyond). - the nurse becomes aware of transference and countertransference issues. -patient problems are articulated, and mutually agreed goals are established.

Question 38

Working Phase

Answer 38

- maintain the relationship -gather further data -promote the patient's problem-solving skills, self-esteem, and the use of language. -facilitate behavioral change -overcome resistance behaviors. - evaluate problems and goals and redefine them as necessary. - promote practice and expression of alternative adaptive behaviors.

Question 39

kinesics

Answer 39

physical characteristics such as body movements and postures.

Question 40

poxemics

Answer 40

personal space and what distance between oneself and others is comfortable for an individual.

Question 41

intimate distance in US

Answer 41

0-18 inches and reserved for those we trust most and with whom we feel safe.

Question 42

personal distance in US

Answer 42

18-40 inches id for personal communications such as those with friends or colleagues.

Question 43

social distance

Answer 43

4-14 feet is applied to strangers or acquaintances, often in public places or formal social gatherings.

Question 44

Public distance

Answer 44

12 feet or more. relates to public space (public speaking)

Question 45

The 5 A's of process integrating best evidencwe into clinical practice includes

Answer 45

1- asking, 2- acquiring, 3- appraising, 4-applying and 5-assessing.

Question 46

Application of the recovery model

Answer 46

assists people with psychiatric disabilities to effectively manage symptoms, reduce psychosocial disability, and find meaningful life in a community of their choosing.

Question 47

With the current knowledge that many common mental disorders

Answer 47

are biologically based, they are now recognized as medical diseases.

Question 48

Nursing diagnoses help

Answer 48

to systematically target symptoms patients may experience.

Question 49

The way symptoms are expressed may reflect

Answer 49

a person's cultural patterns and should be evaluated in this context.

Question 50

Theoretical models and therapeutic strategies

Answer 50

provide a useful framework for the delivery of psychiatric nursing care.

Question 51

The psychoanalytic model is based on

Answer 51

unconscious motivations and the dynamic interplay between the primitive brain (ID), the sense of self (ego), and the conscience (superego). The focus of the psychoanalytic theory is on understanding the unconscious mind.

Question 52

The interpersonal model maintains

Answer 52

that the personality and disorders are created by social forces and interpersonal experiences. Interpersonal therapy aims to provide positive and repairing interpersonal experiences.

Question 53

The behavioral model suggests that

Answer 53

because behavior is learned, behavioral therapy should improve behavior through rewards and reinforcement of adaptive behavior.

Question 54

The humanist model is based on

Answer 54

human potential, and therapy is aimed at maximizing this potential. Maslow developed a theory of personality that is based on the hierarchical satisfaction of needs. Roger's person centered theory uses self-actualizing tendencies to promote growth and healing.

Question 55

The cognitive model posits that

Answer 55

disorders, especially depression, are the result of faulty thinking. Cognitive behavioral therapy is empirically supported and focuses on the recognition of distorted thinking and the replacement with more accurate and positive thoughts

Question 56

The biological model is currently

Answer 56

the dominant model and focuses on physical causation for personality problems and psychiatric disorders. Medication is the primary biological therapy.

Question 57

A variety of nursing theories are useful to psychiatric nursing.

Answer 57

Hildegard Peplau developed an important interpersonal theory for the provision of psychiatric nursing care.

Question 58

long-term/formal commitment

Answer 58

-primary purpose is extended care and treatment of the mentally ill. -admitted through judicial or administrative action or medical certification. -competency related to the capacity to understand the consequences of one's own decisions.

Question 59

involuntary outpatient commitment

Answer 59

outpatient commitment alternative to forced inpatient treatment. -preventive measure -AOT assisted outpatient treatment

Question 60

Patient's Rights

Answer 60

-right to be treated with dignity -right to refuse treatment - right to informed consent -right to legal counsel -right to request to leave the hospital -rights regarding restraint and seclusion -right to be involved in treatment planning/decisions. - right to keep personal belongings unless they can cause harm.

Question 61

Exceptions to patient confidentiality

Answer 61

-duty to warn and protect third parties - most states have similar laws regarding duty to warn third parties of potential life threats. -staff nurse reports threats by patient to the treatment team

Question 62

Ethical Issues

Answer 62

1. right to refuse medication 2. right to the least restrictive treatment. (exception court ordered inpatient)

Question 63

Use of restraint and seclusion

Answer 63

legislation provides strict guidelines for use: - when behavior is physically harmful to patient/others - when least restrictive measures are insufficent - when decrease in sensory overstimulation (seclusion only is needed) - when patient anticipates that controlled environment would be helpful and requests seclusion.

Question 64

Liability Issues

Answer 64

- protection of clients -defamation of character -supervisory liability -staffing issues

Question 65

Assault

Answer 65

no physical contact but fear and apprehension; words, verbal threats.

Question 66

battery

Answer 66

touching another person without consent (hitting, etc)

Question 67

false imprisonment

Answer 67

many issues in psychiatric nursing

Question 68

Violence

Answer 68

- The responsibility for safety is entirely the nurse's - Nurses must protect themselves by creating safe environments. -responsible for protecting client and third parties.

Question 69

negligence

Answer 69

-act or an omission to act that results in or is responsible for a person's injuries.

Question 70

Situation of Professional Negligence

Answer 70

1-Failure to warn 2- Failure to recognize suicidal risk 3- sexual involvement 4- breach of confidentiality 5- failure to honor individual rights 6- failure to use least restrictive alternative 7- failure to protect

Question 71

Concept of Resiliency

Answer 71

-important component of mental health - ability to recover or adjust to misfortune and change - helps people facing tragedy, loss, trauma, and severe stress

Question 72

resilient people

Answer 72

recognize feelings deal with feelings learn from experiences

Question 73

evidence-based practice

Answer 73

scientifically grounded or evidence based medical model

Question 74

recovery model

Answer 74

management of symptoms and psychosocial disability social model nurse-patient partnership

Question 75

trauma-informed care

Answer 75

ask "What has happened to you?" recognizes that trauma is almost universally found in histories of mental health patients and is a contributor to mental health issues, substance abuse, chronic health conditions, and contact with the criminal justice system.

Question 76

DSM 5 Diagnostic and Statistical Manual of Mental Disorders

Answer 76

was published in May 2013 manual that classifies mental disorders focuses on research and clinical observation

Question 77

Culture and Mental Illness

Answer 77

- has been included in DSM 5 - Must consider the norms and influence of culture - Lack of cultural knowledge can result in lack of services or inappropriate services

Question 78

Theories and Therapies

Answer 78

Freuds psychoanalytic theory (level of awareness and defense mechanisms) - Sullivan's interpersonal Theory -Erikson's Ego Theory - Maslow's Humanistic Psychology Theory -Pavlov's Classic Conditioning theory -Watson's Behaviorism Theory - Skinner's Operant Conditioning Theory

Question 79

Freud psychoanalytic

Answer 79

unconscious thoughts; psychosexual development psychoanalysis to learn unconscious thoughts; therapist is nondirective and interprets meaning

Question 80

Sullivan interpersonal

Answer 80

relationships as basis for mental health or illness therapy focuses on here and now and emphasizes relationships; therapist is an active participant.

Question 81

Pavlov, Watson & Skinner Behavioral

Answer 81

Behavior is learned through conditioning Behavioral modification addresses maladaptive behaviors by rewarding adaptive behavior

Question 82

Beck Cognitive

Answer 82

Negative and self-critical thinking causes depression Cognitive behavior therapists assist in identifying negative thought patterns and replacing them with rational ones, and often involves homework.

Question 83

Biological

Answer 83

Psychiatric disorders are heavily influenced by and/or cause changes to the brain and/or neurotransmitter(s) resulting in changes in thinking and behavior. Neurochemical imbalances are corrected through medication and talk therapy. (cognitive behavior therapy)

Question 84

Oral birth to 18 months

Answer 84

Id, pleasure seeking, mouth fixation

Question 85

Anal 18 month to 3 years

Answer 85

Ego is our sense of self and acts as an intermediary between the id and the world using defense mechanisms (potty training)

Question 86

Phallic 3-7 years

Answer 86

superego conscience of right and wrong sexual identity through identification with same-sex parent

Question 87

Latency 7 to 12 years

Answer 87

Peer group loyality begins growing independence from family sexuality is represses close friendships with same sex peers

Question 88

genital phase 13-20 years

Answer 88

dependence vs independence form close relationships with opposite sex based on genuine caring and pleasure in interaction

Question 89

Maslow's Hierarchy of Needs

Answer 89

1- Physiological Needs (food, water, oxygen, rest, sex, elimination). 2. safety needs ( security, protection, stability, structure, order and limits) 3. Love and Belonging Needs (Affiliation, affectionate relationships, and love) 4. Esteem Needs ( self-esteem related to competency, achievement, and esteem from others) 5. Self-Actualization Needs (Becoming everything one is capable of) 6. Self-Transcendent Needs

Question 90

Infancy birth to 18 months,

Answer 90

trust vs mistrust egocentric danger: during second half of first year, an abrupt and prolonged separation may intensify the natural sense of loss and may lead to a sense of mistrust that may last throughout life. Task: develop a sense of trust that leads to hope

Question 91

Early childhood 18 months to 3 years

Answer 91

autonomy vs shame/doubt develop confidence in physical and mental abilities that leads to the development of autonomous will danger: development of a deep sense of shame/doubt is child is deprived of the opportunity to rebel; learns to expect defeat in any battle of wills with those who are bigger and stronger Task: gain self-control of and independence within the environment.

Question 92

Peplau

Answer 92

-developed the first theory for psychiatric nursing - described the nurse-patient relationship as the foundation of nursing practice -shifted focus from what nurses do "to" patients to what nurses do "with" patients

Question 93

Classical psychoanalysis

Answer 93

-developed by Freud - importance of early life trauma in later mental disorders - uses dream analysis and free association - two concepts still important to understand : transference and counter transference.

Question 94

Psychodynamic Therapy

Answer 94

- Based on psychoanalysis -less sessions (10-12) - focus on present instead of early life - Best candidates: relatively healthy, well-functioning, experiencing well-defined difficulty, well motivated for change.

Question 95

interpersonal psychotherapy

Answer 95

- personality disorders are caused by personal interactions. Early relationships with significant others are crucial in personality development. - healthy relationships = healthy personality - focus on reassurance and clarification of feelings, and interpersonal communication. - help client become aware of dysfunctional patterns which leads to change in behavior.

Question 96

Behavior Therapy

Answer 96

- Personality traits (adaptive and maladaptive) are learned - changes in maladaptive behavior can occur without knowing the underlying cause. - works best when directed at specific problems (phobias, alcoholism).

Question 97

systematic desensitization

Answer 97

developing specific tasks specific to the client's fears

Question 98

aversion therapy

Answer 98

used widely to treat unacceptable social behaviors - is based on both classical and operant conditioning and is used to eradicate unwanted habits by associating unpleasant consequences with them. (Antabuse- medication for alcoholism)

Question 99

Biofeedback

Answer 99

is a technique in which individuals learn to control physiological responses such as breathing rates, heart rates, blood pressure, brain waves, and skin temperature. This control is achieved by providing visual or auditory biofeedback of the physiological response and then using relaxation techniques such as slow, deep breathing or meditation.

Question 100

extinction

Answer 100

decrease in behavior when reinforcement is withheld ex. temper tantrum- parent leaves the room.

Question 101

Cognitive therapy

Answer 101

- an individual's cognitive thinking/evaluation of stimulus leads to the emotional response - cognitive distortions (overgeneralization, jumping to conclusion, magnification, etc.) - active, directive, time-limited, structured approach used to treat a variety of psychiatric disorders.

Question 102

Cognitive-Behavior Therapy (CBT)

Answer 102

- modify negative thoughts, feelings, and behaviors. -methods: identify negative patterns of thinking (cognitive distortions); use ABC format for recording and analyzing. - then reframe negative thinking

Question 103

ABC's of irrational beliefs

Answer 103

Activating Event Belief Consequences Reframing

Question 104

Recovery Model

Answer 104

Focus is NOT cure living and managing a chronic disease Nurse's role is to assist with...... - increased individual and family involvement -advocate for self-administration of meds with community supports -develop personal relapse prevention plans -recommend supported employment.

Question 105

Piaget's STages of Cognitive Development

Answer 105

Sensorimotor (birth to 2 years) preoperational (2-7 years) concrete operational (7 to 11 years) Formal operational (11 years to adulthood)

Question 106

Sensorimotor birth to 2 years

Answer 106

begins with basic reflexes and culminated with purposeful movement, spatial abilities, and hand-eye coordination. Around 9 months object permanence is achieved and the child can conceptualize objects that are no longer visible.

Question 107

Preoperational 2-7 years

Answer 107

Language develops, yet children think in a concrete fashion. Expecting others to view the world as they do is call egocentric thinking. Children begin to think in images and symbols and engage in such activities as playing house.

Question 108

Concrete operational 7-11 years

Answer 108

The child is able to think logically and use abstract problem solving. He/she is able to see another's point of view and is able to see a variety of solutions to the problem. Conservation is possible.

Question 109

Formal operational (11 years to adulthood)

Answer 109

Conceptual reasoning beings at approximately the same time as puberty. At this stage, the child's basic abilities to think abstractly and problem solve are similar to those of an adult.

Question 110

Kohlberg Stages of Moral Development

Answer 110

Pre-conventional Conventional Post-Conventional

Question 111

Biological Model

Answer 111

- Mental disorders believed to have physical causes - Treatments directed toward physical interventions; pharmacological/psychopharmacology, electroconvulsive therapy (ECT), and transcranial magnetic stimulation (TMS).

Question 112

Milieu Therapy

Answer 112

-scientific restructuring of the environment -central is a living, learning, or working environment - basic intervention in nursing practice: major focus - one-to-one relationships; major task-developing trust; major responsibility- setting limits on unacceptable behavior; and client teaching also of utmost importance. -example: providing safety for a suicidal patient.

Question 113

Biological basis for understanding psychopharmacology

Answer 113

most medications have their effects at the neuronal synapse, producing changes in neurotransmitter release and the receptors they bind to.

Question 114

Frontal lobe

Answer 114

thought processes, decision making

Question 115

temporal lobe

Answer 115

allows appropriate expression of emotion

Question 116

occipital lobe

Answer 116

visual memory and language formation

Question 117

parietal lobe

Answer 117

body awareness and concept formation, ability for processing abstract concepts/decisions

Question 118

limbic system

Answer 118

emotional brain

Question 119

excessive dopamine

Answer 119

schizophrenia

Question 120

insufficient GABA activity

Answer 120

anxiety

Question 121

deficient norepinephrine and/or serotonin

Answer 121

depression

Question 122

antianxiety/anxiolytics

Answer 122

- bind to a receptor adjacent to GABA receptor which enhances GABA's effect - produce a calming effect by depressing the CNS - Sedative/hypnotic

Question 123

anxiolytics used for

Answer 123

- anxiety and panic -insomnia -alcohol withdrawals - Two classes: benzodiazepines and non-benzo

Question 124

Benzodiazapines (Drug suffices: -PAM, -LAM)

Answer 124

Alprazolam (Xanax) Chlordiazepoxide (Librum) Clonazepam (Klonopin) Diazepam (Valium) Lorazepam (Ativan)

Question 125

Benzodiazapines Side Effects

Answer 125

- CNS depression (lethargy, confusion, blurred vision) -Withdrawal symptoms (tremor, agitation, nervousness, sweating, insomnia, anorexia, muscle cramps) - Insomnia, Euphoria, excitation - Tolerance, Dependence.......Potential abuse

Question 126

Non- Benzodiazepines

Answer 126

Buspirone (BuSpar) Hydroxyzine (Vistaril) - less addictive than benzodiazepines

Question 127

Buspirone (BuSpar)

Answer 127

Does not cause sedation but..... - takes about 2 weeks before patient notices effect - will not reduce anxiety in patient that is use to taking benzos because there is no sedation effect to "take the edge off".

Question 128

Typical Anti-Psychotics 1st Generation

Answer 128

- block dopamine receptors. Some effect acetylcholine, histamine, and norepinephrine receptors. - Problem side effects

Question 129

Typical Anti-Psychotics 1st Generation Drugs

Answer 129

Chlorpromazine (Thorazine) Fluphenazine (Prolixin) Haloperidol (Haldol)

Question 130

Antipsychotic Adverse Effects

Answer 130

- Tardive Dyskinesia (TD) - Neuroleptic Malignant Syndrome - Extrapyramidal Side Effects - Anticholinergic Effects - Agranulocytois

Question 131

Tardive Dyskinesia (TD)

Answer 131

-late EPS which can require months to years of medication therapy for TD to develop -involuntary movements of the tongue and face, such as lip smacking and tongue fasciculations - involuntary movements of the arms, legs and trunk involuntary muscle movements that may not resolve with drug discontinuation- risk approx. 5% per year treatment --Valbenazine (Ingrezza)

Question 132

Neuroleptic Malignant Syndrome

Answer 132

Characterized by severe muscle rigidity, fever, altered mental status, autonomic instability, elevated WBC, CPK (creatine phosphokinase) and liver function tests. Potentially fatal. administer dantrolene or bromocriptine to induce muscle relaxation. take vital signs, cooling blankets antipyretics medications to treat arrhythmias transfer to ICU

Question 133

Extrapyramidal side effects

Answer 133

acute Dystonia, Parkinson syndrome, akathisia treatment- give Benztropine (Cogentin)

Question 134

acute dystonia

Answer 134

severe spasms of the tongue, neck, face and back. crisis situation that requires rapid treatment. treat with benztropine diphenhydramine also, IM or IV

Question 135

parkinson syndrome

Answer 135

-bradykinesia, rigidity, shuffling gait, drooling, tremors treat with antiparkinson agent, such as benztropine or trihexyphenidyl. implement interventions to reduce risk for falling.

Question 136

anticholinergic effect

Answer 136

can't see, can't pee, can't shit, can't spit - dry mouth - blurred vision -photophobia -urinary hesitancy or retention -constipation -tachycardia

Question 137

agranulocytosis

Answer 137

- advise clients to observe for indications of infection (fever, sore throat) and to notify the provider if these occur. - if indications of infection appear, obtain a CBC. Medication should be discontinued if WBC count is less than 3,000 mm3.

Question 138

akathisia

Answer 138

inability to sit or stand still continual passing and agitation - manage with antiparkinsonian agents, beta blockers, or lorazepam/diazepam. - monitor for increased risk for suicide in clients who have severe akathisia.

Question 139

Pseudoparkinsonism

Answer 139

stooped posture shuffling gait rigidity bradykinesia tremors at rest pilling motion of the hand

Question 140

Acute Dystonia

Answer 140

- facial grimacing -involuntary upward eye movement - muscle spasms of the tongue, face, neck and back (back muscle spasms cause trunk to arch forward) -laryngeal spasms

Question 141

Akathisia

Answer 141

-restless -trouble standing still -paces the floor -feet in constant motion, rocking back and forth.

Question 142

Tardive Dyskinesia

Answer 142

- Protrusion and rolling of the tongue -sucking and smacking movements of the lips - chewing motion -facial dyskinesia -involuntary movements of the body and extremities

Question 143

Atypical Anti-psychotics: 2nd Generation

Answer 143

- Bind to dopamine receptors in the limbic system so are able to exert psychiatric action without motor side effects. - are also antagonists at the receptors for serotonin, which makes them a drug of choice for treating Schizophrenia and delaying progression. - may improve cognitive function

Question 144

Atypical Anti-psychotics: 2nd Generation Drugs

Answer 144

Clozapine (Clozaril) Olanzapine (Zyprexa) Quetiapine (Seroquel) Risperidone (Risperdal) Ziprasidone (Geodon)

Question 145

Risperidone (Risperdal)

Answer 145

- Functions more like a 1st gen antipsychotic at higher doses -increased extrapyramidal side effects - most likely atypical to induce hyperprolactinemia - weight gain and sedation

Question 146

Olanazapine ( Zyprexa)

Answer 146

- may cause hypertriglyceridemia, hypercholesterolemia, hyperglycemia (even without weight gain) - weight gain (can be as much as 30-50 lbs with even short term use)

Question 147

Quetiapine (Seroquel)

Answer 147

- most likely to cause orthostatic hypotension - may cause liver dysfunction - may cause hypertriglyceridemia, hypercholesterolemia, hyperglycemia (even without weight gain), however less than olanzapine. - May be associated with weight gain, though less than seen with olanzapine.

Question 148

Ziprasidone (Geodon)

Answer 148

- Clinically significant QT prolongation in susceptible patients - may cause hyperprolactinemia (less than risperidone) - no associated weight gain -absorption is increased with food.

Question 149

Aripiprazole (Abilify)

Answer 149

- Partial dopamine/serotonin antagonist -low EPS, no QT prolongation, low sedation, no weight gain - interaction with fluoxetine (Prozac), Paroxetine (Paxil), Carbamazepine (Tegretol) could cause potential intolerability due to akathisia.

Question 150

Clozapine (Clozaril)

Answer 150

-Is reserved for treatment resistant patients because of side effects. - agranulocytosis..... requires weekly blood draws x 6 months, then every 2 weeks x 6 months - increased risk of seizures (especially in combination with lithium) - associated with the most sedation, weight gain and liver dysfunction. - increased risk of hypertriglyceridemia, hypercholesterolemia, hyperglycemia, including ono-ketotic hyperosmolar coma and death with and/or without weight gain.

Question 151

Antidepressants

Answer 151

- Most work by blocking the reuptake of neurotransmitters serotonin and norepinephrine. - some also block receptor sites.

Question 152

General Guidelines for antidepressant use

Answer 152

- there is a delay typically of 3-6 weeks after a therapeutic dose is achieved before symptoms improve. - if no improvement is seen after a trial of adequate length (at least 2 months) and adequate dose, either switch to another antidepressant or augment with another agent.

Question 153

selective serotonin reuptake inhibitors (SSRIS)

Answer 153

- blocks serotonin reuptake - treat both anxiety and depression - most common side effects include GI upset, sexual dysfunction, anxiety, restlessness, nervousness, insomnia, fatigue or sedation, dizziness, suicidal ideations. -can develop a discontinuation syndrome with agitation, nausea, disequilibrium and dysphoria. - side effects often decrease after 2-4 weeks.

Question 154

SSRIS (Drug Suffixes: Pram, INE)

Answer 154

Citalopram (Celexa) Escitalopram (Lexapro) Fluoxetine (Prozac) Paroxetine (Paxil) Sertraline (Zoloft)

Question 155

Citalopram (Celexa)

Answer 155

- May cause prolonged QT interval -sedation -GI side effects

Question 156

Escitalopram (lexapro)

Answer 156

- more effective than Citalopram in acute response and remission -Prolonged QT interval prolongation -Nausea, headache

Question 157

Fluoxetine (Prozac)

Answer 157

- long half life and active metabolite may build up (not a good choice in patients with hepatic illness) - initial activation may increase anxiety and insomnia - more likely to induce mania

Question 158

Paroxetine (Paxil)

Answer 158

- sedation - weight gain - more anticholinergic effects

Question 159

Sertaline (Zoloft)

Answer 159

- Max absorption requires a full stomach - increased number of GI side effects

Question 160

Tricyclic Antidepressants

Answer 160

Amitriptyline (Elavil) Doxepin (Sinequan) Imipramine (Tofranil) Nortriptyline (Pamelor, Aventyl)

Question 161

Tricyclic Antidepressants

Answer 161

- inhibits serotonin and norepinephrine reuptake. Plus blocks other receptor sites. - Very effective but potentially unacceptable side effects - sedation and weight gaint - anticholinergic (Dry moth, dry eyes, constipation, memory deficits and potentially delirium) - orthostatic hypotension, sedation, sexual dysfunction - lethal in overdoze (even a one week supply can be lethal) - can cause prolonged QT even at a therapeutic serum level.

Question 162

Serotonin/Norepinephrine Reuptake Inhibitors (SNRI)

Answer 162

Desvenlafaxine (Pristiq) Duloxetine (Cymbalta) Venlafaxine (Effexor)

Question 163

SNRI

Answer 163

- Dual action.....inhibit both serotonin and norepinephrine reuptake like the TCAS but without the antihistamine or anticholinergic side effects

Question 164

Desvenlafaxine (Pristiq) side effects

Answer 164

increase in total cholesterole, LDL and triglycerides & BP

Question 165

Venlafaxine (Effexor) side effects

Answer 165

- can cause a 10-15 point increase in diastolic BP - QT prolongation -Sexual side effects

Question 166

Monoamine Oxidase Inhibitor (MAOI)

Answer 166

- binds to monamine oxidase thereby preventing inactivation of norepinephrine, dopamine and serotonin leading to increased synaptic levels. - Side effects: orthostatic hypotension, weight gain, dry mouth, sedation, sexual dysfunction and sleep disturbance. - hypertensive crisis can develop when MAOI' are taken with tyramine-rich foods. - Serotonin syndrome if taken with SSRIs

Question 167

Monoamine Oxidase Inhibitors (MAOIs)

Answer 167

Isocarboxacid (Marplan) Pheneizine (Nardil) Tranylcypromine (Parnate)

Question 168

MAOI + Tyramine = Hypertensive Crisis

Answer 168

Tyramine Foods: -Strong or aged cheeses, such as aged cheddar, Swiss and Parmesan; blue cheeses such as Stilton and Gorgonzola; and Camembert. Cheeses made from pasteurized milk are less likely to contain high levels of tyramine — for example, American cheese, cottage cheese, ricotta, farmer cheese and cream cheese. -Cured meats, which are meats treated with salt and nitrate or nitrite, such as dry-type summer sausages, pepperoni and salami. -Smoked or processed meats, such as hot dogs, bologna, bacon, corned beef or smoked fish. -Pickled or fermented foods, such as sauerkraut, kimchi, caviar, tofu or pickles. -Sauces, such as soy sauce, shrimp sauce, fish sauce, miso and teriyaki sauce. -Soybeans and soybean products. -Snow peas, broad beans (fava beans) and their pods. -Dried or overripe fruits, such as raisins or prunes, or overripe bananas or avocados. -Meat tenderizers or meat prepared with tenderizers. -Yeast-extract spreads, such as Marmite, brewer's yeast or sourdough bread. -Alcoholic beverages, such as beer — especially tap or homebrewed beer — red wine, sherry and liqueurs. -Combination foods that contain any of the above ingredients. -Improperly stored foods or spoiled foods. While you're taking an MAOI, your doctor may recommend eating only fresh foods — not leftovers or foods past their freshness dates. -Beverages with caffeine also may contain tyramine, so your doctor may recommend limits.

Question 169

Serotonin Syndrome (Can't sit still)

Answer 169

- symptoms: abdominal pain, diarrhea, sweats, tachycardia, HTN, muscle spasm/twitching, irritability, delirium. Can lead to hyperpyrexia (high fever), cardiovascular shock and death. - Need to wait 2 weeks before switching from an SSRI to an MAOI. Wait 5 weeks after fluoxetine due to longer half-life. - Can happen when current SSRI dose is increased.

Question 170

Differences between Serotonin Syndrome and Neuroleptic Malignant Syndrome

Answer 170

Question 171

Atypical Antidepressants

Answer 171

- Bupropion (Wellbutrin): common use- smoking cessation - Mirtazapine (Remeron) - Trazodone (Desyrel): common use- sleep aid - affect one or two of the three neurotransmitters: serotonin, norepinephrine, and dopamine. - do not take with MAOIs and do not use within 14 days after discontinuing MAOIs.

Question 172

Serotonergic (SSRIs) side effects

Answer 172

- insomnia - sexual side effects - weight gains - anxiety - nausea/ diarrhea.

Question 173

Dopaminergic- buproprion side effects

Answer 173

- anxiety - insomnia - no sexual SE - no weight gain - seizure risk

Question 174

Norepinephrine (TCAs) side effects

Answer 174

- blood pressure - sedation - weight gain - cardiac in overdose

Question 175

SNRI

Answer 175

- combo SSRI and TCA - nausea - weight gain - blood pressure changes

Question 176

Mood Stabilizers | (Anti-manic)

Answer 176

- Lithium (Eskalith, Lithobid) - Lithium affects the flow of sodium through nerve and muscle cells. Impacts sodium/potassium shift. - increased receptor sensitivity to serotonin - Therapeutic serum range: 0.4 to 1.4 mEq/L - Side Effects: GI distress (reduced appetite, nausea/vomiting, diarrhea, metallic taste), thyroid abnormalities, polyuria/polydipsia.... chronic kidney disease?, reduces seizure threshold, cognitie slowing, tremor.

Question 177

Mood Stabilizers: Anticonvulsants

Answer 177

All treat mania, not the depression * Valproate (Depakote, Depakene) * side effects: thrombocytopenia, weight gain, tremors, liver dysfunction, sedation, decreased folic acid * Carbamazepine (Tegretol) * side effects: rash, sedation, confusion, ataxia, aplastic anemia, weight gain. many drug-drug interactions. * Lamotrigine (Lamictal) * side effects: rash, sedation, confusion, ataxia

Question 178

Lamotrigine (Lamictal)

Answer 178

* Anticonvulsant * rash (Steven-Johnson's syndrome) call HCP

Question 179

ANXIETY

Answer 179

feeling of apprehension, uneasiness, uncertainty or dread resulting from real or perceived threat whose actual source is unknown or unrecognized

Question 180

fear

Answer 180

reaction to specific danger

Question 181

anxiety

Answer 181

* effects us at deeper level than fear does * invades central core of personality * erodes away at our self-esteem and personal worth

Question 182

normal anxiety

Answer 182

motivating force that provides energy to carry out tasks of living

Question 183

acute anxiety

Answer 183

anxiety that precipitated by imminent loss or change that threatens one's security (crisi)

Question 184

Chronic anxiety

Answer 184

anxiety that persists over time

Question 185

mild anxiety

Answer 185

* sees, hears, and grasps more information * problem-solving more effective * may display physical symptoms: * slight discomfort * restlessness * irritable * nail biting * fidgeting

Question 186

moderate anxiety

Answer 186

* perceptual field narrows * sees, hears, and grasps less information * selective inattention * physical symptoms * tension * pounding heart * increased pulse and respirations * perspiration * mild somatic symptoms

Question 187

severe anxiety

Answer 187

* perceptual field greatly reduced * focus on one particular detail or many scattered details * learning and problem solving not possible * physical symptoms * increased somatic symptoms * trembling * pounding heart * hyperventilation * sense of impending doom

Question 188

panic level anxiety

Answer 188

* markedly disturbed behavior * lose touch with reality * confusion, shouting, hallucinations * physical behaviors * erratic * uncoordinated * impulsive

Question 189

Interventions for mild-moderate anxiety

Answer 189

* use of therapeutic communication and listening * open-ended statements * broad openings * seeking clarification * exploration * importance of nurse remaining calm, recognizing client's distress.

Question 190

interventions for severe-panic anxiety

Answer 190

* reduce environmental stimuli * remove patient to quiet area * remain with patient * gross motor activity to drain tension * therapeutic communication techniques * firm, short, and simple statements * reinforce reality * medications and restraints * used only after least restrictive measures fail.

Question 191

Important properties of defense mechanisms

Answer 191

* major means of managing conflict and affect * relatively unconscious * discrete from one another * reversible * can be helpful as well as harmful

Question 192

altruism

Answer 192

dealing with anxiety by reaching out to others A nurse who lost a family member in a fire is a volunteer firefighter.

Question 193

sublimation

Answer 193

dealing with unacceptable feelings or impulses by unconsciously substituting acceptable forms of expression "A person who has feelings of anger and hostility toward his work supervisor sublimates those feelings by working out vigorously at the gym during his lunch period.

Question 194

suppression

Answer 194

voluntarily denying unpleasant thoughts and feelings. ## Footnote Examples: A student puts off thinking about a fight she had with her friend so she can focus on a test. A person who lost his job states he will worry about paying his bills next week.

Question 195

repression

Answer 195

* unconsciously putting unacceptable ideas, thoughts, and emotions out of awareness. * "A person preparing to give a speech unconsciously forgets about the time when he was young and kids laughed at him while on stage." * "A person who has a fear of the dentist continually forgets to go to his dental appointments.

Question 196

Regression

Answer 196

* Sudden use of childlike or primitive behaviors that do no correlate with the person's current development level.

Question 197

Displacement

Answer 197

* shifting feelings related to an object, person or situations to another less threatening object, person, or situation. * "An adolescent angrily punches a punching bag after losing a game." * " A person who is angry about losing his job destroys his child's favorite toy."

Question 198

Reaction Formation

Answer 198

* Overcompensating or demonstrating the opposite of what is felt * "A man who is trying to quit smoking repeatedly talks to adolescents about the dangers of nicotine." * "A person who dislikes her neighbor tells others what a great neighbor she is."

Question 199

undoing

Answer 199

* Performing an act to make up for prior behavior. * an adolescent completes his chores without being prmpted after having an argument with his parent. * a man buys his wife flowers and gifts following an incident of domestic abuse.

Question 200

Anxiety disorders are

Answer 200

* most common mental health disorder in the US * affects women more than men * 90% of people with anxiety disorder develop other psychiatric disorders such as depression, substance abuse, eating disorders.

Question 201

rationalization

Answer 201

* creating reasonable and acceptable explanations for unacceptable behavior. * "An adolescent boy says "she must already have a boyfriend" when rejected by a girl." * A young adult explains he had to drive home from a party after drinking alcohol because he had to feed his dog.

Question 202

dissociation

Answer 202

* creating a temporary compartmentalization or lack of connection between the person's identity, memory, or how they perceive the environment. * a parent blocks out the distracting noise of her children in order to focus driving in traffic. * a women foegets who she is following a sexual assault.

Question 203

anxiety disorders in chidren

Answer 203

* most common mental disorder of children and adolescents (19% of ages 9 to 17) * characteristics similar to those in adults * separation anxiety disorder: excessive anxiety when separated from or anticipating separation from home/parent; can lead to refusal to attend school * posttramatic stress disorder (PTSD) * children with this disorder tend to react with behaviors indicative of internalized anxiety.

Question 204

genetic theory

Answer 204

* clusters in families * first degree biological relatives of people with panic disorder up to 8x more likely to experience panic attacks.

Question 205

Biological Findings theory

Answer 205

* limbic system involvement * decreased serotonin and GABA * increased norepinephrine

Question 206

Behavioral theory

Answer 206

* anxiety is a learned response from modeling from parents and/or peers. * unconscious childhood conflicts the basis for symptom development

Question 207

Cognitive theory

Answer 207

* anxiety is caused by distortions in thinking and perceiving.

Question 208

cultural considerations (anxiety)

Answer 208

* variation in symptoms * latin americans and northen europeans * choking * smothering * fear of dying * numbness or tingling * Japanese and Korean * social phobias

Question 209

denial

Answer 209

* pretending the truth is not reality to manage the anxiety of acknowledging what is real * A person initially says, "No, that can't be true." when they are told they have cancer * A parent who is informed that his son was killed in combat tells everyone one month later that he is coming home for the holidays.

Question 210

compensation

Answer 210

* emphasizing strengths to make up for weaknesses. * an adolescent who is physically unable to play contact sports excels in academic competitions. * a person who is shy works at computer skills to avoid socialization.

Question 211

identification

Answer 211

* conscious or unconscious assumption of the characteristics of another individual or group * a girl who has a chronic illness pretends to be a nurse for her dolls. * a child who observes his father be abusive toward his mother becomes a bully at school

Question 212

Panic Disorder

Answer 212

frequent, spontaneous attacks and avoidance

Question 213

Generalized Anxiety Disorder

Answer 213

Constant worry & physical symptoms

Question 214

Obsessive Compulsive Disorder

Answer 214

excessive, repetitive thoughts and behaviors

Question 215

Social Phobia

Answer 215

embarrasment & humiliation in social situations

Question 216

intellectualization

Answer 216

* separation of emotions and logical facts when analyzing or coping with a situation or event * a law enforcement officer blocks out the emotional aspect of a crime so he can objectively focus on the investigation. * a person learns he has a terminal illness focuses on creating a will and financial matters rather than acknowledging his grief.

Question 217

conversion

Answer 217

* responding through stress through the unconscious development of physical manifestations not caused by a physical illness. * a person experiences deafness after his partner tells him she wants a divorce.

Question 218

Splitting

Answer 218

* demonstrating an inability to reconcile negative and positive attributes of self or others. * a client tells a nurse that she is the only one who cares about her, yet the following day, the same client refuses to talk to the nurse.

Question 219

projection

Answer 219

* attributing one's unacceptable thoughts and feelings onto another who does not have them. * a married woman who is attracted to another man accuses her husband of having an extramarital affair.

Question 220

PTSD

Answer 220

Thoughts and experiences of horrible event

Question 221

panic attack

Answer 221

palpitations, sweating, trembling, shortness of breath, choking, chest pain, nausea, dizziness, unreality, fear of loss of control, fear of dying, parenthesias, hot or cold flashes.

Question 222

panic disorder

Answer 222

* -sudden onset of extreme apprehension or fear of impending doom * concerned an attach will happen. For example, fear of losing one's mind or having a heart attack.

Question 223

Post tramatic stress disorder

Answer 223

* repeated re-experiencing of a traumatic event * threat or actual death/injury to self or others * typically 3 months after trauma

Question 224

Major features of PTSD

Answer 224

* Persistent re-experiencing through flashbacks * avoidance of stimuli associated with the trauma * detachment from others as result of numbing * persistent symptoms of increased arousal * irritable * sleep difficulty * difficulty with concentration * exaggerated startle response

Question 225

PTSD

Answer 225

* unemployed (150 times more likely) * martial problems (60 times more likely) * academic problems (40 times more likely)

Question 226

Compassion Fatigue/ Secondary Traumatic Stress

Answer 226

* nurses/healthcare workers are indirectly traumatized when helping or trying to help a person who has experienced a trauma * Burnout PLUS!

Question 227

Acute Stress Disorder

Answer 227

* occurs and resolves within 1 month of traumatic event * displays dissociateibe signs/symptoms * amnesia (cortisol floods and shuts down short term memory) * subjective sense of numbing * absence of emotional response * reduction in awareness of surroundings

Question 228

Phobias

Answer 228

* persistent irrational fear * specific phobias- high levels of fear and/or anxiety in response to specific objects or situations

Question 229

agoraphobia

Answer 229

* fear of being in open space.....places or situations from which escape is difficult or help unavailable * feared places avoided, restriciting one's life

Question 230

claustrophobia

Answer 230

fear of confined spaces

Question 231

acrophobia

Answer 231

fear of heights

Question 232

mysophobia

Answer 232

fear of being contaminated

Question 233

xenophobia

Answer 233

fear of strangers

Question 234

necrophobia

Answer 234

fear of death/dead things

Question 235

brontophobia

Answer 235

fear of thunder/lightning

Question 236

carcinophobia

Answer 236

fear of cancer

Question 237

aviophobia

Answer 237

fear of flying

Question 238

arachnophobia

Answer 238

fear of spiders

Question 239

social anxiety disorder (social phobia)

Answer 239

* severe anxiety or fear provoked by exposure to a social situation or a performance situation * overwhelming and crippling anxiety * may try to self-medicate with alcohol or other substances

Question 240

generalized anxiety disorder

Answer 240

* excessive anxiety or worry about numerous things lasting at least 6 months * exhibited by (at least 3) * fatigue * irritability * tension * restlessness * sleep disturbance * poor concentration

Question 241

Obsessive Complusive Disorder (OCD)

Answer 241

* obsessions- thoughts, impulses, or images that persist and recur * compulsions- ritualistic behaviors that an individual feels driven to perform in an attempt to reduce anxiety * primary gain from compulsion behavior- anxiety relief

Question 242

obsessive compulsive personality disorder

Answer 242

less extreme form of OCD

Question 243

OCD

Answer 243

* some mild compulsions valued traits in US (ex. cleanliness, timeliness) * affects men and women equally * typically beings in adolescence and early adulthood * course is chronic * complicated by depression and substance abuse

Question 244

OCD

Answer 244

* more common in unmarried individuals * rituals time consuming and disruptive * severity on a continuum * pathologic end typicall involves issues of sexuality, violence, illness or death * hoarding is a related disorder to OCD

Question 245

Body Dysmorphic Disorder

Answer 245

* repetitive behaviors or mental acts in response to preoccupations with perceived defects or flaws in physical appearance * imagined or slight flaws of the face or head the most common

Question 246

Assessment: Anxiety

Answer 246

* determine if anxiety is primary or secondary (due to medical condition) * ensure sound physical/neurological exam * use of hamiltion rating scale * determine potential for self-harm/suicide * perform psychosocial assessment * determine cultural beliefs and background

Question 247

Interventions for anxiety

Answer 247

* structure daily routine * provide daily therapeutic interactions * include client in decision making * do not spend time debriefing. Instead make a list * what i remember * what would I fill in where there are gaps in what i rememer

Question 248

anxiety interventions

Answer 248

* relaxation techniques * antidepressants (SSRIs, SNRIs) * anxiolytics (Benzodiazepines, short term, are habit forming) * buspirone may be a better option (not habit forming) * antihypertensives, beta-blockers or antihistamines may also be used (Clonodine, catapres, catopril) for anxiety

Question 249

Antianxiety agent SSRIs-first-line treatment

Answer 249

* blocks reuptake of serotonin- increasing levels in brain * ex. Paroxetine (Paxil) helpful in GAD

Question 250

Anti-Anxiety Agent SNRI -first-line treatment

Answer 250

* blocks both serotonin and noreepinephrin in the brain * example: Venalafaxine (effexor)- mixed anxiety/antidepression, anxiety and nerve pain

Question 251

Noradrenergic drugs

Answer 251

* propanolol- blocks adrenergic receptor activity * clonidine- stimulate-adrenergic receptors * examples: * Propanolol- short-term relief of social anxiety and performance anxiety * clonidine- anxiety disorders, panic attacks

Question 252

benzodiazepines

Answer 252

* binds to benzodiazepines receptors, facilitates action of GABA, slowing neural transmission thus lower anxiety * example: Alprazolam- may be used short-term to treat panic disorder and agoraphobia

Question 253

Buspirone (BuSpar)

Answer 253

* Buspirone functions as a serotonin 5-HT1a receptor partial agonist resulting in anxiolytic and antidepressant effects * can treat the worry associated with GAD rather than the muscle tension

Question 254

Somatic Disorders and related Disorders

Answer 254

* expression of psychological stress through physical symptoms * associated with repressed depression and/or anxiety

Question 255

somatic symptom disorder

Answer 255

* Physical symptoms that greatly concern and worry the client. These may include: * Pain: head, chest, back, joints, pelvis * GI symptoms: dysphagia (difficulty swallowing), nausea, bloating, constipation * Cardiovascular symptoms: palpitations, shortness of breath, dizziness * excessive time and energy spend devoted to these concerns

Question 256

somatic symptom disorder

Answer 256

* onset prior to age 30 * typically refuse psych level eval as "know it's physical" * symptoms present for 6 months or more * comorbidity * major depression * panic disorder * personality disorders * substance abuse

Question 257

Illness Anxiety Disorder (Hypchondriasis)

Answer 257

* Pervalence 1 of 20 people * misidentify minor sensations as serious illness * preoccupation and fear * history of "doctor shopping" * onset of 20-30 days * affects boths genders equally * typically refuses psychiatric eval.

Question 258

Conversion Disorder (Functional Neurological Symptoms Disorder)

Answer 258

* develop one or more symptoms/deficit suggesting neurological disorder (ex. blindness, deafness, abnormal gait, paralysis, seizures) * neurological exam is essential during diagnosis * onset at any age * affects females twice as often * PNES (psychgenic Nonepileptic Seizures)

Question 259

Conversion Disorder

Answer 259

* symptoms ususally occur after a situation that produces extreme psychological stress * expresses lack of emotional concern when compared to severity of the symptoms * symptoms usually resolve in a few weeks

Question 260

Somatic Disorders and Nursing Process

Answer 260

* Assessment * usually dramatic in discussion of s/s * s/s not under voluntary control * vague and disorganized history * difficulty communicating feelings * dependent on medication

Question 261

Somatic Disorders Interventions

Answer 261

* take symptoms seriously * after physical complaint investigated, avoid further reinforcement * spend time with patient other than when complain occurs * shift focus from somatic complaints to feelings * nurse must be cautious not to become resentful or angry

Question 262

Somatic Disorders Interventions

Answer 262

* use matter-of-fact approach to patient resistance or anger * avoid fostering dependence * teach assertive communication * medications * antidepressant (SSRIs) * short-term use of antianxiety medications

Question 263

Dissociative Disorders

Answer 263

* Altered mind-body connections assocaited with stress and anxiety * an unconscious defense mechanism * includes: * DID (Dissociative Identity Disorder) * Depersonaliation/Derealization disorder * Dissociative Amnesia

Question 264

dissociative Identiy Disorder

Answer 264

* Self emerges as 2 or more distinct personalities * rare * affects adults females more often * "Alter" personality * transitions usually occurs during stress * shifts last minutes to months * signs of DID * finding unfamilar clothes in closet * being called unfamiliar name by stranger * periods of lost time

Question 265

DID Assessment, Interventions, Evaluation

Answer 265

* Assessment * identity and memory * client history * mood * use of alcohol * impact on client and family * suicide risk * Interventions * milieu therapy * safety * trust * health teaching * medications * treat comorbid condition with anxiolytic or antidepressant * Evaluation * safety maintained * minimal anxiety * stress handled without dissociation

Question 266

Somatic Symptom Disorder

Answer 266

* Characterized by the presence of multiple, real, and /or physical symptoms for which no evidence of medical illness is reveals * accompanied by abnormal thoughts, feelings, and reactions to these symptoms.

Question 267

dissociative disorders

Answer 267

* characterized by mental detachment from conscious awareness in reaction to abuse. * involve a disruption in the consciousness with a significant impairment in memory, identity, social functioning, or perceptions of self.

Question 268

personality disorders/traits

Answer 268

* patterns of behavior that deviates from the expectation of the culture * usually occurs prior to onset of a major mental disorder * has long-term maladaptive behavior that prevents accomplishment of desired goals in relationships and other efforts. * behaviors are not experienced as incomfortable by the individual, and some areas of personal functioning may be very adequate.

Question 269

personality disorders/traits

Answer 269

* all personality disorders share two common characteristics: * inflexibility/maladaptive responses to stress * disability in social and professional relationships * tendency to provoke interpersonal conflict * capacity to "get under the skin" of others * demanding * insensitive to needs of others

Question 270

Personality Clusters

Answer 270

* Cluster A * schizotypal * schizoid * paranoid * Cluster B * Antisocial * borderline * histronic * narcissistic * Cluster C * Avoidant * dependant * obsessive-compulsive

Question 271

schizotypal personality disorder

Answer 271

* eccentric * relates inappropriately * odd beliefs leading to interpersonal difficulties * anxious & distrustful about close relationships * do not understand interpersonal cues * Me Peculiar

Question 272

Paranoid Personality Trait

Answer 272

* Distrustful and suspicious-based on belief that someone wants to hurt, exploit or deceive them * hostile and violent * preoccupied with doubts * reads in hiddent meaning * SUSPECT

Question 273

Schizoid Personality Trait

Answer 273

* This is not schizophrenia * Primary feature is emotional detachment * neither desires nor enjoys close relationships * fixated on personal thoughts/fantasies * demonstrates emotional coldness, detachment and flat effect * indifferent to priase or criticism * chooses solitary activities * DISTANT

Question 274

Antisocial Personality Disorder

Answer 274

* Repeatedly breaking the law * conduct disorder in childhood * neglects responsibity, lie, destruction * no concern regarding consequences * usually court ordered into psychiatric treatment * CORRUPT

Question 275

Borderline Personality Disorder

Answer 275

* unstable affect, identity and relationships * impulsive, splitting behavior, mood swings * self-mutilation and suicide risk * emotion regulation problems * IMPULSIVE/DESPAIRER

Question 276

Histronic Personality Trait

Answer 276

* Seductive, flirtatious * Shallow * **Attention seeking, center of attention** * depressed and suicidal * sudden emotional shifts * PRAISE ME/ACTRESS * need to set boundaries with them

Question 277

Narcissistic Personality Disorder

Answer 277

* Arrogant * Inflated sense of importance * Need for constant admiration * Sensitive to rejection/criticism * lack of empathy for others * GRANDIOSE

Question 278

Avoidant Personality Disorder

Answer 278

* social inhibition. Wants close relationships but..... * constant anxiety * low self-worth * self-imposed social isolation * WITHRAWN

Question 279

Dependant Personality Trait

Answer 279

* "unable" to function on own * Excessively submissive * Fear of being alone/abandoned * RELIANCE

Question 280

Obsessive Compulsive Personality Disorderq

Answer 280

* Key characteristic is perfectionism * Much about control * Is not full blown OCD * Do not display unwanted obsessions and ritualistic behaviors * SCRIMPER

Question 281

Depression

Answer 281

It is impossible to convey adequately the personal pain and suffering experienced by an individual going through a sever depressive episode. All races, all ages, and both genders are susceptible to depressive episodes, although some individuals are more vulnerable than others

Question 282

depression

Answer 282

* unipolar mood disorder * individuals with depression experience great personal pain and suffering * vulnerability to depression can be related to genetics and life stressors * comorbidity * frequently with other psychiatric disorders * anxiety disorders, schizphrenia, substance abuse, and eating disorders * increases with presence of medical disorder

Question 283

Depression

Answer 283

* Children as young as three have been diagnosed with depression * adolescents have increased incidence * often associated with substance abuse and antisocial behaviors * older adults (\>65) increased incidence * increased suicide rate occurs with depression in this age group * women are 70% more likely to experience depression than men

Question 284

Biological Theories Related to Depressive Disorders

Answer 284

* Genetics * Twin and adoptive studies point to genetic factors * Biochemical factors: multiple neurotransmitters may be involved * decreased serotonin and norepinephrine are key factors. * These are also involved with pain perception * dopamine, GABA, and Acetylcholine roles are less understood.

Question 285

Other Theories Related to Depressive Disorders

Answer 285

* Psychodynamic factors: stress-diathesis model * early life trauma sensitizes stress pathways in brain, increasing vulnerability to depression * Cognitive Theory: * Automatic Negative thoughts (of self, future and the world) related to depression. * Learned Helplessness: * individual's perception of lack of control over stressful life events leads to depression.

Question 286

Major Depressive Disorder (MDD)

Answer 286

* substantial pain and suffering: psychologic, social, and occupational disability * History: one or more major depressive episodes * No history of manic or hypomanic episodes * Possible psychotic features

Question 287

Major Depressive Disorder (MDD) Common symptoms

Answer 287

* emotional and cognitive symptoms: depressed mood, feelings of worthlessness and guilt, anhedonia (inability to feel pleasure), hopelessness, decreased concentration, recurrent thoughts of suicide/death * Physical: weight gain or loss, insomnia or hypersomnia, increased or decreased motor activity, anergia (abnormal lack of energy), constipation

Question 288

Persistent Depressive Disorder (Dysthymia)

Answer 288

* characterized by chronic sadness usually present for most of day, more days than not, for at least a 2-year period. * Not usually severe enough for hospitalization unless person becomes suicidal * onset is usually early childhood, teenage years, or early adulthood.

Question 289

Depression Assessment Guidelines

Answer 289

* Use any of the multiple standardized depression screening tools available * evaluate patient for suicidal ideation * determine presence of emotional, cognitive, and physical symptoms of depression * determine presence of other medical conditions contributing to depression. * determine history/current support system * ascertain recent "triggering event" related to loss * determine cultural beliefs/spiritual practices related to mental health treatment.

Question 290

Depression Diagnosis and Outcomes identification

Answer 290

* Common nursing diagnoses assigned * risk for suicide, Hopelessness, ineffective coping, social isolation, self-care deficit * Outcomes identification * important to include specific goals for patient safetly and outcomes related to vegetative/physical signs of depression.

Question 291

Depression Planning and Implementation

Answer 291

* Planning * Geared toward specific phase of depression and particular symptoms exhibited * Implementation * focus interventions on specific symptoms with priority related to suicide prevention * teach patient and family about symptoms of depression, treatment, and medication * focus on prediscahrge counseling to alleviate tension on family system

Question 292

Communication Guidelines for a patient with depression

Answer 292

* Understand that patient may need more time to reply to communication * silence/sitting with patient can be therapeutic * allow time for patient to respond * make observations related to patient/situation or environment * avoid platitudes * listen carefully for covert messages and question directly about suicide.

Question 293

Treatment for Depression

Answer 293

* for persons with depression but without psychotic features, a combination of specific psychotherapies (e.g., cognitive-behavioral therapy (CBT), interpersonal therapy (IPT) and antidepressant therapy may be superior to either psychotherapy or psychopharmacologic treatment alone.

Question 294

Treatment for Depression

Answer 294

* Milieu therapy * structured hospital environment helpful * follow protocol for suicide prevention * Psychotherapy * Cognitive-behavioral and interpersonal therapies used * Group therapy * helps decrease feelings of isolation, hopelessness, helplessness and alientation.

Question 295

Treatment for Depression: Antidepressant Medications

Answer 295

* Advantage * Can help alter withdrawal, vegetative symptoms, activity level; improve self-concept * Drawback * can take 1-3+ weeks to note improvement * Safety considerations * Concerns about relationship between use of antidepressant drugs and suicide; however, no conclusive evidence to support this.

Question 296

Treatment for depression: Tricyclic Antidepressants

Answer 296

* Action: inhibit reuptake of norepinephrine and serotonin by presynaptic neurons * Dose: start low and gradually increase * common adverse reactions * dry mouth, blurred vision, constipation, and urinary retention * sedation * potential dysrhythmias, hypotension, myocardial infarction

Question 297

Treatment for Depression: Selective Serotonin Reuptake Inhibitors (SSRIs)

Answer 297

* Action: selectively block neuronal uptake of serotonin * Common adverse reactions * agitation, anxiety, sleep disturbance, tremor, sexual dysfunction, headache, weight changes, nausea, diarrhea, dry mouth * Potential toxic effect * serotonin syndrome (SS): potentially fatal reaction when more than one antidepressant used.

Question 298

Symptoms and Treatment of Serotonin Syndrome (SS)

Answer 298

* Symptoms * Hyperactivitiy, severe muscle spasms, tachycardia leading to cardiovascular, hyperpyrexia (high fever), hypertension, delirium, seizures, coma, death * Treatment * Stop offending agents * Provide respiratory, circulatory support in intensive care environment * Use medications to reverse excess serotonin: cyproheptadine, methyserigide, propanolo

Question 299

Treatment for Depressions: Newer Antypical Agents

Answer 299

* Action: Affect variety of NTs including those affecting serotonin and norepinephrine * Advantage: * Can target unique populations of depressed individuals * Can be used to treat other conditions

Question 300

Treatment for Depression: Monoamine Oxidase Inhibitors (MAOIs)

Answer 300

* Common Adverse reactions * hypotension, sedation, insomnia, changes in cardiac rhythm, muscle cramps, sexual impotence, anticholinergic effects, weight gain * Potential Toxic reaction * Hypertensive crisis

Question 301

Hypertensive Crisi and MAOIs

Answer 301

* Can occur when MAOI prevents the breakdown of tyramine, which is used by the body to make norepinephrine * Preventing hypertensive crisis involves maintaining a special diet (low tyramine) and avoiding medications that contain ephedrine/other psychoactive substances.

Question 302

Electroconvulsive Therapy

Answer 302

* used to subdue severe manic behavior, suicidal or for depression * course of treatment: 2 or 3 threatments/week for total of 6 to 12 treatments * for patients not responding to antidepressants or for depression with psychosis * potential adverse reactions * initial confusion and disorientation on awakening from treatment * memory deficits.

Question 303

Treatment for Depression: Somatic Treatments:

Answer 303

* ECT * Vagus nerve stimulation: long-term implanted treatment device approved by FDA for patients with treatment-resistant depression * Action: not well understood, affects neurotransmitters implicated in depression * device implanted that send electrical signals to left vagus nerve in the neck at regular intervals * transcranial magnetic stimulation * deep brain stimulation

Question 304

Treatment for Depression: integratie therapies

Answer 304

* Light therapy * First-line treatment for seasonal affective disorder * actions: suppresses nocturnal secretion of melatonin, which seems to have beneficial effect on depression

Question 305

Treatment for Depression: integrative Therapies

Answer 305

* St. John's wort * plant with antidepressant properties * not regulated by fda * research suggests effective in mild depression * exercise * research indicates mood elevation and decreased depression occurs with moderate exercise.

Question 306

Evaluation of Depression treatments effectiveness

Answer 306

* evaluate short-term indicators and outcome criteria * reduction in suicidal thoughts * able to state alternatives to suicide * decrease in severity of emotional, cognitive, and vegetative/physical symtpoms of depression.

Question 307

Bipolar Spectrum Disorders

Answer 307

* characterized by two opposite poles * euphoria/mania * depression * alternating moods mania/depression * chronic, recurring, life threatening illness * individuals experience interpersonal, occupational difficulties even during remission * associated with highest lifetime suicide rate amony psychiatric disorders.

Question 308

Bipolar....sometimes referred to as bipolar depression

Answer 308

* biological in nature feels psychological in experiences * frequently years before being diagnosed * less than 50% fail to regain social and/or occupational function.

Question 309

Bipolar 1 disorder

Answer 309

at least one episode of mania alternating with major depression

Question 310

bipolar II disorder

Answer 310

hypomanic episodes alternating with major depression

Question 311

Biplar

Answer 311

* onset 15-19 years of age * first appears as mania in males, depression in females * episodes increase in number and severity with age * rapid cycling (two or more alternating episodes of mania and depression in 12-month period)

Question 312

Biological theories of Bipolar

Answer 312

* strong genetic component * neurobiological factos- transmitters play a role. higher levels of epinephrine and norepinephrine in mania and lower levels in depression * neuroendorine factors: hypothalamic-pituitary-adrenal axis modulates stress response and homeostatsis. Thyroid hormone may also be affected.

Question 313

Continuum of mania

Answer 313

* extreme delirium (completely out of touch with reality, too disorganized to do anything, may have hulicinations, may become completely out of control.) * acute mania (extreme irritability and hyperactivity, speech marked by flight of ideas, profanity, crude sexual remarks, no time to eat, good humor gives way to increased hostility, may go quickly from hostile to docile, restless, no time for sex, too busy) * hypomania (euphoris, talks and jokes icessantly, is the life of the party, gets irritated when not the center of attention, treats everyone with familarity, overactive, distractable, eat on run, gobbles food) *

Question 314

Bipolar disorder: Common manic symptoms

Answer 314

* Mood symptoms * unstable, euphoric mood, intense feelings of well-being, mood may change to irritation and anger when thwarted. * Behavioral symptoms * excessive hyperactivity, involved in pleasurable activities with painful consequences, sexual indiscretion, excessive spending of money, mode of dress/makeup may be outlandish, bizarre.

Question 315

Bipolar Disorder: Common Manic Symptoms

Answer 315

* Physical symptoms * nonstop activity, minimal food intake, little or no sleep * can lead to exhaustion and even death * speech * disorganized and incoherent speech with content often sexually explicit and grossly inappropriate * clang associations: stringinn together of words because of rhyming sounds.

Question 316

Bipolar Disorder: Common Manic Symptoms

Answer 316

* cognitive symptoms (thought processes) * psychotic episodes * poor concentration, problems with verbal memory, sustained attention and executive functioning (may persist even in remission) * flight of ideas: continuous flow of accelerated speech with abrupt changes from topic to topic usually based on understandable associations.

Question 317

Interventions: Mania

Answer 317

* Use firm, calm approach * use short, concise statements * remain neutral; avoid power struggles * be consistent * important with firm limit setting * hear and act on legitimate complaints * firmly redirect energy into appropriate channels * seclusion and restraints may be used of patient becomes dangerously out of control and other least restrictive measures fail

Question 318

Bipolar Pharmacology

Answer 318

* antianxiolytics, antipsychotics, antidepressants used for a limited time * mood stabilizer (Lithium) or anticonvulsants (Divalproex, lamotrigine, carbamazepine) considered lifetime maintenance therapy. * lithium ulters sodium transport in nerve and muscle cells and inhibits release of norepinephren and dopamine.

Question 319

Lithium

Answer 319

* Maintenance blood levels 0.4-1.4 mEq/L * \>1.5 = toxicity * blood levels weekly to biweekly until stable. * Then levels monthly- at 6 months to a year, levels drawn every 3 months * Long-term risks of lithium therapy * hypothyroidism * imapirment of kidney's ability to concentrate urine.

Question 320

Lithium \< 0.4-1 mEq/L (therapeutic level)

Answer 320

* fine hand tremor, polyuria, and mild thirst * mild nausea and general discomfort * symptoms may persist throughout therapy * These symptoms often subside during treatment. give with food to decrease nausea. * Weight gai may be helped with diet, exercise, and nutrition management.

Question 321

Early signs of Toxicity \>1.5 mEq/L

Answer 321

* nausea, vomiting, diarrhea, thirst, polyuria, slurred speech, muscle weakness. * medication should be withheld, blood lithium levels measured and dosage reevaluated.

Question 322

severe lithium toxicity 2 to 2.5 mEq/L

Answer 322

* ataxia, serious EEG changes, blurred vision, clonic movements, large output of dilute urine, tinnitus, blurred vision, seizures, stupor, sever hypotension, coma; death is usually secondary to pulomary complications * there is no known antidote for lithium poisoning. the drug is stopped, and excretion of hastened. If patient is alert, an emetic is administered. Otherwise, gastric lavage and treatment with urea, mannitol, and aminophylline hasten lithium excretion

Question 323

Lithium toxicity \> 2.5 mEq/L

Answer 323

* symptoms may progress rapidly; coma, cardiac dysrhythmia, peripheral circulatory collapse, proteinuria, oliguria, and death * in addition to the interventions above, hemodialysis may be used in severe cases.

Question 324

Bipolar: depression

Answer 324

* treatment same as for depression * CBT * ECT * TMS * antidepressants

Question 325

Schizophrenia

Answer 325

* Devastating brain disease affecting thinking, language, emotions, social behavior, and reality percention * psychotic disorder: refers to experiencing such phenomena as delusions, hallucinations, disorganized speech or behavior * considered a severe mental illness that is a chronic condition; treatable but not curable.

Question 326

schizoaffective

Answer 326

is not schizophrenia- meets criteria for schizophrenia and one affective disorder (IE. depression, mania)

Question 327

Psychosis

Answer 327

* is not a diagnosis but a symptom * refers to a total inability to recognize reality (E.g. delusions and hallucinations).

Question 328

Schizophrenia (comorbidity)

Answer 328

* substance abuse disorders: 40-50% of people with schizophrenia * nicotine dependence: 75-85% of people with schizophrenia * depressive disorders, anxiety disorders and psychosis-induced polydipsia (excessive thirst or drinking) also common * suicide 20 times more prevalent than general population

Question 329

Brain Difference in Schizophrenia

Answer 329

* functional * increased number of dopamine receptors in basal ganglia * excessive dopamine activity * hypersensitive dopamine receptors * alterations in activity of other neurochemicals (serotonin, GABA, norepinephrine) * anatomincal differences too

Question 330

anatomical theory

Answer 330

* meso-cortico and/or meso-limbic pathways are damaged at birth or shortly thereafter * when we go through puberty, frontal lobe develops physically but not mentally * results\>\>\>psychosis

Question 331

Paranoid Schizophrenia

Answer 331

intensely suspicious toward others, paranoid ideas cannot be corrected by experiences or modified by facts or reality

Question 332

Schizophrenia catatonic

Answer 332

* abnormal motor behavior * extreme agitation * extreme psychomotor retardation * posturing: holding arms/legs rigid for long periods * stereotyped behavior: obssessively following routine * negativism and resistance or automatic obedience * echolalia: repeats words spoken to him/her * echopraxia: mimicking movement of another

Question 333

Schizophrenia Disorganized

Answer 333

* most regressed and socially impaired of all types. Large numbers of homeless population with this type. * looseness of associations * grossly inappropriate affect * bizarre mannerisms * incoherent speech * fragmented and poorly organized hallucinations/delusions * frequent giggling or grimacing in response to internal stimuli

Question 334

4 As of Schizophrenia

Answer 334

* Inappropriate AFFECT * Loosening of ASSOCIATIONS (disorganized speech) * AUSTISTIC thoughts * AMBIVALENCE

Question 335

Positive Symptoms

Answer 335

* easier to identify and treat * excesses in behavior (excessive function/distortions) * alterations in speech: * looseness * neologisms- made up words * echolalia * clang association: rhyming * word salad: jumble of words * alterations in perception-hallucinations, personal boundary difficulties * alterations in behavior- motor agitation

Question 336

Positive Symptom: Altered Thinking

Answer 336

* Delusions: false fixed beliefs not corrected by reasoning. * thought broadcasting * thought insertion * thought withdrawal * delusion of being controlled * concrete thinking: impaired ability to think abstractly.

Question 337

Negative Symptoms

Answer 337

* Deficits in behavior (reduced function; self care deficits) * apathy * poor social functioning * change in affect * flat (blank look) or blunted (minimal emotional response) * inappropriate-emotional response incongruent with the situation * bizarre affect- grimacing, giggling, mumbling to oneself.

Question 338

Schizophrenia medications

Answer 338

* antipsychotics * conventional target positive symptoms * atypical antipsychotics target positive and negative symptoms * up to 25% of patients do not respond to meds.

Question 339

Traditional antipsychotics

Answer 339

* always monitor for extrapyramidal side effects (EPS) * akathisia * dystonia * parkinsonism * tardive dyskinesia * Chlorpromazine (Thorazine)- sedating, fewer EPS symtoms * Haloperidol (Haldol)- less sedating, greater EPS symptoms

Question 340

Dealing with hallucinations and delusions

Answer 340

* approach patient in nonthreatening and nonjudgemental manner. * identify feelings patient is experiencing * clarify reality of patient's experience * avoid arguing/orattempting to reason with patient who is delusional * interact with patient about concrete reality * distract patient's attention from halluciantion/delusional belief

Question 341

Dealing with Patient who is paranoid

Answer 341

* be honest and consistent * avoid talking, laughing, whispering when aptient cannot hear what is being said

Question 342

Dealing with associative looseness

Answer 342

* do not pretend to understand patient's communications when you do not * tell patient you are having difficulty understanding * look for recurring topics or themes * emphasize what is going on in the "here and now"

Question 343

Recovery is a long process Psychosis is an assault to "self"

Answer 343

cognitive dissonance 6-12 months insight 6-18 monts cognitive constancy and ordinariness 1-3 years

Question 344

delirium

Answer 344

* disturbed consciousness coupled with cognitive difficulties * thinking, memory, attention and perception * sundown syndrome (increased confusion in evening hours)

Question 345

dementia

Answer 345

* progressive deterioration in intellectual functioning, memory, ability to problem solve/learn new skills, decline in ability to perform ADLS and impaired judgment. VArious types of demntia identified, Alzheimer's most common

Question 346

Common Causes of Delirium

Answer 346

* drug intoxication and withdrawals * infections * metabolic disorders * drugs * neurological diseases: seizures, head trauma, hypertensive encephaolopathy * tumor * psychosocial stressors: relocation/sudden changes, sensory deprivation or overload, sleep deprivation, immobilization, pain

Question 347

Delirium

Answer 347

* most often seen on med/surg units and long-term care * symptoms: withdrawal, agitated, psychotic, personality traits exaggerated * primary need: physical and biophysical safety

Question 348

alzheimer's disease

Answer 348

* no single cause yet identified * age most important risk factor * early onset AD once thought to have a genetic link * irreversible cause of dementia * not all dementia is irreversible * stages: 1 mild, 2 moderate, 3 severe, 4 late * safety is of primary importance * communication a challenge

Question 349

Substance Abuse

Answer 349

* habitual use falls outside medical necessity * use falls outside social acceptance * use is for single purpose of altering mood, emotion or consciousness

Question 350

concept of addiction

Answer 350

* chronic relapsing brain disease * compulsive drug seeking motivated by cravings * compulsion occurs despite harmful consequences * results in long-lasting brain changes * genetic predisposition

Question 351

Other Aspects of Substance Use Disorder

Answer 351

* maladaptive pattern of substance use leading to clinically significant impairment * presence of tolerance: need for higher doses * presence of withdrawal: specific physical and psychological symptoms when stopping use * unsuccessful attempts to cut down * increased time spent obtaining substances * reduced time in normal activities.

Question 352

Biological Theory Related to Substance Abuse Disorder

Answer 352

* Effects of addictive substances on brain * abusive substances affect dopamine systems and directly or indirectly affect limbic system * over time, dopamine receptors/dopamine levels decrease and individuals need more of abusive substance in order to keep dopamine level normal.

Question 353

Other theories related to substance abuse disorder

Answer 353

* Psychological Theories: * lack of tolerance for frustation and pain, impulsiveness, lack of success in life, lack of affectionate and meaningful relationships, low self-esteem, and strong propensity for risk taking. * cultural considerations * differences recognized among cultural groups. * asian cultures: low rate of alcohol abuse * native americans, alaska natives: high rate of alchohol abuse

Question 354

Special populations related to substance abuse disorder

Answer 354

* Pregnant women * alcohol is neurotoxic; affects fetal brain development * fetal alcohol syndrome (FAS) and fetal alcohol spectrum disorders: microcephaly, epicantal folds, low nasal bridge, short nose,micrognathia (undersized jaw), thin upper lip,indistinct philtrum, short palpebral fissures, flat midface * smoking related to low-birth-weight babies, increased risk of congential abnormalities * opiate use in mother causes withdrawal in babies

Question 355

Special Populations Related to Substance Abuse Disorder

Answer 355

* chemically impaired nurses * work with meds all the time. "Magical thinking...."I know these drugs. So, I know how to keep control over them." * addic tion rate is 32-50% higher than general population * important to report impaired nurse to nurse manager for appropriate intervention and referral to treatment program.

Question 356

Impaired nurse warning signs\> controlled substances

Answer 356

* volunteer for extra shift or to give med * frequent breaks * mood swings * pt c/o ineffective pain control * inaccurate drug counts

Question 357

Impaired Nurse Warning Signs\> alcohol & cocaine

Answer 357

* not there: absences, no show/no call * take breaks in car * elaborate excuses * alcohol on breath * blackouts, hangovers

Question 358

Common Effects of Substance Use

Answer 358

* Flashbacks: transitory recurrences of perceptual disturbance caused by earlier use of hallucinogenic drug * codependence: over-responsible behaviors often exhibited by family members of substance user * Examples: * Attemping to control someone else's drug use * covering up for the person's substance use * often bailing the addicted person out of financial or legal problems.

Question 359

USE of CAGE-AID

Answer 359

* C: Have you ever felt the need to CUT down. * A: Have people ANNOYED you by criticizing your use? * G: Have you ever felt GUILTY about use? * E: Have you ever felt need for an EYE OPENER in the morning?

Question 360

Substance Abuse Assessment Guidelines

Answer 360

* Determine history of patient's use * number of drugs taken, pattern of use, dosage * previous treatment for substance abuse * presence of blackouts, delirium, seizures, withdrawal symptoms * Review psychiatric history * determine psychosocial issues * effect of use on patient's life functioning

Question 361

Substance Abuse Assessment Guidelines

Answer 361

* Further Initial Assessment * Neurological changes: determine brain injury * urine toxicology screen or blood alcohol level (BAL): help determine type/amount of substances.

Question 362

Substance Abuse Assessment Guidelines

Answer 362

* Osychological changes * use of defence mechanisms common: denial, projection, rationalization * characteristic thought processes; all-or-none thinking, selective attention * common behaviors: conflict minimzation, avoidance, passivity, and manipulation

Question 363

Intoxication with Alcohol/CNS Depressants

Answer 363

* Common symptoms of intoxication from drugs that are CNS depressants (alcohol, BZAs, barbituates) * slurred speech, incoordination, unsteady gait, drowsiness, decreased blood pressure, impaired judgement * Treatment of intoxication/overdose * treat symptomatically: maintain airway/circulation, induce vomiting, administer flumazenil (Romazicon) for BZA overdose.

Question 364

Opiates: morphine heroin codeine fentanyl methadone meperidine

Answer 364

* Intoxication effects: * constricted pupils * increased respiration * increased BP * slurred speech * drowsiness * psychomotor retardation * initial: euphoria * later: dysphoria * impaired: concentration, judgment and memory * withdrawal effects: * yawning * insomnia * irritability * rhinorrhea * panic * diaphoresis * cramps * nausea and vomiting * muscle aches * chills and fever * lacrimation * diarrhea

Question 365

withdrawal from alcohol

Answer 365

* alcohol withdrawal * increased alertness, irritability, feelings of "shaking inside", presence of illusions, seizures can occur within 7-48 hours * alcohol withdrawal delirium * anxiety, insomnia, delirium * autonomic hyperactivity: increased vital signs (temperature, pulse, BP, respirations) * disorientation, perceptual disturbances, delusions

Question 366

Treatment for Alcohol Withdrawal

Answer 366

* sedation * Use of BZAs in gradually decreasing dosages: chlordiazepoxide (Librium) * Seizure prevention * anticonvulsants: gabapentin (Neurontin) * Preventions of Wernicke's encephalopathy * Thiamine (vitamin B1) * Decrease in autonomic Hyperactivity * folic acid * beta blockers: propranolol (Inderal)

Question 367

Pharmacologic Interventions Maintain Sobriety

Answer 367

* Disulfiram (Antabuse) * Causes unpleasant physical affects if alcohol ingested * Naltrexone (ReVia, Vivitrol) * blocks alcohol craving and reduces desired "high"

Question 368

Pharmacologic Therapy Opioid Addiction

Answer 368

* Methadone (Dolophine) * is a synthetic opiate that blocks the craving for and effects of opiates * buprenorphine-naloxone (Suboxone) * Blocks the signs and symptoms of opioid withdrawal

Question 369

Health Teaching and promotion for Patient who has substance abuse disorder

Answer 369

* focus is relapse prevention * keep program simple, encourage use of notebook/journaling * use cognitive-behavioral principles to increase coping * encourage patient to joing relapse prevention group * encourage patient to enhance personal insight through therapy.

Question 370

Treatment for Substance Abuse: Psychotherapy and Other Modalities:

Answer 370

* Psychotherapy * Assists patient in identifying and using alternative coping mechanisms instead of reliance on substances * self-help groups for patient and family * 12 step programs most effective * AA for the patient * Al-Anon and Alateen for family members * SMART (Self-Management & Recovery Training)

Question 371

SUB. Abuse Treatment Evaluation

Answer 371

* Treatment outcomes are evaluated * increased length of time in abstinence * decreased denial * acceptable occupational, social functioning * ability to use coping strategies * attendance at 12-step support group program

Question 372

Concept of Eating Disorders

Answer 372

* Patient experiences severe disruption in normal eating and disturbance in perception of body shape/weight * several diagnostic categories identified: * anorexia nervosa * bulimia nervosa * binge-eating disorder

Question 373

Biological Theories Related to Eating Disorders

Answer 373

* Neuroendocrine abnormalities * altered serotonin pathway * altered serotonin receptors * unknown whether the abnormalities occur first or after development of the eating disorder * genetics * female relatives of people with eating disorders habe 12 times the risk.

Question 374

anorexia nervosa

Answer 374

* always below weight for age and height * refusal to maintain normal weight * intense fear of gaining weight * disturbed body image * belief that one is fat despite emaciation

Question 375

Anorexia Nervosa: Physica Complications

Answer 375

* Decreased vital signs ( temp, pulse, BP) * electrolyte imbalances * leukopenia * osteoporosis * fine body hair, skin is dry and scaly, constipated * hair brittle, hands cold, nails brittle, * breathing and heart rate slows, BP drops * thyroid function slows

Question 376

Anorexia Nervosa: Physical Complications

Answer 376

* abnormal thyroid function * cardiac abnormalities * fatty degeneration of liver, elevated cholesterol * peripheral edema * hematuria * proteinuria

Question 377

Assessment Guidelines for Patient with Anorexia

Answer 377

* Determine if medical/psychiatric condition warrants hospitalization (appropriate testing important) * severe hypothermia, bradycardia, hypotension, hypokalemia, cardiac abnormalities * weight loss more than 30% over 6 months * suicidal or self-mutilating behaviors * severe depression or psychosis * out of control use of laxative, diuretics, street drugs

Question 378

Assessment Guidelines for Patient with Anorexia

Answer 378

* determine level of family understanding about disorder and where to get support * determine level of acceptance of treatment * determine patient and family need of teaching * determine patient's and family's desire to participate in support group

Question 379

Diagnosis and Outcomes Identification

Answer 379

* Common nursing Diagnoses assigned * imbalanced nutrition: less than body requirements * disturbed body image * chronic low self-esteem * hopelessness/powerlessness * common outcomes- Client will: * normalize eating patterns * demonstrate improved self-acceptance * address maladapticve beliefs related to eating

Question 380

Anorexia Planning and implementing

Answer 380

* hospitalization may be necessary for short time (either medical or psychiatric) * long-term treatment with individual, group and family therapy * focus interventions on establishing trust and monitoring eating patterns * weight restoration and monitoring create opportunities to counter disturbed though processes (cognitive distortions)

Question 381

Specific Nursing Interventions for Anorexia

Answer 381

* weight patient in minimal clothing, at same time of day, after voiding and before eating or drinking * monitor patient during meals to prevent throwing food away/purging

Question 382

Sepcific Nursing Interventions for Anorexia

Answer 382

* Recognize patient's distored body image without minimizing or challenging patient's perception * educate patient about ill effects of low weight * work with patient to identify strengths

Question 383

Treatment for Anorexia: Milieu Therapy

Answer 383

* Relies on interdisciplinary team approach * work for normalization of eating patterns * work toward addressing psychological issues * use of highly structured setting with close monitoring to prevent throwing food away, falsely increasing weight, purging * during meals * during weighing * during bathroom visits

Question 384

Treatment of Anorexia: Medications

Answer 384

* medications not recommended until weight has been restored * SSRI antidepressant * Fluoxtine (Prozac): may reduce relapse * antipsychotic * olanzapine (Zyprexa): helpful in improving mood and decreasing obsessional behaviors

Question 385

Anorexia Treatment Evaluation

Answer 385

* Anorexia nervosa is a chronic illness: relapse common * evaluation criteria: * percentage of weight restored * extent to which self-worth no longer dependant on weight and shape * decreased disruption in patient's life

Question 386

Bulimia Nervosa

Answer 386

* Recurrent episodes of binge eating * behavior to prevent weight gain * self-induced vomiting * laxative and diuretic abuse

Question 387

Bulimia Nervosa: Physical Complications

Answer 387

* cardiomuopathy * cardiac dysrhythmias * electrolyte imbalances * dehydration * loss of dental enamel * parotid gland enlargement * esophageal tears * russel's sign (callus on knuckles from self-induced vomiting)

Question 388

Assessment Guidelines for Patient with Bulimia

Answer 388

* Patient may be at or slight above ideal weight * typical signs: enlarged parotid glands, dental caries, enamel loss, russels sign * review patient history for impulsive behaviors (stealing) or compulsions

Question 389

Bulimia Diagnosis and Outcomes Identifications

Answer 389

* Common outcomes: the patient will (in specified time period) * refrain from binge/purge behaviors * maintain normal electrolye balance * express feelings in non-food-related way * name personal strengths * triggers that causes them to binge or purge

Question 390

Bulimia Planning and Implementing

Answer 390

* May require hospitalization in either medical or psychiatric facility for a short time * long-term outpatient treatment expected * implementations directed toward examining underlying conflicts and distorted perceptions of shape and weight

Question 391

Treatment of Patient with Bulimia: Milieu therapy

Answer 391

* highly structured inpatient unit has goal of interruption binge/purge cycle * close observations during and after meals (similar to patient with anorexia) * teaching focused on: * healthy diet * coping skills * physical and emotional effects of bingeing and purging

Question 392

Treatment of Patient with Bulimia: Psychotherapy and Medications

Answer 392

* Psychotherapy * cognitive-behavioral approach recommended * medications * SSRI antidepressant, fluoxetine (Prozac) * reduces binge eating and vomiting episodes * treats comorbid depression

Question 393

Anorexia Vs. Bulimia

Answer 393

_Anorexia Bulimia_ - terror of gaining weight - binge eating - preoccupation w/food - self-induced vomiting - views self as fat even - laxative & diuretic abuse emaciated - history of anorexia in - preculiar handling of 1/4 to 1/3 of individuals food: cutting into small - depressive signs & bits, pushing food around symptoms the plate -maintain a rigorous - problems with exercise regiment interpersonal relationships

Question 394

Concepts of Suicide

Answer 394

* Suicide: act of intentionally ending one's own life and opting for nonexistence * suicide attempt: includes all willful, self-inflicted life-threatening attempts that have not led to death * suicide ideation: person is thinking about self-harm

Question 395

Shneidman

Answer 395

* proposed victims of suicide suffer unbearable psychological pain, isolation and perception that death is the only solution.

Question 396

Risk Factos for Suicide

Answer 396

* societal: poverty, recent divorce/separation or bereavement, homelessness, negative life events with poor social support * gender: women have more suicide attempts, men have more suicide completion * psycholocial: psychosis, especially presence of command hallucinations; feelings of hopelessness, helplessness, worthlessness; presence of plan, previous suicide attempt.

Question 397

Risk Factors for Suicide

Answer 397

* impulsive or aggressive tendencies * family history of suicide, violence, abuse * incarceration * exposure to suicidal behaviors of others * chronic physical illness

Question 398

Cultural Considerations Related to Suicide

Answer 398

* Hispanic Americans: Protective factor: Roman Catholic religion/family * Asian Americans: * rate increases with age * protective factor: belief tha individual and society are interdependent. * In U.S, European Americans have twice the rate of minority groups * exception is Native Americans (rate equal to European Americans) * African Americans * Men more than women; peak rate in adolescence/young adult * protective factors include family/religion

Question 399

IS PATH WARM?

Answer 399

Ideation Substance Abuse Purposelessness Anxiety Trapped Hopelessness Withdrawal Anger Recklessness Mood Changes

Question 400

Suicide Assessment

Answer 400

* recognize verbal cues: suicide threats need to be taken seriously, including overt and covert statements * recognize behavioral cues: * sudden changes: giving away possessions, writing farewell notes, making one's will/putting affairs in order * sudden improvement after being depressed/withdrawn * neglecting personal hygiene

Question 401

Suicide Assessment

Answer 401

* Always ask the person suspected of being at risk. "Are you thinking about killing yourself?" * assess precipitating events/risk and protective factors * assess suicide history (family/friends) * cutting * assess suicide plan, including intent, lethality, availability of means, any injury suffered * determine support systems, including community supports if person will be managed on outpatient basis.

Question 402

Nursing Interventions for Crisis Period

Answer 402

* Follow institutional protocol * suicide precautions * suicide observations * continuous * 15 min checks * establish no suicide contract * encourage patient to discuss feelings/problem

Question 403

Nursing Interventions for PostCrisis Period

Answer 403

* Arrange for patient to stay with family/friends; if no one available. hospitalization * weapons/pills removed by family/friends * encourage patient to discuss feelings. * encourage patient to avoid decisions during crisis.

Question 404

Nursing Interventions PostCrisis Period

Answer 404

* Activate links to community supports (self-help groups) * if medication used for anxiety/depression * 1-3 day supply only (if by self) * monitored by family/significant other

Question 405

Help for Survivors Of Suicide

Answer 405

* Postvention for survivors initiated 24 to 72 hours after death * survivors often feel they are "going crazy" * need to know these feelings are normal * Anger toward person who completed suicide is normal and needs to be discussed. * PTSD is common in survivors * self-help groups useful as well as counseling

Question 406

Survivors of Suicide

Answer 406

* General Needs of Survivors * information * not wise for survivor to read suicide note.....read between the lines * new identity * medical follow-up * financial support * immediate (funeral) and long term * appropriate Mental Health Services * resolution of unanswered questions

Question 407

Crisis

Answer 407

acute, time-limited event experienced as overwhelming emotional reaction

Question 408

crisis intervention

Answer 408

assistance in coping for those in crisis. Interventions used are broad, creative and flexible.

Question 409

Theory Related to Crisis and Crisis Intervention

Answer 409

* Crisis is self-limiting (4 to 6 weeks) * goal of crisis intervention: return individual to previous level of functioning * deal with person's present problems: "here and now" * nurses take active, direct role when intervening * important to set realistic goals.

Question 410

Examples of a crisis

Answer 410

* marriage, birth of a child, retirement (ustress) * loss of job, death of loved one, change in financial status, divorce * natural diaster (floods, fires, earthquakes) * national diaster (acts of terrorism, wars, riots, airplane crashes) * crime of violence (rape, assault, murder in workplace/school, bombing in crowded areas, abuese

Question 411

Phases of Crisis

Answer 411

* Phase I: Person is confronted by conflict or problem that threatens self-concept and causes anxiety * Phase 2: If usual defensive response fails and threat persists, anxiety continues to rise. * Phase 3: If trial-and-error attempts fail, anxiety can escalate to panic levels * Phase 4: If problem is not solved and new coping skills are ineffectivef, anxiety can overwhelm person; serious personality disorganization, depression, confusion, violence against self/other can occur

Question 412

Crisis Assessment

Answer 412

* Patient's perception of precipitating event * perception critical: one person's minor irritation can be another's major problem * Assess Patient's situational supports * Does stressful event also affect patient's family/support systems? * Assess patient's personal coping skills * Evaluate patient's anxiety level and use of defense mechanisms.

Question 413

Crisis Assessment

Answer 413

* Sample questions that may facilitate the assessment include the following: * Has anything particularly upsetting happened to you within the past few days or weeks? * What was happening in your life before you started to feel this way. * What leads you to seek help now? * Describe how you are feeling right now. * How does this situation affect your life? * How do you see this even as affecting your future?

Question 414

Assessing the Patient's Situational Supports

Answer 414

* With whom do you live? * To whom do you talk when you feel overwhelmed? * Whom can you trust? * Who is available to help you? Do you have a partner or significant other? * Do you have spiritual beliefs or attend a place of worship? * Do you attend school or any activities, groups, or clubs? * During difficult times in the past, who was there to help you?

Question 415

Assessing Patient's Personal Coping Skills

Answer 415

* Have you though of killing yourself or someone else? * What do you usually do to feel better? * Did you try it this time? If so, what was different? * What helped you through difficult times in the past? * What do you think might happen now?

Question 416

Acute Grief from Responding to Crisis in the Aftermath of Diasters

Answer 416

Debriefing: use for rescue workers. "What did you learn from this event and how will it help you deal with the next event?"

Question 417

Implementation of Crisis interventions

Answer 417

* Treatment setting * diaster nursing, mobile crisis units, group work, health education and crisis prevention, victim outreach programs, telephone hotlines * Goals of Intervention: patient safety, anxiety reduction * Meds: Antianxiety, * Antidepressants-depression r/t trauma is not serotonin based. So, SSRIs are typically not effective

Question 418

Robert's Seven Stage Model Crisis Intervention

Answer 418

1. Plan and conduct crisis assessment including lethality measures. 2. establish rapport and rapidly establish relationship 3. Identify major problems ( including the "last straw" or crisis precipitants) 4. deal with feelings and emotions (including active listening and validation). 5. generate and explore alternative 6. develop and formulate an action plan 7. crisis resolution: follow-up plan and agreement.

Question 419

Concepts Related to Anger and Aggression

Answer 419

* Anger: normal feeling * Varies from mild irritation to rage * becomes negative when denied, suppressed or expressed inappropriately * Aggression: harsh physical or verbal action reflecting rage, hostility, and potential for destructiveness * can be directed at self or others

Question 420

Facts: Anger and Aggression

Answer 420

* Workplac eviolence in health care system is higher than for private sector industries * bullying * lateral violence * high risk areas for violence * ER * Geriatrics Units * Mental Health

Question 421

Facts: Anger and Aggression

Answer 421

* Individuals with psychiatric disorder are five times more violent than those without * more likely to hurt self rather than others * Medical/neurological disorders increase risk * males have increased rate of violence * highest percentage occuring among lower-class males with substance abuse or major mental disorders.

Question 422

**STAMP assessment components and cues**

Answer 422

**Staring** Prolonged glaring at the nurse whilst s/he is engaged in nursing practice Absence of eye contact (culture is a variable here) **Tone and volume** Sharp or caustic retorts **of voice** Sarcasm Demeaning inflection Increase in volume **Anxiety** Flushed appearance Hyperventilation Rapid speech Dilated pupils Physical indicators of pain, grimacing, writhing, clutching body Confusion and disorientation Expressed lack of understanding about emergency department processes **Mumbling** Talking ‘under their breath’ Criticizing staff or the institution just loudly enough to be heard Repetition of same or similar questions or requests Slurring or incoherent speech **Pacing** Walking around confined areas such as waiting room or bed space Walking back and forth to the nurses area Flailing around in bed ‘Resisting’ health care

Question 423

Anger Assessment

Answer 423

* Identify patient anxiety before it escalates into acting-out * identify factors for violent outcomes * angry, irritable affect, hyperactivity, increasing anxiety, verbal abuse, loud voice * history of recent acts of violence * suspiciousness or paranoid thinking * substance abuse * possesson of a weapon

Question 424

Anger Assessment

Answer 424

* understand that history of violence is single most predictor of future violence * assess patient risk for violence * Wish to harm, plan to harm, means available, demographic risk factors present, lack of coping skills * staff's response but be consistent (use of well-trained staff skilled in use of de-escalation techniques)

Question 425

Nursing Interventions to Ensure Safety

Answer 425

* Search All patients for dangerous objects * give patient and self adequate personal space * position self between patient and door; stand off to the side * Eye contact and sit/stand at same level as patient * If patient is willing, the nurse and patient should sit at a 45-degree angle. * Do not tower over or stare at the patient. * Trust instincts; if uncomfortable get help

Question 426

Anger/Aggression Nursing Interventions

Answer 426

* Appear calm and in control * do not try to speak while the aggressive person is yelling * speak softly in a nonprovocative, nonjudgmental manner * demonstrate genuineness and concern. * don not treat the individual in a humilating manner * Ask, "What will help now?"

Question 427

Anger/Aggression Nursing Interventions

Answer 427

* Listen and use clarification * Acknowledge the patient's needs whether rational or irrational, possible or impossible. * Encourage client to use comfort room, if available.

Question 428

Nursing Interventions: Limit Setting

Answer 428

* set limits in areas in which clear need to protect patient /others exist * "I need you to stop yelling and walk with me to the dining room where we can talk." * "It's ok to be angry with Bob, but it is not okay to threaten him. If you are having trouble controlling your anger, we will help you." * Establish realistic, enforceable consequences. * Make patient aware of limits and consequences

Question 429

Nursing Interventions to Ensure Safety

Answer 429

* Give feedback about observed behavior * End interview if patient's behavior escalates; asure patient that staff will provide for safety. * When intervening in violent situation: * have enough staff for show of strength * give patient opportunity to voluntaruly go to seclusion room * Leader of team: only one to talk to patient, directs team members to function as unit if restraint is necessary.

Question 430

Treatment for Anger/Aggression

Answer 430

* Cognitive-behavioral approaches to teach anger management skills * Acute aggression * atypical antipsychotics or high potency typica anitpsychotics (haloperidol) * Benzos (lorazepam) * B52: Haloperidol 5 mg, Lorazepam 2 mg, Diphenhydramine 50 mg IM * Chronic aggression * anticonvulsants (carbamazepine) * B-blockers (propanolol) * Lithium carbonate

Question 431

Documentation of Violent Episode

Answer 431

* Nurse Provides documentation related to: * preassultive behaviors, nursing interventions, patient response, and evaluation of interventions * detailed description of patient's beahviors during assaultive stage. * all nursing interventions/patient responses to attempt to defuse crisis. * who was called to assess patient, order medications, seclusion and restraints.

Question 432

Intimate Partner Abuse

Answer 432

* Current or former emotional, pscychological, physical, or sexual abuse between partners in an intimate relationship * between 22% and 39% of all us women experience battering; world wide rate: 69%. * prevalence of domestic violence by women against men has increased. * also occurs in LGBTQ communities * is the leading cause of homelessness among women * depression, PTSD, anxiety disorders, and suicide and suicidal ideation may follow battering in all groups.

Question 433

Why Abused Partners Stay

Answer 433

* No other means of financial support is available * No support system exists after living so long in isolation * Are afraid to be alone, or they think they cannot survive without the partner. * Are in depression and have lost the psychologic energy necessary to leave. * Self-esteem is low; they believe the batterer is powerful and omniscient. * An abusive relationship is about instilling fear and wanting to have power and control in relationship * anger is one way to achieve control * physical/sexual or psychological violence also occurs

Question 434

Battered partner

Answer 434

* Lives in terror of next abusive event * feelings of powerlessness, low self-esteem * becomes afraid not only for self but also children * common for social isolation to occur

Question 435

Intimate Partner Violence has severe, long-reaching effects

Answer 435

* children become vulnerable to feelings of responsibility, guilt, emotional distress, behavioral regression, somatic complaints, post-traumatic disorders, substance abuse * children from violent homes most likely to model this behavior.

Question 436

Batterer

Answer 436

* Violence is a learned behavior * low self-esteem, poor impulse control, and limited tolerance for frustration as well as lack of control * lack of guilt and unconcern about behavior * extremely possessive,pathologically jealous, believe in male supremacy.

Question 437

Cycle of Violence

Answer 437

* Tension building phase * abuser becomes edgy, verbally abusive * victim feels tense, afraid, like "walking on eggs" * Serious battering phase * abuser becomes unbearable; violence occurs * victim may try to cover up the injury or may look for help * Honeymoon phase * abuser displays loving behavior, makes promises to change * victim becomesw trusting, hoping for change

Question 438

When Victim Seeks Help

Answer 438

* Ensure medical attention provided * Interview patient in private * assess in nonthreatening manner information about: sexual abuse, chemical abuse, thoughts of suicide or homicide * encourage patient to talk about incident and carefully listen. * assess if patient has a safe place to go * idenify if patient wishes to press charges and facilitate this process. * if patient not ready to take action, refer to community resources.

Question 439

Safety Plan

Answer 439

* Move to a room with more than one exit: * avoid rooms with potential weapons (ex. kitchen knives) * know the quickest route out of the home * Know the quickest route out of the workplace * find out resources that protect employees * tell the neighbors about the abuse, and ask them to call the police when they hear a diturbance * have a code word to use with the kids, family, and friends. * have a safe place selected in case you have to leave.

Question 440

Safety Plan

Answer 440

* Pack a bag beforehand with: * Essential clothes and valuables * Calling Card, cell phone, address book and 1 month supply of medications * keep this packed bad hidden but easy to grab quickly. * Include legal documents: * birth certificates, social security card, photo id, passports, welfare identification, green card, marriage certificate, restraining orders, health insurance papers, medical cards, school records, investment records, rental agreements, and house deed registration. among other documents.

Question 441

Sexual Assault/Violence

Answer 441

* sexual assault is act of violence, not sex * results in devastating, severe, and long-term trauma * encompasses crimes of rape, date rape, intimate partner violence, molestation or incest, and sexual assault of older adults * Sexual assault includes use of force or any nonconsensual contact involving breasts, genitals, or anus with or without penetration.

Question 442

Sexual Assault/Violence

Answer 442

* Usually commited by men against women, can also be by women against men or between people of the same gender. * gay men more often victims of sexual assault than heterosexual men. * Most vulnerable groups * women before age 12, men between 12-18 * older adults with cognitive or functional impairments.

Question 443

Cultural Considerations

Answer 443

* Some groups maintainwomen as inferior and support male superiority and sexual entitlement * some college fraternities reflect attitudes that could encourage violence toward women * military groups have supported norms of male superiority and dominance.

Question 444

Perpetrator

Answer 444

* High incidence of psychopathology and personality disorders (antisocial personality) * history of being sexually assaulted as child * impulsive and hostile toward women * association with sexually aggressive peers * membership in gang

Question 445

Sexual Assault Nurse Examiners (SANEs)

Answer 445

* forensic nurses who work with the victims of SV: * perform physical examiniation on the survivor * collect forensic evidence * provide expert testimony and forensic evidence * provide support and the psychobiologic needs of survivor.

Question 446

Information to Help a Recent Victim of Sexual Violence in the Aftermath of Rape (Either on the Phone or in Person)

Answer 446

1. Go to a safe place immediately. 2. Consider reporting the rape to the police or to the campus police if it happened on campus. 3. You can report the assault and later choose not to pursue criminal proceedings. 4. If you choose not to report the assault immediately, you can do so at a later time. Preserve evidence of the rape: 1. Do not wash your hands or face. 2. Do not shower or bathe. 3. Do not brush your teeth. 4. Do not change clothes or straighten up the area where the assault took place. Varcarolis, Elizabeth M.. Essentials of Psychiatric Mental Health Nursing - E-Book (p. 354). Elsevier Health Sciences. Kindle Edition.

Question 447

IF Victim Seeks Help

Answer 447

* domestic violence help locally * fulton county family counseling center * montgomer co catholic charities * approach victim in nonjudgemental and emphatic manner * bo not leave alone * should receive priority care * identify survivor's support systems * Consent forms are essential (right to refuse treatment) * after consent forms signed, forensic evidence collected * use institutional protocol for evidence collection (rape kits) * assess for physical trauma, psychological reactions, use of drugs by victim/perpetrator.

Question 448

PTSD: Rape-Trauma Syndrome

Answer 448

* Acute Phase (about 2 weeks) * emotional outburst, calm/blunted or confused * bruising, soreness, headache, muscle tension, sleep disturbance or anorexia * embarrassment, anger, guilt, denial, etc. * reorganization Phase: * fears, phobias, flashbacks, increase emotional responses, difficulties with daily functioning.

Question 449

Children and Adolescents Prevalence and Comorbidity

Answer 449

* First onset of symptoms is most likely to occur early childhood or in early adolescence. * up to 21% prevalence of psychiatric disorders is revealed in children ages 9 to 21 yo. * Only about 20% of all young people who need mental health care are receiving the help they need. * suicide, the third leading cause of death in 15-to24-year-olds, is a frequent complication of untreated mental health disorders. * Children with mental illness often meet the criteria for more than one diagnositc category.

Question 450

ACE Adverse Childhood Experiences Study

Answer 450

Birth 1. adverse childhood experiences 2. social, emotional, & cognitive impairment 3. adoption of health-risk behaviors 4. disease, disability and social problems 5. early death

Question 451

Concept of Resilient Child

Answer 451

* Vulnerable child who does not develop psychiatric disorder has resiliency characteristics of: * temperament that adapts to changes * ability to form nurturing relationships with other adults * ability to distance self from emotional chaos in family * social intelligence * ability to use problem-solving skills

Question 452

Mental Health Assessment Children/Adolsecents

Answer 452

* mental status assessment * provides information about problems in thinking, feeling, and behaving * developmental assessment * information about child's current maturational level compared with chronological age as well as identifying development deficits * denver II developemtn screening TEST (infants to age 6)

Question 453

Mental Health Assessment Children/Adolsecents

Answer 453

* methods of data collection * history collected from parents, caregivers, child or adolescent, and other family members * interviewing (semistructured) in which child/adolescent is asked about life at home and at school * use of activities such as games, drawings, puppets and free play (especially for children)

Question 454

Mental Health Assessment Children/Adolsecents

Answer 454

* Data collection * child may not have the words to describe * child might not understand emotion(s) * so...... draw, color * ask....what color do yo feel like? what color do you want to feel like? can you tell me about your picture

Question 455

General interventions (childre/adolescents)

Answer 455

* Parental involvement: important in supportive and educative system * single and multiple family therapy used. * Group therapy * play therapy for youn children, combination of play and talking therapy for older children * Milieu therapy * physical milieu provides for safe, comfortable place to live, play and learn * daily schedule exists to struture activities.

Question 456

General interventions (childre/adolescents)

Answer 456

* cognitive-behavior therapy * to change cognitive processes and behaviors * Play therapy * based on notion that play is work of a child * forms of play therapy: dramatic, therapeutic games, bibliotherapy, therapeutic drawing * other modalities * music therapy * movement and dance therapy * recreational therapy

Question 457

General interventions (childre/adolescents)

Answer 457

* behavior modification * rewarded behavior is likely to continue * use of point/token systems to reward desirable behaviors * removal and restraint * restraint- controversial, perceived as punishment * quiet room in an acceptable alternative * time-out method useful for disruptive behaviors

Question 458

Intellectual Disability

Answer 458

* Most common developmental disorder * degree of impairment (mild, moderate, sever or profound) assessed via: * Conceptual: academic learning, speech * social: interactions with others * practical: ability for self-care and life management.

Question 459

Intellectual Disabilty

Answer 459

* Individual and family Counseling * appropriate schooling * individual education plan (IEP)

Question 460

Autism Spectrum Disorder

Answer 460

* Must demonstrate two or more of the following: * sterotype or repetitive speech, motor movements, and echolalia, and the reptitve use of objects. * excessive adherence to routines, rtiuals, or excessive resistance to change * fixated interests that are abnormal in intensity. * hyporeactive or hyperreactive to the sense of joy or unusal interest in sensory aspects of the environment (indifference to pain, heat, cold)

Question 461

Autism Spectrum Disorder

Answer 461

Assessment and Diagnosis: * observe for social deficits: bonding with parents, dislike of cuddling, poor eye contact, lack of interaction with peers. * May also see communication delays, rigid routines and rituals * usually diagnoses around toddler age Implementation * Behavioral management * cognitive therapies * early intervention * educational and school-based therapies * sometime atypical antipsychotics, SSRIs or beta blockers

Question 462

ADHD

Answer 462

* Characterisitcs * inattention: difficulty paying attention to task at hand, easily distracted * hyperactivity: fidgets, runs and climbs excessively, talks excessively * impulsivity: blurts out answers before question is finished, has difficulty waiting one's turns, interrupts and intrudes on others' converstations/games

Question 463

ADHD: Assessment & Interventions

Answer 463

Assessments: * Observe level of physcial acitivity, attention span, control of impulses * assess difficulty in making friends and performing in school * assess for problems of incontinence of urine or stoll after has been toilet trained Interventions * behavior modification therapy, parent training, and school accomodations * pharmacologic agents that address inattention and hyperactive and impulsive behaviors.