Mental Health Final Flashcards

Question

Hesi Practise Offering Self

Answer 1

technique that allows the client to set the pace of a conversation. The RN is available, both physically and emotionally. lets the client know you are there for them. helps build trust

Answer 2

Exercise is the least expensive yet most available antidepressant on the market. Exersice increases neurotransmitters and endorphins, and decreases feelings of sadness. W/ a depressed client...walk them around the unit. Don't let them sit around all by themselves. Socialize Socialize Socialize

Answer 3

resorting to an earlier, more comfortable level of functioning that is less demanding ahd has less responsibility.

Answer 4

is the filling of memory gaps with imaginary information in an attempt to distract others from observing an obvious deficit.

Answer 5

symptons of heroin w/d include cravings muscle aches / tremors severe abdominal cramps chills / sweating / runny nose / watery eyes

Answer 6

symptoms of cocaine w/d include: severe cravings depression / fatigue / irritability vivid / unpleasant dreams insomnia or hypersominia

Answer 7

symptoms of cannabis w/d include: irritability / anxiety / restlessness decreased appetite or wieght loss

Answer 8

early symptoms of alcohol w/d include: irritability / anxiety tremors sweating mild tachycradia

Answer 9

To promote healthy coping and adaptation help clients examine personal issues and explore and evaluate the degree of change over time Assist patient with their emotional and physical needs

Answer 10

**1)** Psychoanalytic Theory **2)** Client-Centered Theory By Carl Rogers (**\*\* This is the professors favorite)** **3)** Cognitive-Behavioral Therapies

Answer 11

* Originated by Sigmund Freud * Key Concepts: –The “Self” has 3 distinct parts * **Id** (**instincts**; seek pleasure) - as a child does...I want at any cost * **Ego** (rational adult self) - we start to become self aware...If i do this / this will happen. Is is worth it? * **Superego** (internalized parents; **conscience**) - i.e a parent would say "if you do that...this will happen"

Answer 12

•Originated by **Carl Rogers** ## Footnote •Key Concepts –Unconditional **Positive Regard:** Is the main tool of the therapist –Every person has the potential to become fully functioning, moving toward increased awareness of self

Answer 13

•Genuineness, Warmth, Empathy, Respect –Active listening, Reflection of feelings, Clarification, **Being truly present for the client** It's not about me, it's about the patient (Pt. centered)

Answer 14

## Footnote **paraphrasing** - restating the pts. stmt. using dif words **Restating** - mirroring their words **Reflecting** - assisting the pts to better help them know their own thoughts **exploring** - examining the situation to gain insight into important ideas.

Answer 15

Involves learning to use your unique qualities in a genuine way to develop positive bonds with the client in order to help them grown & change The nurse's "self" is the "instrument" they use to deliver nursing care.

Answer 16

Key apsects **Open / Public** - known to self and others **Hidden / Private** - Known to Self but not Others **Blind / Unaware** - known to Others but not Self **Unknown** - Hidden from Self and Others

Answer 17

**Sympathy** involves projecting yourself into your patient’s situation and imagining what you would feel in that circumstance. Associated with feelings of pity and commiseration

Answer 18

Step 1 **Active Listening** Be fully present with the client—listen with all of your senses Step 2 **Empathic Responding** Communicate your understanding and acceptance of the patient by reflecting the patient’s feelings (“You feel X” or “You feel X because of Y.” )

Answer 19

Linda Richards

Answer 20

"Id" operaties on the pleasure principle, seeking immediate gratification of impluses.

Answer 21

The "ego" phase acts as a mediator of behavior and weighs the consequence of one's action. ie. Would be taking that toy, be worth getting in trouble?

Answer 22

The "superego" would oppose the impulsive behavior as "not nice".

Answer 23

is the intentional act of killing oneself by any means. hsty of attempts is best predictor of another attempt

Answer 24

A voluntary, failed attempt to kill oneself Frequently called attempted suicide

Answer 25

Hopelessness / helplessness severity of depression.

Answer 26

**Remember!** All behavior has meaning! All behavior, including suicidal behavior, represents an attempt to meet a need!

Answer 27

it refers to the components of pts pyschi - intense self-hatred - intense desire to escape oneself

Answer 28

the inability to find meaning in suffering often contributes to suicide

Answer 29

Is a pt's perspective about. 1) self 2) future 3) World With a **negative** outlook in the center of all three views.

Answer 30

It contains three factors: **Psyhchache** - unbearable suffering of the mind **Press** - Stressors that drive the person to suicide as a viable alternative **Perturbation** - extream state of being upset

Answer 31

**Step 1**: Set the Stage **Step 2:** Explore Suicidal Thoughts and Behaviors **Step 3:** Evaluate Lethality

Answer 32

Establish rapport! Promote trust Convey accepting, non-judgmental attitude Facilitate a supportive, collaborative approach to exploring the client’s problems

Answer 33

**Facilitate expression of feelings** **Convey empathy by reflecting feelings:** (“It sounds like you’re feeling hopeless.”) **\*\* Verbalize the implied:** (“When you say there’s no point in going on, I have to wonder, are you feeling like you want to kill yourself?”) **Normalize the patient’s experience:** (“A lot of people in your situation might start wondering if there’s any point in living anymore.”)

Answer 34

**Overt** - Life isn’t worth living anymore (they are direct statements) **Covert** - You won’t have to bother with me much longer *(hidden statements)*

Answer 35

Giving away prized possessions Putting affairs in order Writing farewell notes Buying a gun Loss of interest in activities Social withdrawal

Answer 36

Have you ever wished you were dead (weren’t here)? Have you ever thought about hurting or killing yourself? Have you been feeling suicidal lately?

Answer 37

ederly (w/terminal diagnoses) younge adolesent white females American Indians seem to have a higher rate.

Answer 38

Lethality refers to the probability that a person will successfully complete suicide Determined by the seriousness of the person’s intent and likelihood that the planned method of death will succeed

Answer 39

How lethal is the proposed plan? How accessible are the means? What are the chances of rescue? Is substance use a factor?

Answer 40

**S**ex **A**ge **D**epression **P**revious attempts **E**thanol abuse (alcahol) **R**ational thinking loss (especially psychosis) **S**ocial supports lacking **O**rganized plan **N**o spouse **S**ickness *Score of 7 out of 10 warrants hospitalization*

Answer 41

Prevent harm Re-establish equilibrium Restore hope Enhance coping skills Develop an outpatient support system Develop a suicide prevention plan for discharge

Answer 42

Distressed suicidal clients who suddenly become more peaceful and serene may have decided to kill themselves

Answer 43

Major Depressive Disorder (MDD) Dysthymic Disorder (DD)

Answer 44

5 or more of the following symptoms for at least 2 weeks ## Footnote - Depressed Mood - feelings of guilt / worthlessness - Anhedonia ( loss of interest in activities) - Significant weight change - Insomnia - psychomotor agitation / retardation - Anergia (fatigue or loss of energy - Decreased concentration or indecisivness - Recurrent thoughts of suicide or death

Answer 45

Female / unmarried low socioeconomic status family hsty of depression Alcohol / substance abuse Post-partum Negative life event - especially loss of loved one

Answer 46

2 or more of the following symptoms, along w/depressed mood are present most days over a 2 yr period of time - **d**ecreased appetite - **i**nsomnia or hypersomnia - **d**ecreased self esteem - **f**eelings of helplessness or despair - **l**ow energy or chronic fatigue - **P**oor concentration and difficulty making decisions

Answer 47

1) Neurobiological 2) Genetic Transmission 3) Diathesis-Stress Theory of Depression 4) Psychoanalytic Theory of Depression 5) Cognitive Theory of Depression 6) Learned Helplessness Model

Answer 48

Individuals have a **genetic predispostition** (diathesis) for deprssion This genetic **vulnerability** is activated by exposure to multiple stressors **Exposure** to stressors early in life (abuse / death of parent prior to age 10) lead to lifelong risk for develpment of MDD

Answer 49

Person experiences stressful event preceived as **uncontrollable**. extreme feelings of powerlessness, helplessness and apathy occur loss of initiative and a feeling of futility

Answer 50

Psychotherapy Pharmacotherapy Electroconvulsive Therapy Brain Stimulation Exercise and Stress Management

Answer 51

Selective Serotonin Reuptake Inhibitors (SSRI) Tricyclic Antidepressants (TCAs) Monoamine Oxidase Inhibitors (MAOI'S) St. John’s Wort

Answer 52

1st line therapy for most types of depression effective in 1 to 3 weeks low lethality risk Should not take w/other depression medications -**MAOI'S** (discontinure all SSRI's for 2 - 5 weeks before starting

Answer 53

BAD SSRI - increased body weight - anxiety - Dizziness Serotonin Syndrome Stimulation of the CNS Reproductive issues / sexual dysfunction insomnia

Answer 54

**Rare - but life threatening - medical emergency** –Hyperactivity/restlessness –Irrationality, mood swings, hostility –Abdominal pain, diarrhea, bloating –Elevated blood pressure –Tachycardia / cardiovascular shock –Fever / hyperpyrexia –Confusion / delirium –Myoclonus, incoordination, tonic rigidity –Generalized seizures –Apnea / death

Answer 55

* Inhibit reuptake of serotonin and norepinephrine by the presynaptic neurons * Full therapeutic response can take 4 to 8 weeks * **Potentially lethal** in overdose or in combination with MAOI’s

Answer 56

* Inhibit MAOI's, the enzyme that inactivates norepinephrine, serotonin, dopamine and **tyramine** * Avoid foods containing tyramine **(generally aged, fermented and pickled foods)** and other pressor agents * MAOIs should not be taken within 14 days of starting or discontinuing other antidepressant medications, including tricyclics, SSRIs, SNRIs and St. John’s Wort!

Answer 57

generally aged, fermented and pickled foods avocados (especially if aged) figs / bananas ( if overipe) fermented meats cured fish / dryed fish all cheeses foods (or drinks) w/yeast -- beer / wine etc

Answer 58

* May be effective in mild to moderate depression * Should not be taken with other antidepressants or with tyramine-containing foods * Can decrease digoxin levels 28%

Answer 59

1) acute phase 2) continuation phase 3) maintenance phase

Answer 60

- **6 to 12** weeks - directed at reduction of depressive symptoms and restoration of psychsocial and work functions Hospitalization may be initiated if severe

Answer 61

- **4 to 9** months - directed at prevention of relapse through pharmacotherapy, education & psychtherapy

Answer 62

- 1 year or more treatment is directed at prevention of further episodes of depression medication may be phased out.

Answer 63

loss of ability to experience joy or pleasure in previously plearsurable activities.

Answer 64

healing is possible and attainable for individuals with mental illness including depression., Thourgh partnership with nurse where treatment goals are mutually developed based upon the pt.s personal needs.

Answer 65

Patient Health Questionaire - 9 0-4 none 5-9 mild 10-14 - moderate 15-19 moderately severe 20-27 servere

Answer 66

alterations in body processess necessary to support life and growth - eating - sleeping - elimination - sexual activity

Answer 67

Mild Anxiety Moderate Anxiety Severe Anxiety Panic

Answer 68

Occures in normal everyday living and allows an individual to perceive reality in sharp forcus

Answer 69

as anxiety increases, person experiencing moderate anxiety sees, hears & grasps less informtion often demonstrate "selective inattention"

Answer 70

perceptual field is greatly decreased. Person may be able to focus only on one detail or may have many scattered thoughts. Learning and problem solving not possible Sense of impending doom somatic symptoms include - headache, nausea, dizziness or insomnia may have increased trembling / heart pounding

Answer 71

is the most severe level of anxiety and results in markedly distrubed behavior. Pt is unable to process what is going on & they may loss touch with reality.

Answer 72

normal part of infant development - begins around 8 months through 18

Answer 73

compensation - conversion - denial - displacement - dissociation - indentification - projection - reaction - regression - repression - splitting - sublimation - suppression - undoing

Answer 74

used to change perceived deficiencies by emphaszing strengths

Answer 75

unconscious transformation of anxiety into a physical (somatic) symptom w/ no organic cuase

Answer 76

involves escaping unpleasant anxiety causing thought & feelings by ignoring thier existence

Answer 77

transference of emotions associated w/ a particular person / place or thing with another object that is not threatening.

Answer 78

is a disruption in consciousness, memory, identity that results in compartmentalizing unpleasant aspects of oneself

Answer 79

when you relate yourself to someone else

Answer 80

refers to unconscious rejection of unacceptable behaviors and placing them onto someone else. is the hallmark of blaming, scapegoating, prejudicial thinking, and stigmatizing others.

Answer 81

replacing an unacceptable behavior with one socially acceptable

Answer 82

intense, excessive anxiety or fear about being in places or situation from which escape might be difficult. Pt. will avoid these in an effort to control anxiety.

Answer 83

group of related disorders that all have obsessiv-complusive characteristics. it exist along a continuum between obsessive-complusive behaviors --- to the pathological end which is obsessive-complusive disorders, which obstruct thier very way of living.

Answer 84

thoughts, implulses, or images that persist and recur, so that they cannot be dismissed from ones mind. those experiencing these **are often aware** that these obsessions are senseless

Answer 85

ritualistic behavirors (washing hands) that an individual feels driven to perform in an attempt to reduce anxiety.

Answer 86

14-17 - mild anxiety 18-24 - moderate anxiety 25-30 - severe anxiety

Answer 87

refers to allowing the pt. (w/ your help) to test their automatic responses and then refocus / redraw them with more rational conclusions

Answer 88

involves gradual exposure to a feared object to redirect associated fear of it. a behavioral therapy modality

Answer 89

exposes the pt. to a large amount of an undesirable stimulus in an effort to extinguish the anxiety response. a behavioral therapy modality

Answer 90

is the inability to integrate the positive and negative qualities of oneself or others into a cohesive image.

Answer 91

is a mechanism by which an individual deals with emotional conflict by meeting the needs of others and receiving gratification vicariously or from the responses of others

Answer 92

is a process in which events are analyzed based upon remote, cold facts w/o passion --- rather than incorporating feelings / emotions into the process.

Answer 93

unconscious mechanism that keeps unacceptable feelings out of awarness by expressing the opposite behavior ie. instead of 'hating' a rival, you would say you admire them.

Answer 94

involves uncounsciously making excuses for one's behavior, idadequacies, or feelings by blaming others.

Answer 95

**Oral** - age birth to 1 (thumb sucking) **Anal** - age 1 - 3 (refusiing to use bathroom) **Phallic** - age 3 - 5 **Genital** - age 13 - 20 years

Answer 96

based upon the idea that all members of the environment contribute to the planning and functioning of the setting.

Answer 97

Schemas are unique assumptions about ourselves, according to Beck’s theory a negative schema is an emotional consequence with the end result of negative thinking process

Answer 98

is the expression of psychological stress through physical symptoms

Answer 99

nursing care that addresses the multidimensional interplay of **biological**, **psychological** and **sociocultural** needs.

Answer 100

1) Somatic symtpom disorder 2) Illness anxiety disorder (aka hypochondriais) 3) Coversion disorders (aka neurological disorders) 4) Pshychological factors affecting medical condition 5) Factitious disorders

Answer 101

characterized by a combination of distressing symptoms and an excessive or maladaptive response w/o significant physical findings or diagnoses.

Answer 102

chest pain / fatigue / dizziness / headache swelling / back pain / SOB / insomnia abdominal pain / numbness

Answer 103

results in a misinterpretation of physical sensations as evidence of a serious illness even normal bodily changes, such as a change in HR can be seen as red flags for serious illness

Answer 104

manifest itself as nerological symptoms in the absence of neurological diagnosis

Answer 105

paralysis / blindness / movement disorders gait disorders / numbness / paresthesia (tingling or burning sensation) loss of vision, hearing or even symptoms resembling epilepsy.

Answer 106

**Major Depression disorder (MDD**) & coronary heart disease **Stress** & cancer

Answer 107

those benifits derived from the symptoms alone eg. in the sick role, a pts. are unable to perform usual household duties. **If a pt. derives benefits from the percieived symptoms, it will be very dificult to give them up.**

Answer 108

unlike other somatic disorders...factitious disorders are consciously under the pts. control. They fake ilness to get sympathy or some other benefit.

Answer 109

it is when a caregiver deliberately fakes a pts. illness for their own benefits. money from insurance - admiration from clinet or other staff etc.

Answer 110

consciously motivated to deceive based upon the desire for gain (money or getting out of someting)

Answer 111

When a pt. experiencing a somatic conversion disorders appears to be unconcerned about the symptom eg. A woman suddenly finds she cannot see. She seems unconcerned about her symptom and tells her husband, “Don’t worry, dear. Things will all work out

Answer 112

A therapy technique that attempts to change a patient’s thought processes and behaviors through problem-solving and conscious evaluation of beliefs about the self

Answer 113

* Identify source of anxiety * Link pt's behavior to feelings * Introduce logic * Teach coping skills

Answer 114

**SSRI**s: * Lexapro (Escitalpram) for GAD * Prozac (Fluoxetine) for OCD & Panic Disorder * Luvox (Fluvoxamine) for OCD & SAD * Paxil (Paroxetine) for GAD, OCD, PD, & SAD * Zolfort (Sertraline) for OCD, PD & SAD * Viibryd (Vilazondone) for GAD **SNRI**s: * Cymbalta (Duloxetine) for GAD * Effexor (Venlafaxine) for GAD, PD & SAD **TCA**s: * Anafranil (Clomipramine) for OCD

Answer 115

Benzodiazepines * quick onset of action; used for acute treatment (prn) * may be addictive; limit use to 2 - 3 wks * monitor for sedation, ataxia & decreased cognition * contraindicated in pregnancy * absorption delayed by antacids * i.e. Xanax (Alprazolam), Klonopin (Clonazepam), Valium (Diazepam), Ativan (Lorazapam) **Exception: Buspar** (Buspirone) is _long acting_, _not_ addictive; not for prn use

Answer 116

1) Epinephrine 2) Norepinephrine 3) Dopamine 4) Serotonin 5) GABA GABA is an inhibitory neurotransmitter & thus the focus of pharmacological therapy for anxiety symptoms.

Answer 117

**The most severe form of Schizphenia Spectrum** It is a potentially devastating brain disorder that affects a person's thinking, language, emotions, social behavior, and ability to perceive reality accurately.

Answer 118

**It, and other psychotic disorders** are those that distrub the fundamental ability to deteremine what is real or what is not.

Answer 119

hallucinatioins delusions and / or disorganized speech

Answer 120

usually presents in late teens / early twenties.

Answer 121

(18 to 25) occurs more often in males associated w/poor functioning before onset & more structural brain damage

Answer 122

(25 to 35) more likely to be female less structural brain damage better outcomes

Answer 123

1) Substance abuse disorders - nearly 50% (sucide) 2) Nicotine dependence 70% - 90% 3) Anxiety, depression 4) Physical Health Illnesses **5) Polydipsia -** can lead to fatal water intoxication (20% have insatiable thirst) may be due to medications

Answer 124

scientific consesus is that Schizophrenia occurs due to multiple inherited **genetic abnormalities** combined with **nongenetic factors**. called the **diathesis-stress model** of Schizophrenia

Answer 125

Increased levels of **dopamine** (1st generations treat) Increased levels of **serotonin** (2nd generation meds treat) **glutamate** - which is a major neurotransmitter during neuronmaturation **Brain Structure Abnormalities** - reduced volume of "grey matter" (temporal / frontal lobes) --- more hallucinations.

Answer 126

1) **prenatal stressors** (poor nutrition & hypoxia) 2) **psychological stressors** (stress w/ incr cortisol level which imped hypothalamic development) 3) **environmental stressors** (toxins, ie. solvent tetrochoroethylene in dry cleaning) all increase chances w/ those vulnerable to Schizophrenia

Answer 127

Phase I - **Acute** Phase II - **Stabilization** Phase III - **Maintenance**

Answer 128

**Acute** onset or exacerbation of distruptive symptoms (ie. hallucinations, delusions, apathy w/draw) w/ loss of functional abilities - increased care or hospitalization may be required.

Answer 129

**Stabilization** _symptoms_ are _diminishing_, and there is _movement towards_ one's previous level of functioning (_baseline_)

Answer 130

**Maintenence** pt. is at or near _baseline functioning_ _symptoms_ are _absent_ or significantly decreased.

Answer 131

Positive symptoms Negative symptoms Affective Symptoms Congnitive Symptoms

Answer 132

The presence of something that is _not normally present_ **hallucinations** **delusions** **disorganized speech** **bizarre behavior** will generally respond to medication

Answer 133

absence of something that _should be present_ - **Poverty of thought** (interest in hygiene) - **Avolition** (loss of motivation / energy or drive) - **Blunted affect** (minimal emotional response) - **Alogia** (poverty of speech) - **Anhedonia** (loss of joy in something previously enjoyed) - **Anergia** (lack of energy) **more presistent / crippling b/c they reduce motivation & limit social & vocational success**

Answer 134

often subtle changes in memory, behavior, attention or thinking ie. impaired **executive functioning** (ability to set priorities or make decisions)

Answer 135

symptoms involving emotions and their expression **dysphoria** (dissatisfaction w/ life) **suicidality** **hopelessness**

Answer 136

alterations in 1) **thought** 2) **speech** 3) **perception** & 4) **behavior**

Answer 137

false fixed **beliefs** that cannot be corrected by reasoning. Pt will agree w/ RN about facts but disagree w/ interpretation. 75% of those w/ schizophrenia experience these **persecutory** **gradiose** or those involving **religious** or **hypochondriacal** ideas ex. I think; I believe; I interpret; My opinion

Answer 138

refers to the impaired ability to think abstractly ie. When you ask a pt. what brought them to the hospital --- they would say " a cab" Concreteness reduces one's ability to understand and address abstract concepts such as love or the passage of time.

Answer 139

choosing words based on their **sound** rather then their meaning ie. rhyming "on the track... have a Big Mac"

Answer 140

_jumbled words_ that are meaningless to the listener and possible to the speaker ie. "red chair out town board"

Answer 141

_made-up words_ that have meaning to the pt. but a different or nonexistent meaning to others

Answer 142

pathological _repeating_ of anothers words ie. **Nurse**...Mary, come get your medication **Mary**...come get your medication

Answer 143

feeling that one is somehow _different or unreal_ or has lost his / her identity may feel body parts don't belong to them.

Answer 144

a _false perception_ that the _environment has changed_ - surroundings seem strange and unfamilar

Answer 145

**Hallucinations** involve perceiving a _sensory experience_ for which *no external stimulus* exist **Illusions** are misperceptions or misinterpretations of a real experience (*external stimulus*); a false belief about a perception ie. pts see the coat rack, but believes it is a bear

Answer 146

**Auditory:** hearing voices or sounds **Visual:** seeing persons or things **Olfactory:** smelling odors **Gustatory:** experiencing taste **Tactile:** feeling bodily sensations ex. I see; I hear; I taste; I smell; I feel

Answer 147

**Command hallucinations** those that _direct pts to take action_. voices may command the pt. to hurt themselves or others.

Answer 148

pronounced decrease in the rate and amount of movement Generally pts. may move little if at all

Answer 149

mimicking the movements of another

Answer 150

inability to realize they are ill (caused by the illness itself) The resulting **lack of insight** can make assessment / treatment challenging.

Answer 151

stresses hope, living a full and productive life, and eventually *recovery* **rather than** focusing on *controlling* symptoms and *adapting* to the disability

Answer 152

patient safety and stabilization

Answer 153

helping the pt _understand_ the illness and treatment, become _stabilized_ on medications, and be able to _control or cope_ with symptoms.

Answer 154

_adhering_ to medication, _preventing_ relapse, and achieving _independence_ and a satisfactory quality of life.

Answer 155

the ability to hold distorted postures for extended periods of time.

Answer 156

they are the **initial signs** indicating that a pt. might be leading toward a schizophrenic break Withdrawal misinterpreting poor concentration preoccupation with religion

Answer 157

refers to _jumbled thoughts_ inchoherently expressed to the listener.

Answer 158

feeling tense difficultly concentrating **trouble sleeping** increased w/drawal **increased bizarre or magical thinking** Relapse can occur even w/ medication compliance

Answer 159

**Bizarre** type are _unreal_ and _impossible_ beliefs i. e. Pt believes body organs replaced in absence of scars i. e. Pt believes they are another animal (not human)

Answer 160

- Delusions of control - Ideas of reference - Persecution - Grandeur - Somatic - Erotomanic - Jealousy

Answer 161

Believing that another person, group of people, or external force controls thoughts, feelings, impulses, or behavior i.e. Pt covers his apartment walls w/ aluminum foil to block government efforts to control his thoughts

Answer 162

Giving personal significance to unrealated or trivial events; perceiving events as relating to you when they are not i.e. Pt believes that birds sing when she walks down the street just for her.

Answer 163

Believing that one is being singled out for harm by others; this belief often takes the form of a plot by people in power. i.e. Pt believes the Secret Service was planning to kill him by poisoning his food; therefore, he would eat only prepackaged food.

Answer 164

Believing that one is a very powerful or important person i.e. Pt believed he was a famous playwright and tennis pro

Answer 165

Believing that the body is changing in unusual ways (i.e. rotting inside) i.e. Pt said his heart had stopped and was rotting away.

Answer 166

Believing that another person desires you romantically. i.e. Although he barely knew her, Patti insisted that Eric would marry her if only his current wife would stop interfering.

Answer 167

Believing that one's mate is unfaithful i.e. Pt wrongly accused her spouse of going out w other women. Her proof was that he twice came home from work late (even though his boss explained that everyone had worked late).

Answer 168

Priorities will change depending on the situation and context (use critical thinking) - Physical integrity - Establishing trust - Preventing inappropriate behavior - Treating symptoms: hallucinations/delusions - Enhancing compliance w/ treatment - Reinforcing reality

Answer 169

Bipolar disorder mood cycling: Mania Hypomania Normal mood Mild depression Major depression

Answer 170

MANIC EPISODE **M**ood swings **A**ctive, agressive behavior **N**othing is wrong (denial) **I**mpulsive, intrusive behavior **C**an't sit still, can't stop talk **E**uphoric mood **P**oor judgement, provocative behavior **I**ncreased sexual interest **S**ubstance (stimulant) abuse **O**mnipotent feelings **D**ecreased need for sleep **E**ndless energy

Answer 171

**Lithium** (used for mood stabilization) **Anticonvulsants** (used for mood stabilizaiton) * Depakote (valproate) * Tegretol (carbamazepine) * Lamictal (lamotrigine) **Antipsychotics** (used for acute manic phase) * Seroquel (quetiapine) * Zyprexa (olanzapine) * Geodon (ziprasidone) * Ambilify (aripiprazole) * Risperdal (resperidone) * Haldol (haloperidol)

Answer 172

Antipsychotics & benzodiazapines Typical "cocktail" given in psych ER: Haldol 5 - 10 mg w/ Avtivan 2 mg

Answer 173

Use very cautiously w/ bipolar pts *All* antidepressants **induce mania** in bipolar pts If pt is bipolar, antidepressants should always be used **in conjuction w/ a mood stabilizer**.

Answer 174

Bipolar I Bipolar II Cyclothymic disorder

Answer 175

mood disorder that is characterized by **at least one-week long manic episode** that results in excessive activity and energy

Answer 176

**E**xtreme drive & energy **I**nflated sence of self-importance **D**rastically reduced sleep requirements **E**xcessive talking combined w/ pressured speech **P**ersonal feeling of racing thoughts **D**istraction by environmental events **U**nusually obsessed with and overfocused on goals **P**urposeless arousal and movement **D**angerous activities (ie. indiscriminate spending, reckless sexual encounters, or risky investments)

Answer 177

**low-level mania** alternated with **profound depression** this is called **hypomania**...unlike mania, psychosis is generally never present.

Answer 178

symptoms of **hypomania alternate with** symptoms of **mild to moderate depression** for at least **two years** in *adults* & **one year** in *children*.

Answer 179

**Acute** Phase **Continuation** Phase **Maintenence** Phase

Answer 180

The primary goal is **injury prevention** outcomes in the acute phase reflect both physiological and psychiatric issues

Answer 181

can last for 4 - 9 months overall outcome is **_relapse prevention_**, but consist of **Psycheducational classes** for the pt. & family to: **a)** understand the disease process **b)** medication knowledge **c)** knowledge of the early warning signs of replapse

Answer 182

continuing to focus of **relapse prevention** & **limiting** the severity and duration of **future episodes**.

Answer 183

An unrealistic fear of harm

Answer 184

**Dopamine** Traditional _antipsychotics block_ excessive dopamine, an excitatory neurotransmitter, so that symptoms r/t psychosis are reduced.

Answer 185

**Diphendhydramine** (Benadryl) IM or IV or **Benztropine** (Cogentin) IM or IV IV response is 5 mins; IM response is 15 - 20 mins Other anticholingerics may be used

Answer 186

* Sedation * Muscle stiffness * **Akathisia** * alters effectiveness of exogenous insulin Antipsychotics often produce sedation & EPS effects (i.e. stiffness, gait disturbance). The pt might describe the medication as making them feel like a "robot".

Answer 187

Pts with personailty disorders are **inflexible** & deomonstrate **maladaptive** responses to stress - they are unable to develop true intimacy with others - unable to develop trusting relationships. **"Impaired soical interaction"**

Answer 188

1) Avoidant 2) Antisocial 3) Borderline 4) Dependent 5) Histrionic 6) Narsicistic 7) Paranoid 8) Obsessive-complusive 9) Shizioid 10) Schizotypical

Answer 189

characterized by a longstanding _distrust & suspiciousness_ of others based on the belief (unsupported by evidence) that others want to exploit, harm, or deceive them. * difficult to treat b/c they distrust everyone * have a need for _space & reassurance_ * are _hypervigilant_ **Projection** is the dominant defense mechanism; they blame others for their shortcomings.

Answer 190

exhibits a _poor ability to function_ in their lives...Relationships are particularly affected due to their prominent feature of **emotional detachment**. **need for soical isolation** Individuals _do not seek out or enjoy close relationships_. They are reclusive, avoidant, and uncooperative. They do not do well with resocialization.

Answer 191

more common in men then women. **It is the 1st of the schizophrenia spectrum.** severe *social* and *interpersonal* deficits. These individuals experience extreme anxiety in social settings & conversations tend to _ramble_ w/ lengthy, unclear & overly detailed content. **eccentricity, odd or unusual beliefs** (magical thinking) prefer periods of _solitude_

Answer 192

characterized by emotinal **attention-seeking** behaviors & **melodramatic**, including self-centeredness, low frustration tolerance, & **excessive emotionality** demonstrates poor verbal boundaries - In general, those with this disorder do not believe they need psychiatric help. - **flirtatious** - overly intense attachment w/ the opposite sex; _provocative_. - **Psychotherapy** is the txmt of choice.

Answer 193

comes across as **arrogant** & w/ an inflated view of thier own self-importance **(grandiose self-importance)**. _needs constant admiration_ _lack of empathy_ for others pathological traits include: antagonism, represented by _grandiosity_ and _attention-seeking behaviors_. txmt includes **cognitive-behavioral therapy**, family & group therapy.

Answer 194

main traits are _low self-esteem_ associated w/ feelings of _inferiority_ compared to peers. **timid, socially uncomfortable** they tend to avoid engaging in new or unfamilar activities involving new people d/t _fear of criticism or rejection_

Answer 195

people with this disorder have a high _need to be taken care of_, which can lead to patterns of submissiveness with fears of separation & abandonment by others. _urgently seek relationships_ have a _constant need for reassurance_ _lack self-confidence_ **Psychotherapy** is the txmt of choice

Answer 196

the _most prevalent disorder_ in the general community - associated w/ the highest burden of medical cost. main traits include: **rigidity & inflexible standards** of self & others --- along with persistence of goals long after they are necessary. They will typically rehearse over & over for situations where they will deal with others. _perfectionists_ (interferes w/ task completion) **SSRI's & prozac** may help.

Answer 197

has the central characteristic of _instability_ in affect, identity, & relationships desperately seek relationships to avoid feeling _abandoned_, but often drive others away with **excessive demands, impulsive behavior, or uncontrolled anger**. chronic feelings of **emptiness** assess for suicidal & self-mutilating behaviors, especially during times of stress...**Risk for self-directed violence.** teach pt to _identify triggers_ & _positive coping_ The frequent use of the defense of **splitting** strains personal relationships & creates turmoil in health care settings.

Answer 198

most studied & researched personality disorder - **concerned with personal pleasure & power**; does not conform to social norms **-** characterized by **decietfulness, impulsiveness, aggressiveness, disregard for others, lack of remorse, & manipulation.** usually presents w/ _depression_ or because of the consequences of their behaviors, not because they care about the effects of their actions on others Txmt w/_one caregiver_ is preferred to avoid having the manipulative nature play one staff against another.

Answer 199

involves loving a person, then hating the person b/c the pt. is unable to recognize that an individual can have both positive and negative qualities. **black & white thinking** **defense mechanism** often used with BPD

Answer 200

Medications RN-patient relationship Reduce environmental stimuli Increase internal stimuli (exercise) - tell the hallucinations to go away...listen to my voice or music

Answer 201

* Limited ability to focus when lots of things are happening * Concrete thought * black/white thinking * right/wrong judgments * relationship w/ objects * ambiguous boundaries btwn reality & fantasy * ambiguous boundaries btwn self & others

Answer 202

* Reinforce **reality** for the pt. * Establish a relationship or milieu that promotes **trust** * Give **meds on time** (do not be late w/ prescribed meds)

Answer 203

* psychosis is frightening to the pt - **provide safety** * use **kindness & respect** * pts experiencing psychosis NEED an **anchor to reality**

Answer 204

A **delusion** (false belief) does not change w/ the use of logic. An **illusion** (false belief about a perception) can often change once a person is given evidence that the belief is not true.

Answer 205

Perceptions involving the **senses** (sight, sound, odor, taste or feeling on the skin) The body's ability to detect things in the environment that are not detected by others.

Answer 206

A false belief about a perception Based on a **real perception** (sight, sound, taste or feeling) that is **misinterpreted** ex. the person actually sees something but believes they see something else

Answer 207

## Footnote **Benxodiazepines**

Answer 208

**Naltrexone (ReVia) -** it is an opiod antagonist that blocks the action of opiods & reduces alcohol cravings.

Answer 209

* Paranoid * Schizoid * Schizotypal

Answer 210

* Antisocial * Borderline * Histrionic * Narcissistic

Answer 211

* Avoidant * Dependent * Obsessive-Compulsive

Answer 212

**TCAS** **T**hrombocytopenia (low platelets) **C**ardiac (arrythmia, MI, stroke) **A**nticholinergic effects (tachycardia, urinary retention dry mouth, etc) **S**eizures

Answer 213

**BAD SSRI** **B**ody wieght increase **S**eritonin Syndrome **A**nxiety **S**timulation of the CNS **D**izziness **R**eproductive dysfuntion **I**nsomnia

Answer 214

**HAHA** **H**ypotension, orthostatic **A**nticholinergic effects **H**ypertensive crisis (avoid tyramine foods) **A**nxiety, agitation, anorexia

Answer 215

**BAD SNRI** **B**ody wieght increase **S**uicidal thoughts **A**nxiety **N**ausea / vomiting **D**izziness **R**eproductive dysfuntion **I**nsomnia

Answer 216

* **SSRIs** * **SNRIs** * **TCAs** * **MAIOs**

Answer 217

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

Answer 218

Duloxetine (Cymbalta) Venlafaxine (Effexor)

Answer 219

Phenelizine (Nardil) Isocaroxzid (Marplan) Tranylcyproine (Parnate)

Answer 220

Amitriptyline (Elavil) Clomipramine (Anafranil) - ***risk for glacoma*** Imipramine (Tofranil)

Answer 221

**First-line** approach for trmt of depression Increases **Serotonin** levels in brain Uses: Major Depressive Disorder, anxiety disorders, panic disorders & OCD Mood responds gradually (over 2 wks) Do NOT STOP taking ABRUPTLY

Answer 222

Increases **Serotonin** & **Norepinephrine** levels in brain Treats both **chronic neuropathic pain** _&_ **depression**

Answer 223

Boosts **Norepinephrine** Uses: _adjunctive therapy_ to treat chronic neuropathic _pain_ & _anxiety_ disorders; used only when other antidepressants fail or need to be boosted **SEs** much more **bothersome** than SSRI class; results in nonadherence Effects are **slow to work** Do **NOT stop** taking **abruptly**

Answer 224

Rarely used d/t danger they present when combined w/ certain pharmaceuticals & foods Uses: _Atypical depressio_n (oversleeping & overeating); _adjunctive med_ for anxiety disorders & bulemia **Monitor BP** **AVOID tyramine**, alcohol, & yeast Do NOT take w/ oral decongestant Dietary & med restrictions to stay in place 2 wks after MAIO stopped

Answer 225

Toxicity resulting from SSRI use w/ other meds that increases serotonin Manifestions: **HARM** **H**yperthermia **A**utonomic instability (delirium) **R**igidity **M**yoclonus - Be alert for sweating & diarrhea - Late sign is apnea & death

Answer 226

Stop SSRI Administer serotonin-receptor blocker Cooling blankets or meds to reduce fever Benzodiazepines for seizures & muscle rigidity Anticonvulsants for seizures Ventillation support for apnea

Answer 227

TCA toxicity / overdose can be **fatal** Signs associated w/ toxicity: * altered LOC / delirium * arrhythmias: VTach, VFib, prolonged QRS, QT & PR intervals * vomiting * fever * coma * hypoventilation from CNS depression

Answer 228

Aged & fermented foods: * *All* hard cheese (use caution w/ Italian & Mexican foods) * pickled or smoked meats * olives, pickles, sauerkraut * soy sauce (avoid Asian foods) * ripe alvocados

Answer 229

Toxicity can occur when MAOIs are combined w/ certain foods & medications resulting in **Hypertensive Crisis** & **death** MAOIs prevent the break down of tyramine & certain meds; results in significant vasoconstriction

Answer 230

"Other" antidepressant Boosts **Norepinephrine** & **Dopamine** **Only antipressant w/out unpleasant sexual SEs** Lowers seizure threshold Not very effective w/ anxiety or pain Effective in treating **nicotine** addiction & **ADHD**

Answer 231

2 types: Benzodiazipines & Non-benzodiazipines _Benzodiazepines_: * target **GABA** * uses: sedative effect for anxiety; anticonvulsant effect for seizures (Klonopin); prevention of seizures induced by alcohol w/drawal (Librium) * lead to **physical & psychological dependence** * **short term** use only (1-2 wks) * do NOT discontinue abruptly * when combined **w/ alcohol** can result in **overdose & death** by respiratory suppression

Answer 232

_Benzodiazapines_: * Aloprazolam (Xanax) * Lorazepam (Ativan) * Chlordiazepoxide (Librium) - use for severe DTs * Diazepam (Valium) * Clonazepam (Klonopin) - effective anticonvulsant _Non-benzodiazapines_: * Buspirone (BuSpar)

Answer 233

Does _not_ result in tolerace or addicition Targets **Serotonin** & **Dopamine** Does _not_ have rapid onset of action Takes **up to 2 wks** to be effective Must be taken **daily**; not for PRN use **AVOID** drinking **grapefruit juice**

Answer 234

**CAN HAM SUCS** **C**onfusion **A**n increase of urine & thirst **N**ausea **H**and tremors (coarse) **A**taxia (uncoordinated arm & leg movements) **M**uscle twitches **S**eizures **U**ncontrollable eye movements **C**oma **S**lurred speech

Answer 235

* effective against both **positive & negative** symptoms of schizophrenia * block *dopamine* & *serotonin* * causes little / _no_ weight gain * causes _no_ increase in glucose, cholesterol, or triglycerides **Good choice for pts w/ obesity &/or heart disease** Ex. Abilify (Aripiprazole)

Answer 236

* targets both **positive & negative symptoms** of schizophrenia * block *dopamine* & *serotonin* * high incidence of **significant weight gain**, **diabetes**, & **hyperlipidemia** w/ use * low incidence of tardive dyskinesia * produces drowsiness (sedates w/o causing confusion; can use for severe anxiety instead of benzodiazapines) * may cause constipation Ex. Latuda (Lurasidone); Zyperxa (Olanzapine)

Answer 237

* Lithium is a salt; regulated by body like sodium * Be very alert for SUDDEN DROPS in sodium * Lowering of dietary sodium intake, use of diuretics, excessive sweating or vomiting can have drastic effect on lithium; if Sodium goes DOWN, Lithium goes UP * Narrow therapeutic index (0.6 - 1.2) * 3 wks to reach therapeutic level; not for quick control of mania * Teach strict adherence to dosing regimen * Fluid intake 1-2qt/day & maintain normal salt intake

Answer 238

**_Lithium_** **_Anticonvulsants_**: treat/prevent mood episodes in Bipolar by slowing neuron firing & mood cycling * Valproate / Valproic acid (Depakote) * Carbamazepine (Tegretol) * Lamotrigine (Lamictal) - risk of **SJS** (severe rash) * Clonazepam (Klonopin) - anxiolytic/benzodiazepine effective for seizures **Depakote** & **Tegretol** require blood levels to be monitored for therapeutic effect; periodic monitoring of liver enzymes & CBC

Answer 239

**Naltrexone hydrochloride (ReVia, Vivitrol)** **Disulfiram (Antabuse)** * causes unpleasant effects when alcohol is consumed; negative reinforcer * AVOID foods/products containing alcohol (cough syrup, mouthwash, cooking wine) * extremely poor compliance; does not reduce alcohol cravings **Acamprosate (Campral)** * eliminated thru kidneys; pts w/ kidney disease at risk for adverse rxns * eases discomfort of w/drawal & prevents cravings * stimulates GABA

Answer 240

Chlorprom**_azine_** (Thorazine) Fluphen**_azine_** (Prolixin) Prochlorper**_azine_** (Compazine) Haloperidol (Haldol)

Answer 241

Aripiprazole (Abilify) **Cloz**_apine_** (Clozaril)** - risk of ***Agranulocytosis*** Lurasi**_done_** (Latuda) Olanz**_apine_** (Zyprexa) - ***significant wt gain*** Quenti**_apine_** (Seroquel) **Risperi**_done_** (Risperdal)** Ziprasi_done_ (Geodon) - ***prolonged QT interval***

Answer 242

Reduce **positive symptoms** of psychosis Blocks **Dopamine** Uses: quick hallucination remission (delusions take longer to respond); out-of-control aggression; acute manic episodes Safe, highly effective, very affordable Poor compliance d/t bothersome SEs (i.e. **EPS**)

Answer 243

***movement disorders*** resulting from effects of antipsychotics on extrapyramidal motor system (primarily **Typcial** antipsychotics) _4 types of EPS reactions_: * acute dystonia * pseudo-parkinsonism * akathisia\* * tardive dyskinesia \*most common EPS

Answer 244

EPS rxn characterized by severe spasm of muscles of tongue, face, neck, or back **Torticollis** (head turned & arched) & **oculogyric crisis** (upward deviation of eyes) occurs rxn develops w/in **1st few wks** of drug therapy; possibily w/in **hrs of 1st dose** Requires rapid intervention if intense rxn **Anticholinergics** used for initial trmt

Answer 245

**Mild EPS rxn** characterized by bradykinesia, mask-like facies, drooling, tremor, rigidity, shuffling gait, cog wheeling, & stooped posture Rxn develops **w/in 1st month** of drug therapy Treat w/ central acting **anticholinergics** (i.e. benztropine (Cogentin), diphenhydramine) Must AVOID use of Levadopa (promotes activation of dopamine; will induce psychosis)

Answer 246

**Serious & troublesome** EPS rxn characterized by pacing & squirming (uncontrollable need to be in motion); profound sense of restlessness Rxn develops **w/in 1st 2 months** of drug therapy Most common reason for non-compliance w/ meds Trmt is **beta blockers & benzodiazapines** (does not respond to anticholinergics) Only "cure" is to stop taking antipsychotic

Answer 247

**Serious & troublesome** EPS rxn characterized by abnormal muscle movements (i.e. slow, worm-like movements of the tongue, tongue flicking, lip smacking, pursing lips, grimacing) Movements become constant; exhausting for the pt Occurs late in antipsychotic drug therapy; 1 in 5 pts **Only trmt is to stop taking antipsychotic**; maybe irreversible **Prevention** is best approach; antipsychotics s/b used in lowest effective dose & for shortest time required; AIMS test every 3 mo. if long term use

Answer 248

**Acute & dangerous** EPS rxn Acute dystonia that becomes **life-threatening d/t involvement of the throat muscules** **Inability to swallow** & **respiratory distress** **Emergent** use of **anticholinergics** necessary

Answer 249

**Acute & dangerous** EPS rxn; life-threatening **medical emergency**; transfer to ICU NMS symptoms: **FEVER** * **F**ever, sudden & high (105⁰+) * **E**ncephalopathy * **V**ital signs unstable (dysrhythmias, BP fluctations) * **E**levated enzymes (CK) * **R**igidity of muscles Death can result from respiratory failure, cardiovascular collapse, or dysrhythmias Tmt is immediate w/drawal of antipsychotic, supportive measures & drug therapy

Answer 250

Fewer overall SEs w/ Atypical antipsychotics **iSHADE** **i**mpotence **S**edation, seizures (reduce seizure threshold) **H**ypotension, orthostatic **A**kathisia (inability to sit still) **D**ermatological effects (risk of severe sun burn) **E**xtrapyramidal rxns (acute dystonias, rigidity, tremor, tachycardia)

Answer 251

it is a **secondary** emotion usually triggered by another feeling in response to some preceived threat or unmet need.

Answer 252

anger is a **feeling** where as agression is a **behvoior** agression becomes more likely when the angry, frustrated client feels ignored or discounted.

Answer 253

Aggression is a harsh physical or verbal action that reflects rage, hositility with the potential to cause harm or destruction to Self others property Agressive behavior violates the rights of others.

Answer 254

**Past history** of agressive behavior is the single **best** predictor of **future** behavior **increasing agitation** is the most *important* predictor of **imminent** agression and violence.

Answer 255

* Restlessness, pacing, hyperactivity * Rapid breathing * Tensing of muscles * Tight jaw/clenching teeth * Shouting, cursing, making threats * Verbal abuse * Intense eye contact or avoidance of eye contact * Clenched or raised fist * Menacing posture * Kicking or punching walls * Picking up a weapon * Throwing objects * Stone silence

Answer 256

* Dementia * Delirium * PTSD * Bipolar Disorder * **Substance abuse** * Antisocial Personality Disorder * Impulse-control disorders * Delusional disorder, persecutory type * **Schizophrenia, paranoid type** * ADHD, conduct disorder and oppositional defiant disorders in children

Answer 257

* Chronic pain * Neurological disorders * traumatic brain injury, seizure disorder, neurosyphillis, HIV encephalopathy * Endocrine disorders * thyroid, parathyroid and adrenal hormone imbalances * Metabolic disorders * chronic renal failure, hepatic encephalopathy, hyponatremia, lupus * Exogenous toxins * inhaled solvents, alcohol, amphetamines, hallucinogens, heavy metals * Vitamin deficiencies * folate deficiency, Wernicke’s/Korsakoff’s encephalopathy

Answer 258

* Safety first! * Protect yourself * Maintain self-awareness and self-control * Focus on prevention * Always use the LEAST RESTRICTIVE intervention possible **Stop the Violence Before it Starts!** **If it’s Predictable, it’s Preventable!**

Answer 259

* Never see a potentially violent patient alone * Maintain a safe, comfortable distance from the patient * Avoid touching the client or invading his/her personal space * Maintain a non-aggressive, neutral stance * Be prepared to move quickly—Learn to scoot! * Identify an “escape route” and do not allow the patient to block your exit path

Answer 260

* Speak in a calm, caring manner * Ensure that non-verbal messages are not defensive or provocative * **Slow** your cadence and lower the volume of your voice if/when patient escalates. **Watch your tone!** * Do not argue with the patient, shout, or belittle his feelings * Use open ended questions to explore issues, then reflect/paraphrase * Facilitate problem solving, but avoid telling the client what to do--unless limit setting becomes necessary

Answer 261

* Avoiding * Defensiveness * Retaliating / Punishing * illegal, unprofessional, & unethical * monitor for countertransference & personal motives * Threatening * unethical & unprofessional * Condescension

Answer 262

**Establish** limits only when and where there is a clear need **Never** set a limit you cannot enforce **Don’t** use limit setting to threaten the patient **Establish** reasonable and enforceable consequences or exceeding limits **Be** consistent in enforcing limits

Answer 263

**•Support** •Remind client that you are an ally and you have his/her best interests in mind - (“I care about you and I want to help you.”) **•Empathy** •Convey to client that you understand and care about his/her feelings - (“I can see how frustrating and distressing this is for you.”) **•Truth** •Clearly state the limit and tell the patient what you want him/her to do - (“I won’t let you hurt yourself or anyone else. I need you to put the chair down now, please.”)

Answer 264

Assemble a Show of Force **Assign only one person** to communicate with the patient - **Continue** to offer client opportunities to change behavior when possible - ***Follow** approved policies and procedures for doing a “takedown” if necessary*

Answer 265

* **Requires** “emergency declaration” by physician when ordered * **Danger** to patient or others must be **imminent** * **Must document failure** of less restrictive interventions * **No “prns” allowed** for emergencies _•**Considered** a “chemical restraint”_

Answer 266

*Considered “last resort” interventions.* **Seclusion** is used when there is risk of danger to *others*. **Restraints** are used when there is risk of danger to *self.* **NEVER** used for punishment or staff convenience **Both** require MD order, declared emergency due to imminent danger to patient or others and failure of less restrictive interventions

Answer 267

* **One** hour for **children** * **Two** hours for **adolescents** * **Four** hours for **adults** * If longer use is indicated, intervention must be reordered * Patients must be evaluated face to face by physician or specially trained nurse within one hour of initiation * Patients in **seclusion** must be **monitored** at least **q15 min**. * Patients in seclusion who have also received **sedation** must be monitored **continuously** * Patients in **restraints** must be monitored **continuously** on **1:1 observation**

Answer 268

* **Behavioral** Observations * **Interventions** * In the **order they were done**, least restrictive to most restrictive * **Patient’s responses** to interventions * **Debriefing** & patient’s response **•Patient education** and response to education

Answer 269

Risk for other-directed violence

Answer 270

meeting the patient "where he/she is at the moment --- **acknowledging the patients wishes** ex. Cognitivly impaired patient want to go home...you would say "So you want to go home?" Validation **does not** redirect, reorient or probe

Answer 271

**Olanzapine** (Zyprexa) short acting antipsychotic useful in calming angry, aggrssive patients regardless of diagnosis.

Answer 272

Notify the health care provider to obtain a seclusion order. **This is a state law**

Answer 273

**Tension-building stage** - characterized by minor incidents (pushing, shoving, and verbal abuse)...victim ignores or acepts the abuse for fear more will follow. **Acute battering state** --- abuser releases the built up tension by brutal beatings which result in injuries. **Honeymoon stage** ---characteized by kindness and loving behaviors, abuser is apologetic, remorseful and often give gifts to apologize --- victim wants to believe the response and often agrees to drop any charges.

Answer 274

**- keep** a phone fully charged - **have** number of nearest shelter - **secure** a supply of medications for self & childrens **- Assemble** birth certificates, SS card, and licenses **- Determine** a code word to signal when it's time to leave.

Answer 275

**Primary prevention** - measures taken to prevent occurence of abuse **Secondary prevention** - involves *early intervention* in abusive situations to minimize disabling or long term effects. **Tertiary prevention** - often occures in mental health settings, involves facilatating *healing and rehabilitation*. .

Answer 276

“involve one’s **attention and pledge** to do something” They are focused on the task at hand / in what they are doing (heart & soul)

Answer 277

**Actions** individuals must take to obtain the greatest benefit from the health care services available to them." **Behaviors** of individuals relative to their health care that are **critical and proximal** to *health outcomes*, rather than the actions of professionals or policies of institutions. **Processes** in which information and professional advice with own needs, preferences and abilities in order to prevent, manage and cure disease

Answer 278

- risk for poor health - perform specific health behaviors - without insurance - education

Answer 279

**Non vitamin**, non mineral supplements-18.9% in 2002 and unchanged from 2007 to 2012 (17.7%). **deep-breathing** exercises were the second most commonly used complementary health approach in 2002 (11.6%), 2007 (12.7%), and 2012 (10.9%) **yoga, tai chi, and qi gong** increased linearly over the three time points, beginning at 5.8% in 2002, 6.7% in 2007, and 10.1% in 2012

Answer 280

A randomized controlled trial of mindfulness-based cognitive therapy for **bipolar disorder**.

Answer 281

**B12** -Cyanoboalamin **B9** folic acid **B 12 & B 9** - 60–74 years old with mild depressive symptoms in a RCT-no effect **B 12, B 9, & B 6** - Prevented depression post stroke (mean ages 45.8–76.6 years old). **Well** – designed study showing benefit of l-methyfolate augmentation of antidepressant

Answer 282

**Fish**: salmon, almonds & walnuts. **The data support** an ***antidepressant*** effect of Ω3. **Low levels** of Ω3 in depression & suicidal patients. **Bipolar depressive** symptoms may be improved by adjunctive use of omega-3. ***Not effective in mania.***

Answer 283

Ginkgo biloba originates from the Maidenhair tree. **Neuro**protective **inhibits** platelet activation **relaxes** endothelium **inhibits** cholinergic receptors **increases** choline uptake in the hippocampus **antioxidant effects.** **Small** effect on cognitive decline in those already afflicted with certain types of dementia.

Answer 284

Effect of **Lemongrass** Aroma on Experimental **Anxiety** in Humans.

Answer 285

Lavender and bergamot essential oils are **antidepressants and relaxants**, **Essential oils** can be **absorbed** by inhalation into the **olfactory pathway** and from there to the brain. The scores on depression, anxiety, and stress decreased in the intervention group after the aromatherapy programme, but there was increased psychological distress in the control group. The results were consistent with those of previous studies, namely, that aromatherapy was able to relieve negative emotional symptoms

Answer 286

**We** have care for the beginning of families, new parents, and infants **We** nurture mothers and fathers, children, and youth. **We** offer wisdom and understanding concerning life’s stresses, anxieties, and challenges; we face together the realities of evil, suffering, and death. **We** address the power of guilt, hopelessness, and despair; we mark our boundaries and limits; we create meaningful and shared narratives of the world and of our life journeys **We** seek to name and contain what is toxic, and we foster food and drink that promote health and well-being. **We** have care also for the experience of aging and the end of life

Answer 287

**One in four** persons sitting in our pews has a family member struggling with mental health issues A majority of individuals with a mental health issue go **first** to a spiritual leader for help *Studies show that **clergy** are the **least effective** in providing appropriate support and referral information* Our **faith** communities **can be** a caring congregation for persons living with a mental illness and their family members

Answer 288

**Support** Respite care Mini-relaxations **Nutrition** Exercise **Sleep** Annual check up Spiritual care **Stress management** Resilience

Answer 289

**Annual exam** Vitamin D - sunlight (get alot of it) Eye exam Dental exam Blood pressure Complete metabolic levels, complete blood count **Follow recommended treatments**.

Answer 290

**no procedure** – patient signs self in and can sign self out with 24 hr letter.

Answer 291

> **1)** EMERGENCY DETENTION -- using EITHER: a **MIW** (Mental ill warrent) OR an **APOWW** (apprehension by Police Officer without warrent) > > **2)** evaluation by 2 physicians to make sure legal criteria are met > > **3)** (2 possibilities) release persons who do not meet criteria OR retain person and ensure legal representation > > **4)** probable cause hearing – this ***results*** in the **OPC** > > **5)** (2 possibilities) patient does **not contest**, judge reviews documents and, if legal rules followed commit patient to **90 days**. OR – **patient contests** the commitment and has choices – (with or without their own lawyer) present their own case before the judge alone OR ask for a jury trial. IF patient has already served 90 days and STILL meets criteria – there is another trial to commit for a longer period.( **EXTENDED MENTAL HEALTH SERVICES**)

Answer 292

**1)** Go to judge --- issues a MIW (mental illness warrant) **2)** Call the police --- Determine danger --- APPOW (Apprehension by Police Officer Without a Warrant)

Answer 293

**Voluntary** Patient signs a CONTRACT with facility allowing 24 hour hold before AMA release Voluntary admission occurs when the client is willing to be admitted and agrees to comply with hospital and unit rules. **Involuntary** Allows State of TX to hold citizen, against pt will, until psychiatric care provider deems no longer meets criteria or **90** days, ***whichever comes first*** *(Patient may invoke habeas corpus)* in an attempt to get released.

Answer 294

**1.** Danger to Self **2**. Danger to Others **3**. Danger of deterioration of condition\* \*Must be serious enough to cause substantial harm or death

Answer 295

**Tarasoff v. Regents** of the University of California Pt. admitted to Doc intended harm to an ex-girlfriend... -- Doc told the authorities... Pt still let go... - then killed the ex.

Answer 296

Delirium is characterized by an abrupt onset of **fluctuating levels** of awareness, clouded consciousness, perceptual disturbances, and **disturbed memory and orientation**

Answer 297

Amnestic syndrome involves **memory impairment** **without** other cognitive problems. Just lost ur memory

Answer 298

Lewy body disease, frontal-temporal lobar degeneration, and Huntington's disease.

Answer 299

1) cognitive impairment 2) cognitive distrubances: ie. a) aphasia b) apraxia c) agnosia

Answer 300

Agnosia refers to the loss of sensory ability to **recognize** objects.

Answer 301

Aphasia refers to the loss of **language** ability.

Answer 302

Apraxia refers to the **loss** of **purposeful** **movement**

Answer 303

**1)** Preclinical Alzheimer’s disease **2)** Mild cognitive decline **3)** Moderately severe cognitive decline **4)** Severe cognitive decline

Answer 304

Mild cognitive decline (**early-stage**) Alzheimer's can be diagnosed in some, but not all, individuals. Symptoms include **misplacing items** and **misuse of words.**

Answer 305

In the moderately severe stage, deterioration is evident. Memory loss may include the **inability to remember addresses or the date**. Activities such as driving may become hazardous, and frustration by the **increasing difficulty of performing ordinary tasks** may be experienced. The individual has difficulty with clothing selection

Answer 306

**personality changes** may take place, and the patient needs extensive help with daily activities.

Answer 307

apolipoprotein E (apoE) malfunction, **neurofibrillary tangles,** neuronal degeneration in the hippocampus, and **brain atrophy**

Answer 308

Hyperorality refers to **placing objects** in the **mouth**

Answer 309

Confabulation refers to **making up of stories** or answers to questions by a **person** who **does not remember.** It is a **defensive tactic** to protect self-esteem and **prevent others** from **noticing** **memory loss.**

Answer 310

1) **A Crisis is an Acute Time-Limited Phenomenon**...a crisis will be resolved *w/i 4-6* weeks after exposure to the stressor 2) **A Crisis Results from Exposure to a Stressful Situation or Event** 3) **The Crisis Creates Emotional Distress**...person in crisis feels anxious, overwhelmed and out of control 4) **Existing Coping Skills Fail to Fix the Problem or Alleviate the Person’s Distress**

Answer 311

- **Maturational Crisis**...Occurs when a person arrives at a new and predictable stage of development where previously used coping strategies are no longer effective or appropriate - **Situational Crisis**...critical life event from an external source. can change self - concept & esteem. (divorce, death of a loved one...job loss) - **Adventitious Crisis**... uplanned accidental or deliberate event not part of every day life. (Ie natural disasters / wars / murder / child abuse). --- * Psychological first aid and crisis intervention are critical for persons of all ages after any adventitious crisis*

Answer 312

- **Phase I** Person is exposed to a crisis event which triggers anxiety (robbery) - Anxiety stimulates the use of problem-solving strategies and defense mechanisms to decrease distress - **Phase II** Previously used coping skills fail to alleviate the problem (overload) - coping strategies become increasingly maladaptive as emotional distress increases **Phase III** - Every internal and external resource is mobilized to solve the problem and relieve distress - Automatic relief behaviors such as withdrawal and flight are mobilized **Phase IV** - The individual’s condition deteriorates as tension mounts, and “desperate measures” may be considered to alleviate distress (**Suicide?**)

Answer 313

A short-term helping process focused on resolution of the immediate problem through the use of personal, social and environmental resources Crisis Intervention can be considered **“Psychological First Aid”**

Answer 314

**Safety First** - Determine Whether There is an Immediate Need for External Controls --- All Clients in Crisis Should be Assessed for Suicidal and Homicidal Ideation (thoughts) **Stabilization is the Goal** - Restoring equilibrium and returning the client to the pre-crisis level of functioning is the **objective**

Answer 315

**Establish trust and develop rapport**...Explore the patient’s feelings **Explore the problem**...Find out what happened **Summarize both facts and feelings**...“You feel x because of y.” **Focus on _one_ problem**...What does the patient want to change? What has to change in order for client to regain stability? **Explore resources and alternatives**...Identify coping skills and resources **Develop plan of action**...Consider contracting with client

Answer 316

Review accomplishments and discuss ways in which adaptive coping skills can be used to deal with crises in the future

Answer 317

A group approach designed to help people who have been exposed to a crisis situation Recent research suggests that it may not be as effective as once believed and may be harmful to some people

Answer 318

an intentional threat designed to make the victim fearful: produces reasonable apprehension of harm.

Answer 319

Autonomy is the right to self-determination, that is, to make one’s own decisions. (e.g. acknowledging the pts right to refuse medicine promotes autonomy)

Answer 320

Battery is an intentional tort in which one individual violates the rights of another through **touching** without consent.

Answer 321

is the capacity to understand the consequences of one's decision's Pt.s are considered legally competent **until** they have been declared incompetent through a formal legal proceeding.

Answer 322

confidentiality of care and treatment remains an important right to all patients. discussion or consultation involving a patient should be conducted discreetly and only w/individuals who have a NEED TO KNOW **Can only be released by the pt.'s written consent** The duty to warn a person whose life has been threatened by a psychiatric patient **overrides** the patient’s right to confidentiality.

Answer 323

Confidentiality extends to death and beyond. Nurses should never disclose information after the death of a client that they would have kept confidential while the client was alive.

Answer 324

1974 Tarasoff v. Regents of the University of California..was a case in which the Supreme Court of California held that mental health professionals **have** a **duty** to **protect individuals** who are being threatened with bodily harm **by a patient**. It is the health care professional’s duty to warn or notify an intended victim after a threat of harm has been made. Informing a potential victim of a threat is a legal responsibility of the health care professional.

Answer 325

False imprisonment involves holding a competent person against his or her will. Actual force is not a requirement for false imprisonment. *The individual needs only to be placed in fear of imprisonment by someone who has the ability to carry out the threat.*

Answer 326

is admission to a facility **w/o** the patients consent. generally necessary when a person is in need of psychiatrict treatment, **presents a danger to self or others**, or is unable to meet his / her own basic needs. Pts. can be kept involuntarily for up to 90 days, w/interim court apprearances. After that a panel reviews their cases.

Answer 327

writ of habeas corpus and the least restrictive alternative doctrine are two of the most important concepts applicable to civil commitment cases. Least restrictive **mandates** that the least drastic means be taken to achieve a specific purpose *ex. if someone is being treated for depression only on an outpatient basis....then hospitalization would be too restrictive and unnecessarily disruptive.*

Answer 328

malpractice is an act or omission to act that breaches the duty of due care and results in or is responsible for a persons injuries.

Answer 329

is the failure to use **ORDINARY** care in any professional or personal situation when you had a duty to do so. ex. duty to drive safely...if you don't and cause an accident, you could be changed with negligence.

Answer 330

Pt.s right have been modified over time, but the following are some of the basic patient rights: pg 101 - 106 - **Right** to treatment - **Right** to refuse treatment - **Right** to informed consent - **Rights** regarding involuntary admission and advance psychiatric directives - **Rights** regarding restraint and seclusion - **Right** regarding Confidentiality

Answer 331

is that information / communication obtained between a patient / provider.

Answer 332

is legally protected by HIPAA (Health Insurance Protability and Accountability Act) Release of information without patient authorization violates the patient’s right to privacy.

Answer 333

Pts. may w/hold consent or withdrew constent to take medication at any time. Commintment to a hospital facility does not mean they are forced to take medications....they retain their right to refuse treatment. ***THE ONLY* circumstance where medication will be forced is an emergency to prevent harm to self or others.**

Answer 334

Federal Statute 1964 - **Hospitalization of the Mentally ill** All public hospitals are required to provide medical and psychiatric care to all persons admitted to a public facility. **O'Conner v. Donaldson (1975)** Court ruling that State cannot confine a non-dangerous individual who is able to survive in freedom by themself or w/help of family.

Answer 335

a restraint can be any **device, equipment or material** that prevents or reduces **movement** of the pt.s **arms/legs or head**. restraints can also be chemical or even one individual holding another (Therapeutic hold).

Answer 336

Time-out is designed so that staff can be consistent in their interventions. Time-out may require going to a designated room or sitting on the periphery of an activity until the child gains self-control

Answer 337

**_Seclusion_** - confining a pt alone & preventing the pt from leaving. Should be used only when pt demonstrates violence / self-distructive behavior that jepardizes the safety of others or the pt **_Timeout_** - pt chooses to spend time alone in a specific area for a certain amt of time. Pt can leave the area at any point.

Answer 338

**1)** duty **2)** breach of duty **3)** cause in fact **4)** proximate cause **5)** there were actual damages.

Answer 339

_Biological factors_: **Genetic** & **Neurobiological** * Resilience, intelligence & supportive environment aid in avoiding development of mental disorders _Psychological factors_: **Temperament**; **fit w/ parents** is crucial to development. **Resilience** _Environmental factors_: Dependent on **family**; witness **violence**; **neglect / sexual abuse**; **bullying** _Cultural factors_: **Expectations**; **stigma** follows throughout lifespan

Answer 340

Having a parent with a substance abuse problem has been designated an adverse psychosocial condition that increases the risk of a child developing a psychiatric condition. Having a family history of schizophrenia presents a risk, but an **alcoholic parent** in the family offers a greater risk.

Answer 341

The ability to **adapt & cope** Helps people to face tragedies, loss, trauma, & severe stress

Answer 342

Child's **inborn strengths** Child's **success in handling stress** in the environment

Answer 343

The style of **behavior** a child **habitually uses to cope** w/ the demands & expectations of the environment

Answer 344

* **Trusts** others & sees his/her world as being safe & supportive * **Correctly interprets reality**; makes accurate perceptions of the environment & one's ability to influence thru actions (i.e. self-determination) * **Behaves in developmentally appropriate way**; doesn't violate social norms * Has a **positive**, **realistic self-concept** & developing identity * **Adapts** to **& copes** w/ anxiety & stress using age appropriate behavior * Can **learn/master developmental tasks** & new situations * **Expresses self** spontaneously & creatively * Develops & maintains **satisfying relationships**

Answer 345

Autism is primarily biogenetic

Answer 346

IDD is characterized by severe deficits in three major areas of **functioning: intellectual, social, and managing daily life.** Specific learning disorder is diagnosed when a child demonstrates persistent difficulty in the acquisition of reading (dyslexia), mathematics (dyscalculia), and/or written expression (dysgraphia) and their performance is well below the expected performance of their peers.

Answer 347

A motor (neurodevelopment) disorder **Motor & verbal tics** appearing between age 2 & 7 Tics change in location, frequency & severity over time Tics cause marked distress, significant impairment in social & occupational functioning, & low self-esteem Disorder is **permanent**; periods of remission may occur Symptoms often diminish in adolescence & may disappear by early adulthood **Familial pattern** in 90% of cases Often co-exists w/ depression, OCD, & ADHD Treated w/ antipyschotic meds: **Hadol & Orap**

Answer 348

**Inattention** **Impulsive** **Hyperactive** Symptoms present **before age 7** Symptoms must be present at **home & school** Low frustration tolerance, temper outbursts Poor school performance Primarily biogenetic

Answer 349

**Stimulants** Methyphenidate (Ritalin) s/e...The most common side effects are gastrointestinal disturbances, reduced appetite, weight loss, urinary retention, dizziness, fatigue, and insomnia Weight loss has the potential to interfere with the child’s growth and development.

Answer 350

*"reduce loneliness and increase self-esteem."* Because of their disruptive behaviors, children with ADHD often receive negative feedback from parents, teachers, and peers, **leading to self-esteem** disturbance. These behaviors also cause peers to avoid the child with ADHD, leaving the child with ADHD vulnerable to **loneliness**.

Answer 351

manage the milieu with **structure** and **limit setting**

Answer 352

***Developmentally inappropriate*** levels of concern over being away from a significant other May also be a fear that something horrible will happen to the other person resulting in permanent separation Anxiety is so **intense** it distracts the pt from their norm activities, causes sleep disturbances & nightmares, is often manifested in GI disturbance & headaches

Answer 353

**Persistant pattern** of behavior in which the **rights of others are violated** Age appropriate societal **norms/rules are disregarded**

Answer 354

Disruptive/impulsive control behavior disorder ***thought to be caused by parenting*** **Cruel bahvior** to animals 1st then people Violates rights & disregards norms (**truancy** before age 13, **alcohol &/or heavy drug abuse**, **running away**) **Aggressive** & destructive (**vandalism**) **Deceitfulness** **Pyromania** and/or **Kleptomania** Poor peer relationships; may be precursor to antisocial personality disorder Meds for aggression, impulsivity & mood: **Risperdal**, **Zyprexa**, **Seroquel**, **Geodon**, & **Abilify**

Answer 355

ADHD Oppositional child behaviors Parental rejection Inconsistent parenting w/ harsh discipline Early institutional living Chaotic home life Large family size Absent or alcoholic father Antisocial & drug-dependent family members Association w/ delinquent peers

Answer 356

Disruptive behavior disorder ***thought to be caused by parenting*** **Angry** & irritable; **temper tantrums past usual age** Defiant & **vindictive** **Disregard for authority** Deliberately **annoys & blames** **Distructive** (usually short of criminal) Difficulty w/ home, school, peers **_Not_** age limited but usually seen in **preteens** Meds. not generally indicated but must treat comorbidity

Answer 357

**Frequent temper tantrums** (verbal / behavioral outbursts) **out of proportion to the situation & not developmentally age appropriate** **Persistent irritable mood** btwn outbursts Dx given to children btwn **ages 6 - 18** w/ no other medical/mental health dxs accounting for tempertantrums (i.e. autism)

Answer 358

Time-out Quiet Room

Answer 359

Core symptoms of depression in children/adolscents are same as for adults: sadness & anhedonia Frequently assoc w/ anxiety & anger Symptoms display differently in children/adolscents. * **very young** children **cry** * **school age** children are **withdrawn** * **teens** become **irritable** in response to feeling sad / hopeless Generally, depressed children/adolscents display increased **irritability**, **negativity**, **isolation**, & **w/drawl** along w/ **loss of energy**. Younger children may suddenly **refuse to go to school**. Adolscents may engage in **substance abuse** or **sexual promiscuity** & become **preoccupied w/ death or suicide**. **Bipolar** is **more severe** if starts in childhood/teens. Youth w/ **bipolar** have **more frequent mood switches**, **more mixed emotions**, are **sick more often**, & have **greater suicide attempts**.

Answer 360

**Family therapy** * specifical goals defined for ea family member **Group therapy** - used for breavement, physical abuse, substance use, dating, or chronic illness (diabetes) * young child: play therapy * school-aged child: combines play, learning skills, & talking about activity; aids w/ social skills * adolscent: popular media event/personality used as basis for discussion **Behavioral therapy** * behavior modification * rewards desired behaviors to reduce maladaptive behaviors * **use least restrictive intervention** **Cognitive-Behavioral therapy (CBT)** * negative/self-defeating thoughts are replaced by more realistic & accurate appraisals * results in improved functioning

Answer 361

**Physical problems** have higher **priority** than mind/behavior problems Parent training (positive parenting) Behavioral therapies Milieu therapy Psychopharmacology

Answer 362

**Predict & prevent** **Act EARLY** to stop escalation Provide **safety** **Causes & prevention** of non-genetic types of disorders **Parental expectations** of behaviors **Behavioral control** of socially unacceptable behaviors

Answer 363

**Stimulants** excite neurons responsible for focus

Answer 364

Who is interviewed? How is interview conducted? Data collected:

Answer 365

* **Behavior modification** - use it **RIGHT** or NOT AT ALL * Rewards occur **ALL THE TIME** but to effect **change** you **MUST** PLAN * **Punishment** is **not allowed** * **Extinction** - ignoring / not reacting to behavior will prevent the "reward" \*RNs don't have time or relationship to use extinction

Answer 366

is learning the beliefs, values, and practices of a new cultural setting, which sometimes takes several generations

Answer 367

is a process where members of a group are introduced to the culture’s worldview, beliefs, values, and practices

Answer 368

Directly confronting problems is a highly valued approach in the American culture **but not** part of many other cultures in which harmony and restraint are valued American nurses sometimes mistakenly think that all patients should take direct action.

Answer 369

*Present orientation, interdependence, and a flexible perception of time* **are not** valued in Western culture These views are more predominant in other cultures

Answer 370

Hispanic individuals usually value **relationship behaviors.** Their needs are for learning through **verbal** communication rather than reading and for having time to chat before approaching the task. Many people from Central American cultures express distress in somatic terms

Answer 371

identify strategies that fit within the cultural context of the patient RN's should understand that Western biomedicine is one of several established healing systems

Answer 372

Asian Americans commonly express psychological distress as a **physical problem.** The patient may believe psychological problems are caused by a physical **imbalance.** The patient will probably respond best to a therapist who is perceived as giving.

Answer 373

Soft voice; break eye contact occasionally; general leads and reflective techniques. Native American culture stresses living in **harmony with nature.** Cooperative, sharing styles rather than competitive or intrusive approaches are preferred; thus, the more passive style described would be best received.

Answer 374

The Asian community **values** the **family** in caring for each other. The Asian community uses traditional medicines and healers, including herbs for mental symptoms. The Asian community describes **illness in somatic terms**. The Asian community attaches a **stigma to mental illness**, so interfacing with the community would not be appealing

Answer 375

The Western biomedical perspective holds the belief that sick people should be as independent and self-reliant as possible. Self-care is encouraged; one gets better by “getting up and getting going.” An ability to function at a high level is valued.

Answer 376

Wind illness is a culture-bound syndrome found in the Chinese and Vietnamese population. It is **characterized** by a **fear of cold, wind, or drafts**. It is treated by keeping very warm and avoiding foods, drinks, and herbs that are cold. **Warm broth** would be most in sync with the patient’s culture and provide the most comfort.

Answer 377

Cultural competence is dependent on understanding the beliefs and values of members of a different culture. A nurse who works with an individual or group of a culture different from his or her own must be open to learning about the culture.

Answer 378

**YES** Cytochrome enzyme systems, which **vary** among different cultural groups, influence the rate of metabolism of psychoactive drugs

Answer 379

Culture-bound syndromes occur in specific sociocultural contexts and are easily recognized by people in those cultures. A syndrome recognized in parts of Southeast Asia is running amok, in which a person (usually a male) runs around engaging in furious, almost indiscriminate violent behavior.

Answer 380

## Footnote **Culture-Bound Syndrome****heritage** - Ataque de nervios Latin American - Ghost Sickness Navajo - Hwa-byung Korean - Susto Latin American - Wind Illness Chinese

Answer 381

Legal principles are fundamental to nursing practice. They supersede all other principles, standards, and judgments.

Answer 382

**fair distribution of care**, which includes treatment with the least restrictive methods

Answer 383

. Beneficence means promoting the good of others

Answer 384

*Fidelity* is the observance of loyalty and commitment to the patient. Fidelity refers to being “true” or faithful to one’s obligations to the client. Client abandonment would be a violation of fidelity.

Answer 385

A tort is a civil wrong against a person that violates his or her rights. ex. Giving unnecessary medication for the convenience of staff controls behavior in a manner similar to secluding a patient; thus, false imprisonment is a possible charge.

Answer 386

The DSM-5 classifies disorders people have rather than people themselves

Answer 387

The 12-month prevalence for **Alzheimer’s disease** is 10% for persons older than 65 and 50% for persons older than 85.

Answer 388

A broad field that addresses **studies** of the **natural history** (or what happens if there is no treatment & the problem is left to run its course) **of an illness**, studies of **diagnostic screening** tests, & observational/experimental studies of **interventions** used to treat people w/ the illness or symptoms.

Answer 389

The **number** of **new cases**

Answer 390

The number of **new cases** of mental disorders in a healthy population **within a given period**.

Answer 391

The key areas of care promoted by QSEN are patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics.

Answer 392

Studies have shown a **positive** correlation between spiritual practices and **enhanced** immune system function and sense of well-being

Answer 393

* Complex medical/psychiatric **illness** * Disease of **control** (pt can control eating) * Anorexia is 3rd most common chronic illness * Genetic, biological, behavioral, social, & psychological factors * **Develop over time** * Occurs across all socioeconomic & age groups * Bulimia is **life-threatening**; highest mortality rate of all mental illnesses * Causes are **multifactoral** * **Global** issue

Answer 394

Perception is never reality A distorted body image is DELUSIONAL & will not chg w/ reasoning (no nursing interventions will work)

Answer 395

Restricted calories w/ significantly low BMI **Low body wt** ( Intense **fear** of gaining wt **Distorted** body image Extreme focus on shape / wt Amenorrhea **Denial** of illness (secretive)

Answer 396

_2 types_: * **Restricting** - no consistent bulimic features * **Binge-Eating** - primarily restriction, some bulimic behaviors

Answer 397

* How can I appear perfect? * What is this feeling? * **When I eat, I feel sick**. * **No energy** * **No sleep** (not just insomnia) * **No peristalsis** * **No appetite** (not the same as hunger) * **No control** * **No future** * I HATE **being me** * Nobody can love ME the way I am

Answer 398

Perfectionism Obsessive thoughts & actions r/t food Intense feelings of shame People pleasing Need to have complete control over their therapy

Answer 399

* Terror of gaining wt; **repeated re-weighting of self** * **Preoccupation w/ thoughts of food** * View of self as fat even when **emaciated** * Peculiar handling of food; cutting into **mini bites** * **Food portioning** (eats sm amts of certain foods) * Pushing pieces of food around plate * Poss. development of **rigorous exercise** regimen / hyperactivity * Poss. self-induced vomiting, misuse of laxatives/diuretics * Cognition so distrubed that pt **judges self-worth by his/her wt**

Answer 400

* **Low body wt** r/t caloric restriction / excessive exercise * **Amenorrhea** d/t low wt * **Lanugo** & thin, brittle hair d/t starvation * **Cold** extremities/cold intolerance/hypothermia d/t starvation * **Peripheral edema** d/t **hypoalbuminemia** & refeeding * **Muscle weakening**/**letheragy** d/t starvation & electrolyte imbalance * **Constipation** d/t starvation * **Cardio abnormalities** (hypotension, bradycardia, HF) d/t starvation & **dehydration** * **Impaired renal function** , **low urine output**, **increased urine concentration** d/t dehydration * **Hypokalemia** d/t starvation * **Decreased bone density** * **Dry skin** d/t dehydration

Answer 401

* **Disturbed body image** * excessive self-monitoring * describes self as fat despite emaciation * **Ineffective coping** * destructive behavior toward self * poor concentration * inability to meet role expectations * inadequate problem solving * **Chronic low self-esteem** * rejects positive feedback about self * reports feelings of shame * lack of eye contact * passive * indecisive behavior * **Powerlessness**

Answer 402

Eating habits History of dieting Methods used to achieve wt control (restricting, purgeing, exercising) Value attached to a specific shape & wt Interpersonal & social functioning Mental status & physiological parameters

Answer 403

**Hormonal chgs** **Cardiac issues** (leaky heart valves, orthostatic pulse & BP chgs, prolonged QT, ST-T wave abnormalities) & **arrhythmias** **Edema** (ankle & periorbital) **Electrolyte imbalances** (lead to fatigue, weakness, letheragy) **Infertility** **Bone density loss** (osteoporosis) **Anemia** Neuro problems (**peripheral neuropathy**) **Death**

Answer 404

Refeeding resulting in too-rapid weight gain & can overwhelm the **heart,** resulting in cardiovascular collapse. *Deadly complication* of treatment involving *metabolic alteration* in serum electrolytes, vitamin defciencies, & sodium retention. **Focused assessment** is a necessity to ensure the patient’s physiological integrity.

Answer 405

Cycle of **bingeing/purging (1x per wk x 3 mo)** Feeling out of control **Compensatory behaviors** (self-induced vomiting, excessive exercising, fasting, laxative/diuretic misuse) Usually **normal body wt** **Self-image largely influenced by body image**

Answer 406

_2 types_: * **Purging** - self induced vomiting or laxative/diuretic misuse * **Non-Purging** - excessive exercising or fasting

Answer 407

* How can I appear perfect? * What is this feeling? * **I eat to fill the void.** * lack of emotion / emotional pain drives binge * **I rid myself of food to get rid of the tension**. * I HATE **being this way**. MAKE it STOP. * Nobody can love ME the way I am.

Answer 408

* Binge eating behavior * Often self-induced vomiting (or laxative/diuretic use) after bingeing * Hx of anorexia nervosa in 1/4 - 1/3 of pts * Depressive signs & symptoms * Problems w/: * interpersonal relationships * self-concept * **impulsive behaviors** * Increase levels of anxiety & **compulsivity** * Poss. chemical dependency * Poss. impulsive stealing * Family relationships usually chaotic & lack nurturing * Life reflects instability & troublesome interpersonal relationships

Answer 409

* **Normal to slightly low wt** r/t excessive caloric intake w/ purgeing or excessive exercise * **Dental caries** & tooth **erosion** r/t vomiting * **Puffy cheeks / parotid swelling** (enlarged salivary glands) d/t **increased serum amylase** levels * Gastric dilation / rupture r/t binge eating * **Callused**, **ulcered**, or **scarred knuckles** r/t vomiting * Swollen hands / feet (peripheral edema) d/t rebound fluid (seen w/ diuretic use) * Weakness & fatigue d/t electrolyte imbalances * Menstrual irregularities * Abdmonial pain * **Sore throat**

Answer 410

* **Disturbed body image** * obsession w/ body * denial of problems * dissatisfaction w/ appearance * **Ineffective coping** * obsessed w/ food * substance abuse * impulsive responses to problems * misuse of laxatives/diuretics/enemas * fasting * inadequate problem solving * **Chronic low self-esteem** * feelings of shame / guilt * views self as unable to deal w/ events * *excessive seeking of reassurance* * **Powerlessness** * loss of control w/ binge/purge cycle * **Social isolation** * absence of supportive significant other(s) * hides eating behaviors from others * reports feelign alone

Answer 411

Are you satisfied w/ your eating habits? Do you ever eat in secret?

Answer 412

**Tooth erosion**, **cavities, gum disease** **Water retention** / abd bloating **Low serum potassium** Irregular menstrual cycles **Swallowing problems** & **esophagus damage** (perforation) **Salivary gland hypertrophy** **Petechiae** **Hematemesis**

Answer 413

* **Change** dysfunctional **eating behavoirs** * **Prevent** use of dysfunctional **compensation** * monitor bathroom use after meals * ensure pt doesn't purge or exercise w/o staff knowledge * **Maintain physical integrity** * **Boost self-esteem**

Answer 414

**How to recognize hypokalemia** Hypokalemia results from potassium loss associated w/ vomiting. Physiological integrity can be maintained if the pt can self-diagnose potassium deficiency & adjust the diet or seek medical assistance. Self-monitoring of daily food & fluid intake is _not_ useful if the pt purges.

Answer 415

**Recurring episodes** (\>/= 1x wk x **3 mo**) Feeling of shame, guilt, embarrassment & disgust _NO_ use of _compensatory behavoirs_ Common SE is **obesity**

Answer 416

* **Disturbed body image** * embarassment d/t wt gain * fear of negative rxn by others * attempts to hide wt gain * body dissatisfaction * **Ineffective coping** * *eats as coping method* * absence of other/more effective coping methods * *eats when full* * **Anxiety** * feelings of discomfort/dread * feelings of inadequacy * focused on self * increased wariness * irritability * **Chronic low self-esteem** * feelings of shame/guilt * views self as unable to deal w/ events * **Powerlessness** * loss of control of eating * **Social isolation** * absence of supportive significant other(s) * *eats normally in presence of others* * hides eating behaviors * reports feeling alone

Answer 417

Individual **restricts food intake** & experiences significant associated physological / psychosocial problems but *doesn't met criteria for any other eating disorder*. * difficulty digesting certain foods * avoids certain colors / textures of foods * eats only **very small portions** / **no appetite** * **afraid to eat** after *freightening episode of choking* / *vomiting* Significantly **low BMI**; dependent on **enteral feeding** or experiencing nutritional deficiencies **No distortion of body image** Symptoms show up in infancy / childhood

Answer 418

Ingestion of **non-nutritive substances** past toddlerhood Varies w/ age & availability Occurs in pregnancy, children, iron deficient adults, & institutionalized persons Not culturally sanctioned Not part of any other mental illness _Psych comorbidities_: IDD, Austism, OCD, Schizophrenia, Trichotillomania (if hair ingested)

Answer 419

**Repeated regurgitation** of food Regurgitate, re-chew, spit out or re-swallow No GI or medical reason Behavior is volitional (done willingly) Occurs in secret Not part of other mental illness/eating disorder _Psych comorbidities_: IDD & generalized anxiety disorder

Answer 420

**Depression** **Anxiety** (r/t food) **OCD** Substance abuse Personality disorders Bipolar Obesity

Answer 421

Height, weight (blind wts), & muscle mass Electrolytes Cardiac function Bradycardia, orthostatic hypotension Amenorrhea Mood changes Use of enemas, laxatives, diuretics, diet pills Dental caries, sore throat, calloused fingers Cold intolerance Hair loss I & O

Answer 422

Refeed Stabilize wt Resolve cognitive distortions Normalize eating Treat comorbidities Improve family relationships Understand importance of balanced nutrition Develop age-appropriate identity

Answer 423

Psychiatrist Psychologist RN Dietician Social Worker (family therapist) Milieu therapist (PCT) Art / Music / Recreational therapists

Answer 424

* Restore pt to **healthy wt** * wt gain of **0.2 kg/day** *(slow & steady)* * food intake must be increased slowly to prevent stressing heart * Treat **psych issues** r/t eating disorder * Reduce / eliminate **behaviors or thoughts** that lead to disordered eating; prevent relapse * Control issues: do NOT agrue over wt; **emphasize HEALTH not wt**.; avoid coerision * **Behavior modification** can help decrease manipulative behavior (CBT)

Answer 425

Medications: * **Prozac** (fluoxetine) _or_ **Zoloft** (sertraline) * **Zyprexa** (olanzapine) - antipsychotic helps w/ distored thoughts **Psychotherapy** (group & individual) **Behavior modification** * promote behaviors that contribute to wt gain * limit wt-loss behaviors **Monitoring** * physiological parameters (vitals, electrolytes) * wt routinely * daily caloric intake & fluid I&Os * restrict food to scheduled, pre-served meals/snacks * observe during & after meals/snacks * accompany to bathroom designated observation times; limit time spent in bathroom if not observed * limit physical activity **Support** * use behavioral contracting w/ pt to elicit desired wt gain * reinforce wt gain & behaviors that promote it * assist pt to develop self-esteem compatible w/ healthy body wt **Promote increased independence** * allow opportunity to make choices about eating & exercise as wt gain progresses **Remove anger** / **anxiety** from eating situation (keep conversations light) Well-balanced meals & adaquate calories (**meal plans**) Be a **role model**

Answer 426

* Support restorative wt gain & normalization of eating patterns * Close supervision of pt's eating * Prevention of exercise & purging * **Strict adherence to menus** * Observe pt during/after meals to prevent throwing away food or purging * Monitor all trips to the bathroom * **Structured mealtimes** (not flexible) * **Regularly scheduled weighing** * **Privileges** correlated w/ **wt gain** & **trmt plan compliance**

Answer 427

* **TCAs** & **SSRI** - prevent relapse in _Bulimia_ * **Zyprexa** - used to control _anxiety_; tends to cause wt gain * **Antianxiolytic** agents are **contraindicated** * **Wellbutrin contraindicated** in _Bulimics_ * MAOIs are _not_ indicated * **Beta Blockers** are **contraindicated**

Answer 428

* Wt loss \> **30% over 6 mo**. (severe malnutrition * Rapid decline in wt * Inability to gain wt w/ outpt trmt * Physiologic instability * Severe hypothermia d/t loss of sub-Q tissue or dehydration (**body temp oC or 96.8^oF**) * Bradycardia (**HR)** * Hypotension (**systolic )** * **Electrolyte imbalances** *not corrected by oral supplmentation* * hypokalemia * hyponatremia * hypophosphatemia * Cardiac **dysrhythmias**

Answer 429

* **Suicidal ideation** or severely out of control, self-mutilating behaviors * **Out of control use** of laxatives, emetics, diuretics, or street drugs * **Failure to comply** w/ trmt contract * **Severe depression** * Acute **psychosis** * **Family** crisis or dysfunction \**pt must be physiologically stable to come to psych unit*

Answer 430

autism repetitive movements or sounds...self soothing

Answer 431

CAGE **C** (have you ever felt that you should **CUT** down?) **A** (have people **ANNOYED** you by criticizing you) **G** (have you every felt **GUILTY** about our drinking?) **E** (have you ever had an EYE OPENING moment in the morning?)

Mental Health Final Flashcards

(458 cards)