Mental Health N4615 Module 1 Flashcards
(141 cards)
1
Q
Chpt 8
Therapeutic Relationships are used for what?
A
Therapeutic relationships exist to meet the needs of the patient:
Their needs / thoughts / feelings / goals
Roles are clearly defined and professional boundaries are established and maintained
Areas to be worked on are agreed on and outcomes are continually evaluated
2
Q
Goals of a therapeutic Relationship
A
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
3
Q
Social Relationships refer to what?
A
Primarily initiated for the purpose of friendship, socialization, enjoyment or to accomplish a task
Social relationships exist for mutual gratification of the participants
4
Q
Transference
A
Sigmund Freud
Pt. unconsciously and inappropriately displaces (transferes) onto the RN feeling’s / behaviors r/t significant figures in their past (parents / siblings etc.)
i.e. “you remind me of…(mom / dad / sister)
5
Q
Chpt 8
Countertranferences
A
When the RN unconsciously and inappropriately displaces (transferes) onto the pt. feeling’s / behaviors r/t significant figures in their past (parents / siblings etc.)
Can be either a positive or negative response
6
Q
Chpt 8
RN’s tend to diviate from therapeutic relationsips when they are:
A
Bored - want to rescue the pt
overinvolved w/pt - overidentify w/pt
anger w/pt - feelins of hoplessness / helplessness
7
Q
Chpt 8
Peplau’s (1952)
Nursing - pt. relationship phases
A
1) PreOrientation Phase
2) Orientation Phase
3) Working Phase
4) Termination Phase
8
Q
Chpt 8
Peplau’s Orientation
Phase
A
- can last a few minutes or extend over a longer period
- is the initial interview
- Used to establish rapport (demonstate genuiness, empahty, & develope a postitive regard
- Set parameters
- discuss confidentiality
- **Plan for termination phase (pt needs to know) is 1st used here.
9
Q
Chpt 8
Peplau’s Working
Phase
A
RN & pt work together to Id / explore area’s that are causing problems in the pts life.
Key point. describing can often cause the pt. to reexperiencing old conflicts & can awaken high anxiety, anger etc
10
Q
Chpt 8
Peplau’s Termination
Phase
A
Final / intergal phase
Summation of goals / objectives that pt. can implement when discharged
Key point - if pt has unresolved feelins of abandonment / unwanted….this phase can awaken those feelings
Ask the pt…“How do you feel about…?
11
Q
Chpt 8
Factors that promote Pt. growth
A
1) Genuiness
2) Empathy (not sympathy)
3) Positive regard (respect 4)
12
Q
Chpt 8
Genuiness
A
what we display to the outside world for a person / pt is congruent (same) w/ our internal feelings
RN would use congruent communication strategies
*what we project is real
don’t hide behind rules / using staff or informal guidlines to explain our actions…show an ability to interact honestly w/pts.
13
Q
Chpt 8
Empathy
A
Empathy
The ability to understand a situation from the patient’s point of view
Empathy occurs when there is a deep understanding of the patient with the patient
Strongly associated with positive patient outcomes
14
Q
What is Empathy’s 2 step process
A
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.” )
15
Q
What is Sympathy
A
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
16
Q
Chpt 8
Positive Regard Def
A
An attitude of deep and genuine caring for the patient that acknowledges his/her intrinsic dignity and worth and is not contaminated or diminished by judgments about the person’s attitudes, beliefs, thoughts, feelings, behaviors
17
Q
Chpt 9
Patient Centered
refers to…
A
refers to the Pt. as a full partner in his/her care - whose values, preferences, and needs are respected.
18
Q
Chpt 9
Factors that affect communications
A
1) Personal factors (ie. mood, level of education, cultural backgroud)
2) Environmental factors (noise, lack of privacy, uncomfortable chairs etc)
3) Relationship factors ( status…who is in charge, age, social standing)
19
Q
Chpt 9
Verbal vs. nonverbal communication
A
Words (verbal) equate to “content”
nonverbal (what we project) equates to “the process”
roughly 10% of all conversation is verbal & 90% is nonverbal (what we see)
when the content is congruent with the process - communication is said to be “healthy”
20
Q
Chpt 9
List 3 Therapeutic Communication techniques
A
1) Silence - is not the absence of communication, but a specific channel for transmitting / receiving messages.
2) Active Listening - carefully looking for both verbal and non-verbal cues to what is really meant.
3) Clarifying techniques
21
Q
What are some Clarifying techniques
A
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.
22
Q
Chpt 9
Types of communicatoin Q’s a nurse will use with a pt.
A
1) Open ended - encougage pts to share about experiences / perceptions
2) close ended - should use only during initial interviews to get specific details
3) Projective Q’s - “what if” (ie. #what if you had 3 wishes, what would they be”)
4) Presuppose - known as the “miricle Q” (ie. suppose you woke up today a millionaire and all your problems dissapeared. What would be diffent?)
23
Q
Chpt 9
Nontherapeutic Communicaiton
A
1) excessive q’s
2) giving approval or disapproval
3) Why q’s — implies judgement or wrong doing
4) Giving advise — rarely helpful
24
Q
Hesi Practise
Reframing def
A
is a technique that teaches clients to monitor their negative thoughts and replace them with ones that are more positive.
ie. by reminding a pt. complaining of a painful procedure that he had the same one the day before, this helps them refocus thier thoughs (reframing)
25
Hesi Practise
Distraction def
focusing the clients attention on something other then what they are going through (ie. pain)
26
Hesi Practise
Imagery def
uses mental imagaes to assist with relaxation
27
Hesi Practise
Progressive relaxation def
strategy in which muscles are alternately tensed and then relaxed.
28
Hesi Practise
Clarifying def
technique of restating a conversation with the pt.
helps examine the meaning of the pt. statement
helps the Rn in preventing making assumptions about a clients message
ie. what do you mean by...
29
Hesi Practise
Offering Self
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
30
Hesi Practise
w/ depressed pts, what is the best assisstance a RN can give.
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
31
Hesi Practise
Regression def
resorting to an earlier, more comfortable level of functioning that is less demanding ahd has less responsibility.
32
What are the Fraud's psychosexual development stages
**Oral** - age birth to 1 (thumb sucking)
**Anal** - age 1 - 3 (refusiing to use bathroom)
**Phallic** - age 3 - 5
**Genital** - age 13 - 20 years
33
Hesi Practise
Confabulation def
is the filling of memory gaps with imaginary information in an attempt to distract others from observing an obvious deficit.
34
Hesi Practise
Herorin withdraw s/s
symptons of heroin w/d include
cravings
muscle aches / tremors
severe abdominal cramps
chills / sweating / runny nose / watery eyes
35
Hesi Practise
Cocaine withdrawal s/s
symptoms of cocaine w/d include:
severe cravings
depression / fatigue / irritability
vivid / unpleasant dreams
insomnia or hypersominia
36
Hesi Practise
Cannabis withdrawal s/s
symptoms of cannabis w/d include:
irritability / anxiety / restlessness
decreased appetite or wieght loss
37
Hesi Practise
Alcohol withdrawals s/s
early symptoms of alcohol w/d include:
irritability / anxiety
tremors
sweating
mild tachycradia
38
What are the Major **Theories (3)** in practise today?
**1)** Psychoanalytic Theory
**2)** Client-Centered Theory By Carl Rogers (**\*\* This is the professors favorite)**
**3)** Cognitive-Behavioral Therapies
39
**Psychoanalytic Theory**
Psychoanalysis makes you examine your life, retell your life. You have to confront the parts of yourself that are painful.”
who developed the theory & what are the 3 concepts of Self
* 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"
40
Describe the "Id" phase of Freuds system
"Id" operaties on the pleasure principle, seeking immediate gratification of impluses.
41
Describe the "ego" phase of Freuds system
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?
42
Describe the "superego" phase of Freuds system
The "superego" would oppose the impulsive behavior as "not nice".
43
**Client-Centered Theory**
who developed theory & what is the main tool used
•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
44
•Client-Centered Interventions / qualities of the therapist
•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)
45
What is Therapeutic Use of Self
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.
46
What is the Johari Window
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
47
Who was the 1st pyschiatric nurse
Linda Richards
48
Suicide def.
is the intentional act of killing oneself by any means.
hsty of attempts is best predictor of another attempt
49
Parasuicide def.
A voluntary, failed attempt to kill oneself
Frequently called attempted suicide
50
What are two key feelings that are important predicters of future suicide attempts
Hopelessness / helplessness
severity of depression.
51
Theoretical foundations for understanding the suicidal client
**Remember!**
All behavior has meaning! All behavior, including suicidal behavior, represents an attempt to meet a need!
52
What is Baumeister's Escape Theory
it refers to the components of pts pyschi
- intense self-hatred
- intense desire to escape oneself
53
What is the "Existential" Theory refer to
the inability to find meaning in suffering often contributes to suicide
54
What is the "cognitive theory of suicide"
Becks Cognitive Triad
Is a pt's perspective about.
1) self
2) future
3) World
With a **negative** outlook in the center of all three views.
55
What is
"Shneidman's Cubic Model of Suicide"
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
56
What are the Assessment stages for the suicidal patient
**Step 1**: Set the Stage
**Step 2:**
Explore Suicidal Thoughts and Behaviors
**Step 3:** Evaluate Lethality
57
Suicidal assessment
Step 1: Set the Stage
Establish rapport!
Promote trust
Convey accepting, non-judgmental attitude
Facilitate a supportive, collaborative approach to exploring the client’s problems
58
Suicidal Assessment
Step 2:
Explore Suicidal Thoughts and Behaviors
**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.”)
59
What is the difference btwn **"overt"** statements vs. **"Covert"** statements
**Overt** - Life isn’t worth living anymore (they are direct statements)
**Covert** - You won’t have to bother with me much longer *(hidden statements)*
60
Watch for signs / clues that suggest suicidal intent
Giving away prized possessions
Putting affairs in order
Writing farewell notes
Buying a gun
Loss of interest in activities
Social withdrawal
61
Ask the Q - be bold to a suicidal pt.
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?
62
What are some the demographic risk factors for suicidal pts.
ederly (w/terminal diagnoses)
younge adolesent white females
American Indians seem to have a higher rate.
63
Suicidal Assessment
Step 3: Evaluate Lethality
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
64
What are some ( 4 main )of the Lethality Assessment's
How lethal is the proposed plan?
How accessible are the means?
What are the chances of rescue?
Is substance use a factor?
65
What is the SAD PERSONS Scale
**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*
66
What are the Goals for Hospitalization of suicidal patients
Prevent harm
Re-establish equilibrium
Restore hope
Enhance coping skills
Develop an outpatient support system
Develop a suicide prevention plan for discharge
67
Always Observe for “Sudden Serenity” in suicidal patients - what does this mean
Distressed suicidal clients who suddenly become more peaceful and serene may have decided to kill themselves
68
What are the two most prevelent Depressive Disorders
Major Depressive Disorder (MDD)
Dysthymic Disorder (DD)
69
What is the Diagnostic Criteria for Major Depressive Disorder (MDD)
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
70
Major Risk factors for Depression
Female / unmarried
low socioeconomic status
family hsty of depression
Alcohol / substance abuse
Post-partum
Negative life event - especially loss of loved one
71
What is Dysthymic Disorder
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
72
What are some of the theories regarding
depression
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
73
Explain the Diathesis-Stress
Theory of Depression
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
74
What is the Learned Helpless Model
of depression
Person experiences stressful event preceived as **uncontrollable**.
extreme feelings of powerlessness, helplessness and apathy occur
loss of initiative and a feeling of futility
75
What are some of the treatments for
depression
Psychotherapy
Pharmacotherapy
Electroconvulsive Therapy
Brain Stimulation
Exercise and Stress Management
76
Name 4 Pharmacotherapies for
depression
Selective Serotonin Reuptake Inhibitors (SSRI)
Tricyclic Antidepressants (TCAs)
Monoamine Oxidase Inhibitors (MAOI'S)
St. John’s Wort
77
Selective Serotonin Reuptake Inhibitors (SSRI)
FACTS
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
78
What are some of the S/E of SSRI's
mnemonic
BAD SSRI
- increased body weight
- anxiety
- Dizziness
Serotonin Syndrome
Stimulation of the CNS
Reproductive issues / sexual dysfunction
insomnia
79
Serotonin Syndrome is a potential toxic effect of SSRI's - what are the signs
**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
80
Tricyclic Antidepressants (TCAs)
FACTS
* 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
81
Monoamine Oxidase Inhibitors (MAOI'S)
FACTS
* 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!
82
Foods that contain
Tyramine
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
83
St. John’s Wort
FACTS
* 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%
84
What are the three phases in treatment and recovery from major depression
1) acute phase
2) continuation phase
3) maintenance phase
85
Describe the acute phase of major depression tx / recovery
- **6 to 12** weeks
- directed at reduction of depressive symptoms and restoration of psychsocial and work functions
Hospitalization may be initiated if severe
86
Describe the continuation phase of major depression tx / recovery
- **4 to 9** months
- directed at prevention of relapse through pharmacotherapy, education & psychtherapy
87
Describe the maintenance phase of major depression tx / recovery
- 1 year or more
treatment is directed at prevention of further episodes of depression
medication may be phased out.
88
Anhedonia def.
loss of ability to experience joy or pleasure in previously plearsurable activities.
89
What does the "recovery model" emphasize
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.
90
What is the PHQ - 9
Patient Health Questionaire - 9
0-4 none
5-9 mild
10-14 - moderate
15-19 moderately severe
20-27 servere
91
What are "vegative signs" of depression
alterations in body processess necessary to support life and growth
- eating
- sleeping
- elimination
- sexual activity
92
What are the four levels of
Anxiety
Mild Anxiety
Moderate Anxiety
Severe Anxiety
Panic
93
Mild Anxiety def.
Occures in normal everyday living and allows an individual to perceive reality in sharp forcus
94
Moderate Anxiety def.
as anxiety increases, person experiencing moderate anxiety sees, hears & grasps less informtion
often demonstrate "selective inattention"
95
Severe Anxiety def.
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
96
Panic def.
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.
97
List some of the common "defense mechanisms" associated with anxiety
compensation - conversion - denial - displacement -
dissociation - indentification - projection - reaction -
regression - repression - splitting -
sublimation - suppression - undoing
98
The defense mechanism
**compensation** is def. as
used to change perceived deficiencies by emphaszing strengths
99
The defense mechanism
**conversion** is def. as
unconscious transformation of anxiety into a physical (somatic) symptom w/ no organic cuase
100
The defense mechanism
**denial** is def. as
involves escaping unpleasant anxiety causing thought & feelings by ignoring thier existence
101
The defense mechanism
**displacement** is def. as
transference of emotions associated w/ a particular person / place or thing with another object that is not threatening.
102
The defense mechanism
**Dissociation** is def. as
is a disruption in consciousness, memory, identity that results in compartmentalizing unpleasant aspects of oneself
103
The defense mechanism
**identification** is def. as
when you relate yourself to someone else
104
The defense mechanism
**Intellectualization** is def. as
is a process in which events are analyzed based upon remote, cold facts w/o passion --- rather than incorporating feelings / emotions into the process.
105
The defense mechanism
**projection** is def. as
refers to unconscious rejection of unacceptable behaviors and placing them onto someone else.
is the hallmark of blaming, scapegoating, prejudicial thinking, and stigmatizing others.
106
The defense mechanism
**Reaction formation** is def. as
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.
107
The defense mechanism
**Rationalization** is def. as
involves uncounsciously making excuses for one's behavior, idadequacies, or feelings by blaming others.
108
The defense mechanism
**Sublimation** is def. as
replacing an unacceptable behavior with one socially acceptable
109
The defense mechanism
**Splitting** is def. as
is the inability to integrate the positive and negative qualities of oneself or others into a cohesive image.
110
What is "Altruism"
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
111
What is Separtion Anxiety Disorder
normal part of infant development - begins around 8 months through 18
112
What is Agoraphobia
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.
113
Obsessive-complusive disorder is def. as
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.
114
Obsessions are def. as
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
115
Compulsions are def. as
ritualistic behavirors (washing hands) that an individual feels driven to perform in an attempt to reduce anxiety.
116
The Hamilton Rating Scale for Anxiety is on a scale
0 - none
1 - mild
2 - moderate
3 - disabling
4 - severely disabling
**\*\* What are the scoring ranges?**
14-17 - mild anxiety
18-24 - moderate anxiety
25-30 - severe anxiety
117
What is "cognitive restructuring"
refers to allowing the pt. (w/ your help) to test their automatic responses and then refocus / redraw them with more rational conclusions
118
What is desesitization
involves gradual exposure to a feared object to redirect associated fear of it.
a behavioral therapy modality
119
What is "flooding"
exposes the pt. to a large amount of an undesirable stimulus in an effort to extinguish the anxiety response.
a behavioral therapy modality
120
Describe Milieu therapy
based upon the idea that all members of the environment contribute to the planning and functioning of the setting.
121
What is the def. of schema
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
122
What is the def. of somatization
is the expression of psychological stress through physical symptoms
123
What is the def. of "holistic approach" for
nursing
nursing care that addresses the multidimensional interplay of **biological**, **psychological** and **sociocultural** needs.
124
List the five most common somatic disorders according to the American Psychiatric Association
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
125
What is Somatic symtpom disorder
characterized by a combination of distressing symptoms and an excessive or maladaptive response w/o significant physical findings or diagnoses.
126
What are the most common symptoms with Somatic symptom disorder
chest pain / fatigue / dizziness / headache
swelling / back pain / SOB / insomnia
abdominal pain / numbness
127
What is Illness Anxiety Disorder
aka hypochondriasis
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
128
What is conversion disorder
aka functional nurological disorder
manifest itself as nerological symptoms in the absence of neurological diagnosis
129
What are some of the symptoms of Conversion disorders
paralysis / blindness / movement disorders
gait disorders / numbness / paresthesia (tingling or burning sensation)
loss of vision, hearing or even symptoms resembling epilepsy.
130
List some (2) of the psychological factors affecting medical conditions
**Major Depression disorder (MDD**) & coronary heart disease
**Stress** & cancer
131
What are "secondary gains"
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.**
132
What is factitious disorder
aka Munchausen's syndrome
unlike other somatic disorders...factitious disorders are consciously under the pts. control.
They fake ilness to get sympathy or some other benefit.
133
What does factitous disorder imposed on another mean
aka Munchausen by proxy
it is when a caregiver deliberately fakes a pts. illness for their own benefits.
money from insurance - admiration from clinet or other staff etc.
134
Def. Malingering
consciously motivated to deceive based upon the desire for gain
(money or getting out of someting)
135
What is "la belle indifference"
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
136
What is congitive behavioral therapy?
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
137
Nursing Interventions for GAD
* Identify source of anxiety
* Link pt's behavior to feelings
* Introduce logic
* Teach coping skills
138
Antidepressants (SSRIs) are the 1st line of defense in most anxiety & OCD related disorders.
The FDA has approved some SNRIs & TCAs for use with anxiety & OCD related disorders.
**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
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Antianxiety agents (Benzodiazepines) are often used to treat somatic & psychological symptoms of anxiety disorder
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
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What neurochemicals regulate anxiety?
1) Epinephrine
2) Norepinephrine
3) Dopamine
4) Serotonin
5) GABA
GABA is an inhibitory neurotransmitter & thus the focus of pharmacological therapy for anxiety symptoms.
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