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PNRS 252 Mental Health Nursing II > Midterm 1 > Flashcards

Midterm 1 Flashcards

(74 cards)

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1
Q

Atypical Antipsychotics - Metabolic Syndrome Signs

A

**High fasting blood glucose: ** > 5.6

Hypertension:
>130/85

Abdominal obesity:
Waist to hip ratio (M >0.90; W > 0.85)
Waist circumference (M >102; W; 88)

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2
Q

Constellation (>3) of coronary artery disease risk factors. Metabolic syndrome signs

A

Abdominal obesity (Waist circumference M >102cm; W > 88cm)

Hypertension

Glucose intolerance/resistance (fasting glucose 100mg/dL)

Elevated triglycerides (150)

Low HDL (>40 males, >50 females)

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3
Q

CASE Approach

A

Chronological Assessment of Suicide Events

• Presenting suicidal events (how?)
•Recent suicide events (2 months)
•Past suicide events
•Immediate suicide events (now; what’s next?)

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4
Q

CASE Validity Techniques

A

Behaviour incident
Shame attenuation
Gentle assumption
Symptom amplification
Denial of the specific
Normalization

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5
Q

Behavioural Incident

A

What did they do? Ask questions about concrete behavioural fact

Example: “can you walk me through what happened the night you almost attempted suicide?”
..”what did you do next?” .. “what did you feel next?”

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6
Q

Shame Attenuation

A

Showing sincerity and wanting to understand rationalizations that shape how individuals perceive their reality.

Inquires about behaviours that individuals may be hesitant to discuss because of shame and guilt.

Enforces a stance for unconditional positive regard.

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7
Q

Symptom Amplification

A

How often/how intensely?

Example: “I only have a couple of drinks” - Clarify what “a couple” is for the client

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8
Q

Denial of the specific

A

When individuals deny generic questions.

Example:
Clinician: have you made any preparations for suicide?
Pt: No
Clinician: Have you written a will?
Pt: No
Clinician: Have you written a suicide note?
Pt: Well, yes, but only on my phone. I haven’t printed it or anything

Many people who say “no” to a general question will say “yes” when the question is asked about specifics

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9
Q

Functional vs Encapsulated vs Chaotic families

A

Functional: No preexisting family conflict or psychopathology. Suicide due to chronic physical illness

Encapsulated: Psychopathology and conflict generally observed only in deceased, not other family members

Chaotic: Clear evidence of psychopathology in multiple family members

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10
Q

Recovery-focused approach

A

Includes building relationships that fosters hope, empowerment, self-determination, and responsibility. Values address:

•Family engagement
•Respect and dignity
•Choice
•Determination
•Independence
•Family caregiver needs and sustainability

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11
Q

Ethical Considerations in nursing care

A

Competence

Privileged communication: Privilege provides relief from having to disclose info in court

Confidentiality:

Advocacy

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12
Q

Calgary Family Assessment Model Components

A

Developmental

Structural

Functional

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13
Q

Tidal Model

A

Theoretical model that recognizes individuals are in a constant state of change while negotiating their relationship with intrinsic and extrinsic influences and that growth and development occur through changes that follow patterns

Relevant to care of older adults in psych

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14
Q

Clinical Recovery vs Personal Recovery

A

Clinical Recovery: Reduction or removal of symptoms

Personal Recovery: Belief that even if they live with an illness, their life will continue and they will find a way to live well. Focus on strength/resources

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15
Q

4 R’s of trauma informed care

A
  1. Recognize your biases
  2. Regulation
  3. Relate (make a connection)
  4. Reason
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16
Q

First generation (typical)
vs
Second generation (atypical)

A

First gen: Significant neurological side effects such as EPS, dystonia(involuntary muscle contractions), neuroleptic malignant syndrome (life-threatening; fever, altered LOC, muscle rigidity)

Second gen: Metabolic syndrome. Still has neuro risks but lower risk

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17
Q

Extrapyramidal Symptoms (EPS)

A

Effects motor control and coordination.

•Tardive dyskinesia

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18
Q

Neuroleptic Malignant Syndrome

A

Life-threatening

fever
altered mental status
muscle rigidity
autonomic dysfunction

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19
Q

Dystonia

A

Neurological movement disorder. Involuntary contractions that cause slow repetitive movements or abnormal postures that can be painful

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20
Q

Waist / hip to waist ratio for obesity

A

Men:
Waist >102cm
Hip-to-waist >0.90cm

Women:
Waist >88cm
Hip-to-waist >0.85cm

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21
Q

Acute Stress Disorder

A

Symptoms appear 2-4 wks after event, resolve by 4 wks

Display of 3 dissociative symptoms during or after traumatic event and within month of experiencing trauma

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22
Q

PTSD

A

When psychological behavioural reactions persist over a month of an event

Flashbacks, nightmares, intrusive thoughts

Avoidance of situations/environments

Interventions:
CBT
Exposure
Group therapy
EMDR
Neurosequential therapeutics
Somatic centred approaches
meds

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23
Q

Perry’s Neurosequential Model of Therapeutics

A

NMT is a developmentally sensitive, neurobiology-informed approach to clinical problem solving. It’s not a specific technique or intervention.

Used for children but can be effective with adults.

Inverted triangle.
From bottom to top:

Brainstem -> Midbrain -> Limbic -> Cortical

Brainstem: Interoception (internal) and external input from world. HR, fight/flight.

Midbrain: arousal/sleep/appetite/movement

Limbic: Emotional response, memory, reward, bonding

Cortical: Creativity, empathy, self-control, values, language, time

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24
Q

Positive relationships develop when:

A

The nurse establishes credibility (knowledgeable)

The focus is on the immediate intervention need of the family

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25
Challenges for families
Difficulty in **access** related to limited capacity **Poor information sharing** between provider, consumer and carer Carers **not always included in decisions**
26
Community treatment orders (CTOs)
Provide a legal framework that requires adherence to treatment in order to avoid treatment in restrictive environments such as inpatient units
27
Recovery Oriented Practice: How?
Focus on strengths Belief in potential for growth Hope Understand that recovery is individualized process Being supported by others Develop connections to community and natural supports
28
Psychosocial Rehabilitation
Promotes personal recovery, successful community integration and satisfactory quality of life for persons who have mental illness
29
Phase I, Phase II and Phase II recovery outcomes
**Phase I** (Acute) safety and medical stabilization **Phase II** (Stabilization) Adhere to treatment and self care **Phase III** (Maintenance) Building on success. Living more individually with more satisfaction. Prevent relapse
30
Recovery vs Rehabilitation
**Rehabilitation** Focuses on managing deficits and helping them learn to live with illness **Recovery** •Focuses on achieving goals of patients choosing •Collaborative, **client-centred** •Focus is on person and future
31
Trauma Informed Care Principles
Trauma awareness/understanding Cultural competence Promote Safety/Stability Compassion and dependability Collaboration and empowerment Belief in Resilience and recovery
32
PTSD Risk Factors
Biological: •Hypothalamic-pituitary Adrenal Axis •Deficits in arousal and sleep regulating systems •Endogenous opioid system problems Psychological: •Mood disorders •Anxiety disorders
33
Considerations for children with PTSD
Less likely to show distress. Express emotions through play
34
Sequential Engaging & processing
Builds off neurosequential model. Remember the upside down triangle. Bottom to top: Brainstem, midbrain, limbic, cortical. **Sequential engaging and processing** Midbrain: Regulate Limbic: Relate Cortical: Reason and reflect
35
Post Traumatic Growth
Growth happens are a result of the struggle to find a new normal through emotional and cognitive processing. NOT because of the direct result of trauma •Life appreciation •Closer relationships •Setting new goals and letting go of old ones •Increased personal strengths •Having a greater connection
36
Allostasis
Stress. The adaptive processes that maintain homeostasis through the production of mediators such as adrenalin, cortisol and other chemical messengers.
37
Depersonalization vs Derealization
**Depersonalization** A state in which one's **thoughts and feelings** seem unreal or not to belong to oneself, or in which one loses all sense of **identity.** **Derealization** A mental state where you feel **detached from your surroundings.** People and objects around you may seem unreal.
38
Fear conditioning
The pairing of an initially neutral stimulus with a fear eliciting stimulus
39
Paresthesia
pins and needles sensation
40
Each “type” of anxiety disorder has symptoms clustered in 4 areas. What are those 4 areas?
Physical response Thoughts Emotions Behaviours
41
Agoraphobia
Excessive anxiety or fear about being in places or situations in which escape might be difficult or embarrassing
42
Generalized Anxiety Disorder
Physical response: dizziness, itching, choking feeling, GI changes, blurred vision, nausea, vomiting, increased HR Thoughts: automatic negative thoughts, catastrophizing, excessive worry Emotions: Agitation, sadness, guilt Behaviours: Avoidance, procrastination
43
Pharmacotherapy for anxiety
SSRI/SNRI are first line for long-term Tx Benzodiazepines Hypnotics OTC SSRI: Zoloft SNRI: Effexor Non-benzodiazepines: Buspirone (good for anxiety, not panic). Displaces digoxin, a med used for irregular HR Zolpidem (sleep) Hypnotics: Zopiclone (increase GABA activity), Temazepam OTC: Antihistamines, melatonin
44
Benzodiazepine Side Effects
CNS depression Autonomic effects Paradoxical reactions
45
Panic disorder most closely associated with addiction to what?
Alcohol
46
GAD closely associated with addiction to what substances?
Cannabis, etc. Less commonly alcohol
47
Trauma Resiliency Model
The model is a brief, effective, body-based crisis response intervention that takes advantage of the body‘s natural propensity to self regulate, using the biological stabilization skills of tracking internal sensations of well-being
48
Exclusion
Major health problem globally Impacts all populations, community, individuals Carries mental health consequences on a mass scale, ranging from mild depression to suicide
49
Social Exclusion
Lack of or denial of resources, rights, and goods/services and inability to participate in normal activities available to the majority of people in a society, whether in economic, social, cultural, or political areas
50
Delirium tremens
Most severe form of ethanol withdrawal, manifested by altered mental status (global confusion) and sympathetic overdrive (autonomic hyperactivity), which can progress to cardiovascular collapse
51
Motivational Interviewing
52
What is the most preventable cause of death globally?
Tobacco/Nicotine use
53
Biologic Theories in Addiction
Interplay between stressors in the environment and genes (epigenetics). Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, and the environment and individuals life experiences
54
Psychological Theories in Addiction
The contribution of psychological and psychiatric factors that reflect the individuals preferences, experiences, or problems
55
Social Theories in Addiction
Substance availability, legislation, and other health policies. Culture is another factor influencing addiction prevalence rates
56
Spiritual Theories in Addiction
The relationship between an individual snd the sacred
57
Substance Use Disorder: **Medical Model Approach**
Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences
58
Substance Use Disorder: **sociological Perspective**
Looks at social influences; economic, homelessness, health inequities..
59
What are the 4 overarching Criteria of Substance Use Disorder?
•Impaired control (4) •Social Impairment (3) •Riskier use (2) •Pharmacological Criteria (2)
60
Substance-Induced disorders
Intoxication, withdrawal, and other substance/medication-induced mental disorders (psychosis, anxiety, etc), caused by the effects of substances
61
Impacts of substance use disorder
Relationships Economical Public health (eg. opioid crisis)
62
Substance Withdrawal
Development of a substance-specific maladaptive behavioural change that is due to the cessation, or reduction, of heavy and prolonged substance use Can be life threatening or just uncomfortable
63
Substance/medication-induced mental disorders
Challenges that develop when people who did not have mental health challenges before using now do
64
What is a standard drink?
341 ml (12 oz) bottle of regular beer
65
What is a standard drink?
341 ml (12 oz) bottle of regular beer 1.5 oz of 80-proof spirits 5 oz wine
66
Alcohol Use Disorder
A problematic pattern of alcohol use leading to clinically significant impairment or distress, manifested by at least two of the following occurring within a 12 month period: 1. Alcohol is often taken in **larger amounts** over a longer period than was intended 2. There is a persistent desire or **unsuccessful efforts to cut down** or control alcohol use
67
CAGE Questionnaire
68
COWS
Clinical Opiate Withdrawal Scale
69
CIWA
Clinical Institute Withdrawal Assessment for Alcohol
70
SUD assessment includes:
Standard use assessment Comprehensive physical assessment Collateral information assessment
71
Which substance are older adults more often hospitalized for?
Opioids
72
Family Assessment Components
Structural: Who, what connections, context Developmental: Life cycle events/sequence Functional: Detail behaviour toward eachother
73
4 Pillars of Substance Use Strategy
**Prevention** Encourages people to make healthy choices, provide opportunities for people to reduce likelihood of substance use (affordable housing, employment training, jobs) **Treatment** Access to services, outpatient services, Opioid dependency program, residential treatment **Enforcement** Non criminalization, improving safety, community engagement **Harm Reduction**
74
Pragmatism
Recognize that substance use is inevitable in society

PNRS 252 Mental Health Nursing II (1 decks)

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