Psych Flashcards
(73 cards)
1
Q
Anhedonia
A
Loss of pleasure in usually pleasurable things
2
Q
Mild depression weight
A
Gain
3
Q
Severe depression weight
A
Loss
4
Q
Severe depression crying
A
No more tears
5
Q
Mild-moderate depression crying
A
Crying spells
6
Q
Why might depressed clients be irritable?
A
Decreased serotonin
7
Q
Do you compliment depressed clients?
A
No, they might make them feel worse
8
Q
Do you isolate the depressed client?
A
No, seek them out
9
Q
How to help the severely depressed client
A
Sit with them and make no demands, they can’t make simple decisions, they will worry about the decisions they do make
10
Q
Suicide risk with depressed clients
A
It increases once the depression lifts, because now they have the energy to do it
11
Q
Thoughts with depression
A
Slowed thoughts, use silence and slow speaking to them. They can’t concentrate
12
Q
Can depressed clients have delusions/hallucinations?
A
Yes
13
Q
Sleep with depression
A
In mild depression, hypersomnia-want to sleep all the time. In moderate to severe, insomnia
14
Q
S/S of mania
A
Labile (changing) emotions Flight of ideas Delusions-false ideas Delusions of grandeur Delusions of persecution Inappropriate dress Can't stop to eat-give snacks Spending sprees Poor judgement, no inhibitions (no filter) Hypersexual, exploiting Manipulation-gets mad when they fail Decreased attention span Hallucinations
15
Q
Delusions of grandeur
A
You think you’re Jesus
16
Q
Delusions of persecution
A
Think someone’s out to get them
17
Q
How to deal with a delusional client
A
Make them feel safe, don’t argue, don’t talk about it. Tell them you accept they believe it, but you do not believe it.
18
Q
How to treat the manic client
A
Set limits, be consistent Decrease stimuli Limit group activities One on one relationships are the best Remove hazards Stay with them if anxious Structured schedule Writing activities work well Finger foods Weigh daily Walk with them during meals Don't try to argue or reason Brief, frequent contact with staff. Too much conversation stimulates them Maintain their dignity They blame everyone
19
Q
S/S of schizophrenia
A
Inward focus on their own world Inappropriate affect Disorganized thoughts Loose associations (interrupted connections in thought and confused thinking) Rapid thoughts, jump from idea to idea Echolalia Neologism (make up new words) Concrete thinking Word salad (jumble of words) Delusions/hallucinations Child-like mannerisms Religiosity
20
Q
Nu Dx for schizophrenia
A
Alteration in communication
21
Q
Most common hallucinations with schizophrenia?
A
Auditory, then visual
22
Q
What type of hallucinations with schizophrenia should you assess for?
A
Command; they’re auditory that tell the client to hurt themselves or others. They scare the client and can signal a psychiatric emergency
23
Q
As an RN, can you go into a psych client’s room alone?
A
Yes
24
Q
How to care for the schizophrenia client
A
Decrease stimuli Observe frequently-don't look suspicious Orient frequently (they may be oriented x3 but still have delusions/hallucinations) Keep conversations reality based Make sure personal needs are met
25
What are some of the most lethal methods of suicide?
Guns, car crashes, hanging, carbon monoxide
26
Contract to postpone suicide
They sign saying they won't harm themselves or others for 24 hours. Don't forget to renew the contract
27
How to you speak to the suicidal client?
Direct, closed ended statements. Ask if they have a plan to hurt themselves.
28
How to answer exercise questions
Pick the answer that is most exerting that won't hurt them. Just bc you haven't seen a punching bag at a hospital doesn't mean there isn't one at the NCLEX hospital.
29
Restraints
Check q 15 minutes
Remember hydration, nutrition, & elimination
Not used much more on psych units
On NCLEX, stay away from restraints as long as possible
Observation at 15 to 30 minutes intervals or one to tone if the client cannot contract for safety
30
How to answer questions about staying with clients
Don't act like you have other patients, only worry about the patient on the question
31
Which client thinks life has been unfair to them?
Paranoia
32
Which client do you HAVE to be reliable and keep your word with?
Paranoia
33
Which client thinks everyone else has the problem?
Paranoid
34
How to treat the paranoid client
Brief visits, careful with touch, don't mix meds, don't hide them, be matter of face, always ID meds, they eat sealed foods, they need consistent nurses, no competitive activities, be honest
35
S/S of generalized anxiety disorder
Chronic anxiety
Fatigue due to constant muscle tension
Uncomfortable
Seek help
36
Tx for GAD
Short term use of anxiolytics
Relaxation techniques
Journaling over time to gain insight into anxiety, peaks and valleys and triggers
37
Which client is emotionally numb and detached
PTSD
38
Which client has difficulty with relationships, isolates themselves
PTSD
39
Tx for PTSD
Support groups
Talk about it, don't push
Meds may help
40
OCD
Comes from an unconscious conflict/anxiety
Need schedule
Give time for their rituals
Do not verbalize disapproval
You should never take away the ritual without replacing it with another coping mechanism, such as anxiety reduction techniques
41
Obsession
Recurrent thoughts
42
Compulsion
Recurrent acts
43
Tx of OCD
Time delay techniques and relaxation
| Meds-SSRIs or TCAs
44
Dissociative disorders s/s
Client uses dissociation as a coping mechanism to protect self from severe physical or psych trauma
Hx of abuse
Not commonly seen
Client or others may be aware of the problem, but may have periods of time or events not remembered
45
Dissociative identity disorder
Multiple personalities, extreme example of a dissociative disorder
46
Tx of dissociative disorder
Process trauma over time
| Meds may be used to treat co-existing depression or anxiety
47
Alcohol is what?
A depressant
48
Stages of alcohol withdrawal
1-mild tremors, nervous, nausea
2-increased tremors, hyperactive, nightmares, disorientation, hallucinations, increased HR/BP
3-most dangerous, severe hallucinations (visual and kinesthetic are most common), grand mal seizures
49
Stage II and III alcohol withdrawal
DT's (withdrawal delirium) keep light on
50
Stage I and II alcohol withdrawal
Walk and talk to them, reorient them a lot
51
Tx for alcohol withdrawal
Anxiolytics-don't be afraid to give
- They have a tolerance to alcohol, and a cross-tolerance to other CNS depressants
- They can handle meds every two hours
- DTs should be prevented, don't let them suffer through
- They will be very frightened
52
What is an anxiolytic that is frequently given for outpatient alcohol detox?
Chlordiazepoxide
53
Alcohol detox protocol consists of what?
Thiamine injections, multivitamins, maybe mag
54
Complications of alcohol withdrawal caused by B vitamin (thiamine) deficiencies
Korsakoff's syndrome (disorientated to time, confabulate-they don't mean to lie but they make up things to fill in gaps)
Wernicke's syndrome (emotions labile, moody, tire easily)
55
Peripheral neuritis
Nerve problem with alcohol withdrawal, think B vitamin deficit
56
Other S/S of alcohol withdrawal
Impotence-can't get an erection
Liver/pancreas problems
Gastritis
Mg and K loss from diuresing
57
Major defense mechanism used in alcohol withdrawal
Denial and rationalization
58
Antabuse
Deterrent to drinking alcohol
Before they're given it, they have to sign consent and say they'll stay away from ANY for of alcohol: cough syrup, aftershave, perfume, alcohol prep
59
What must a client have prepared after alcohol detox?
Relapse prevention plan
60
S/S of anorexia
Lanugo, decreased sexual development, lose weight, exercise, periods stop, plan meals for others, hight achiever, perfectionistic, use intellectualization as defense mechanism
61
Tx of anorexia
Increase weight gradually
Monitor exercise
Allow their input on choosing healthy foods for meals
Limit activity and decisions if weight is low enough to be life threatening
62
S/S of bulimia
Teeth decay, laxatives, diuretics, strict dieter: fasts and exercise, binge alone and secret, NORMAL weight, the binge is initially pleasurable but when they're done they are very self critical
63
When do bulimia and anorexic pts feel in control?
As long as they can eat and not eat how they want
64
Tx for bulimia
Sit with them at meals, observe for 1 hour after
Allow 30 minutes for meals
Take focus off of the food, don't talk about it with them
Self esteem building is important
65
Causes of bulimia
Usually family problems, they usually deny conflicts
66
Personality disorder s/s
```
Intensely emotional
Manipulative
Suicidal gestures
Self mutilation
Depressed or bulimic
Substance abuse
Fear of abandonment, many negative relationships
To them, any relationship is better than no relationship
```
67
Most common personality disorder
Borderline
68
Tx of personality disorders
```
Improve self esteem
Treat co diagnoses
Enforce rules and limits
Don't reinforce negative behaviors
Treat self mutilation and suicide gestures in matter of fact way
```
69
Phobia s/s
The object they're scared of doesn't present danger
Must have trusting relationship
Don't talk about the phobia a lot
Follow up is the key to successful tx
Desensitization (gradual exposure to the fear) must occur over time
70
Panic disorder
```
Stay 6 feet away
Simple words
Have to learn how to stop the anxiety
Teach that symptoms should peak within 10 minutes
Teach journaling to manage anxiety
```
71
Hallucinations
```
Warn before touching
Don't say "they"
Involve in an activity
Elevate head of bed
Decrease stimuli
Offer reassurance, they're scared
```
72
Electro-Convulsive Therapy
```
*Last resort tx*
Can induce grand mal seizure
For severe depression, manic episodes
NPO, void, atropine to dry up secretions
Signed permit is necessary
Series of tx, depends on client response
Very effective, very humane with current meds
Succinylcholine chloride-relaxes muscles
```
73
Post procedure ECT
```
Position on side
Stay with client
Temporary memory loss
Reorient
Involve in day's activities ASAP
Always look for injuries
Tell family that the client will be confused for a while, will get better over time
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