Psych Flashcards
(89 cards)
1
Q
Adhendonia
A
Loss of pleasure in usually pleasurable things
2
Q
Depression is usually related to what?
A
Loss - job, body part, esteem
3
Q
Weight in mild and severe depression
A
Mild - gain
Severe - loss
4
Q
Crying with moderate and severe depression
A
Moderate: crying spells
Severe: No more tears
5
Q
Why would depressed patients be irritable?
A
Due to decreased serotonin
6
Q
Do depressed patients have energy?
Do they need help with self care?
Can they make simple decisions?
A
No
Yes
No
7
Q
What do we need to be careful with when talking with depressed patients?
Why?
A
Giving compliments
May make the client feel worse
8
Q
Is it good for depressed patients to interact with others?
What if they are severely depressed?
A
Yes, even if they don’t want to
Sit with the client and make no demands may be the best thing to do
**Seeking out the patient is key
9
Q
What is the biggest risk to assess in depressed patients?
Why?
A
Suicide
As depression lifts, the patients have more energy and ability to carry out suicide
10
Q
What might indicate that a patient has made the decision to kill themselves?
A
Change of mood
11
Q
Which population is at increased risk?
Use weapons?
A
Elderly
Older men
12
Q
Can depressed patients have hallucinations and delusions?
A
YES
13
Q
What are the thoughts like in a depressed patient?
What is an appropriate nursing intervention for this?
A
Slowed thoughts and speech
Can’t concentrate
*Silence is key
14
Q
Sleep in mild depression vs severe depression
A
Mild: Hypersomnia
Severe: Sleep disturbances common
Generally, these nations will have trouble falling asleep, stay asleep, or wake up early
15
Q
Emotions and thought process of a manic patient
How do they look?
Are they good with money?
A
Continuous high
Crazy emotions
Flight of ideas
Poor judgment
Crazy dress
Spending sprees
16
Q
What kind of delusions could a manic patient have?
A
Delusions (false idea) of:
Grandeur - think you’re jesus
Persecution - always feel like someone is out to get you
17
Q
How to react to a patient’s delusions
A
Don’t argue about the delusion or talk about it a lot
Let the patient know that you accept that they need the belief BUT you don’t believe it… This helps with their security and self esteem
Look for an underlying need for the delusion (Such as persecution: need to feel safe, or Grandeur: need self esteem
18
Q
What happens when a manic patient has consistent manic behavior?
A
Exhaustion
19
Q
Do manic patients have inhibitions?
A
NO - may be hyper sexual and exploit other patients
20
Q
What makes the manic client feel powerful?
What should the nurse do?
A
Manipulation - if this fails, they get man
*Think about the patient that constantly bugs you - “I’ll be right back”
Interrupt them and send them back to their room if they are trying to manipulate you
Set BOUNDARIES and BE CONSISTENT
21
Q
Best foods for a manic patient
What to do while they eat?
A
Finger foods - It’s hard for them to stop and eat
Walk with the patient while they eat
Often underweight - Weight them DAILY
22
Q
Can the manic patients have hallucinations?
What is their attention span like?
A
Yes
Short
23
Q
Best environment for a manic patient
A
Decreased stimuli
Limit group activity - they ruin it for everyone!
Remove hazards - limit cigarettes
24
Q
What should you do if the patient’s anxiety increases?
A
STAY with them!
25
Why kind of schedule does a manic patient need?
What do we do when they partake in purposeless activity?
Ex of a good outlet for high energy
Structured schedule / boundaries
Provide activity
Writing is a god energy outlet
26
Schizophrenia
How is their focus?
Inward - create their own world
27
Schizophrenia
What is their affect like?
Inappropriate, flat, or blunted
| Ex: Laughing about mother's death
28
Schizophrenia
How are their thoughts?
Disorganized, loose associations, confused
Rapid thinkers, jumping form idea to idea
Concrete thinkers
29
What are 4 main characteristics of a Schizophrenic patient?
1. Echolalia - hear something and repeat it over and over
2. Neologism - Making up knew words
3. Word salad - jumble of words
4. Hallucinations / delusions
30
What to do if a schizophrenic patient makes up words?
Don't use them
Seek clarification and say things like "I don't understand"
31
Do schizophrenics have child-like mannerisms?
YES - they may do something like go into the fetal postitions
32
Most common types of schizophrenic hallucinations?
What kind are most alarming?
Auditory most common, then visual
COMMAND Hallucinations!! May comment the patient to hurt themselves or others! Often frightening to the patient and signal a psychiatric emergency
33
What is a good environment for a schizophrenic patient?
How often are we going to observe them?
Some things to keep in mind?
One with decreased stimuli
Observe them FREQUENTLY but WITHOUT looking suspicious!!
Make sure their personal needs are met
Maintain SAFETY, especially when going into their room
34
What is the best way to communicate with a schizophrenic patient?
Keeping conversations reality based, and orienting them frequently
May be oriented x3 but still have hallucinations and delusions
35
Key things to note when assessing suicide
Do they have a plan?
What is the plan?
How lethal is the plan?
Do they have access to the plan?
36
Signs of a patient being suicidal
Isolating themselves
Writing a will
Collecting harmful objects
Giving away their belongings
37
Highest population at right for suicide
Elderly men
38
Nursing considerations for the suicidal patient
Provide a safe environment and safe proof room
Contract to postone harm - Need to renew it!
39
Best communication technique for suicidal patient
Direct, close-ended questions
One time in nclex where a closed ended questions is appropriate!
*Stay calm because anxiety in contagious - don't let all the patients know what's going on
40
Best way for a suicidal patient to channel anger?
Best way to do this?
Exercise
Pick the answer that is going to let out the most amount of energy with no harm! Even something like a punching bag
41
Things to keep in mind if we are suspecting that a patient is suicidal
NCLEX!
Even if there is a TINY indication, we MUST ASK!!!!
It is completely fine to ask abruptly! This is important! BE DIRECT!!!!!!!!!!!! FOR NCLEX
42
How often do we need to assess a patient with restraints?
How often should we observe them? What if they can't contract for safety?
What 3 things to keep in mind about assessment?
What about in regards to NCLEX?
EVERY 15 MINUTES
Observe every 15-30 or one-one if they can't be safe
Hydration, nutrition, eliminate
- They deserve this even if the patient tried to cause them harm
LAST RESORT
43
How do the paranoid patients act? Why?
Do they relax?
What do they crave?
Always suspicious but don't have a reason to be
These patients are responding in a way that is consistent with their paranoid beliefs
No
Recognition
44
What do we need to keep in mind about the paranoid patient's beliefs?
You can't explain away their delusions or false beliefs
45
How to paranoid patients act in relationships?
How do they often feel about others?
How to they typically react to others?
Guarded - simply because they trust
Pathology jealousy toward others - ALL they can think about, consumes their thoughts
Hypersensitive and react with rage
46
What are the emotions like of a paranoid patient?
| View on life?
No humor
Unemotional
Life in unfair
They think that everyone else has the problem
47
What is the best way to earn a paranoid patient's trust?
Be reliable!!!!!! Be honest!!!
You must follow through with what you said you we're going to do
Have consistent nurses
48
How often should we visit with the paranoid patient?
What should we be careful with?
What to avoid when talking with them or others?
Brief visits
Be careful with touch and respect personal space
Avoid whispering
49
How to give meds to a paranoid patient
What about food?
Don't mix their meds
Always ID them
Be up-front
Don't give them sealed foods because they may think they are being poisoned
50
What activities are bad for a paranoid patient
Competitive activities - feel humiliated with loss
51
What kind of person if hard for a paranoid patient to handle?
Why?
How should we fix it?
An overly-friendly nurse
They start to really look into
Use an unemotional affect (Be matter-of-fact, don't use too much inflection)
52
What is anxiety?
| What does it become a disorder?
A universal emotion
| When it interferes with day-to-day functioning
53
Mild vs high anxiety in regards to performance
What should the nurse do?
Increased performance at mild levels but decreased with high anxiety
Stay with the patient with high anxiety and give step-by-step instructions
54
S/S of Generalized Anxiety Disorder
Chronic anxiety that occurs daily
Fatigues d/t constant anxiety and muscle tension
Uncomfortable
55
Treatment of Generalized Anxiety Disorder -
Do these people seek help?
Meds
What else helps?
Often seek help because they are so miserable
Short-term anxiolytics
Relaxation techniques
Journaling to gain insight about anxiety peaks, valleys and triggers
56
PTSD - What causes it?
What happens frequently?
How are their emotions?
How are they with relationships?
Results d/t life-threanting events
They relive the experience, nightmares, and flashbacks
Emotional numb
Difficulty with relationships and tend to isolate themselves
57
Treatment of PTSD
What to be careful with?
Support groups - They can talk about the experience BUT DON'T PUSH THEM!
Meds
58
Obsession vs Compulsion
| What disorder are we talking about?
Obsession: recurrent thought
Compulsion: Recurrent act
OCD
59
S/S OCD
Can they stop?
Why does this usually happen?
What kind of schedule works best?
Obsession, compulsion
Comes from an unconscious conflict/anxiety - something is making them anxious whether they know what what is or not
Structured schedule
60
What to keep in mind about an OCD patient and their rituals?
What if we want to stop them?
What if we disapprove of what they are doing?
We need to give them time to do them because if they can't do them, anxiety will increase or cause a panic attack
NEVER take away a ritual without replacing it with another coping mechanism, such as anxiety reduction techniques
Never tell them that you disagree - they feel bad enough as it is
61
How to treat OCD patient
Time delay techniques - start to decrease amount of time to give them for the ritual
Relaxation techniques
Meds - SSRI or Tricyclic antidepressants
62
What is a dissociation?
Patient used dissociation (Lack of connection in a person's thoughts, memories, or identity)
63
What is dissociative Disorder?
What kind of patients may we see this with?
Is this common?
Is the patient aware?
Patient uses dissociation to protect themselves from severe physical or psychological trauma
Common in pt with a history of physical or sexual abuse
No
Patient may be aware but have periods of time and events that they can't remember
64
What is Dissociate Identity Disorder?
Extreme for of dissociation disorder where a patient has multiple personalities
65
How to treat dissociative disorders?
Patient must process the trauma over time
Meds may be used for co-existing anxiety or depression
66
What is alcohol?
A depressant
67
Stages of Alcohol withdrawal
Do what with stage 2&3
Do what with stage 2&3
Do we need to sit with these patients?
Stage 1: Mild tremor, nervous nausea
Stage 2: ^tremors, hyperactive, nightmares, disoriented, hallucinations, ^P, ^BP
Stage 3: Severe hallucinations (visual and kinesthetic common), grand-map seizures
2&3: Keep the light on (DTs - delirium treatments)
1&2: Walk and talk to them, reorient A LOT
Don't need to sit with a withdrawal patient
68
Medication for alcohol withdrawal
Anxiolytics
| Detox protocol
69
Anxiolytics and considerations regarding the patient
How often to give?
What do we want to prevent?
How do these patients feel?
Don't be afraid to give it
Patient has a cross-toleranceto CNS depressants, so they can handle these meds every 2 hours
Prevent DTs (delirium
Very frightened during the episode
70
What does detox protocol include?
Example med?
Chlordiazepoxide
Thiamin injections, multivitamins, and maybe magnesium
71
Chronic complications of Alcohol withdrawal?
What are these caused by?
Caused by thiamine/niacin deficiencies
Korsakoff's syndrome: disoriented to time, confabulate (Make things up but don't mean to)
Wernike's syndrome: Emotions labile, moody, tired easily
72
Other problems of alcoholism
Nerves?
Liver/pancreas/GI?
Sex drive?
Electrolyte imbalance?
Peripheral neuritis - alcohol kills nerves
ALCOHOL KILLS THE GI TRACT!
Impotence - Alcohol kills nerves
Mg and K loss (Alcohol causes diuresis and you will lose these E)
73
Major defense mechanism of alcoholic
Denial and rationalization
74
Rehab options for the alcoholic
What if they relapse?
What happens within the family?
Antabuse - need content
Consent to stay away from anything that includes alcohol (this includes cough syrups, aftershaves, cologne, alcohol prep)
12 step program is very affective
Need a relapse prevention plan in place
Dynamics changes, causing stress
75
Anoxia view on the body
Distorted view
Will see a fat person in the mirror even if they are tiny
Preoccupied with food but won't eat - like to plan meals
76
What happens to the body with anorexia?
Amenorrhea d/t malnourishment
Decreased sexual development
May develop lanugo
Exercise+no food = Low weight
77
Anorexia defense mechanisms
Uses intellectualization
| Perfectionist
78
How to treat anorexia?
Do we let them decide foods?
Increase weight gradually
Monitor exercise
Teaching
Allow input but limit decisions if their weight is life threatening
79
Key characteristics of Bulimia
What is usually the cause?
Tooth decay
Strict diet
Binge eating - alone/secret
May steal food
NORMAL WEIGHT
Family problems
80
How to treat Bulimia
Allow how much time for meals
Sit with patient during meals and observe for 1 hour
Allow 30 min for meals
Redirect their focus - may become angry because of lack of control
IMPROVE self esteem
81
Personality Disorders
```
Most common one?
How are their emotions?
How are they with others?
Are they harmful?
What might be a coexisting condition?
Do they abuse substances?
What do they fear?
Are they sexual?
```
```
Borderline personality
Intensely emotional
Manipulative with many negative relationships
Suicidal gestures and self-mutilation
Anorexia/Bulimia
May abuse substances
Fear of abandonment
May be sexually promiscuous
```
*Any relationship is better than no relationship
82
How to treat personality disorders
ENFORCE RULES AND LIMITS
Improve self-esteem
Treat co-existing conditions
Relaxation techniques
Don't reinforce negative behaviors
Treat harmful behaviors in a matter-of-fact way
don't pick diversional activities that would cause harm (Like anorexic playing a sport)
83
PHOBIA
Does a phobia, either a person or object, pose actual danger?
```
Best may to treat this----
Relationship to pt?
Desensitization?
Talking about it?
KEY to treatment is what?
```
NO
Trusting relationship
Gradual exposure over time
Don't talk about it a lot
Follow-up is KEY
Try to find the underlying reason for the fear
84
How do we intervene with a patient with panic disorder?
Stand how far away?
Have them learn what?
Teach that S/S should peak within ____?
Good way to manage anxiety?
Stay 6 ft away - avoid harm
Simple messages - can't understand complex messages
Learn to stop the anxiety
Anxiety should peak within 10 min
Journaling
85
Hallucinations things to remember with communications----
```
Touching them?
Don't say what?
Let patient know what?
Remember to asses for what?
These occur most often when?
TV?
```
```
Warn before toughing
Don't say "they"
Let them know you don't share the perception (voice)
Assess for command hallucinations!
Occur during times of anxiety
Turn it off to decrease stimuli
```
86
Best thing to do when a patient is having a hallucination?
What if they are in bed?
What if they are scared?
Involve them in an activity!!
Engage them into the real world!
HOB elevated
Offer them reassurance
87
What is ECT (electroconvulsive therapy)?
What is it used for?
Last resort
Electric currents based through the brain under anesthesia
Severe depression
Manic episodes
88
What is needed pre-procedure ECT?
What might it cause?
Will the patient have multiple treatments?
What other drug is given and what does it do?
```
NPO
Void
Atropine - dry up secretions
^ Prevent aspiration
Signed consent
```
Might cause grand-map seizure
of treatments depends on how the patient responds to therapy
Succ to relax muscles during the procedure and prevent injury
89
Post-op ECT---
Postion?
What happens with LOC?
What to watch for?
What might happen to the patient's memory?
What should we do as soon as possible?
Place on side
Stay with them - confused for a little while
Temporary memory loss
Need to reorient them!
Involve in day's activity ASAP
*Remember to tell the family that results won't be seen right away directly post-op - pt really confused
