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Flashcards in Psych Deck (89)
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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
Q

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

A

Structured schedule / boundaries

Provide activity

Writing is a god energy outlet

26
Q

Schizophrenia

How is their focus?

A

Inward - create their own world

27
Q

Schizophrenia

What is their affect like?

A

Inappropriate, flat, or blunted

Ex: Laughing about mother’s death

28
Q

Schizophrenia

How are their thoughts?

A

Disorganized, loose associations, confused

Rapid thinkers, jumping form idea to idea

Concrete thinkers

29
Q

What are 4 main characteristics of a Schizophrenic patient?

A
  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
Q

What to do if a schizophrenic patient makes up words?

A

Don’t use them

Seek clarification and say things like “I don’t understand”

31
Q

Do schizophrenics have child-like mannerisms?

A

YES - they may do something like go into the fetal postitions

32
Q

Most common types of schizophrenic hallucinations?

What kind are most alarming?

A

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
Q

What is a good environment for a schizophrenic patient?

How often are we going to observe them?
Some things to keep in mind?

A

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
Q

What is the best way to communicate with a schizophrenic patient?

A

Keeping conversations reality based, and orienting them frequently

May be oriented x3 but still have hallucinations and delusions

35
Q

Key things to note when assessing suicide

A

Do they have a plan?
What is the plan?
How lethal is the plan?
Do they have access to the plan?

36
Q

Signs of a patient being suicidal

A

Isolating themselves
Writing a will
Collecting harmful objects
Giving away their belongings

37
Q

Highest population at right for suicide

A

Elderly men

38
Q

Nursing considerations for the suicidal patient

A

Provide a safe environment and safe proof room

Contract to postone harm - Need to renew it!

39
Q

Best communication technique for suicidal patient

A

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
Q

Best way for a suicidal patient to channel anger?

Best way to do this?

A

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
Q

Things to keep in mind if we are suspecting that a patient is suicidal

NCLEX!

A

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
Q

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?

A

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
Q

How do the paranoid patients act? Why?

Do they relax?
What do they crave?

A

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
Q

What do we need to keep in mind about the paranoid patient’s beliefs?

A

You can’t explain away their delusions or false beliefs

45
Q

How to paranoid patients act in relationships?

How do they often feel about others?

How to they typically react to others?

A

Guarded - simply because they trust

Pathology jealousy toward others - ALL they can think about, consumes their thoughts

Hypersensitive and react with rage

46
Q

What are the emotions like of a paranoid patient?

View on life?

A

No humor
Unemotional
Life in unfair

They think that everyone else has the problem

47
Q

What is the best way to earn a paranoid patient’s trust?

A

Be reliable!!!!!! Be honest!!!
You must follow through with what you said you we’re going to do

Have consistent nurses

48
Q

How often should we visit with the paranoid patient?

What should we be careful with?

What to avoid when talking with them or others?

A

Brief visits

Be careful with touch and respect personal space

Avoid whispering

49
Q

How to give meds to a paranoid patient

What about food?

A

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
Q

What activities are bad for a paranoid patient

A

Competitive activities - feel humiliated with loss

51
Q

What kind of person if hard for a paranoid patient to handle?
Why?
How should we fix it?

A

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
Q

What is anxiety?

What does it become a disorder?

A

A universal emotion

When it interferes with day-to-day functioning

53
Q

Mild vs high anxiety in regards to performance

What should the nurse do?

A

Increased performance at mild levels but decreased with high anxiety

Stay with the patient with high anxiety and give step-by-step instructions

54
Q

S/S of Generalized Anxiety Disorder

A

Chronic anxiety that occurs daily

Fatigues d/t constant anxiety and muscle tension

Uncomfortable

55
Q

Treatment of Generalized Anxiety Disorder -

Do these people seek help?
Meds
What else helps?

A

Often seek help because they are so miserable

Short-term anxiolytics
Relaxation techniques
Journaling to gain insight about anxiety peaks, valleys and triggers

56
Q

PTSD - What causes it?
What happens frequently?
How are their emotions?
How are they with relationships?

A

Results d/t life-threanting events

They relive the experience, nightmares, and flashbacks

Emotional numb

Difficulty with relationships and tend to isolate themselves

57
Q

Treatment of PTSD

What to be careful with?

A

Support groups - They can talk about the experience BUT DON’T PUSH THEM!

Meds

58
Q

Obsession vs Compulsion

What disorder are we talking about?

A

Obsession: recurrent thought
Compulsion: Recurrent act

OCD

59
Q

S/S OCD

Can they stop?
Why does this usually happen?

What kind of schedule works best?

A

Obsession, compulsion

Comes from an unconscious conflict/anxiety - something is making them anxious whether they know what what is or not

Structured schedule

60
Q

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?

A

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
Q

How to treat OCD patient

A

Time delay techniques - start to decrease amount of time to give them for the ritual

Relaxation techniques
Meds - SSRI or Tricyclic antidepressants

62
Q

What is a dissociation?

A

Patient used dissociation (Lack of connection in a person’s thoughts, memories, or identity)

63
Q

What is dissociative Disorder?

What kind of patients may we see this with?

Is this common?

Is the patient aware?

A

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
Q

What is Dissociate Identity Disorder?

A

Extreme for of dissociation disorder where a patient has multiple personalities

65
Q

How to treat dissociative disorders?

A

Patient must process the trauma over time

Meds may be used for co-existing anxiety or depression

66
Q

What is alcohol?

A

A depressant

67
Q

Stages of Alcohol withdrawal

Do what with stage 2&3
Do what with stage 2&3

Do we need to sit with these patients?

A

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
Q

Medication for alcohol withdrawal

A

Anxiolytics

Detox protocol

69
Q

Anxiolytics and considerations regarding the patient

How often to give?

What do we want to prevent?

How do these patients feel?

A

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
Q

What does detox protocol include?

Example med?

A

Chlordiazepoxide

Thiamin injections, multivitamins, and maybe magnesium

71
Q

Chronic complications of Alcohol withdrawal?

What are these caused by?

A

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
Q

Other problems of alcoholism

Nerves?
Liver/pancreas/GI?
Sex drive?
Electrolyte imbalance?

A

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
Q

Major defense mechanism of alcoholic

A

Denial and rationalization

74
Q

Rehab options for the alcoholic

What if they relapse?

What happens within the family?

A

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
Q

Anoxia view on the body

A

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
Q

What happens to the body with anorexia?

A

Amenorrhea d/t malnourishment

Decreased sexual development
May develop lanugo

Exercise+no food = Low weight

77
Q

Anorexia defense mechanisms

A

Uses intellectualization

Perfectionist

78
Q

How to treat anorexia?

Do we let them decide foods?

A

Increase weight gradually
Monitor exercise
Teaching

Allow input but limit decisions if their weight is life threatening

79
Q

Key characteristics of Bulimia

What is usually the cause?

A

Tooth decay
Strict diet
Binge eating - alone/secret
May steal food

NORMAL WEIGHT

Family problems

80
Q

How to treat Bulimia

Allow how much time for meals

A

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
Q

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?
A
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
Q

How to treat personality disorders

A

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
Q

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?
A

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
Q

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?

A

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
Q

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?
A
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
Q

Best thing to do when a patient is having a hallucination?

What if they are in bed?

What if they are scared?

A

Involve them in an activity!!
Engage them into the real world!

HOB elevated

Offer them reassurance

87
Q

What is ECT (electroconvulsive therapy)?

What is it used for?

A

Last resort

Electric currents based through the brain under anesthesia

Severe depression
Manic episodes

88
Q

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?

A
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
Q

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?

A

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