Psychiatric Nursing Flashcards
(406 cards)
1
Q
“I’ll sit with for a while.”
A
Offering self
2
Q
(observe for non-verbal clues)
A
Silence
3
Q
“How are you feeling today?”
“Is there something you’d like to talk about?”
“Tell me what you are thinking?”
A
Broad opening
4
Q
“Tell me more….”/ “Tell me what happened”
A
Exploring
5
Q
“Go on.” / “And after that?
A
General Lead
6
Q
CLIENT: “I can’t sleep. I stay awake all night.”
NURSE: “You have difficulty sleeping
A
Restating
7
Q
CLIENT: “I’m feeling sick inside.”
NURSE: “What do you mean by ‘feeling sick inside?”
“Tell me whether my understanding of it agrees with yours.”
A
Clarifying
Consensual validation
8
Q
CLIENT: “I’m way out in the ocean.”
NURSE: “You seem to feel lonely.
A
Translating into feelings
9
Q
CLIENT: “Life is hard. I just want to put an end to everything.”
NURSE: “You seem to be having a difficult time, are you planning to harm yourself?”
A
Verbalizing the implied
10
Q
CLIENT: “Do you think I should tell my dad?”
NURSE: “What do you think would work best?”
A
Reflecting
INDEPENDENT DECICION MAKING
11
Q
“I know it isn’t easy, but you can do it.”
“It would be difficult at first, but you’ll get through it.
A
Supportive confrontation
ACKNOWLEDGE
client’s feelings.
12
Q
-Not allowed to agree and disagree
-Do not give opinion to the patient
-All feelings are valid
-Acknowledge
-Give Recognition
-Do not give compliment
A
Therapeutic Communication
13
Q
statements of acknowledgements
A
I can see…
You seem…
It seems…
You sound…
It sounds…
It must be…
14
Q
CARES
A
Clarify (what do you mean? are you saying this/that?)
Acknowledge
Restate ; Reflect
Explore
Sit ; Silence
15
Q
[NON THERAPEUTIC]
“Just have a positive attitude.”
A
Stereotyping
16
Q
[NON THERAPEUTIC]
“Everybody gets down in the dump.”
A
Belittling
17
Q
[NON THERAPEUTIC]
“Everything will be alright.”
A
Reassuring
18
Q
[NON THERAPEUTIC]
“Why did you do that?”
A
Requesting an
explanation
19
Q
focusing on feelings of patient
A
Empathy
20
Q
focusing on own (RN) feelings
A
sympathy
21
Q
[Disturbances in PERCEPTION]
-misinterpretation of EXTERNAL stimulus
A
Illusion
22
Q
[Disturbances in PERCEPTION]
-misinterpretation of SENSORY stimulus
A
Hallucination
23
Q
Hallucination seen in marijuana use
A
Visual (psychedelics)
24
Q
Hallucination seen in alcohol withdrawal
A
Tactile (formication)
25
Hallucination seen in post traumatic stress disorder
Olfactory (phantosmia)
26
Hallucination seen in epilepsy [aura of seizure]
Gustatory (spontaneous dysgeusia)
27
Hallucination seen in paranoid schizophrenia
Auditory (command auditory)
28
Management for Hallucination
(HARDER)
Hallucination must be recognized
Assess the content (don't ask them to describe!)
Reality presentation
Divert the attention
Engage in reality-based activity
Reintegrate with the milieu
*TALK BACK to the voices – “practice saying GO AWAY!
29
examples of reality based activity for a pt with hallucinations
Gardening, household chores, arts and crafts, exercises
30
mixing of senses (hears the color, sees the sound, tastes the words)
Synesthesia
31
[Disturbances in THOUGHT]
- false belief
Delusion
32
[Disturbances in THOUGHT]
-giving meaning to events or actions of others
Ideas of Reference / Referential delusion
33
false belief that he/she has superiority or invulnerability
Delusion of Grandiose
34
false belief that “to be harmed by others”
Persecutory Delusion
35
false belief that bodily functions are abnormal
Somatic Delusion
36
false belief that a part of the body is missing
Nihilistic Delusion
37
false belief that a person is in love with her/him.
Erotomanic Delusion
38
Management for Delusion
(CAVE)
Clarification the meaning
Acknowledge the feelings, but NOT the DELUSION
Voice doubt, but DO NOT CHALLENGE
Engage in reality-based activities
39
[Disturbances in THOUGHT]
-fullness of detail, still does answer the question
Circumstantiality
40
[Disturbances in THOUGHT]
- lack of focus, did not answer the question
Tangentiality
41
[Disturbances in THOUGHT]
- fragmented ideas
-walang konek
Looseness of Association (derailment)
42
[Disturbances in THOUGHT]
- rapid speech, jumping from one topic to another
-medyo may konek
Flight of Ideas
43
[UNUSUAL SPEECH PATTERNS]
– coining of new words
Neologisms
44
[UNUSUAL SPEECH PATTERNS]
– word salad, mixing of words without rhyme
Schizophasia
45
[UNUSUAL SPEECH PATTERNS]
– rhyming of words
Clang associations
46
[UNUSUAL SPEECH PATTERNS]
– repeating the words of others
Echolalia
47
[UNUSUAL SPEECH PATTERNS]
-repeating own words (fast and decreasing audibility)
Palilalia
48
[UNUSUAL SPEECH PATTERNS]
- repeating phrases
Verbigeration
49
[UNUSUAL SPEECH PATTERNS]
-use of flowery words
Stilted language
50
[UNUSUAL SPEECH PATTERNS]
-adherence to a single topic
Perseveration
51
internal / loob
e.g. Happy
mOOd
52
external
e.g. smiling
affEct
53
[Disturbance in AFFECT]
- no emotion response (Withdrawn)
Flat Affect
54
[Disturbance in AFFECT]
- minimal emotional response (Major Depression)
Blunt Affect
55
[Disturbance in AFFECT]
- emotions are opposite to the context of the situation (Schizophrenia)
Inappropriate Affect
56
[Disturbance in AFFECT]
- single emotional response (Paranoid)
Restrictive Affect
57
[Disturbance in AFFECT]
-sudden shift of emotions (Bipolar disorder)
La bile Affect
58
[Disturbances in MEMORY]
- loss of memory
Amnesia
59
inability to recall memories formed before a traumatic event (Reminiscence therapy)
Retrograde Amnesia
60
inability to make new memories after a traumatic event (Reorient the client)
Anterograde Amnesia
61
making stories that are not true to fill the gap between memory loss
Confabulation
62
[Psychosis vs Neurosis]
- Has Contact with reality
Neurosis
63
[True or False]
- Schizophrenia is curable.
FALSE. It is only manageable.
64
[True or False]
- Schizophrenia is hereditary and contagious.
FALSE. It is hereditary but not contagious.
65
[SCHIZOPHRENIA]
2 or more of the following for at least __________.
- Hallucinations
- Delusions
- Disorganized speech
- Disorganized behavior
- Negative symptoms
1 month
66
4As of Schizophrenia
Autism – indifference
Ambivalence – 2 opposing feelings
Associative looseness
Abnormal affect
67
BIOLOGIC THEORY OF SCHIZOPHRENIA
Genetics: 1 parent (15%);
2 parents (35%)
Neuroanatomy: less CSF and brain tissue
68
Social Causation Hypothesis of Schizophrenia
↑risk (low income)
diet (malnourished)
lack of access to healthcare, recreation
69
[SCHIZOPHRENIA]
Neurochemistry: _______
Increased DOPAMINE AND SEROTONIN
70
psychosis (<1 month)
Brief Psychotic Disorder
71
psychosis (1 – 6 months)
Schizophreniform
72
- 2 people sharing similar delusion
Shared Psychotic Disorder (Folie à Deux)
73
Hallucinations, Delusions, and other disturbances in thought and perception
POSITIVE Signs of Schizophrenia
74
lack of relationships
Asociality
75
lack of motivation
Avolition
76
lack of pleasure
Anhedonia
77
lack of speech
Alogia
78
waxy flexibility, stupor and mutism
Absence of movement (catatonia)
79
Flat, blunt, inappropriate la bile
Abnormal affect
80
another term for ANTIPSYCHOTICS
NEUROLEPTICS
81
1st Generation ANTIPSYCHOTICS
Mode of action:
Indication:
1st Generation ANTIPSYCHOTICS
-decreases DOPAMINE
-to manage (+) signs
82
2nd Generation ANTIPSYCHOTICS
Mode of action:
Indication:
-decreases DOPAMINE AND SEROTONIN
-to manage (+) (-) but more on (-)signs
83
another term for 1st Generation Antipsychotics/Neuroleptics
Conventional / Typical Antipsychotics
84
another term for 2nd Generation Antipsychotics/Neuroleptics
Atypical Antipsychotics
85
Chlorpromazine
Thioridazine
Fluphenazine
Haloperidol (Haldol)
1st Generation / Conventional / Typical Antipsychotics
86
Olanzapine Risperidone
Quetiapine Ziprasidone
Clozapine Lurasidone
2nd Generation / Atypical Antipsychotics
87
Antipsychotic that is contraindicated to ELDERLY (>65y/o)
1st Generation / Conventional / Typical Antipsychotics
88
side effect of 1st Generation / Conventional / Typical Antipsychotics
Pseudoparkinsonism
(due to decreased dopamine)
89
safest Antipsychotic drug for elderly
2nd Generation: Clozapine!
- least likely to develop pseudoparkinsonism
90
High potency 1st generation antipyschotic drug that can be immediately given to eliminate hallucinations
Haloperidol (Haldol)
91
1st Generation / Typical Antipsychotic drug that is an exception to the rule, as it ends with -pine and -done. ( which is for 2nd gen rule)
1st Gen: (LoMo)
Loxapine
Molindone
92
3rd Generation Antipsychotics / Dopamine System Stabilizer (DSS)
Mode of action:
Advantage:
- regulates dopamine receptors
-less side effects
93
Aripiprazole
Brexpiprazole
3rd Generation Antipsychotics / Dopamine System Stabilizer (DSS)
94
Indication: NON – COMPLIANCE
Common cause: side effects; memory problem
Long Term Injection / DECANOATE
95
Previous term for Long Term Injection
Depot Therapy
96
when and how is the decanoate / LTIs given?
Intramuscularly, 1-2x / month
- prolong effect so does not need daily
97
pleasure hormone
dopamine
98
happy hormone
serotonin
99
SIDE EFFECTS OF ANTIPSYCHOTICS
[CAT DOG PAWS]
Constipation – increase fluid, fiber in the diet
Agranulocytosis – Monitor WBC, report any signs of infection (fever, sore throat)
Tooth decay – sugarless hard candy or gum
Dry mouth – sugarless hard candy or gum to stimulation salivation
Orthostatic hypotension – change position gradually
Galactorrhea – use cotton underwear
Photosensitivity – avoid direct sunlight, use umbrella and sunglasses, apply SPF 25 lotion
Arrhythmias – immediately report abnormal heart beat
Weight gain – lessen intake of sugary food and beverages
Sedation – avoid driving and operating machineries
100
Extra Pyramidal Syndrome
[DAP]
Dystonia
Akathisia
Pseudoparkinsonism
101
Neuroleptic Malignant Syndrome
Hyperthermia
Hypertension
Muscle spasms
102
Extra Pyramidal Syndrome Nursing Action
Notify the physician, DO NOT discontinue!
103
Neuroleptic Malignant Syndrome Nursing Action
Discontinue the Medication
104
Neuroleptic Malignant Syndrome Prevention
Hydrate the patient
105
Tardive Dyskinesia
Tongue protrusion
Teeth grinding
Lip Smacking
106
Tardive Dyskinesia Nursing Action
Notify the physician
107
Tardive Dyskinesia Prevention
Start with the lowest dose
108
Complementary and Alternative Therapy: [S/E Antipsychotics]
✓ Ketogenic diet, Omega-3 fatty acids, Vitamin D, Sulforaphane
109
Neurochemistry on MAJOR DEPRESSIVE DISORDER
Decreased DOPAMINE, SEROTONIN, and NOREPINEPHRINE
110
at least 5 of the following symptoms of Major Depressive Disorder
[DIWAGAS]
Difficulty thinking
Insomnia/Hypersomnia
Weight loss/gain (5%)
Anhedonia
Guilt feeling
Anergia
Suicidal thoughts
111
Defense Mechanism of MAJOR DEPRESSIVE DISORDER /Depression
Introjection
112
[MAJOR DEPRESSIVE DISORDER]
Impairs educational, social, and occupational functioning in at least ___ weeks
2 weeks
113
Hallmark Sign of MAJOR DEPRESSIVE DISORDER /Depression
Hopelessness, Helplessness,
114
Initial sign of Major Depressive Disorder
Sleeplessness
115
Best time to take Antidepressants
Morning with meals (some may cause insomnia)
Principle: at the same time each day
116
Effectivity of Antidepressants
after 2-4 weeks
-increase suicide precaution
117
TO PREVENT RELAPSE:
Continue taking antidepressants for _______.
6mos - 2 yrs
- even the client feels better
118
Wash-out period for antidepressants to prevent hyperstimulation, increasing serotonin
Wash-out period: 5-6 weeks
119
SEROTONIN SYNDROME
[DEAD CHART]
Diaphoresis
Elevated temperature
Anxiety
Diarrhea
Clonus
Hypertension
Agitation
Restlessness
Tachycardia
120
last resort, when medications are ineffective, acute suicidal crisis
Electroconvulsive Therapy
121
Contraindication for Electroconvulsive Therapy
presence of metals (jewelries, pacemaker, hip prothesis)
122
pre-medication for ECT
[SAM]
Succinylcholine (muscle relaxant)
Atropine Sulfate (Anti-cholinergic)
Methohexital (Anesthesia)
123
Duration of seizure for ECT
30-60 seconds
124
Nursing intervention before ECT
-NPO post midnight
-clean oil from the head
-Discontinue anticonvulsant
- Insert bite guard
125
Nursing intervention after ECT
Priority: Assess the respiratory status
-turn the client to the side
-reorient the patient
126
5 Types of Antidepressants
-MONOAMINE OXIDASE INHIBITOR (MAOI)
-TRICYCLIC ANTIDEPRESSANTS (TCA)
-SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRI)
- SEROTONIN NOREPINEPHRINE REUPTAKE INHIBITORS (SNRI)
-ATYPICAL ANTIDEPRESSANTS
127
tyramine rich foods (CI: MAOIs)
Frozen, Fermented, Pickled, Preserved, and Overripe Fruit
-old foods
-aged cheese (parmesan, cheddar)
safe cheese: cottage cheese,
cream cheese, ricotta
128
What to avoid when taking MAOIs?
Avoid tyramine rich foods
if mixed with MAOIs = Hypertensive crisis
= (+) occipital headache
129
[PAMANA] [TIP]
PArnate Tranylcipromine
MArplan Isocarboxacid
NArdil Phenelzine
SELegiline (Eldepryl)
MAOIs = money
130
TOFRAnil ImiPRAMINE
ANAfranil ClomiPRAMINE
ELAvil AmiTRYPTILINE
Pamelor NorTRYPTILINE
- Sinequan Doxepine
TRICYCLIC ANTIDEPRESSANTS (TCA)
131
most FATAL antidepressant
TRICYCLIC ANTIDEPRESSANTS (TCA) because can cause arrythmia
132
Side effect of TCA
Adrenergic stimulation
(ASA = dry)
Arrhythmia: Tachycardia, Bradycardia (toxicity)
133
ZOLOFT (sertraline)
PAXIL (paroxetine)
LUVOX (fluvoxamine)
PROZAC (fluoxetine)
LEXARPO (escitalopram)
Celexa (Citalopram)
SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRI)
134
Fastest antidepressants
Safest antidepressants
- less suicide
-less side effect
-nausea
-gastrointestinal upset
-dizziness
-sexual dysfunction
SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRI)
135
Side effect of SSRI
Gastrointestinal upset (nausea)
136
3 Side effect of SNRI
Increase Blood Sugar
Increase Intraocular Pressure
Increase Cardiac Rate
137
CYMBALTA (Duloxetine)
EFFEXOR (Venlafaxine)
SEROTONIN NOREPINEPHRINE REUPTAKE INHIBITORS (SNRI)
138
What is the priority nursing intervention for ATYPICAL ANTIDEPRESSANTS ?
monitor AST, ALT
139
BUPROPION (Wellbutrin)
TRAZODONE
ATYPICAL ANTIDEPRESSANTS
140
HERB FOR DEPRESSION
St. John's wort
141
Neurotransmitter: increase DOPAMINE, SEROTONIN, and NOREPINEPHRINE
BIPOLAR DISORDER
142
Psychosocial Factors: Type A personality (Competitive, Perfectionist, Goal-oriented)
Sociocultural Factors: Upper Class
BIPOLAR DISORDER
143
Defense Mechanism for Bipolar Disorder
Reaction Formation, Projection
144
MANIC PHASE: ____ or more of the following
✓ FLIGHT OF IDEAS
✓ Inflated self-esteem or grandiosity
✓ Decreased need for sleep
✓ Increased talkativeness
✓ Distracted easily
✓ Increase in goal-directed activity
✓ Engaging in risky activities
3 or more
145
manic phase manifestations last for more than 1 week
mania
146
manic phase manifestations last for only 4 days
Hypomania
147
Manic episodes with or without major depression
Bipolar I
148
alternating periods of depressed mood and hypomania for 2 yrs
CYCLOTHYMIA
149
Major depression with hypomanic episodes
Bipolar II
150
persistent mild depression for 2 yrs
DYSTHYMIA
151
CarboLITH LITHothab
EskaLITH LITHobid
LITHane
ANTIMANIC MEDICATION
-Lith - para sa Makulit
152
DRUG OF CHOICE - Antimanic
Lithium Carbonate
Valproic acid
153
ANTIMANIC MEDICATION
Mechanism:
Onset: __weeks
Peak: __ hours
ANTIMANIC MEDICATION
Mechanism: to stabilize the mood
Onset: 3 weeks
Peak: 3 hours
154
Lithium Carbonate Therapeutic Level
0.6-1.2 meq/L
max: until 1.5 meq/L
155
if serum lithium level >3 meq/L =
DIALYSIS
156
When to obtain specimen in serum lithium level?
1. before breakfast
2. 8 hours after last dose
157
Common side effects of Lithium Carbonate
FINE TREMORS
Polyuria
Hypothyroidism
158
Drug at bedside if lithium toxicity occur
Mannitol (osmotic diuretic)
159
electrolyte imbalance where lithium toxicity may occur
Hyponatremia
160
Lab test important for Antimanic Medication such as Lithum Carbonate
BUN (renal function)
161
if no antipsychotic, antimanic,
antidepressant = Give_____
Anticonvulsant Medications:
Carbamazepine (Tegretol)
Divalproex (Depakote)
Gabapentin (Neurontin)
Pregabalin (Lyrica)
Lamotrigine (Lamictal) -- ADHD
162
after giving Anticonvulsant medication, you see a rash. What is the priority intervention?
RASH, Report MD!
163
PERSONALITY DISORDERS
Age of diagnosis:
Age of Improvement:
PERSONALITY DISORDERS
Age of diagnosis: Adolescent
Age of Improvement: 40 – 50 years old
164
ODD / ECCENTRIC / MAD
Cluster A
165
EMOTIONAL / ERRATIC / BAD
Cluster B
166
FEARFUL / ANXIOUS / SAD
Cluster C
167
Cluster __
- suspicious
Cluster A
Paranoid
168
Cluster ___
- social isolation and indifference
- hard time forming relationship
Cluster A
Schizoid
169
Cluster ___
- superstitious, magical thinkers
-"lucky charm"
Cluster A
Schizotypal
170
EMOTIONAL / ERRATIC / BAD
Cluster B
171
Cluster ___
-unpredictable mood, clings to relationship, unstable relationship
Cluster B
Borderline
172
Cluster ___
- law breakers, no regard for right or wrong
Cluster B
Antisocial
173
Cluster ___
- attention seekers, dramatic and theatrical
Cluster B
Histrionic
174
Cluster ___
-self-entitlement, denies weakness and failure
Cluster B
175
Cluster ___
Narcissistic
Cluster B
176
FEARFUL / ANXIOUS / SAD
Cluster C
177
Cluster ___
-avoids responsibilities and social interactions
Cluster C
Avoidant
178
Cluster ___
- extreme submissiveness (depends on others for decision making)
Cluster C
Dependent
178
Cluster ___
-extreme neatness and perfectionism
Cluster C
Obsessive compulsive
178
Management for Personality Disorders
Behavioral therapy (Role Playing)
179
Eating Disorder Goal
!!!To manage anxiety: impose rigid rules + regulations
180
Diagnostic criteria: more than ___ months
1. Intense fear of gaining weight
2. Body weight less than ___ % of the ideal
3. Food intake restriction
4. Distorted body image
5. Amenorrhea
Anorexia Nervosa
180
Diagnostic criteria:
1. Recurrent BINGE eating
2. Distress regarding binge eating (GUILT)
3. Compensatory behaviors (PURGING)
Bulimia Nervosa
181
Once a week for 3 months purging
(+) Binge Purge Syndrome
182
MEDICAL TREATMENT for EATING DISORDER
Selective Serotonin Reuptake Inhibitors
182
decrease GAMMA AMINO BUTYRIC ACID
ANXIETY
183
DECREASED SEROTONIN AND NOREPINEPHRINE
EATING DISORDERS
184
teeth markings or scarring on the knuckles
Russel's sign
185
Distortion of facts, unjustifiable excuse
-Man says he beats his wife because she does not listen
to him
Rationalization
186
-acknowledging the facts but not the emotions
-Person shows no emotional expression when discussing
serious car accident
Intellectualization
187
– replacing unattained goals with by one that is more attainable
Woman who would like to have her own children opens
a day care center
Substitution
188
overachieve in another area to
compensate for failure
Nurse with low self-esteem working double shifts so
that her supervisor will like her
Compensation
189
- rechanneling of unacceptable impulses to acceptable once
- Person who has quit smoking sucks on hard candy when
the urge to smoke arises
Sublimation
190
- categorizing people as either good or bad
Seeing all people without mustache as all feminine
Splitting
191
unconscious forgetting with disintegration of personality, consciousness, memory, identity, and emotion.
Dissociation
192
Formerly known as MULTIPLE PERSONALITY DISORDER
DISSOCIATIVE IDENTITY DISORDER
193
different identity in a different environment
DISSOCIATIVE FUGUE (Psychogenic fugue)
194
– unconscious forgetting
Woman has no memory of the mugging she suffered
yesterday
Repression
195
conscious forgetting
Student decides not to think about a parent’s illness to
study for a tests
Suppression
195
Exhibiting acceptable behavior to make up for
or negate unacceptable behavior
Person who cheats on a spouse brings the spouse a
bouquet of roses
Undoing
196
Acting the opposite of what one
thinks or feels
Person who despises the boss tells everyone what a
great boss she is
Reaction Formation
197
Acting the opposite of what one
thinks or feels
Person who despises the boss tells everyone what a
great boss she is
Reaction Formation
198
– ventilation of intense feelings toward persons less threatening
Person who is mad at the boss yells at his or her spouse
Displacement
199
unconscious blaming of unacceptable
inclinations or thoughts on an external object
An unfaithful husband suspects his wife of infidelity
Projection
200
accepting another person’s attitude beliefs, and values as one’s own (conforms feelings for approval)
"ginaya mo, ayaw mo"
Person who dislikes guns becomes an avid hunter, just
like a best friend
Introjection
201
-imitating or emulating others while searching for identity
"ginaya mo, gusto mo"
Nursing student becoming a critical care nurse because
this is the specialty of an instructor she admires
Identification
202
return to early stage of development
Man pouts like a 4-year-old if he is not the center of his
girlfriend’s attention
Regression
203
– failure to admit the reality of a situation
-Diabetic person eating chocolate candy
Denial
204
Pleasure seeker, needs immediate gratification
ID
204
Balancer – REALITY
Ego
205
Moral conscience, guilt
SUPEREGO
206
When coping mechanism are ineffective that results to disequilibrium.
CRISIS
206
to protect the feeling brought about own ego
ego defense mechanism
207
Freud Structural Theory of Personality on people with obsessive compulsive disorder, anorexia nervosa
Superego
208
Freud Structural Theory of Personality on people that are antisocial, borderline
ID
208
When coping mechanism are ineffective that results to disequilibrium.
CRISIS
209
caused by unexpected event (Loss of a job / starting a new job, Death of a loved one)
Situational
210
caused by natural catastrophe (earthquake, fire, tornado)
Adventitious / Social
211
– caused by expected events (menarche, marriage, pregnancy, retirement)
Maturational / Developmental
212
Focus or Therapy on Crisis
Here and Now (GESTALT THERAPY)
- immediate problem, feelings, and solutions
213
CRISIS
Initial assessment:
Factors to consider:
Initial assessment: Precipitating event
Factors to consider:
Perception
Support system
Coping mechanism
214
Age of group for Anorexia Nervosa
12-20 y/o
215
Age of group for Bulimia Nervosa
18-22 y/o (stress)
216
Anorexia Nervosa
___ loss of appetite
___ refusal to talk about food
___ lack of knowledge about food
___ counting calories
___ compulsive exercising
___ ritualistic food behaviors
___ preoccupation with food related activities
___ RECOGNIZES the problem
X loss of appetite
X refusal to talk about food
X lack of knowledge about food
/ counting calories
/ compulsive exercising
/ ritualistic food behaviors
/ preoccupation with food related activities
X RECOGNIZES the problem
216
Complications of Anorexia Nervosa
Alopecia, Anemia, Lanugo
217
Priority nursing diagnosis for Eating Disorder
1. Electrolyte imbalance
2. Altered Nutrition
218
Eating Disorder
____ Body Image Disturbance
_____ Altered Body Image
/ Body Image Disturbance (Perception problem)
X Altered Body Image
(if there is an actual deformity in the body natanggal or nasira or kinabit; e.g. amputation, mastectomy, burns, colostomy)
219
INTERVENTIONS for Eating Disorder
- Plan meals with the client
- Set time limit during meals
- Supervise client after eating
- LIMIT TIME ON SOCIAL MEDIA
220
[LEVELS OF ANXIETY]
Increased alertness, learning is effective
Gastrointestinal butterflies
Mild Anxiety
-Acknowledgement
-Verbalization
221
[LEVELS OF ANXIETY]
Selective attention, narrowed perception
Can be redirected
Gastrointestinal upset
Diarrhea
Urinary Frequency
Moderate Anxiety
PARASYMPATHETIC
(ParaTae, ParaIhi)
-Redirect
-Refocus
-ORAL anxiolytics
222
[LEVELS OF ANXIETY]
Cannot complete task, cannot solve problem
Cannot be redirected
Nausea, vomiting, diarrhea
Physiologic symptoms (chest pain, tachycardia)
Severe Anxiety
-IM anxiolytics
223
[LEVELS OF ANXIETY]
Delusions and Hallucinations
Violence and Suicide
Panic Anxiety
-Take Control
Restraint if needed
224
GENERALIZED ANXIETY DISORDER
3 or more of the symptoms for more than ___________.
6 months
224
repetitive thoughts
Obsession
225
repetitive actions (RITUALS)
Compulsion
226
Defense Mechanism of OCD
Undoing
226
Management for OCD
Management:
1. Allow the patient to perform the ritual
2. Adjust the schedule of the patient
3. Gradually limit the ritual
4. COGNITIVE BEHAVIORAL Therapy (challenge negative thinking)
227
fear of interacting with strangers
Social Phobia
227
irrational fear
PHOBIC DISORDER
227
fear of enclosed spaces
Claustrophobia
228
fear of inescapable places such as open areas - football field, market, park
Agoraphobia
229
fear of hospitals
Nosocomephobia
230
fear of death
Thanatophobia
231
Defense Mechanism of Phobic Disorder
Displacement and avoidance
232
sudden exposure to maximum stimulus
Flooding
233
emotional blindness
not able to determine/ not express
alexithymia
233
gradual exposure to the feared object
Systematic Desensitization
1st step: Let the client think and talk about the feared object
234
(+) Physical symptoms
(+) Excessive worry
Complex Somatic Symptom Disorder (CSS)
235
DOCTOR SHOPPING
Illness Anxiety Disorder (Hypochondriasis)
236
(-) Physical symptoms
(+) Excessive worry
Illness Anxiety Disorder (Hypochondriasis)
237
(+) Physical symptoms
(-) Excessive worry
Functional Neurologic Disorder (Conversion Disorder)
238
LA BELLE INDIFFERENCE
Functional Neurologic Disorder (Conversion Disorder)
239
nabulag ako pero okay lng kasi hindi na ko makakapag exam
LA BELLE INDIFFERENCE
Functional Neurologic Disorder (Conversion Disorder)
240
241
241
Primary Gain on SOMATOFORM DISORDERS
Relief of anxiety or guilt
242
Nursing interventions on SOMATOFORM DISORDERS
Rule out any possible organic of physiologic cause
Attend to physical complaints
Consistent care giver must be provided
Encourage verbalization of feeling
242
Secondary Gain on SOMATOFORM DISORDERS
Attention
242
Cause: Rape, War, Natural calamities
POST TRAUMATIC STRESS DISORDER (PTSD)
242
PTSD Manifestations:
Hypervigilance, Flashback, Avoidance, Dissociation, Detachment > 1 month
More than __ years old:
more than 6 yrs old
243
PTSD Manifestations:
Repetitive play and re-enactment
Less than ___ years old:
Less than 6 years old:
243
Psychotherapy
Adaptive closure therapy (empty chair technique)
BREATHING technique
Catharsis – releasing repressed emotions thru art and music
Debriefing – client is asked about their emotional reaction to an incident
Exposure therapy – confronting trauma associated thoughts rather than avoiding
244
out of the body experience
Depersonalization
244
Medical Management for PTSD
Selective Serotonin Reuptake Inhibitors
245
out of the world experience
Derealization
246
Primary Management for DEPERSONALIZATION / DEREALIZATION DISORDER
Talk Therapy
247
substance use that result in maladaptive behavior
Intoxication
247
use of a drug that is inconsistent with medical or social norms
Abuse
248
need for a higher dose to produce the same effect
Tolerance
249
physical or mental symptoms occurs when a person stops the use of the substance
Withdrawal
250
unsuccessful attempts to stop using the substance
Dependence
251
2 Contributing factor of Substance Abuse Disorders
Genetics and Family Dynamics
252
downers to escape reality
NARCOTICS
253
Commonly abused narcotics
Opiods
Codeine, Tramadol, Oxycodone, Morphine, Meperidine, Fentanyl
254
weakest opiod narcotic
Codeine
255
strongest opiod narcotic
Fentanyl
255
Hypotension
Bradycardia
Bradypnea
Pupil CONSTRICTION
Signs of Abuse
255
Sign of Overdose of narcotics
PINPOINT pupil
256
Detoxification drug for Narcotic
Methadone (low potent opiod)
-does not interfere with function, productivity
257
process of safe withdrawal
Detoxification
258
Antidote for Narcotic Overdose
Naloxone (Narcan) /
Naltrexone (ReVia)
259
Early signs of withdrawal of narcotics
Lacrimation, Diaphoresis, Rhinorrhea, Yawning
260
Late signs of withdrawal of narcotics
Vomiting and Diarrhea
261
Downers = Dryness
stop=Withdrawal = Wetness
262
Management for overdose of Barbiturate
Activated charcoal
262
sedative-hypnotics to cause sedation
BARBITURATE
262
Commonly abused barbiturates:
-barbitals (phenobarbital, methohexital, thiopental) -anesthesia
263
Signs of Withdrawal of Barbiturate
Anxiety and Seizure
263
Sign of abuse for Barbiturate
same with narcotics
Hypotension
Bradycardia
Bradypnea
Pupil CONSTRICTION
264
Uppers to cause euphoria
STIMULANT
264
Signs of abuse of Stimulants
Hypertension
Tachycardia
Tachypnea
Pupil DILATION
265
Commonly abused stimulants
CoMet
COCAINE
METHAMPHETAMINE HCl (shabu)
266
Sign of abuse of METHAMPHETAMINE
DILAT
Di makatulog
Di makakain
Decreased appetite, insomnia
: stained and rotting teeth
266
Sign of abuse for COCAINE
Excoriated nostrils, nosebleeds
267
Sign of withdrawal of METHAMPHETAMINE
HALLUCINATIONS
"lost his job" = no money
hindi nakatira = crime
268
Sign of withdrawal for COCAINE
BIPOLAR CYCLING
(high -> stop -> depression = suicide)
269
Medical Management for STIMULANTS
Bromocriptine (Parlodel) – decreases cravings
270
to cause hallucinations
HALLUCINOGENS
271
Most commonly abused hallucinogens:
Cannabis Sativa (Marijuana)
Lysergic Acid Diethylamide (LSD) – Synesthesia
Phencyclidine (PCP) – violence
Ecstasy – aggression
272
Blood shot eyes (increased blood flow to eyeballs)
Cannabis Sativa (Marijuana)
272
Active ingredient in Marijuana
Tetrahydrocannabinol
273
type of hallucinations in Marijuana
Visual hallucinations
274
weight gain, food trip, laugh trip
Cannabis Sativa (Marijuana)
275
Detectability (urine)
Marijuana
30 days
276
Detectability (urine)
Methamphetamine
3 days
277
Detectability (urine)
Cocaine
3 days
278
Shabu, cocaine, marijuana Hair follicles
3 months
279
Effects of alcohol:
Sedation
280
common side effect of DISULFIRAM ANTABUSE (for alcoholism)
DIZZINESS
280
Defense mechanism of Alcoholism
Denial
280
to stop alcoholism / to maintain sobriety
AVERSION THERAPY
-pair a behavior with unpleasant stimulus
281
Drug used for Alcoholism
DISULFIRAM ANTABUSE
282
DISULFIRAM + ALCOHOL =
severe adverse reaction (headache, abdominal pain, vomiting, palpitation)
283
What to assess in Alcoholism
TIME OF THE LAST ALCOHOL INTAKE
-wait for 8 hours (to eliminate last intake of alcohol in the body)
283
Contraindication for Alcoholism
Anything with alcohol (Mouthwash, cough suppressants, perfume etc)
284
Alcohol Large amount (Sedative) = Decrease vital signs
Alcohol Stop/ Withdrawal = increased Vital signs
285
ALCOHOL WITHDRAWAL (6-12 hours)
Stage 1
286
ALCOHOL WITHDRAWAL (48-72 hours):
Stage 3: Delirium Tremens (seizures and hallucinations)
286
ALCOHOL WITHDRAWAL (12-48 hours)
Stage 2
287
To decrease cravings to alcohol –
Acamprosate (Campral)
288
To block the effect of alcohol
Naloxone / Naltrexone
289
No. of participants in group therapy
8 - 10
290
norming
rules
290
storming
sharing
291
Stages of Group therapy
Forming, Norming (rules), Storming (sharing)
292
Group therapy
Leader:
Decision Maker:
Leader: Stable patient
Decision Maker: All members
292
Most important element in Group therapy
Motivation
292
Formation of Group Therapy
Circular formation
293
Tool in Group therapy
Cut, Annoy, Guilt, Eye opener (Cage)
-stop, angry, regrets, realization
294
kinokonsinti
CODEPENDENCY
295
Support Groups
Alcoholic anonymous:
Al-Anon:
Alateen :
Rainbow Recovery :
Support Groups
Alcoholic anonymous: alcoholic
Al-Anon: spouse
Alateen : children
Rainbow Recovery : LGBTQIA
295
pinagtatakpan
ENABLING
296
Alcoholism – causes THIAMINE DEFICIENCY (Vitamin B1)
WERNICKE – KORSAKOFF’s SYNDROME
297
Acute
Short-term
Reversible
[ACO]
Ataxia
Confusion
Ophthalmoplegia
Wernicke’s
298
Chronic
Long-term
Irreversible
[CHA]
Confabulation
Hallucination
Amnesia
Korsakoff’s
298
Management for WERNICKE – KORSAKOFF’s SYNDROME
Thiamine-Rich diet
-Coordinate with DIETICIAN
299
rich in thiamin (Vit B1) foods
1. lean pork chops
2. fish (salmon)
3. Flax seeds
4. Navy Beans
5. green peas
6. Firm tofu
7. brown rice
8. acorn squash
9. asparagus
10. mussels
300
Delirium: Sudden Onset
Dementia: Gradual Onset
301
Delirium: Alcohol withdrawal
Dementia: Alzheimer’s disease
302
Delirium: Temporary Disorientation
Dementia: Permanent Disorientation
303
Delirium: Hours to days
Dementia: Lifetime
304
Delirium: altered LOC
Dementia: normal LOC
305
Delirium: altered attention span
Dementia: normal attention span
305
Delirium: Impairment of neuron
Dementia: Death of neurons
306
Delirium: Reversible Prognosis
Dementia: Irreversible Prognosis
307
Delirium: Temporary Memory Loss
Dementia: Permanent Memory Loss
308
addiction + severe mental illness
Dual Diagnosis
309
Aloof, alone, catatonic (have the tendency to hold their breath)
WITHDRAWN CLIENT
310
Engage in highly structured, scheduled activities
depressed clients
310
approach to DEPRESSED CLIENT
Kind Firmness (SOME)
Silence
Offering Self
Motivate – remind client of time when she or he felt better and was successful
310
approach to WITHDRAWN CLIENT
Active Friendliness
1. Activity – Achievable, and non-competitive activities
>watering the plants
>folding linens
>arranging table
2. Accompany – Offering self
3. Appraise – NO material rewards
311
approach for SUICIDAL CLIENT
DIRECT CONFRONTATION APPROACH
Clarify the client’s statement
Confront the client directly
Consider the plan, method, and lethality (How? When? Where?)
Confiscate dangerous objects
Contract of Safety: “I will not harm myself intentionally or accidentally with the next 24 hours”
312
signs of suicidal clients
[GCASH]
Giving of valuables
Cancelling of appointments
Apologetic
Sudden cheerfulness and increase in energy
Homicidal and suicidal thoughts
313
314
315
Most Common Time of Suicide
Early morning, Monday, During endorsement
316
Most Common Method of Suicide
Hanging
316
Most Common Place of Suicide
Home
317
Gender and age of Suicide
Males (20-24)
Female (15-19)
more common: Male
4 males: 1 female
318
Civil Status for Suicide
Single
319
Important factor to consider for suicidal client
Substance Abuse!!!
320
Constant Observation: ___________
Irregular observation
best answer: 1 on 1 supervision
alternative: frequent monitoring every 15 mins
320
What is the priority:
a. suicidal history
b. suicidal thoughts
c. suicidal ideation (plan)
priority: with means readily available!
c. suicidal ideation (plan)
321
not suicide but will do dangerous activities
"passive suicidal"
322
approach to Paranoid client
Passive Friendliness
-(keep doors open/ be available for pt to approach you)
323
[DISARM]
Develop trust
Involve the client in planning
SEALED CONTAINER (for food and medicine)
Avoid staring, whispering, and giggling
Respect personal space (not less than 4ft) / 3-6ft
Maintain professional tone (use simple, direct, concise words)
Passive Friendliness
324
"May lason yan, di ko kakainin"
a. Martha was prepared by the hosp chef
b. food given is same with other pts
c. the food is not poisoned, eat it when you get hungry
c. the food is not poisoned, eat it when you get hungry
325
approach to MANIC / MANIPULATIVE client
Matter-of-Fact Approach
326
Point out unaccepted behavior, and inform client of what is expected
(Calm, non-threatening, non-punitive, directive tone of voice)
Matter-of-fact Approach
(SET FIRM LIMITS)
326
"Maria, its not time for lunch. Go back to your room.
"Maria shouting and cursing is not allowed in the building. It's not yet time to eat. Go back to your room."
Matter-of-Fact Approach
326
Activity for Manic/Manipulative Pts
Non-competitive, Solitary, Gross Motor Activities
327
Room for Manic/Manipulative Pts
Private Room
328
[MANIC PTS]
a. running
b. walking
b. walking
328
[MANIC PTS]
a. watching TV
b. reading newspaper
c. listening to radio
d. writing a journal / drawing
d. writing a journal / drawing
329
Diet for Manic/ Manipulative Pts
high calorie, fingerfood
330
Verbally abusive
AGGRESSIVE CLIENT
330
Diet for Manic/ Manipulative Pts
1. a. fruit salad
b. banana
2. a. spaghetti
b. cheeseburger
3. a. tinola
b. french fries
4. a. potato chips
b. milk shake
1. b. banana
2.b. cheeseburger
3. b. french fries
4. b. milk shake (high calorie, healthier)
331
Visibility of 4 – 6 staff members
SHOW OF FORCE
Note: Only 1 RN is allowed to communicate with the patient
332
Physically violent
ASSAULTIVE CLIENT
333
Decrease Stimulation – turn of television, let other clients leave the room
Deescalate – Encourage expression of feelings, promote ASSERTIVE COMMUNICATION
Directive approach – calm, non-threatening
AGGRESSIVE CLIENT (Verbally abusive)
334
Goal of Management for ASSAULTIVE CLIENT (Physically violent)
To strengthen patient’s impulse control
335
RESTRAINTS PRINCIPLE
Principle: Least to Most restrictive
336
Room for Seclusion
lockable and observable from the outside
337
337
RESTORATIVE, NOT PUNITIVE to help client regain self-control
SECLUSION
338
SECLUSION
Monitoring:
Environment:
Monitoring: one-on-one monitoring on the first hour
Environment: less stimulated environment (no visitors and phone calls allowed)
339
If pt has schizo, ayaw niya itake due to side effects, wag pilitin. They can think clearly at the time
Principle: if client admitted in mental facility -they can still refuse treatment but loses it if they are a threat to themselves or to other people! And they cannot go out without doctor’s order.
340
is the doctor's order needed for application of restraints?
NOT REQUIRED! BUT must be obtained within 1 hour
MORE CORRECT: according to hospital policy/agency protocol!!!
341
Proper Application of Restraints:
- ____ staff members required
- Adequate circulation must be ensured every ____ mins
- Anchor on a stable part of the bed:
- 6 to 8 staff members required
- Adequate circulation must be ensured every 15 mins
- Anchor on a stable part of the bed: Bed Frame
342
is the doctor's order required for the removal of restraints?
YES. Required doctor's order for the removal of restraints
343
how many RN needed for removal of restraints?
2 RNs
344
Temporary removal of restraints
alternately, one at a time,
for 10 minutes every 2 hours
345
Permanent removal of restraints
alternately one at a time
346
how to tie restraints
QUICK-RELEASE KNOT /
"Half-bow tie"
347
Most Important Element of Nurse-Patient Relationship
ACCEPTANCE
347
Elements of a contract of Professional Relationship
-Time, duration, and venue of sessions
- Termination and criteria for termination
- Nurse’s and patient’s responsibilities
- Participants
347
Purpose of Nurse-Patient Relationship
To help client develop new and effective coping mechanisms
348
Phases of Nurse Patient Relationship
(POWT)
PRE – ORIENTATION
ORIENTATION
WORKING
TERMINATION
349
Nurse’s Responsibility: Read the patient’s chart
Problem: Reluctance of the nurse
Goal: Self – awareness / INTROSPECTION
PRE – ORIENTATION
349
Nurse’s Responsibility: Formulate Nursing Diagnosis
Problem: Resistance of the patient
Goal: Establish TRUST / Build RAPPORT
ORIENTATION
350
Nurse’s Responsibility: Promote the client’s insight
Problem: EMOTIONAL ATTACHMENT
Goal: RN (explore); Patient (verbalize)
WORKING
350
Patient to Nurse
Transference
351
Nurse to Patient
Countertransference
-laging nasa counter - nurse
352
BQ: Which of the ff emphasizes on the concept of countertransference?
When the nurse provides personal contact details to the pt.
353
Nursing responsibility:
Determine client’s feelings about the end of the relationship
Problem: Separation Anxiety
Prevention: Constantly remind patient about the contract
Intervention: Encourage verbalization of feelings
Goal: Evaluate effectives of intervention
TERMINATION
354
Intervention for Transference and Countertransference
Intervention:
▪ Remind the patient about the contract
