TAKE 2 Flashcards

Question

Cognitive distortion Catastrophizing

Answer 1

We expect disaster to strike, no matter what. We exaggerate the importance of insignificant events. - Ex. I'm going to die if I gain weight

Answer 2

A distorted belief that everything others do or say is somehow about us. - Ex. A family moves and a child is having trouble making friends. The parents blame themselves

Answer 3

We see ourselves as helpless, a victim of fate, having no control, or we assume total responsibility for the pain and happiness of everyone around us (overcontrol). - Ex. I’m sorry my stuttering makes you uncomfortable

Answer 4

We feel resentful because we think we know what is fair, but other people won’t agree with us. - Ex. Coworker gets promoted but we think the boss is being unfair because I should have been promoted

Answer 5

We hold other people responsible for our feelings and behaviors. Nobody can “make” us feel any particular way—only we have control over our own emotions and emotional reactions.

Answer 6

We have a list of ironclad rules about how we and others should and must behave. - Ex. I should have arrived to the meeting earlier

Answer 7

We believe that what we feel must be true automatically. “I feel it; therefore it must be true.” - Ex. I feel anxious so I know something dangerous will happen

Answer 8

We generalize one or two qualities into a negative global judgment. For example, “I’m a loser” versus “In one situation, I failed.” - Ex. Because she is always late to work she is irresponsible. I failed my test so i'm a failure

Answer 9

I have to prove my opinions and actions are correct. Being wrong is unthinkable.

Answer 10

Health teaching and health promotion Milieu therapy Mindfulness-Based Cognitive Therapy Group therapy First-line psychotherapy interventions - Cognitive Behavioral Therapy (CBT) - Interpersonal psychotherapy (IPT) - Problem-solving therapy (PST)- make lists? - Cognitive Behavior Therapy for Insomnia (CBT-I)

Answer 11

- question underlying assumptions, and consider alternative explanations to problems - identify cognitive distortions - activities that raise self-esteem - physical activities the patient enjoys - supportive relationships/ support groups, therapy, and peer support - referrals for spiritual/religious information

Answer 12

- mute: make observations - Use simple, concrete words - Allow time for the patient to respond - Listen for covert messages and ask about suicide

Answer 13

- small, high calorie/protein food and fluids frequently - encourage family/ friend to remain with the patient during meals - Offer patient preferred foods/ drinks choices. Involve the dietitian - Weigh the patient weekly

Answer 14

- Encourage patient to get up and dress and to stay out of bed during the day - periods of rest after activities - Encourage the use of relaxation measures in the evening (warm bath, warm milk, progressive muscle relaxation techniques) - Reduce environmental and physical stimulants in the evening-provide decaffeinated coffee, soft lights, quiet activities

Answer 15

- Encourage the use of toothbrush, wash cloth, soap, make up, shaving equipment, and so forth - When appropriate, gift, step by step reminders, such as, “ wash the right side of your face, now the left”

Answer 16

- Specifically monitor bowel movements - Offer foods high in fiber, and provide periods of exercise - Encourage the intake of fluids - Evaluate the need for laxatives and enemas

Answer 17

- panic disorder - generalized anxiety disorder (GAD) - OCD - PTSD - bulimia - PMDD - panic disorder - social phobia

Answer 18

- Increase serotonin - inhibits serotonin transporter proteins (SERT) therefore inhibiting reuptake of serotonin from the synaptic cleft

Answer 19

Increased SI Headaches Dizziness Sweating Blurred vision Dry mouth Insomnia/drowsiness Indigestion Diarrhea/constipation Loss of appetite/weight loss Sexual dysfunction: - Reduced libido/ Erectile dysfunction/ Difficulty achieving orgasm in men Anxiety : first few weeks

Answer 20

Agitation Increased HR Increased BP Increased Temp Sweating Mydriasis: dilated pupils Seizures Hypertonia Mild: restlessness, shivering, and diarrhea Severe: “cog-wheel” rigidity: incremental movement/ not fluid movement, fever, and seizures.

Answer 21

- muscle relaxants - serotonin antagonists

Answer 22

- St. John’s wort - OTC: dextromethorphan (cough and cold medications)

Answer 23

Teratogenic: Pregnant/ Breastfeeding Diabetic Epileptic Diagnosed with Kidney, Liver, or Heart Disease Diagnosed with Bipolar I Diagnosed with bleeding disorders

Answer 24

Other SSRIs /antidepressants NSAIDs/ Antiplatelet Medication Clozapine and Pimozide St. John’s Wort Alcohol /Caffeinated drinks Bipolar 1: can cause mania Do not discontinue abruptly

Answer 25

higher risk of suicide Teratogenic

Answer 26

F-SPEC Fluoxetine (Prozac) Sertraline (Zoloft) Paroxetine (Paxil) Escitalopram (Lexapro) Citalopram: (Celexa)

Answer 27

SNRIs SNDIs

Answer 28

may be added to SSRI (to augment) counteract SSRI s/s: nausea, anxiety, or insomnia.

Answer 29

mirtazapine (Remeron)

Answer 30

- blocks presynaptic α2-noradrenergic receptors - Increases norepinephrine - Increases serotonin

Answer 31

- duloxetine (Cymbalta) - venlafaxine (Effexor)

Answer 32

- Weight gain - fatigue - sexual dysfunction - hypotension - muscle cramps - urinary retention - constipation

Answer 33

depression chronic pain (neuropathy; improves sleep in pts with fibromyalgia)

Answer 34

educate pt on why medication is given. Pt may refuse to take antidepressant meds for pain.

Answer 35

CIAN Clomipramine (anafranil) Imipramine (Tofranil) Amitriptyline (Elavil) Nortriptyline (pamelor, Aventyl)

Answer 36

- depression and chronic pain - OCD/ anxiety - Neuropathic pain

Answer 37

- Blocks reuptake of norepinephrine and serotonin - Increase NE/ SR - Block: ACh, H1, A1

Answer 38

dysrhythmias (cardiotoxic) heart block (cardiotoxic) Increased HR Decreased BP; OTH (fall risk) dizziness weight gain sedation/Drowsiness (give at night) Sweating anticholinergic effects: - dry mouth - blurred vision - constipation- need immediate medical attention - urinary retention- need immediate medical attention

Answer 39

phenelzine (Nardil) tranylcypromine (Parnate)

Answer 40

depression panic disorder social phobia/ anxiety OCD PTSD bulimia

Answer 41

prevent monoamine oxidase from breaking down monoamines: norepinephrine, serotonin, and dopamine Increases: - norepinephrine - serotonin - Dopamine

Answer 42

Weight gain Fatigue Sexual dysfunction Muscle cramps Urinary retention Constipation HTN Crisis

Answer 43

Increased BP Increased HR Increased Temp Headache AMS Confusion Nausea/ Vomiting Chest pain Arrhythmias Palpitations

Answer 44

Pseudoephedrine (Sudafed) foods containing Tyramine Other antidepressants

Answer 45

Chocolate Wine Cheese Cured meats Dried fruits Avocado Dry, pickled cured fish Caffeine Alcohol

Answer 46

- drug therapy failure - acutely suicidal patient - depressed patient with psychotic symptoms - Severe manic behavior/ treatment resistant mania and pts with rapid cycling

Answer 47

Anticonvulsants

Answer 48

head trauma seizure disorders brain tumors

Answer 49

- short term memory loss - Don't make any life changes/ decisions while undergoing ECT - Sedation; anesthesia - Do not drive; Fall risk

Answer 50

Talk therapy - CBT

Answer 51

CBT: reframes cognitive distortions

Answer 52

DBT: dialectical behavioral therapy

Answer 53

Exercise - At times as effective as talk therapy

Answer 54

Depression

Answer 55

Substance use Anxiety disorders - Panic disorder - Social phobia

Answer 56

Only depression

Answer 57

Depression and mania - Episodes last one week or need hospitalization

Answer 58

Euphoric/elated/ energized (high) irritable/hostile labile: mood swings

Answer 59

- Grandiose delusions; hallucinations; disorganized - Have many plans, but unable to organize thoughts to complete them; - poor attention- easily distracted: hallmark symptom of mania - Sexual thoughts; volger

Answer 60

- Pressured; loud, rapid - Circumstantial: adding unnecessary details - Taginatial: when people think taginitially they lose the point they were trying to make and never find it again. - LOA: mid sentence derailment - flight of ideas; nonstop talking; disorganized - clang associations: rhyming - inappropriately demanding, sarcastic, crude - Sexual inappropriate language

Answer 61

- agitation - restless and disorganized; - impulsive; may have angry outbursts; - extreme goal oriented: too busy for eat, sleep (insomnia), sex; - manipulative and pushes limits; - wild & uncontrolled spending; - dress extreme (colorful/bizarre); may disrobe; push limits

Answer 62

- reduce stimulation - No group contact - Physical exercise - Set structure and limits on aggression - finger foods/ water/ sleep/ self care

Answer 63

Depression; Hypomania: - 2 episodes

Answer 64

- Good humor - very sociable, boundless self-confidence - Partake in get rich quick schemes - inappropriately familiar with strangers (poor boundaries)

Answer 65

Psychosis never present

Answer 66

- Flight of Pressured speech but makes sense; - sexual/crude themes; treats everyone as a friend

Answer 67

- Overactive - distractible - increased sexual activity - voracious appetite - decreased sleep - buying sprees & gives away money and gifts; - flamboyant dress and excessive make-up

Answer 68

milder lows and milder highs cycle over a period of 2 years

Answer 69

4-5 cycles (high & lows) within 1 year

Answer 70

Bringing on a manic episode

Answer 71

Quetiapine monotherapy Olanzapine and fluoxetine combo Acute bipolar depression: Lurasidone

Answer 72

Depression: Intense rage Reflective of developmental level of child Hard to dx

Answer 73

Greater neurologic abnormalities/ cognitive disturbances - Incidence of mania decreased with age

Answer 74

- Use firm and calm approach: (“John come with me. Eat this sandwich” finger foods) - Use short and concise explanations or statements - Remain neutral; avoid power struggles and value judgments - - Set limits in a firm, non threatening, and neutral manner to prevent further escalation/ provide safe boundaries - Be consistent in approach and expectations: limits manipulation - Have frequent staff meetings - Identify expectation in simple concrete terms with consequences - Firmly redirect energy into more appropriate and constructive channels - Use distraction techniques as a tool to de-escalate

Answer 75

Medication compliance

Answer 76

Non-adherence to medication

Answer 77

Egosyntonic - They miss the highs of hypomania that make them to feel invincible, so they don’t believe they need the meds any longer

Answer 78

Major depression - Prevent manic episodes/anti-suicidal properties

Answer 79

its a salt; works on sodium channels. Decreases dopamine & glutamate Increases GABA

Answer 80

- excessive diarrhea - vomiting - sweating - Drug serum: 1.5+ mEq/ L

Answer 81

Cr BUN GFR TSH Drug serum

Answer 82

NSAIDS - increase effects of lithium

Answer 83

< 1.5 mEq/L fine hand tremor polyuria mild thirst mild nausea (give with food) mild weight gain

Answer 84

1.5 - 2.5 mEq/L nausea vomiting lethargy coarse hand tremor fatigue

Answer 85

2.5 - 3.5 mEq/L confusion agitation delirium tachycardia hypertonia

Answer 86

>3.5 mEq/L Coma seizures hyperthermia hypotension

Answer 87

No antidote - flush drug from system

Answer 88

High lithium levels

Answer 89

Low lithium levels

Answer 90

Low lithium levels

Answer 91

High Lithium Levels

Answer 92

Maintain normal/ consistent fluid and Na intake

Answer 93

carbamazepine (Tegretol) valproic acid (Depakene/Depakote) lamotrigine (Lamictal)

Answer 94

carbamazepine (Tegretol) valproic acid (Depakene/Depakote)

Answer 95

- rapid-cycling bipolar disorder; acute manic/ mixed episodes - neuropathic pain; migraines - Seizures - makes neurons less excitable in acute mania by stabilizing the inactive state of sodium channels in neurons

Answer 96

Decreases synaptic transmission in CNS by affecting the sodium channels. - Inhibits Na channels - increases dopamine - increases GABA

Answer 97

bone marrow depression; D/C Leukopenia Agranulocytosis Stevens-Johnson syndrome: Toxic Epidermal Necrolysis Accidental pregnancy- birth control ineffective

Answer 98

CBC ALT AST Bilirubin Amylase Lipase Blood glucose Platelets Drug serum: (6-8 mg/L)

Answer 99

Grapefruit - Increases serum levels

Answer 100

- seizures - Bipolar with mania - Unresponsive to lithium - Rapid cycling - Severe agitation

Answer 101

Increases GABA

Answer 102

- CNS depression - Vomiting - Anorexia - edema - Weight gain - tremors (postural) - Increase risk for bleeding with warfarin. - thrombocytopenia: PLT count

Answer 103

ALT AST Bilirubin Amylase Lipase Blood glucose Platelets Drug serum: 50-100 mcg/mL

Answer 104

50-100 mcg/mL

Answer 105

CNS depression - antihistamines - antidepressants - opioids - MAOIs - sedatives/hypnotics. - increases the concentrations of lamotrigine (Lamictal) Dont D/C abruptly

Answer 106

Hepatotoxicity pancreatitis Teratogenicity: Birth defects

Answer 107

bipolar depression/ antiepileptic

Answer 108

Inhibits sodium channels. Inhibits glutamate Inhibits aspartate Increases GABA

Answer 109

Blurred vision Double vision Stevens–Johnson syndrome (SJS) Photosensitive skin arrhythmias heart block cardiac arrest

Answer 110

AZ-O-QRAP - aripiprazole - ziprasidone - Olanzapine (ZyPREXA) - quetiapine - risperidone - asenapine - paliperidone

Answer 111

Olanzapine and quetiapine: - monotherapy - as adjunctive medications to lithium or valproate

Answer 112

- Reduces overwhelming stimuli - Protects the pt from self & others - Prevents destruction of property - Not used as punishment - Used when other less restrictive measures have been tried and failed. - Maintain usual procedures - Reassure pt that this measure is temporary. - Use brief, concrete, kind statements.

Answer 113

renewed every 24 hours Emergency: obtain order within 1 hour

Answer 114

ask a patient to return to room 1–1 PRN meds Seclusion Emergency meds – chemical restraint Physical restraints

Answer 115

circulation: q15 MINS for 1st hour; then q30 min ROM: q2h Toileting: q2h Refreshments: q2h

Answer 116

- recurrent nature of disease - Long term medication therapy - Signs and symptoms of relapse - - heightened mood - - decreased sleep - - increased activity - Help putting lives back together; support groups - - Intensive therapy - - Medications - - Partial Hospitalization Programs - - home visits

Answer 117

done to divide staff - Must stay united/ staff meetings/ set limits - consistency among the staff is the key to success.

Answer 118

Counter transference

Answer 119

Stop. discuss these feelings with your supervisor.

Answer 120

- Loss of interest in activities - Trouble sleeping - Trouble eating - physical aches/ pains - tense - irritable - powerless

Answer 121

physiological harm and chronic emotional difficulties. - Colds and influenza - Asthma - Stomach ulcers - Eczema and other skin disorders - Heart disease - Cancer - Depression - PTSD

Answer 122

- quality sleep - Balanced nutrition - Physical activity - Mindfulness practices: - Experiencing nature - Mental healthcare - Supportive relationships

Answer 123

Stress Anxiety Relief behavior : defense mechanisms Effective or ineffective mediation

Answer 124

Resilience

Answer 125

Exposure/witness to a severe trauma/ unbearable event. (Often ACEs)

Answer 126

more than 4 weeks

Answer 127

extraordinary helplessness or powerlessness flashbacks nightmares Avoidance of stimuli associated with the event numb feeling empty Detachment Distorted negative cognitions Relationship issues Negative mood/ thoughts

Answer 128

irritability Aggression Self-destructive behavior Hyper-vigilance Exaggerated startle response lack of trust Dissociative symptoms

Answer 129

Cognitive processing therapy (CPT) Cognitive behavioral therapy (CBT) especially when combined with exposure Prolonged exposure (PE) therapy Eye movement desensitization and reprocessing (EMDR) Family therapy Relaxation/stress relieving techniques

Answer 130

SSRI’s - Sertraline - Paroxetine Psilocybin mushrooms AKA: Shrooms

Answer 131

Same as PTSD But lasts less than 4 weeks

Answer 132

Depersonalization disorder Dissociative Amnesia Dissociative Amnesia: Fugue Dissociative identity disorder

Answer 133

Feeling detached from and outside one’s body or mental processes – “dreamy or mechanical.” 3rd person perspective Not delusion

Answer 134

Unconscious/ involuntary - Inability to recall important information about oneself. - May be selective for the traumatic event or for a particular time period or can be one’s whole life

Answer 135

Sudden unexpected travel away from home; assumes a new identity Inability to remember the past

Answer 136

Existence of two or more distinct alternate-personalities “alters” that recurrently take control over the patient’s behavior Each alter has its own characteristics Alters are aware of other personalities Primary personality notices gaps in memory; strange clothing; strangers call person by another name; not aware of other personalities Primary cause: ACEs

Answer 137

Safe simple milieu Reassure patient of their safety Orientation pt to surroundings Offer self Allow expression of feeling Let memories return on their own Help pt recognize increased anxiety causes increase in symptoms Help patient identify triggers Assess current methods of coping Journaling: helps pt see patterns Grounding techniques: - Ice in hands - Counting - Being in safe place - Blanket wrapping

Answer 138

CBT DBT EMDR Individual / group therapy

Answer 139

Egodystonic

Answer 140

Depressive disorders alcohol/drug use disorders eating disorders bipolar disorders Major depressive disorder (MDD)

Answer 141

cancer irritable bowel syndrome kidney and liver dysfunction reduced immunity Cardiovascular: Chronic anxiety

Answer 142

Respiratory Cardiovascular Endocrine Neurologic Metabolic

Answer 143

Relief of anxiety symptoms

Answer 144

Benefits as a result of the disorder - Increased attention - Decreased work Responsibilities - Preventing secondary gains is important during treatment, because they cause a person to be reluctant to change their behavior

Answer 145

healthy life response that provides the energy to handle life - Alex has a chemistry test this morning. She “crammed” for the test the previous night but did not study before that. She has an upset stomach and headache

Answer 146

temporary response to loss of security. Example: anxiety before an exam - Charlie is 19 years old with an ileostomy caused by rectal surgery for cancer, which has rendered him sexually impotent. He is admitted to the psychiatric unit and is unable to state his name

Answer 147

persistent anxiety not related to any actual problem - Mr. Jones has not left his house for 3 months. He tells his family, “I know this is not normal, but I just can’t go outside.” His wife died 3 years earlier

Answer 148

Perceptual field: - Heightened perceptual field, grasps all aspects of environment, able to identify anxiety producing issues Ability to learn: - Works effectively, problem solves Other characteristics: - restless, impatient, mild tension-relieving behaviors (tapping foot, nail biting)

Answer 149

Perceptual field: - narrowed perceptual field, focuses better if helped, selective inattention Ability to learn: - problem solves but not optimally, benefits from guidance from others Other characteristics: - shakiness, urinary frequency & urgency, increased pulse, more extreme tension-relieving behaviors (pacing)

Answer 150

Perceptual field: - tunnel vision, not able to attend to events in environment even when pointed out Ability to learn: - compromised; unable to see connections, distorted perceptions Other characteristics: - feelings of dread, confusion, intense somatic symptoms (nausea, dizziness, headache), tachycardia, loud and rapid speech, demanding attitude

Answer 151

Perceptual field: - unable to focus, may have hallucinations or delusions. Ability to learn: - disorganized; irrational thinking Other characteristics: - sense of terror, agitation or immobility, mute or unable to speak in an understandable way, severe shakiness

Answer 152

last 6 months or more - Furrowed brow - Twitching eyelid - Wrenching of hands

Answer 153

Depression

Answer 154

SSRI’s &/or Buspirone

Answer 155

Excessive fear that: (provokes panic attack) - a person might do something embarrassing - be evaluated negatively by others

Answer 156

intense shyness sensitive to criticism Poor self-esteem Distorted view of strengths and weaknesses Avoidance of: - situations where they have to talk to others - feared situations: — public speaking — writing in public — meeting strangers — eating in public — public restrooms

Answer 157

- Reassure patient safety - Discuss perception of threat - Discuss the reality of the situation - Include patient in selection of alternative coping skills - Group activities; w/ patient if too scared - No touching - Space to exit - Positive feedback for interactions with others

Answer 158

- Behavior therapy - Systematic desensitization - Exposure Therapy - Flooding - Aversion therapy - Relaxation techniques: — Breathing — progressive muscle relaxation - Decrease stimulants — Caffeine — pseudoephedrine — amphetamines — cocaine — assess for use of self medicating with alcohol (CNS depressant) - Sleep hygiene - Increase Physical Activity

Answer 159

- Calm voice - Help patient focus on the problem - Exploring (Therapeutic coms) - Clarification (Therapeutic coms) - Explore previous successful coping strategies - Burn off excess energy

Answer 160

Remain calm Stay with the person Minimize environmental stimuli Simple/ Clear statements Set limits/ pt safety Medication

Answer 161

SSRIs - Fluoxetine/Prozac - Sertraline/Zoloft - Paroxetine/Paxil SNRIs - Venlafaxine Benzodiazepines: short term use - Lorazepam - Clonazepam/Klonopin - Alprazolam/Xanax

Answer 162

Cope with anxiety Make reality less threatening Preserve self-esteem

Answer 163

Altruism Sublimation Humor Suppression

Answer 164

Displacement Undoing Repression Reaction formation Rationalization Somatization /conversion

Answer 165

Denial Regression Passive aggression Projection Splitting

Answer 166

stressors met by meeting the needs of others

Answer 167

- substituting constructive activity for unacceptable impulses - Similar to displacement, but takes place when we manage to displace our unacceptable emotions into behaviors, which are constructive and socially acceptable, rather than destructive activities. - Satisfying an impulse (e.g. aggression) with a substitute object. In a socially acceptable way Example: - Sport is an example of putting our emotions (e.g. aggression) into something constructive. - Anger issues= pt takes up boxing

Answer 168

deal with stressors by finding the humor in them

Answer 169

Consciously deciding to ignore stressor temporarily

Answer 170

- Unconsciously bury memories of stress unconsciously - not being able to recall a threatening situation, person, or event. Thoughts that are often repressed are those that would result in feelings of guilt from the superego. Example: - In the oedipus complex, aggressive thoughts about the same sex parents are repressed and pushed down into the unconscious. - War vet: forgetting trauma

Answer 171

- transferring emotions to something non- threatening - The redirection of an impulse (usually aggression) onto a powerless substitute target. The target can be a person or an object that can serve as a symbolic substitute. Example: - Someone who is frustrated at his or her boss at work, may go home and kick the dog/ yell at wife

Answer 172

- overcompensation, behavior opposite - “ believing the opposite” - A person goes beyond denial and behaves in the opposite way to which he or she thinks or feels Example: - Men who are prejudice against homosexuals, are making a defense against their own homosexual feelings by adopting a harsh, anti-homosexual attitude, which helps convince them of their heterosexuality - The dutiful daughter, who loves her mother, is reacting to her Oepipus hatred of her mother - Bad mom- you become good mom

Answer 173

- making up for an unacceptable act or communication - Feeling bad for doing wrong and making up for it

Answer 174

- justifying unreasonable ideas, actions, or feelings through “acceptable” explanations; (blaming) - A cognitive distortion of “the facts” to make an event, or an impulse less threatening. - When a person finds a situation difficult to accept, they will make up a logical reason why it has happened. Example: - A person me explain a natural disaster as ‘Gods will’ - Joe is broke and sells car, uses bike says i like the bike anyway

Answer 175

- physical s/s without medical explanation. - Unconsciously, - Ex: unexplained pain; Laryngitis with no medical explanation before a presentation.

Answer 176

indirect aggression against others often through procrastination or inefficiency

Answer 177

- behaving at a less mature level - A defense mechanism, whereby the ego reverts to an earlier stage of development, usually in response to stressful situations - a movement back in psychological time when one is faced with stress - When we are troubled or frightened, our behaviors often become more childish or primitive - Kids deal with anxiety with this one: using mommy daddy again; or bed wetting; transitional item - Educate parents that this behavior is normal and expected Example: - A child may begin to suck their thumb again or wet the bed when they need to spend some time in the hospital - Teenagers may giggle uncontrollably when introduced into a social situation involving the opposite sex.

Answer 178

inability to combine the (+) and (-) aspects of people; Manipulative

Answer 179

- rejecting unacceptable personal traits and attributes them to another (blaming) - This involves individuals attributing their own unacceptable thoughts, feeling and motives to another person Example: - Thoughts most commonly projected onto another are the ones that would cause guilt such as aggressive and sexual fantasies or thoughts. - You might hate someone, but your superego tells you that such hatred is unacceptable. You can ‘solve’ the problem by believing that they hate you. - Calling someone ugly because you have insecurities and feel you are ugly - Cheat on spouse- think spouse is cheating on you

Answer 180

- escaping unpleasant realities by ignoring them - Denial involves blocking external events from awareness. If some situation is just too much to handle, the person just refuses to experience it. - a refusal to accept reality, thus blocking external events from awareness. Example: - Smokers may refuse to admit to themselves that smoking is bad for their health - a husband may refuse to recognise obvious signs of his wife’s infidelity. - A student may refuse to recognise their obvious lack of preparedness for an exam

Answer 181

- Sometimes called identification - Involves taking into your own personality characteristics of someone else, because doing so solves the emotional difficulty. Example: - A child, who is left alone frequently, may in someway try to become “mom” in order to lessen his or her fears —You can sometimes catch them telling their dolls or animals not to be afraid - Older children or teenager, imitating his or her favorite star, musician, or sports hero in an effort to establish an identity

Answer 182

- A version of introjection that focuses on the adoption, not of general or positive traits, but of negative or fear treats. - Involves the victim adopting the behavior of a person who is more powerful and hostile towards them - If you are afraid of someone, you can partially conquer that fear by becoming more like them Example: - Stockholm syndrome, where hostages establish an emotional bond with their captors and take on their behaviors

Answer 183

- A way to cover up one's perceived shortcomings - Take acting or display traits to come across as the thing they are insecure about - Pretending that they’re what they’re insecure about Example: - An employee may flaunt all of their awards and recognitions because they feel they are not good enough

Answer 184

Increased heart rate palpitations Sweating Chest pain may think they are having a heart attack Walls closing in on them

Answer 185

characteristics of the panic attack Pts strengths and problems.

Answer 186

- What were you doing when the panic attack occurred? - What did you experience before and during the episode,including physical symptoms, feelings and thoughts? - When did you begin to feel that way? How long did it last? - Do you have an explanation for what caused you to feel that way? - Have you experienced these symptoms in the past? —If so, under what circumstances? - Has anyone in your family had similar experiences - What do you do when you have these experiences to help you to feel safe? - Have the feelings and sensations ever gone away on their own?

Answer 187

history of traumatic event repeated exposure to information warning of danger

Answer 188

Acrophobia: Fear of heights Arachnophobia: Fear of spiders Claustrophobia: Fear of closed places Cynophobia: Fear of dogs Hematophobia: Fear of blood Microphobia: Fear of germs Nyctophobia: Fear of the dark, Night Ophidiophobia: Fear of snakes Pyrophobia: Fear of Fire

Answer 189

- afraid to be placed in situation in which you don't have control; - afraid to go outside - fear of being in places and situations from which escape is impossible. — Feared places are avoided to control anxiety. — Avoidance behaviors can be debilitating and life constricting

Answer 190

People cope by avoiding the stimuli that cause the fear No Medication treatment CBT: Exposure Therapy

Answer 191

Characterized by unwanted repetitive: - intrusive thoughts (obsessions) - causes distress and anxiety ritualistic actions (compulsions) - that relieve the distress. - But only for a short time so on a loop

Answer 192

Dirt/Toxins/germs Intense fear something terrible is going to happen Need for symmetry individuals feel uncomfortable unless the things around them are ordered.

Answer 193

Washing Constant need to check doors/appliances Movement ritual Enter and leave the room Tap on the desk Sit or stand

Answer 194

cognitive restructuring (CBT) exposure and response prevention SSRI’s (second line therapy because sx return when stop the meds) Therapeutic Communication Health Teaching focusing on Diet/Sleep/Exercise Milieu Cognitive Restructuring Behavioral Techniques

Answer 195

trauma experienced by 18 years of age

Answer 196

ABUSE: - Physical - Emotional - Sexual NEGLECT: - Physical - Emotional HOUSEHOLD CHALLENGES: - Mental Illness - Intimate partner violence - Parental separation or divorce - Incarceration - Substance misuse or dependence

Answer 197

Mentorship Career Workshops Parent training classes Summer camp Child care; affordable/ high-quality After school activities Baseball, soccer, volleyball Strategies to prevent ACEs and their side effects Strengthening economic supports for families Changing social norms to support positive parenting Quality child care and education early in life Enhancing parenting skills to promote healthy child development Intervening to lessen harms and prevent future risk

Answer 198

change the way they perceive the world

Answer 199

- Safety - Trust/ transparency - Recognizing S/S of trauma - Peer support - Self-help - Collaboration; pt centered care/ EBP - Empowerment/voice/choice - Cultural/historical/gender sensitivity

Answer 200

- Maintain emotional safety - Supportive, compassionate responses to trauma histories of ACEs - Don’t elicit specific details. - Empower patients - Refer patients to mental health providers. - Practice compassionate resilience - Learn as much as you can - Grow your skill of being attuned with your patient and fellow staff - Look for causes of behaviors - Use Person-Centered, Strength based thinking and language - Provide consistency, predictability, and choice making opportunities - Always weigh the physiological, psychological and social risks of physical interventions - Debrief

Answer 201

- Being new to the field - Having a history of personal trauma or burnout - Working long hours and/or having large caseloads: COVID - Having inadequate support systems

Answer 202

- Withdraw socially; isolation - Emotionally disconnected - Demoralized - Questioning one’s professional competence and effectiveness - Easily frustrated - Insomnia - Lowered self-esteem - Loss of hope - Feeling overwhelmed; physically/mentally - Inability to function - Intrusive thoughts/images of another’s critical experience - Difficulty separating work from personal life - Pessimistic - Jaded - Critical - Irritable - Prone to anger - Dread of working with certain individuals - Depression; self-medication - Ineffective and/or destructive - Reduced sense of efficacy at work. - Concentration and focus problems - Apathy and emotional numbness. - Exhaustion - Secretive addictions

Answer 203

- safe housing - Transportation - Neighborhoods - Racism - Discrimination - Violence - Education - Job opportunities - Income - Nutritious foods - Clean water - Clean air - Physical activity - Language/literacy skills

Answer 204

- Professionalism - Leadership - Communication - Safety - Critical thinking - Patient centered care

Answer 205

- Person - Nursing - Health - Environment

Answer 206

S: Male sex: 1 A: Age If less than19 or more than 45 years: 1 D: Depression or hopelessness: 2 P: Previous suicidal attempts or psychiatric care: 1 E: Excessive ethanol or drug use: 1 R: Rational thinking loss (psychotic or organic illness): 2 S: Separated, widowed, or divorced: 1 O: Organized plan or serious attempt: 2 N: No social support: 1 S: Stated future intent (determined to repeat or ambivalent): 1

Answer 207

0-5: D/C 6-8: PSYCH CONSULT 8+: HOSPITAL ADMIT

Answer 208

- Have you wished you were dead or wished you could go to sleep and not wake up? - Have you actually had any thoughts about killing yourself? - Have you thought about how you might do this? - Have you had any intention of acting on these thoughts of killing yourself, as opposed to you having the thoughts but you definitely would not act on them? - Have you started to work out or worked out the details of how to kill yourself? Did you intend to carry out this plan? - Have you done anything, started to do anything, or prepared to do anything to end your life?

Answer 209

- ideation - Substance abuse - Purposelessness - Anger - Trapped - Hopelessness - Withdraw - Anxiety - Recklessness - Mood

Answer 210

- asking a depressed person about suicide, and they put the idea and their heads - There is no point in asking about suicidal thoughts… if someone is going to do it, they won’t tell you - Some of that make suicidal threats won’t really do it, they are just looking for attention

Answer 211

Establish sense of resiliency

Answer 212

- “I cant take it anymore” - “Life isn’t worth living anymore” - “I wish I were dead” - “Everyone would be better if I died” - “I won’t be a problem much longer” - “I just want to go to sleep and not wake up” - “Things will never work out”

Answer 213

Giving away prized possessions Writing farewell notes Making out a will Putting personal affairs in order Having global insomnia Exhibiting a sudden and unexpected improvement in mood after being depressed or withdrawn Neglecting personal hygiene

Answer 214

- Normalizing - Asking about behavioral events rather than the client’s opinions. - Gentle assumptions encourage further discussion by assuming there is more to tell. - Denial of the specific is helpful when a pt generally denies suicidal ideation.

Answer 215

communicates that the pt is not the only one who experiences suicidal ideation. - Example: “Sometimes when people are in a lot of emotional pain, they have thoughts of killing/hurting themselves. Have you had any thoughts like that?”

Answer 216

Example: - “What did you do when you had those thoughts?” - “How many pills did you take?” - What happened next?”

Answer 217

Example: “What other times have you tried to attempt suicide?”

Answer 218

This strategy encourages more in-depth thought and response by asking questions that might trigger memories of specific events. - Example: After the pt denies suicidal ideation in response to a general question, the nurse asks more specifically: - “Have you ever thought of overdosing?” - “Have you ever had thoughts about shooting yourself?”

Answer 219

Conveys to the sender that the receiver is interested in what is being communicated through: - Open relaxed body language - Listening for false notes or inconsistencies/ providing feedback - Ask questions that permit the sender to expound on the message

Answer 220

Gives the person time to collect thoughts or think through a point. - Increases self awareness - Gives participants a break to reflect

Answer 221

- Indicates that the person has been understood. The statement does not necessarily indicate agreement but is nonjudgmental. However, nurses should not imply that they understand when they do not understand. - indicates the person has been understood, non-judgemental and interested, attitude of regard - “Yes”… “I follow what you say”

Answer 222

- Clarifies that the lead is to be taken by the patient. However, the nurse discourages pleasantries and small talk

Answer 223

- Calls attention to the person’s behavior (e.g., trembling, nail biting, restless mannerisms). Encourages the person to notice the behavior to describe thoughts and feelings for mutual understanding. Helpful with mute and withdrawn people. - Stating to client what the nurse is observing, Enable patient to recognize behaviors - “You are pacing a lot” - “You seem angry when he said….”

Answer 224

- Repeats the main idea expressed. Gives the patient an idea of what has been communicated. If the message has been misunderstood, the patient can clarify it.

Answer 225

- Directs questions, feelings, and ideas back to the patient. Encourages the patient to accept his or her own ideas and feelings. Acknowledges the patient’s right to have opinions and make decisions and encourages the patient to think of self as a capable person. - Questions and feeling are referred back to the patient to allow recognition and acceptance, lets patient know that his or her view is valued - Example: Pt: “What should I do about my husband’s affair?” RN: “What do you think you should do?” - Example: Pt: “My brother spends all of my money and then has the nerve to ask for more” RN: “You feel angry when this happens”

Answer 226

- Concentrates attention on a single point. It is especially useful when the patient jumps from topic to topic. If a person is experiencing a severe or panic level of anxiety, the nurse should not persist until the anxiety lessens. - Taking note of a single idea or even a word: effective with FOI - “You’ve mentioned many things. Let’s go back to talking about…” - “That is a good point you make. Perhaps we can discuss that a little bit more”

Answer 227

- Examines certain ideas, experiences, or relationships more fully. If the patient chooses not to elaborate by answering no, the nurse does not probe or pry. In such a case, the nurse respects the patient’s wishes. - Going further into a subject, idea, experience - “Can you tell me a little more about that?” - “How did you feel when you heard that voice?’

Answer 228

- Clarifying the nurse’s understanding of the situation. Addresses a vague or incomprehensible concept - Helps patients clarify their own thoughts and maximize mutual understanding between nurse and patient.

Answer 229

- Undermines the patient’s beliefs by not reinforcing the exaggerated or false perceptions. - Expressing or voicing doubt when a client relates a situation. Often used with clts experiencing delusional thinking - “I find that hard to believe”

Answer 230

- Allows the patient to identify alternative actions for interpersonal situations the patient finds disturbing (e.g., when anger or anxiety is provoked). - Allows the patient to identify alternative actions for situations (ie when anger, anxiety provoked) - “What could you do to let anger out harmlessly?” - “The next time this comes up what might you do to handle it?”

Answer 231

Offers presence, interest, and a desire to understand. Is not offered to get the person to talk or behave in a specific way.

Answer 232

Implies criticism; often has the effect of making the patient feel defensive

Answer 233

Results in the patients not knowing which questions to answer and possibly being confused about what is being asked

Answer 234

Implies that the pt is doing the right thing- and that not doing it is wrong. May lead the patient to focus on pleasing the nurse or clinician; denies the pt the opportunity to change his or her mind or decision

Answer 235

Underrates the pt’s feelings and belittles the pt’s concerns.

Answer 236

May indicate the patient's feelings and needs. Can leave the pt feeling alienated and isolated and increase feelings of hopelessness.

Answer 237

Assumes the nurse knows best and the pt cannot think for self. Inhibits problem solving and fosters dependency

Answer 238

- Promotes behavior change by guiding the patient to explore their own motivation for change and the advantages and disadvantages of their decisions. - may decrease defensive patient responses. - incorporates active listening and verbal therapeutic communication techniques, but is focused on what the patient wants rather than what the nurse thinks should be the next steps in behavior change. - NURSES GOAL: Understand the reasons why a patient exhibits difficult behaviors and then using therapeutic communication techniques to diffuse the behaviors.

Answer 239

Empathy- feeling alongside of someone else

Answer 240

- background - Affect - Trouble - Handle - Empathy - Open ended - affirmation - Reflection - Summarizing

Answer 241

- important - Confidence level - Readiness - Availability

Answer 242

History of childhood violence, abuse, addictions

Answer 243

Cognitions drive anger

Answer 244

Some people may be biologically predisposed to anger & aggression; some disorders result in agitation

Answer 245

- normal human emotion/ emotional state - Need not be a negative expression - Responses to perceived threat or loss of control - instills feelings of power - generates preparedness

Answer 246

mild irritation - intense fury and rage

Answer 247

Facial expressions

Answer 248

pts solve problems make decisions concerning life situations

Answer 249

When not expressed When expressed aggressively

Answer 250

increased HR, BP, levels of the energy hormones adrenaline and noradrenaline

Answer 251

not always related to anger; always intends harm - occurs when individuals lose control of their anger.

Answer 252

Learned - can come under personal control

Answer 253

hurt frustration fear.

Answer 254

History of violence Paranoid ideation Poor coping skills/impulsivity

Answer 255

Frightened Humiliated Ignored Insecure Not heard Vulnerable

Answer 256

Avoid emotional reactions, especially personal dislikes Eliminate contraband Give patient/staff enough space Sufficient staff for show of force Set limits appropriately: - Realistic and enforceable - Supported by entire staff

Answer 257

Overcrowding Staff inexperience Staff controlling Poor limit setting Not enough activities

Answer 258

Solutions with options Empathy without options Empathy with options (best)

Answer 259

Hyperactivity (pacing) Verbal abuse Increased tension Loud voice Intense eye contact Carrying a weapon

Answer 260

Respond early Maintain patient’s self-esteem/support their ego Remain calm and emphasize you on on pts side Do not speak when the aggressive person is yelling Establish pt’s concern Maintain large personal space off to the side Give options and acknowledge needs Non-aggressive posture Pg 381 & 383

Answer 261

Listen to the patient Use de-escalation techniques (see next slide) Maintain your safety Offer PRN medications

Answer 262

Seclusion and/or restraint initiated: “Take down” In emergencies nursing staff initiates procedure and obtains M.D. order within 1 hour Medication

Answer 263

Talk to pt about incident Talk about stressors (trigger) Explore alternative behaviors Talk with staff and patients about incident

Answer 264

Behaviors during pre-assaultive phase - Interventions & evaluation Behaviors during assaultive phase - Interventions & patient responses Interventions during restraint Reintegration into milieu

Answer 265

- Collaborate to problem solve - Validation of patient’s feelings Implications: - Help patient name feelings underlying feelings of anger - Anxiety reduction techniques

Answer 266

- Provide interactions when pt not abusive - Schedule regular contact which is separate from pt’s behavior Verbal abuse: - leave room & return at specified time — If cannot leave, stop talking, finish procedure, leave

Answer 267

Patients with cognitive deficits

Answer 268

Orientation aids Regular routine Decrease sensory stimulation - If agitated: Stay calm, make eye contact, meet needs, short simple sentences.

Answer 269

- Behavioral: reinforce appropriate behavior (token economy=positive reinforcement; Operant conditioning) - Cognitive-behavioral (CBT) is an anger management technique - Pharmacological interventions

Answer 270

- Haldol, Zyprexa, Risperdal - Ativan - Cogentin or Benadryl if Haldol used —Given IM —50 mg Benadryl —5 mg Haldol —2 mg Ativan=>must be administered in a syringe alone, otherwise crystalizes

Answer 271

Antipsychotics Beta-blockers: - Propranolol Buspar Clonidine Lithium Anticonvulsants SSRIs

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