Week 9 Flashcards
(92 cards)
1
Q
define: cognition
A
- the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses
2
Q
children/adolescents dont always recieve the treatment they require for mental illness. what contributes to this? (4)
A
- causes may be misdiagnosis
- stigma
- not being taken seriously
- non-adherence to treatment
3
Q
what are some risk factors for mental health problems/illnesses (14)
A
- unhealthy child development
- abusive parents
- substance abusing parents
- family trauma
- negative peer relationships
- minority or ethnic status
- social media use
- ACEs
- learning disabilities, academic failuire
- illness & disability
- children in care of family services
- children w parents w mental illness
- children w multiple risk factors
- any of the social determinants of health
4
Q
describe assessment of children & adolescents (6)
A
- consider the stage of growth & development
- assess in the contect of family culture and familt circumstances
- gather info from multiple sources
- include the child’s perspective, sense of identity, self-esteem
- consider the strengths of the child
- MSE –> adapt to child’s age
5
Q
define: intellectual disability
A
- onset during the developmental period w deficits in conceptual, social, and practical domains
6
Q
what are 3 aspects of intellectual disability
A
- deficits in intellectual functions (ex. reasoning, problem solving)
- deficits in adaptive functioning (ex. social participation, independent living)
- onset of deficits during the developmental period
7
Q
define: global developmental delay
A
- diagnosed when the individual fails to meet expected developmental milestones in several areas of intellectual functioning
- includes children who are unable to participate in assessment & standardized testing
8
Q
who does global developmental delay include
A
- individuals <5 years of age
9
Q
global developmental delay requires…
A
- reassessment after a period of time
10
Q
describe the epidemiology, rates, and onset of autism
A
- epidemiology: 1% of population which is increasing as more people seek diagnosis and spectrum is more broad
- rate: 4-5x higher in males than females
- onset: 12-24 months old
11
Q
describe the cause of autism (4)
A
- structure/function of the CNS
- genetic link (higher chance w close relative)
- environmental (virus exposure in the womb)
- NOT related to vaccines or parenting styles
12
Q
describe the diagnosis of autism
A
- observation/screening tools
- neuro, cognitive, and language testing
13
Q
the autistic spectrum disorder is characterized by: (4)
A
- persistent deficits in social communication & social interaction across multiple contexts
- restricted, repetitive patterns of behavior, interests, or activities
- symptoms present in early developmental period (typically 12-24 months of age)
- symptoms cause signifiant impairment in social, occupational, or other areas of functioning
14
Q
autism is diagnosed on…
A
- a spectrum, and individual diagnosis is further narrowed by specfiers
15
Q
describe the diagnostic criteria of “persistent deficits in social communication & social interaction across multiple contexts”: in ASD (3)
A
- social-emotional reciprocity (ex. sharing interests, responding to social interaction)
- nonverbal communication behaviors used for social interaction (ex. lack of facial expressions)
- developing, maintaining, and understanding relationships (ex. difficulties in sharing imaginative play or making friends)
16
Q
describe the diagnostic criteria of “Restricted, repetitive patterns of behavior, interests, or activities” in ASD (4)
A
- stereotyped or repetitive motor behaviors, use of objects, or speech (ex. lining up toys, echolalia, self-harm behaviors)
- insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal and nonverbal behaviors
- highly restricted, fixated interests that are abnormal in intensity or focus
- hyper or hypo reactivity to sensory input or unusual interest in sensory aspects of the enviro (ex. indifference to pain/temp, adverse response to specific sounds, textures, fascination w lights)
17
Q
other specifiers of ASD include:
A
- with or without accompanying intellectual, language impairment
18
Q
describe impairment in communication in ASD (4)
A
- delayed language development
- echolalia may be present (repeating thing which they heard, parroting)
- extreme concrete interpretation of language (not understanding figures of speech)
- pronoun reversals (“you are doing this” but meaning “i am doing this”
19
Q
what are some nursing considerations with short-term acute care (6)
A
- maintain the child’s shcedules
- keep admin of meds, breakfast at the same time
- make communication tools like communication board or book
- have a quiet place to go if sensory stimulation becomes too much
- if something is going to change their routine (ex. have to go for a test) give them notice in advance
- don’t rearrange their enviro
20
Q
what medications can be used to manage hyperactivity & stereotypical behavior for developmental disorders (4)
A
- antipsychotics
- antidepressants
- antianxiety
- meds for seizures
21
Q
how long can the average person hold their attention
A
- 8 seconds
22
Q
what is ADHD (3)
A
- a biological condition that can impact focus, organization, and self-control
- a cluster of difficulties that involve self-management of the brain
- NOT a problem of laziness or willpower
23
Q
what are some key takeaways r/t ADHD (5)
A
- people w ADHD have few tasks or activities that are interesting to them & that they can pay attention to very well
- effects emotional & mental health of the individual and their families
- with the right support, symptoms may be managed & treated
- may resemble a mood disorder
- may have co-occurring disorders (depression, anxiety, conduct disorder, etc.)
24
Q
describe the cause of ADHD (5)
A
- no clear cause
- temperamental
- environmental
- neurological (lower dopamine lvls)
- genetic theories
25
describe the diagnosis of ADHD
- DSM criteria
| - no standardized tests
26
r/t ADHD, behaviors are the _____
- behaviors are the rule. not the exception
| - must have behaviors consistently and in at least two settings (school & home)
27
what combo of symptoms are seen in ADHD
- inattention
| - hyperactivity - impulsivity
28
describe the inattentive symptoms of ADHD (7)
- lack of attention to details, makes careless mistakes
- difficult sustaining attention in tasks or play activitis
- does not seem to listen when spoken to directly
- does not follow thru on instructions and fails to finish school work or tasks
- difficulty organizing tasks & activities
- avoids tasks that require sustained attention
- often loses things, easily disctracted, forgetful in ADL
29
list the hyperactivity and impulsivity symptoms of ADHD (8)
- fidgets or squirms
- leaves seat in classroom
- on the go --> runs about, climbs where in appropriate, acts as if driven by a motor
- difficulty in engaging in leisure activities quietly
- talks excessively
- blurts out answers
- difficulty w waiting their turn
- interrupts or intrudes on others
30
what are 3 types of ADHD
- ADHD, predominately inattentive
- ADHD, predominately hyperative-impulsive
- ADHD, combined type
31
describe "ADHD, predominately inattentive" (2)
- unable to get focused on or stay focused on task/activity
| - individual does not display significant hyperactive/impulsive behaviors
32
describe "ADHD, predominately hyperactive-impulsive" (3)
- person is very active
- often acts without thinking
- individual does not display significant inattention problems
33
describe "ADHD, combined type"
- individual is attentive, hyperactive, and impulse
34
what is a potential outcome of the 3 types of ADHD
- predominately inattentive & combined = risk of worse academic outcome
- predominately hyperactive = potential for good academic outcome, but more difficultly w interpersonal injuries or interpersonal relationships
35
describe how symptoms vary over time
- symptoms decrease over time in many children
| - impulsivity may persist into adulthood
36
describe treatment for ADHD (6)
- specific skill instruction
- accommodations
- compensatory strategies
- self-advocacy
- provide structure and precictability thru help w routines, organization, minimize distraction
- meds
37
what meds are used for ADHD
stimulants:
| - methylphenidate/ritalin
38
describe the impact of methylphenidate/ritalin on ADHD (3)
- found to improve core symptoms
- rapid onset (~90 min)
- short acting (duration of 4 hrs)
39
what are the pros fo meds for ADHD (2)
- reduced or eliminated behavioral symptoms
| - the ability to do better in school, make friends, and participate in activities
40
what are the cons to meds for ADHD (2)
- handful of studies done on long-term effects
- mild side effects
- type of psychological dependency
41
what are some mild side effects of meds for ADHD (7)
- loss of appetite
- difficulty falling asleep
- dizziness
- moodiness
- growth troubles
- depression
- weight loss
42
what can help reduce side effects of meds for ADHD
- taking med vacations (ex. take meds 5 days a week and break from it on the weekend)
43
what is a calming jar
- a creative tool to help a child calm down during upsetting or overwhelming situations, help w falling asleep at night, or can be used as a visual fisget when trying to focus on directions or new info
44
describe ADHD in adults (5)
- inattention and memory
- hyperactivity
- impulsiveness
- emotional turmoil
- irriability / easily angered
45
challenges r/t ADHD in adults include (3)
- work --> disorganization, inattention
- relationships --> may be strained/chaotic
- finances --> procastination, impulsiveness can interfere w money mngmt
46
what are positive characteristics of persons w ADHD (4)
- creativity
- enthusias,
- spontaneity
- high energy
47
what are some recommendations from the Manitoba Centre for Health Policy Report (4)
- continue to invest in mental health to address the needs of children and adolescents
- focus on programs and services that focus on prevention and the promotion of strong mental health, coping skills
- support high risk groups of children and their families so they get the services they need
- provide increased training for service providers, working w youth
48
define: addiction (3)
- a compulsive and maladaptive dependence on a substance or behavior
- a chronic, relapsing, and treatable medical condition
- an unhealthy relationship between a person and a mood-altering substance, experience, event, or activity which contributes to life problems and their recurrence
49
describe the scope of addiction (2)
includes:
- substance addictions
- behavior addictions
50
define: gaming addiction
- a pattern of persistent or recurrent gaming behavior so severe it takes precedence over other life interests
- not an official disorder in DSM, but is a condition for further study
51
DSM-5 disorders related to taking of substances has two categories:
1. substance use disorders (SUD)
| 2. substance induced disorder (SID)
52
define: SUD
- cognitive, behavioral, and physiological symptoms that indicate the individual continues to use the substance despite its negative consequences
53
define SID
- substance intoxication & substance withdrawal
54
SUD includes 11 behaviors grouped into
- impaired control
- social impairment
- risky use
- pharmacologic categories
55
SUD occurs in a range of severity from mild to severe. describe each
- mild: the presence of 2 or 3 symptoms
- moderate: presence of 4 or 5 symptoms
- severe: presence of 6 or more symptoms
56
define: craving
- the intense desire or urge for more of a substance
57
define: tolerance
- increased amounts of a substance are required to achieve the desire effect
- or there is diminished effect w the same amount of the substance
58
define: substance intoxication
- the development of a reversible substance-specific syndrome from recent ingestion
59
define: substance withdrawal
- development of a substance specific maladaptive behavioral change that is due to the cessation, or reduction, of heavy & prolonged substance
60
define: acute alcohol withdrawal syndrome
- a life-threatening condition that may occur unexpectedly whenever long-term daily alcohol consumption is abruptly discontinued
61
define: alcohol detoxification
- treatment consists of achieving safe withdrawal from alcohol followed by supportive interventions/referrals
62
Your patient has been hospitalized for acute alcohol withdrawal. It is the fifth day, and he is having visual hallucinations followed by a seizure. What is the most likely source of the patient's problem?
delirium tremens
63
what are the 3 stages of alcohol withdrawal
- minor (6-12 hrs after last drink)
- intermediate (q12-72 hours)
- severe (5-6 days after)
64
describe symptoms seen in the minor stages of alcohol withdrawal (5)
- anxiety
- NV
- coarse tremor
- tachycardia
- HTN
65
list symptoms seen in the intermediate stage of alcohol withdrawal (4)
- remain oriented and alert
- seizures
- dysrhytmias
- hallucinations (auditory, visual)
66
list symptoms seen in the major stage of alcohol withdrawal (7)
- delirium tremens
- severe agitation
- gross tremulousness
- global confusion
- disorientation
- auditory, tactile, visual hallucinations
- psychomotor & autonomic hyperactivity (HTN, fever)
67
Mr. Earl Grey is admitted to the hospital detoxication unit. He admits to drinking large amounts of alcohol for the last 6 years. What question is most important for the nurse to ask initially?
when was ur last drink
68
describe management of alcohol withdrawal (4)
- provide a safe enviro
- IV replacement of fluids & electrolytes
- BW: CBC, renal, liver, electrolytes
- pharmacological
69
what pharmacological interventions are included in management of alcohol withdrawal (2)
- benzos
| - thiamine/folic acid (for prevention long-term consequences due to nutritional deficiencies)
70
A client who is going through alcohol detoxification states, “I see bugs crawling on the wall.“ Which is the best nursing response?
a. “I’ll remove the bugs from the wall.”
b. “You are confused because of your addiction.”
c. “There are no bugs on the wall. I’ll stay with you
until you feel less anxious.”
d. “You are hallucinating. You do not see any bugs on
the wall.”
c --> presents objective reality and may decrease pts anxiety
71
what is included in primary prevention for addictions (3)
- increasing legal drinking age
- media campaigns geared around reducing alcohol use
- prevent the problem before it occurs
72
what is included in secondary prevention of addictions (4)
- screening for risks of alcohol abuse --> ex. cirrhosis
- screening w the aim of determining if addictions is a health concerns
- questionnaires or tools that can help facilitate a convo
- detect potential to develop an addiction and prevent it
73
what is included in harm reduction r/t addictions
- safe drug use clinics
74
what are Canada's Low Risk Alcohol Drinking Guidelines for women & men
- men: 15 drinks a week, with no more than 3 drinks a day most days
- women: 10 drinks a week, with no more than 2 drinks a day most days
75
what is included in the CAGE questionnaire
In the last 12 months:
- Have you ever felt like you should CUT down on your drinking?
- Have people ANNOYED you by criticizing your drinking?
- Have you ever felt bad or GUILTY about your drinking?
- Have you ever had a drink first think in the morning to ‘steady your nerves’ or get rid of a hangover (EYE Opener)?
* positive screen = one or more yesses*
76
describe the Alcohol Use Disorders Identificiation Test (4)
- assess: alcohol consumption, drinking behaviors, and alcohol-related problems
- 10 item questionnaire
- scored from low to high risk (0-40)
- score determines clinicians next steps
77
what is SBIRT
Screening
Brief Intervention
Referall to Treatment
- can be used to screen people showing up at hospital for non-alcohol issues
78
what should you do if SBIRT shows low risk? moderate risk? high risk?
- low = reinforce, educate, re-screen
- mod = brief intervention, re-screen
- severe = assess, refer, coordinate & assess, care plan, treat
79
describe: brief intervention (2)
- time limited (5-20 min) of pt centered counselling designed to reduce substance abuse
- uses the principle of motivational interviewing & workbooks
80
what is motivational interviewing (2)
- a brief, pt centered, directive method for enhancing change in intrinsic motivation by exploring and resolving pt ambivalence
- an effective counselling method that enhances motivation thru the resolution of ambivalence
81
what elements are included in the process of MI (4)
- MI spirits
- change talk
- OARS
- MI principles
82
what is included in the stages of change model (5)
precontemplation (not ready) -----> contemplation (getting ready) ------> preparation (action, ready) -----> maintenance (sticking to it) ------> relapse (recycling, learning)
83
what are the 3 spiritis of MI
- collaboration
- evocation (activate the clients own motivation for change)
- honoring (if they dont want to make a choice, that's their choice)
83
what are the 3 spiritis of MI
- collaboration
- evocation (activate the clients own motivation for change)
- honoring (if they dont want to make a choice, that's their choice)
84
what are the four guiding principles of MI
Resist the righting reflex
Understand individual's motivations
Listen with empathy
Empower individual
(RULE)
85
what does OARS stand for
Open ended questions
Affirmations
Reflective Listening
Summarizing
86
what 4 processes are involved in MI
- engaging
- fousing
- evoking
- planning
87
describe the engaging process of MI (2)
- establishing a trusting and mutually respectful relationship
- ask permission
88
describe the focusing process of MI
- setting an agenda based on mutual goals & priorities
89
describe the evoking process of MI (2)
- eliciting a client's own motivation to change
| - "change talk" --> client speech that favor movement in direction of change, should reinforce and encourage it
90
describe the planning process of MI
- developing a plan that the pt agrees to and is willing to implement
91
what is a vital part of the assessment process and support treatment strategies for addiction
- assessing readiness for change
