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95 Cards in this Set
- Front
- Back
Stages of Grief |
Denial Anger Bargaining Acceptance Length varies from few weeks to years |
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Anticipatory Grief |
Grieving before the actual loss occurs |
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Maladaptive Responses to Loss |
Delayed or inhibited grief: absence of evidence of grief when ordinarily expected Chronic/prolonged Grieving: Unable to let go of personal possessions, disabling behaviors, unhealthy coping mechanisms Distorted(exaggerated) grief Response: All symptoms of normal grieving process exaggerated |
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Normal Grief |
Self esteeem intact opnely expresses anger misture of good and bad days able to exp. moments of pleasure accepts comfort and support from others maintains feeling of hope May express guilt feeling sover some aspect of the loss relates specific feelings of loss may exp transient physical symptoms |
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Clinical Depression |
Self esteem disturbed doesn't directly express anger persistent state of dysphoria Anhedonia is prevalent Does not respond to social interaction adn support from others Feelings of hopelessness prevail has generalized feelings of guilt Does not relate feelings to a particular experience Expresses chronic physical complaints. |
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Voluntary committment |
client or guardian chooses committment to a mental health facility, and has the right to apply for release at any time |
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Involuntary committment |
client enters facility against their will for indefinate period of time. AEB their risk of harm to self or others, or the inability to provide self-care. |
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Intentional tort |
a purposefully wrongful act or injury committed by an entity or persona gainst another person or another person's property. |
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Example of intentional tort |
State laws may vary Assault Battery False Imprisonment |
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Maslows hierarchy of needs |
Physiological- Safety- belongingness and love- esteem-self actualization |
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Transference |
pt unconsciously displaces to the nurse feelings formed toward a person from his or her past. Could be due to appearance or quality that reminds them of |
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Countertransference |
the nurse's behavioral and emotional response to the client. May be r/t unresolved feelings towards significant others from the nurse's past, or they may be generated in response to transference feelings on the part of the client |
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Primary Intervention |
preventative measures for groups that may be at risk but have nto been effected yet |
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Secondary Intervention |
interventions such as early detection for people experiencing symptoms, but may not be permenantly disabled |
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Tertiary(3rd) intervention |
interventions for people who are permanatly effected or imparied |
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ECT |
used for clients who have bipolar disorder with rapid cycling- 4 or more episodes of acute mania in 1 year Higher risk includes: Recent MI History of cerebrovascular accident Cerebrovascular malformation Intracranial mass lesion Increased Intracranial pressure Hold MAOIs and Bnzos(seizuure inhibiting) |
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Child Abuse- When to report? |
S/S Unexplained injuries Child is frightened of adults child reports injury by parent or caregiver conflicting or unconvincing explanation for injuires |
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Somatic Symptom Disorder |
physical symptoms suggesting medical disease but without demonstratable organic pathology or mechanism to accou8nt for them. Why? pts may not have organic disease so they don't identify as having mental disorders and do not seek treatment as a result |
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Hysteria |
SSD- affects mainly women characterized by recurrent mutliple somatic complaints that are unexplainable by organic pathology -thought to be associated with repressed anxiety |
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Dissociation |
SSD- splitting off of clusters of mental contents from conscious awareness. a mechanism central to hysterical conversion and dissociative disorder |
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s/s Bulimia |
binge eating uncontrolled compulsive and rapid ingestion of large amounts of food followed by vomiting or laxitive low sellf esteem, impulsivity, and difficulty with interpersonal relationships ow BP, orthostatic HTN, low pulse and low body temp, irregular HR and poor skin turgor Enlargment of Parotid, dental erosion and carries |
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s/s Anorexia |
Gross distortion of body image, preoccupations with food, refusal to eat refusal to maintain body weight intense fear of gaining weight Postmenarcheal females, amenorrhea(abnormal period) Many pts. with anorexia nervosa participate in sports and athletic activities relentless exercise to lose more weight. |
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Psychotherapies- Cognitive (pg 56 ati) |
cognative reframing changing cognitive distortions can decrease anxiety priority restructuring journal keeping assertiveness training monitoring thoughts -helps patient ID negative thoughts that cause anxiety. Uses both a cognative and behavioral tehapy for clients who have anxiety management issues |
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Psychotherapies- Behavioral(pg 56 ati) |
changing behavior was the key to treating problems used n phobias, substance use or addictive disorders |
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Systematic Desensitization |
Planned progressive or graduated exposure to snxiety provoking stimuli irl. pt uses relaxation tech during exp |
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Modeling |
therapist or others serve as role models for a cleint, who imitates behavior to improve situaiton |
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Operant conditioning |
Positive reinforcement, rewards for positive behavior |
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Aversion therapy |
negative consequences for negative behavior |
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Meditation, guided imagery, diaphragmatic breathing, muscle relaxation and biofeedback |
Various techniques to control pain, tension, and anxiety |
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Delirium |
pharmalogical management focuses on the treatment of the underlying disorder antipsychotic or antianxiety medications may be prescribed Rapid onset |
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Dementia/Neurocognitive disorder |
pharmalogic fous is to increase acetylcholine at synapses- donepezil, rivastigmine and agalantamine adverse effects include nausea and diarrhea, bradycardia- monitor and provide adequate fluid intake, monitor pulse, watch HR Contradicted by use of NSAIDS, antihistamines, TCA, and conventional antipsychotics Gradual onset |
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Care for Delirium |
screen for heart disease, avoid NSAIDs, expect cognitive decline to slow, expect adverse affects AEB: rapid personality changes perceptual disturbances, ie hallucinations and illusions restlessness and agitation in pt. |
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care for Dementia |
childproof doorlocks no rugs secure electrical cords cleaning supplised shouold be locked up mattress on floor(fall risk) light fixtures above stairs to improve visibility(fall risk) |
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Depression |
Therapeutic communication: Make time to spend with pt make observations rather than asking direct questions give directions in simple concrete sentences because a client who has depression may have difficulty focusing on and comprehending long windedness |
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Interventions r/t Suicide- depression |
1 to 1 remove harmful objects ask them regarding command hallucinations if they want to hurt themselves, others, do they have a plan, means, observe client, ensure all meds are ingested- no pouching or cheeking |
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Interventions for panic attack |
Stay w/ pt. be calm simple words give meds explore reason once attack subsides |
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Benzo for long term? |
No, addictive, physical/chemical dependance occurs, need to be tapered off |
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Benzo OD is counteracted by |
Flumazenil(Romazicon) antidote |
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Crisis Intervention |
rapid but through biopsychosocial assessment establish rapport ID triggering event, prioritize problem, discuss style of coping encourage feelings explore options shift from crisis to resolution |
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Situational/external Crisis |
unanticipated loss or changed experienced in everyday |
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Maturation/internal |
New developmental stages |
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adventitous crisis |
Natrual disasters, crime |
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s/s of alcohol intoxication |
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s/s of alcohol withdrawal |
Abdminal cramping vomiting tremors restlessness inability to sleep + to the following: BP, HR, temp, Resp Hallucinations anxiety tonic clonic seizures initiate seizure precautions |
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s/s of alcohol withdrawal delirium |
occurs 203 days after cessation of alcohol and may last 2-3 days- medical emegency. Symptoms may include severe disorientation, psychotic symptoms(hallucination), sever hypertension, dusrhythmias, and delirium. Can progress to death- transferred to er or critical care for monitoring |
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CAGE assessment |
CUT DOWN ANNOYED BY PEOPLE criticizing your drinking? Guilty about drinking? |
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Medications to support Abstinence/withdrawl for alcohol |
Antabuse- causes alcohol aversion( you get sick if you ingest alcohol) Valim, atavan, librium for withdrawl Revia takes off the cravings, similar to zarcan Benzos |
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Meds for opiods |
Methadone for treatment (removed the highs and lows Narcan for OD |
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Tolerance |
the ability to withstand larger amounts of stimulant to achieve desired therapeutic effect |
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Addiciton |
chatracterized by loss of control due to addictive behavior participation continues despite continuing associated problems a tendency to relapse back into the addictive behavior |
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Withdrawl |
when substance is not available, there is a strong urge for desired substance |
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s/s Wernicke's Encephalopathy |
most severe form of thiamine eficiency in alchoholics. paralysis of the ocular muscles, diplopia, ataxia, and stupor Thiamine replacement therapy required |
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Korsakoff's Psychosis |
State of confusion, loss of memory, and confabbulation, frequently encountered in pts recovering from Wernicke's |
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Schizophrenia how to communicate with actively psychotic pt |
Do not feed into delusion Focus on positive aspect Keep them safe reorient them to reality via techniques Don't argue |
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Understand prognosis of Schizophrenia |
difficult to predict complete return not common positive outcomes include good premorbid functioning, later age at onset, female gener, abrupt onset of sumptoms with obvious precipitating factor associated mood disturbance, rapid resolution of active phase symptoms, no genetic or family dispositions or history |
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Short term goals |
Verbalization of ideas within week, or specified times |
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Long term goals |
Pt will demonstrate independance and behavior consistent prior to onset |
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positive symptoms of Schizophrenia |
alterations in speech hallucinations delusions bizzzare behavior |
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Negative symptoms of Schizophrenia |
affect, alogia-poverty of thought or speech, may only mmble or respond vaguely anergia- lack of energy Anhedonia- lack of pleasure or joy Avolition- lack of motivation |
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cognitive symptoms of Schizophrenia |
Disordered thinking inability to make decisions poor problem solving ability difficulty concentrating to perform tasks memory deficits long term and working |
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Paranoid Schizophrenia |
pt has delusions that a person/persons are plotting against them or members of their family |
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loose associations |
pt responses don't relate directly to conversation or what is being asked |
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neologisms |
made up words only the client can understand |
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World Salad |
words jumbled together |
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clang associations |
meaningless rhyming of words |
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echolalia |
pt. repeats words spoken to them |
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depersonalization |
when ones thoughts and feelings seem unreal or not to belong to oneself |
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Flight of ideas |
associative loosness client may say sentence after sentence, but each sentence may relate to another topic, and the listener is unable to follow the client's thoughts |
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disorganized Schizophrenia |
poor prognosis disorganized behavior and speech, and disturbed emotional expression |
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catatonic Schizophrenia |
inability to move normally |
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delusions |
false personal beliefs that are inconsistent with theperson's intelligence or cultural background |
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hallucinations |
false sensory perceptions ont associated with external stimuli |
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tardive dyskinesia |
long term use of neuroleptic drugs cuases repetitive involuntary movements, such as grimacing and blinking |
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akinesia |
loss or impairment of the power of voluntary movement(parkinsons) |
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akathisia |
state of agitation, distress, and restlessness that is an occasional side effect of antipsychotic and adtidepressant drugs |
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anhedonia |
unable to feel pleasure |
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dystonia |
involuntary muscle contractions that cause repetitive or twisting movements |
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Anti-social |
exploitive and disregards the rights of others unlawful actions deceitful lacks empathy manipulative lacks personal responsibility and aggressive |
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borderline |
unstable identity and relationships fear of abandonment splitting behaviors manipulation impulsive self-mutilation and frequent SI |
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narcissistic |
arrogaance grandiose vies of self and self-importance need for admiration lacks empathy strained relationships sensitive to criticism |
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dependant |
extremed dependency on others need of a close relationship- even if abusive lacks ability to make own decisions |
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Personality disorder nursing interventions |
nurse slef assessment milieu safety is priority use firm supportive approach set boundaries consequences |
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Treatment modalities for personality disorders |
medication cognitive behavioral therapy dialectical behavior therapy case management |
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Bipolar |
Lithium 0.8-1.5- watch for signs of toxicity Valproic Acid(depakote)- nausea vomiting, indigestion, hepatoxicity, pancreatitis aeb n/v, ab pain |
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Intellectual development disorder |
mild- capable of independent living and development of social skills moderate- can perform some activities independently,, some speech limitation severe- can be trained in basic hygiene skills, communicates by acting out behaviors profound- no capacity |
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Conduct disorder |
persistent pattern of habaviorin which the basic rights of others and major age appropriate societal norms or rules are violated - high risk anti social personality isorder |
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ADD/ADHD pp |
Autism Spectrum Disorder- withdrawl of child into the self and into a fantasy world of his or her own creation- more often in boys than girls, onset in early childhood- chaotic ADHD- developmentally inapprorpriate degrees of inattention, impulsiveness and hyperactivity |
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Autism pp |
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Stimulant medications pp |
SSRI/cns Stimulants palpitations, tachycardia anorexia, weight loss Nausea, vomiting constipation severe liver damage new or worsened psychiatric symptoms administer at least 6 hours before bedtime administer sustatined relaes forms in the morning pt should be weighted regularly |
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Paraphilic disorders PP |
repetitice or preferred sexual fanasies or behaviors that involve- preference for use of nonhuman object suffering or humiliation(masochistic) repetitive sexual activity with nonconsenting partners |
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Pedophilia PP |
Adult desired to have sexual relations witha child, hetero or homo |
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Gender Dysphoria PP |
Gender dysphoria occurs when there isincongruence between biological/assigned gender and one’s experienced/expressedgender. MAN WANTING TO BE WOMEN IS MOST COMMON. |
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Alternative medicine T |
practices that differ from and are used instead of the usual traditional practices |
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complimentary medicine T |
oractices that differ from but are used in conjunction with traditional or conventional medical treatement |
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Assertiveness training-T |
assertive- standing up for one's own rights while protecting the rights of others |