Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
300 Cards in this Set
- Front
- Back
|
Body prepares for situation that individual perceives as threat to survival
|
fight or flight response
|
|
|
Hans Selye is known for
|
General adaptation syndrome
|
|
|
3 stages of general adaptation syndrome
|
Initial adaptive response
Resistance or Adaptation: Eventual maladaptive response Exhaustion Stage: Attempts to reduce stress fail |
|
|
psychological reactions to stress
|
distress
eustress |
|
|
how did Selye define stress
|
the nonspecific result of any demand upon the body
|
|
|
2 stages general adaptation syndrome occurs in
|
(1) an initial adaptive response (fight or flight), or acute stress, and (2) the eventual maladaptive consequences of prolonged stress
|
|
|
distress
|
destructive to health
|
|
|
eustress
|
beneficial
motivates energy |
|
|
Neurotransmitter Stress Responses
|
Serotonin synthesis more active
May impair serotonin receptor sights and brain’s ability to use serotonin |
|
|
components of the psychoimmunological model (PNI)
|
Hypothalamic-pituitary adrenal
Sympathetic-adrenal medullary axes Proinflammatory cytokines |
|
|
PNI psychoimmunological links
|
stress
immune system disease |
|
|
examples of physical stressors
|
Environmental conditions
Physical conditions exemplified by environmental conditions such as cold, trauma, excessive heat and physical conditions such as infection, hemorrhage, hunger, or pain; |
|
|
2 categories of stressors
|
physical
psychological |
|
|
examples of psychological stressors
|
exemplified by divorce, job loss, unmanageable debt, death of a loved one, retirement, marriage, unexpected success
|
|
|
what determines a person's reaction to a life event
|
the person's perception of it
|
|
|
purpose of Holmes and Rahe Readjustment Rating Scale
|
Monitor level of stressful life events over a given period of time
Perception of recent life events determines emotional and psychological reactions to stress |
|
|
Rahe identifies four categories of coping styles that people use as stress buffers
|
1) health-sustaining habits, (2) life satisfactions, (3) social supports, (4) response to stress.
|
|
|
how do nurses use the 4 categories of coping styles
|
id areas to target for improvement
|
|
|
coping strategies include
|
psychological defense mechanisms,
psychophysiological defenses that are in our awareness (e.g., headache) or out of awareness (hypertension or depression |
|
|
Benefits of stress reduction include
|
altering the course of medical conditions such as hypertension;
decreasing need for medications such as antihypertensives; diminishing or eliminating the need for unhealthy behaviors such as smoking; increasing cognitive functions such as learning, breaking up static patterns of thinking to allow creative perceptions of events; and increasing sense of well-being via endorphin release. |
|
|
Mediating Factors in the Response to Stress
|
age, sex, culture, life experiences, life style, and social support
|
|
|
what type of groups may help provide social support
|
self help groups
|
|
|
high-quality social support should be provided since research tells us it is linked with
|
high satisfaction
|
|
|
High-quality support relationships are free from
|
conflict and negative interactions;
they are close, confiding, and reciprocal. Low-quality support relationships may negatively affect a person’s coping effectiveness in a crisis |
|
|
Culture plays a role in determining
|
what is considered dangerous,
how to manage violations of social code, what reactions are permissible in given experiences, how a stressful event is appraised, and how emotion generated by the event should be expressed. Culture plays a role in how people experience stressors in their lives and what interventions will be useful |
|
|
The majority of Asian, African, and Central American peoples express subjective distress in
|
somatic terms, rendering psychological interpretations less useful.
|
|
|
Studies have demonstrated that spiritual practices can enhance
|
immune system and sense of well being
|
|
|
the most effective ways to reduce stress
|
cognitive behavioral methods
|
|
|
behavioral approaches to stress management include
|
Relaxation techniques
Benson's relaxation techniques Meditation Guided imagery Breathing exercises Muscle relaxation and exercise Progressive muscle relaxation Biofeedback |
|
|
Benson’s relaxation technique allows clients to
|
switch from the sympathetic mode of autonomic arousal to the parasympathetic mode of relaxation, and can be learned with practice.
|
|
|
cognitive approaches to stress management
|
Journal keeping and writing
Restructuring and setting priorities Cognitive reframing Humor Assertiveness training |
|
|
informal diary of daily events and activities helps identify sources of daily stress. The individual can then take measures to modify or eliminate the stressors.
|
Journal writing
writing keeping |
|
|
restructuring of irrational beliefs and replacing worried self-statements with more positive self-statements. Essentially, it is reassessing a situation. Restructuring a disturbing event to one that is less disturbing gives the client a sense of control, reduces sympathetic nervous system stimulation, and, in turn, reduces secretion of cortisol and catecholamines
|
cognitive reframing
|
|
|
assertiveness training helps person
|
learning behavior that allows one to stand up for one’s rights without violating the rights of others
|
|
|
4 formulas of assertive communication
|
1) simple assertion via a direct statement; (2) empathic assertion, showing understanding of the other’s feelings and assertively stating what one needs; (3) nonaccusingly describing the situation, stating one’s feelings about the situation, and asking for change; (4) confrontational assertion.
|
|
|
effective stress busters
|
Sleep
Exercise Reduction or cessation of caffeine intake Music Pets Massage |
|
|
this can be produced by change in environment
|
stress
|
|
|
Individual perceives change as
|
Challenging
Threatening Damaging |
|
|
most common response to stress
|
anxiety
|
|
|
fear is a reaction to a specific
|
threat
|
|
|
a feeling of apprehension, uneasiness, uncertainty, or dread resulting from a real or perceived threat whose actual source is unknown or unrecognized
|
anxiety
|
|
|
Acute anxiety, or state anxiety, is precipitated by
|
imminent loss or change threatening the individual’s sense of security
|
|
|
anxiety that one has lived with for a long time.
|
chronic anxiety
|
|
|
3 categories of anxiety
|
normal
acute or state chronic or trait |
|
|
Healthy life force necessary for survival
|
normal anxiety
|
|
|
with this type of anxiety Crisis threatens sense of security
|
acute anxiety or state anxiey
|
|
|
Long-term anxiety (e.g., chronic fatigue or insomnia)
Discomfort in relationships or poor job performance |
chronic anxiety or trait anxiety
|
|
|
4 levels of anxiety
|
Mild
Moderate Severe Panic |
|
|
Occurs in the normal experience of everyday living. Ability to perceive is in sharp focus and problem solving becomes more effective. Slight discomfort, restlessness, or mild tension-relieving behaviors may be observed
|
mild anxiety
|
|
|
Perceptual field narrows; some details are excluded from observation. Selective inattention may be experienced. Problem-solving ability is reduced, and may be improved in the presence of a supportive person. Physical symptoms include tension, pounding heart, increased pulse and respiration rate, diaphoresis, and mild somatic symptoms.
|
moderate anxiety
|
|
|
Perceptual field is greatly reduced. Learning and problem solving are not possible, and the person may appear dazed and confused, experience a sense of doom, and have intensified somatic complaints.
|
severe anxiety
|
|
|
Results in markedly disturbed behavior, inability to process environmental stimuli, and possible loss of touch with reality. Hallucinations may be experienced. Physical behavior may be erratic, uncoordinated, and impulsive. Automatic behaviors are used to reduce and relieve anxiety.
|
panic level of anxiety
|
|
|
nursing interventions for anxiety
|
help the client focus and solve problems with the use of specific communication techniques.
Other helpful interventions include providing a calm presence, recognition of the person’s distress, willingness to listen. |
|
|
counselor's interventions for anxiety
|
help clients focus and problem-solve by using communication techniques such as open-ended questions,
broad openings, and clarification seeking. calm presence; recognize the person’s distress and show willingness to listen. |
|
|
unable to solve problems, may not fully understand what is happening, and may not be in control of his or her actions. The nurse is concerned about client safety and the safety of others
|
sever to panic levels of anxiety
|
|
|
nursing interventions for panic levels of anxiety
|
Physical needs (fluids, rest) must be met to prevent exhaustion.
A quiet environment is best, medications and restraints may be used after less restrictive interventions have failed. Themes in conversation may be identified. |
|
|
how counselors respond to panic or severe anxiety
|
communicate via firm, short, simple statements;
point out reality if there are distortions; reduce environmental stimuli; provide a safe environment; and meet physical needs. |
|
|
severe to panic levels of anxiety are seen in
|
ER
ICU |
|
|
Five Properties of Defense Mechanisms
|
1. Manage conflict and affect
2. Relatively unconscious 3. Discrete from one another 4. Often hallmarks of psychiatric syndromes, but reversible 5. Adaptive as well as pathological |
|
|
protect the individual against anxiety and from the awareness of internal or external dangers or stressors. These relief behaviors are used by everyone to lower anxiety, maintain ego function, and protect the sense of self
|
defense mechanisms
|
|
|
maladaptive use of defense mechanisms may lead to
|
distortions in reality
self-deception |
|
|
Emotional conflicts and stressors are dealt with by working with others and helping others
|
altruism
|
|
|
The unconscious process of substituting constructive and socially acceptable activity for strong impulses that are not acceptable
|
sublimation
|
|
|
A way of dealing with stress or emotional conflicts using amusing or ironic aspects of the conflict or stressors
|
humor
|
|
|
The conscious denial of disturbing situations or feelings
|
suppression
|
|
|
most healthy defenses include
|
altruism
sublimation humor suppression |
|
|
intermediate defenses include
|
repression
displacement reaction formation somatization undoing rationalization |
|
|
The exclusion of unwanted experiences or emotions from the conscious awareness; also the cornerstone of the defense mechanisms
|
repression
|
|
|
Placing emotions associated with a particular person, object, or situation onto another person, object, or situation that is nonthreatening
|
displacement
|
|
|
Overcompensation
|
reaction formation
|
|
|
The transfer of anxiety from the psychological to a physical symptom that has no organic cause
|
somatization
|
|
|
Making up for an argument with someone by giving a gift to “undo”
|
undoing
|
|
|
Justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations that satisfy the teller as well as the listener
|
rationalization
|
|
|
immature defenses include
|
passive aggression
action out behaviors dissociation devaluation idealization splitting projection denial |
|
|
Dealing with emotional conflict or stressors by indirectly and unassertively expressing aggression toward others
|
passive aggression
|
|
|
Dealing with emotional conflicts or stressors by actions rather than reflections or feelings
|
acting out behaviors
|
|
|
Feeling unattached to self, others, or environment
|
dissociation
|
|
|
Giving negative value to self or others to try to appear “good” and reduce stress and anxiety
|
devaluation
|
|
|
Emotional stressors are dealt with by idealizing or exaggerating another’s qualities
|
idealization
|
|
|
Inability to integrate positive and negative attributes to another at the same time; the all or nothing way of dealing with stressors; prevalent in individuals with borderline personality disorder
|
splitting
|
|
|
Placing one’s own negative attributes onto another person, object, or situation; also called “blaming” or “scapegoating
|
projection
|
|
|
Escaping from unpleasant realities by ignoring their existence; a hallmark defense mechanism in alcohol or drug addicted individuals (“I can stop drinking or taking drugs anytime I want to.”)
|
denial
|
|
|
when does anxiety become pathological
|
when it interferes with adaptive behavior, causes physical symptoms, or exceeds a tolerable level.
|
|
|
what types of behaviors do people with anxiety use to try and control anxiety
|
rigid, repetitive, and ineffective behaviors to try to control anxiety.
|
|
|
% of population anxiety affects
|
13.3%
women more than men |
|
|
T or F
People may have more than one type of anxiety disorder. |
true
|
|
|
possible cause of general anxiety disorder and panic disorder
|
One theory suggests that aberrant production of a substance that interferes with benzodiazepine binding to receptors or altered receptor sensitivity interfering with proper benzodiazepine receptor function is involved.
|
|
|
Phobias—Social phobias may well be related to
|
noradrenergic dysfunction
|
|
|
possible cause of obsessive compulsive disorder
|
Neuroimaging techniques point to orbitofrontal-limbic-basal ganglia circuit dysfunction, whereas neurochemistry points to serotonin dysregulation
|
|
|
cause of PTSD
|
number of theories exist, including one suggesting that extreme stress is associated with damaging effects to the brain.
|
|
|
Other frequent comorbid disorders include of anxiety include
|
DEPRESSION often
substance abuse, somatization, and other anxiety disorders. |
|
|
is anxiety genetical
|
There is evidence of specific genetic contributions that increase a person’s susceptibility to specific anxiety disorders. However, no anxiety disorder has been proved to be the result of a specific gene
|
|
|
Recurrent, unexpected panic attacks of sudden onset are a clinical symptom of this disorder. Physical symptoms of sympathetic arousal are accompanied by terror, limited perceptual field, and severe personality disorganization
|
panic disorder
|
|
|
Clinical picture for this disorder is recurrent panic attacks accompanied by fear of being in an environment or situation from which escape might be difficult or embarrassing or in which help may not be available (e.g., being alone outside; being home alone; traveling in a car, bus, or plane; being on a bridge or in an elevator).
|
Panic Disorder with Agoraphobia
|
|
|
Simple agoraphobia is fear of being in an environment or situation from which escape might be difficult (as listed above).
|
simple agoraphobia
|
|
|
persistent, irrational fears of a specific object, activity, or situation that lead to a desire for avoidance or actual avoidance of the specific object or situation. Specific phobias are provoked by a specific object (e.g., a dog or spider) or situation (e.g., a storm); they are common and usually do not cause much difficulty because people can avoid the situation/object. Social phobia, or social anxiety disorder, is provoked by exposure to a social situation or a performance situation and can cause great difficulty
|
phobias
|
|
|
Thoughts, impulses, or images that persist and recur, so that they cannot be dismissed from the mind
|
obsessions
|
|
|
Ritualistic behaviors that an individual feels driven to perform in an attempt to reduce anxiety
|
compulsions
|
|
|
is characterized by the presence of excessive anxiety or worry lasting for 6 months or longer; symptoms can include poor concentration, tension, sleep disturbance, and restlessness
|
generalized anxiety disorder
|
|
|
involves reexperiencing of a highly traumatic event involving actual or threatened death or serious injury to self or others to which the person responded with intense fear or helplessness. Symptoms usually begin within 3 months after the traumatic incident and include flashbacks, persistent avoidance of stimuli associated with the trauma, numbness, or detachment, and increased arousal
|
PTSD
post traumatic stress disorder |
|
|
This occurs within 1 month after exposure to a highly traumatic event, such as described for PTSD. Individual must display three dissociative symptoms during or after the event (e.g., numbness, detachment, derealization, depersonalization, or dissociative amnesia
|
acute stress disorder
|
|
|
Symptoms of anxiety, panic attacks, obsessions, and compulsions that develop with the use of a substance or within a month of stopping use.
|
substance-abuse anxiety disorder
|
|
|
Symptoms of anxiety are sometimes the physiological result of a medical condition such as pheochromocytoma, cardiac dysrhythmias, hyperthyroidism, etc.
|
anxiety due to medical condition
|
|
|
basic nursing interventions for anxiety
|
Reduce anxiety
2. Enhance coping 3. Instill hope 4. Enhance self-esteem 5. Use relaxation therapy Counseling Milieu therapy Promotion of self-care activities Psychobiological interventions Health teaching |
|
|
assessment for anxiety will always include
|
determining if the anxiety is from a secondary source (medical condition) or a primary source (anxiety disorder). Symptoms specific to various anxiety disorders include panic attacks, phobias, obsessions, and compulsions.
|
|
|
often used (Table 12-9); for example: feeling like one is going to die or having a sense of impending doom; having narrowed perceptions and difficulty concentrating or problem-solving; increased vital signs, muscle tension, dilated pupils; complaints of palpitations, urinary frequency or urgency, nausea, tight throat; complaints of fatigue, insomnia, irritability, disorganization
|
Hamilton Rating Scale for Anxiety
|
|
|
If the client with an anxiety disorder does require hospitalization, the environment should be
|
structured to offer safety and predictability, should have activities to shift the client’s focus from his or her anxiety and symptoms, and should provide therapeutic interactions
|
|
|
Assumes that cognitive errors made by the client produce negative beliefs that persist. Counseling calls for the nurse to assist the client to identify these thoughts and negative beliefs and to appraise the situation realistically.
|
cognitive therapy
|
|
|
this type of tehrapycalls for the nurse to assist a client to identify automatic negative anxiety-arousing thoughts and negative self-talk, discover the basis for the thoughts, and to assist the client to appraise the situation realistically and replace automatic thoughts and negative self-talk with realistic thinking.
|
cognitive restructuring
|
|
|
variety of approaches such as psychoeducational methods, continuous panic self-monitoring, breathing retraining, development of anxiety management skills, and in vivo exposure to feared stimuli.
|
cognitive behavioral therapy
|
|
|
Shows client how an individual copes effectively and expects the client to imitate the adaptive behavior
|
modeling
|
|
|
Extinguishes anxiety as a conditioned response by exposing a client to a large amount of the stimulus he or she finds undesirable.
|
flooding
implosion therapy |
|
|
The individual who would reduce anxiety by performing a ritual is not permitted to perform the ritual
|
response prevention
|
|
|
A technique calling for the client to shout “STOP” or snap a rubber band on the wrist whenever an obsessive thought begins. This helps the client dismiss the thought
|
thought stopping
|
|
|
meds for anxiety disorders include
|
Antidepressants
Selective serotonin reuptake inhibitors Tricyclics Monoamine oxidase inhibitors Serotonin-norepinephrine reuptake inhibitors Anxiolytics Benzodiazepines Antihistamines β-Blockers Anticonvulsants |
|
|
Physical symptoms suggest a physical or medical disorder
Diagnostic tests are negative for physical illness Symptoms are linked to psychobiological factors |
somatoform disorders
|
|
|
anxiety translated into a physical illness
|
Complaints of physical symptoms not explainable by physiological tests.
2. Psychological factors and conflicts are important reasons the illness continues. 3. The client cannot control the symptom voluntarily. 4. Symptoms that are not intentionally produced (as in malingering or factitious disorde somatoform |
|
|
theories about etiology of somatoform disorders
|
biological - abnormalities in brain chemical balance or structural abnormalities of sensory or limbic systems.
Serotonin and endorphin deficiency CNS arousal disturbances, and cytokine system dysregulation may be associated with symptoms such as fatigue and anorexia. tend to run in families, according to twin studies and studies of first-degree female relatives of clients with somatization disorder. |
|
|
This theory holds that psychogenic pain, illness, and loss of function are related to a repressed conflict and a transformation of anxiety into a physical symptom. In
|
psychoanalytical theory of somatoform disorder
|
|
|
Drugs for Pinworms?
|
Enterobius vermicularis (called helminth)
Symptom: Anal itching Mebendazole (Vermox) x1 tab can repeat 1-3weeks for >2 mos up, SE: N/V, diarrhea Albendazole (Albenza) Pyrantel pamoate (Pin-Rid, Pin-X) (OTC) Counseling: Wash hand, keep nail short *treat the whole family |
|
|
In body dysmorphic disorder, some theorists believe the special meaning attached to a part of the body is traceable to
|
event during an early developmental stage and that the individual makes use of repression, symbolization, and projection.
|
|
|
This theory suggests somatoform symptoms are learned ways of communicating helplessness, which allows the individual to manipulate others. The symptoms are reinforced by attention, obtaining financial gain, and avoiding certain activities the individual dislikes
|
behavioral theory of somatoform disorders
|
|
|
holds that the somatoform client with hypochondriasis focuses on body sensations, misinterprets their meanings, and then becomes alarmed by them.
|
cognitive theory of somatoform
|
|
|
Intentionally producing symptoms to achieve an environmental goal
|
malingering
|
|
|
Fabrication of symptoms or self-inflicted injury to assume the sick role
|
factitious disorder
|
|
|
A general medical condition affected by stress or psychological factors
|
psychosomatic illness
|
|
|
History of many physical complaints beginning before age 30.
Over a period of years resulting in frequent visits to health care providers. Impaired social, occupational and other problems with functioning. |
somatization disorder
|
|
|
Misinterpretation of physical sensations
Diagnostic tests are negative Depression or anxiety disorders common History of childhood trauma possible preoccupation with having a serious disease, or with fear of having a serious disease, that lasts for over 6 months, causing impaired social or occupational functioning Despite appropriate medical tests and reassurance, the preoccupation persists |
Hypochondriasis
|
|
|
Diagnostic testing rules out organic cause
Discomfort leads to impairment Suicide a serious risk factor Usual sites of pain: head, face, lower back, pelvis |
Pain Disorder
|
|
|
Preoccupation with an imagined defective body part
Obsessional thinking and compulsive behavior Impaired social, academic, or occupational functioning Major depression, OCD, and social phobia common |
Body Dysmorphic Disorder
|
|
|
Presence of deficits in voluntary motor or sensory functions
Common symptoms: involuntary movements, seizures, paralysis, abnormal gait, anesthesia, blindness, deafness "La belle indifférence" versus distress Comorbid conditions: depression, anxiety, other somatoform disorders, personality disorders |
Conversion Disorder
|
|
|
indifference to their condition
|
la belle indifference
|
|
|
assessment for somatoform disorder
|
Collect data about nature, location, onset, character, and duration of symptoms or loss of function.
Assess affect for lack of concern. Assess for dramatic presentation, ideas about symptoms, and workups that have been performed, results of workups Resistance to suggestion that symptoms are psychogenic. Note alterations in rest, comfort, activity, and self-care. Include any self medication that is used. Dependence on medication to relieve pain or anxiety or to induce sleep needs to be assessed in clients with somatoform disorders. Dependence develops quickly. If treatment has been sought from a number of physicians, substance misuse may occur. Social assessment and family assessment. Mental status exam is also important as part of the assessment. |
|
|
nurse's feelings towards client with somatoform disorder may include
|
Nurse’s feelings may include anger, helplessness, finding the client difficult and unsatisfying to work with, and perplexity that a client who has no physical basis for symptoms is being treated on a medical unit. Clients with somatoform disorders are sometimes very draining!!!
|
|
|
nursing interventions for somatoform disorder
|
Promotion of Self-Care
Use matter-of-fact approach to support highest level of self-care of which the client is capable.Health Teaching Clients using somatization may need basic information about how the body functions as part of cognitive restructuring. Other coping skills that may be taught include relaxation skills, assertiveness training, biofeedback, and physical exercise. Case Management “Doctor shopping” is a common practice of clients with somatoform disorders. Having a case manager may help client avoid this by giving the client someone to whom to relate. |
|
|
nursing interventions for somatoform should include
|
focus initially on establishing a helping relationship, given the client’s resistance to the concept that no physical cause for the symptom exists and the client tendency to go from caregiver to caregiver. Interventions usually take place in the home or clinic setting. Accupuncture and therapeutic touch may be beneficial.
|
|
|
complications of somatoform disorder
|
Addiction. Withdrawl symptoms when they cannot get the sedatives, hypnotics and narcotics that are commonly prescribed.
Client may feel alienated due to “wearing out the staff” |
|
|
Person consciously pretends to be ill to get emotional needs met and attain the status of “patient”
High costs to health care system Client very demanding and accusatory if limits are set by healthcare team Usually sees the same doctor over and over Test results negative |
factitious disorder
|
|
|
4 types of dissociative disorders
|
Depersonalization disorder
Dissociative amnesia Dissociative fugue Dissociative identity disorder |
|
|
involve disruption of the usually integrated mental functions of consciousness, memory, and identity or perception of environment (e.g., depersonalization disorder involves feeling detached or disconnected from mind or body;
|
disassociative disorders
|
|
|
a client whose ability to integrate memories is impaired
|
dissociative amnesia
|
|
|
a client unable to maintain his or her identity may develop
|
dissociative fugue or dissociative identity disorder.
|
|
|
commonly associated with all of the dissociative disorders.
|
Mood disorders and substance-related disorders
|
|
|
Dissociated amnesia also may be present with
|
conversion disorder or personality disorder.
|
|
|
Dissociative fugue may co-occur with
|
PTSD
|
|
|
possible causes of dissociative disorders
|
Biological Factors The development of the limbic system may be faulty, allowing experiences to be detached from memory. Early trauma and lack of attachment may affect neurotransmitter availability. Depersonalization has a possible neurological link as evidenced by its occurrence with epilepsy, brain tumors, and schizophrenia.
Genetic Factors Dissociative identity disorder is more common among first-degree relatives of individuals with the disorder than among the population at large. Psychosocial Factors Learning theory suggests dissociative disorders are learned methods for avoiding stress and anxiety, and that the more often “tuning out” is used, the more likely it is to become automatic |
|
|
All dissociative disorders are believed to be linked with
|
traumatic life events. Abused individuals, for example, may learn to use dissociation to defend against feeling pain and to avoid remembering.
|
|
|
This is the inability to recall important personal information of a traumatic or stressful nature. It is more pervasive than forgetfulness. Two types exist: localized and selective
|
dissociative amnesia
|
|
|
Sudden unexpected travel away from the customary locale
Inability to recall one's identity and some or all of the past During fugue state tend to live simple, quiet lives When remember former identity, become amnesic for time spent in fugue state |
dissociative fugue
|
|
|
Presence of two or more distinct personality states
Primary personality (host) usually not aware of alters Alternate personality (alters) or subpersonalities take control of behavior Alters often aware of each other Each alter thinks and behaves as a separate individual |
Dissociative Identity Disorder
|
|
|
assessment needed for dissociative disorders
|
Identity and memory
Client history Moods Use of alcohol and other drugs Impact on client and family Suicide risk |
|
|
how can prevention of dissociative episodes be taught
|
The client learns to identify triggers to dissociation, and to develop a plan to interrupt the dissociation by singing, playing an instrument, talking to someone, icing the hands, etc
|
|
|
are psychobiological interventions helpful with dissociative disorders
|
There is no evidence that medication of any type has been therapeutic. Antidepressants are the most useful because many with DID have mood disorder.
|
|
|
normal personality is defined as
|
Capacity to function autonomously
Capacity to function competently Ability to adjust to changing demands of life Personal sense of contentment and satisfaction with life |
|
|
common characteristics of personality disorders
|
Inflexible and maladaptive response to stress
Disability in working and loving Ability to evoke interpersonal conflict Capacity to "get under the skin" of others |
|
|
long-term and repetitive use of maladaptive and often self-defeating behaviors
|
personality disorder
|
|
|
why do people with personality disorders not seek help
|
they do not recognize their symptoms as uncomfortable
|
|
|
why is effective care of people with personality disorders at risk
|
People with PD tend to be perceived as aggravating and demanding by health care workers, so the potential for value judgments is high and effective care is at risk
|
|
|
describe a person with PD (personality disorder)
|
Persons with PD are very rigid
The problem is chronic and tends to have vicious cycles. The person is “Clueless” They create psychodramas- “pathological problem solving” Non compliant with treatment or have questionable motivation for treatment They have difficulty translating therapeutic insight into specific, concrete behavioral changes They have intense transference / counter-transference reactions. |
|
|
PD may coexist with
|
May co-exist with depression, panic disorder, substance use disorder, eating disorder, anxiety disorder, PTSD, somatization, and impulse control disorders.
|
|
|
Schizotypal PD occurs more frequently in genetics or not
|
yes more in
nonpsychotic first-degree relatives of schizophrenics than in control families |
|
|
Paranoid PD occurs more frequently in
|
relatives with major depression than in controls
|
|
|
PD patients have atypical brain chemistry that may be caused by
|
of genetics, predisposition, pre-birth trauma, birth trauma, post-birth psychological or physical trauma, physical or emotional neglect, medical conditions or a combination of the above
|
|
|
primary areas of the brain affected by PD include
|
cerebral cortex, the prefrontal cortex and sections of the limbic system. Especially the amygdala and the hippocampus.
|
|
|
how might chronic trauma cause PD
|
Repeated cycles of trauma may reorganize the brain’s cortical map, cognitive and behavioral development, and the unconscious.
Later, clients may act out a forgotten history, disconnect from emotions, and develop fear of others |
|
|
what is the norm in all relationships with persons with PD
|
manipulation and power struggles are the norm
|
|
|
Developmental Fixation means what
|
The person is stuck between age 7 and 8. Theorists: Freud, Adler, Young. The person can function in some situations but not others. Some of the proposed causes of this fixation are
Physical trauma, loss of a parent, home, sibling etc. Emotional trauma, sexual trauma Toxic parenting- three styles of parenting |
|
|
Toxic parenting- three styles
|
Parent who smothers and engulfs and does not allow the child to become autonomous.
b. Distant or overly abusive to the child. Forces the child to separate to early. c. Mixed style of engulfing and abusive. He said this is the most toxic. The child does not know what to expect |
|
|
what does cognitive behavioral theory say about PD
|
All beliefs and behaviors are learned. PD patients have developed a number of maladaptive beliefs and behaviors. Anything that is learned can be unlearned. Maladaptive ways of thinking and behaving can be discarded and healthier more adaptive coping styles can be learned. This theory believes with improved coping comes improved affect.
|
|
|
Potentially Inherited Personality Traits
|
Novelty seeking
Harm avoidance Reward dependence Persistence Neuroticism (negative affect) versus emotional stability Introversion versus extraversion Conscientiousness versus undependability Antagonism versus agreeableness Closeness versus openness to experiences |
|
|
inventory used to assess personality
|
Minnesota Multiphasic Personality Inventory (MMPI)
|
|
|
what is the following behavior below known as
Primary defense used by clients with borderline PD Client labels one person “all good” and the others “all bad” When all-good person has not met client's needs, that person becomes all bad Someone else then labeled all good, others all bad Creates conflict in staff members |
splitting
|
|
|
3 clusters of PDS
|
Cluster A: Odd or eccentric
Cluster B: Dramatic, emotional, erratic Cluster C: Anxious or fearful |
|
|
this form of PD is
They are tense, guarded, suspicious, self-righteous, rigid, petty, vengeful. They bear grudges and are prone to primitive They bear grudges and are prone to primitive, overt violent acts of aggression. They rarely seek treatment voluntarily. They are typically court ordered into treatment or are sent to treatment by their doctors. They tend to be highly somatic and hypochondriacal. Especially prone to GI problems of psychogenic nature |
paranoid
|
|
|
this form of PD is
Blunted affect Socially isolated Socially awkward Somewhat robotic 1 % of population No gender differences There is a gap or a division between the individual and the emotional life “Don’t do relationships” They are drawn to highly emotional intense partners but will be overwhelmed by it. They have little or no desire to be with people and are content to live a routine, orderly, quiet life. Mr. Spock in the original “Star Trek” series 1966 to 1969 Sandra Bullock in “The Net |
schizoid
(nothing to do with schizophrenia) |
|
|
Peculiar
Highly eccentric Bizarre in thought, appearance or behavior 1 % or less of population No gender differences Appears Inherited often look schizophrenic but will not meet a sufficient number of diagnostic criteria for full blown psychosis They are typically not helped by anti-psychotics Kramer on “Seinfeld” “Phoebe” on “Friends” Film “Psycho” 1960 |
Schizotypal PD
|
|
|
Antisocial
Borderline Narcissistic Histrionic Most vulnurable to eating disorders and substance abusers. Very conflict oriented |
Cluster B: Dramatic, Emotional, Erratic
|
|
|
Also called Sociopath
Pervasively dishonest Manipulative Exploitative Disloyal Intense insecurities Anxiety 3-4 % of population 4 males to 1 female lack a well developed super ego and experience little or no guilt when they break the rules, violate laws, and shatter lives of others. They deal with their insecurities and anxiety by raising it in others Responsible for 80 % of the crime that occurs in any culture. Career Criminals Films “Little Caesar: 1931 and “Public Enemy” 1932 The “Godfather” 1972 and Tony Soprano on “The Soprano’s” “Wallstreet” 1988 |
antisocial PD
|
|
|
this form of PD is responsible for 80% of all crime
|
antisocial PD
|
|
|
Fragile Egos
Straddle between sanity and psychosis Fragmented Psyches Intense and unstable moods Chaotic personal relationships Self destructive Controversial if it is gender specific Do not like to be alone. They crave intamacy but they repel it by being childish, overly demanding, jealous, possessive and verbally and physically abusive with significant others. They use splitting, projection, and denial often. They tend to self-mutilate and are at high risk for suicide. Examples: Marilyn Monroe, Jim Morrison, Princess Diana Films: “Wuthering Heights” 1939 “Fatal Attraction” 1987 and the “Talented Mr. Ripley” 2002 Mr. Shannon does not feel it is gender specific. There are 4 women to 1 man diagnosed but there is quite a bit of controversy as to whether it is mis-diagnosed in women. |
borderline PD
|
|
|
Seductive and flirtatious
Center of attention Rapidly changing shallow moods 2 % of general population Occurs in men and women equally Pathologically vain and are phobic about aging. Can be very quick-witted, talented, beautiful and a “must” at a party. Examples: Judy Garland, Liza Minnelli, Robin Williams, Jim Carey. T.V. “Jack” and “Karen” on “Will and Grace” Films: “Dark Victory” 1939 and “A Streetcar Named Desire” 1951 and “Annie Hall” 1977 and “Private Benjamin” 1980 |
histronic PD
|
|
|
2 types of narcissistic PD
|
Closeted” Narcissist
“Malignant” Narcissist |
|
|
Superficially Nice
Aim to please Passive-aggressive Very sensitive to criticism Self-absorbed and self-centered Bill Clinton” Many TV celebrities such as “Bing Crosby” TV shows: “Frazier Crane” on “Frazier” and “Jerry Seinfeld” on “Seinfeld” |
closeted narcissistic
|
|
|
Truly believe they are superior to everyone
Demand special treatment Fantasies of perfection insatiable need for power, wealth, prestige and attention. Very Sensitive to shame and embarrassment. They take credit for your successes and blame you for their failures. When confronted about a shortcoming they will become hostile and defensive and will project blame onto others. High risk for addiction, sado-masoshistic sex and white-collar crime. They may have some psychopathic tendencies. Example: Sadam Hussein, Hitler Films: “Citizen Kane” 1941 “American Gigolo” 1979 |
malignant narcissist
|
|
|
Shy
Fear being judged and criticized Long for human contact Debilitating fear and panic in social settings Easily hurt and embarrassed 1-2 % of population No gender differences Very “thin skinned” They tend to live very routine, lonely, sad lives. Films “The Glass Menagerie” 1950 and “The Accidental Tourist” 1988 |
avoidant PD
|
|
|
Feel Inadequate
Low self-esteen Insecure Profoundly passive 2 % of population No gender differences overcompensate for their perceived short-comings by encouraging others to develop a strong dependency on them for emotional nurturance. They then depend on that person for just about everything. Terrifying fear of abandonment. Thy are not as manipulative, self-destructive or annoying as Borderline’s can be when faced with the threat of abandonment. TV “Edith Bunker” “All in the Family” and “Marie” on “Everybody Loves Raymond” Films: “Come Back Little Sheba” 1953 and “Rocky” 1976 |
dependant PD
|
|
|
Stiff
Perfectionistic Aloof, unemotional Unempathetic Overly conscientious and controlling Rigid, unforgiving in interpersonal conflict Can become preoccupied with details. They have anxiety and tend to keep this at bay by creating a meticulously-ordered, efficient and at at times a beautiful environment. This helps them deal with their pain and distress. They don’t like or tolerate mess!! TV: “Niles” on “Frasier” “Martha” on “Martha Stewart Living” “Kate” on “John & Kate Plus Eight” Film: “Ordinary People” 1979 “Sleeping with the Enemy” 1991 “The Remains of the Day” 1999 |
Obsessive-Compulsive PD
|
|
|
Fearful of anger or conflict
Sensitive to being manipulated Notoriously late for appointments 2 % of population No gender differences They deal with their own anger or hurt feelings in a sneaky way They are always fearful of manipulation or being controlled. They become resentful easily. They show irritation by brooding, complaining, sulking or by being deliberately inefficient. They often times withold affection or sex to punish the loved one. They are not often open or clear about why they are upset. TV “George” on “Seinfeld” or “Sue Ann Nivens “ on “The Mary Tyler Moore Show |
Passive Aggressive
|
|
|
Moderate to severe depressive symptoms
Pessimistic Negative Self-doubting Guilt 2 % of population No gender differences Depressive symptoms date back to early childhood. TV “Dr. House” on “House” “Debbie Downer” on “Saturday Night Live” “Eyore” from “Winnie The Poo” Films: “Annie Hall” 1977 |
depressive PD
|
|
|
effective treatment for PD
|
Pharmacological intervention target to specific symptoms
Psychotherapy Diet & Exercise |
|
|
whenever the client imputes malevolent intentions to the nurse or others, the nurse should
|
orient back to reality
reassure the client that even though the caregiver has been insulted or threatened, the client will still be helped and protected. The nurse must explain how people, systems, families, and relationships work and acknowledge shortcomings and limitations. |
|
|
Potential for pain and suffering in all aspects of life
Affects children, teenagers, adults, elderly Symptoms may include psychotic, catatonic, melancholic features |
Major depressive disorder
|
|
|
how long must chronic depressed mood be present for diagnosis of dysthmia in adult, in child
|
> 1 yr for child or teen
>2 yr for adult |
|
|
assessment tools for depression
|
Beck Depression Inventory
Hamilton Depression Scale Geriatric Depression Scale Zung Depression Scale |
|
|
key symptoms of depression
|
Depressed mood
Anhedonia Anxiety Psychomotor agitation/retardation Somatic complaints Vegetative signs |
|
|
areas to assess for depression
|
Affect
Thought processes Feelings Guilt Physical behavior Communication |
|
|
self-assessment for nurse dealing with depression
|
Unrealistic expectations
Feelings originating from client Understanding of depression as a systemic illness with a complex interaction of causes |
|
|
potential nursing diagnosis with depression
|
Risk for suicide
Hopelessness Powerlessness Disturbed thought process Ineffective coping |
|
|
outcome criteria for depression
|
Remains safe
Reports hope for future Identifies precursors of depression Reports improved mood Plans strategies to reduce effects of precursors of depression |
|
|
basic level interventions for depression
|
Communication
Counseling Encourage self-care activities Maintain therapeutic milieu Health teaching Administer medications per physician/advanced practice nurse Assess effects of medications |
|
|
advanced practice interventions for depression
|
Psychotherapy
Cognitive behavioral therapy Interpersonal therapy Social skills training Group therapy |
|
|
first line agent antidepressants
|
Selective serotonin reuptake inhibitors (SSRIs)
Newer atypical antidepressants Tricyclic antidepressants (TCAs |
|
|
second line interventions for depression
|
Monoamine oxidase inhibitors (MAOIs)
Electroconvulsive therapy (ECT |
|
|
Start low, go slow” with
|
tricyclic antidepressants
|
|
|
possible causes of bipolar disorders
|
Genetic component
Neurobiological factors Neurotransmitters and hormones Neuroendocrine factors Hypothalamic-pituitary-thyroid-adrenal axis Neuroanatomical factors Dysregulation in neurological circuits |
|
|
assessment of characteristics of mania
|
Hypomanic to manic
Sociality and euphoria to hostility, irritability, paranoia Behavior Hyperactivity Bizarre and colorful dress Highly distractible Impulsive Flight of ideas Grandiosity Poor judgment Cognitive function Significant and persistent problems Difficulties in psychosocial areas Manipulative Splitting Aggressively demanding |
|
|
what must staff do when working with manic client
|
Set limits consistently
Frequent staff meetings to deal with patient behavior and staff response |
|
|
must assess suicide risk with manic pt how and why
|
Assess for suicidal thoughts or plans
May exhaust themselves to the point of death May not eat or sleep for days at a time Poor impulse control |
|
|
possible nursing diagnosis for manic
|
Risk for violence
Defensive coping Ineffective coping Disturbed thought processes Situational low self-esteem |
|
|
focus of care during phase of manic
|
Maintain safety
Medication stabilization Self-care |
|
|
focus of care during continuation phase of manic
|
Maintain medication compliance
Psychoeducation teaching Counseling |
|
|
focus of care during maintenance phase of manic
|
Prevent relapse
|
|
|
how to communicate with manic client
|
Use firm, calm approach
Use short and concise explanations Remain neutral: avoid power struggles Be consistent in approach and expectations Firmly redirect energy into more appropriate areas |
|
|
Mood stabilizer
First-line agent Takes 7 to 14 days to reach therapeutic levels in blood Therapeutic blood level 0.8 to 1.4 mEq/L Maintenance blood level 0.4 to 1.3 mEq/L |
lithium carbonate
|
|
|
what is used for Initial Treatment of Acute Mania Until Lithium Takes Effect
|
antipsychotics
|
|
|
antipsychotics may
|
Slow speech
Inhibit aggression Decrease psychomotor activity |
|
|
benzodiazepine is used to prevent
|
Exhaustion
Coronary collapse Death |
|
|
expected side effects fromlithium
|
Fine hand tremor
Polyuria Mild thirst Mild nausea General discomfort Weight gain |
|
|
Blood level: 1.5 mEq/L
Signs Nausea Vomiting Diarrhea Thirst Polyuria Slurred speech Muscle weakness |
early signs of lithium toxicity
|
|
|
advanced signs of lithium toxicity
|
Blood level: 1.5 to 2.0 mEq/L
Signs Coarse hand tremor Persistent gastrointestinal upset Mental confusion Muscle hyperirritability Incoordination |
|
|
signs of severe lithium toxicity
|
Blood level: 2.0 to 2.5 mEq/L
Signs Ataxia Blurred vision Clonic movements Large output of dilute urine Seizures Stupor Severe hypotension Coma Death |
|
|
major long term risks of lithium use
|
Hypothyroidism
Impairment of kidneys’ ability to concentrate urine |
|
|
lithium contraindications
|
Cardiovascular disease
Brain damage Renal disease Thyroid disease Myasthenia gravis Pregnancy Breastfeeding mothers Children younger than 12 years |
|
|
Client and Family Teaching for Lithium Therapy
|
Effects of treatment
Need to monitor lithium blood levels Side effects and toxic effects Effects of food and over-the-counter medications When to call the physician |
|
|
antiepileptic meds
|
Carbamazepine (Tegretol)
Divalproex (Depakote) Lamotrigine (Lamictal) Gabapentin (Neurontin) Topiramate (Topamax) |
|
|
antipsychotics
|
Olanzapine (Zyprexa)
Quetiapine (Seroquel) Risperidone (Risperdal) |
|
|
anxiolytics
|
Clonazepam (Klonopin)
Lorazepam (Ativan |
|
|
when is ECT used
|
Severe manic behavior
Rapid cycling Paranoid, destructive features Acutely suicidal behavior |
|
|
when is seclusion or self-restraint used
|
Used in an emergency for client when:
Clear risk of harm to client or others Client's behavior has continued despite use of less restrictive methods to keep client and others safe |
|
|
when can self-restraint be allowed
|
Only on written order of physician and reviewed and re-written every 24 hours. Must include type of restraint to be used. A charge nurse can place restraint only in emergencies and a written order must be obtained with in 30 minutes. See policy and procedure for facility you are in.
|
|
|
issues surrounding seclusion or restraints
|
Therapeutic behaviors
Ethics State and federal laws Hospital protocols Specific documentatio |
|
|
Delusions
Hallucinations Disorganized speech Disorganized catatonic behavior Psychotic symptoms more pronounced and disruptive than in other psychotic disorders |
schizophrenia
|
|
|
schizophrenia occurs more often in
|
men
|
|
|
typical age of onset of schizophrenia in men
|
18 - 25
|
|
|
typical age of onset of schizophrenia in women
|
25 - 35
|
|
|
what percent of people with schizophrenia attempt suicide
|
50%
|
|
|
schizophrenics and illness
|
have an increased risk of illness
1.6 - 2.8 X greater premature death |
|
|
polydipsia occurs in what percent of schizophrenia pts
|
occurs in 7 % of patients with schizophrenia. May be due to antipsychiotics, compulsive behavior, and neuroendocrine abnormalities.
|
|
|
4 As of schizophrenia
|
Affect
Associative looseness Autism Ambivalence |
|
|
signs and symptoms of schizophrenia
|
Positive symptoms
Negative symptoms Cognitive symptoms Affective symptoms |
|
|
subtypes of schizophrenia
|
Paranoid
Catatonic Disorganized Undifferentiated Residua |
|
|
3 phases of course of schizophrenia
|
Acute phase
Positive symptoms and negative symptoms Maintenance phase Acute symptoms are less severe Stabilization phase Remission of symptoms |
|
|
early symptoms of prepsychotic schizophrenia
|
Withdrawn from others
Depressed Anxious Phobias Obsessions and compulsions Difficulty concentrating Preoccupation with religion Preoccupation with self |
|
|
Dimensions Altered in Individuals with Schizophrenia
|
Ability to work
Interpersonal relationships Self-care abilities Social functioning Quality of life |
|
|
positive symptoms of schizophrenia of alteration in thinking
|
Delusions: false, fixed beliefs that cannot be corrected by reasoning
Ideas of reference Persecution Grandiosity Somatic sensations Jealousy Control Thought broadcasting Thought insertion Thought withdrawal Delusion of being controlled Concrete thinking |
|
|
Positive Symptoms: Alterations in Speech
|
Associative looseness
Neologisms Echolalia Clang association Word salad |
|
|
Positive Symptoms: Alterations in Perception
|
Hallucinations: sensory perceptions for which no external stimulus exists
Auditory Visual Olfactory Tactile Personal boundary difficulties |
|
|
Positive Symptoms: Alterations in Behavior
|
Extreme motor agitation
Stereotyped behaviors Automatic obedience Waxy flexibility Stupor Negativism |
|
|
negative symptoms of schizophrenia
|
Affective blunting
Anergia Anhedonia Avolition Poverty of content of speech Thought blocking Flat affect/inappropriate affect |
|
|
negative cognitive symptoms of schizophrenia
|
Inattention, easily distracted
Impaired memory Poor problem-solving skills Poor decision-making skills Illogical thinking Impaired judgment |
|
|
Depression and Other Mood Symptoms of schizophrenia
|
Dysphoria
Suicidal ideation Hopelessness |
|
|
assessment of client with schizophrenia
|
Safety of client and others
Medical history and recent medical workup Positive, negative, cognitive, and mood symptoms Current medications and compliance to treatment Family response/support system |
|
|
potential nursing diagnosis for schizophrenia
|
Risk for self-directed or other-directed violence
Disturbed sensory perception Disturbed thought processes Impaired verbal communication Ineffective coping Compromised or disabled family coping |
|
|
Outcome Criteria acute phase schizophrenia
|
Client safety and medical stabilization
|
|
|
outcome criteria stabilization phase schizophrenia
|
Adherence to medical regimen
Understanding schizophrenia Participation of client and family in psychoeducational activities |
|
|
outcome criteria maintenance phase schizophrenia
|
Target negative symptoms
Anxiety control Relapse prevention |
|
|
possible appropriate interventions acute phase schizophrenia
|
Possible hospitalization
Ensure client safety Provide symptom stabilization |
|
|
possible appropriate interventions maintenance and stabilization phases
|
Psychosocial education
Relapse prevention skills |
|
|
safety concerns for schizophrenia
|
Potential for physical violence due to hallucinations or delusions
Priority is least restrictive safety technique Verbal de-escalation Medications Seclusion or restraints |
|
|
communication guidelines for hallucinations
|
Hearing voices most common
Approach client in nonthreatening and nonjudgmental manner Assess if messages are suicidal or homicidal Initiate safety measures if needed Client anxious, fearful, lonely, brain not processing stimuli accurately |
|
|
communication guidelines for delusions
|
Be open, honest, matter-of-fact, and calm
Have client describe delusion Avoid arguing about content Interject doubt Validate part of delusion that is real |
|
|
communication guidelines for associative looseness
|
Do not pretend that you understand
Place difficulty of understanding on yourself Look for reoccurring topics and themes Emphasize what is going on in the client's environment Involve client in simple, reality-based activities Reinforce clear communication of needs, feelings, and thoughts |
|
|
coping techniques to teach clients with schizophrenia
|
Distraction
Interaction Activity Social action Physical action |
|
|
what to teach client and family about schizophrenia
|
Learn all you can about the illness.
Develop a relapse prevention plan. Avoid alcohol and drugs. Learn ways to address fears and losses. Learn new ways of coping. Comply with treatment. Maintain communication with supportive people. Stay healthy by managing illness, sleep, and diet |
|
|
antipsychotic meds include
|
Traditional or conventional
Atypical or novel |
|
|
conventional antipsychotics are
|
Dopamine antagonists (D2 receptor antagonists)
Target positive symptoms of schizophrenia Advantage Less expensive than atypical antipsychotics |
|
|
disadvantages of conventional antipsychotics
|
Do not treat negative symptoms
Extrapyramidal side effects (EPS) Tardive dyskinesia Anticholinergic effects (ACH) Lower seizure threshold |
|
|
advantages of atypical antipsychotics
|
Diminishes negative as well as positive symptoms of schizophrenia
Less side effects encourages medication compliance Improves symptoms of depression and anxiety Decreases suicidal behavior |
|
|
what is an atupical antipsychotic - name category
|
Serotonin-dopamine antagonists
(5-HT2A receptor antagonists |
|
|
disadvantages of atypical antipsychotics
|
Weight gain
Metabolic abnormalities |
|
|
high potency antipsychotic meds include
|
Haloperidol (Haldol)
Trifluoperazine (Stelazine) Fluphenazine (Prolixin) Thiothixene (Navane |
|
|
medium potency antipsychotic meds include
|
Loxapine (Loxitane)
Molindone (Moban) Perphenazine (Trilafon |
|
|
Low potency = high sedation + high ACH + low EPSs
antipsychotic meds include |
Chlorpromazine (Thorazine)
Thioridazine (Mellaril) Mesoridazine ( Serentil |
|
|
long acting antipsychotic meds include
|
Decanoate = Long acting
Haloperidol decanoate (Haldol) Fluphenazine decanoate (Prolixin |
|
|
Antipsychotic Medications: Atypical include
|
Clozapine (Clozaril)
Quetiapine (Seroquel) Risperidone (Risperdal Zipreasidone (Geodon) Olanzapine (Zyprexa) Aripiprazole (Abilify) |
|
|
Side Effects: Anticholinergic Symptoms of antipsychotics
|
Dry mouth
Urinary retention and hesitancy Constipation Blurred vision Photosensitivity Dry eyes Inhibition of ejaculation or impotence in men |
|
|
Side Effects: Extrapyramidal Side Effects of antipsychotics
|
Pseudoparkinsonism
Acute dystonic reactions Opisthotonos Oculogyric crisis Akathisia Tardive dyskinesia (AIMS test) Facial Limbs Choreic Athetoid Trunk |
|
|
Side Effects: α2 Block: Cardiovascular Effects of antipsychotics
|
Hypotension
Postural hypotension Tachycardia |
|
|
Side Effects: Rare and Toxic Effects of antipsychotics
|
Agranulocytosis
Cholestatic jaundice Neuroleptic malignant syndrome (NMS) Severe extrapyramidal Hyperpyrexia Autonomic dysfunction |
|
|
Disorders caused by changes in the brain marked by disturbances in:
Orientation Memory Intellect Judgment Affect |
cognitive disorders
|
|
|
Delirium: Essential Features
|
Acute onset
Disturbances in consciousness Disturbed thinking, memory, attention, and perception Disorientation and confusion that fluctuates by minute, hour, and day Always caused by an underlying condition Temporary Transient |
|
|
treatment priority for delirium
|
Identify cause, then intervene so that permanent damage to neurons does not result
|
|
|
Delirium: Assessment
|
Cognitive and perceptual disturbances
Physical needs Safety Physical Bacteriological Biophysical Mood and behavior |
|
|
nursing diagnosis for delirium
|
Risk for injury
Deficient fluid volume Acute confusion Disturbed thought processes Fear Disturbed sleep pattern Impaired verbal communication Impaired social interaction |
|
|
outcomes for delirium
|
Client will return to premorbid level of functioning.
Client will remain safe and free from injury while in the hospital. Client will correctly identify day, month, year, season, and place. Client will communicate appropriately for the situation. |
|
|
interventions for delirium
|
Assess vital signs and neurological status on an ongoing basis.
Maintain a hazard-free environment at all times. Provide appropriate level of supervision and surveillance to monitor patient and allow therapeutic actions as needed. Orient client to person, place, and time as needed. Communicate with simple, direct, descriptive statements |
|
|
A cognitive disorder with these signs and symptoms:
Insidious onset Deterioration of Memory Judgment Ability to think abstractly Orientation May be progressive and irreversible |
dementia
|
|
|
examples of primary irreversible dementia
|
Alzheimer's disease
Vascular dementia Pick's disease Lewy body disease |
|
|
secondary reversible dementia is caused by
|
Caused by other pathological processes
|
|
|
possible causes of Alzheimer's
|
Pathological
Cerebral atrophy Neuritic plaques Neurofibrillary tangles Genetic Chromosome 19 Apolipoprotein E gene Nongenetic Neurochemical Acetyltransferase Estrogen |
|
|
Alzheimer's Disease: Stages
|
Stage 1 (mild): forgetfulness
Stage 2 (moderate): confusion Stage 3 (moderate to severe): ambulatory dementia Stage 4 (late): end stage |
|
|
Alzheimer’s Disease: Samples of Behavior Manifestations
|
Confabulation
Perseveration Aphasia Apraxia Agnosia |
|
|
unconscious attempt to maintain self-esteem
|
Confabulation
|
|
|
repetition of phrase or behaviors
|
perseveration
|
|
|
loss of language ability
|
aphasia
|
|
|
loss of purposeful movement in the absence of motor or sensory impairment
|
apraxia
|
|
|
loss of sensory ability to recognize objects
|
agnosia
|
|
|
Alzheimer’s Disease: Nursing Diagnosis
|
Risk for injury
Impaired verbal communication Impaired memory Ineffective coping Caregiver role strain Anticipatory grieving |
|
|
Alzheimer's Disease: Outcome Criteria
|
Client will remain safe.
Client and family will be treated with empathy and respect at all times. Client will be able to communicate to get needs met as long as possible. Client and family will have knowledge about Alzheimer's disease and what physical, mental, and behavioral changes to anticipate in the client. Client and family will receive counseling as needed. Family will be informed of community resources that may be of help. |
|
|
Alzheimer's Disease: Interventions
|
Assess for safety.
Maintain attitude of unconditional positive regard. Follow guidelines for communicating with clients with dementia. Teach client and family about various aspects of Alzheimer's disease. Provide counseling to client and family as needed. Provide family with information about community recourses related to Alzheimer's patient care |
