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149 Cards in this Set
- Front
- Back
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nurse doesn't like client based on another experience with someone else
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transference
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person doesn't like nurse based on an unrelated past experience
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counter
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what are the phases of a therapeutic relationship?
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preinteraction, orientation, working, termination
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therapuetic phase where you develop a goal, there is no mutual sharing in conversation (all divulge has a purpose) and understand self awareness
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preinteraction
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theraputic phase where you identify the problem that needs to be worked on
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orientation
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theraputic phases where you work on a problem, and where you solve the problem and evaluate what the relationship meant
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working
termination |
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** we are dealing with signs and symptoms of an illness and not bad behavior
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**however sometimes bad behavior is picked up in a psyche unit and is not a symptom
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any kind of behavior that does not conform with environment
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maladaptive
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the only conscious defense mechanism
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suppression
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voices and visuals that are not there
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hallucinations
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what are you assessing with a psych patients speech?
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look at form of speech as much as content. loud/soft, flowing/slurred, if they give too many details or are mute
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not able to let a certain thought go
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percevorate
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disconnected statements that make no sense together
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flight of ideas
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responses that are delayed
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block speech
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a diminished but not entirely absent affect
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blunted affect
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what are common historys of psych patients?
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a history of substance abuse and a history of traumatic past
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what are some mental health disorders?
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mood disoders, schizophrenia, personality disorders, anxiety disorders
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a person does not get pleasure out of things they once got pleasure out of
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anhadonia
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condition where patient only provides one or two word answers
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poverty of speech
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if a patient is suicidal what steps must be taken?
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establish a contract for safety, ask them if they have a plan
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What is shown under axis I?
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Clinical disorders. Various disorders except for personality disorders and mental retardation
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What is shown with axis II?
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Mental retardation and personality disorders
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What is axis III showing?
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Genial medical conditions like thyroid conditions. They must have direct relation With axis 1
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What is covered under axis IV?
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Psychological or emotional problems like "problems related to social environment"
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What does access V cover?
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Global assessment functioning - 20 point system, focus' on suicidal ideations
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What are the 5 mood types no the spectrum?
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MDD---dysthymia---euthymic---psychothymia---manic
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Mood type where patient is a little edgy all the time
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Psychothymia
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A functional depression where patient is always depressed but is still able to function
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Dysthymia
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Normal midline mood, not manic or depressed
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Euthymic
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MDD means
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Major depressive disorder
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Mood disorders include
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MDD, dysthymia disorder, bipolar, cyclothymic, seasonal, postpartum, schizoaffective
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To diagnose major depression, 5 symptoms must be present during a 2 week period. What are all the symptoms to choose the 5 from?
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Depressed mood most of the day, diminished interest in pleasures, weight loss, insomnia, fatigue, feelings of worthlessness, inability to concentrate, thoughhts of death
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If a person exhibits symptoms of depression but also has a history of manic behavior, what would they be considered?
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Bipolar
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Getting depressed at the same time of year, usually winter, for at least 2 years
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Seasonal depression- ssri's and light therapy effective
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What is the major focus in postpartum depression?
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Inability to care for the baby
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Ehat are nursing interventions of depression assessment?
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Safety- ask about suicide ideation, provide for physical needs- encourage autonomy, meaningful socialization- attend groups, encourage expression- through groups and 1 on 1s
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When a patient goes from laughing to crying in seconds their mood is ...
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Labile
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Feeling that notng can touch them, poor judgement, puts them in danger
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Bipolar manic phase- feelings of grandiose
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Type of mood where presentation is normally manic
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Bipolar I
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Type of mood where presentation is usually depression and they don't get about hypomanic
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Bipolar II
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What is the gold standard drug to use for bipolar?
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Lithium
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What are the primary symptoms of a manic attack?
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Dig fast
Distracted, indiscretion, grandiosity, flight of ideas, activity increase, sleep deficit, talkativeness |
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Hypomanic that lasts longer than 2 years. Characterized by mood range, depressive and hypomanicBipolar moods, chronic conditions
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Cyclothymic disorder
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What types of medications are used for antimaniacs
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Litium, anticonvulsant (mood stabilizers) , antipsychotics- can be used as mood stabilizers as well.
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What types of medications are used for antimaniacs
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Litium, anticonvulsant (mood stabilizers) , antipsychotics- can be used as mood stabilizers as well.
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What types of medications are used for antimaniacs
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Litium, anticonvulsant (mood stabilizers) , antipsychotics- can be used as mood stabilizers as well.
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To give oneself over to a constant practice which affects persons life and they can't stop
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Addiction
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What are the 5 types of addiction?
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Sex, drugs (including alcohol), food, gambling, work
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Most addictive drugs
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Cocaine, nicotine is second
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Overspending is considered what kind of addiction?
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Gambling
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What drug can you die during detox from
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Alcohol
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What are some early stages of alcoholism?
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Increase in alcohol tolerance, desire to continue when others stop, loss of control of drinking, preoccupation with alcohol
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What are the middle stage symptoms of alcoholism
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Sneaking drinks, increase relief drinking, drinking bolstered with excuses, blackouts, early morni drinks, tremors, dishonesty, loss of interests, avoid family and friends
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Late signs of alcoholism
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Loss of relationships, physical, and moral deterioration, urgent morning drinking, persistent remorse, hospitalization, decrease in alcohol tolerance, obsession with drinking
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What is the progression of alcohols
Ism? |
Social drinking- rationalization begins- loss of control - complete abandonment
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The only socially acceptable addiction
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Work
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How is a disease didn't from a syndrome?
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A syndrome must display a group of symptoms over time, a disease is a progression of predictable symptoms
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Some drugs are considered biological or sociological.
Addicitive behavior is done because it makes people feel better |
We do behaviors that make us feel good and then we get hooked on them and then we have to determine if behavior outweighs consequences.
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Major defense mechanisms of addictive behavior
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Denial, rationalization, projection
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The progression of alcoholism is labeled as
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Jellinek's disease
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loss or death not related to the reason someone was admitted to the hospital. (#1 suicide, #2 loss of limb)
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sentinel events
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whar are the different types of suicide?
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egoistic (loners, not supported), altruistic (die for a cause), anomic (in times of rapid change)
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whar are the different types of suicide?
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egoistic (loners, not supported), altruistic (die for a cause), anomic (in times of rapid change)
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what are some psychological theories for suicide
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inward anger, hopelessness, guilt, history of violence, shame, stressors
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who has the highest rate of suicide
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elderly men over 85 and adolescent boys
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if an adolescent suddently has a loss of friends, changes in school, acting out, increased reckless behavior- what may this indicate
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he is depressed and may be suicidal
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tunnel vision thinking when people only see a goal and nothing else
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though constriction
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a type of thinking where everything is black and white
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polarized thinking
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what should be analyzed during a suicidal crisis?
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if they have done it before, if a family member has done it before, what's going on in their life, what coping strategies have worked in the past?
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guidelines for treating a suicidal patient
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do not leave alone, establish a contract, trust relationship, family involvement,
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how does a person with schizophrenia present
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lack of hygeine, inappropriate dress, illogical thought, dellusions, impaired social skills, disordered thinking
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how long must symptoms be present for patient to be diagnosed with schizophrenia?
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6 months. must have dellusions and usually a deterioration of function
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what are the 3 phases of schizophrenia>?
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prodromal phase, active phase, residual phase
prodromal and residual does not always show but active always is apart of it |
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phase of schizophrenia that lasts a few weeks to a few years, feel seperated from everyone, different strange, social withdrawl.
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prodromal phase
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onset of negative symptoms in schizophrenia, loose aspects of personality
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prodromal phase onset
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things that are added to personality- dellusions for example
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posative symptoms
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when you loose aspects of your personality
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negative symptoms
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symptoms of active schizophrenia
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delusions, hallucinations, impairment in work, social relationships, and self care (posative symptoms)
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schizophrenia phase where odd, bizzare, but functional. flat affect, impairment in role functioning are prominent
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residual phase- considered recovery. Similar to predromal phase
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schizophrenia phase where odd, bizzare, but functional. flat affect, impairment in role functioning are prominent
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residual phase- considered recovery. Similar to predromal phase
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what are the two types of catatonic schizophrenia
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catatonic stupor- psychomotor retardation, patient usually mute, posturing
catatonic excitement- purposeless movements, psychomotor agitation |
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aspects of disorganized schizophrenia
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child like, inappropriate affect, silliness, giggling, disorganized, bizzarre
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schizophrenia that exhibits bizzarre behavior but can not be placed into a specific catagory
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undifferentiated
(also have paranoid) |
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used to diagnose a person who has a history of at least one episode of schizophrenia
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RESIDUAL
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what are common thought content of schizophrenia
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delusions, religiosity, paranoia, magical thinking
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term where a group of words make no sense together
term where too many detail are included in sentence |
word salad
circumstantiality |
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posative symptoms of schizophrenia involving form of though - talking is presented in 4 ways
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associative looseness- lots of disconnected sentences
neologisms- make up words concrete thinking- simple, literal, thinking clang associations- rhyming |
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persistent repitition of thought word or idea
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perseveration
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difference between hallucinations and illusions
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hallucinations- not reality based
illusions- reality based but misinterpreted |
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posative symptoms how schizophrenia view themselves
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echolalia- repeating everything you say
echopraxia- mimic what you do, movement identification and imitation- want to be a HACC nurse depersonalization- disconnection from self |
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negative symptoms of schizophrenia
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affect gone, volition (no goal directed activity) emotional ambivalence (hard to decide on anything), impaired social function (autism), psychomotor behavior (posturing)
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why are schizophrenics at risk of hypernutremia?
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water intoxication- can't stop drinking it
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what does a haldol cocktail consist of?
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haldol (antipsychotic), ativan, cogenin
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what are some side effects of haldol?
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dry mouth, drooling, rigidity, shuffling gait
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what is coganen
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antiparkinsonian, helps remove shuffling gait that is a side effect of haldol
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when a patient is started on new medications, if they start to show flu like symptoms what might this be a sign of?
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neuroleptic malignant syndrome (toxicity)
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what is a common side effect of new anti psychotics and mood stabilizers?
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weight gain
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what are the 11 personality disorders?
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cluster A- odd/eccentric
paranoid, schizoid, schizotypal cluster B- dramatic/emotional antisocial, borderline, histrionic, narcissistic cluster c- fearful anxious avoidant, dependent, obsessive compulsive |
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disorder where patient agrees to do something but then never does it
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passive aggressive
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what are the cluster A personality types?
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paranoid- all out to get me (usually from a difficult childhood)
schizoid- longer, fringe of society schizotypal- odd, bizzarre, having illusions, loner, misinterprets environment |
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what is the best way to treat cluster A personalities
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gentle approach, safe environment, calm them to avoid anxiety
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what are the cluster B personalities?
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antisocial- don't care about other people, sbstance issues, only regards own needs, normally men
boderline- suicide, threats, poor me, all good or bad, plot people against eachother histrionic- dramatic, hysterical narcissistic- arrogance, better than everyone else |
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when people feel like everything that happens is their fault
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egodistonic
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when people feel like nothing is wrong with them and they could do no wrong
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egocentonic
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what are ways to care for cluster B patients?
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assess safety, need to give patients feedback on their behavior and how it affects others
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what are the cluster C types?
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avoidant- embarrisment would be devistation so they avoid situations entirely
dependent- can't function on their own obsessive compulsive- perfectionism, aggressive, only they can do it correctly |
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what are ways to treat cluster c personality types?
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behavior modification, reward independence, educate on realistic expectations for self, teach assertive behavior
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what are different types of anxiety disorders?
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panic attacks, obsessive compulsive, phobia, dissociative, conversion, PTSD, generalized anxiety disorder
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anxiety that causes you to not be able to function anymore
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generalized anxiety disorder
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anxiety that presents with physical signs and symptoms that have no underlying cause (blindness)
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conversion
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what are some presenting signs of anxiety?
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increased VS, diaphoresis, tremor, diarrhea, abd pain, NV, decreased concentration, forgetful, pacing, aggitated, annoyed
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how do you approach someone with anxiety
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deal with feelings, not behavior. Offer self
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prominent sign of a panic attack
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tightness in chest call, anxiety induced. Frequest attacks called panic disorders
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what are the two panic attack types (with agoraphobia)
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with agoraphobia, panic attack is incident induced
without agoraphobia, panic attack can happen for any reason at any time |
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nursing care for panic attack
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stay with patient, divert with simple tasks like coloring
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what are the different types of OCD?
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washers/cleaners, checkers, hoarders, ritualizers
**focus on individual, NOT the behavior** |
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fear of something that has never harmed you
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phobia
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an alteration in cconscious awareness of behavior, affect, thoughts and memories. Often precipitated by traumatic event
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dissociative disorders
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what are the 4 types of dissociative disorders
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amnesia, fugue, identity disorder (multiple personality), depersonalization disorder (seperation between mind and body)
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when you make yourself sick for attention or make your child sick to get attention
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munchousins
muchousins by proxy |
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symptoms for which no underlying organic basis exists
seen more in females |
somatoform disorders
body pysmorphic (plastic surgery), somatization (unconsciously created illness) and undifferentiated somatoform (consciously created) |
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sudden feeling that your life is threatened, feels like a loss, self limiting - will resolve
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crisis
occurs in all people specific to person, not all people react the same way |
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what are some ways to reduce crisis effects
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preparation, changing goals, developing communication skills, seeking help
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what is the ultimat goal when treating someone in a crisis
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assist client in developing more effective coping skills, and encourage a higher level of functioning
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what are the neurotransmitters affected by medications
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serotonin (depression) dopamine (schizophrenia)
epinephrine norepinephrine |
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the area of the brain that controls emotions and is affected by some medications
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limbic
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what are the types of abuse
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emotional, physical, sexual, social, economic, neglect
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what are the 3 kinds of rape?
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acquaintance rape/date rape
marital rape statutory rape |
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causes for abuse
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learned behaviors, changes in family structure/roles, drugs and alcohol, power dynamics in relationship
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what is the cycle of violence?
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tension builds, abuse takes place, apologies, excuses, amends.
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if you suspect violence, what are the 4 W's?
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what happened?
who did this? where did it happen? when did it happen? |
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what are some typical (older) anti depressants?
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tricyclic (TCAs)
monoamine oxidase inhibitors (MAOIs) |
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what are some atypical (newer) antidepressants?
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SSRIs 2nd generation improved tricyclics
3rd generation- SNRIs seratonin noraepinephrine retake inhibitors |
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physical pain that usually has an underlying emotional issue
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fibromialgia
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common side effects of tricyclic antidepressents
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dry mouth, orthostatis HTN, urinary retention, tachycardia, sedation, decreased sexual desire
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what can not be taken with MAOIs
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can not eat anything aged, smoked, processed, or fermented. no antidepressants, antiHTN, cold meds
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what are warning S&S of a reaction with MAOIs?
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HA increased BP, palpitations, diaphoreses, dialated pupils
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what are 2 side effects of lithium?
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lithium toxicity, weight gain
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need to have routine blood drawn to adjust dose of this drug to avoid toxicity
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lithium
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side effect of older medications that make tongue dart out uncontrolably
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tardiv disconeesia
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what type of med may cause neuroleptic malignant syndrome? (similar to seratonin syndrome)
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dopamine blocker
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a drug that builds up a tolerance, can become addicted, their is a short half life, depresses the CNS, don't stop taking them abruptly
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ativan
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what medications may cause serotonin syndrome?
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antidepressants, cold meds, illicit drugs, amphetamines, demerol, pain medicaiton, herbals, anti-infectives, and anti-retrovirals
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S&S or serotonin syndrome
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changes in mental status (agitation, hallucinations, coma, seizures), motor function usually in lower extrem. (ataxia, rigidity, tremors), and autonomic function (tachy, HTN, fever, emotional lability)
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red as a beet, mad as a hatter, sway like a sailor, dry like a bone
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anticholinergic syndrome (ACS)
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what are some causes for anticholinergic syndrome?
S&S- hallucinations, psychoses, seizures, coma |
overdose, medical noncompliance, geriatric polypharmacy
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what is the goal of milieu therapy
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the manipulate the environment s o that every aspect of this environment is considered therapeutic
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when is seclusion used?
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if you are a danger to yourself or to someone else
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a way to treat depression when nothing else works
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electroconvulsive therapy- induces seizures to reset the brain. 25 second needed. Short term memory loss a SE
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