Final- Mental Heath - Ch 33-38

Front 1

techniques for managing disruptive behavior

-behavioral contract:
what is it?

-when is it reviewed?

Back 1

-a verbal or written agreement between the pt and nurse or other parities (family,. treatment team, teacher) about behaviors, expectations, and needs.

-the contract is periodically evaluated and reviewed and typically coupled with rewards and other contingencies, positive and negative

Front 2

techniques for managing disruptive behavior

behavioral contracts
-3 steps

Back 2

-: stating the rule “curfew time is 6pm on a school night” stating the reward if you get home at 6 pm, “you get an hour of TV and computer time” if you miss or are late for your curfew you get a consequence

Front 3

techniques for managing disruptive behavior

-how does a behavioral contract decrease parent child conflict?

Back 3

---it decreases parent child conflict, there is no discussion, they know the rules

Front 4

techniques for managing disruptive behavior

limit setting
-what does it involve?

Back 4

involves giving direction, stating an expectation, or telling a child what to do or where to go.

Front 5

techniques for managing disruptive behavior

limit setting
-how should you do this?

Back 5

-this should be done firmly, calmly, without judgment or anger, preferably in advance of any problem behavior occurring, and consistently when in a treatment setting among multiple staff.

Front 6

techniques for managing disruptive behavior

3 steps for behavioral contract

Back 6

-identify undesirable behaviors

-desirable

-consequence if limit is exceed

“john do not hit him (expected behavior), there is no hitting, if you can’t control your hitting you need to go to the quiet room”

Front 7

Mary’s belief about giving children and adolescents consequences

-besides the consequence being immediate, it needs to be .

Back 7

moderate and short lived

Front 8

Mary’s belief about giving children and adolescents consequences

-everybody should

Back 8

get a fresh start the next day.

Front 9

Mary’s belief about giving children and adolescents consequences

-how do you know what consequence you should give them?

Back 9

-the consequence should affect them so they feel it, happen the same day, and the next day they get a new start

Front 10

Depression

isa normal part of aging

T or F

Back 10

false it is not normal

Front 11

Depression

is often underidentified because of

Back 11

comborbid medical conditions

Front 12

Depression

depression is often confused with _____

and ______is often misdiagnosed as _____

Back 12

dementia,


and delirium is often misdiagnosed as dementia

Front 13

Depression
the cardinal difference in depression, dementia, and delirium are:

1
2
3

Back 13

1. onset of mental status change and course of illness

2. LOC

3. attention span

Front 14

depression and suicide risk
highest rate of suicide is (what gender, and what age)

Back 14

-white males over the age of 75 yrs old

Front 15

depression and suicide risk

--white males over the age of 75 yrs old. this may be due to
2 things

Back 15

the changes in occupational status
and
measures of success in men at the time of retirement

Front 16

depression and suicide risk

depression accounts for ___% of late life suicides

Back 16

70

research has shown that older adults who commit suicide suffer from the most treatable kind of depression but do not receive needed mental health services

Front 17

depression and suicide risk

what are key measures for suicide prevention

Back 17

early identification of and treatment for depression

-other facts that can lead to suicide are feelings of hopelessness, uselessness, and despair

Front 18

depression and suicide risk

for older adults, suicide may be seen as what?

Back 18

as a final gesture of control at a stage when independence is at risk or activities are limited

Front 19

depression and suicide risk

unlike younger persons, whose suicidal gestures may be a cry for help, older adults have a real desire to die

Back 19

unlike younger persons, whose suicidal gestures may be a cry for help, older adults have a real desire to die

Front 20

depression and suicide risk

-what is the first line treatment for depression

Back 20

SSRIs

Front 21

zDepression

-if pain or diabetic neuropathy is a comborbid condition, ____ are used

Back 21

SNRIs

Front 22

Depression
--_____are used in those people with chronic pain

Back 22

TCAs

Front 23

Alcohol

the risk factors for heavy drinking in older adults are being

Back 23

male,
single,
having less than a high school education,
low income,
smoking

Front 24

Alcohol

-the stressful or reactive factors that precipitate late onset alcohol abuse are often related to

Back 24

envt conditions that may include retirement, widowhood, loneliness

Front 25

Alcohol

-whenever there is suspicion or indication that an older adult is abusing ETOH, the HCP should conduct a screen test (CAGE-AID)

Back 25

-C- have you ever felt that you ought to CUT down on your drinking(drug use)

A-have people ANNOYED you by criticizing your drinking(drug use)

-G- have you ever felt bad or GUILTY about your drinking (drug use)

-E-have you ever had a drink or used drugs first thing in the AM (EYE- opener to steady your nerves or get rid of a hang over

-AID: adapt to include drugs. One positive answer indicates a possible problem, 2 positive answers indicate a probable problem

Front 26

Alcohol abuse

-who responds easily to emotional and social support and family therapy should be encouraged

Back 26

older people

Front 27

Alcohol abuse
-what may be present during alcohol abuse?

Back 27

-diarrhea, urinary incontinence, decreased functional status, failure to thrive, and apparent dementia may be present

Front 28

Alcohol abuse
what may help keep a potential alcoholic from drinking too much?

what happens when those demands are gone and daily life is disrupted???

Back 28

work and family responsibilities




there is little impetus to remain sober

Front 29

Alcohol
-signs of alcohol abuse in younger individuals

Back 29

(alcohol-induced pancreatitis or liver disease, blackouts, major trauma) and occur infrequently in older adults.

Front 30

Alcohol
- signs of alcohol abuse in older adults?

(5)

Back 30

the older adult may display vague geriatric syndromes of
contusions,
malnutrition,
self-neglect,
depression,
falls

Front 31

Pain: stats

-pain is common among older adults and affects their (2 things)

Back 31

sense of well being and quality of life

Front 32

Pain: stats
what % of the population has conditions that predispose them to pain??


what are the conditions that predispose someone to pain? -3

Back 32

-85%

arthritis, peripheral vascular disease, diabetic neuropathy

Front 33

Pain: stats

-pain is often associated with what other disorder?

Back 33

depression

Front 34

Pain: stats
pain can lead to
-increased:
-delayed:
-decreased:
-what can it do to ones sleep pattern?
-decreased:
-it can also cause agitation with what kind of behaviors?

Back 34

increased stress,
delayed healing,
decreased mobility, disturbances in sleep,
decreased appetite,

agitation with accompanying aggressive behaviors

Front 35

Pain: stats
-3 categories of depressive symptoms:

Back 35

emotional:
cognitive:

physical:

Front 36

Pain: stats
-3 categories of depressive symptoms:
EMOTIONAL
-4

Back 36

mood,
motivation,
apathy,
anxiety

Front 37

Pain: stats
-3 categories of depressive symptoms:
COGNITIVE
-2

Back 37

concentration,
memory

Front 38

Pain: stats
-3 categories of depressive symptoms:
PHYSICAL
-4

Back 38

insomnia,
fatigue,
h/a,
stomach, back and neck pain

Front 39

-what kind of pain can cause depression, low self esteem, social isolation, and feelings of hopelessness

Back 39

chronic pain

Front 40

Barriers to accurate pain assessment

what can interfere with appropriate assessment and treatment of pain in older adults?

Back 40

-beliefs and misconceptions about pain

Front 41

Barriers to accurate pain assessment

-older adults may believe that pain is what?

Back 41

a punishment for past behaviors, an inevitable part of aging, indicative of impending death, related to serious illness, expensive to test and diagnose, signs of weakness

Front 42

Barriers to accurate pain assessment

external obstacles include what?

Back 42

- inadequate assessment by HCP, complicated clinical presentation assumptions by HCP that pain is part of aging, communication deficits due to cognitive impairment

Front 43

Barriers to accurate pain assessment

what may indicate pain and should be assessed (esp in pts who have difficulty communicating their needs (those with dementia)

Back 43

changes in behavior may

Front 44

Barriers to accurate pain assessment

-older adults may understate their pain using words such as (3)

Back 44

discomfort, hurting, or aching

Front 45

Barriers to accurate pain assessment

sensory impairments, memory loss, dementia, depression can add to difficulty obtaining an accurate pain assessment. so what can the nurse do to help get information?

Back 45

an interview with family members, caregivers, or friends is vital

Front 46

A nurse planning continuing education programs for nursing staff at a multipurpose senior center will plan programs based on the knowledge that one of the most common mental health problems among the elderly is
A) schizophrenia.
B) agoraphobia.
C) obsessive compulsive disorder.
D) suicidal ideation

Back 46

D) suicidal ideation

Suicide rates of the elderly in the United States are the highest for any age group. Suicide is one of the top 10 causes of death among the aged.

Front 47

Which of the following statements should be disregarded by a nurse planning care for elderly individuals?
A) As a group, the elderly are major consumers of prescription drugs.
B) As much as 50% of restorative sleep is lost as the result of aging.
C) The senses of vision, hearing, touch, taste, and smell decline with age.
D) Most adults past the age of 75 years have some form of cognitive disorder

Back 47

D) Most adults past the age of 75 years have some form of cognitive disorder

Ninety percent of older adults possess a healthy mental ability. Five percent exhibit symptoms of chronic mental dysfunction and another 5% display signs of acute mental impairment.
Text page: 653

Front 48

Ageism is best explained as
A) prominent personality disorganization after age 65 years.
B) learned helplessness among elderly clients.
C) discrimination against the elderly on the basis of age.
D) behaviors of elderly persons that serve as barriers to health

Back 48

C) discrimination against the elderly on the basis of age.

Ageism is a destructive phenomenon based on negative attitudes toward the elderly causing age-related discrimination.
Text page: 662

Front 49

A nurse doing a survey about adequacy of pain management in the elderly will be most likely to find that the elderly
A) receive less analgesia than younger adults, resulting in inadequate pain relief.
B) need smaller doses of pain medication to achieve adequate pain relief.
C) excrete analgesics more rapidly, thus needing more frequent doses.
D) respond better to meperidine than to morphine sulfate when opiates are necessary.

Back 49

A) receive less analgesia than younger adults, resulting in inadequate pain relief.

It is estimated that half of elderly clients with postoperative pain will be undermedicated and that 80% of elderly clients with cancer will not receive sufficient analgesia.
Text page: 658

Front 50

Under what conditions can the nurse seek an order to restrain an elderly resident of a health care facility?
A) To ensure the physical safety of the resident or other residents.
B) To prevent the client from injuring self by falling.
C) To permit staff to provide routine care measures when the resident refuses.
D) To facilitate care when the client is actively hallucinating.

Back 50

A) To ensure the physical safety of the resident or other residents.

Restraints to ensure the physical safety of the resident or other residents may be imposed on the written order of a physician that specifies the duration and the circumstances under which the restraints are to be used.
Text page: 672

Front 51

A client wanders about the long-term care unit. She is unsteady and often falls, sustaining bruises and scrapes. The family is concerned about her falls and the potential for serious injury. They suggest that she be restrained. The best response for the nurse would be
A) "You will need to make your request to the physician at the planning meeting."
B) "The federal government forbids the use of restraints on elderly clients."
C) "Using restraints puts the client at higher risk for serious injury, even death."
D) "Immobilization will cause constipation and necessitate the use of enemas."

Back 51

C) "Using restraints puts the client at higher risk for serious injury, even death."


This response would open the door to being able to explain the hazards of restraint use compared with the minor problems incurred when the client is unrestrained.
Text page: 672

Front 52

An elderly client is moderately cognitively impaired and terminally ill with breast cancer. When asked if she is in pain, she usually denies it. She tells staff "My back aches a bit." The nurses note she lies rigidly in bed and grimaces when she turns from side to side. In an attempt to obtain a more accurate assessment the nurses might choose to use
A) the Present Pain Intensity Rating Scale.
B) the Visual Analog Scale.
C) the FACES Scale.
D) the Pain Assessment in Advanced Dementia (PAINAD) scale.

Back 52

D) the Pain Assessment in Advanced Dementia (PAINAD) scale



The PAINAD scale is used to evaluate the presence and severity of pain in patients with advanced dementia who no longer have the ability to communicate verbally. The scale evaluates five domains: breathing, negative vocalizations, body language, and consolability. The score guides the caregiver in the appropriate pain intervention.
Text page: 659

Front 53

Dr. White writes the following order for restraint for a confused elderly resident who walks up to other residents and slaps them: "3/11/01 Restrain in chair or bed prn. William A. White, MD." The nurse transcribing the order should
A) transcribe the order as written.
B) point out that the order is premature.
C) insert the type of restraint to be used.
D) suggest the alternate use of an anxiolytic.

Back 53

B) point out that the order is premature.


The resident has the right to the least restrictive measures be implemented in order to assure safety for himself and others. Restraints are the last of a variety of options.
Text page: 672