Final- Mental Heath - Chapter 14-21

Front 1

Sleep requirements
--most adults require how many hours of sleep for optimal functioning

Back 1

7-8 hrs

Front 2

Sleep requirements
--long sleepers: require __ or more hours per night
-short sleepers: requiring less than __hrs per night

Back 2

-long sleepers: require 10 or more hours per night
-short sleepers: requiring less than 5 hrs per night

Front 3

Sleep requirements

-the amount of sleep required is the amount

Back 3

necessary to feel full awake and able to sustain normal levels of performance during the periods of wakefulness

Front 4

what is the most accurate way to determine ones sleep requirements?

Back 4

is to establish a routine bedtime and allow oneself to sleep undisturbed without an alarm for several days. this is best accomplished during an extended period of leisure time, such as during a vacation.


the average of several nights sleep undisturbed is probably a good estimate of total sleep requirement

Front 5

Parasomnias
--characterized by

Back 5

unusual or undesirable behaviors or events that occur during sleep/wake transitions, certain stages of sleep, or during arousal from sleep

Front 6

Parasomnias
--pts do not complain of:

Back 6

-pts do not have specific sleep related complaints such as insomnia or daytime sleepiness

Front 7

Parasomnias
-if the pts don't report sleep problems, how does this get known about

Back 7

-it is the partner that reports the behavioral disturbance

Front 8

Parasomnias
-treatment:

Back 8

reduce stress, stress management, and any measures that would protect the pt

Front 9

-somnambulism is also called

Back 9

sleep walking:

Front 10

sleep walking
-consists of a sequence of complex behaviors that begin when

Back 10

in the first third of the night during NREM sleep (stages 3 & 4) and usually progress (without full consciousness or later memory) to leaving bed and walking about (may include dressing, going to the bathroom, screaming, or driving)

Front 11

sleep walking
-treatment consists of:

Back 11

-instructing the patient and family regarding safety measures such as alarm or locks on windows and doors and gating stairways

Front 12

sleep walking
-treatment...
what are some things you can tell them to do to be helpful

Back 12

attention to sleep hygiene, limiting alcohol prior to bed, obtaining adequate amounts of sleep, and stress reduction is helpful

Front 13

REM sleep behavior disorder (RSBD)

-what is this disorder about?

-most often seen in what population?

Back 13

-excessive motor activity, someone acting out their dreams,

most often seen in elderly men

Front 14

REM sleep behavior disorder (RSBD)
-characterized by:

Back 14

-characterized by absence of muscle atonia during sleep

Front 15

REM sleep behavior disorder (RSBD)
--can be seen in symptoms of neurological pathology such as

Back 15

Parkinson’s disease

Front 16

REM sleep behavior disorder (RSBD)
-what 2 meds can induce or exacerbate episodes?

Back 16

-SNRI and SSRIs

Front 17

REM sleep behavior disorder (RSBD)
--treatment focuses on

Back 17

patient and sleep partner safety

ex:-placing the mattress on the floor is sometimes necessary to prevent injury as a result of falling out of bed

Front 18

Primary Insomnia-
-how long does this condition persist for?

-key for diagnosis?


-give examples

Back 18

-this condition must persist for 1 month and must not be related to any known physical or medical condition


-key to the diagnosis is a report of some type of daytime consequence associated with the sleep disturbance


(ex:
impaired social or vocational functioning,
decreased concentration or memory impairment,
somatic complaints,
mood disturbance

Front 19

Primary Insomnia: -individuals complain that they have difficulty with sleep

Back 19

initiation, sleep maintenance, early awakening, or non-refreshing non-restorative sleep

Front 20

insomnia is best understood as a state of

Back 20

constant hyperarousal

Front 21

sleep disorders
-treatment?

Back 21

sleep hygiene is the treatment, along with behavior therapies, and in some cases the use of hypnotic medication

Front 22

sleep hygiene
-maintain:
-develop:
-reserve the bedroom for:

Back 22

-maintain a regular sleep/wake schedule
-develop a pre sleep routine that signals the end of the day
-reserve the bedroom for sleep and a place for intimacy

Front 23

sleep hygiene
-creat an envt that is:
-avoid:
-limit:
-avoid:

Back 23

-create an envt that is conducive to sleep (taking into consideration light, temperature, and clothing)
-avoid clock watching
-limit caffeinated beverages to 1 or 2 a day and non in the evening
-avoid heavy meals before bedtime

Front 24

sleep hygiene
-alcohol?
-naps?
-exercise?

Back 24

-use alcohol cautiously, avoid use for several hours before bed
-avoid daytime napping
-exercise daily but not right before bed

Front 25

sleep hygiene
-alcohol use
-avoid
-exercise?

Back 25

-use alcohol cautiously, avoid use for several hours before bed
-avoid daytime napping
-exercise daily but not right before bed

Front 26

-Treatment for insomnia:

Back 26

hypnotics (Benzodiazepines, melatonin receptor agoinst, antidepressant, antihistamines)

Front 27

Treatment for insomnia:
-teach what to give a sense of control?


-what is the key factor?

Back 27

-teaching relaxation techniques gives control (deep breathing effectively)



key factor: anxiety and worry will capture attention

Front 28

treatment
-sleep restriction therapy:
what is it?

Back 28

spending less time in bed when you are awake (get up and fold laundry)

Front 29

-stimulus control: 5 principles (p. 470)
what is the most important part

Back 29

-getting up at the same time everyday – most important part

Front 30

-the sleep medications (benzos, hypnotics) produce dependence and withdrawal so ideally, they are suppose to be prescribed for __weeks. once the drug (hypnotics) is discontinued , the person can have rebound insomnia and nightmares.

Back 30

2

Front 31

Cognitive-Behavioral strategies

-includes educational, behavioral, and cognitive components
-what does it target?

Back 31

-it targets factors that perpetuate insomnia over time

Front 32

Cognitive-Behavioral strategies

-the first objectives are to provide what?


-what should you ask the patients?

Back 32

education regarding sleep and sleep needs and help the patient to set realistic expectations regarding sleep


patients should be asked what they believe constitutes healthy sleep and have any misconceptions clarified

Front 33

Cognitive-Behavioral strategies

eliciting information about the total number of hours spent sleeping typically has value

true or false

Back 33

it has little value

Front 34

focusing in the # of hours slept rather than the quality of sleep and daytime functioning (increases or decrease) the insomnia experience

Back 34

increases

-many patients are stuck on a set number of sleep hours rather than on the quality of sleep obtained

Front 35

the first objectives are to provide education regarding sleep and sleep needs and help the patient to set realistic expectations regarding sleep

the next approach involves

Back 35

modifying poor sleep habits and establishing a regular sleep/wake schedule

Front 36

what is helpful in establishing overall sleep patterns and determine over all sleep efficiency (total sleep time divided by total time in bed x 100)

Back 36

sleep diaries for a period of 2 weeks

Front 37

what is sleep restriction

Back 37

limiting the total sleep time creates a temporary, mild state of sleep deprivation and strengthens the sleep homeostatic drive (this decreases sleep latency and improves sleep continuity and quality

Front 38

stimulus control, involves adherence to 5 basic principles that decrease the negative associations between the bed and bedroom and strengthen the stimulus for sleep. patients should be instructed to:

Back 38

go to bed only when sleepy

2. use the bed/bedroom only for sleep and intimacy (no tv, reading, or other activities)

3. get out of bed if unable to sleep and engage in quiet time activity like reading or crossword puzzles, no TV, work, or computer

4. maintain a regular sleep/wake schedule, getting up at the time same time each day – most important factor

5. avoid daytime napping (If napping is necessary it should be limited to 20-30 min max)

-other objectives are aimed at identifying and correcting maladaptive attitudes and beliefs about sleep that perpetuate insomnia

Front 39

Sleep diaries are helpful to:

-what do they help guide?

Back 39

helpful in identifying sleep patterns and behaviors that may be contributing to the sleep complaint

will help guide the assessment and direct the plan of care

Front 40

Sleep diaries are used for evaluation how so?

Back 40

used for evaluation (which is based on whether ot not the pt experience improved sleep quality as evidence by decreased sleep latency, fewer nighttime awakenings, short time to get back to sleep after awakened) the pt may perceive that he or she is no longer controlled by sleep (or lack of it) but exerting control over sleep through lifestyle changes and better sleep routine

Front 41

Spielman’s 3P assessment model for insomnia is used for what 3 reasons?

Back 41

causes of insomnia,
suggest appropriate interventions,
provide rationales for treatment

Front 42

Spielman’s 3P assessment model for insomnia suggests that there are 3 factos that contribute to the insomnia which are:

Back 42

predisposing, precipitating, perpetuating factors

Front 43

Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors

individual factors that create a vulnerability to insomnia

Back 43

Predisposing factors:

Front 44

Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors

may include a prior history of poor quality sleep, history of depression and anxiety, state of hyperarousal

Back 44

Predisposing factors:

Front 45

Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors

pts at risk to develop insomnia may describe themselves as light sleepers and night owls

Back 45

Predisposing factors:

Front 46

Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors

Back 46

Predisposing factors:

Front 47

Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors

something that triggers it, external event, like stressors, job loss, death

Back 47

Precipitating factors:

Front 48

Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors

external events that trigger insomnia

Back 48

Precipitating factors:

Front 49

Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors

personal and vocational difficulties

Back 49

Precipitating factors:

Front 50

Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors

Back 50

Precipitating factors:

Front 51

Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors

medical and psychiatric disorders

Back 51

Precipitating factors:

Front 52

Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors

grief

Back 52

Precipitating factors:

Front 53

Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors

changes in role identity (retirement)

Back 53

Precipitating factors:

Front 54

Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors

factors that one practices and attributes that maintain the sleep complaint :

Back 54

Perpetuating factors:

Front 55

Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors

- excessive caffeine
-alcohol use
-cigaretts

Back 55

Perpetuating factors:

Front 56

Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors

Back 56

Perpetuating factors:

Front 57

Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors

spending excessive amounts of time in bed or napping,

Back 57

Perpetuating factors:

Front 58

Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors

worry about the consequences of insomnia

Back 58

Perpetuating factors:

Front 59

Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors

personal and vocational difficulties

Back 59

Precipitating factors:

Front 60

Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors

Back 60

Precipitating factors:

Front 61

Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors

medical and psychiatric disorders

Back 61

Precipitating factors:

Front 62

Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors

grief

Back 62

Precipitating factors:

Front 63

Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors

changes in role identity (retirement)

Back 63

Precipitating factors:

Front 64

Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors

factors are sleep practices and attributes that maintain the sleep complaint such as: excessive caffeine
-alcohol use,

Back 64

Perpetuating factors:

Front 65

Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors

spending excessive amounts of time in bed or napping

Back 65

Perpetuating factors:

Front 66

Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors

-worry about the consequences of insomnia

Back 66

Perpetuating factors:

Front 67

Spielman’s 3P assessment model for insomnia: predisposing, precipitating, or perpetuating factors

coffee, cigs, alcohol (keeps the problem going

Back 67

Perpetuating factors:

Front 68

Facilitative Statements (table 21-2 p 487)

when talking to a patient about a sensitive or awkward subject, whta should the nurse try to do?

Back 68

normalize things (go from something general to specific)

Front 69

Facilitative Statements (table 21-2 p 487)

it’s our job to teach about sexual side effects from medication (psychotropic meds is a primary offender..

what is an example of a drug?

Back 69

SSRIs can cause sexual dysfunction –someone not able to have an orgasm, main reason people go off meds)

Front 70

Facilitative Statements (table 21-2 p 487)

anxiety directly affects

Back 70

performance (someone who has ED has a problem with anxiety performance)

Front 71

Purpose and statements:

to provide a rationale for a question –

Back 71

“as a nurse, I am concerned about all aspects of your health. many individuals have concern about sexual matters, especially when they are sick or having other health problems

Front 72

Purpose and statements:

to give statements of generality or normality –

Back 72

“most people are hesitant to discuss… many people worry about feeling…many people have concerns about…”

Front 73

Purpose and statements:

to identify sexual dysfunction –

Back 73

“most people have difficulties sometime during their sexual relationships. what have yours been?”

Front 74

Purpose and statements:

-to obtain information –

Back 74

“the degree to which unmarried persons have sexual outlets varies considerably. some have sexual partners. some relieve sexual tension through masturbation. others need no outlet at all. what has been your pattern”

Front 75

Purpose and statements:

to identify sexual myths –

Back 75

“while growing up, most of us have heard some sexual myths or half truths that continue to puzzle us. are there any that come to mind”

Front 76

Purpose and statements:
to determine whether homosexuality is a source of conflict

Back 76

–“what is your attitude toward your homosexual orientation”

Front 77

Purpose and statements:
to identify an older person’s concerns about sexual function –

Back 77

“many people, as they get older, believe or worry that this signals the end of their sex life. much misinformation continues this myth. what is your understanding about sexuality during the later years? how has the passage of time affected your sexuality (sex life?)”

Front 78

Purpose and statements:

to obtain and give information (miscellaneous areas) –

Back 78

“frequently people have questions about… what questions do you have about…what would you like to know about…”

Front 79

Purpose and statements:

to close the history-

Back 79

“is there anything further in the are of sexuality that you would like to bring up now”

Front 80

NIC interventions for sexual counseling box 21-2 p489

use of an interactive helping process focusing on the need to make adjustments in sexual practice or to enhance coping with a sexual event or disorder

Back 80

use of an interactive helping process focusing on the need to make adjustments in sexual practice or to enhance coping with a sexual event or disorder

Front 81

:
NIC interventions for sexual counseling box 21-2 p489

-establish a therapeutic relationship based on (2)

Back 81

trust and respect

-provide privacy and ensure confidentiality

Front 82

NIC interventions for sexual counseling box 21-2 p489

what should the nurse disucss?

Back 82

-discuss the effect of the illness or health situation on sexuality & -discuss the effect of medications on sexuality, as appropriate

Front 83

NIC interventions for sexual counseling box 21-2 p489

what should the nurse avoid?

Back 83

-avoid displaying aversion to an altered body part

Front 84

NIC interventions for sexual counseling box 21-2 p489

what should the nures do reguarding myths about sexual information?

Back 84

provide factual information about sexual myths and misinformation that patient may verbalize

Front 85

NIC interventions for sexual counseling box 21-2 p489

-include the spouse/sexual partner in the counseling as much as possible

true or false

Back 85

true

Front 86

Health Teaching and Health promotion

-nurses should help pts weigh only the pros of any type of pharmacotherapy

true or false

Back 86

false, a nurse must weight the pros AND cons

Front 87

Health Teaching and Health promotion

-many drugs can cause sexual SE (esp. psychotropic medications) –nurses tend to ignore sexual SE with these meds perhaps in an attempt to promote adherence

Back 87

-many drugs can cause sexual SE (esp. psychotropic medications) –nurses tend to ignore sexual SE with these meds perhaps in an attempt to promote adherence

Front 88

Health Teaching and Health promotion

-how can the nurse empowers the pts to choose the best course of action and increase their ability to be informed consumers of mental health? services

Back 88

-helping pts to evaluate for themselves the benefits vs the risks

Front 89

client tells the nurse that he is unable to relax when he gets into bed, so it takes him hours to fall asleep. An appropriate intervention would be to
A) teach the client how to do progressive relaxation.
B) advise the client to drink an ounce or two of brandy at bedtime.
C) suggest that the client seek a referral for polysomnography.
D) point out that reducing stress at work would be advisable.

Back 89

A) teach the client how to do progressive relaxation.

Progressive relaxation relaxes muscle groups sequentially and generates a state of pleasant comfort and ease, a natural prelude to sleep.
Text page: 476

Front 90

A client tells the nurse she sleeps poorly every night. She mentions that when she was younger she slept 8 to 10 hours nightly, whereas now she sleeps only 6 or 7 hours and has to take a nap each afternoon. The nurse can assess that the client
A) has a primary sleep disorder.
B) is suffering from sleep apnea.
C) has an age-related sleep pattern change.
D) is displaying signs of sleep deprivation.

Back 90

C) has an age-related sleep pattern change.

The older the person gets, the more likely he or she is to have decreased total time sleeping, even though time in bed is increased. REM sleep is also reduced, and wakefulness during the night is increased.
Text pages: 463, 464

Front 91

The nurse responds best to a client's report that, "I just don't sleep more than 5 hours at night" by asking:
A) "Are you aware that some people require less sleep than others?"
B) "When did this pattern of sleep start for you?"
C) "Do you usually feel rested and alert when you get up?"
D) "Are you taking any medication that could affect your sleep?"

Back 91

C) "Do you usually feel rested and alert when you get up?"


The most accurate way to determine an individual's sleep requirements is to ask if they feel fully awake and function effectively on the sleep they are getting.
Text page: 465

Front 92

One criteria for the diagnosis of primary insomnia is met when the client reports:
A) "I've actually missed work because I'm too tired to go."
B) "I've been diagnosed with depression 2 months ago."
C) "I've had problems falling asleep for 3 weeks now."
D) "I have these terrible nightmares when I fall asleep."

Back 92

A) "I've actually missed work because I'm too tired to go."
"

A criteria of DSM-IV-TR for primary insomnia includes a disruption to normal routine as a result of the sleep disturbance.
Text page: 466

Front 93

7. When providing sleep hygiene information to a client reporting difficulty falling asleep, the nurse includes:
A) drinking a small amount of alcohol to relax just before bedtime
B) taking a short nap after lunch whenever possible
C) keeping the bedroom warm to induce 'coziness'.
D) taking a 20 minute walk after dinner

Back 93

D) taking a 20 minute walk after dinner

Light, daily exercise often promotes sleep; the exercise should not be done right before bedtime.
Text page: 467

Front 94

A depressed client is likely to report a sleep disorder that includes:
A) frequent awakenings during the night
B) nightmares
C) difficulty falling asleep
D) sleepwalking

Back 94

A) frequent awakenings during the night

Front 95

Mr. T, a 76-year-old man, comes to the outpatient clinic with the report of difficulty with nighttime sleeping. He states that he is getting enough sleep each day; he takes an afternoon nap every day, but still feels tired. The nurse should help Mr. T understand that
A) an afternoon nap includes a great deal of REM sleep.
B) a late afternoon nap does not compensate for a lack of nighttime sleep.
C) a noontime nap includes very little REM sleep.
D) the elderly always need fewer than 6 hours of sleep each night.

Back 95

B) a late afternoon nap does not compensate for a lack of nighttime sleep.

Daytime naps do not compensate for a lack of nighttime sleep. Daytime naps differ in structure from normal nighttime sleeping as a result of a circadian cycle.
Text page: 464

Front 96

A 69-year-old male client is reporting symptomology that suggests REM sleep behavior disorder (RSBD). The nurse is correct in recognizing that this client is at risk for developing:
A) lymphoma
B) hypertension
C) acute renal failure
D) Parkinson's disease

Back 96

D) Parkinson's disease


RSBD is seen in elderly males as they begin to develop neurological pathologies such as Parkinson's disease.
Text page: 471

Front 97

When providing possible interventions to promote the safety of a client reporting symptoms of somnambulism, the nurse includes:
A) gating the stairways
B) sleeping on a mattress placed on the floor
C) regular bedtime dose of a benzodiazepine
D) avoiding the use of serotonergic medications

Back 97

A) gating the stairways

Somnambulism or sleep walking can result in falls; gating the stairways may minimize that risk.
Text page: 471

Front 98

The most effective nursing intervention regarding the accurate assessment of sleep disorders involves:
A) a sleep diary
B) information regarding sleep cycles
C) client description of the symptomology
D) assessment for substance abuse

Back 98

a) sleep diary

Self reported sleep patterns may be biased and so clinical tools such as a sleep diary is helpful in accurately estimating total sleep time.
Text page: 473

Front 99

The nurse appropriately assesses an obese, hypertensive, Type 2 diabetic client when asking:
A) "Do you regularly have nightmares?"
B) "Is getting to sleep a problem for you?"
C) "Do you snooze when you sleep?"
D) "How much sleep do you usually get each night?"

Back 99

D

Short sleep duration had been associated with obesity, cardiovascular disease, hypertension and diabetes.
Text page: 473

Front 100

The most beneficial nursing intervention directed towards minimizing the discomfort associated with conducting a sexually focused assessment is to:
A) Assure the client that the responses will be kept confidential
B) Provide the client with a rationale for asking the questions
C) Begin with the most relevant, non-personal question
D) Project a relaxed, causal demeanor when questioning the client

Back 100

B) Provide the client with a rationale for asking the questions

Letting the client know why the questions are being asked increases openness and cooperation.
Test page: 486

Front 101

The initial task of an outpatient clinic nurse working with a client who has a sexual disorder is to
A) establish trust with the client.
B) explain the process to report illegal activities as the client reports them.
C) explain that the nurse is a therapeutic agent.
D) orient the client to the clinic's opportunities that he may use as part of his therapy.

Back 101

A) establish trust with the client.

The initial task of working with any client is to establish trust.
Text page: 486