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214 Cards in this Set
- Front
- Back
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Transference
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uncouncious emotional reaction that patients have in a current situation based on childhood experiences
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Example of transference
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A patient percieves the nurse as acting the way that his mother did regardeless of how the nurse is trully acting.
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Transfernce positive or negative?
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positive if patients view the nurse as helpfull and caring. Negative if emotions interfere with treatment.uch as anger and fear.
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example of transference
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If alcoholic family and nurse meet with patients nurse and nurse has a history of alcoholic family there will be a tranference.
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Countertransference
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might occur in response to a patients transference.
an unconscious phenomenon in which the patient projects onto the nurse attitudes or feelings and desires previously connected with significant people earlier in life |
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example of countertransference
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when a patient critisizes the nurse the nurse might relieve the feelings that were experienced when a teacher gave negative feedback to him or her in class.
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Tools for nurses
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-self awareness: how you look at yourself
-positive self regard : act as a professional - values: neutral - transference -countertransference -self perceptions |
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Defense mechanisims
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when anxiety is too painful the individual copes by using defense mechanisims
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Denial
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uncouncious refusal to admit an acceptable idea or behavior
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Denial example
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Mr. Davis who is alcohol dependant belives that he can control his drinking if he desires.
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Repression
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unconcious forgeting of painful ideas, events, and conflicts.
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Represssion example
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Ms. Young a victim of incest no longer remebers the reason she hated the uncle who molested her.
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Supression
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CONCIOUS exclusion from anxiety producing feelings ideas and situations
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Example of Supression
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Ms Ames states to the nurse that she is not ready to talk about her recent divorce.
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Rationalization
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Concious or Unconcious attempts to prove that one behavior are justifiable.
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example of rationalization
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Mr. Jones DX. w/ schizoprenia states that he can't go to work because his co worker are mean, instead of admmiting that that his ilness interferes with working( makes up a rational excuse)
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Intelectualization
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Consciously or unconsciously
using logical explanations without feelings. I'll learn about it not deal with it. |
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Example of intelectualization
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Mr. Man talks about his son's deah from cancer as being merciful and shows NO signs of sadness and anger.
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Dissociation
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The unconscious separation of painful feelings from and unnaceptable idea, situation or object.
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Example of Dissociation
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Mrs. Adams remembers that when she was sexually molested asa child she felt as if she were outside of her body watching what was happening w/o feeling anything.
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Identification
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Conscious or Unconcious attempt to model onself after a repected person
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Example of identification
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Ms Kelly states to the nurse" When I get out of the hospital I want to be a nurse just like you."
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Introjection
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Unconsciously incorpoating values and attitudes of others as if they were your own.
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Example of introjection
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without realizing Mr. Chad wishes, talks, acts simillar to hi therapist, analyzing other patients.
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Compensation
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CONSCIOUSLY covernig up for a weakness by overempahasizing or making up a desirable trait
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Example of Compensation
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Mr, Hann who is depresed and unable to share his feelings writes and becomes known for his expressive poetry.
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Sublimination
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Coniously or Unconciously directing instinctual drives into acceptable behaviors.
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example of sublimination
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Mr. smith a sexual predator who fears relapse forms a local chapter of Sex addicts Anonymous.
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Reaction Formation
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CONSCIOUS behavior that is opposite to an uncounscious feeling.
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Example of reaction formation
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Ms. Wren. who uncounsciouslly wishes her mother was dead , continuoslly tells the the staff that her mother is wonderfull.
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Undoing
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CONSCIOUSLY doing something to makeup for wrongdoing
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Example of undoing
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After accidentally eating a patients cookies Ms. Donnelye apologizes to the patients , cleans the refrigirator and labels evryones snacks with their names
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Displacement
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Unconsciously dicharging feelings to another object
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Example of displacement
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A husband come home and after a bad day at work yells at the wife or kicks the dog.
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Projection
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Uncounsciously or Consciously blaming to someone else for one' difficulties or placing one's unethical desires on someone else
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Example of Projection
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An adolescent comes home late from a dance and states that her date did noty bring her home on time.
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Converion
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Unconcious expression of intrasphychic conflict through physical symptoms
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Example of conversion
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A student awakeness with a migrane headache and feels to bad to take the test. She does not realize that 2 hours of cramming left her unprepared.
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Regresssion
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unconcious return to a more comftorable developmental stage
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Example of regression
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A six year old child has been wetting the bed since the birth of his baby sister.
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Mental Status Assesment
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focuses on the patients current state in terms of feelings, thoughts, behaviors
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How to document Mental Status Assesment
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Document how you see w/o how you feel.
Document the persons affect hygene, eye contact. |
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What do we look for in a Mental status Assesment
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general apperance
mood and affect eye contact smile motor activity orientation degree of concentration memory feelings thoughts behaviors |
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What is mood?
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is what the patient reports.It relates to the affect and feelings while patients discuss
their issues and concerns. Could be euphoria, depression anxiety, anger, guilt, or fear |
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What is the Affect?
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Is the mood that they say it in. Is what the nurse sees.It could be flat, blunted, lable, or incongrugent.
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what are two types of behaviors?
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catalepsy
compulsion |
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what is catalepsy?
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rigid posture . Dopamine regulates movements and motor skills.
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what is compulsion?
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action w/o thinking, reppetetive, normal to some degree
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schizoprenia and dopamine?
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shizoprenic patients have high dopamine levels so medication takes it away.
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parkinsons and dopamine?
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parkinon patients have low dopamine so medications are give to increase dopamine.
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Components of flight of ideas?
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Flight of ideas
circumstatantiality tangentiality neologisims concrete thinking clang asosciations |
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What is flight of ideas?
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rapid process in which a patients speech changes abruptly from one topic to another topic. Usually occurs in bipolar disorders because thoughts do not connect well.
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what is thought blocking?
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bocks away stares and walks away.
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what causes motor deffects?
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medication or illness deffect
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how are social skills in people with thought disorders?
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They do not have good social skills, Unable to interact with each other.
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who has a slow speech?
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bipolar and schizoprenia. Shizoprenic patients can't answer question they answer something else.
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Components of thought process?
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clang associations
word salad perseveration echolalia |
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Contents of thought
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delusions
persecutory grandiose reference nihilistic obsessions paranoia phobia |
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what is a delusion?
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they are fixed beliefs not changed by reasons.
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example of delusions?
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does not want to eat beause thinks food is poisoned.
Thinks she is a queen. |
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what is circumstantiality?
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inappropriate thoughts into ideas by individual which delays reaching the point of communication
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what is tangentiality?
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communication pattern in which main point is obscured Never gets to the desired goal Happens with schizoprenic patients.
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what is neologisim?
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new word created by a patient.Seen in schizoprenia.
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what is concrete thinking?
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Use of literal meaning without ability to consider abstarct meaning.
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Example of concrete thinking?
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don't cry over spilt milk might be interprented as okay I'll cry over the sink.
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what is clang asscoiations?
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rhyming words that are similiar in sound but not in meaning that conjure up new thoughts
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what are loose asscoiations?
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it's a pattern of speech in which a persons idea slips of one track to another completelly different and unrealted to each other.
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example of grandiose delusions?
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individual has an exaggerated feeling of importance
I am the president |
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exaple of nihilistic delusions
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individual has false idea that the self, apart of the self, or others is/are nonexistant
A patient states: I am dead . and you ask if you are dead how can you talk? patient answers: ' I dont know but I'm dead" |
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what is echolialia?
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exact, automatic repitition of anothers words
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what is a word salad?
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communication in which unrelated words are strung together w/o logical connection
incoherent mixture of words and phrases |
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what is perseveration?
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repetition of the same word in response to a diferent question
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what is an obsesssion?
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perssitent of unwilled thought
to the extent it cannot be eliminated from consciousness by logical effort. |
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what is paranoia?
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extreme suspiciousness of others and their actions
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what are phobias?
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exagerated fear of a specific type of stimulus or situation.
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types of deluisons?
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persecutory
grandiose reference nihilistic |
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What are perceptual disturbances?
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It involves all 5 senses. It includes hallucinations.
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what are hallucinations?
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they are disturbed sensory perceptions not associated with real stimuli. involves 5 senses: olfactory, tactile, gustatory, auditory, visual.
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What do we check in Sensorium cognition?
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-Orientation x4 to time , place, person, and level of conciousness.
-Memory |
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What are the types of memory?
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recall, recent or short, remote, amnesia, and coafubiltaion.
or short, long ,recall. |
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how can you check ability to concentrate?
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with serial 7's or spelling a word backwards.
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what is intellectual functioning?
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it's abstarct versus concrete thinkink and calculations ( serial 7's)
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what are components of abstract thought?
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insight: patients understanding of problem and illness.
judgement: decisions patient makes related to their illness. Most of them have poor judgement because they don't want to take their meds. |
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What is motivation?
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motivation for treatment. Most are not voluntary in Florida baker act.
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What is important in the nurse client relationship?
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-The nurse uses self is the most important tool.
-The nurse must be value neutral -Hope. The nurse must believe that patient can be helped |
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Therapeutic Comunication
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offering self, refelcting, giving broad oppenings, silence, seeking consensual validation, offering general leads, restatinting, exploring, focusing down, giving information, encourage formulation of a plan, giving recognition, showing acceptance, making observations, placin events in sequence of time, stating reality, verbalizing the implied, voicing doubt"unusuall".
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Non Therapeutic Communication
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Rejecting, advising, probing, requesting, interprenting, introducing an unrelated topic, challenging, disagreeing, reassuring, dissaproving, belitttiling feelings expressed, making stereotype remarks, givieng literal responses, defending, using denial.
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What is Crisis Intervention?
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A turning point when a person is confronted by a situation in which his usual problem solving no longer works.
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affected areas when in a crisis?
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eating, sleeping, working,
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Phases of a Crisis?
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1. Precipitating event: ex( loss of job, divorce, ) before the crisis.
2.Percieved event as a threat and causes increased anxiety 3. The person becomes increasingly anxious , thinking becomes disorganized, as coping mechanisims fail persons thought begin to race and feel as they are falling apart( hoplesness, desperate) 4. The person mobilizes internal and external resources and tries new problem solving methods.. The person is able to redifine the problem. |
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What is a developmental crisis accoriding to Ericksons?
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PREDICTABLE life events that normally occur in most peoples lifes.
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ericksons deveolpmental stages
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1. Trust vs Mistrust
( 0-18months) 2. Autonomy vs shame (18- 3 yr). 3. Initiative vs guilt (3-5 yr) 4. industry vs inferiority (6-12 yr) 5.identity vs role diffusion ( 12- 18 or 20) 6. intimacy vs isolation (18-25 0r 30) 7. generativity vs stagnation (30-65yr) 8. integrety vs despair (65 to death) |
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what is a situational crisis?
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UNANTICIPATED events that threaten a persons integrity.
We fight it until crisis occurs. |
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Assesment for CRISIS
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Collect the data about the crisis . Establish trust with the client.
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Question to asses Crisis?
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What brought you for help today?
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Nursing Interventions for a CRISIS
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1. Identify the precipitating event and the clients perception on the problem .
ex: How is this problem affecting your life now? 2. Identify the clients strenghts and coping skills ex:Has anything like this happened to you before? 3. Identify the clients supprort sytem? ex: Who do you trust? |
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Planning for a CRISIS
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Assist client to propose alternative solutions and ways to accomplish them.
Have you ate? have you slept? kids eaten? |
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Additional Nursing Interventions for a CRISIS?
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The goal directed plan is implemented by the client help them get through.
Assist cleints to focus on the crisis and not on a major personality change Give clients positive feedback to increase self esteem. Set limits on self destructive behavior. |
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Evaluation for CRISIS
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1.Compare the clients goals to the clients behavior
2.Trouble shoot for the future 3. Encourage the client to make future plans. If something like this happens what can you do about it |
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Can CRISIS be individual or community wide?
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Crisis can be individual and community wide. Caplan identified a 3 tiered approach for community intervention in mental health problems.
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What is Caplan 3 tired approach for community intervention in mental health problems
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Primary prevention
Secondary Prevention Teritary Prevention |
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What is Primary Prevention
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Identifies a population at risk for experiencing psychosocial problems. The population is supported to not experience the problem.
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What is secondary Prevention
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Aims at early diagnosis and treatment of mental health problems.Thoughts of sucide may affect a population if someone near them killed themselves.
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What is Tertiary Prevention
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Reduces long term effects of mental health problems.
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What is Milieu?
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The enviroment and everything in it.
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What is Therapeutic Milieu
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Nursing staff set the Tone/ Climate on any psyquiatric unit.
They adjust the climate according to the clients needs. The most important element is SAFETY and appropiate limits. |
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How to set tone when patients acting out?
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keep rules more rigid and firm
opposite for patients that are deppresed. |
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what is anxiety?
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it's a universal safety feature
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what are physical symptoms of anxiety?
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fight or flight is activated causing:
Blood to be diverted from the brain (lightheadiness and dizziness, fixed eyes, scanning vision ,numbness tingling,) Affects the Heart pulse rate increases, HR >, BP>. Blood is pumped to the LARGE MUSCLES. Gulp of air make respiratory rate increase feel like they are not breathing but are overbreathing. Nausea, Vomiting, Diahrrhea, dry mouth |
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What causes the highest anxiety response?
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Symapathetic Nervous system
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What organs are affected by the fight or flight response?
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heart
lungs large muscles brain stomach |
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what role do the sympathetic and parasympathetic play in anxiety?
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the sympathetic save our life if not stopped by the parasympathetic which is the primary caue of passing out.
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Theories for anxiety
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Freud: ego controls the id by manipulating the enviroment.
Peplau: nurse said anxiety is a reaction to fear |
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What is Generalized Anxiety Disorder according to the DSM-4
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Excessive worry
-Diffculty in controling the worry Anxiety and worry are evident in : *restleness *fatigue *irritability *decreased ability to concentrate *muscle tension *disturbed sleep |
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Are patients with generalized anxiety disorder hopitalized?
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Rarely , however people who are depressed are also anxious. It is common to see this DX with other DX.
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Nursing Interventions for Generalized Anxiety Disorder
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-Maintain Safety
-Identify precipitating events -Educate client: anxiety is self limiting. - Educate them on the signs and symptoms of anxiety -Assist them in strengthening thier control. -Cognitive reframing: changing thoughts about anxiety.and helping them come to more realistic conclusions |
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example of cognitive reframing
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If person anxious of flying and think they can never fly in a plane they might not be able to do it but if you can change their thoughts and ask them what their anxiety level is and they say a six and that they are able to cope with a six for an hour and a half. That is a way of changing their thought.
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What does the nurse do first to treat anxiety?
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Anxiety must be reduced first before problem solving can occur.
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What is the nurses goal in anxiety?
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assist patients with developing adaptive coping responses
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what is the initial response after anxiety has been reduced?
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The nurse promotes trust through acceptance of patients positive and negative feelings and aknowledge their discomfort
ex: This must be uncomfortable and painful for you. |
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Nursing Interventions to Reduce Anxiety
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*Provide a calm quiet enviroment.
* Ask patients to identify what and how they feel. *Encourage patients to discuss feelings with you *Help patients identify possible causes for their feelings. *Listen carefully for expresssions of hoplessness, and helplesness. *Ask patients wether they feel suicidal. * Plan activities like walking or games. |
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what medications are used for generalized anxiety disorder
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because GAD is a chronic condition antidepressants work better than benzodiazapines because of the posibility of dependence and tolerance with long term use of benzodiazapines.
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Defense Mechanisims in GAD and Panic disorder
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Regression
Repression |
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When are benzodiazapines used in GAD?
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only when quick acting medication is needed untile the antidepresant takes effect and is tappered.
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What is a Panic Disorder according to the DSM4?
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*Reccurent unnexpected panic attacks.
*After the attack they worry about another attack , worry about the results of the attack , and changes related to the attack. *Panic disorder may be accompanied by agrophobia |
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What is agorophobia?
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fear of not being in a safe place or fear of not being with someone to help them.
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What is the difference between a panic attack and a panic disorder?
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Patients with panic disorder experience reccurent panic attacks and are worried of having more attacks.
A panic attack is sudden with fear and discomfort . They have a fight or flight response when something triggers it. |
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What are the nursing Interventions for Panic disorder
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same as GAD.
*Patients experience relief when giving information about the disorder, symptoms they might experience, and medications that can relieve the symptoms. -Educate about how they can regain control |
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What are Nursing Interventions for a Panic Attack
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*Stay with patient
*Maintain CALM *speak in short simple sentences. *If patient hyperventilating offer brown bag and breath with patient every 5 sec focusing on watch. *Allow patients to cry which relieves tension. *Let them know that you are in controls and won't let anything happen. *Reduce enviromental stimuli. *Do not touch these patients *Ask patients to express their fears about what is happening to them. |
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What are obsessions?
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are reccurent persistent THOUGHTS that produce anxiety.
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What are compulsions?
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are repetetive BEHAVIORS in response to an obssesion.
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What is Obssesive Compulsive disorder according to DSM4?
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*Obsessions are recurrent thoughts that produce anxiety.
*unssucsesful at ignoring thoughts or impules *Recognition that obsessions are produced by own thoughts *Compulsions are repetetive BEHAVIORS such as hand washing,( impaired skin integrity) counting, in response to a obsession. *Obsessions and compulsions cause distress are time consuming and interfere with daily functioning. |
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What happens if Individuals with OCD ressist the obssesions or compulsions?
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They will experience anxiety.
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What to do with a patient that is hospitalized with OCD?
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Delay the ritual with specific thought instruction.
ex: If patient handwashes let them perform their ritual for an hour but with the condition of eating afterwards . |
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What are Nursing Interventions for OCD
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*Ensure that basic needs are met food, rest, grooming
*Provide patients time to perform rituals.Set limits to decrease rituals but never take away a ritual. *Explain expectations, routines and changes to prevent anxiety *Be empathetic and be aware of their need to perform rituals * Assist patients with connecting behaviors and feellings. *Structure simple activities games, tasks to patients. *Recognize and reinforce nonritualistic behaviors. |
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What medications are used for OCD?
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The antidepressant clomipramine (Anafranil) an also some SSRI's such as Prozac, But most effective Anafranil which works on dopamine receptors.
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What are defense mechanisims in OCD
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Isolation of Affect (ignore other's feelings)
Undoing (washing) Reaction Formation Regression |
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What are Phobic Disorders according to the DSM4?
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They are intense, irrational, fear, response to external object or situation.Anxiety is experienced when person comes in contact with dreaded object or situation.
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Types of Phobias?
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Social phobia
specicific phobia agoraphobia |
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example of agorophobia
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when a person has a panic disorder they become agorophobic and do not come out of the house because it's a safe space
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example of social phobia
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afraid of bieng public embarresed , fear of public speaking
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example of specific phobia
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snakes, bugs, If afraid of bees still able to go outside and normal be anxious but person with phobic disorder is unable to carry out their daily activities because of their phobia.
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Nursing Interventions for Phobic Diosrders
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*Desensitization: GRADUALLY assit the client to do what he fears .
*The client is NEVER FORCED into contact with the FEARED OBJECT. *To start desinitization they must agree . *Thinking of what they fear to produce anxiety on a scale of 1-10 . Look at the numbers over a week. |
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Medications used for Phobic Disorders
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Cognitive Behavioral Therapy is most succesful in treatment . medications have no effect. Some medications may be prescribed for anxiety or panic attacks.
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Defense Mechanisims in Phobic Disorders.
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Displacement,
Symbolization, Avoidance |
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which memory impairment am i describing?
difficulty organizing sequence but most complete except for last week |
recent memory
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what is remote memory
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good detail of birth of children
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what is confabulation
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unconscious filling of gaps in memory with imagined or untrue experiences that the person believes but has no basis in reality
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therapeutic milieu
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environment designed to promote health, respect, communication b/t staff and pt, responsibilities, safety, and appropriate limits and boundaries
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tell me about mild anxiety
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v/s are normal, facilitates learning
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tell me about moderate anxiety
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v/s are normal or slighty elevated, perception is narrowed
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tell me about severe anxiety
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symptoms escalate, perception is scattered or closed, unable to take in stimuli
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what could be the cause of a panic disorder?
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genetic, caffeine, CO2, Na lactate
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Post traumatic Stress Disorder division
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acute stress disorder
post traumatic stress disorder |
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What is acute stress disorder according to the DSM4?
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* Exposure to a traumatic event involving threat to self or others.
*Responses of horror helplesness and fear *Dissociaciative symptoms occur during or after the event like: abscence of emotions, numbing, detachment, decreased awareness, dearealization or depersonalization, amnesia, *Reexperience or relive the traumatic event by dreams, ilusins , flashbacks. *Avoidance of stimuli related to the trauma like: feelings, thoughts, people, conversations. *Sleep disturbances, hypervigilant, startle response. *Impaired functioning in daily activities. Lasts for 4 weeks Most common seen in rape patients |
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What is Post traumatic Stress Diorder accoridng to the DSM4?
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*same as ASD in addition to more symptoms
*Restrictive affect not being able to love *lack of expectations about the future *hallucinations *decreased participation in activities *outburts of anger *Lasts more than 4 weeks *Seen most commonly in exually abued women that do not have a concious awareness that they have been abused, or Vietnam War survivors. * |
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Nursing Interventions For ASD and PSD
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goal: verbalize feelings surrounding the event
reintegrating memories and allow a healthy regression and re-integration They have to come to consciousness on their own terms . |
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If woman is raped what stage of ericksons would she be in?
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Trust vs Mistrust because not able to trust .
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Therapeutic response to people with ASD and PSD
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I haven't been through what you have but the more you tell me , the better I will understand what you have been through . These patients need to know they are not crazy but are having a trypical reaction of their trauma.
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What medications are recommended for PSD?
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they are usually for short term Benzodiazapines might be prescribed to reduce levels of anxietyand fear or Buspirone.
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Nursing Interventions for PSD and ASD
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*Be non judgmental and honest
*Help them reconize the connections between the trauma and their current feelings *Help patients evaluate past behaviors in context of the trauma *encourage safe verbalisation of feelings and anger *encourage adaptive coping stargeties excercise, realaxation *encourage to reestablish relationships. |
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Types of Somatoform disorders acoording to the DSM4?
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somatization d/o
pain d/o conversion d/o hypochondriasis |
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what is a somatization d/o?
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*Usually develops during adolescence
*May be asscociated with childhood abuse *Most women *Patients seek treatment from multiple doctors and undergo numerous tests and procedures. *Symptoms are not manufactured or fake. *involves stomach, head, back, reproductive organs. *have secondary gain they get attention from their disorder |
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Do all illnes have secondary gain?
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yes
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Example of Somatization d/o
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*Patient always on cal bell. If it get persistant call doctor.
*Mauncheson sydrome make their kids sick to get attention. |
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Defense Mechanisims for Somatization disorders
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Repression
Denial dissociation |
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What is Hypocondria?
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*affects men and women
*begins at age 30 *associated with a illness in childhood *lasts at least 6 months *impairs functioning at home or work. *believe something is wrong with them but there is no medical evidence. |
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What is Conversion disorder?
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*One or more symptoms affecting motor or senory functions.
*psychiatric trauma manifested in a physical way. *They have la belle indifferance. *primary gain *secondary gain |
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Example of conversion disorder
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Mother and son driving in a car. and suffer a car crash. Mother dies in accident and son becomes blind.The child cannot process the fact that his mother died so if he can't see he can't see his mother die. He becomes blind because he was unable to accept the trauma
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What is la belle indifference
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They have no awarness of the symptom. They know something is physically wrong with them but don't pay attention to it . All of their anxiety is wrapped up into their conversion.
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Nursing Intervetions for Conversion disorder
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Same as care for a blind person . Setting the food and how tray is laid out in a clock basis.
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What is primary gain?
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alleviation of the anxiety the disorder provides ex: the actuall blindness or paraylisis of the arm with sleeve
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What is secondary Gain?
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Gratification and attention recieved as a result of their illness
ex: helping the blind person eat. |
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What are the defense mechanisims in conversion diorder?
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Repression and denial
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why is it that people with la belle indifference lack concern/anxiety about their d/o?
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the lack of concern occurs b/c their sx binds his anxiety so that it is not behaviorally expressed
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what d/o's last at least 6 months?
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somatization
hypochondria |
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tell me about pain d/o?
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it is severe pain in one or more anatomic sites that causes significant distress or impairment in fxning and location of pain doesnt change
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example of pain d/o
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A patient who ha experienced a MI is now convinced he can no longer engage in walking swiming, resulting from fear of suffering another MI.
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Nursing Interventions for Somatoform Disorders
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*Use a matter of fact caring approach when providing care for physical symptoms
*set limits not focusing on their physicall wrong. *ask them how they are feeling and ask them to describe their feelings *Use positive reinforcement and set limits by withdrawing attention when they are focusing on physical complaints. *Be consistant and have all requests directed to the primary nurse or doctor providing care. *Use diversion by including them in recreational activities *Do not push awareness or insight into conflicts or problems. |
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Medications used for Somatoform diorders
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usually SSRI's to treat anxiety and depression.
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example of somatoform disorders
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On call bell all the time says you can't help them alleviate their pain, listen to them remain in a matter of fact, tell them what you can do and be firm by saying I can stay with you , give you your pain medication but let them know that planning of time is impotant for you
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What are the types of dissociative disorders
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*dissociative amesia
*dissociative fugue *depersonalization *dissociative identity disorder. one develops after the next one |
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What caues Dissociative disorders?
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sexual trauma in childhood
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tell me about dissociative d/o's
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unconscious def mech that protects the individual from the emotional pain of experiences or conflict that have been repressed(removal from conciouss awareness) , The splitting helps survive intense emotion, physical pain or both.
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what is dissociative amnesia?
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loss of important personal events that were traumatic or stressful
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what si dissociative fugue?
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sudden, unexpected travel away from home or work with a loss of memory about the past; confusion about identity or assumption of partial or completly new identity is present
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what is depersonalization
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experience of feeling detached from or an outside observer of ones body or mental processes
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what is dissociative identity disorder?
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prescense of two or more identities or personalaties that take control of the persons behavior , loss of memory for important personla information.
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is realtiy testing intact during depersonalization
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yes
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NI for dissociative d/o's?
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*establish trust and support
*contract for client safety *set consistant limits to avoid staff splitting * help reintegrate personalaties *ask them if they have blocks of memory that they can't account for |
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What medications are used in DID?
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Medications do not eliminate DID
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example of DID?
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some of them mutulate to see if they are real important to keep them safe
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What are Antianaxiety drugs
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They are also called anxiolytics, minor tranquilizers, sedatives and hypnotics.
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What is the purpose of Antianxiety medications
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Reduce anxiety without interfering with daily activities.
If sleeping all day in the hopital not a good therapeutic use . Call doctor to have dose decreased. |
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what is a major risk of benzo's?
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*physical dependence and tolerance
*withdrawl sx can be life threatening |
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what warnings should you give a pt on benzo's?
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warn against abrupt disconnection
shouldnt be combined w/alcohol |
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benzo's can be used as..?
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anxiolytics: reduce anxiety
hypnotics: promote sleep *prevent seizures *produce amnesia |
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What are the indications for using Benzos
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They are not the first line of medications ued but are prescribed for:
*chronic anxiety *time limited for crisis *pre surgery jitters *panic disorder |
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what is romazicon (aka flumazonil) ?
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a benzo receptor antagonist blocker (blocks receptors).
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How do Benzodiazapines work?
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On the GABA receptors
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Side effects for Benzodiazapines?
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*dry mouth
*ataxia provide assit. with ambulation *dizziness, drowsiness *dependance *withdrawl *tolerance * most common sedation and reduced mental alertness. *Important to monitor BP. |
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What is dependance?
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The body functions normal when drug is present.
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What is withdrawl?
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Benzo's can cause withdrawl . S/S are aggitation, trembling, insomnia, vomiting. Graduall tapering of the drug is imperative
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what is tolerance?
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Occurs with Benzos .They need increasing amounts of the drug to reach the same effect
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examples of Benzodiazapines?
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Valium, Librium, clonopine
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tell me about:
ativan |
used to tx anxiety, anti-tremors
recommended for older pts when benzo is indicated |
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tell me about:
librium |
tx of anziety d/o's and acute alcohol withdrawl
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tell me about:
klonopin |
most often used an anticonvulsant
and also tx of panic d/o's |
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why would a pt be taking Valium?
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presurgery jitters
skeletal muscle spasm ETOH withdrawls status epilepticus |
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tell me about:
BuSpar |
NOT BENZO
takes 7-10days to relieve anxiety does not produce withdrawl, dependance, tolerance does not have cross tolerace |
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What are SSRI's
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they are the first line agents used to treat anxiety
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tell me about xanax
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used for GAD
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short acting benzo?
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triazolam (Halcion)
max dose 0.5 mg/day |
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intermediate acting benzo?
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Alprazolam (Xanax)
max 4 mg/day Diazepan(Valium) max dose 40 mg day |
