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122 Cards in this Set

  • Front
  • Back
Behavior is considered a disorder when it interferes with
ADLs
Ellis
Theory designed to help individuals apply a scientific approach to their own situation to Test the Validity of their self-assumptions
Methylenedioxamphetamine (MDA) the parent drug of MDMA is an amphetamine-like drug that destroys serotonin-producing neurons in the brain
Goal of RET -
to assist individuals in their unconditional self-acceptance
Mental health
possible definitions; what does it mean.
Mental health is culturally defined
Pre-Interaction Phase
Obtain information
Begin initial assessment
Become aware of personal responses
Examine one's own feeling and anxieties
Be aware of preconceptions and the affect on ability to give care
Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (eg, arguments with spouse about consequences of intoxication, physical fights)
Basis Premise of RET
the ways in which an individual interprets data will affect emotions and actions
Dual Diagnosis =
the simultaneous occurrence of a substance-related disorder and a medical or psychiatric disorder in an individual
Conditions Essential to Development of a Therapeutic Relationship
Rapport
Trust
Respect
Genuineness
Empathy
Psychologic dependence involves feelings of
satisfaction and pleasure from taking the drug
Role of the Nurse
The nurse-client relationship is the foundation upon which psychiatric nursing is established

Relationship in which both participants must recognize each other as unique and important human being

Relationship in which mutual learning occurs

Role of the nurse to proved the client with opportunity to -
Identify and explore problems in relating to others
Discover healthy ways of meeting emotional needs
Experience a satisfying interpersonal relationship
DSM-IV Criteria - Substance Abuse
* Maladaptive pattern of substance use leading to clinically significant impairment or distress, that has never met the criteria for substance dependence of this class or substance, and is manifested by at least one of the following -
* Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home
* Recurrent substance use in situations in which it is physically hazardous
* Recurrent substance-related legal problems
Orientation Phase
Creating an environment to establish trust and rapport
Establish a contract for intervention
Gather assessment information to build data base
Formulate nursing diagnosis
Set goals that are mutually agreeable
Develop a plan of action
Explore feelings
Signs of Common Child Substance Abuse
1) Sudden behavioral changes
2) Night sweats
3) Needle marks
4) Inebriation
5) Changes in nutritional uptake
6) Nasal congestion
Phases of a Therapeutic Nurse-Client Relationship
Pre-interaction Phase
Orientation Phase
Working Phase
Termination Phase
Hallucinogens =
chemical substances that possess mind-altering or mental perception-altering properties
Temperament
Refers to inborn personality characteristic that influence and individual's manner of reacting to the environment and ultimately their developmental progression
Addiction =
state when the person experiences severe psychological and behavioral dependence on drugs
Psychiatric Mental Health Nursing
Medical Commitment
Legal Commitment
Community Implications
Prison Populations
Therapies
Tolerance
The need for increasingly larger or more frequent doses of a substance in order to obtain the desired effects originally produced by a lower dose
Mahler
Separation-Individuation Process
Four phases
Sullivan
Interpersonal Theory
Anxiety
Satisfaction Needs
Interpersonal Security
Self-system
Hallucinogenic drugs include
a variety of substances that cause mood changes, anxiety, distorted sensory perceptions, hallucinations, delusions, depersonalization, pupil dilation, elevated body temperature, and elevated blood pressure
Characteristics - Substance Abuse
* Substance abuse involves at least one of the following behaviors for at least one month's duration -* Continued use of substance despite awareness of the problem it produces or exacerbates
* Continues use of substance under dangerous situations
* Uses defense mechanisms of denial, rationalization, and projection concerning substances, use and results
Milestones in Psych Care
Dorothae Dix (1841)
Mental Institutions Populations
Hill-Burton Act
1963 Community MH Centers Act
Patient Bill of Rights
Standards of Care
Highest prevalence of substance use occurs between ages 18 and 24
Psych Legal Issues
Least Restrictive Alternative
Informed Consent
Voluntary Admission
Involuntary Admission
Emergency Commitment
Civil commitment
Mandatory Outpatient Treatment
Benzodiazepine antianxiety agents are the drugs of chose for treating alcohol withdrawal syndromes
Nurses must have a basic knowledge of human personality development to understand maladaptive behavioral responses
Axes II
Personality disorders and mental retardation
Usually begin early adolescent and persisting into adulthood
Patient Rights
Confidentiality
Privileged Communication**
Release of Information
Duty to Warn and Protect
Access to Records
Seclusion and Restraints**
Right to Treatment
Right to Refuse Treatment
Forensic Evaluations
Competency to Stand Trial
Criminal Defense
Guilty but Mentally Ill
Nursing Responsibilities
Substance Withdrawal
* Development of a substance-specific maladaptive behavioral change, with physiological and cognitive concomitants, that is due to cessation of, or reduction in, heavy and prolonged substance use
* Withdrawal is usually, but not always, associated with substance dependence
Erikson
Eight Life Stages
Tasks
Developmental Crisis
DSM IV
Diagnostic and Statistical Manual of Mental Disorders, fourth edition
Freud
ID - pleasure principle
EGO - reality principle
SUPEREGO - perfection principle
Nursing implications
* Substance abuse is progressive
* Health care providers are a population with a high proportion of abusers
Peplau
Applied Interpersonal Theory to Nursing Practice
Psychodynamic Nursing
Interpersonal Involvement of the nurse with the client in a given nursing situation
Axes IV
Psychosocial and environmental problems
These things will affect diagnosis and support access to health care
Interaction with legal system
Personality
Enduring patterns of perceiving, relating to, and thinking about the environment and oneself
Apply Nursing Process in the Psych Setting
Role of the Nurse -
Assisting the client to successfully adapt to stressors within the environment
Goals - are directed toward change in thoughts, feelings, and behaviors that are age-appropriate and congruent with local and cultural norms
Nursing Responsibilities
Malpractice
Documentation
Sexual Misconduct
Suicide and Homicide
Symptoms of alcoholism
* DT's
Working Phase
Therapeutic relationship is accomplished during the phase
Maintain trust and rapport
Promote client's insight and perception of reality
Problem solve
Overcome resistive behaviors on the part of the client as the level of anxiety rises in response to discussion of painful issues
Continually evaluate progress toward goal attainment
Relapse =
recurrence of dependent behavior after having maintained abstinence for a period of detoxification
History of Psychiatric Nursing
Roman Law
Middle Ages
American Colonies
Witchcraft
Native Americans
Asylums
First Hospital
Free Standing TX Centers
Mental Health -
Successful adaptation to stressor from internal or external environment evidenced by thought, feelings, and behaviors that are incongruent with the local and cultural norms
Mescaline is an alkaloid of
the peyote cactus
To help motivate the patient to quit using nicotine, the nurse describes the negative effects of smoking, including
chronic cardiovascular and respiratory diseases, as well as secondhand effects on other people
Mescaline is an alkaloid of
the peyote cactus
Axes I
Clinical disorders and other conditions that may be the focus of clinical attention
There is no antidote for barbiturate overdose; treatment is symptomatic and supportive
DSM-IV Criteria - Substance Withdrawal
* Substance-specific syndrome caused by the cessation of or reduction in heavy and prolonged substance use
* Substance-specific syndrome causes clinically significant distress or impairment is social, occupational, or other important areas of functioning
* Symptoms are not due to a general medical condition and are not better accounted for by another mental disorder
Cocaine produces powerful CNS stimulation by
preventing reuptake of neurotransmitters (eg dopamine, norepinephrine, serotonin) which increases and prolongs neurotransmitter effects
Substance Use Disorders
* Dependence
* Abuse
Phencyclidine (PCP) produces
excitement, delirium, hallucinations, and other profound psychological and physiologic effects, including a state of intoxication similar to that produced by alcohol; altered sensory perceptions; impaired though processes; impaired motor skills; psychotic reactions; sedation and analgesic; nystagmus and diplopia; and pressor effects that can cause hypertensive crisis, cerebral hemorrhage, convulsions, coma, and death
Two disorders noted with alcoholism
Wiernicke Syndrome -
* Occur after years of alcohol abuse
* Neurological disorder
* Neurological encephalopathy
* Usually involves the sixth cranial nerve
* Confusion
* Ataxia (difficulty with movement)
* Vitamin B deficiency
* Lack of fluid intake
Korsakoff's Syndrome
* Amnesic syndrome
* Caused by deficiency in Vitamin B, thiamine, folic acid
* Characterized by amnesic disorientation to time and place
* Falsification of memory (blackouts)
* Confabulation
* Peripheral neuropathy (Sensory changes in hands and feet
* Muscle weakness
* Tingling
* IMPORTANT TO TRY TO PREEVEN FOOT DROP
Barbiturates are old drugs that are rarely used therapeutically but remain drugs of abuse
Enmeshed means
that problem is more than individual; it usually involves family/group
Signs and symptoms of withdrawal are less severe with benzodiazepines than with barbiturates
American Psychiatric Association
Psychiatric Diagnosis
Consists of Five Axes
Lysergic Acid (LSD) is a major hallucinogenic drug in the drug community
Benzodiazepine antianxiety agents are the drugs of chose for treating alcohol withdrawal syndromes
One-third of hospital admissions are alcohol related
Phencyclidine (PCP) produces
excitement, delirium, hallucinations, and other profound psychological and physiologic effects, including a state of intoxication similar to that produced by alcohol; altered sensory perceptions; impaired though processes; impaired motor skills; psychotic reactions; sedation and analgesic; nystagmus and diplopia; and pressor effects that can cause hypertensive crisis, cerebral hemorrhage, convulsions, coma, and death
Psychological Dependence
* An individual is considered to be psychologically dependent on a substance when its use is perceived by the user to be necessary to maintain an optimal state of personal well-being, interpersonal relations, or skill performance
Opiates produce tolerance and high degrees of psychological and physical dependence
Physiologically, nicotine has both stimulant and sedative that affect the CNS
Prevention of alcohol and other drug abuse
1) Decrease the supply or availability of commonly abused drugs
2) Decrease the demand for drugs
3) Each person must take personal responsibility for drinking alcoholic beverages and taking mind-altering drugs
4) Physicians can help prevent drug abuse by prescribing drugs appropriately
5) Nurses can help prevent drug abuse by administering drugs appropriately, using nondrug measures when possible, teaching clients about drugs prescribed for them, and participating in drug education programs
6) Parents may help prevent drug abuse in their children by minimizing thier own use
7) Pregnant women should avoid alcohol, nicotine, and other drugs of abuse because of potentially harmful effects on the fetus
Signs and symptoms of withdrawal are less severe with benzodiazepines than with barbiturates
The symptoms for SUBSTANCE ABUSE have never met the criteria for SUBSTANCE DEPENDENCE for this class of substance
Phencyclidine, commonly knows as PCP, is an animal anesthetic that causes a feeling of detachment in humans
CNS Depressants
* Cause respiratory system depression -
- Alcohol
- Sedatives (secobarbital)
- Hypnotic (Quaalude)
- Antianxiety (diazepam)
- Opiates (demarol, codeine, heroin)
Drug dependence involves compulsive drug-seeking behavior
Reasons given for drug use
* Restore health
* Reduce pain
* Reduce anxiety
* Increase energy
* Create feeling of euphoria
* Induce sleep
* Ensure alertness
* Alter mood or consciousness
* Relieve stress/tension
* Provide escape
* Peer pressure
* Rite of passage
* Risk taking
Number of stressors and responses (defense mechanism) come into play surrounding behavior
DSM-IV Criteria - Substance Intoxication
* Development of a reversible substance-specific syndrome caused by recent ingestion of a substance
* NOTE - Different substances may produce similar or identical syndromes
* Symptoms are not due to a general medical condition and are not better accounted for by another mental disorder
* Clinically significant maladaptive behavior or psychological changes that are due to the effect of the substance on the CNS and develop during or shortly after use of the substance
Categories of Substance Related Disorders
* Substance Induced Disorders
* Substance Use Disorders
Alcohol is metabolized at the same rate regardless of the amount present in body tissues.

S/S of Alcohol Withdrawal

Agitation
Anxiety
Tremors
Sweating
Nausea
Tachycardia

Benzodiazepine antianxiety agents are the drugs of chose for treating alcohol withdrawal syndromes.

Barbiturates are old drugs that are rarely used therapeutically but remain drugs of abuse.

Signs and symptoms of withdrawal are less severe with benzodiazepines than with barbiturates.

There is no antidote for barbiturate overdose; treatment is symptomatic and supportive.

Opiates produce tolerance and high degrees of psychological and physical dependence.

Cocaine produces powerful CNS stimulation by preventing reuptake of neurotransmitters (eg dopamine, norepinephrine, serotonin) which increases and prolongs neurotransmitter effects.

Hallucinogenic drugs include a variety of substances that cause mood changes, anxiety, distorted sensory perceptions, hallucinations, delusions, depersonalization, pupil dilation, elevated body temperature, and elevated blood pressure.

Mescaline is an alkaloid of the peyote cactus.

Phencyclidine (PCP) produces excitement, delirium, hallucinations, and other profound psychological and physiologic effects, including a state of intoxication similar to that produced by alcohol; altered sensory perceptions; impaired though processes; impaired motor skills; psychotic reactions; sedation and analgesic; nystagmus and diplopia; and pressor effects that can cause hypertensive crisis, cerebral hemorrhage, convulsions, coma, and death.

Prevention of alcohol and other drug abuse
1) Decrease the supply or availability of commonly abused drugs.
2) Decrease the demand for drugs.
3) Each person must take personal responsibility for drinking alcoholic beverages and taking mind-altering drugs.
4) Physicians can help prevent drug abuse by prescribing drugs appropriately.
5) Nurses can help prevent drug abuse by administering drugs appropriately, using nondrug measures when possible, teaching clients about drugs prescribed for them, and participating in drug education programs.
6) Parents may help prevent drug abuse in their children e by minimizing tier own use.
7) Pregnant women should avoid alcohol, nicotine, and other drugs of abuse because of potentially harmful effects on the fetus
Know the difference between physical and psychological dependence
Signs of withdrawal
* Shakes
* Psychiatric hyperactivity
* Insomnia
* Agitation
A patient may be "held" if the court/medical system deems them a
threat to themselves of others
Social Factors
* Environmental factors
* Peer influence/pressure
* Dysfunctional family dynamics
* Dysfunctional family communication
* Deviance or social maladaption
* Enmeshed (overly dependent) family relationships
* Easy access to substances
* Societal ambivalence about substance use
* Societal messages that medicine solves all problems
Librium and vitamin B are often used in alcohol detoxification
Physical dependence involves
physiologic adaptation to chronic use of a drug so that unpleasant signs and symptoms occur when the drug is stopped or its action is antagonized by another drug
Physical dependence is promoted by the phenomenon of tolerance
Dependence =
continuing use despite adverse consequences
Substance Induced Disorders
When something is induced and body has to deal with it
* Intoxication
* Withdrawal
* Delirium
* Dementia
* Amnesia
* Psychosis
* Sexual Dysfunction
* Sleep Disorders
* Mood Disorders
* Anxiety Disorders
There is no antidote for barbiturate overdose; treatment is symptomatic and supportive
Axes V
Global assessment of functioning
GAF
Global Assessment Functioning Scale (0-100)
Single measurement of how this individual functions (occupationally-psychosocially)
Physical Dependence
* Evidenced by a cluster of cognitive, behavioral, and psychological symptoms indicating a loss of control over use of the substance and a continual use of the substance despite significant substance-related problems.
* As the condition develops, the repeated administration of the substance necessitates its continued use to prevent the appearance of unpleasant effects characteristics of the withdrawal syndrome associated with that particular drug.
* Physical dependence is promoted by the phenomenon of tolerance
Termination Phase
Occurs for many reasons -
Goals reached
Discharge
Therapist/Student leaves
Abuse =
use of drug or purpose of intoxication
Mental health is on one end of a continuum, mental illness on the other end
Detoxification =
process of safely and effectively withdrawing a person from an addictive substance, usually under medical supervision
Psychological Factors
* Depressed mood
* Low self-esteem, self-derogating
* Excessive dependency needs
* Increased need for success or power
* Inability to cope with overwhelming painful feelings
* History of antisocial personality disorder or hyperactivity
* Codependent personality
* Insecurity
* Maladaptive coping skills
Tasks of Termination
Bringing a therapeutic conclusion to the relationship. This occurs when -
Progress has been made toward attainment of mutually set goals
A plan for continuing care is mutually established
Feelings about termination of relationship are recognized and explored
Amphetamine can be altered to become a
hallucinogen, as in the case of 3,4-methylenedioxymethamphetamine (MDMA)
Withdrawal =
adverse physical and psychological symptoms that a person has when ceases using substance
Biological (Causative) Factors
* Genetic predisposition
* Low levels of monoamine oxidase enzyme
* Low levels of acetaldehyde dehydrogenase
* Increased extracellular levels of dopamine
* Inadequate self-care abilities
Etiological Implications
* A number of factors have been implicated in the predisposition to abuse of substances
* NO single theory can adequately explain the etiology of this problem
* Complex collection of factors that influence substance abuse
Adaptation would be mental health if maladaptation is mental illness
Enmeshed =
an individual's inability to differentiate or establish a personal identity
Addiction

Incorporates the concepts of -
* loss of control substance ingestion
* substance use despite associated problems
* tendency to relapse
Axes III
General Medical Conditions
Substance Abuse
* Psychoactive drug use of any class or type, used alone or in combination, that poses significant hazards to health
* Maladaptive pattern of substance use manifested by recurrent and significant adverse consequences r/t repeated use of the substance (DSM-IV)
Categories of substances commonly abused include -
* Stimulants
* Hallucinogens
* Depressants
* Opiods (narcotics)
Psychoactive Substance Classes
* Alcohol
* Amphetamines and Related Substances
* Caffeine
* Cannabis
* Cocaine
* Hallucinogens
* Inhalants
* Nicotine
* Opiates
* Phencyclidine (PCP) and Related Substances
* Sedatives, Hypnotics, or Anxiolytics
DSM-IV Criteria - Substance Dependence
* At least three of the following characteristics must be present for a Dx of substance dependence -
- Evidence of tolerance, as defined by either of the following
- a need for markedly increased amounts of the substance to achieve intoxication or desired effects
- Markedly diminished effect with continued use of the same amount of the substance
- The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
* The substance is often taken in larger amounts or over a longer period than was intended.
* There is a persistent desire or unsuccessful efforts to cut down or control substance use.
* A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
* Important social, occupational, or recreational activities are given up or reduced because of substance abuse.
* The substance is continue despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance
Polysubstance Abuse
* Involves concurrent abuse of two or more substances
Characteristics - Substance Dependence (addiction)
* Substance dependence involves any 3 of the following behaviors for more than one month's duration
* Consumes more than is intended and over a longer time period than intended
* Is unable to control excessive use of the substance
* Spends a great amount of time getting, taking, and recovering from the substance
* Is unable to fulfill responsibilities because of intoxication or withdrawal symptoms
* Reduces former activities; life revolves around substance use
* Experiences biopsychosocial problems from substance use
* Develops tolerance; needs more of the substance to produce intoxication or high
* Experiences withdrawal with discontinuance or reduced use of the substance
* Takes the substance to prevent withdrawal symptoms
Maladaptation
- to stress
- internal/external
- thoughts/feeling/actions
- Inconsistent with local norms
- interferes with social, occupational, or physical function
Substance Intoxication
* Development of a reversible substance specific syndrome caused by recent ingestion of a substance
* Behavior changes can be attributed to the physiological effects of the substance on the CNS and develop during or shortly after use of the substance
* This category does not apply to nicotine
Substance Abuse =
overindulgence of a chemical substance and the resulting dependence that interferes with life's activities
CNS Stimulants
* Promote psychological dependence, which tends to be more powerful than the physical dependence -
- Amphetamines (Dexedrine)
-Cocaine
S/S of Alcohol Withdrawal
Agitation
Anxiety
Tremors
Sweating
Nausea
Tachycardia
Care
* Give B vitamins
* Give Fluids
* Hydrate
* Do not force fluids/flushing
* Check stools for blood
* GI symptoms are common with alcohol withdrawal
* Assess neurolgoic status at least every hour
* Assess elimination (in DTs)
Mind Altering Substances
* Promote psychological dependence
- Hallucinogens (LSD)
- Cannabis (marijuana, hashish)
- Phencyclidine (PCP or angel dust)
Barbiturates are old drugs that are rarely used therapeutically but remain drugs of abuse
Opiates produce tolerance and high degrees of
psychological and physical dependence
Cocaine produces powerful CNS stimulation by
preventing reuptake of neurotransmitters (eg dopamine, norepinephrine, serotonin) which increases and prolongs neurotransmitter effects
Dual Diagnosis =
two or more disorders occurring simultaneously, indicating that an individual has two initially unrelated disorders that interact and cause increased manifestations of the other disorder
Hallucinogenic drugs include a variety of substances that cause
mood changes, anxiety, distorted sensory perceptions, hallucinations, delusions, depersonalization, pupil dilation, elevated body temperature, and elevated blood pressure