Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
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
|
