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130 Cards in this Set
- Front
- Back
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What is anxiety?
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- Anxiety is a RESPONSE to stress
- Higher levels of anxiety result in behavior changes - DEFENSE MECHANISMS are used by people who have anxiety disorders |
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What are some nursing interventions for the patient who is having an anxiety attack?
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- STAY WITH THE PATIENT, provides reassurance
- Provide SAFETY and comfort during crisis period - Teach client to identify when anxiety is developing - Evaluate the coping mechanisms that work to control anxiety |
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What is a panic disorder?
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- The client experiences recurrent panic attacks with episodes typically lasting 15-30 minutes
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What are the symptoms of a panic disorder?
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- Palpitations
- Shortness of breath - Choking/smothering sensation - Chest pain - Nausea - Feelings of depersonalization - Chills/hot flashes |
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What does "phobia" mean?
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- The client FEARS a specific object or situation to an unreasonable level causing severe anxiety
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What does "social phobia" mean?
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- Fear of embarrassment
- Client is unable to perform in front of others, and has a dread of social situations - Impaired relationships |
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What does agoraphobia mean?
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- Fear of being outside
- Client has impaired ability to work or perform duties |
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What does xenophobia mean?
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- Fear of strangers
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What does ophidophobia mean?
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- Fear of snakes
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What does arachnophobia mean?
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- Fear of spiders
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What does aviophobia mean?
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- Fear of flying
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What does nyctophobia mean?
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- Fear of the dark
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What does claustrophobia mean?
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- Fear of enclosed spaces
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What is an obsessive compulsive disorder (OCD)?
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- Client has intrusive thoughts of UNREALISTIC obsessions and tries to control these thoughts with COMPULSIVE BEHAVIORS such as repetitive CLEANING or WASHING HANDS
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What is the best nursing intervention for the patient who has an obsessive compulsive disorder?
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- SUPPORTIVE but LIMITING behavior
- If rituals include constant hand washing or cleaning, skin damage/infection may occur, the goal is to DECREASE BEHAVIORS |
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What does a generalized anxiety disorder (GAD) mean?
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- More than 6 months of UNCONTROLLABLE, EXCESSIVE WORRY
- GAD causes significant impairment in 1 or more areas of functioning, such as work related duties *FREE FLOATING ANXIETY* *NURSING CONSIDERATION: BE PRESENT WITH THE PATIENT* |
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What are the symptoms of a GAD?
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- Fatigue
- Restlessness - Problems with concentration - Irritability - INCREASED muscle tension - Sleep disturbances |
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What is an acute stress disorder?
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- Exposure to a traumatic event, that causes numbness, detachment, and amnesia about the event
- First symptoms occur within 4 weeks, and may last for 2 days, to 4 weeks |
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What is post-traumatic stress disorder (PTSD)?
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- Exposure to a traumatic event, that causes INTENSE fear, horror, flashbacks, feelings of detachment, and foreboding (feeling that something bad is going to happen), restricted affect and impairment
- Client will have recurrent, intrusive recollection of event, dreams, images, reliving through flashbacks, illusions and hallucinations - Client will show symptoms of avoiding people, poor concentration, irritability, sleep disturbance - Client is usually an ex-military, let them know they are not alone |
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What does a somatoform disorder mean?
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- A psychiatric condition, in which the physical symptoms that the client is experiencing cannot fully be explained by a medical problem or another psychiatric disorder
- Client may receive SECONDARY GAINS (i.e. more attention from friends and family when "ill") |
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What is a somatization disorder?
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- A chronic, severe, psychiatric disorder characterized by many recurring clinically significant physical reports that cannot be fully explained by a physical disorder
- Typically client will be dramatic, such as making statements like, "unbearable", or "beyond description" - Client tends to be extremely dependent on personal relationships, increasingly demanding help or emotional support - Client may demand specific tests or procedures to be done (they are convinced something is wrong) |
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What are the symptoms of a somatization disorder?
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- Multiple and chronic reports of unexplained physical symptoms
- Multiple pain symptoms involving multiple sites |
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What does hypochondriasis mean?
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- A preoccupation with bodily functions and fears of acquiring or having serious diseases, based on MISINTERPRETATION of the physical symptoms
- Persists for at least 6 months, despite negative medical evaluation; must EVALUATE ALL NEW SYMPTOMS - Often times, the client will NOT believe the provider, believing the provider has failed |
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What is a conversion disorder?
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- SUDDEN LOSS of neurological function, usually at a time of SEVERE stress, that cannot be fully explained by a physical disorder
- Behaviors are necessary for the client to cope - ONSET of symptoms is linked to a socially psychologically stressful event |
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What are the signs and symptoms of a conversion disorder?
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- Inability to walk
- Weakness - Impaired coordination or balance - Paralysis of an arm or leg - Loss of sensation in a body part |
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What is a nursing intervention for the patient who has a conversion disorder?
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- Focus on the client's stress they are dealing with, NOT the disorder
- Help the client cope with stressful situations |
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What is a pain disorder?
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- A disorder in which pain in one or more anatomic sites, is exclusively or predominantly caused by psychologic factors, is the MAIN focus of the client's attention, and results in significant stress and dysfunction
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What is a body dysmorphic disorder?
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- Preoccupation with an imagined defect in appearance, causing significant distress or interfering with social, occupational, or other important areas of functioning
- This disorder may be associated with multiple, frantic, and unsuccessful attempts to correct the imagined defect by COSMETIC SURGERY - Client may avoid appearing in public due to being self conscious about their appearance |
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Patient states, "I am afraid to leave my house, because people will make fun of me, because of my nose", what type of disorder do you anticipate the patient to have?
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- Body dysmorphic disorder
- Nursing interventions: encourage the client to verbalize fears and stressful life situations |
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Patient states, "Only 1 nurse is trustworthy", what does this mean?
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- SPLITTING
- Splitting is the inability to incorporate positive and negative aspects of self into a whole image, and is commonly associated with BORDERLINE PERSONALITIES - ALL GOOD, OR ALL BAD - Black and white |
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What is a dissociative disorder?
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- Failure to integrate one's memories, perceptions, identity, or consciousness normally
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What is dissociative amnesia?
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- An inability to recall important personal information, usually of a traumatic event or stressful nature, that is TOO EXTENSIVE to be explained by NORMAL forgetfulness
- Usually associated with overwhelming stress |
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What are the symptoms of dissociative amnesia?
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- Memory loss for a period of time
- May become confused or depressed shortly after an episode of amnesia |
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What is the treatment for the patient who has dissociative amnesia?
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- Establish a supportive environment, and a sense of safety
- Be aware, that recall of lost memories may be upsetting, but also helpful to restore identity |
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What is dissociative fugue?
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- Amnesia, in which the inability to recall some or all of one's past, along with the loss of one's identity or the formation of a new identity
- Occurs with sudden, unexpected, purposeful travel away from home |
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What are the symptoms of dissociative fugue?
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- May assume a new identity, and engage in complex social interactions for a period of time, to hours or weeks
- Fugue in progress, is asymptomatic to an outside observer - when fugue ends, depression, discomfort, grief or shame may appear |
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What is a dissociative identity disorder (DID)?
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- Characterized by 2 or more personalities that alternatively take over the person's behavior
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What are the symptoms of a dissociative identity disorder?
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- Client may have amnesia
- DID is associated with a HIGH incidence of suicide attempts - May experience DEPERSONALIZATION (feeling unreal, as if observing from the outside) |
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What are personality disorders?
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- Enduring pattern of inner experience and behavior that deviates markedly from the expectation of one's culture, is pervasive, maladaptive and inflexible, and leads to distress or impairment
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What are the 4 common characteristics that ALL personality disorders share?
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1. Inflexibility/maladaptive response to stress
2. Disability in social/professional relationships 3. Tendency to prove interpersonal conflict 4. Capacity to cause irritation or stress to others |
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What Axis diagnosis are personality disorders under?
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- Axis II diagnosis
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What are the 3 groups (clusters), personality disorders are grouped in called?
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- Cluster A: odd or eccentric (weird, schizo)
- Cluster B: emotional, dramatic, erratic - Cluster C: anxious and fearful |
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What type of personalities are in cluster A?
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- PARANOID PERSONALITY: distrustful, suspicious, hypervigilant towards others based on unfounded beliefs that other want to harm, exploit, or deceive them
- SCHIZOID PERSONALITY: emotional detachment, disinterest in close relationships, and indifference to praise or criticism; often UNCOOPERATIVE, flat affect, social withdrawal - SCHIZOTYPAL PERSONALITY: odd beliefs leading to interpersonal difficulties, eccentric appearance, magical thinking |
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What type of personalities are in cluster B?
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- ANTISOCIAL PERSONALITY: disregard for others with exploitation, repeated unlawful actions; deceit, sexual acting out, maladaptive coping, low tolerance for frustrations, violence
- BORDERLINE PERSONALITY: inability of affect, identity; lack of self esteem, fear of abandonment, strong dependency needs; SPLITTING BEHAVIORS, manipulation and impulsiveness - HISTRIONIC PERSONALITY: emotional attention seeking behavior, in which the person needs to be in the center of attention - NARCISSTIC PERSONALITY: arrogant, grandiose views of self importance, need for consistent admirationm lack of empathy toward others that STRAINS most relationships |
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What type of personalities are in cluster C?
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- AVOIDANT PERSONALITY: social inhibition and avoidance of situations that require interpersonal contact, due to extreme fear of rejection
- DEPENDENT PERSONALITY: extreme dependency in close relationships with urgent search when 1 relationship ends - OBSESSIVE COMPULSIVE DISORDER (OCD): perfectionist with focus on orderliness and control |
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A patient has a police record of his teenage years stealing cars and other UNLAWFUL activities, what personality disorder does this patient have?
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- ANTISOCIAL PERSONALITY
- Patient has disregard for others with exploitation, REPEATED UNLAWFUL ACTIONS, deceit and sexual acting out |
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What do you do before admitting a patient into a psych unit?
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- EVALUATION (danger level)
- Evaluate SAFETY |
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What is a good communication strategy for a patient that has a borderline/antisocial personality disorder?
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- SET LIMITS
- Be consistent, manipulative |
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What is a good communication strategy for a patient who has a histrionic personality disorder?
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- Use ASSERTIVENESS in training and modeling
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What is a good communication strategy for the patient who has a schizoid or schizotypal personality disorder?
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- Respect the client's need for social isolation
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What is a good communication strategy for dependent clients?
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- Self assess for countertransference
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What is anorexia nervosa?
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- An eating disorder, characterized by preoccupation with food and the rituals of eating, along with voluntary refusal to eat
- Patient will have a morbid fear of obesity |
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What are the 2 types of anorexia nervosa?
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1. Restricting
2. Binge-purge |
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What is bulimia nervosa?
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- An eating disorder, characterized by RECURRENT episodes of eating large quantities of food over a short period of time (binging), that may be followed by vomiting (purging)
- Patient MAY be at a normal weight |
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What are the 2 types of bulimia nervosa?
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1. Purging
2. Non-purging |
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Do males also experience eating disorders?
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- YES
- Males account for 5-10% cases of anorexia nervosa, and 10-15% of all cases of bulimia - "Other girls don't like me because i'm fat" |
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What are some nursing interventions for patients who are struggling with eating disorders?
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- Establish and maintain trust through consistency and therapeutic communication
- Monitor MEAL INTAKE, exercise patterns and attempts to purge after eating - Provide a highly structured milieu in an inpatient unit - CLOSELY MONITOR THE CLIENT AFTER MEALS |
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What are some complications that can result from an eating disorder?
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- RE-FEEDING SYNDROME: circulatory collapse when a client's compromised cardiac system is OVERWHELMED by a replenished vascular system after normal fluid intake resumes (nurse should implement re-feeding over 7 days and MONITOR electrolytes)
- Cardiac dysrhythmias: severe BRADYCARDIA, and hypotension (nurse should implement cardiac monitoring, monitor VS) - Osteoporosis: fragile bones, more prone to fracture (client should take calcium supplements) - Excessive vomiting may cause DENTAL CARIES (due to the acidity of the vomit) |
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What are some examples of mood disorders?
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- Depression is a mood (affective) disorder and is a widespread problem, ranking high upon causes of disability
- UNIPOLAR DEPRESSION: client's mood is "normal" or depressed, as opposed to a bipolar disorder, which includes mood swings from major depression to mania - High risk for suicide: especially if family or personal history of suicide attempts |
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What is a major depressive disorder (MDD)?
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- A SINGLE episode or RECURRENT episodes of UNIPOLAR DEPRESSION, resulting in significant change in the client's normal functioning, accompanies at least 5 specific symptoms
- Symptoms must happen ALMOST EVERY DAY, last most of the day, and occur continuously for a minimum of 2 weeks |
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What are the symptoms of a major depressive disorder?
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- Depressed mood
- Difficulty sleeping - Excessive sleeping |
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What is a dysthymic disorder?
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- Dysthymic disorder is a MILDER form of depression that usually has an earlier onset such as in CHILDHOOD, lasts at least 2 years in length for adults
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What other disorders could depression be a comorbidity to?
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- Depression may be comorbid with anxiety disorders, schizophrenia, substance abuse, eating disorders and personality disorders
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What are the phases of recovery for depression?
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- Acute phase: hospitalization may be needed in this phase, which may last 6-12 weeks - symptoms of depression will be reduced
- Continuation phase: lasts 4-9 months, purpose of this phase is to PREVENT relapse through education and medication - Maintenance phase: phase includes prevention of further depressive episodes, may last several years |
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What does anergia mean?
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- Lack of energy
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What does anhedonia mean?
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- Lack of pleasure in normal activities (patient may present with poor hygiene and grooming if suffering from a depressive disorder)
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What does the term affect mean?
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- Expression of mood (in depressed patient, affect will often be sad, blunted effect)
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What are some nursing interventions for the patient who is suffering from a depressive disorder?
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- Remain alert for overt and covert signs that the client is planning suicide
- Keep AT RISK clients safe through manipulation of the milieu, along with close observation - Encourage group activities to promote self-esteem - Make time to be with the client, even if the client is too tired to speak - St. John's wort plant ingested by some individuals to relieve symptoms of depression (assess medication history, St. John's wort increased bleeding) |
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What are bipolar disorders?
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- Bipolar disorders are mood disorders with recurrent episodes of depression and mania
- Psychotic, paranoid, and/or bizarre behavior may be seen during periods of MANIA |
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What does "mania" mean?
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- Abnormally, ELEVATED MOOD, which may be described as expansive or irritable, easily distracted, and usually requires inpatient treatment
- Sleep disturbances may come before, be associated with, or be brought on by an episode of mania |
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What is a bipolar I disorder?
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- Client will have at least 1 episode of mania, alternating with major depression
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What is a bipolar II disorder?
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- Client has REPEATED HYPOMANIC episodes, alternating with major depressive episodes
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What does cyclothymia mean?
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-The client has at least 2 years of repeated hypomanic episodes, alternating with minor depressive disorders
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What is the manic phase of a bipolar disorder?
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- Patient will have a persistent elevated mood (EUPHORIA)
- Grandiose view of self - Impulsivity (spending money) - Neglect of ADL'S, including nutrition and hydration - Denial of illness |
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What is the depressive phase of a bipolar disorder?
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- Affect: flat, blunted, labile (emotionally unstable)
- Anhedonia: loss of pleasure, lack of interest in activities, hobbies and sexual activity |
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What are some nursing interventions for the client with a bipolar disorder?
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- Provide a SAFE environment (therapeutic milieu) during the ACUTE phase and within an acute care mental health facility
- Assess client regularly for suicidal thoughts - DECREASE stimulation WITHOUT isolating the client if possible - Provide outlets for physical activity - DO NOT REACT PERSONALLY to the client's comments |
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What is schizophrenia?
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- Groups of psychotic disorders that affect thinking, behavior, emotions, and the ability to perceive reality
- The term "psychosis" refers to the PRESENCE OF HALLUCINATIONS, delusions, disorganizes speech or catatonic behavior |
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How is a patient diagnosed with schizophrenia according to the DSM-IV-TR criteria?
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- 2 or more of the following characteristic symptoms are PRESENT for a significant portion of the time during a 1 month period
- Delusions - Hallucinations - Disorganized speech - Grossly disorganized catatonic behavior and negative symptoms - 1 or more major areas of social or occupational dysfunction exist |
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What are delusions?
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- Delusions are ALTERATIONS in thought, false fixed beliefs that cannot be corrected by reasoning which are usually BIZARRE
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*Delusions*
What does the type of delusion, "ideas of reference" mean? |
- The client misconstrues trivial events and attaches personal significance to them
- "Believing that others, who are discussing the next meal, are talking about him" |
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*Delusions*
What does delusions of persecutions mean? |
- Client feels singled out for harm by others, such as being hunted down by the FBI
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*Delusions*
What does delusions of grandeur mean? |
- Client believes they are all powerful and important, like a "god"
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*Delusions*
What does somatic delusions mean? |
- Client believes body is changing in an unusual way, such as growing a 3rd arm
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*Delusions*
What does the "being controlled" delusion mean? |
- Client believes that a force outside of their body is controlling them
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*Delusions*
What does thought broadcasting mean? |
- Client believes that their thoughts are being heard by others
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*Delusions*
What does thought insertion mean? |
- Client believes that others' thoughts are being inserted into their mind
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*Delusions*
What does thought withdrawal mean? |
- Client believes their thoughts have been removed from their mind by an outside agency
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What are hallucinations?
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- Hallucinations are SENSORY PERCEPTIONS that do not have any apparent external stimuli
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*Hallucinations*
What are auditory hallucinations? |
- Client hears voices or sounds that are not there
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*Hallucinations*
What are visual hallucinations? |
- Client sees people, or things that are not really there
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*Hallucinations*
What are olfactory hallucinations? |
- Client smells odors that are not really there
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*Hallucinations*
What are gustatory hallucinations? |
- Client experiences different tastes in mouth that are all in their mind
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*Hallucinations*
What are tactile hallucinations? |
- Client feels strange bodily sensations that are not really there
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*Alterations in Speech*
What does flight of ideas mean? |
- Client may say sentence after sentence; each sentence may relate to another topic, and the listener is unable to follow the client's thoughts
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*Alterations in Speech*
What does neologisms mean? |
- Client uses made up words
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*Alterations in Speech*
What does echolalia mean? |
- Client repeats words that are spoken to them
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*Alterations in Speech*
What does clang association mean? |
- The use of meaningless rhyming words that are often forceful
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*Alterations in Speech*
What does a word salad mean? |
- Word jumbled together with little meaning or significant to the listener
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What are personal boundary difficulties?
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- Disenfranchisement (feeling deprived) with one's own body, identity and perceptions
- Depersonalization: feeling of losing their identity - Derealization: perception that the environment has changed |
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What are the POSITIVE signs and symptoms of schizophrenia?
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- POSITIVE SYMPTOMS: hallucinations, delusions, disorganized speech and bizarre behavior
*POSITIVE SYMPTOMS ARE THE CRAZY ONES* |
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What are NEGATIVE signs and symptoms of schizophrenia?
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-NEGATIVE SYMPTOMS: blunted or flat affect, alogia, avolition, anhedonia and anergia
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What are COGNITIVE signs and symptoms of schizophrenia?
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- COGNITIVE SYMPTOMS: disordered thinking, inability to make decisions, poor problem solving ability
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What are the DEPRESSIVE signs and symptoms of schizophrenia?
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- DEPRESSIVE SYMPTOMS: hopelessness and suicidal thoughts and feelings
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What does alogia mean?
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- Alogia: POVERTY of thought or speech
- Example: client may sit with a visitor, but only mumbles or responds vaguely to questions |
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What does avolition mean?
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- Avolition: LACK of motivation in activities and hygiene
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What does anhedonia mean?
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- Anhedonia: LACK of pleasure and joy, indifference to things that often make other people happy
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What does anergia mean?
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- Anergia: lack of energy
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What is paranoid schizophrenia?
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- Characterized by SUSPICION TOWARDS OTHERS
- Common symptoms include: auditory hallucinations (hearing threatening voices), delusions (believing oneself is the president of the US) - Other directed violence may occur |
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What is disorganized schizophrenia?
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- Characterized by withdrawal from society, and inappropriate behaviors, such as poor hygiene and muttering to self
- FREQUENTLY SEEN IN THE HOMELESS POPULATION - Common symptoms include: loose associations, bizarre mannerisms, and incoherent speech, poor hygiene |
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What is catatonic schizophrenia?
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- Characterized by abnormal motor movement
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What is residual schizophrenia?
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- Active symptoms are NO LONGER present, but the client has 2 or more "RESIDUAL SYMPTOMS"
- Common symptoms include: anhedonia, avolition and withdrawal from social activities |
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What is undifferentiated schizophrenia?
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- Client has symptoms of schizophrenia but does not meet the criteria for any of the types of schizophrenia
- Common symptoms include: any positive or negative symptoms may be present |
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What is the disease progression of schizophrenia?
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- Schizophrenia may be characterized by exacerbations and remissions
- ACUTE PHASE: periods of both POSITIVE and NEGATIVE symptoms - MAINTENANCE PHASE: acute symptoms DECREASE in severity - STABILIZATION PHASE: symptoms are in REMISSION |
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What are some nursing interventions for the patient who has schizophrenia?
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- Identify PERSONAL feeling and responses to the client
- Assess client using GAF scale - Assess client's use of drugs and alcohol - DON'T ARGUE WITH THE CLIENT'S DELUSION, instead, FOCUS on the client's FEELINGS and offer REASONABLE explanations, such as, "I can't imagine the president of the US would have a reason to kill a citizen, but it must be frightening for you to believe that" - Establish a TRUSTING relationship with the client (therapeutic communication) - Encourage development of social skills and friendships |
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If a patient is delusional, are they psychotic?
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- YES
- DELUSIONAL = PSYCHOSIS |
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What is the CAGE screening for alcohol?
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- The CAGE questionnaire, the name of which is an acronym of its four questions, is a widely used method of screening for alcoholism
- The questionnaire asks the following questions: 1. Have you ever felt you needed to CUT down on your drinking? 2. Have people ANNOYED you by criticizing your drinking? 3. Have you ever felt GUILTY about drinking? 4. Have you ever felt you needed a drink first thing in the morning (EYE-OPENER) to steady your nerves or to get rid of a hangover? *Used to identify alcoholism* |
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What type of drugs caused constricted pupils?
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- OPIOIDS
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A client is admitted with depression, in an effort to promote POSITIVE self-regard, what types of activities would the nurse encourage the patient to perform?
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- Encourage activities that promote SUCCESS
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A severely dehydrated teenager is admitted to the hospital with a diagnosis of anorexia nervosa, what is your nursing intervention?
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- Patient may present with bradycardia, hypotension, electrolyte imbalance
- Common laboratory findings: hypokalemia, anemia and leukopenia, elevated liver enzymes, decreased bone density (osteoporosis), abnormal thyroid function tests - Closely monitor the client during/after meals, monitor meal intake |
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A client with a BORDERLINE PERSONALITY DISORDERS, expresses feelings about each nurse, stating only ONE nurse is understanding and trustworthy, and NO ONE else, what type of behavior is this client exhibiting?
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- SPLITTING BEHAVIOR
- Patient sees things as ALL GOOD, or ALL BAD - Black and while |
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A nurse understands that in a conversion disorder, pseudo-neurologic symptoms such as paralysis and blindness meets what need?
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- These behaviors are necessary for the client to COPE
- The client NEEDS the pseudo-neurologic symptoms to help them cope |
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How do you know a patient with a generalized anxiety disorder (GAD), is improving?
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- They begin to recognize their own triggers, and have their own methods to cope
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A patient with hypochondriasis complains about chest pain and tuberculosis, the x-rays come back negative (patient does NOT have TB), what do you do?
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- Respond to ALL of the client's complaints and concerns
- Evaluate ALL NEW symptoms |
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What is a weight goal for the patient with anorexia nervosa?
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- Gain 1LB a week
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What is a positive nursing action when caring for a middle-aged client that is depressed, how can you as the nurse build trust?
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- Sit with the patient
- Spend time with the patient 1 on 1 |
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A patient on a mental health unit is yelling loudly, and talking to themselves, what is this behavior called?
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- Hallucinations
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A patient is having symptoms of mania and depression, what disorder could this be?
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- Bipolar disorder
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A patient is going through a "manic" phase, how can you as the nurse help them?
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- Have them organize something, or take a walk
- DO NOT give ANYTHING to the patient they could use to harm themselves |
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What is one of the risks for a patient that has schizophrenia?
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- Violence to themselves or others
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A patient who has been diagnosed with acute psychosis, schizophrenia is characterized by what?
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- Waxy flexibility, echolalia, alteration in thoughts, delusions
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