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335 Cards in this Set
- Front
- Back
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a maladaptive reaction to an identifiable psychosocial stressor that occurs within 3 months after onset of the stressor |
adjustment disorder
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behavior expression of emotion- may be congruent or incongruent (inappropriate)- can be described as flat, constricted or labile
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affect
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fear of being in places or situations from which escape might be difficult
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agoraphobia
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restlessness; an urgent need to move; associated with use of antipsychotics
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akathasia
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muscular weakness or loss of muscle movement; associated with EPS
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akinesia
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inability to experience or even imagine pleasure
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anhedonia
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a subjective state of emotional, physical, and social responses to an anticipated loss of a valued entity
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anticipatory grief
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Personality disorder:
client with a pattern of social irresponsibility, exploitative, guiltless behavior, problems conforming to laws, can't develop stable relationships, manipulates others |
antisocial
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a vague feeling of uneasiness
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anxiety
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a thinking process characterized by speech in which ideas shift from one unrelated subject to another
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looseness of associations
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muscular incoordination
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ataxia
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a treatment modality aimed at chaing undesirable behaviors using a system of reinforcement to bring about the changes desired such as tokens or rewards
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behavior modification
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personality do:
patterns of intense and chaotic relationships, impulsivity, splitting, self-destructiveness, extreme attitudes regardng other people |
borderline personality
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type of schizophrenia with either stupor or excitement, mutism, waxy flexibility, psychomotor agitation or retardation
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catatonia
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in speaking, the delay in reaching a point, adding unnecessary and tedious details
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circumstantiality
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a pattern of speech in which the choice of words is governed by sounds, words may rhyme
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clang associations
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mental operations that relate to logic, awareness, intellect, memory, language, and reasoning
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cognition
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defense mech
covering up real or perceived weakness by emphasizing a trait one considers more desirable |
compensation
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absence of grief when it ordinarily would be expected
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delayed or inhibited grief
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state of mental confusion and excitement with hallucinations, incoherent, aimless physical activity that comes on suddenly, an medical ER
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delirium
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defense mech
refusal to acknowledge the existence of a real situation or/or the feelings associated with it |
denial
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an alteration in the perception or experience of the self so that the feeling of one's own reality is temporarily lost
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depersonalization
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defense mech:
feelings are transferred from one target to another that is considered less threatening |
displacement
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milder form of MDD, with periods of normal mood, no loss of contact with reality
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dysthymic disorder
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involuntary movements (spasms) of face, arms, legs, neck, associ with EPS
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dystonia
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parrot-like repetition by an individual with loos ego boundaries of the words spoken by another
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echolalia
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part of the personality
functions on reality principle, the mediator |
ego
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exaggerated connectedness among family members- poor boundaries in which there is over-involvement in each others lives
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enmeshment |
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psychological disequilibrium in a person who confronts a hazardous circumstance that constitutes an important problem
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crisis
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false, fixed beliefs that persist despite obvious proof of the false nature
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delusions
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dystonia, akathisa, akinesia
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extrapyramidal symptoms (eps)
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a syndrome of physical symptoms that result from a person's real or perceived perception that danger is imminent
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fight or flight
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the reinforcements that a person gets for somaticizing
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gains
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a sense of discomfort associated with an incongruence between biologically assigned gender and subjectively experienced gender
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gender identity disorder
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at least 6 months of unrealistic and excessive worry over at least 2 things
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GAD
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a subjective state of emotional, physical and social responses to the real/perceived loss of a valued entity
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grief
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a therapy group, led by a person with an advanced degree in psychology, social work or nursing to encourage improvement in interpersonal functioning
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group therapy
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false sensory perceptions not associated with real external stimuli involving one of five senses- person may recognize as unreal, but still experiences
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hallucinations
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personality do
overly dramatic behavior used for drawing attention to self |
histrionic personality
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a mild form of mania with excessive hyperactivity but not severe enough to impair social or occupational function or require hospitalization
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hypomania
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freud
operates on pleasure principle, locus of instinctual drives |
id
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a misperception of a real external stimulus
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illusion
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the process of bringing multiple personalities together into one usually thru hypnosis
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integration
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defense mech
an attempt to avoid expressing actual feelings by using the intellectual process of logic, reason, and analysis |
intellectualization
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a syndrome in alcoholics of confusion, loss of recent memory and confabulation dt a deficiency of thiamine
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wernicke-korsakoff's
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part of the brain associated with love, aggression, joy, anger- the emotional brain-
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limbic system
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predominant mood is elevated, expansive or irritable, motor activity is frenzied and excessive with or without psychotic features |
mania
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therapy using the environment to improve mental health and functioning; with rules, limit setting and peer pressure utilized
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milieu therapy
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process through which one passes on the way to successful adaptation to the loss of a valued object
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mourning
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personality do |
narcissistic
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new words with no meaning
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neologisms
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severe muscle rigidity, high fever, labile BP, diaphoresis and rapid deterioration in mental status related to neuroleptic drugs
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NMS
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disorder with recurrent thoughts and inability to refrain from completing an act; person knows thoughts are silly but cannot stop; act reduces anxiety
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OCD
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eyeballs fixed upward, may occur with antipsychotic meds
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oculogyric crisis
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disorder with intense apprehension, fear, and intense physical discomfort
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panic disorder
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persistent repetition of the same word in response to different questions
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perseveration
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an irrational fear
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phobia
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defense mech
attributing to another person feelings or impulses unacceptable to oneself |
projection
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extreme slowdown of movements, slumped posture, slow speech and digestion
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psychomotor retardation
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defense mech
attempting to make excuses or formulate logical reasons to justify unacceptable feelings or behaviors |
rationalization
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defense mec
exaggerating opposite thoughts or behaviors |
reaction formation
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defense mech
involuntary blocking of unpleasant feelings and experiences from one's awareness |
repression
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personality do
profound defect in ability to form personal relationships or to respond to others in any meaningful way |
schizoid
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personality do
odd, eccentric behavior, magical thinking |
schizotypal
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unable to integrate positive and negative feelings, all bad or all good mentality often used by borderline personalities |
splitting
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defense mech
rechanneling of personally or socially unacceptable drives into activities that are tolerable by others and constructive |
sublimation
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physically unable to stop using a drug despite attempts to stop; continual use leads to tolerance and discontinuing drug leads to withdrawal |
substance dependence
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part of personality that operates on morals, the conscience |
superego
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defense mech
voluntary blocking of unpleasant feelings |
suppression
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treatment for phobias in which person is taught to relax and then asked to imagine various components of the phobic stimulus on a graded hierarchy |
systematic desensitization
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inability to get to the point of a story. introduces unrelated topics until the original topic of discussion is lost
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tangentiality
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syndrome of bizarre facial and tongue movements, stiff neck, difficulty swallowing, toe tapping, lip smakcing, tongue thrusting related to long term antipsychotic use
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tardive dyskinesia
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when anxiety builds in a 2 person relationship, a third person is brought in as a diversion |
triangles
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defense mech |
undoing
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a group of words that are put together in a random fashion without any logical connection
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word salad
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client presents with pronounced changes in attention, staring, parkinsonian symptoms, visual hallucinations, rapid course of onset |
dementia with lewy bodies
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name 3 anti-alzheimer meds
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aricept, namenda, cognex
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what are some measures family members are taught to maintain safety of a relative with AD
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no throw rugs
remove knobs from stoves cover electrical outlets |
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how should a family member talk to a relative with AD who is paranoid and argumentative
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by talking about how the person is feelings vs arguing the validity of the statement
client "People are stealing from em" family "that must be hard for you, we will help you protect your things: |
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what are 5 potential causes of dementia, besides AD
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wernicke-korsakoff
neuro-syphilis HIV substance abuse ischemic vascular disease |
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what screen is used to determine if a person is an alcoholic
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CAGE
c-cut down a-annoyed g-guilt e-eye opener |
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how soon does withdrawal begin after the last drink of ETOH |
several hours to few days after last drink
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what are s/sx of ETOH withdrawal
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tremors, N&V, sleep disturbances, hyperactivity, AH or VH, agitation, anxiety, delusions, seizures
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what are indicators of impending delirium tremens |
elevated temp (100F) and tachycardia
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when do DTs begin
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24 to 72 hours after last drink-
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what vitamin is always included in drug regimen for recovering alcoholics and why
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thiamine- poor nutritional habits may lead to thiamine deficiency and wernicke's encephalopathy
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what med is given as a form of aversion therapy for ETOH
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disulfiram (antabuse)
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what teaching is given to a client on antabuse
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no ETOH for 1-2 weeks after last dink; ingestion or skin contact with ETOH (in cologne, mouthwash, rubbing alcohol, etc) will cause headache, flushing, tachycardia, bloodshot eyes, N&V, hypotension, tachypnea
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what drug is given to assist alcoholics in maintaining sobriety, besides antabuse
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revia- decreases cravings for etoh if person takes med and drinks during a relapse
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what support group based on 12 steps and peer support is available for alcoholics
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alcoholics anonymous
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what is really the only way to maintain sobriety
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abstinence
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what support groups are available for family members of alcoholics or substance abusers
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al-anon, teen-anon, naranon
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impaired attention span, disorientation, slurred speech, lack of coordination, nystagmus, impaired memory, impaired functioning, mood changes and increased verbalization suggests.... |
alcohol intoxication
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what do alcoholics often do to fill in memory gaps that occur during alcoholic blackouts
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confabulate (lie)
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what is the number one defense mechanism used by alcoholics
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denial
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what are the positive signs of schizophrenia
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hallucinations, delusions, bizarre dress, agitation, aggressiveness, pressured speech
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what are the negative sx of schizophrenia
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anergia
avolition alogia anhedonia blunted affect poor attn to ADLs |
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what are the disorganized sx of schizophrenia
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incoherent speech
attention deficits |
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what are 5 types of hallucinations
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visual
auditory tactile gustatory olfactory |
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what are types of delusions |
grandeur
persecutory paranoid somatic |
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what are the most dangerous kind of hallucinations
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command, the voices may tell the person to kill or be killed
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what is the difference in schizophrenia and schizoaffective disorders
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schizoaffective do includes a mood disorder along with psychotic behavior
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what is the type of schizophrenia with the poorest prognosis
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disorganized schizophrenia- there is complete disintegration of personality, may be completely incoherent, unable to self care
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which type of schizophrenia has the most favorable prognosis
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undifferentiated- person is odd, may have delusions and hallucinations
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which type of schizophrenia may pose medical risks due to not eating, refusing meds, and vegetative or excessive motor states
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catatonic type-
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how is EPS treated
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with ABCS- artane, benadryl, *cogentin, symmetrel
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what must be monitored in a client on clozaril
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WBC count for agranulocytosis- report sore throat, fever, cough stat
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what are indicators of metabolic syndrome in clients on an antipsychotic
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elevated BP, elevated triglycerides, increased abdominal girth, low serum HDL, elevated bBS
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what are some s/sx of MDD
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hopelessness, helplessness, anhedonia, change in sleep and eating patterns, isolation, thoughts of death, tearfulness, fatigue or psychomotor agitation
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name a TCA
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amitriptypline
nortriptyline |
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what must be closely monitored in a client on a TCA
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ECG for arrhythmias and suicidality (easy to OD because potent med)
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name 3 MAOIs
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nardil, parnate and marplan
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what are s/sx of hypertensive or tyramine crisis
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occipital headache, elevated SBP, diaphoresis, pupil dilation, intracerebral bleed
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what types of foods must be avoided if on a MAOI
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foods containing tryptophan such as aged cheeses, salami, yeast, beer, wine, sauerkraut, raisins, soy sauce, yogurt, bananas, avocados, caffeine, sour cream
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what could happen if a person goes from taking a MAOI to an SSRI in a few days tiime
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Serotonin syndrome-
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what are s/sx of serotonin syndrome
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ataxia, irritability, delirium labile BP, cyanosis, tachycardia, hyperthermia, resp depression
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during what phase of psychosexual development is pleasure derived from sucking
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oral, ages 0-18months
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during what phase is the young person most interested in school, learning to develop control over aggressive impulses through sports and growing in intellectually (according to Freud) |
latency, 7 to teens
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during what phase, according to Freud, does the person learn to love, mature sexually and establish an identity
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genital (puberty to adult life)
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I am not an alcoholic
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denial
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Defense mech: |
displacement
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Defense mech:
man blames his wife for not setting alarm clock when he is late for work |
projection
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Defense mech: |
sublimation
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Defense mech:
man who witnessed his parents getting murdered cannot recall the event |
repression
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Defense mech:
little girl plays with a doll and acts like a mommy |
identification
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Defense mech:
man becomes blind after seeing his wife get raped |
conversion
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Defense mech
womans dresses like a teenager |
regression
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Defense mech
man who owes the IRS, refuses to talk about it |
suppression
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Defense mech |
reaction formation
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Defense mech
man treats his sons like they are in the military because that's how his father raised him |
introjection
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what is the developmental task of 0-18 mos according to Erikson
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trust v mistrust- if not mastered- suspicious, untrusting of others
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what is the developmental task of 18 mos-3y according to Erikson
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autonomy v shame/doubt- if not mastered grows up with self doubt, dependent personality
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what is the developmental task of 3-5yrs according to Erikson
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initiative v guilt- if not mastered will have excessive guilt and feeling of being the victim
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what is the developmental task of 6-11 years according to Erikson
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industry v inferiority- if not mastered grows up with low self esteem, no motivation to grow and feelings of incompetence
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what is the developmental task of 12-18yrs according to Erikson
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identification v role confusion- if not mastered leads to dysfunctional relationships, substance abuse, rebellion
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what is the developmental task of 18-40y according to Erikson
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intimacy vs isolation- if not mastered leads to isolation, possessivness
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what is the developmental task of 40-65y according to Erikson
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generativity v stagnation- time to leave a legacy for future generations, save for retirement, leave inheritance for future generations, if not mastered, leads to selfishness and egocentricity
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what is the developmental task of 65 to death according to Erikson
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ego integrity v despair- if unmastered, regrets life, fears death, dwells on past failures and can't adjust to aging process
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define: beneficence
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doing good for the people we care for
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define: veracity
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being honest with the people we care for
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define: fidelity
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being loyal to the people we care for
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what are the rights of mentally ill clients?
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wear own clothes
see chart refuse care/meds leave (unless commitment) give informed consent privacy/confidentiality communicate with others |
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when can confidentiality be breached?
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if client professes to be suicidal or homicidal
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what is a normal process that occurs after a loss of someone/something valuable that should be time limited and subside gradually?
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grief
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what type of grief leads to denial of the loss, change in sleep/eating patterns, mood disturbances such as anger, and impairs libido and ability to work or socialize |
unresolved or dysfunctional grief
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what nursing measures may help the person suffering from dysfunctional grief?
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allow the person to talk about loss
try to maintain a simple schedule avoid having client make major decisions discourage ETOH encourage the person to seek professional help if needed |
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what is the outward expression of grief with emotional detachment, that eventually will lead to the griever finding new interest and enjoyments called? |
mourning
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"feelings" of sadness, insomnia, loss of appetite, deprivation and desolation is....
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bereavement
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what are 4 common types of delusions or false fixed beliefs
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grandeur, paranoid, persecutory and somatic
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what are 5 types of hallucinations or false sensory perceptions
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auditory, visual, tactile, gustatory, olfactory
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how is orientation assessed?
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ask name, where are you, what time is it...
person, place and time |
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if a person tells you a shoe is a large rat he may experiencing ......
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an illusion- the misperception of a REAL stimulus
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how is recent memory assessed
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ask client to recall events in the immediate past such as "what did you have for lunch" and as far back as 2 weeks
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how is remote memory assessed
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ask client to recall events such as place of birth, names of schools attended
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how is intellectual ability assessed
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ask the person who the vice president is
or to add 7+7+7 |
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how is insight assessed
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ask the person if he considers himself sick- insight is self understanding, a person who lacks good insight will say "i'm fine. I don't need medicine"
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what are 7 boundary crossings?
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gift giving or receiving
sharing personal info about yourself with a client discussing your job with a client showing favoritism keeping secrets allowing a client to do staff work socializing during work time |
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what are the 3 phases of the therapeutic relationship
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pre-initial- complete self awareness, go over data
initiation (orientation) working termination |
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when is termination first discussed with the client
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during initiation phase- client is told "we have 2 weeks to meet and work through some of your problems before you return to the community..."
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what emotions may emerge during termination phase
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person becomes angry, scared, sad, may verbalize feelings of rejection or attempt to malinger (by introducing a new problem as an excuse to stay)
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when is the care plan implemented and coping skills taught in the therapeutic relationship
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working phase
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what is the term for a client developing intense feelings for the therapist based on a previous relationship
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transference
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what is the term for a nurse developing feelings for a client based on a previous relationship
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countertransference- seek support and guidance from supervisor to maintain a professional relationship
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what type of therapy involves rules, limit setting, peer pressure, a safe, structured environment and fosters socialization and appropriate behaviors
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milieu therapy
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what type of short term therapy serves to change negative, irrational thoughts/beliefs
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cognitive behavior therapy
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what type of therapy uses an unpleasant stimulus to change inappropriate behavior
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aversion therapy such as antabuse
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what type of therapy is used for people suffering from phobias or PTSD to gradually help them overcome fears
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desensitization
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what are 2 types of crisis
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situational and maturational
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marriage, childbirth, retirement and puberty can lead to which type of crisis
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maturational
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how long does a typical crisis such as losing a job last?
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24-36 hours
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what are the phases of a crisis
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pre-crisis, impact, crisis, resolution and post-crisis
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during which phase of the crisis does the victim feel anxious, disorganized and helpless
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crisis phase
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during which phase of the crisis does the victim feel in shock
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impact
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during which phase of the crisis does the victim use everyday coping skills to function
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pre-crisis- these skills will be ineffective once the crisis begins
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during which phase of the crisis does the victim problem solve, ask for help and regain control of the situation
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resolution (solving) phase
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during which phase of the crisis does the victim resume normal activities with improved coping skills and a more mature sense of self
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post crisis
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what is the ultimate responsibility of the nurse during a crisis
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help the victim(s) to organize, mobilize, and problem solve enough to return to pre-crisis functioning; it is NOT to solve problems for the client or to give advice
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what are 5 intervention during a crisis
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1. acceptance
2. let the person talk it out 3. help person to accept reality of crisis ( no false hope) 4. explain what they are feeling is normal 5. set limits on destructive behavior |
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what are 3 components of an unhealthy family
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1. guarded (not open to outsiders)
2. enmeshed (everyone is in everyone's business and controlling) 3. don't communicate |
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what is scapegoating
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when family members target one particular member as the 'sick one' or the blame one member for the problems in the household
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what is an open group
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no set starting date or ending date (people can join at any time)
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what is a closed group
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set membership (for example, just for anorexics) and group starts and ends together
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during which phase of group therapy are members resistant to disclosure, testing limits and anxious
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orientation; the nurse-leader must set a tone of acceptance and define the purpose of the group
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during which phase of group tx does cohesiveness and trust start and behaviors of members can be confronted
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working
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what type of leader says "do it my way. do it now!"
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autocratic
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what type of leader says "I am interested in what others think about this idea"
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democratic
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what type of leader says "you can do whatever you think will work the best"
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laissez-faire
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during which level of anxiety is the person still able to focus, has increased awareness, feels restless, competitive and wants to 'get things rolling..."
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mild anxiety
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during which level of anxiety is a person's field of focus narrowed and a feeling of doom takes over with a feeling of "i'm losing it" taking place
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severe
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during which level of anxiety is a person's ability to concentrate on more than one thing difficult, he paces, speaks faster and louder and talks about his fears |
moderate
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during which level of anxiety has a person lost it- and is unable to focus or act
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panic state
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what is the term for an irrational, intense fear of an object, activity or situation |
phobia
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fear of open spaces with no escape
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agoraphobia
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fear of closed spaces
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claustrophobia
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fear of heights
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acrophobia
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what type of therapy exposes the person to what is feared all at once (immediately facing one's fears)
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implosive therapy
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what is the criteria for a diagnosis of GAD?
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6 MONTHS or more of having excessive worry more days than not about several issues
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what are signs/sx of GAD
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restless, fatigue, insomnia, muscle tension, can't concentrate, can't work/socialize
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what are 4 benzodiazepines used to treat anxiety disorders
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ativan, valium, xanax, librium (more for ETOH withdrawal)
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what nursing teaching is given to the client on a benzopdiazepines
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no ETOH
no operating heavy machinery/driving don't stop suddenly change positions slowly |
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what are major SE of anxiolytics
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sedation, tolerance, confusion
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what is a major concern about prescribing benzo's
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they are addicting, tolerance can develop; ideally for short term use and as PRN for anxiety
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what is a nonbenzodiazepine used for anxiety
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BuSpar- takes longer to work and not appropriate as a prn
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what are nursing measures when caring for a person with OCD
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allow to complete compulsive act once started (stopping will lead to anxiety)
set limits on amount or time permitted for compulsive act safety- don't shame person |
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flashbacks, nightmares, hypervigilance, exaggerated startle response, detachment, acting out an event, restricted affect...are s/sx of what anxiety do?
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PTSD post traumatic stress disorder- safety for self/others no#1
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what are the major anxiety disorders
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GAD, OCD, Panic attack, PTSD, phobias
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what is the priority nursing action for a client having a panic attack
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stay with the person
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According to Hans Selye, what can happen if a person's body cannot recover and is overtaxed by stress
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exhaustion, the last stage in GAS- general adaptation syndrome- somatoform disorders, even death may occur in a weakened, overstressed body
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what are the 3 stages of the GAS
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alarm
resistance exhaustion |
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expression of emotional conflict and anxiety in the form of significant physical complaints that lack medical explanation
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somatization disorder
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unrealistic, exaggeration of complaints, making minor clinical symptoms into great concern, doctor shop and become professional patients |
hypochondriasis
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unconsciously changes anxiety provoking impulses into a motor or sensory condition
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conversion disorder
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a person with a seemingly serious problem, such as blindness, is nonchalant or has a "it's no big deal' attitude about the blindness
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la belle indifference
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refers to the relief from anxiety a person gets; keeps the internal need or conflict out of awareness and putting all attention on the illness
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primary gain
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refers to any other benefit or support from the environment that a person gets from being sick, such as love, sympathy or attention
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secondary gain
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what is it???
john can't a remember where he was or what he was doing on friday night when his wife was killed? |
dissociative amnesia
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what is it???
John walks off the job, boards a bus to Texas and starts a new life as Jim. As far as he's concerned, John never existed |
dissociative fugue
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what is it???
John has alters named Jeb, Jacob and Josiah living inside him |
dissociative identity disorder (multiple personality do)
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what is it????
John does LSD and has an 'out of body' experience while in a meditative trance |
depersonalization
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what are the major somatic disorders
|
somatization, body dysmorphia, hypochondriasis, conversion do
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what are the 3 dissociative disorders
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DID, amnesia and fugue
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what is the criteria for major depression
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2 or > weeks of anhedonia, anergia, psychomotor retardation/excitation, apathy, change in appetite and sleep patterns, hopeless, helpless, thoughts of death, feelings of guilt, depressed mood
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when does seasonal affective disorder (SAD) occur
|
during fall, winter months
most common in Alaska |
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how is SAD treated
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light therapy
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what are drugs of choice for treating MDD
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SSRIs- prozac, zoloft, paxil, celexa, lexapro, luvox
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what are major SE of SSRIs
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headache, sex. dysfunction, wt loss, elevated P and BP, dry mouth, diaphoresis
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what may occur if a person is also taking St John's Wort and an SSRI
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serotonin syndrome- restless, hyperreflexia, tachycardia, labile BP, diaphoresis, tremors, shivering, myoclonus- will need a lower dose of SSRI if client insists upon continuing with St John's
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What are nursing measures/teaching for SSRIs
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take Prozac in AM because of insomnia
be aware that person may be at greatest risk to commit suicide once medication starts working stop MAOIS 14 days or > before beginning SSRIs Blacks and Asians may take a lower dose of SSRIS |
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What anticholinergic SE are seen with TCAs such as nortriptyline
|
dry mouth, mydriasis (blurred vision) ,urinary retention, flushing, delirium
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what histamine blockade SE is seen with TCA use
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bronchoconstriction
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why are TCAs only prescribed one week at a time
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highly toxic, OD could be lethal to CV system- monitor for arrhythmias
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What atypical antidepressant is often prescribed if the client is suffering from insomnia or losing weight |
remeron- give HS- very sedating also causes wt gain
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what atypical antidepressant can cause a prolonged painful erection
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trazadone (desyrel)
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what would be some contraindications to Lithium usee
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low salt diet
urinary retention Hypertension pregnancy, breastfeeding renal disease |
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what is a therapeutic lithium level
|
<1.5 (toxic >2.0, will be symptomatic >1.5-1.8
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what are s/sx of LICo3 toxicity
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between 1.5-2.0 you may see bl. vision, ataxia, tinnitus, N&V&D
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what are s/sx of a lithium level over 2.0 |
diluted urine, tremors, muscular irritability, mental confusion
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what teaching is done for the client on lithium
|
increase fluid intake (8-10 glasses/day)
moderate salt intake (don't cut down!) bloodwork weekly, then biweekly, then monthly, then Q3 months report diarrhea, vomiting, fever- can deplete sodium and increase risk of toxicity avoid overperspiration- also depletes sodium |
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what anticonvulsants are also used for BPD (6)
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anticonvulsants: klonopin, tegretol, neurotin, lamictal, depakote, topamax
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what is a toxic level for depakote
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>150
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what major, potentially fatal skin disorder is associated with lamictal |
steven-johnson syndromw- look for blisters and rashes on mucous membranes (inside mouth, gums, eyelids, etc)
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what must be monitored when a client is on depakote
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platelets, ammonia level and LFTs- known to cause liver disease and blood dyscrasias
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what is the difference between dysthymia and major depressive disorder
|
DYSthymia is intermittent periods of depression, with periods of normal mood and not as severe as MDD; symptoms can persist for 2 years or >; person with dysthymia might be described as "moody" with patterns of overeating and oversleeping (opposite with MDD)
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what is the difference in hypomania and mania
|
a hypomanic person is overly enthusiastic, talking a bit faster and louder, not sleeping as not using best judgment, but ABLE to function at all levels although slightly off baseline; the manic person is not sleeping at all, grandiose, pressured speech, psychomotor agitated, irritable, and UNABLE to function at work or home
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what is the difference between Bipolar I and Bipolar II
|
bipolar I is more severe, periods of depression and mania;
bipolar II is periods of depression and hypomania (this person can still function, may not need hospitalization) |
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what are s/sx of a manic episode
|
1 week or > of grandiosity, decrease sleep, not eating, can't stop talking, Flight of ideas, agitation, easily distracted, risk for self harm, promiscuous behavior, breaks laws, careless, reckless behavior, can't work
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what type of diet for a person who is manic
|
high protein, high calorie, finger foods- OK to eat and walk, may not be willing to sit at table
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what type of environment for a person who is manic
|
private room
calm setting provide opportunities to spend energy however remove safety risks q15 min checks |
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Using maslow's hierchy of needs, what would be the priority nursing measure for a suicidal client
|
safety- remove safety hazards, provide safety contract, 1:1
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using SAD PERSONS what are the risk factors for suicide
|
sex
age depression past history of attempt ethanol use rational thinking- lack of social support- lack of organized plan no spouse sickness- also has medical problems |
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how should a suicidal person be questioned
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directly "how would you go about killing yourself"
" what has stopped you from killing yourself" |
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what is it???
the biological caregiver or childcare provider fabricates (lies) or deliberately causes injury/illness to the child simply to satisfy a craving for attention and psychological gain |
munchausen by proxy
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what has happened??
retinal detachment, subdural hematoma, bruising around the neck in an infant who "wouldn't stop crying" |
shaken baby syndrome
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what is happening to this child???
stuttering, encopresis, enuresis, hypochondriasis, autism, overeating, depression and suicidal tendencies in a 9 year old child |
suspect child neglect
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what are the 3 phases of domestic abuse
|
tension building
acute battering honeymoon |
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during which phase of domestic abuse does the abuser use undoing, and promise to never hit his partner again |
honeymoon
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during which phase of the domestic abuse cycle will the victim use somatization
|
tension building
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during which phase of the domestic abuse cycle will the victim use depersonalization and the abuser use denia |
acute battering
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when child abuse is suspected what is the nurse legally bound to do
|
report findings to child protective services through social services department
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what can the nurse do to help a victim of domestic abuse
|
never advise the client to stay or to leave but instead give her information on shelters and other sources of help should she decide to leave
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what are the 2 priority nursing measures when caring for a client who is withdrawing off a drug or alcohol
|
safety and stabilization medically
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what is the drug of choice for heroin withdrawal
|
catapres (clonidine_
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what is the drug of choice for heroin recovery or rehab
|
methadone
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what is the drug of choice for ETOH withdrawal
|
librium
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|
what's happening???
john is hungry, can't think clearly, is uncoordinated and has slowed reflexes |
cannabis (marijuana) use
|
|
|
what is happening??
John is euphoric, cocky (inflated self esteem), hyperalert, has pupil dilation, elevated BP and P, and no appetite. He hasn't slept all night and has nasal congestion |
cocaine use
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what is happening??? |
hallucinogenic (LSD)
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|
what is happening???
tom is nodding off, constricted pupils, slow breathing and slow pulse, no feelings for food, sex or pain |
heroin (opiate)
|
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what is happening??? |
heroin withdrawal
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|
what is it????
lois complains that it hurts when her husband touches her sexually |
dyspareunia
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What 3 meds are used to treat Erectile dysfunction
|
levitra
cialis viagara |
|
|
what medication must not be taken along with a
phosphodiesterase type 5 inhibitor such as viagara |
anti-anginal such as nitroglycerin
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|
what medical disorders can contribute to ED in men
|
DM, HBP
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|
what is it????
3 days after she delivered, Megan became tearful, stopped sleeping and was anxious about whether she could care for her new daughter. When questioned she was in contact with reality and expressed a desire to feel better |
postpartum blues- key is no loss of contact with reality; usual onset 3-5 days postpartum
|
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|
what is happening???? |
postpartum depression- up to 12 months of delivery, disorientation, depersonalization and suicidal thoughts may also occur
|
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|
what is happening???
2 days after delivery, Janice packs all the new baby's clothes, accuses her husband of cheating on her, stops eating or sleeping, says god is telling her to kill the baby and bury her in the woods |
postpartum psychosis- requires hospitalization, antipsychotic meds
|
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|
what recommendations can the nurse give the mom experiencing postpartum blues
|
get help- with housework and child care
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|
what recommendation should be given to the new mom with postpartum depression
|
seek professional help- will be treated with antidepressants for up to 1 year
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Ben has an IQ of 38. What level of retardation is this
|
moderate 35-50
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what level of retardation would be considered profound
|
below 20
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when is autism diagnosed
|
before/near age 3
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what are s/sx of autism
|
child is unresponsive to people, environment, delays in social and language skills, ritualistic behavior, resistant to change, sudden outbursts of violence (headbanging), variable intellect, doesn't need cuddling, more attached to objects
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|
what are s/sx of asperger's
|
normal to high IQ, pedantic speech (overemphasis on detail), hand-flapping, paces. circumscribed interests ("only" like 1-2 things), can't display emotions, verbal IQ > than performance- think 'rain man'
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what would be the best way for a nurse to begin bonding with a child with autism
|
sit and play side by side (parallel play)
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|
what is it???
8 years old Little Bill can't sit still in class, he interrupts, leaves his desk to look out in the hall if he hears a noise, has poor impulse control and does poorly in school work. He can be aggressive and frequently puts himself down |
ADHD
|
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|
what is drug of choice for ADHD
|
Ritalin- given in increments, one week 5 mg, 2nd week 10 mg etc- until noticeable change in child's behaviors
also strattera, adderall, concerta |
|
|
How is ritalin given
|
30 minutes after a big breakfast and lunchtime
Avoid late day use b/c of insomnia (last dose,if TID no later than 4 pm) |
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what are SE of ritalin
|
wt loss, tachychardia, HBP, dizziness, headache
|
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|
does a drug like ritalin or adderall have the potential to be abused
|
yes, these are CNS stimulants that many adults abuse either for the energy of a speed pill (college kids take them when cramming for a test) and to lose weight
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|
what is happening?
Little Ryan tortured his cat. He set his parents garage on fire. He picks on other kids, cuts school, he lies and runs away. Sometimes he smokes pot |
conduct disorder
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|
A child with conduct disorder may grow up to have what personality disorder
|
antisocial
|
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|
what is happening????
Before the age of 8, Johnny's parents noted negativity, hostility towards adults and other authority figures, temper tantrums, talking back, blaming others for mistakes, aggressive behavior at school, hard time keeping friends, problems at school |
oppositional defiant disorder (ODD)
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|
|
what is it???
One day in class Alan starts barking, clearing his throat and grunting. He shrugs his shoulders and twists his head. and His body begins to twitch and he falls out of the chair. |
tourettes
|
|
|
what is copralia
|
repeated use of profanity
|
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|
How is tourette's treated
|
antipsychotics such as haldol
risperdal, zyprexa |
|
|
what's happening????
15 year old marjorie's parents got divorced 2 months ago. Now she is depressed, tearful and she wants to sleep in her mom's bed every night. |
adjustment disorder
|
|
|
what is it???? |
bulimia nervosa
|
|
|
what are s/sx of bulimia
|
Repeatedly eating unusually large quantities of food in one sitting, especially high-fat or sweet foods
Not wanting to eat in public or in front of others Going to the bathroom right after eating or during meals Having sores, scars or calluses on the knuckles or hands Having damaged teeth and gums from acid erosion person is at or near baseline weight- not underwt |
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|
besides binging and purging what other methods do bulimics use to keep wt off
|
laxatives, diuretics, enemas, herbal products and OTC dietary supplements
|
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|
what is the psychological component to bulimia
|
Being preoccupied with your body shape and weight
Living in fear of gaining weight Feeling t of not being able to control your eating behavior |
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|
what is it????
Diane is 5'6 and weighs 96lbs. She hasn't had her menses in 4 months and she is cold all the time. Her BP is 88/50. |
anorexia nervosa
|
|
|
what are s/sx of anorexia n.
|
extreme wt loss
abnl CBC dizziness low BP cardiac arrhythmias dry skin constipation cold intolerance osteoporosis swollen arms and legs |
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|
what are the emotional behaviors of an anorexic
|
refuses to eat
EXTREME DRIVE FOR PERFECTIONISM afraid to gain wt over achiever socially withdrawn flat affect lies about how much food was eaten |
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|
besides starvation how else does an anorexic attempt to control weight
|
over exercises
laxatives and diuretics Skipping meals Making excuses for not eating Eating only a few certain "safe" foods, usually those low in fat and calories Adopting rigid meal or eating rituals, such as cutting food into tiny pieces or spitting food out after chewing Cooking elaborate meals for others but refusing to eat Repeated weighing of themselves Frequent checking in the mirror for perceived flaws Complaining about being fat Not wanting to eat in public |
|
|
what are complications of anorexia
|
Death
Anemia Heart problems, such as mitral valve prolapse, abnormal heart rhythms and heart failure Bone loss, increasing risk of fractures later in life In females, absence of a period In males, decreased testosterone Gastrointestinal problems, such as constipation, bloating or nausea Electrolyte abnormalities, such as low blood potassium, sodium and chloride Kidney problems |
|
|
what lab is an indicator of starvation
|
Serum albumin.
Indicates degree of protein depletion (2.5 g/dl indicates severe depletion; 3.8 to 4.5 g/dl is normal). |
|
|
Tarzan feels like Jane trapped in a man's body. He has....
|
gender identity disorder
|
|
|
what is it? painful spasms of vaginal musculature related to traumatic intercourse (first coitus, rape or guilt) |
vaginismus |
|
|
what is it? male exposes self |
exhibitionism |
|
|
what is it? man secretly watches a woman undress |
voyeurism |
|
|
what is it? sexual pleasure from having pain inflicted upon oneself |
masochism |
|
|
what is it?? sexual pleasure from inflicing pain on others |
sadism |
|
|
what are the 5 phases of sexual response |
desire, excitement, plateau, orgasm, resolution |
|
|
what meds are used to treat ED |
phosphdiesterase type 5 inhibitors such as cialis, viagra and levitra |
|
|
what is it?? 46XXYY in a child with small penis, tall stature, sparse body hair, gynecomastia and infertility |
klinefelter's syndrome |
|
|
what is it? acute onset of confusion, impaired judgment, visual hallucinations, agitation and clouded consciousness post surgery or other stressor |
delirium |
|
|
what are the 3 D's of AD |
dementia, delirium and depression |
|
|
how is the dementia treated with DAT |
cholinesterase inhibitors such as aricept, exelon, tacrine and razadyne |
|
|
what med may be used to treat moderate to severe DAT |
namenda |
|
|
what is it?? man can't recall events of long ago but has normal recall of recent events |
anterograde amnesia |
|
|
what is it? man DAT can't put on his shoes |
apraxia |
|
|
what is it? parkinson-like gait, confusion with the presence of spherical proteim deposits in nerve cells |
lewy body dementia |
|
|
what is it? man cant write |
dysgraphia |
|
|
what is it? type of dementia often related to infarctions, microvascular disease or hypoxic conditions |
vascular dementia |
|
|
in what stage of the battering cycle is the abuser appologetic and loving |
honeymoon phase |
|
|
in what stage of the battering cycle is the abuser anxious, accusatory and may use drugs or alcohol to cope |
tension building |
|
|
what med has been linked to priapism (antidepressant) |
trazodone |
|
|
what behaviors should the client with BPD be assessed for |
splitting, and cutting |
|
|
what is it? increased amounts of a substance over time are needed to achieve same effect as previously obtained with lesser doses |
tolerance |
|
|
what is it? woman is obsessed with the size of her hips and hates the way she looks |
body dysmorphia |
|
|
what type of delusion? man accuses wife of sleeping with his brother even though there is no proof or truth to this |
conjugal |
|
|
what type of delusion? man believes his boss gave him a promotion because she is in love with him and he plans to leave his wife for her |
erotomanic |
|
|
what type of delusion? man believes the IRS is stealing his tax returns and planning to arrest him on federal charges of tax evasion |
persecutory |
|
|
what type of delusion? man won't sleep in a bed because he believes it was used to kill a person many years ago |
paranoid |
|
|
what type of delusion? man believes he is the son of Christ |
grandeur |
