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145 Cards in this Set

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What are the Diagnostic Criteria for Anorexia Nervoas? (5)
-Body Weight < 85% Exptected
-Intense Fear of Gaining Weight
-Distorted View of Own Body
-Obsessive Exercise Routines
-Amenorrhea for at least 3 Months
Define Restricting Type Anorexia Nervosa.
Does not engage in binge eating or purging.
Define Binge-Eating/Purings Anorexia Nervosa.
Self Induces vomiting, laxatives, diuretics, enemas.
What is Type I Anorexia?
Chronic and Lifelong.
What is Type II Anorexia?
Short Course with complete recovery.
What are the body weight characteristics of Bulimia clients?
Body Weight usually normal.
What are the Eating characteristics of Bulimia clients?
Excessive craving of food, with Binging.
What are the Elimination Techniques of Bulimia clients?
Self Induced Vomiting, Laxatives, etc.
What are the exercise characteristics of Bulimia clients?
Sporadic Exercising
What are the emotional characteristics of Bulimia clients?
Sense of lack of control over eating behavior.
What emotional concepts should be stressed for clients with eating disorders?
Issues of enhanced concept of self and feelings of self worth.
What happens to the HR during Anxiety?
It Increases
What happens to pupils during anxiety?
They Dialate
What happens to the immune response during anxiety?
It is decreaed.
What is a Panic Disorder?
When a client has frequent Panic States.
What is Mild Anxiety?
Its Good. We need it to function and keep us motivated.
What is Moderate Anxiety?
It narrows the perceptual field.
What is Severe Anxiety?
It further decreased the perceptual field.
What is happens at Panic Level Anxiety.
The client is not able to function.
How do you Grade Anxiety?
On a scale of 0-10 like Pain.
What is Free Floating Anxiety?
Tabers:unrelated to an identifiable condition, situation, or cause.

Jeff Says "Restlessness, On Edge, Difficulty Sleeping, Hand Wringers"
What are the warning signs for when a client with Panic Disorder is about to have an attack?
There is no warning.
How often do clients with Panic Disorder experience trouble?
Several times a weei.
What are some sypmtoms that you might see in a client with Panic Disorder?
SOB ** Vertigo ** Faintness -** Palpations - Shaking ** Sweating ** Choking ** Nauese ** Fear of Dying
What is the main Intervention for someone with a Panic Disorder Attach?
Reassure them, and remove from the Over Stimulating Environment.
What is a Phobia?
Tabers:
Any persistent and irrational fear of a specific object, activity, or situation that results in a compelling desire to avoid the feared stimulus.
What happens when a client experiences a Phobic trigger?
It can produce the symptoms of a Panic Attack.
Is a Phobic Client Really afraid of Clowns?
Now, there is an underlying meaning that is displaced with the fear of the clown.
Is a Phobia a Defense Mechanism?
Jeff says the book says it is.
Is the RN role in OCD to stop the behavior?
No, it is to help the client make changes to function better in society.
What is an Obsession?
Tabers:
A persistent or recurring idea or feeling, esp. one that causes emotional distress or that interferes with effective living.
What is a Compulsion?
Tabers:
A repetitive stereotyped act performed to relieve fear connected with obsession.
How can rituals of OCD be controlled?
Through Behavior Modification or with AntiAnxiety Medications.
If an RN sees a client washing his hands 25 times should they interrupt?
No, it will only extend the compulsion until it can be completed. Focus should be on address the OCD afterwards to help deal better with it.
What is PTSD?
Post Traumatic Stress Disorder.
Tabers:
Intense psychological distress, marked by horrifying memories, recurring fears, and feelings of helplessness that develop after a psychologically traumatic event, such as the experience of combat, criminal assault, life-threatening accidents, natural disasters, or rape.
What are PTSD Flashbacks?
Events Persistently re-experienced with an emotional response on a regualr basis.
How do PTSD clients avoid the problem?
They self medicate or avoid sleeping to stave off nightmares.
What is Hypervilligance in PTSD?
The feeling that someone is always after them.
How does low self esteem play into combat issues of PTSD?
Survivor asks "Why did I live"
What is the Primary Intervenion used today to help prevent PTSD Sx?
Immediately debrief of all exposed is "best" intervention which will speed the griefing process.
Other than debrief, what is another intervention for PTSD clients.
Begin Tx ASAP before other things like ETOH coping can take hold.
What is a Dissociative Disorder?
Tabers:
A sudden, temporary alteration in the normal functions of consciousness, identity, or motor behavior

Jeff Slide:
Alteration in consious awareness of behavior, affect, thought or memories.
What is dissociative identity disorder?
Formerly known as “multiple personality disorder,” a rare, but increasingly reported, psychiatric illness in which a person has two (or more) distinct personalities.
How does Dissociative Disorder affect many of us each day? Give Three.
-Day Dreaming
-"How did I get here" after driving 30 miles.
-Tune out a nagging partner.
What is Dissociative Amnesia?
Tabers:
Inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by ordinary forgetfulness.

Jeff:
Memory loss NOT ORGANIC associated with a traumatic event.
What is DID?
Dissociative Identity Disorder.
What generally causes DID?
Severe childhood Abuse.
What is unique about the Host Personality in DID?
May have at best only partial awareness of the other personalities.
What is a Somatoform Disorder?
Tabers:
A psychological disorder in which the physical symptoms suggest a general medical condition and are not explained by another condition such as a medication or another mental disorder.
Jeff:
Unconsious use of physical Sx to manage conflicting issues.
What is Conversion Disorder?
Tabers:
A psychological disorder marked by symptoms or deficits affecting motor or sensory function that mimic a neurological or general medical disease

Jeff:
Loss of function secondary to traumatic event
What is La belle indifference?
Tabers:
[Fr., beautiful indifference] A disproportionate degree of indifference to, or complacency about, symptoms such as paralysis or loss of sensation in a part of the body.

Jeff:
The loss of eyesight is no big deal. The primary gain is dec Anxiety and inc attention.
What is Hypochondriasis?
Tabers:
An abnormal concern about one's health, with the false belief of suffering from some disease, despite medical reassurance to the contrary.

Jeff:
Preoccupation with fear of death/serious illness. Believe they have severe disease even with good test results.
What happens with physical sensations in hypochondriasis?
They are exagerated.
What type of contracting might be done with Hypochondriasis?
Set contracts for pre-determined attention periods.
What might be an underlying problem in Hypochondriasis?
Does the client have an unmet need?
How do hypochondriaic clients interact with providers?
They may change providers in order to maintain their system of denial.
Are there many Tx options for hypochondriasis?
No, generally not a good prognosis.
What is a major and common problem for all somataform disorders?
Denial.
Describe Crisis Theory.
Something occurs that upsets equilibrium -> normal problem solving fails -> reach lower functionion level, continue interplay with problem solving. Soon will reach crisis level.
What type of threats create crisis?
Real or Percieved.
When can Crisis causing events have happened?
A recent or distant event, might have been days or weeks ago.
What are the cognative characteristics of Crisis?
Confused.
What is Tabers Crisis defination?
In counseling, an unstable period in a person's life characterized by inability to adapt to a change resulting from a precipitating event.
What are some assessment questions to ascertain during a crisis?
-What can RN do to help, and what must refer for further help?
-What was the precipitating event?
-What is patients perception of the event.
-What strengths and coping mechanisms has clients used in the past?
What is the RN role during the 4th Level of Anxiety (Crisis)?
Take control and leave questions for later.
What is the general rule of interventions for Crisis?
The Greater the Severity of the Crisis, the fewer the resources, the more direct the intervention.
What is the General Goal for a Crisis Intervention?
To return to Pre-Crisis Levelof Function.
What is the immediate goal of a crisis intervention?
Establish Equilibirim, Get past the Immediate Crisis.
Can all problems be solved in a crisis intervention?
No, cant solve all the problems, just what can be done immediately.
Family is homeless. Living in a car, no insurance, no food or water for infant. What is the focus of the crisis intervention?
Get food and water for the infant, then refer for assistance with housing, and insurance, and helping the clients learn problems solving skills to prevent further problems.
What percentage of clients have genes making them sensetive to stress?

Genes protecting from stress?
17% Stress Causing
32$ Strews Protecting
51% Have Neither.
How does Unipolar Depression affect sleep?
Causes Restlessness.
What is the appearence of a Unipolar client?
Dejected with Blunt affect.
How does Unipolar Depression affect psychomoter skills?
They are retarded with a slow gate.
What is Dysphoria?
A long-lasting mood disorder marked by depression and unrest without apparent cause; a mood of general dissatisfaction, restlessness, anxiety, discomfort, and unhappiness.
How does Unipolar Depression affect attention span?
Decreased.
How does Unipolar Depression affect Problem solving?
Unable to problem solve.
What type of hallucinations are seen in Unipolar Depression?
Auditory and Somatic.
What is the clients longterm outlook with Unipolar Depression?
Does not feel ike they will ever get better.
Is Unipolar or BiPolar Disease more common?
UniPolar.
How does Unipolar differ from Bipolar disease?
Unipolar does not have Mania Perios.
What two things are important for an RN to avoid when dealing with a depressed client?
-False Reassurances
-Dependancy Relationship by the client on the RN
What is Mania?
Tabers:
Mental disorder characterized by excessive excitement. 2. A form of psychosis characterized by exalted feelings, delusions of grandeur, elevation of mood, psychomotor overactivity, and overproduction of ideas.
What is Hypomania?
Tabers:
Mild mania and excitement, with a moderate change in behavior.
Match:
Bipolar I Mania
BIpolar II Hypomania
Bipolar I - Mania
Bipolar II - Hypomania
Which is more severe Bipolar I or Bipolar II?
Bipolar I because of Mania rather than Hypomania.
What are the manifestiations of the Manic phase of a bipolar client?
-Psychomotor acceleration
-Expressions of Self Inflated Esteem
-Destructive Behavior
What is the drug of choice for the Manic Stage of a Bipolar client?
Lithium.
What are some problems with Lithium?
Narrow therapeutic range, GI/Bloating/N-V/Diahrreah/Nephrotoxic
What nutrition interventions might be planned for a client in a manic phase?
Finger food.
Should you be competative with a client in a manic phase?
No. Recognize with self esteem building.
What is an important intervention to take with a manic client who had managed to stay on task?
Praise them.
What kinds of choices should be given to a manic client?
Don't offer choices. They raise anxiety in a manic client.
What is important to recognize in assessing a manic client.
S/Sx of escalation.
Is depression always recognized in the elderly?
No, it can be discounted as dementia in the elderly.
How do psychotic Symptoms differ between Demenia and Depression?
Dementia VH
Depression AH
How do somatic complaints differ between Demenia and Depression?
Dementia Hard to pin down-vague.
Depression No sleep. Low Energy Low Appatite
How do orientation Symptoms differ between Demenia and Depression?
Depressed clients are easilly reoriented, demented are not.
How does judgement differ between Demenia and Depression?
Dementia lacks judgement. Depression not impaired, just slow to respond.
How does memory differ between Demenia and Depression?
Dementia Cant
Depression Wont
Define dysthymic disorder.
Tabers:
A chronically depressed mood that is present more than 50% of the time for at least 2 years in adults or 1 year for children or adolescents.

Jeff:
Chronic non-psychotic depression for 2 years.
What determines treatment for Dysthymia?
The level of functional ability.
What is Cyclothymic Disorder?
Tabers:
A diagnosis of exclusion in which for at least 2 years there has been the presence of numerous periods of hypomanic symptoms and numerous periods with depressive symptoms that do not meet the criteria for major depressive episode.

Jeff:
Chronic 2 years mild sx of depression and manic.
Who has SAD more Men or Women?
Women
What seasons does SAD present?
Fall & Winter
What happens in SAD in the Spring and SUmmer?
Euphoria.
What is thought to be the reason for SAD?
Amout of light
What is seen when clients are affected SAD?
Fatigue, Decreased Activity, irritability.
What is the most common form of Domestic Violence?
Sibling Abuse
How many states require child abuse reporting?
All
How many states require elder abuse reporting?
Unknown, but not all. It is reportable in WA at 1-866-ENDHARM
What percentage of psych clients have a substance abuse problem?
50%
What is the term when a client has a psych problem and substance abuse?
Dual Dx.
Define Substance Abuse
Self medication. Purposful use of drug for 1 month that results in adverse affects to ones self or others.
Define Substance Dependence.
No longer under the control of the individual and they continue to use depsite adverse affects.
Define Tabers Dual Diagnosis
The presence of mental illness in a patient with a history of concurrent substance abuse.
What is a danger with dual diagnosis and treatment?
Cant treat one without the other.
How do interventions with substance abuse differ from metnal illness?
Substance abuse is a more "In your face" approach. Mentally ill clients need more caring and non-intimidating.
What is dual diagnosis treatment Ping-Pong?
Going back and forth between substance abuse and mental health treatment facilities.
Define Cluster A
Odd, Excentric Features
Define Cluster B
Dramatic, Emotional, erratic
Define Cluster C
Anxious and Fearful.
Are personality disorders short-term actions?
No, they are lifelong, and become the primary behavior.
What differentiates between Antisocial Disorder and Condust Disorder?
Before Age 15 is Conduct Disorder, then becomes AntiSocial Disorder.
What are some symptoms of AntiSocial/Conduct Disorder?
-Agression towards People & Animals
-Bully with a Weapon or Intimidation
-Destruction of Property, Mailboxes, FireSetting
-Decite or Theft
-Serious Violation of Rules despite partental involvement.
What is Borderline Personality Disorder?
Alternating between Love and Hate.
Unstabel, Intense Interpersonal Relationships of Idealization and Devaluation.
What are some other aspects of Borderline Personality Disorder?
-Feelings of Abandonment
-Feelings of Emptiness
-Inpulsivity
-Self Mutalation
-Problems with Anger Control
-Manipulative
What is the steps in Suicide Assessment?
-Do you have thoughts of Killing Yourself?
-If Yes, Do you have a plan?
-Judge the Lethality
*How Quickly will it kill
*Are there provisions for Rescue?
What are two feelings that might lead to Suicide.
Hoplessness
Helplessness
Can you give the idea of Suicide to a person not already considering it?
No
What word is Interchangable for Violence?
Abuse
What are Five types of Abuse/Violence?
-Physical
-Psychological-Words as Weapons
-Physiological
-Sexual - Non Consenting Acts
-Exploitation - Financial Gains
What is the Name of the Triangle?
Karpman
What are the 3 faces of the Victim in the Karpman Triangle?
Victim
Persecutor
Rescuer
What previous psychological study produced the Karpman Triangle?
Transactional Analysis.
What is the Stockholm Syndrome?
Tabers:
The emotional involvement between a hostage and the person holding him or her captive.
What are the behaviors of the Victim in the Karpman Triangle?
They have a One Down Position
Greatest Fear "I Cant Make it"
Need someone more capable to carry them.
What is Bettered Woman Syndrome?
A woman continues to return to the same or different abuses.
Which piece of the Karpman Triangle is optional?
None, all must exist to support the others.
What is the greatest fear of a Rescurer?
None one out there for them to rescue.
What is the Generation of Abuse?
When a child becomes an adult abuser.
When is risk to an abused person highest?
When Victim threatens to leave.
What are two things you can encourage a victim to have ready in case of an emergency?
A Safe Plan with where to go.
A Safe List with numbers of people and agencies who can help.
If you believe that a client is being abused by someone who brings them to you what might you do.
Split them. "We have to give him a test in a special lead lined room. Please wait here."
What is the most important intervention in child abuse cases.
Assure the safety of the child.