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147 Cards in this Set
- Front
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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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an accumulation of grief that occurs when an individual experiences many losses over a short period and is unable to resolve one before another is experienced
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bereavement overload
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covering up a real or perceived weakness by emphasizing a trait one considers more desirable
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compensation
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refusal to acknowledge the existence of a real situation and or the feelings associated with it
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denial
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feelings are transferred from one target to another that is condidered less threatening or neutral
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displacement
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an attempt to increase self-worth by acquiring certain attriutes and characteristics of an individual one admiders
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identifcation
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an attempt to avoid expressing actual emotions associated with a stressful situation by using the intellectual processes of logic, reasoning, and analyis
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intellectualization
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the beliefs and values of another individual are internalized and symbolically become a part of the self, to the extent that the feeling of separateness or distinctness is lost
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introjection
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the sepration of a thought or a memory from the feeling tone or emotions associated with it
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isolation
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attributing to another person feelings or impulses unacceptable to oneself
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projection
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attempting to make excuses or form logical reasons to justify unacceptable feelings or behaviours
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rationalization
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preventing unacceptable or undesirable thoughts or behaviors from being expressed by exaggerating opposite thoughts or types of behaviors
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reaction formation
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a retreat to an earlier level of development and the comfort measures associated with that level of functioning
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regression
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the involuntary blocking of unpleasant feelings and experiences from one's awareness
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repression
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the rechanneling of personally and or socialy unacceptable drives or impulses into activities that are more tolerable and constructive
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sublimation
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the voluntary blocking from one's awareness of unpleasant feelings and experiences
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suppression
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a mechanism used to symbolically negate or cancel out a previous action or experience that one finds intolerable
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undoing
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the four body fluids described by Hippocrates blood, black bile, yellow bile, and phlegm. Hippocrates associated insanity and mental illness with these four fluids
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humors
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the successful adaptation to stressors from the internal or external evnvironment, evidenced dby thoughts, feelings, and behaviours that are age-appropriate and ciongruent with local and cultural norms
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mental health
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maladaptive responses to stressors from the internal or external environment, evidenced by thoughts, feelings and behavious that are incongruent with the local and cultrual norms, and interfere with the individual's social, occupational and or physical functioning
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mental illness
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no loss of contact with reality in these disorders
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neurosis
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the term given during the Middle Ages to sailing boats filled with severely mentally ill people that were sent out to sea with little guidance and in search of their lost rationality
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"ship of fools"
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vague diffuse apprehension that is associated with feelings of uncertainty and helplessness
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anxiety
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independence; self-governance. and ethical princeple that emphasizes the status of person as autonomous moral aagents whose right to determine their destinies should always be respected
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autonomy
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an ethical principle that refers to one's duty to benefit or promote the good of others
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beneficence
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a fubfective state of emotional physical, and social responses to the real or perceived loss of a valued entity. Change and failure can also be perceived as losses.
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grief
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the ethical principle that espouses abstaining from negative acts toward another, including acting carefully to avoid harm
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nonmaleficence
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personal beliefs about the truth, beauty, or worth of a though, object, or behavior, that influence an individual's actions
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value
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the term used with ethical principles that refer to concepts within a scope of medicine, nursing, and allied health
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bioethics
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a branch of philosophy dealing with values related to human conduct, to the rightness and wrongness of certain actions, and to the goodness and badness of the motives and ends of such actions
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ethics
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conduct that results from serious critical thinking about how individulas ought to treat others, reflects repect for human life, freedom, justice or confidentiality
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moral behavior
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that which an individual is entitled to have, or to do, or to receive from others within the limits of the law
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right
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French for middle, the english translation connotes surroundings or environment
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milieu
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theapy that consists of a scientific sgtructuring of the environment in order to effect behavioral changes and to improve the individual's psychological health and functioning
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milieu therapy or therapeutic community
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the use of instumentation to become aware of processes in the body that usually go unoticed and to bring them under voluntary control (bp/HR); used as a method of stress reduction
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biofeedback
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a method of relaxation in which an individual sits in a quiet place and focuses total concentration on an object, word, or thought
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meditation
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a method of stress reduction that employs the emagination. The individual focuses imagicination on a scenario that is particularly relaxing to him
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mental imagery
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a method of deep muscle relaxation in which each muscle group is alteranately tensed and relaxed to a systmeatic order with the person concentrating on the contrast of sensations experienced from tensing and relaxing
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progressive relaxation
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various methods used by individuals to reduce tension and other maladaptive responses to stress in their lives; includes relaxation exercises, physical exercise, music, mental imagery or any other technique that is successful for a person
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stress management
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a state of disequilibrium that occurs when there is a disharmony between demands occurring within an individual's internal or external environment and his or her ability to cope with thos demands
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stress
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a stimulus that follows a behavioral response and decreases the ptobablity that the behaviour will recur; also called punishment
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aversive stimulus
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a type of learning that occurs when an unconditioned stimulus that produces and unconditioned response is paired with a conditioned stimulus until the conditioned stimulus alone produces the same response (Pavlov)
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classical conditioning
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a written contract between individuals used to modify behavior. Benefits and consequences for fulfilling the tersm of the contract are delineated
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contingency contracting
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an aversion technique used to moidfy behavir that relies on the individuals imagination to produce unpleasant symptoms. When the individual is about to succumb to undesirable behavior, he/she visualizes something that is offensive or even nauseating in an effort to block the behavior
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covert sensitization
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a stimulus that precedes a behavioral response and predicts that a particular reinforcement will occur. Individuals learn to discriminate between various stimuli that will produce the responses they desire
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discriminative stimulus
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the gradual decrease in frequency or disappearance of a response when the positive reinforcement is withheld
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extinction
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sometimes called implosive therapy, this technique is used to desensitize individuals to phobic stimulus. the individual is preseneted with continuous phobic stimulus until it no longer elicits anxiety (usually through mental imagery)
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flooding
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learning new behaviors by imitating the behaviors of others
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modeling
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increasing the probability that a behavior will recur by removal of an undesirable reinfrocing stimulus
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negative reinforcement
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the learning of a particular action or type of behavior that is followed by a reinforcement
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operant conditioning
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a type of aversion therapy that produces unpleasant consequences for undesiralbe behavior (antabuse)
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overt sensitization
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a reinforcement stimulus that increases the probability that the behavior will recur
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positive reinforcement
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theis principle states that a frequently occurring response can serve as a positive reinforcemtn for a response taht occurs less frequently
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Premack principle
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in learning, one shpes the behaviou of another by giving reinforcements for increasingly closer approximation to the desired behavior
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shaping
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the process by which a conditioned response if elicited from all stimuli similar to the one from twhich the response was learned
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stimulus generalization
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a treatment for phobias in which th e client is taught to relax and then asked to imagine various componenets fo the phobic stimulus on a graded hierarchy, moving grom that which produces the least fear to that which produces the most
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systematic desensitization
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an aversive stimulus or punishment during which the individual is removed from the environment where the unacceptable behavior is being exhibited
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time out
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in behavior modificagtion, a type of contracting in which the reinforcers for desired behaviors are preseneted in the form of tokens, which may then be exchanged for designated privileges
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token economy
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traditional medicine. the type traditionally and currently preacticed in the US
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allopathic medicine
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the removal of mentally ill individuals from institutions and the subseqent plan to provide care for these individuals in the community setting
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deinstitutionalization
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a system used to determine prospective payment rates for reimbursement of hospital care based on the client's diagnosis
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diagnostically related groups (DRGs)
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a concept purposefully designed to control the balance between cost and quality of care
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managed care
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programs in which volunteers and paid professional drive or wallk around and seek out homeless individulas who need assistance with physcial or psychological care
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mobile outreach units
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a group of people living close to and depending to some extent on each other
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community
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reduction of the incidence of mental disorders within the population by helping individuals to cope more effectively with stress nad by trying to diminish stressors within the invironment
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primary prevention
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health care that is directed at reduction of the prevalence of psychiatric illness by shorteneing the course of the illness. This is accomplished through early identification of problems and prompt initiation of treatment
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secondary prevention
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health care that is directed toward reduction of the residual effects associated with severe or chronic physcial or mental illness
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tertiary prevention
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a type of thinking error in which the indiviual automatically comes to a conclusion about an incident without the facts to support it, or even sometimes despite contradictory evidence to support it
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arbitrary inference
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thoughts that occur rapidlly in response to a sitation and without rational ananlyses. they are often negative and based on eroneous logig
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automatic thoughts
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always thinking that the wors twil occur without considering the possibility of more likely, positive outcomes
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catastrophic thinking
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in cognitive therapy, with this technique the therapist helps the pt to examine the validity of a negative automatic thought.
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decatastrophizing
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in this type of thinking, situations are viewed in all or nothing black or white good or bad terms
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dichotomous thinking
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a type of thinking in which the negative significance of an event is exaggerated
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magnification
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a type of thinking in which the positive significance of an event is minimized or undervalued
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minimization
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also called absolutisitc thinking. Sweeping conclusions are made based on one incident
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overgeneralization
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taking complete responsiblityfor situations without considering that other circumstances may have contributed to the outcome
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personalization
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cognitive structures that consist of the individual's fundamental beliefs and assumptions, which develop early in life from personal experiences and identification with significant others. These concepts are reinforced by further learning experieces and in trun, influence the formation of other beliefs, values, and attitudes
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schemas
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a type of thinking in which a conclusion is drawn based on only a selected portion of the evidence
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selective abstraction
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questions that ask the client to describe feelings associated with specific situations. Questions are sated in a way that may stimulate and produce a dissonance about the validity of the thoughts
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Socratic questioning
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a type of therapy in which the individual is taught to control thought distortions that are considered to be a factor in the fevelopment and maintenance of emotional disorderes
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cognitive therapy
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extremely low levels of WBC's. Symptoms include sore throat , fever, and malaise. This amy be a side effect of long-term therapy with some antipsychotic medications
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agranulocytosis
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restlessness: an urgent need for movement. A type of extrpyramidal side effect associated with some antipsychotic meds
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akathisia
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muscular weakness; or a loss or partial loss of muscle movement; a type of extrapyramidal side effect associated with some antipsychotic medications
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akinesia
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cessation of menses; may be a side effect of antipsychotic meds
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amenorrhea
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involuntary muscular movements of the fae, arms, legs, and neck; may occur as an extrapyramidal side effect of some antypsychotic medication
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dystonia
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a variety of responses that origiante outside the pyramidal tracts and in the basal ganglion of the brain. Symptoms may include tremors, chorea, dystonia, akinesia, akathisia and others. May occur as a side effect of some antipsychotic medications
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Extrapyramidal symptoms (EPS)
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enlargement of the breasts in men; may be a side effect of some antipsychotic medications
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gynecomastia
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potentially life threatening syndrome that results when an individiual taking MAO inhibitors eats a product high in tyramine (aged cheeses or other aged, overripe, and fermented foods; broad beer and wine; yeast products; choclate; caffeinated drinks; canned figs; sour cream; yogurt; soy sauce; and some OTC cold meds and diet pills. Sx severe occipital HA, palpitations, N&V, nuchal rigidity, fever, sweating, marked increase in BP, chest pain, and coma
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Hypertensive crisis
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a rare but potentially fatal complication olf treatment with neuroleptic drugs. Sx include sever muscle rigidity, high fever, tachycardia, fluctuations in BP, diaphoresis, and rapid deterioration of mental status to stupor and coma
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Neuroleptic malignant syndrome (NMS)
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an attack of involuntary deviation and fixation of the eyeballs, usually in the upward osition. It may last for several mnutes or hours and may occur as an extrapyramidal side effect of some antipsychotic medications.
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oculogyric crisis
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prolonged painful penile erection, may occur as an adverse effect of some antidepressant medications, particularly trazodone
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priapism
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ejaculation of the seminal fluid backwards into the bladder; may occur as a side effect of antipsychotic medication
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retrograde ejaculation
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delayed or absent ejaculation, even though the man has a firm erection and has had more than adequate stimulation
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retarded ejaculation
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syndrome of symptoms characterized by bizarre facial and tongue movements, a stiff neck, and difficulty swallowing. It may occur as an adverse effect of longterm therapy with some antipsychotic medications
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tardive dyskinesia
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a chemical that is stored in the axon terminals of the presynaptic neuron. An electrical impulse though the neuron stimulates the release of the neurotransmitter into the synaptic cleft, which in turn determines whether or not another electrical impulse is generated
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neurotransmitter
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the number of people in a given environmental space, influencing interpersonal interaction
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density
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the closest distance that individuals will allow between themselves and others. In the US this distance is 0-18 inches
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intimate distance
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the gestural component of the spoken word. It consists of pitch, tone, and loudness of spoken messages, the rate of speaking, expressively placed pauses, and emphasis assigned to certain words
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paralanguage
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the distance between individuals who are having interactions of a personal nature, suchas a close conversation. In the US culture, personal distance is approximately 18-40 inches
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personal distance
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appropriate interactional distance for speaking in public or yelling to someone some distance away. US culture defines this distance as 12 ft or more
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public distance
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the distance considered acceptable in interactions with strangers or acquaintances, such as at a cocktail party or in a public building. US culture ddfines this distance as 4-12 feet
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social distance
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the innate tendency of individuals to own pace. This phenomenon can have an influence on interpersonal communication
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territoriality
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an abbreviated plan of care that provides outcome-based guidelines for goal achievement within a designated length of time
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critical pathways of care
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a type of documentation that follows a data, action, and response (DAR) format. Main perspective is client focus which can be a nursing diagnosis, a clients concern, change in status or significant event in the clients therapy. the focus cannot be a medical diagnosis
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Focus charting
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a concept of providing care for a client in which members of various discilines work together with common goals and shared responsibilities for meeting those goals
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interdisciplinary care
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a concept puposefully designed to conrol the balance betwwen cost and quality of care. (HMO's and PPO's)
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managed care
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a dynamic, systematic process by which nurses assess, diagnose, identify outcomes, plan, implement, and evaluate nursing care.
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nursing process
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method of documentation has an assessment, problem, intervention, and evaluation format and is a problem-orented system used to document nursing process
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PIE charting
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A system of documentation that follows a subjective, ofjective, assessment, plan, imlementation, and evaluation (SOAPIE) format. It is based on a list of identified patient problems to which each entry is directed
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problem-oriented recording (POR)
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a clinical judgment about individual, family, or community responses to actual and potential health problems/life processes. Nursing diagnoses provide the basisfor selection of nursing interventions to achieve outcomes for which the nurse is accountable
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nursing diagnosis
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one curative factor of group therapy (identified by Yalom) in which individuals gain self-esteem through mutual sharing and concern. Providing assistance and support to others creates a positive lef-image and promotes self-growth
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altruism
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a leadership style in which the leader makes all the decision for the group. Productivity is very high with this type of leadership, but morale is often low because of the lack of member input and creativity
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autocratic
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one curative factor of group therapy (identified by Yalom), in which members in a group can express both positive and negative feelings in a nonthreatening atmosphere
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catharsis
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a leadership type in which the leader lets group members do as they please. There is no direction from the leader. Member productivity and morale may be low, owing to grustration from lack of direction
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laissez-faire
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a specialized type of group therapy that employs a dramatic approach in which patients become actors in life situation scenarios. The goal is to resolve interpersonal conflicts in a less threatening atmosphere than the real life situation would present
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psychodrama
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one curative factor of groups in which individuals realize that they are not alone in a problem and in the thoughts and feelings they are experiencing. Anxiety is relieved by the support and understanding of others in the group who share similar experiences
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universality
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therapy led by a person with an advanced degree in psychology, social work, nursing, or medicine. The goal is to encourage improvements in interpersonal functioning
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group therapy
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What is Depression
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Different from feeling blue. The severity of the feelings, how long they last, and the presense of other symtoms. More common in women than men, probability increases with age.
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Symtoms of depression
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persistent sad/ancous or empty feeling; loss of interest in ordinary activities; fatigue; sleep problems; eating problems; difficulty concentrating; recurring aches and pains that don't respond to tx; irritability; excessive crying; feelings of guilt/worthlessness/hopelessness/pessimism; thoughts of death or suicide
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causes of depression
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runs in families; deficiency in neurotransmitters; hormones may contribute; meds such as steroids;hormones;cancer chemo, and antiparkinsonian agents; deficiencies in vit b1, b6, b12, and c and niacin, iron, folic acid, zinc, calcium, and potassium
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tx for depression
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psychotherapy, antidepressant meds; combo of the two more effective than either one alone; for those who fail to improve with meds and or psychotherapy, other techniques, such as ECT are safe and effective
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What is Bipolar Disorder
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sometimes called manic depressive illness; indicated by moods that swaing between two opposites of mania and depression
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symptoms of bipolar disorder
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depression state same as regular depression; mania=very excited, irritable, distracted, and unable to sleep, racing thoughts, delusions, may be angry and suspicioius, may spend lots of money and abuse substances; some have thoughts of suicide
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Causes of bipolar disorder
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hereditary; elevation of dopamine and norepinephrine in mania; side effects of steroids, amphetamines, antidepressants, and high doses of anticonvulsants and narcotics have the potential for initiating a manic episode
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Diagnosing Bipolar
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History of any and all episodes of depression, mania, or both; other illnesses such as ADHD/schizophrenia/substance abuse/thyroid disorders/adreanl disorders/and certain neurological disorders must all be ruled out b/c they can all cause mood swings
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Tx of bipolar
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mood-stabilizing drugs (lithium, balproic aced, carbamazepine, clonazepam, gabapentin, topiramate, or lamotrigine); antipsychotic meds (risperidone, olanzapine, aripiprazole, chlorpromazine, ziprasidone, or quetiapine) are sometimes given; psychotherapy has shown to be helpful in pts with bipolar disorder to assist in t management of every day stressors and t help prevent relapse
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what is PTSD
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an anxiety disorder in which the symptoms of which occur following exposure to an extreme traumatic stressor
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what are the symptoms of PTSD
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recurrent and distressing thoughts about the event; nightmares about the event and sleeping problems; falshbacks and reliving the event; inability to remember parts of the event; avoids people or activivties that remind of the event; guilt for surviving when other died; difficulty concenetrating; irritability or outbursts of anger; exaggerated startle response; decreased inters or participation in activities; emotional withdrawal
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tx for PTSD
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grop therapy and family therapy are effective in association with prescribed meds; cognitive/behavioral therapy is also recommended; sertraline (Zoloft) and paroxetine (Paxil) approved for tx; SSRIs fluoxetine (Prozac), citalopram (Celexa), escitalopram (Lexapro), and fluvoxamine (Luvox); other antidepressants also used are bupropion (Wellbutrin), mirtazapine (Remeron), nefazodone, and venlafaxine (Effexor); trecyclic and MAOI antidepressants have been used; benzodiazepines may relieve anxiety, but are not recommended b/c they are addictive; antihypertensives propranolol (Inderal) and clonidine (Catapres) as well as lithium and carbamazepine (Tegretol) have been successful in alleviating nightmares, intrusive recollections, insomnia startle responses, and angry outbursts
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What is OCD
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anxiety disorder in shich a person has recurring thoughts or images (obsessions) and /or repetitive, ritualistic type behaviors that the individual is unable to keeep from doing (compulsions). pt may try to suppress these thoughts/behaviours, but is unable to do so. The pt knows that the thoughts or behaviours are irrational but feels powerless to stop
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symptoms of OCD
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repeated thoughts about contamination; repeated doubts; a need to have things in a certain order; thoughts of aggression; sexual imagery
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causes of OCD
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distubance in the chemistry of the brain involving the neurotransmitter serontonin; seems to run in families; may be patterns of learned behavior in one's early family development
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tx for OCD
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antidepressants used with success, clomipramine (Anafranil); SSRIs first line of tx due to effectiveness and low side effect; other antidepressants that have also shown to be effective include venlafaxine (Effexor) and mirtazapine (Remeron); in addition to med cognitive behavioral therapy, individual psychotherapy, and relaxation training have been helpful
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What is panic disorder
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characterized by periodic attachs of anxiety, feelings of terror, and intense physical discomfort; usually last about 15-30 min; feels nervous and fearful b/n attacks; occur spontaneously or in response to situations; may occur daily or remit for months
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symptoms of panic disorder
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fast pounding heartbeat, SOB, nausea, fear of going insane, chills or hot flashes, sweating, a choking feeling, dizziness, fear of dying, trembling or shaking, chest pain, felings of unreality, numbness
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causes of panic disorder
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may be disturbance in balance of norepinephrine, runs in families
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how is panic disorder diagnosed
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physical examination to rule out physical illness
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tx for panic disorder
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combo of psychosocial therapy and medications is tx of choice for panic disorder; meds may include benzodiazepines (xanax, ativan, Klonopin), care must be used in taking these meds b/c they are addictive; SSRIs are particularly effective and are often first line tx for panic disorder; individual psychotherapy, cognitive behavioral therapy, and relaxation training are helpful
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examples and uses of benzodiazepines
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xanax, librium, klonopin, tranxene, valium, ativan, serax; some used to treat insomnia (Restoril, Dalmane); some used for muscle spasms and to treat seizure disorders; GAD, Panic disorders; acute alcohol withdrawal, status epilepticus,
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Actions of benzodiazepines
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depress subcortical levels of the CNS (particularly the limbic system and reticular formation); may potentiate the powerful inhibitory neurotransmitter GABA in the brain, thereby producing a clmative effect; all levels of CNS can be effected from mild sedation to hypnosis to coma (BuSpar doesn't suppress CNS)
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Contraindications of benzodiazepines
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hypersensitivity to any benzodiazepine; to be taken in combo with oher CNS depressants and are contraindicated in pregnancy and lactation, narrow angle glaucoma, shock, and coma; can be habit forming and can cause increase in depression or suicidal ideation
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side effects of benzodiazepines
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drowsiness, confusion, lethargy are most common-no driving; dependencies-can't stop taking abruptly life threatening withdrawal (depression, insomnia, increased anxiety, abdominal and muscle cramps, tremors, vomiting, sweating, convulsion, and delirium), ability to potentiate the effects of other CNS depressants-do not drink alcohol or take other med that depress the CNS; orthostatic hypotension-monitor lying and standing bp and pulse at q shift, instruct to arise slowly; paradoxical excitement (symptoms opposite of the meds desired effect)-withhold drug and notify dr; dry mouth-ice chips hard candy; N&V- take with food or milk; blood dyscrasias-symptoms of sore throat, fever, malaise, easy bruising, or unusual bleeding should be reported to the dr immediately; delayed onset (buspirone only)- lag time of 10 to 14 days before anxiety subsides
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Antianxiety Agents
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antihistamines (atarax/vistaril); benzodiazepines(xanax, librium, klonopin, tranxene, valium, ativan, serax; azaspirodecanediones (buspar)
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Indications for anxiolytics
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anxiety d/o, anxiety symptoms, acute alcohol withdrawal, skeletalmuscelspasms, convulsive d/o, status epilepticus, and preop sedation
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Cautions of antianxiety drugs
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should not take in combo with other CNS depressants; contraindicated in pregnancy and lactation, narrow angle glaucoma, shock, coma; hepatic and renal dysfunction; hx of addictive behaviours; depression; suicidal
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Side effects of antianxiety meds
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drowsiness, confusion, lethargy, tolerance, dependence, orthostatic hypotension, paradoxical excitement, dry mouth, N&V, blood dyscrasias (sore throat, fever, malaise, easy bruising, unusual bleeding), delayed onset
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antidepressants
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tricyclics, SSRI, MAOIs,
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