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141 Cards in this Set

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What is passivity?
turning anger inward and might be unaware of underlying anger (see themselves as good, kind, congenial and helpful.) may indirectly damage or destroy relationships/intimacy.
Assertiveness?
direct expression of feeling
Passive aggression
expression of anger indirectly and undermine others in various subtle, evasive ways
Verbal aggression
tend to have repetitve patterns and indicate major warning sign of assualt and battery
Physical aggression
battery
What is the etiology of aggression?
Limbic system, frontal lobe, temporal lobe, neurotrans (serotonin, GABA, dopamine)
What does the social-psychological model for agression etiology state?
interaction of individuals with their social envt and locate the source of violence
Sociocultural model
social structures. e.g. gang activity to explain violence.
Name the stages of the assault cycle
triggering, escalation, crisis, recovery and postcrisis/depression
What is the criteria for Intermittent Explosive Disorder?
Several episodes of loss of control resulting in serious assaultive acts or property destruction
What is characteristic of an episode of intermittent Explosive disorder?
Degree of aggression out of proportion to precipitating stressor
Doesn't fit with another mental disorder
Prior to episode is head pressure, palpitations, tremors, chest tightness
Nurses often feel inadequate when a pt becomes aggressive. What is the best way to help the patient.
reassure the patient that help is available to regain control and deal more constructively with the environmental stressed that caused the initial problems and hospitalization
What are Milieu elements contributing to escalation?
Excessive stimuli
Overcrowding
Lack of resources for energy expenditure
Perceived lack of control of life/freedom
Lack of activities
What are variables that may lead a pt to be agressive?
Predisposing comorbidities (Severe pain, confusion, malnutrition, infection, etc)
History of family violence/abuse etc.
Three steps to assess the angry (nonviolent aggressive) pt?
1) source of pts anger
2) target of pts anger
3) likelihood of escalation
What is the nursing intervention for the triggering phase of the assault cycle?
calm, clear, simple communication
Suggest a time-out in room
Offere safe tension-reduction measures
What is the nursing intervention for the escalation phase of the assault cycle?
take charge
Maintain safe distance
State observation that pt is losing control
Offer time-out or voluntary seclusion
Have staff on standby to show determination**
What is the nursing intervention for the crisis phase of the assault cycle?
Verbal limits ineffective
External control essential
Seclusion or restraint
Stat IM medication
Follow hospital protocols
Document completely
Staff training in aggression management essential
What is the nursing intervention for the recovery and postcrisis phase of the assault cycle?
Provide support and reassurance
Staff debriefing
Document incident
Process with other patients
Process with patient via discussion
how many pp for restrain during the crisis phase?
6-8 staff (show force), impose phsyical control, administer IM med, MD eval and follow protocol for care and documentation
After a pt is restrained during a crisis, how long do you have to get an order for the MD for the restraints?
within 1 hour written order required
First-line agents: ______, novel antidepressants
SSRI_
Second-line agents:?
TCAs
antidepressant Third-line agents: ?
MAOIs
catagory of antidepressant? Paroxetine (Paxil)
Fluoxetine (Prozac)
Citalopram (Celexa)
Sertraline (Zoloft)
Escitalopram oxolate (Lexapro)
Fluvoxamine (Luvox)
Devenlafaxine (Pristique)
SSRI
SE of SSRI
_sexual__dysfunctions (1/3)

__GI_______upset

__Low_____ potential for overdose
How to tx SE of SSRI?
TX: wait, decrease dose, timing, change med , augment with other drugs
Serotonin syndrone Occurs if SSRI combined with:?
Tryptophan
__MAOI___________
Amphetamines
lithium
ecstasy
Cocaine
dextromethorphan
some TCA
venlafaxine
Buspirone
LSD
What are symptoms of serotonin syndrome?
(CONFUSION, HYPERTENSION, HYPERTHERMIA)
confusion, hypomania, hallucinations, agitation, coma
Autonomic effects: shivering, sweating, hyperthermia, _hypertension, tachycardia, nausea, diarrhea
Somatic effects: ataxia, myoclonus, twitching, hyperreflexia, rigidity, tremor, and ataxia
Catagory of antidepressant:Bupropion ( Wellbutrin, Zyban)
Trazadone ( Desyrel)
Venlafaxine (Effexor) (SNRI)
Mirtazapine( Remoron)
Duloxetine (Cymbalta) (SNRI)
Desvenlafaxine (Pristique) (SNRI)
novel
What are the novel antidepressant SE?
Bupropion- aggitation, seizures
Trazadone- __sedation_, priapism
Venlafaxine- few SE, hi BP
Mirtazapine- sedation, wt gain
category of antidepressant? Enhances _norepinephrine_ more:

Desipramine (Norpramin)
Nortriptyliine (Aventyl,Pamelor)
Protriptyline (Vivsactil)
Amoxepine
TCA and related nonselective cyclic antidepressants
these are drugs that enhance _____ more : Imipramine (Tofranil) (tx enuresis)
Amitriptyline (Elavil)
Doxepin (Sinequan)
Clomipramine ( Anafranil)
serotonin
Enhances ______ more:

Desipramine (Norpramin)
Nortriptyliine (Aventyl,Pamelor)
Protriptyline (Vivsactil)
Amoxepine
norepinephrine
Major TCA side effect
orthostatic hypotension
What are interventions for orthostatic hypotension?
Monitor _Vital Signs_____ __________
Caffeine
NaCl tablets
Support hose
What are risk factors for orthostatic hypotension?
65 years or older
Dehydration
Cardiac medication
How to prevent OHypotension?
To arise slowly, dangle before standing
OH is worse in AM______
Adequate fluid intake
To avoid hot showers, hot baths
Decreases with __time____
What happens when you mix TCA with MAOI?
fever, hypertensive crisis
What happens when you mix TCA with Sympathomimetics
cardiac arrhythmias
What happens when you mix TCA with warfarin?
increased bleeding
What happens when you mix TCA with barbituates/anticonvulsants
decreased TCA effect
What happens when you mix TCA with anticholinergic?
increased anticholinergic effect
What happens when you mix TCA with l-dopa?
agitation, tremor ,rigidity
What happens when you mix TCA with alcohol and benzodiazepines?
increased sedation
describe symptoms of hypertensive crisis.
Palpitations
Tightness in the chest
Stiff neck
Throbbing, radiating headach
Elevated BP_ and tachycardia
Diaphoresis and dilated pupils
What are the two types of MAOI ?
irreversible and reversible
What type of antidepressant? Phenelzine (Nardil)
Tranylcypromine (Parnate)
MAOI (irreversible)
What type of antidepresant? moclobemide (Manerex)
Seligiline (Emsam)
Maoi (reveersible)
What are SE of MAOI?
CNS hyperstimulation
Decreased BP_ (so prevent falls!)
OD- lethal
What is the food-drug interaction with MAOI?
Tyramine (aged cheese, bananas, salami, coffee, yogurt, smoked meats, etc)
What happens during the food-drug interatction of MAOI and tyramine?
hypertension or hypertensive crisis
What are rules for giving MAOI with other antidepressants?
Do not give TCA with MAOI
DC TCA for 2 weeks_ before starting on MAOI
Never give SSRI with MAOI- fatal_
What will you teach a patient about MAOIs?
2-4 weeks_ for effectiveness
Avoid some drugs
DC slowly
Report eye pain- glacoma emergency
SE will decrease_
What are the variants of depression?
atypical, melancholic, catatonic, postpartum, psychotic, seasonal affective disorer (SAD)
Name the variant of depression: younger age, More women
Increased appetite, wt gain
Hypersomnia
Leaden paralysis
Very sensitive to rejection
atypical
name the variant of depresion: Elderly , misdiagnosed as dementia
Anhedonia
Sad
Depression worse in am
Early morning wakening
Slow movements or agitation
Wt loss
Guilt
melancholic
Immobility
Excessive motor activity
Mutism
Echolalia
Posturing
catatonic depression
First 30 days PP, 10-15% of moms
1% psychotic features
postpartum depression
PP blues ____ depression and occurs in
50-80% of new moms
mild
Delusions & hallucinations –consistent with guilt, punishment, etc

TX. Antipsychotic & antidepressant meds
PSYCHOTIC DEPRESSION
Less sunlight, fall & winter

TX. Light therapy
SEASONAL AFFECTIVE DISORDER (SAD)
how to test for depression (screening)?
biological (dexamethason supression) and nonbiological (hamilton beck scale)
What are risk factors for dysfunctional grief?
Risk factors:
Hx of psychiatric illness
Ambivalent, overly close, or intense relationship
Hx of multiple losses
Loss of parent or SO at young age
Loss of social support
Death by suicide, AIDS, murder, or unexpected means
N-Pt interventions with depression
Accept patient; focus on strengths
Be honest; work on developing trust
Acknowledge emotional pain; offer to help work through pain
Point out accomplishments and strengths; reprogram via cognitive therapy
Reinforce efforts to make decisions
Milieu interventsions for depressed pts
Opportunity to experience accomplishment and receive positive feedback
Assertiveness training
Help avoid embarrassment
Supportive group activities
Assistance with grooming and hygiene
Brief and frequent interpersonal contacts
Assistance with nutrition and sleep
Protection from suicide intent
Ensure adequate nutrition
Prevent constipation
Monitor and promote nighttime sleep
Discourage daytime sleep
What are the questions to ask in a suicide assessment?
Ask about suicidal ideation (SI)
Are you feeling suicidal?
On a 0-10 scale how suicidal are you?
Do you have a plan?
What method would you use?
(how lethal is the method?)
Effort to block rescue?
What are some risk factors for completed suicide?
Male
Caucasian or Native American
Age 60 years or older
Hopelessness
General medical illness
Severe anhedonia
Living alone
Prior suicide attempts
Unemployed/financial problems
When is somatic therapy (ECT) used?
in elderly or when other therapies not working. response can be rapid
What should a nurse monitor in a patient after ECT?
Ventilate patient (100% O2)
Monitor respirations
Watch for post-ECT confusion
Evaluate for agitation on awakening; administer prn benzodiazepine
Continue to monitor
Document
Later that am- HA, tired, transient memory loss, confusion
Bright light therapy is used to tx which type of depression and can be helpful in which other conditions?
Used to treat seasonal affective disorder . Might help bulimia, insomnia, and depression
ch 37-Somatic therapies
is bright light therapy thought to be mediated thru the skin or eyes?
Mediated by the eyes, not the skin
ch 37-Somatic therapies
What is bright light therapy?
Exposure to intense artificial light , phototherapy
ch 37-Somatic therapies
What are some AEs from magnetic stimulation?
seizures in seizure-free pp, headache, transient hearing loss
ch 37-Somatic therapies
Use magnetic stimuation with care with individuals who have...
metal implants
ch 37-Somatic therapies
How is magnetic stimulation thought to work?
Probably increases neurotransmitter release or down-regulation of beta-adrenergic receptors
ch 37-Somatic therapies
in order to be classifed as a manic episode, one must have an elevated mood for at least how long?
one week
Ch 29-bipolar disorder
in order to have a hypomanic episode, the episode must be how long?
at least 4 days
Ch 29-bipolar disorder
what is the difference between manic and hypomanic?
hypomanic is not serve enough to warrant hospitalization
Ch 29-bipolar disorder
Which episode is bipolar person expeincing if a person is having hypersomnia, daytime sleepiness, hyperphagia, weight gain, craving for carbohydrates, leaden paralysis
paranoid thoughts, hallucinations, and/or irritability
depressive episode
Ch 29-bipolar disorder
what episodes are experienced during cyclothymic disorder?
Swing between a hypomanic episode and depressive symptoms
Ch 29-bipolar disorder
in order to be classified as cycothymic disorder, how long must the symptoms occur and how long without remission?
for at least 2 years and without remission for 2 mnths
Ch 29-bipolar disorder
The following are behaviors related to which episode in bipolar: Disturbed speech patterns
Altered social, interpersonal, and occupational relationships
Alterations in activity and appearance
Alterations of affect
Alterations of perception
manic
Ch 29-bipolar disorder
what are some key nursing interventions for pt in manic episode?
Matter-of-fact tone
Clear, concise directions and comments
Limit setting
Remain calm
Avoid arguing and debating
Ch 29-bipolar disorder
What are important ways of managing the milieu for a manic patient?
Safety
Staff consistency
Reduce environmental stimuli
Do not escalate patients
Reinforce appropriate hygiene, dress
Monitor nutrition and sleep
Establish routines
Ch 29-bipolar disorder
What are nutrition interventions for a manic patient?
Provide food to eat on the run
Provide high-protein, high-calorie snacks
Provide daily multivitamins
Weigh regularly
Ch 29-bipolar disorder
What are some sleep interventions for a manic patient?
Provide quiet environment for sleep
Structure to avoid stimulating activities during evening
Reduce caffeine intake, especially in evening
Assess sleep-rest patterns
Ch 29-bipolar disorder
What should the nurse educate the bipolar patient about?
Illness
Signs of relapse
Medication
Coping with symptoms
Providing support
Ch 29-bipolar disorder
When is Lithium absorbed?
gi tract
Ch 20-Antimanic Drugs
where does lithium excretion occur?
kidneys
Ch 20-Antimanic Drugs
What is the plasma half life of lithium?
24 hrs
Ch 20-Antimanic Drugs
what is the therapeutic index for lithium?
0.6-1.2 mEq/L
Ch 20-Antimanic Drugs
How long does it take for lithium to be clinically effective?
7-10 days
Ch 20-Antimanic Drugs
At what time should lithuim be taken?
same time daily
Ch 20-Antimanic Drugs
What are mild transient side effects of lithium?
small tremors
Ch 20-Antimanic Drugs
Which SEs of lithium should be reported?
Report: Diarrhea, vomiting, coarse hand tremor, sedation, weakness, vertigo
Ch 20-Antimanic Drugs
What are some important patient guidelines for lithium related to salt?
Maintain salt intake, balanced diet
Illness with fever, excessive sweating
Might require dose adjustment
Ch 20-Antimanic Drugs
What are some nursing interventions regarding lithium tx?
Maintain salt intake, balanced diet
Illness with fever, excessive sweating
Might require dose adjustment, Advise to elevate legs to reduce edema
Advise to maintain consistent salt intake, but increase with heavy sweating
Advise to avoid conception
Discuss not driving until stabilized
Stress importance of lithium levels
Ch 20-Antimanic Drugs
Which drug category are these drugs found: Divalproex sodium—Depakote
Carbamazepine—Tegretol
Lamotrigine—Lamictal
Oxcarbazepine—Trileptal
Gabapentin—Neurontin
Topiramate—Topamax
anticonvulsants
Ch 20-Antimanic Drugs
Olanzapine—Zyprexa
Risperidone—Risperdal
Quetiapine—Seroquel
Ziprasidone—Geodon
Clozapine—Clozaril
Aripiprazole—Abilify
antipsychotics
Ch 20-Antimanic Drugs
What are the three drugs/drug categories used to tx bipolar (antimanics)?
lithium, anticonvulsants, antipsychotics
Ch 20-Antimanic Drugs
what is the best evnt for a person with anxiety?
calm
Ch 30-Anxiety-Related, Somatoform and Dissociative Disorders
one intervention for anxiety would be to Help identify causes of ___________
feelings
Ch 30-Anxiety-Related, Somatoform and Dissociative Disorders
What are some ways to problem solve anxiety?
discuss coping strategies, teach relaxation exercises, promote hobbies
Ch 30-Anxiety-Related, Somatoform and Dissociative Disorders
What is general anxiety disorder? Intense symptoms of ____________ are felt and expressed
anxiety
Ch 30-Anxiety-Related, Somatoform and Dissociative Disorders
What is the etiology of GAD?
genetic, comorbid depression, GABA dysregulation, psychological & environmental factors
Ch 30-Anxiety-Related, Somatoform and Dissociative Disorders
Which drugs are usually given for GAD?
antidepressants (SSRIs, SNRIs) or buspar
Ch 30-Anxiety-Related, Somatoform and Dissociative Disorders
What are some therapies that can help with GAD?
cognitive, recreational, relaxation, group therapy
Ch 30-Anxiety-Related, Somatoform and Dissociative Disorders
to be classified as a panic attack, the attack must last how long?
10 minutes
Ch 30-Anxiety-Related, Somatoform and Dissociative Disorders
What is the etiology of a panic attack?
genetic, life stress
Ch 30-Anxiety-Related, Somatoform and Dissociative Disorders
Panic disorder can lead to which other fear?
agoraphobia
Ch 30-Anxiety-Related, Somatoform and Dissociative Disorders
What are interventions for a panic attack?
stay with patient; acknowledge discomfort
Remain calm, avoid touch
Speak in short, simple sentences
Give one direction at a time
Treat hyperventilation, as necessary
Allow to pace, cry
Communicate that you are in control
Communicate that patient is safe
Encourage discussion of perceptions and fears
Ch 30-Anxiety-Related, Somatoform and Dissociative Disorders
In obsessive compulsive disorder, what is the obsession?
the thought
Ch 30-Anxiety-Related, Somatoform and Dissociative Disorders
In obsessive compulsive disorder, what is the compulsion?
the action
Ch 30-Anxiety-Related, Somatoform and Dissociative Disorders
The Purpose of obsessive and compulsive rituals- to decrease ___________
anxiety/stress
Ch 30-Anxiety-Related, Somatoform and Dissociative Disorders
What are OCD interventions?
Ensure that basic needs are met
Provide time to perform _____________
Explain expectations, routines, changes
Convey _______ and _______
Assist to ____________ behavior and feelings
Structure ______ activities
Reinforce _________ behaviors
Ensure that basic needs are met
Provide time to perform _____________
Explain expectations, routines, changes
Convey acceptance and understanding
Assist to rituals behavior and feelings
Structure simple activities
Reinforce nonritualistic behaviors
Ch 30-Anxiety-Related, Somatoform and Dissociative Disorders
What are nursing interventions for phobias?
behavior therapy (systematic desensitization or implosion/flooding therapy)
Ch 30-Anxiety-Related, Somatoform and Dissociative Disorders
ASD- onset within _____ weeks of event
4
Ch 30-Anxiety-Related, Somatoform and Dissociative Disorders
ASD duration: ?
2days- 4 weeks
Ch 30-Anxiety-Related, Somatoform and Dissociative Disorders
PTSD onset: within ______ mos, or after
6
Ch 30-Anxiety-Related, Somatoform and Dissociative Disorders
PTSD duration: ?
1-3 mos, or longer
ch 30--anxiety
What are symptoms of ASD and PTSD?
Dissociation- amnesia, numbing ,detachment
Avoidance of triggors
Reexperiencing the Trauma
flashbacks, nightmares, intrusive thoughts
Arousal symptoms- insomnia, anxiety, irritable, impaired memory & concentration
Anger outburts, survivor’s
Other problems
substance abuse, depression, panic attacks
ch. 30 anxiety-related, somatoform and dissociative disorders
What is the etiology of ASD, PTSD?
neuro chem basis and brain changes from stress
ch. 30 anxiety-related, somatoform and dissociative disorders
What are interventions for ASD and PTsd?
Be________ and honest
Offer ___________ and support
Assure that ______ and behaviors are ______
Help see ____________ between trauma and current feelings
Help evaluate past behaviors in context of trauma
Provide for safe verbalization of ___________
Encourage adaptive coping strategies
Facilitate progressive review of trauma and its consequences
Encourage to establish or reestablish ________________
Be nonjudgmental and honest
Offer empathy and support
Assure that feelings and behaviors are typical
Help see connections between trauma and current feelings
Help evaluate past behaviors in context of trauma
Provide for safe verbalization of feelings
Encourage adaptive coping strategies
Facilitate progressive review of trauma and its consequences
Encourage to establish or reestablish relationships
ch. 30 anxiety-related, somatoform and dissociative disorders
An adjustment disorder must be anxiety symptoms within ____ mtns of a identifiable life event and last ___ mths after the end of the stressor
3; 6
ch. 30 anxiety-related, somatoform and dissociative disorders
What is a somatoform disorder?
hypochondriasis
ch. 30 anxiety-related, somatoform and dissociative disorders
What is the primary gain from a somatoform disorder?
anxiety relieved for now
ch 30
What is the secondary gain from a somatoform disoder?
attention from others
ch 30
What are interventions for somatoform disorder?
Use a ________, caring approach
Encourage description of _____
Assist to use direct verbalization of ___________ and needs
________________ attention when patient focuses on physical complaints
_____________ reinforcement of alternate focus
Be consistent; direct all requests to primary nurse
Encourage _______________ activities
Do not force insight into conflicts
Use a matter-of-fact, caring approach
Encourage description of feelings
Assist to use direct verbalization of feelings and needs
withdraw attention when patient focuses on physical complaints
positive reinforcement of alternate focus
Be consistent; direct all requests to primary nurse
Encourage diversional activities
Do not force insight into conflicts
ch 30
Classical conditioning is ______ stimulus-response reaction after repeated ______of neutral and eliciting stimuli, neutral stimulus alone elicits expected response
PAIRING of neutral and eliciting stimuli, neutral stimulus alone elicits expected response
Ch 37 Behavior Therapies
What is operant conditioning? ______ modification
Focuses on external variables that _________ and ______________ the response to learn which variables control behavior
Behavior modification
Focuses on external variables that precede and follow the response to learn which variables control behavior
Ch 37 Behavior Therapies
Conditioning, premack principle, shaping, reinforcement, continuous, intermittent will all _____ the probability of a behavior.
increase
Ch 37 Behavior and Somatic Therapies
Differential reinforcement of other behavior, extinction, negative consequences, and time-out will all ______ the probability of a behavior.
decrease
Ch 37 Behavior and Somatic Therapies
Skills training, contingency contracting, self-control, and token economy are all ways of _______ ______ behaviors
acquiring new
Ch 37 Behavior and Somatic Therapies
What is a dissociative disorder?
Removal of painful memories from consciousness awareness (repression) to help a person survive extreme emotional and/or physical pain/abuse
Dissociative disorders
Localized amnesia- person cannot remember what happened within a specific ___________ period (after fire for hrs-2 days)
Localized amnesia- person cannot remember what happened within a specific time period (after fire for hrs-2 days)
Dissociative disorders
Selective amnesia- able to recall ______, but not all, events related to a traumatic event.
some
Dissociative disorders
Generalized Amnesia- unable to recall __________ about their life, including identity
anything
Dissociative disorders
Continuous Amnesia – unable to recall events occurring after a ____________ time (traumatic event) up to and including the present
specific
Dissociative disorders
What is dissociative fugue?
Sudden unexpected _______ away from home
New Identity, appears to have __________ behavior; not outwardly confused, upset
Lasts for few hours to few days
Amnesia after, no recall of fugue state
Rare, usually after extreme _________, an escape
Preexisting depression, and hx of ______ often
Sudden unexpected from away from home
New Identity, appears to have normal behavior; not outwardly confused, upset
Lasts for few hours to few days
Amnesia after, no recall of fugue state
Rare, usually after extreme stress, an escape
Preexisting depression, and hx of abuse often
Dissociative disorders
What is depersonalization?
oriented to PPT, but sense of self is changed, feels like watching a dream, unreal, robot...response to overwhelming stress, intereres with fx
Dissociative disorders