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207 Cards in this Set

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What is stress? What general effects does it have on individuals?
Stress refers to both the causes and the cfonsequences of disorder and disease in the body. Specific stress factors upset a person's emotional and physiological homeostasis to some degree.
Describe the different forms and dimensions of stress and give examples of each.
Stress can be physical, physiological , or psychological. Physical=direct injury to body, Physiological=disease processes and infections, Psychological=chronic illness of loved one
What can be the end result when stress overwhelms a person's normal ways of coping?
it can lead to a behavioral disorder or contribute to the development of a physical disorder.
what is behavior?
a person's ovservable actions or reactions (conscious and unconscious) to life stresses.
identify 6 components of behavior that can be altered by stress
Affective responses, anxiety responses, responses associated w/altered thought processes, aggressive responses, dysfunctional coping behaviors
What is stress? What general effects does it have on individuals?
Stress refers to both the causes and the cfonsequences of disorder and disease in the body. Specific stress factors upset a person's emotional and physiological homeostasis to some degree.
Describe the different forms and dimensions of stress and give examples of each.
Stress can be physical, physiological , or psychological. Physical=direct injury to body, Physiological=disease processes and infections, Psychological=chronic illness of loved one
What can be the end result when stress overwhelms a person's normal ways of coping?
it can lead to a behavioral disorder or contribute to the development of a physical disorder.
what is behavior?
a person's ovservable actions or reactions (conscious and unconscious) to life stresses.
identify 6 components of behavior that can be altered by stress
Stress can change a person's behavior by altering perceptions of reality, perceptions of self, feelings and emotions, thought processes, language and communication, and interpersonal relationships
What are the 6 major types of observable hehavioral responses to life stresses that are amenable to some type of RN/pharmacological intervention?
Affective responses, anxiety responses, responses associated w/altered thought processes, aggressive
What are the 3 primary categories of regulatory disorders?
Disorders related to excess production of hormones, Disorders related to insufficient production of hormones, Disorders related to impaired renal function
What are the 3 primary categories of metabolic disorders?
Responses to obstruction of secretions, Responses to toxic substances, Responses to inadequate production or utilization of secretions
What is the difference between intrinsic and extrinsic influencing factors? How are these factors related to stress, disease, and RN assessment?
Intrinsic=essential nature of a person. Extrinsic=factors originating outside of individual. both factors provide a basis for questions that help the RN more fully explore and understand a PT risk for disease development and progression
What are the major categories of intrinsic factors?
Gender, age, genetic predisposition, developmental issues, personality characteristics, psychological variables, and physiological factors
What are the major categories of extrinsic factors?
Culture, ethnicity, and religion; diet, exercise.
What are familial diseases? Why is it important to consider familial diseases when making a RN assessment?
diseases that run in families because of genetic predispositon for occurrence. a review of family Hx to help determine PT risk for acquiring a particular disease or disorder. with this info the RN can suggest possible preventive measures and assist PT in planning and choosing interventions that may improve their long term health.
What is the developmental process? How is this process related to dysfunctional behavior?
The sequence by which people acquire various physical, mental, and social skills and abilities. If physical, emotional, or social development is frustrated during a given stage of this process, dysfunctional behaviors may take root.
What are defense mechanisms? When can they be useful and when can they be harmful?
Psychological responses to life stresses that can help people both defend against and cope w/ the full impact of a crisis. When sustained over a long period of time, however, these emotions can impact the various systems of the body compromising organ function and increasing susceptibility to disease
What are some physiological factors that can influence a person's susceptibility to disease and response to stress?
Physiological changes such as those that occur w/ the onset of puberty, pregnancy, menopause, and aging can make PT more susceptible to certian diseases and disorders & influence responses to stress. Preexisting chronic illnesses can also affect emotional/physiological responses to life stress.
Describe at least one way in which culture, ethnicity, or religion can influence a PT behavioral and physiological responses to stress?
cultural prescices can influence diet and contribute to imbalanced nutrition.Ethnicity= predisposition to certian diseases. these also determine if PT will seek care
Why should RN's ask adult PT w/ behivoral disorders about their childhood experiences?
Many behavioral disorders have roots in childhood. RN shouolod explore the relevancy of PT past experiences to present health conditions and stress responses, and make appropriate referrals to other health professionals when necessary.
Why is it important for the RN to explore a PT diet Hx, especially if they are taking medications?
eating patterns can have major effect on development, curse, and Tx of diseases and disorders. RN must know about food/drug interactions to provide teaching about meds.
Identify 3 types of enviromental factors that may contribute to the development of behavioural, regulatory, and metabolic disorders
A PT's choice of occupation, sanitary conditions, and location.
What are circadian rhythms and how are they related to stress?
Circadian rhythms are the behavioral or physiological rhythms associated w/ the 24 hr day. People have regular glandular and sleep rhythms that are based upon this concept of time, these rhythms can be disrupted by situations such as occupations that require shift work.
Describe why support systems are valuable and give 3 examples of support groups for people w/ behavioral and metabolic disorders.
People whe have support systems may be less likely to engage in self destructive behaviors. AA, National alliance for the mentally ill, and American association of Kidney PT.
Why is it important for the RN to ask a PT about alternative or complementary therapies?
some alternative therapies can effect the Tx, ie medications and supplement interactions.
Define Theory. what is the relationship of theory to research?
A theory is a statement that attempts to explain the available evidence w/ relation to a given topic.
What are the 2 primary categories of theories that help explain variations in behavioral, metabolic, and regulatory responses to disease?
Biological and psychosocial theories.
What is genetics? How does genetic theory relate to behavioral and physiological responses?
Genetics=study of heredity. genetic theory states that there appears to be a strong genetic predisposition for some regulatory and metabolic diseases like diabetes as well as behavioral conditions, i. e. bipolar, regulatory, and metabolic disorders.
What are hormones? What is their relationship to stress?
Hormones=substances formed in one organ or gland and carried by blood to other organs or glands where they exert a specific effect. many hormones secreted in response to stress and contribute to numerous symptomes associated w/ various behavioral, regulatory, and metabolic disorders.
What 3 types of diagnostic imaging can be used to scan the brain
Computerized Axial Tomography (CAT or CT) Magnetic resonance imaging (MRI) Positron-Emission Tomography (PET)
What are some types of structural changes w/ in the brain that can be seen by diagnostic imaging?
Atrophy, hypertrophy, increased/decreased blood flow.
What are neurotransmitters? What is their relationship to behavioral disorders and medications?
chemical substances secreted from neurons. responsible for cell-to-cell message transmission in CNS. too much or too little can cause abnormal behavior or disease.
What are histamines? What effect do they have on the body?
Histamines are neuropeptides that affect the heart and muscles in similar ways as neurotransmitters. histamines enhance mental alertness. when released from tissue in allergic reactions, histamines can also dilate blood vessels, lower B/P, and stimulate gastric secretion.
What are antihistamines?
chemicals that block the action of histamines. sometimes given to block side effects of medications used in Tx of behavioral disorders.
Why is it important for the RN to understand the variouspsychosocial theories?
they are the basis for many interventions for behavioral disorders. also useful when caring for PT's w/ regulatory and metabolic disorders.
Describe the theory of personality developed by Sigmund Freud.
based on 3 psychic structures
the ID=pleasure, Superego= values, ethical decision making, Ego=conscious level and mediates between the id and superego
What is the primary therapeutic intervention associated w/ psychoanalytic theory? What are its underlying assumptions and primary purpose?
psychoanalysis, rooted in the belief that various mood disturbances and personality disorders are caused by the repression of unpleasant experiences from ones past. psychoanalysis helps bring repressed memories into the conscious mind to be delt w/ therapeutically.
What basic assumptions serve as the foundation for Erikson's theory of development?
includes 8 stages of development. it assumes that each stage is characterized by conflict between a specific developmental task and a threat to mature and move on to next level. if conflict is not resolved the person may not fully mature.
What specific needs are associated w/ each level of Maslow's hierarchy? How is the consideration of these needs useful in the RN process?
The foundation consists of 1st basic physiological needs, 2nd safety and security, 3rd love and belonging, 4th self esteem, 5th self actualization. this hierarchy outlines the order in which PT needs should be addressed, useful when setting RN priorities.
Describe Sullivan's understanding of personality and behavior.
Satisfaction and security. satisfaction met through the fulfillment of basic human requiremsnts for rest, nourshment, sexual gratification, and close relationships w/ others.
Who developed the social- interpersonal theory of nursing? What is the focus and goal of this theory?
Developed by Hildegard Peplau. theory focus is the social and interpersonal process of the RN-PT relationship, and its primary goal is to resolve the health difficulties of the PT
Define Crisis. What is the goal of crisis theory? Who developed it?
A crisis is an upset in the stady state of a person when faced w/ an obstacle to desired goals in his life. the goal is to confront and cope w/ the anxiety associated w/ various crises so that this anxiety does not become dysfunctional. Developed by Gerald Caplan
How do nursing Dx differ from medical Dx?
nursing Dx are specific to the PT's actual problem, or a potential problem that can be influenced by nursing interventions/treatment.
What is the nrusing process? What is its primary purpose?
ongoing and systematic cycle of sequential steps ADPIE. the purpose is to attain expected outcomes (goals) for physical, psychosocial health restoration, health maintenance, and health promotion.
Compare and contrast subjective and objective data.
Subjective= data collected from the PT or family members can't be measured. Objective= RN's sight, smell, hearing, touch, as well as labs and Dx testing can be measured.
How do nursing Dx differ from medical Dx?
nursing Dx are specific to the PT's actual problem, or a potential problem that can be influenced by nursing interventions/treatment.
What are affective responses? What are the 3 primary categories of affective responses?
One of 6 primary categories of behavioral responses to life stresses. Can be sucategorized into greif responses, depressive responses, and bipolar responses.
Discuss the grief responses and give some examples of precipitating causes.
Common and intense emotional reactions that occur when a person experiences the real/anticipated loss. causes=
death of child, spouse, or pet
the loss of a house, Dx of incurable Disease/illness.
List the steps of the crisis cycle in their usual order.
Denial, anger, bargining, depression, acceptance.
What are some somatic syptoms that may be associated with the crisis cycle?
sensations of numbness or hollowness, sighing, hyperventilation, anorexia or overeating, insomnia or exces sleeping, lump in throat, crying and fatigue
During what stage of the crisis cycle is guilt most likely to occur? Why
Deppression. more likely to experience guilt because of a belief that they caused it or they could have prevented it.
What are some common precipitating causes of depressive responses?
situational crises, long term illness of self/loved one, and behavioral disorders that affect the mind.
What neurotransmitters appear to play a role in depressive responses?
Norepinephrine & Serotonin. believed to be abnormally low in PT w/ deprssive mood disorders. Acetylcholine, a cholinergic neurotransmitter may also be low.
What houmone appears to be present in high levels in people experiencing depressive responses? How can its presence be evaluated?
Cortisol levels may be elevated in people experiencing depressive responses. Cortisol is secreted by cortex of adrenal gland and involved in protein and carbohydrate metabolism. is helps protect the body against stress. the Dexamethasone suppression test can help measure cortisol response in people w/ major psychotic depression
What is psychomotor retardation? How is it usually exhibited in people w/ depression
Psychomotor retardation is a slowing of both physical and mental reactions. i. e. fatigue and decreased ability to concentrate.
What should the RN consider to be the greatest risk in a PT w/ depression? Why?
the greatest risk is suicide. suicidal ideation is generally a result of the hopelessness, low self-esteem, guilt, and social isolation associated w. depressive mood disorders
Name and define the 2 symptoms that are consistent w/ psychotic forms of depression
Delusions and hallucinations. Delusions are false and generally persistent or fixed beliefs or feelings that a person holds in the face of all evidence to the contrary. Hallucinations are apparent perceptions of sights or sounds that are not real (can also involve smell and touch)
What is the primary nursing concern for a woman w/ postpartum depression?
the saftey of the mother and the child. people w/ this disorder often have suicidal / infanticide ideations.
What is a bipolar mood respponse?
a person'[s mood alternates widely between manic or hypo manic states and varying degrees of depression. between these periods PT often have a stable mood.
What symptoms of mania are characteristic of bipolar disorder?
Elation, euphoria, irritability, flight of ideas psychomotor hyperactivity, delusions of grandeur, weight loss and fatigue
What are some possible factors that contribute to the development of bipolar disorder? at what age does this disorder normally become evident?
the result of genetic predisposition as well as some sort of neurotransmitter balance w/in the brain. norepinephrine excess has been shon to add to hyperexcitability and manic behavior. norepinephrine deficiency is believed to add to depressive hehavior. it usually occurs before 30.
What is cyclothymia? How is it different from bipolar disorder?
Cyclothymia is a chronic mood disorder characterized by both depressive and manic states that alternate for 2 or more years and are seperated by brief periods of normal mood. The states of mania and depression associated w/ cyclothymia are much milder than bipolar disorder
Define anxiety and discuss its relationship to behavioral disorders
A feeling of uneasiness, apprehension, or dred. it is a normal response to abnormal situations and usually disipates once a stressful situation is eliminated. if it remains unresolved/chronic it can be detrimental to health.
Describe the relationship between anxiety and the autonomic nervous system
anxiety is generally accompanied by one or more autonomic responses. increased heart/breathing rate
elevated b/p, increased gastric motility, activation of the endochrine system, and the release of neurotransmitters.
What neurotransmitters are thought to play a role in anxiety?
Gamma-aminobutyric (GABA) and norepinephrine. decreased GABA and increased norepinephrine levels are usually present in people w/ anxiety. Epinephrine is another catecholamine neurotransmitter that can trigger anxiety/fear
What are some possible long-term physiological effects of anxiety?
Chronic or recurring anxiety can result in stress hypertension, cardiovascular disease, and gastric ulcers
What are the 3 major categories of anxiety responses?
basic anxiety resposes, dissociative anxiety disorders, and somatoform anxiety disorders
Compare and contrast obsessions and compulsions
Obsession=persistent and recurring idea/thought that does no disappear w/ any amount of reasoning. Compulsion= an irresistible and irrational impulse to act on a thought or idea
What feelings and behaviors characterize dissociative anxiety disorders? What are 2 subcategories of DAD's
People break away or disordering of thought processes w/ a concurrent disruption in consciousness. Perceptions of oneself and one's enviroment can be markedly disturbed. 2=dissociative identity disorder, and ammnesia.
Describe dissociative identity disorder. What are some common precipitating factors for this condition?
to protect the true personality from further trauma. when the true personality is confronted w/ a stressful situation, an alter can emerge to deal w/ the problem and any associated anxiety. typical behaviors associated w/ various alters might include different voices, names, and even sexual orientations.
Define anxiety and discuss its relationship to behavioral disorders
a feeling or state of uneasiness, apprehension or dred it is a normal response to an abnormal situation. if it remains unresolved or chronic following the removal of a stressful situation it can be detrimental to health and affect ADL's
Describe the relationship between anxiety and the autonomic nervous system
usually accompanied by 1 or more autonomic responses (fight/flight) i. e. increased heart/breathing rate
elevated b/p, increased gastric motility, activation of the endocrine system and release of nuerotransmitters.
What neuro transmitters are thought to play a role in anxiety?
Gamma-aminobutyric acid (GABA)
and norepinephrine. decreased GABA and increased norepinephrine levels are usually present in people w/ anxiety. epinephrine is another catecholamine neurotransmitter that can trigger anxiety/fear
What are some possible long-term physiological effects of anxiety?
Chronic or recurring anxiety can result in stress hypertension, cardiovascular disease, and gastric ulcers
What are the 3 major categories of anxiety responses?
Basic anxiety responses, dissociative anxiety disorders, and somatoform anxiety disorders
Compare and contrast obsessions and compulsions
obsession= persistent and recurring idea/thought that does not disappear w/ any amount of reasoning. compulsion= an irresistible and irrational impulse to act on a thought/idea
What feelings and behaviors characterize dissociative anxiety disorders? What are 2 subcategories of DAD's?
experience a breaking away or disordering of thought processes w/ a concurrent disruption in consciousness. perceptions of oneself and one's enviroment can be markedly disturbed. 2 subcategories of DAD's are dissociative identity disorder and amnesia.
Describe dissociative identity disorder. what are some common precipitating factors for this condition?
simultaneously experiences 2 or more personalities (alters)
the alters that coexist may have totally different personalities and may be unaware of the existence of one another. common precipitating factors include childhood abuse or some other type of mental shock.
What is the purpose of an alter in dissociative identity disorder? How can alters manifest themselves?
the purpose is to protect a person's true personality from further trauma. when the true personality is confronted w/ a stressful situation, an alter can emerge to deal w/ the problem and any associated anxiety. behaviors associated w/ alters
can include having different voices, names, and even sedxual orientations.
What is dissociative amnesia?
a specific type of amnesia characterized by an inability to recall important facts and info about the self, including one's name, as well as any personal info that may be stressful in nature. Loss of memory associated w/ this disorder may be total or partial and is often precipitated by severe emotional shock
What aresomatoform anxiety disorders?
anxiety responses that are inextricably related to the physical body. These may feature actual physical symptoms of specific disease processes, but are believed to be related to psychological factors
What is a risk factor for somatoform anxiety disorders?
1 risk factor is childhood situations in which emotions were not encouraged or acknowledged; adults who experienced such situations in their youth often develop or at least complain of physical symptoms in an unconscious attempt to seek attention
What is la belle indifference?
la belle indifference is an attitude that is characteristic of people w/ conversion disorder. a person w/ this attitude is rarely anxious about the physiological symptoms of conversion disorder and generally appears emotionally detached from them
What are some common Tx for ulcerative colitis?
meds that atrget acutal physical symptoms and decrease bowel inflammation (prednisone, aminosalicylates (5-ASA). diet high in calories and low in residue and dairy. caffeine and spices should be avoided
what is the major side effect of sulfasalazine (5-ASA)? How is this side effect usually addressed?
folate depletion. supplements are given to increase serum folate levels.
What is a RN Dx? What 3 things does a RN Dx include?
An actual or potential problem that can be influenced by RN interventions
they include 1 an actual or potential problem, 2 the etiology of that problem, and 3 the defining characteristics of the problem as determined from the various subjective/objective assessments made by the RN
What is Aphasia?
Difficulty finding the right word
What is Anomia?
Inability to remember the names of objects
What is Apraxia?
Inability to perform purposeful movements (shoe tying)
What is Agnosia?
Inability to comprehend certain visual, auditory, or other sense-related stimuli.
What is ataxia?
Lack of muscle coordination
What is Wernicke-Korsakoff syndrome?
A dementing brain encephalopathy that is associated w/ chronic alcholism. This syndrome is related to a deficiency of thiamine (vit B1) secondary to malnutrition and malabsorption. Symptoms are:
fatigue, irritability, nystagmus, ptosis (drooping of upper eyelid), muscle tenderness, and anorexia.
What is the chief difining characteristic of the responses associated w/ altered thought processes?
Some degree of withdrawl from reality
What are the 7 categories of altered thought processes?
Delusions, hallucinations, paranoid behavior, autistic behavior/autism, schizophrenia, delirium, and cognitive disorders that involve the various dementias and diseases that cause symptoms of dementia.
What are command hallucinations?
Hallucinations in which people hear voices that order them to take their own life or harm other people.
What is the chief defining characteristic of paranoid behavior?
A persistent belief that one is being persecuted or falsely accused by others.
Define autism. What are the primary symptoms of autism?
A type of altered thought process characterized by self-absorption and withdrawal from social interaction. symptoms include; impaired language and interpersonal communication skills, repetitive behavior, rages if play or repetitive activities are interrupted, and referring to oneself in the 3rd person
What is schizophrenia? What are some influencing factors and theories of causation associated w/ this disorder?
A mental disorder characterized by a separation between one's emotions and one's thought process. it is considered a psychotic disorder and is characterized by frequent relapses. specific auses anre unknown, there appears to be a genetic predisposition, can also be linked to a Hx of severe emotional problems and interpersonal conflict w/in the family. physical changes include enlarged ventricles, atrophy of cerebellum, and prescence of excessive amounts of dopamine.
List some + and - symptoms that might be observed in PT w/ schizophrenia
+ delusions, hallucinations, disorganized thought, incoherent speech, paranoia, odd or bizarre behaviors. - flat affect alogia, lack of close relationships, short attention span, poor grooming, anhedonia, avolition, and depression.
Compare and contrast the symptoms of a PT w/ catatonic schizophrenia w/ those of a PT w/ paranoid schizophrenia.
PT w/ catatonic schizophrenia may exhibit increased psychomotor retardation/activity, echopraxia, echolalia, clang association, and mutism. a PT w/ paranoid schizophrenia may exhibit auditory hallucinations, delusions of persecution, extreme and irrational suspicions, argumentativeness, and use of projection.
Define delirium and identify some possible causative factors.
An acute and usually reversible response to stress, physical injury, or some other precipitating condition that involves altered thought processes. causative factors include; brain injury/illness, cerebrovascular accidents, high fever, medication buildup alchol and drug abuse and withdrawl.
List the effects of delirum on the central nervous system
Confusion, agitation, insomnia, restlessness, hallucinations, delusions, illusions, short/long term memory loss, and varied levels of consciousness, especially durring nights and early mornings
List the effects of delirum on language.
Slurred speech and difficulty forming words
list the effects of delirum on the cardiac system.
Irregular heart rate
list the effects of delirum on motor function.
difficulty maintaining balance and tremors of the limbs.
list the effects of delirum on the urinary system
urinary incontinency
What is cognition?
Includes all the various activities associated w/ the mind. i. e. abilities to think concretely and abstractly, solve problems, make judgments and decisions, engage in reasoning and learn new things.
What declines and changes occur in chronic dementias?
there is a multifaceted decling of intellectual function that is of sufficient severity to interfere w/ a person's career, social relationships, social activities. Language comprehension, speech, memory, reasoning ability, orientation, and judgment are all usually affected.
What is one of the most widely used mental status exams in dementia assessment? What does in assess?
Folstein Mini Mental Status Exam. Assesses word memory and recall, orientation to time/place, attention and ability to calculate, language and object recognition, and reading and writing ability.
What are 2 types of brain scans used to Dx and R/O dementia?
CT/CAT and MRI
Define Festination.
Shuffling gait marked by involuntary acceleration.
What are the symptoms of thiamine deficiency?
fatigue, irritability, nystagmus, ptosis (drooping upper eyelid), muscle tenderness, and anorexia
What is Parkinson's disease and what neurotransmitters are associated w/ it?
progressive degenerative disorder that involves nerve cell destruction in the basal ganglia of the brain. characterized by an imballance in acetylcholine and dopamine.
What are the 2 primary categories of aggressive responses?
Self-Destructive behaviors, and aggressive behaviors
What are the 4 types of self-destructive behavior?
suicide, substance abuse, eating disorders, and self-mutilation.
What types of perople are more at risk for suicide?
People w/ undiagnosed or untreated mood disorders, family Hx of mood disorders, people w/ depression/ schizophrenia.
What primary warning signs might alert the RN that a PT is suicidal?
specific verbalizations expressing a desire to die, readily available means for committing suicide, feelings of euphoria or well being following a period of depression, a plan on how to commit suicide, previous attempts, auditory hallucinations w/ voices encouraging the taking of one's own life.
Describe the approach a RN should take when dealing w/ a suicidal PT.
RN stay w/ PT at all times, remaining calm while providing for his/her saftey. A direct approach should be taken when asking the PT about his/her intentions ("have you thought about suicide?"/"Do you have a plan?"
What is substance abuse? What are some substances that can be abused?
Excessive or improper use of any chemical that can produce disordered cognition and altered mood/behavior. i. e. alcohol, prescriptiojn drugs (sedatives/hypnotics) illegal drugs, nicotine, and caffeine.
What is the CAGE questionnaire? What 4 areas does it explore?
Dx test used to screen for alcoholism. Alcohol consumption/desire to cut down, annoyuance when alcohol use is criticized by others, guilt associated w/ alcohol use, and eye openers
What are some physiological effects of narcotic or opiate overdose?
can cause respiratory depression and arrest. initial signs of overdose = pinpoint pupils, drowsiness, and slowed respirations. later stages = pupil dilation, low b/p, and slurred speech
What would be included in a RN assessment for a PT who is hospitalized w/ severe anorexia nervosa? How is this disorder usually Tx?
accurate recording of daily weights, I&O, monitor labs, and body temp.Tx may include tube feeding or TPN.
Describe some physiological and psychological defining characteristics of bulimia.
irritation from daily vomiting can affect teeth, acid from undigested stomach contents can irritate the esophagus and lead to esophageal lesions. PT may have calluses on fingers/back of hand, as well as enlarged parotid glands from decreased salivary flow. electrolyte problems are common. psychological characteristics = abuse, low self-esteem, and poor impulse controll.
What electrolyte imbalances might you expect in a person who is bulimic?
hypokalemia, hypomagnesemia, hyponatremia, and hypocalcemia. can cause cardiac symptoms and death.
Why is obesity dangerous? What are some risk factors?
can lead to variety of chronic conditions, diabetes, depression, heart/blood vessel disease. risk factors are sedentary lifestyle, poor diet, genetic predispositon, psychological factors, hormone imbalance. meds can cause weight gain (steroids)
What is self-mutilation and what is its major effect?`
an act in which a person's intent is to injure (but not kill) themselves in some way. the major effect is tissue damage.
What are the 2 types of aggressive behavior disorders in which aggression is largely directed at others?
antisocial personality disorder and conduct disorders.
What are some interpersonal risk factors w/ roots in childhood or adolescence that are associated w/ antisocial personality disorder?
family Hx of abuse, and emotional deprivation. aggressive patterns of behavior like fire setting and cruelty to animals and a Hx of enuresis
Compare and contrast psychopathic and sociopathic behavior.
Psychopathic is marked by a desire to harm other people through menta/physical abuse. Sociopathic behavior is similar but implies indifference to pain of others, no guilt or remorse. both types are characterized by impulsivity and irresponsibility.
What are conduct disorders?
persistent, repetitive behavior patterns that result in some sort of violation of the rights of others
What are 4 criteria that can indicate the presence of a conduct disorder?
Aggressive behavior toward people/animals, some form of theft, destruction of property, breaking of some preestablished rule set by society or family
What are the 2 major categories of disruptive responses?
ADHD, and impulse control disorders.
What are the symptoms of ADHD in young children? in older children?
young= failure to respond to discipline, high levels of frustration, impulsiveness, short attention span, fidgeting and hyperactivity. Older= rapid mood swings and exhibit careless and restless behaviors, generally more noticeable in group or social situations.
What characterizes an impulse control disorder (ICD)?
compulsive behaviors, deficits in behavioral inhibition, and the desire to act upon one's impulses.
Define Trichotillomania.
An irresistible desire to pull out one's own hair
Define intermittent explosive disorder.
A tendency to experience volatile and explosive emotional outbursts in response to events and situations that would seem minor to most other people.
What do dysfunctional coping behaviors involve? What is the effect of these patterns of behavior?
Disturbances in cognition, communication, emotional response, and impulse control. Such behavior patterns adversely affect an individual's ability to work and relate to others
What are the primary characteristics exhibited by people w/ dysfunctional personality disorders?
Exhibit characteristics that are exaggerated traits of their normal personalitites, such as introversion, suspiciousness, and passivity. these can impact an individual's interpersonal relationship and employment
What is the defining characteristic of paranoid personality disorder?
Distrust of others, Extreme suspiciousness, overreaction to criticism, delusions of persecution
What is the defining characteristic of Borderline personality dosorder?
Fear of abandonment, splitting, high impulsivity, manipulative tendencies, total dependence on or complete neglect of friends, self-directed aggressive behaviors, and sarcastic verbalizations
What is the defining characteristic of Schizoid personality disorder?
Familial Hx of schizophrenia, avolition (lack of desire or motivation), daydreaming, flat affect and exaggerated shyness
What is the defining characteristic of Schizotypal personality disorder?
Familial Hx of schizophrenia, introversion and eccentrick behavior, and participation in transient societal groups (cults)
What are some situational crises that commonly lead to denial, withdrawl, and dissociation?
Physical, mental or sexual harm (rape, child abuse, spousal abuse or elder abuse)
what is denial? When can it occur? When does it become dysfunctional?
when a person refuses to acknowledge reality, specifically a past event that produced fear, anxiety, and physical Px. denial is common. Denial can be dysfunctional when it persists over time.
How does withdrawl differ from denial?
it involves an escape from the present reality in addition to a refusal to acknowledge the memory of the past.
What is dissociation?
the splitting of one's consciousness into 2 or more personalities, with none of them being consciously aware of the thers. it can also take the form of either general or dissociative amnesia
What would be the most appropriate nonpharmacological RN intervention for a PT who has had a radical mastectomy several days postop and is crying and appears depressed.
PT probably has a greif response. PT will usually benefit from being able to talk about their greif and from coming to realize that their responses are normal. RN can listen in a nonjudgmental manner and encourage the woman to express + & - emotions including anger, and depression
What would be the most appropriate nonpharmacological RN intervention for a PT w/ a Hx of alcohol abuse how wants to change behavior and become abstinent.
RN should tell PT about AA, and mention that people who are serious about the program will be assigned a sponsor. someone who has been personally successful w/ abstinence and can mentor and support the PT in times of crisis
What would be the most appropriate nonpharmacological RN intervention for the spouse of a PT recently Dx w/ parkinson's looking for infor and emotional support
Direct spouse toward a support group aimed at helping the friends and family of PT w/ parkinson's. they provide good emotional support and valuable info.
What would be the most appropriate nonpharmacological RN intervention for a PT w/ schizophrenia who is hospitalized because of hallucinations and delusions. he shares a room w/ another PT who insists on listening to the radio at a loud volume
reduction of environmental stimuli is important. PT will benefit from a calm quiet environment that may decrease the risks for delusions. the RN can adjust the PT milieu by moving PT to a single room or room w/ quiet roommate
What would be the most appropriate nonpharmacological RN intervention for a PT who has a desire to quit smoking but doubts he can do it cold turkey.
encourage PT to participate in behavior modification therapy. Tx goals associated w/ this will probably be short term and incremental. usually available through hospitals.
What would be the most appropriate nonpharmacological RN intervention for a PT who had a hysterectomy and has recurrent nightmares about abandoned buildings. she asks RN for Tx advice
PT may benefit from psychotherapy. the RN could refer the PT to a psychiatric social worker or advanced practice RN trained in psychotherapeutic techniques including dream analysis.
What is desensitization?
involves gradually exposing a person to a feared object or situation for very brief periods in a safe invironment in order to help that person overcome a specific fear. useful for PT w/ phobic disorders.
What is modeling?
the therapist encourages the PT to learn a desired behavior by personally serving as a role model for that behavior. role play is also a means of modeling that can encourage an individual to exhibit a desired behavior.
What is the primary goal of nursing according to Peplau's social-interpersonal theory?
to resolve the health difficulties of the PT
What are the three stages of Peplau's theory? What specific actions do they include?
Orientation, working, and termination. these stages include establishing trust, setting short/long term PT centered goals, maintaining boundaries, and referring PT to support systems.
What is debriefing?
A component of crisis intervention used w/ groups. in a session one or more therapists come together w/ a small group of people who have experienced a cirsis. they then encourage these people to share their reactions to the crisis.
Explain the orgin of crisis intervention.
from Gerald Caplan and other theorists (Erich Lindemann) durring 1940's. Lindemann studied the crisis reactions of people whose loved ones had died in a nightclub fire. He discovered that prevention was key to moving people through a crisis successfully and w/ fewer associated behavior disorders and reactions later in life. this provides a theoretical basis for crisis therapy
What are 2 other names for antipsychotic medications? What is the effect of these drugs on the body, especially in relation to specific neurotransmitters?
Tranzuilizers or neuroleptics
since excess dopamine is found in PT's w/ symptoms of psychosis these meds work by blocking the dopamine receptors in the CNS.
What is the specific rationale for the use of antipsychotics in PT's w/ schizophrenia?
it is believed that some of the positive symptoms of this condition are related to excess dopamine in portions of the limbic system of the brain.
What is agranulocytosis? What are some symptoms that RN's should look for in a PT who may be developing this?
Acut depression/absence of WBC's that can compromise the immune system and put PT at ^ risk for infection. Symptoms of infection in relation to developing agranulocytosis are, cough, sore throat, fever, and mouth sores.
What lab tests and RN interventions are important for a PT on daily clozaril therapy?
Interventions include establishing precautions for convulsions and monitoring lab values. WBC should be done weekly (low WBC = compromised immune function that could ^ risk for infection). reverse isolation may be needed to protect PT's immune system from others.
What are some specific anticholinergic side effects and why do they usually occur?
dry mucous membranes (especially mouth), dry eyes, mydriasis (dilated pupils), blurred vision, constipation, masal congestion, and urinary retention. these occur when anticholinergic agents block the impulses of the parasympathetic nerves.
What are some specific Tx and RN interventions that are used to counter anticholinergic side effects?
Interventions include hard candies and sugarless gum for dry mouth and eye drops. H2O and fiber for constipation, also colace. accurate I&O's is essential if urinary retention is suspected. if present a cholinergic med like bethanechol (Urecholine) can ^ urine output.
Why do extrapyramidal side effects occur?
EPSE's are caused by the blocking effects of high-potency antipsychotic meds on dopamine, and neurotransmitter that normally helps regulate or control movement.
What Dx scale is used to evaluate tardive dyskinesia? What areas does it target for observation?
Abnormal Involuntary Movement Scale (AIMS). This targets 3 areas for observation: The face, the extremities, and the trunk
What is the usual Tx for extrapyramidal side effects?
Tx usually includes discontinuing current drug therapy and switching to different antipsychotic medications. may also involve lowering dose of current med, and adding antiparkinsonian medication to help relax muscles and reduce tremors. a quiet enviroment can additionally help decrease the occurrence of EPSE's.
What are some antiparkinsonian meds that are used to Tx extrapyramidal side effects?
Benztropine (Cogentin) and trihexyphenidyl (Artane). both are anticholinergics. amantadine (Symmetrel) a dopaminergic antiparkinsonian drug works to decrease bradykinesia and muscle rigidity.
What precautions should a RN take when caring for a PT at riskfor orthostatic hypotension as a result of antipsychotic medication?
Encourage PT to dangle feet over the side of the bed before standing, and stand up slowly from any sitting position. Elastic stockings may also used to prevent pooling of blood in extremities. B/P and pulse should be checked regularly w/ the PT supine, sitting, and standing. if PT systolic b/p is 80 mmHg or lower when standing hold medication and notify the physician.
What is neuroleptic malignant syndrome (NMS)? When can it occur? What are the primary defining characteristics of this condition?
NMS is rare but fatal condition that results when dopamine is blocked in the hypothalamus. can occur following the administration of high-dosage and high-potency antipsychotics or after the withdrawl of drugs that increase dopamine levels. the primary defining characteristics of NMS are hyperthermia and muscular rigidity.
How is neuroleptic malignant syndrome treated?
Tx includes immediately discontinuing antipsychotic meds and instituting measures to lower body temp. Curare-based paralytic meds such as dantrolene (Dantrium) or bromocriptine may be used to alleviate muscle spasms. bromocriptine also reduces fever.
What are anxiolytic medications used for? What is their overall action and effect?
Tx mood disorders in which generalized anxiety is present. also used for more severe and specific anxiety disorders like phobias, panic disorder, and acute mania accompanied by extreme movement or motor agitation. Anxiolytics depress the CNS and aid in muscle relaxation and sleep.
What are benzodiazepines? What is their primary effect?
are the primary category of anxiolytic meds. they enhance the effect of GABA decreasing the electrical activity and excitability of nerve cells in the brain.
What specific precautions should the RN take when administering benzodiazepines?
advise PT severe respiratory depression can occur iv taken w/ alcohol or other meds w/ sedative effects. also use w/ caution in elderly to reduce falls. benzodiazepines are lipophilic (fat stored) levels should be carefully monitored. when given IV must be given slowly to prevent respiratory arest. They can be addictive.
What are antidepressants used for? How do they act in the body?
given to PT experiencing depressive mood sisorders and certain anxiety disorders (PTSD) it is believed that antidepressants act by raising levels of norepinephrine and serotonin w/in the brain thereby increasing the efficacy of them.
Why are antidepressants generally not used to Tx bipolar disorder?
not used w/ bipolar because they have a tendency to induce mania.
What are the signs of an impending hypertensive crisis related to a MAOI-tyramine interaction?
severe headache in occipital region at the back of skull. other include hypertension, heart palpitations, Px, and stiffness of the neck, perspiration, N/V and photophobia. intracranial hemorrhage may also occur, precipitating a CVA (stroke)
What foods and beverages should PT avoid if they are taking MAOI's?
certain dairy products (most aged and natural cheeses, yogurt, and sour cream), beverages (beer, red wine, and caffeinated and chocolate drinks), fruits and vegetables (bananas, raisins, and avocados), and meats (pickled herring, sausage, and organ meats) also avoid soy sauce and yeast products.
What is serotonin syndrome? What are its symptoms?
serious drug interaction that can occur if MAOI is given w/ a SSRI or initiated too soon after SSRI is discontinued. symptoms include very high fever, hypertension, and muscle rigidity and twitching.
What are antimanics and how do they work?
they alter sodium transport, working to decrease psychomotor activity.
What is the most common antimanic med? For what 2 conditions is it primarily used? How is the drug believed to work?
Lithium carbonate (Lithane, Eskalith). Lithium used to Tx mania and prevent the depression associated w/ bipolar disorder. also used in Tx of autism. it is believed to work by enhancing the action of 4 neurotransmitters: Acetylcholine, GABA, Norepinephrine, and Serotonin
Why should a PT blood levels be closely monitored when taking lithium? What is the normal range for lithium levels in the blood?
the potential of lithium toxicity is very high. levels that are considered therapeutic are very close to the toxic level. normal therapeutic plasma levels are between 1.0-1.2mEq/L
What are the symptoms of lithium toxicity?
muscle weakness, lack of coordination, coarse hand tremors, polydipsia (extreme thirst w/ ingestion of large amounts of water), confusion, blurred vision, and persistent GI side effects (N/V/D) more severe symptoms include muscle rigidity, seizure activity, and coma.
What meds if given at the same time as lithium may result in lithium toxicity? Why? What meds increase lithium excretion?
Thiazide diuretics (Diuril) they deplete sodium and contribute to dehydration and lithium toxicity. medications like sodium bicarbonate can increase lithium excretion.
What 2 mood stabilizers are frequently given to people who do not respond to lithium? How do they work?
carbamazepine (Tegretol) and valproic acid (Depakene, Depakote) Tegretol is primarily used to Tx tonic-clonic seizures by preventing or reducing the discharge of impulses in the nerve synapses in the brain. Also has sedative effect. Valproic acid acts by ^ the concentration of neurotransmitter GABA.
What are CNS stimulants used for? How do they act in the body?
used for a variety of situations involving disruptive responses, sleep disorders, and impulsive behavior patterns, particularly in children. amphetamines or amphetamine-like meds act by stimulating the release of catecholamine neurotransmitters, especially norepinephrine in the cerebral cortex. this caused ^ alertness
What medication are given to children w/ ADHD? Why?
Methylphenidate hydrochloride (Ritalin). It acts to improve and lengthen attention span and increase concentration and coordination, paradoxically this amphetamine-like stimulant has a quieting effect. pemoline (Cylert) and dextroamphetamine sulfate (Dexedrine) may be given if Ritalin is not tolerated. Cylert is an amphetamine-like med, while Dexedrine is an amphetamine.
What side effect can amphetamines produce in children? What are the symptoms of this effect?
Tourette's can develop in children who take amphetamines. the primary indicator is the presence of repetitive motor movements (tics) they include blinking, jerking one's arms, and clearing throat. Abnormal verbalizations like repetitive grunting, humming, or panting sounds are also associated w/ Tourette's.
When are anticonvulsants used? What is their effect?
used to controll chronic aggressive behavior and seizures including those precipitated by electroconvulsive therapy. they stabilize nerve cell membranes and raise the seizure threshold decreasing initiation of the nervous impulses in the CNS that precipitate seizure activity by ^ the action of GABA
What are sedatives/hypnotics used for? How do they work?
used in Tx of sleep disorders such as insomnia, sleep disturbances frequently accompany mood disorders and can work by depressing the CNS
Why are sedatives/hypnotics normally recommended for short-term use?
they have a tendency to make people dependent on them. they also lead to decreased REM resulting in abnormal sleep patterns.
What are some common symptoms of withdrawl from sedatives/hypnotics? When will these symptoms usually occur?
initial symptoms include headache, nausea, vomiting, anxiety, restlessness, and insomnia. more severe can occur w/in several days of drug discontinuation, i.e. tinnitus, delirium, disturbing dreams, and seizure activity.
What are the symptoms of sedative hypnotic overdose? How is this overdose Tx?
respiratory depression, unconsciousness, coma, and seizure. immediate Tx is induction of vomiting. Activated charcoal is given to absorb the drug. seizure precautions are necessary w/ this condition and v/s should be checked often.
What are substance abuse deterrents?
Pharmacological interventions that are given to help Tx drug misuse and abuse.
What is Antabuse? What is the theoretical rationale for this medication?
oral med used in Tx of chronic alcoholism. given to PT who want to remain sober but need daily assistance in doing so. Antabuse is a type of negative reinforcement or aversion conditioning. it reacts w/ even small amounts of alcohol to produce very unpleasent symptoms. the theory is PT will abstain from alcohol in order toavoid the effects
What are the symptoms of an Antabuse-alcohol reaction? What causes these symptoms?
confusion, nausea, vomiting, throbbing headache, tachycardia, heart palpitations, dyspnea, hypotension, neck and or chest Px, diaphoresis, flushing, blurred vision, and vertigo. they are coaused by an accumulation of acetaldehyde, and intermediate product of alcohol metabolism.
What should the RN include when teaching PT about Antabuse?
emphasize the importance of avoiding all internal and external sources of alcoohol i.e. OTC cough/cold, certain foods, topical lotions and meds that contain alcohol, even house hold products.
What is naltrexone (ReVia) and what is it used for?
Opioid narcotic antagonist used for both narcotic and alcohol addiction especially for alcoholism accompanied by somatic symptoms. also used experimentally to Tx autism.
What are the symptoms of methadone withdrawl?
nausea, vomiting, ^ b/p, tachycardia, ABD cramping and flushing.
What is phototherapy and what PT's might benefit from it?
Tx via sun or UV light exposure especially in the morning. Tx seasonal affective disorder.
When is electroconvulsive therapy (ECT) useful?
useful in Tx of major depressive disorders when medications fail to alleviate symptoms. also helps in cases of depression accompanied by suicidal ideation and psychomotor retardation as well as Tx of certain bipolar disorders. especially lithium-resistant mania.
What type of injuries could result from ECT? What medications might prevent them?
seizures can result in injury to long bones, or the cervical vertebrae. muscle relaxants like succinylcholine (Anectine) are usually given before the procedure to decrease the likelihood of these injuries.
What are some reasons for the ethical guidelines that govern the use of somatic and nonpharmacological interventions in PT's w/ behavioral disorders?
In all behavioral therapy PT are not only highly vulnerable to manipulation and control, but they may engage in manipulative and controlling behaviors on their own behalf. both situations pose a variety of ethical and legal dilemmas.
What was the major result of the Community Mental Health Center Act of 1963?
it resulted in the movement of PT out of hospitals and other institutions and into community Tx settings (Deinstitutionalization)
Is there ever a time in which a PT's right to confidentiality may be justifiably violated by a nurse or other health-care professional? If so when and why?
Yes. cases in which PT are contemplating suicide or homicide may involve the justifiable violation of the right to confidentiality. the general rule is that confidentiality may be breached only when the PT is a risk to themselves or other people