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138 Cards in this Set

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What is a group?
A collection of individuals witih a common connection.
What is a therapeutic group?
The goal is to improve mental health status of the group.
What is group therapy?
A closed group that works on a specific issue. People get to know each other well in a group.
What are some goals of a therapeutic group?
Increase socialization/social skills
Strengthen self esteem
Help people learn about other options
Place to express feelings/thoughts
Medication management
Spirituality
Leisure activities
People learn to care about others
Physical elements of a group
seating issue - circle, large table
distractions - tv, people around
size of group
closed or open
What is the role of the leader in a group?
To manage patients and have a presence of leadership.
Problem people in a group.
Person who is dominant
Person who acts out
Person who is hyperactive
What two parts of the brain are most important for behavior?
The cortex and the limbic system.
Some functions of the cortex include...
working memory, ability to plan and initiate activity, insight, judgment, reasoning, problem-solving skills, abstraction, modulations of impulses.
All cognitive functions.
What is the limbic system primarily responsible for?
Emotions
Name the 5 main parts of the limbic system
Hippocampus
Thalamus
Hypothalamus
Amygdala
Limbic midbrain nuclei
What is the main function of the hippocampus?
Memory - deterioration may lead to Alzheimer's disease.
What is the main function of the Thalamus?
It is a relay-switching center. Filters out sensory data that is not needed. People with ADHD and Schizophrenia may have faulty Thalamus. (bombarded w/ sensory data)
What is the main function of the Hypothalamus?
Regulates basic human activities (sleep rest patterns, body temperature, hunger, sex, appetite, thirst) Directly connected to the pituitary.
Which part of the limbic system is involved in the control of the autonomic nervous system?
The Hypothalamus.
What is the function of the Anygdala?
Modulation of extreme emotions such as aggression and sexuality. Focus of research into bipolar disorder.
What is the function of the limbic midbrain nuclei?
Remembers pleasurable events. Related to addiction.
What are the 2 parts of the autonomic nervous system?
The sympathetic (fight or flight) and the parasympathetic (normalizes heart rate, blood pressure, digestion and elimination)
Many psychiatric medications interfere with this part of the autonomic nervous system.
The parasympathetic - because of its effect on heart rate, blood pressure, digestion, elimination.
How many neurons are in the CNS?
About 10 billion
What are the types of neurons?
Sensory (send messages to brain), Motor(send messages to muscles and glands), Associative (integrators between sensory and motor data)
What are glial cells?
A lipid substance that supports and nourishes the brain. Makes up about 90% of the brain.
What are the parts of a neuron?
Cell body, cell membrane, axon, nerve endings (terminals), dendrites, synapse, neurotransmittors, deactivating enzymes
Two types of conduction for impulses.
Electrical and Chemical
3 major categories of neurotransmitters
Cholinergics
Biogenic Amines
Amino Acids
What 2 neurotransmitters are involved in coordination?
Acetylcholine and Dopamine
What are the side effects of an anticholinergic?
Dry mouth, blurred vision, constipation, urinary retention, tachycardia, photosensitivity
What are the functions of acetylcholine?
motor behavior
mood regulation
sleep/arousal
stimulates parasympathetic nervous system
What is dopamine?
an excitatory neurotransmitter involved in cognition, motor, and neuroendocrine functions. Influences mood.
Dopamine has 3 major pathways which include:
Cognition and Mood
Motor system (voluntary & involuntary)
Pituitary gland (hunger, sex, sleep, digestion, temperature)
What is norepinephrine?
An excitatory neurotransmitter that plays a major role in generation and maintenance of mood states. Also responsible for vasoconstriction necessary to maintain BP in upright position.
What are the receptors called for Norepinephrine?
Adrenergic receptors.
What are the receptors called for Acetylcholine?
Muscarinic.
What mental illness happens when there is too much seratonin?
Schizophrenia
What is histamine?
a neurotransmitter that is involved in autonomic and neuroendocrine regulation.
Drugs that block histamine receptors produce the side effect of...
sleep
Three properties of psychotropic drugs.
Selectivity
Affinity
Intrinsic Activity
These 2 drugs work because of their affinity for GABA receptor sites.
Benzodiazepine antianxiety drugs and sedative barbiturate drugs.
Circadian rhythms control wake-sleep cycle. What illness has the characteristic of sleep cycles being mixed up?
Bipolar
What 2 nutrients prevent brain deterioration?
Thiamine (vit. B) and fish oil
What mental illness is characterized by loss of brain mass?
Dementia
What is MRI used for in mental illness?
To see minute structures in the brainstem and spinal cord.
What is done in a PET scan?
Glucose tagged with a radioactive isotope is injected into the CNS and brain activity can be seen.
What is substance abuse?
Using a drug despite negative consequences.
What is substance dependency?
Using a drug despite negative consequences plus at least 3 of the following: tolerance, withdrawal, taking larger amounts than needed, can't quit, lots of time spent getting it, other activities suffer, use despite problems.
What is addiction?
It is a progressive disease, chronic, incurable, treatable, characterized by loss of control, cravings, withdrawal, biochemical changes and genetic factors.
What is psychological dependency?
need for drug in order to feel good; it dominates thinking and leads to compulsive behavior to get drug.
Name 6 defense mechanisms of Addiction.
Denial
Minimizing
Projects blame
Rationalizing
Manipulation
Anger
Some characteristics of codependency.
protects the user, keeps secrets, feels guilty, bails out user, assumes responsibilities of user.
4 Family Roles in the Addicted family.
Hero - strong one
Clown - mascot)
Lost child - quiet one
Scapegoat - blamed for problems
4 Phases of alcohol dependency.
Prealcoholic phase - uses daily
Early Alcoholic phase - needs to drink
Crucial phase - drinking is total focus
Chronic phase - intoxicated more than sober - may be life threatening
Symptoms of intoxication
impaired judgment, poor coordination, unsteady gait, slurred speech, inability to focus, impaired memory.
Effects of alcohol on body (9 areas)
GI, nutrition, pancreatitis, liver, nerve damage, nerve damage in brain, korsakoff's psychosis, cutaneous effects, decreased white count.
Sometimes called the "emotional brain"; associated with multiple feelings and behaviors.
Limbic system
Concerned with visual reception and interpretation
Occipital lobe
Voluntary body movement; thinking and judgment; expression of feeling.
frontal lobe
Integrates all sensory input (except smell) on way to cortex
Thalmus
Part of the cortex that deals with sensory perception and interpretation
Parietal
Hearing, short-term memory, and sense of smell
Temporal lobe
Control over pituitary gland and autonomic nervous system; regulates appetite and temperature.
hypothalmus
At a synapse, the determination of further impulse transmillion is accomplished by means of what?
Neurotransmittes.
A decrease in which neurotransmitter has been implicated in depression?
Norepinephrine, serotonin, dopamine.
Which hormone has been implicated in the cause of seasonal affective disorder (SAD)?
increased levels of melatonin.
In which psychiatric disorder do genetic tendencies appear to exist?
Schizophrenia
Which diagnostic imaging technology can neurotransmitter-receptor interaction be visualized?
Positron Emission Tomography
During stressful situations, stimulation of the hypothalamic-pituitary-adrenal axis results in suppression of the immune system because of the effect of what?
Glucocorticoid release from adrenal cortex.
Anxiety medications produce a calming effect by_________
Depressing the CNS
What anti-anxiety drug has delayed onset of action and cannot be used on a prn basis?
Buspirone
Tyramine-restricted diet and prohibitive concurrent use of over-the-counter medications without physician notification would be contraindicated with the use of __________
MAOI's
What is the toxic level of lithium carbonate in the blood?
1.5 mEq/L
Initial symptoms of lithium toxicity include_____________
Ataxia, tinnitus, blurred vision, and diarrhea
Antipsychotic medications are thought to decrease psychotic symptoms by
blocking the action of dopamine in the brain
Extrapyramidal symptoms of antipsychotic medications include
muscular weakness, rigidity, tremors, and facial spasms.
What is the nursing intervention for the patient with extrapyramidal symptoms such as muscular weakness, rigidity, tremors, and facial spasms?
Administer prn trihexphyenidyl (artane)
A patient taking phentermine for 12 weeks says the medication isn't working anymore. What should the nurse say?
Continue to take the medication as prescribed and come in to see the physician as soon as you can.
Phentermine (Fastin) is a drug that helps weight loss. What is a side effect of discontinuing the use of it?
Serious withdrawal symptoms.
When are the first signs of alcohol withdrawal symptoms expected to occur?
Several hours after the last drink.
Symptoms of alcohol withdrawal include what?
Diaphoresis, nausea, vomiting, and tremors.
What medication is commonly ordered for alcohol withdrawal?
Chlordiazepoxide (Librium)
Dan states "I don't have a problem with alcohol. I can handle my booze better than anyone I know..." What is the nurse's best response?
"You are here because your drinking was interfering with your work Dan."
Dan's drinking buddies come for a visit, and when they leave, the nurse smells alcohol on Dan's breath. What is the best intervention at this time?
Send a urine specimen from Dan to the lab for drug screening.
Dan begins attendance at AA meetings. Which statement by Dan reflects trhe purpose of this organization?
They claim they will help me stay sober.
Which symptom might the nurse identify in a chronic cocaine user?
Red, irritated nostrils.
An individual who is addicted to heroin is likely to experience which symptoms of withdrawal?
Nausea and vomiting, diarrhea, and diaphoresis.
A polysubstance abuser makes the statement, "The green and whites do me good after speed." How might the nurse interpret this statement?
The client abused amphetamines and sedative/hypnotics.
A client presents in the ER with reports of spending alot of time alone, looking at his family strangely, and attempting to stab his father with a kitchen knife. The first nursing intervention for Tony is to...
Ensure a safe environment for him and others.
The primary goal in working with a client with schizophreniform disorder, provisional is...
decrease his anxiety and increase trust.
Why is chlorpromazine ordered for the patient with schizophreniform disorder, provisional?
To decrease psychotic symptoms.
Benztropine is ordered on a prn basis. Which assessment by the nurse conveys the need for this medication?
The client develops tremors and a shuffling gait.
A client tells the nurse that the CIA is looking for him and will kill him if they find him. The most appropriate response by the nurse is...
I find that very hard to believe, Tony.
A belief about the CIA looking for someone and trying to kill them is an example of
Delusions of persecution.
A client tilts his head to the side, stops talking in midsentence, and listens intently. The nurse recognizes from these signs that the client is likely experiencing...
Auditory hallucinations.
The most appropriate nursing intervention for auditory hallucinations is...
Ask the client to describe what he is hearing.
A client suddenly becomes aggressive and violent on the unit, which approach is best for the nurse to use first?
Call for sufficient help to control the situation safely.
A client and his parents attend a weekly family therapy group. The primary focus of this type of group is...
To promote family interaction and increase understanding of the illness.
A client with borderline personality disorder often exhibits alternating clinging and distancing behaviors. The best nursing intervention is...
Rotate staff members who work with Kim so that she will learn to relate to more than one person.
A client manipulates the staff in an effort to fulfill her own desires. An example that is NOT manipulative behavior is ...
Refual to stay in room alone, stating, "It's so lonely."
Splitting by a client with borderline personality disorder denotes:
A primitive defense mechanism in which the client sees objects as all good or all bad.
According to Margaret Mahler, predisposition to borderline personality disorder occurs when developmental tasks go unfulfilled in which phase?
Rapproachment pahse, during which the mother withdraws emotional support in response to the child's increasing independence.
A client with a long history of maladaptive behavior has been given the diagnosis of antisocial personaltiy disorder. Which characteristic do you expect to assess in the client?
Lack of guild for wrongdoing.
Milieu therapy is a good choice for clients with antisocial personality disorder because it:
Emulates a social community in which the client may learn to live harmoniously with others.
In evaluating the client with antisocial personality disorder, a behavior that would be considered the most significant indication of positive change is...
The client sent a note of apology to a man he had injured in a recent fight on his own initiative.
A behavior pattern which is characteristic of histrionic personaltiy disorder is...
Overreacting inappropriately to minor stimuli.
An 18-yr-old woman is admitted to an inpatient unit with the diagnosis of anorexia nervosa. A cognitive behavioral approach is used as part of her treatment. The nurse understands that the purpose of this approach is to:
Help the client identify and examine dysfunctional thoughts and beliefs.
A nurse is preparing to provide reminiscence therapy for a group of clients. Which of the following clients would the nurse select for this group?
A client with mild depression who demonstrates normal cognition.
A client with major depression is considering cognitive therapy. The client says to the nurse, "How does this treatment work?" The nurse tells the client that:
This type of treatment helps you examine how your thoughts and feelings contribute to your difficulties.
A client asks the nurse about milieu therapy. The nurse responds, knowing that the primary locus of milieu therapy can be described as:
A living, learning, or working environment.
A nurse is caring for a client with a phobia. The client is introduced to short periods of exposure to the phobic object while in a relaxed state. This form of behavior modification is:
Systematic desensitization
A client with an eating disorder is planning to attend group meetings with Overeaters Anonymous. A characteristic that is not part of OA is:
The leader is a nurse of psychiatrist.
A client is preparing to attend Gamblers Anonymous for the first time. The prototype used by this group is the 12-step program. The first step of a 12-step program is:
Admitting to having a problem.
A nurse is conducting a group therapy session and a client with a manic disorder is monopolizing the group. The most appropriate nursing action is:
Suggest that the client stop talking and try listening to others.
A nurse is planning to formulate a psychotherapy group. Several clients are interested in attending the session. The maximum number to include in this group is:
10
A nurse is monitoring a group therapy session. During this session, the members are identifying tasks and boundaries. The nurse determines that these activities are characteristic of which stage of group development?
Forming
A nurse is planning activities for a client who has bipolar disorder with aggressive social behavior. Which of the following activities would be most appropriate for this client?
Writing
A client is admitted to the hospital with a diagnosis of "Major depression: severe, single episode." The nurse assesses the client & identifies the client's altered nutrition related to poor nutritional intake as a major concern. What is the nursing intervention for this diagnosis?
Consulting with the nutritionist, offering the client small, frequent meals per day, and scheduling brief nursing interactions with the client during these times.
When planning activities for the depressed client, especially during the early stages of hospitalization, which of the following plans is best?
Providing a structured daily program of activities and encouraging the client to participate.
A depressed client verbalizes feelings of low self-esteem and self-worth with statements such as, "I;m such a failure... I can't do anything right!" What is the best nursing response?
Identifying recent behaviors or accomplishments that demonstrate skill ability.
A client with a diagnosis of "major depression: recurrent with psychotic features" is admitted to the mental health unit. To create a safe environment, the nurse most importantly devises a plan of care that deals with the client's...
Altered thought processes.
A depressed client is ready for discharge. The nurse feels comfortable that the client has a good understanding of the disease process when the client states:
It's important for me to eat well, exercise, and to take my medication. If I begin to lose my appetite or not sleep well, I've got to get in to see my doctor.
A nurse assesses a client with the admitting diagnosis of "Bipolar affective disorder: mania" Which of the following symptoms presented by the client requires immediate intervention?`
Nonstop physical activity and poor nutritional intake.
A nurse reviews the activity schedule for the day and plans which activity for the manic client?
Tetherball
A client who is delusional says to the nurse, "The federal guards were sent to kill me." What is the nurse's best response?
"I don't know anything about the guards. Do you feel afraid that people are trying to hurt you?"
A woman comes into the emergency room in a severe state of anxiety after a car accident. What is the most appropriate nursing intervention?
Remaining with the client.
A male client with delirium becomes disoriented and confused in his room at night. What is the most appropriate initial nursing intervention?
Using a nightlight and turning off the television.
A hospitalized client is being considered for electroconvulsive therapy (ECT). The client appears calm, but the family is anxious. The client's mother begins to cry and states, "My son's brain will be destroyed. How can the doctor do this to him?" Nurse response?
It sounds as though you have some concerns about the ECT procedure. Why don't we all sit down together and discuss any concerns you may have.
A nurse is performing an assessment on a client with dementia. Which data gathered during the assessment would indicate a potential complication associated with dementia?
Confabulation
The community health nurse visits a client who recently retired. The client states,"Lately I'm getting forgetful about things. Do you think I'm getting Alzheimer's disease?" Which response is most therapeutic?
Tell me more about your forgetfulness. It isn't unusual for forgetfulness to occur if memory is not exercised. Are you staying socially active?
A nurse is discharging a client with a history of command hallucinations to harm self or others. The nurse provides instructions to the client about interventions for hallucinations and anxiety and determines that the client understands if he says...
I can call my therapist when I'm hallucinating so that I can talk about my feelings and plans and not hurt anyone.
A nurse develops a nursing diagnosis of self-care deficit for an elderly client with demintia. Which of the following is the most appropriate goal for this client?
The client will function at the highest level of independence possible.
A nurse observes that a client is pacing, agitated and presenting aggressive gestures. The client's speech pattern is rapid and affect is belligerent. Based on these obserations, what is the nurse's immediate priority of care?
Providing safety for the client and other clients on the unit.
A nurse is caring for a male client diagnosed with catatonic stupor. The client is lying on the bed, with his body pulled into a fetal position. Which of the following is the most appropriate nursing intervention?
Sitting quietly beside the client and asking occuasional open-ended questions.
A client is admitted to the mental health unit with a diagnosis of schizophrenia. A nursing diagnosis formulated for the client is "altered thought process secondary to paranoia." What instructions does the nurse give to the team?
Avoid laughing or whispering in front of the client.
A client is admitted with a diagnosis of depression. A nurse develops a plan of care for the client. Which would be the most appropriate activity to include in the plan of care?
A structured daily program of activities, with the nurse encouraging the client to participate.
When planning the discharge of a client with chronic anxiety, a nurse directs the goals at promoting a safe environment at home. The most appropriate maintenance goal should focus on what?
Identifying anxiety producing situations.
A client is unwilling to go out of the house for fear of "doing something crazy in public". Becuase of this fear, the client remains homebound except when accompanied outside by the spouse. The client is experiencing what?
Agorophobia
A nurse is developing a plan of care for a client who is scheduled to have electroconvulsive therapy. Which nursing diagnosis is a priority for this client?
Risk for aspiration
A client is admitted to a medical nursing unit with a diagnosis of acute blindness. There seems to be no organic reason why this client cannot see. The nurse learns that the client became blind after witnessing a hit-and-run car accident. The client may be experiencing what?
A conversion disorder - loss of a physical function that cannot be medically explained.
A manic client announces to everyone in the day room that a stripper is coming to perform this evening. When the nurse firmly states that this will not happen, the manic client becomes verbally abuseive and threatens physical violence. Most appropriate action is?
With assistance, escort the client to a room and administer PRN haloperidol (Haldol).