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74 Cards in this Set
- Front
- Back
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Function of Brainstem
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Core – regulates internal organs and vital functions
Hypothalamus – basic drives and link between thought and emotion and function of internal organs Brainstem – processing center for sensory information |
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Functions of Cerebellum
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Regulates skeletal muscle
Coordination and contraction Maintains equilibrium So movement is accomplished in smooth manor |
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Functions of Cerebrum
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Mental activities
Conscious sense of being Emotional status Memory Control of skeletal muscles – movement Language (sensory & motor aspects) and communication |
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Cortex
Associated Function Pathophysiology |
-Higher cognitive functioning
-Dementia & Confusional states |
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Pre-Frontal Cortex
Associated Function Pathophysiology |
- Impulse control, attention, monitor behavior
-ADD, Schizophrenia & OCD |
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Diencephalon- thalamus. hypothalamus
Associated Function Pathophysiology |
-Regulates sleep cycles, hunger, sex drive, controls endocrine & ANS. Pleasure centers, immune system
-Depression & Anxiety disorders |
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Amygdala
Associated Function Pathophysiology |
-Elicits and controls aggression
-Impulse control d/o, Borderline Personality D/O & Schizophrenia |
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Septum
Associated Function Pathophysiology |
-Emotional/stimulus “gate”, pleasure centers
-Impulse control D/O |
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Cingulate
Associated Function Pathophysiology |
-Neuronal pathways connecting limbic system structures & prefrontal lobes
-Obsessive-compulsive D/O |
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Hippocampus
Associated Function Pathophysiology |
-Recent memory/new learning, impulse/ emotional control
-Alzheimer’s D/O, post-concussion D/O, Depression |
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Basal Ganglia
Associated Function Pathophysiology |
-Controls aspects of motor behavior
Neuronal pathways connecting Limbic system & pre-frontal lobes -Parkinson’s disease Antipsychotic medication side effects (EPS) Obsessive compulsive D/O |
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Brain stem- Reticular system
Associated Function Pathophysiology |
-Stimulus filter or “gate”
-Attention Deficit D/O |
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Structured imaging techniques to visualize the brain
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Computed tomography (CT)
Magnetic resonance imaging (MRI) |
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Functional imaging techniques to visualize the brain
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Positron emission tomography (PET)
Single photon emission computed tomography (SPECT) |
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Antianxiety and Hypnotic Drugs:
Benzodiazepines |
Diazepam (Valium)
Clonazepam (Klonopin) Alprazolam (Xanax) Lorazepam (Ativan) Flurazepam (Dalmane) Temazepam (Restoril) Triazolam (Halcion) Estazolam (ProSom) Quazepam (Doral) Works on GABA A receptors. Have a sedative hypnotic affect. There are benzodiazepine receptor sites that will enhance the action of the GABA resulting in a calming affect When combine with alcohol or other CNS depressants its bad. Watch dosages in older adults, may increase incidence of falls and broken bones |
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Antianxiety and Hypnotic Drugs:
Short-Acting Sedative-Hypnotic Sleep Agents (“Z-hypnotics”) |
Zolpidem (Ambien)
Zaleplon (Sonata) Eszopiclone (Lunesta) Sedative effects without antianxiety affects. Potential for amnesia or ataxic side affects Must take when RIGHT before bed because they kick in quickly. |
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Antianxiety and Hypnotic Drugs:
Melatonin Receptor Agonist |
Ramelteon (Rozerem)- Acts like a melatonin has a high selectivity for melatonin I & II receptor sites. Has no abuse potential
Buspirone (BuSpar)- often used as an antianxiety affects without sedative affects. Better tolerated than benzo. Not a CNS depressant so there’s not as high potential of an overdose as with BENZOs when combines with other CNS depressants |
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Antidepressant Drugs:
Typical or standard antidepressants |
Tricyclic antidepressants (TCAs)
Amitriptyline (Elavil) Imipramine (Tofranil) Nortriptyline (Pamelor) Blocks norepi uptake. Not used as often because they are old school- have a lot of side effects and have lethal overdoses. Also have anticholinergic side effects such as blurred vision, dry mouth, tachycardia, urinary retention and constipation |
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Antidepressant Drugs:
Selective serotonin reuptake inhibitors (SSRIs) |
Fluoxetine (Prozac)
Sertraline (Zoloft) Paroxetine (Paxil) Citalopram (Celexa) Escitalopram (Lexapro) Fluvoxamine (Luvox) Luvox is also used for OCD Blocks reuptake of serotonin. Have less side effects than TCAs. But they have sexual side effects: no big O. May cause apathy, low libido and n/v. |
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Antidepressant Drugs:
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) |
Venlafaxine (Effexor)
Duloxetine (Cymbalta) Block serotonin and norepi reuptake so there are more free neurons. |
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Antidepressant Drugs:
Monoamine oxidase inhibitors (MAOIs) |
Phenelzine (Nardil)
Tranylcypromine (Parnate) Selegiline (ENSAM) Prevents distruction of monoamines. May be very affective for those who have not has success with others Side effects: hypertensive crisis |
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Antidepressant Drugs:
Serotonin-Norepinephrine Disinhibitors (SNDIs) |
Mirtazapine (Remeron)
Also acts as an anti-anxiety. Has minimal sexual disfuction, Has antiemetic effects, Side effects: weight gain and sedation |
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Bupropion (Wellbutrin, Zyban)
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Buproprian- also acts as an antismoking aid. Has no sexual side effects. It does lower seizure threshold.
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Trazodone (Desyrel)
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Trazodone- used for sleep, not first like for depression. May cause priaprism
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Lithium
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Mood Stabilizer
Keeps people at a more even keel. Affects mania more than depression May stabilize electrical conductivity of the neurons.Can cause sinus bradycardia or tremors. May cause convulsions in OD. Lithium Toxicity: n/v hand tremors, diarrhea, thirst, polyuria, lethargy or slurred speech, mental confusion, ataxia, seizures, coma and death |
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Anticonvulsant drugs
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These are also used for MANIA- WAAAAAAHOOOOO or with Lamictal- for management of depression
Valproate (Depakote, Depakene) Carbamazepine (Tegretol) Lamotrigine (Lamictal) Gabapentin (Neurontin) Topiramate (Topamax) Oxcarbazepine (Trileptal) Common side effects: ataxia, weight gain |
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Antipsychotic Drugs:
First-Generation or Conventional Antipsychotic Drugs |
Strong antagonists (blocking agents)
Bind to D2 receptors Block attachment of dopamine Reduce dopaminergic transmission Antagonists of receptors for Acetylcholine Norepinephrine Histamine May cause amenorrhea or discharge of breasts or development of breasts in men May cause movement disorders |
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Antipsychotic Drugs:
Atypical Antipsychotics (Second-Generation) |
Bind to dopamine receptors in the limbic system
Preferentially over dopamine receptors in neostriatal areas of basal ganglia Decrease motor side effects Clozapine (Clozaril) Risperidone (Risperdal) Olanzapine (Zyprexa) Ziprasidone (Geodon) Aripiprazole (Abilify) Paliperidone (Invega) |
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Drugs For Attention Deficit Hyperactivity Disorder (ADHD)
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Methylphenidate (Ritalin)
Dextroamphetamine (Adderall) Atomoxetine hydrochloride (Strattera) R & A- mimic the effects of norepi or dopamine. They are psychostimulants. May exacerbate psychosis. Has potential for abuse S- norepi reuptake inhibitor. Doesn’t have potential for abuse that the others due. |
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Drugs For Alzheimer's Disease
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Tacrine (Cognex)
Donepezil (Aricept) Galantamaine (Razadyne) Revastigmine (Exelon) Memantine (Namenda) most of these inhibit cholinesterase, increasing the amount of acetylcholine. |
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Herbal Medicine: Major Concerns
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Potential long-term effects
Nerve damage Kidney damage Liver damage Possibility of adverse chemical reactions With other substances With conventional medications Aren't regulated by the FDA. ex: St. Johns Wart is an SSRI (not to be mixed with other SSRIs) |
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Axis I
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Mental Disorder that is the focus of treatment
Ex: Schizophrenia, Mood disorder, Anxiety disorder & Dissocialize Identity Disorder (even though it seems more axis 2) |
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Axis II
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Personality Disorders and Mental Retardation
Ex: OCD, Borderline, Paranoid, Narcissistic |
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Axis III
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General Medical Disorders relevant to axis I
Ex: Hypothyroidism or Diabetes |
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Axis IV
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Psychosocial and Environmental Problems
Ex: unemployed, interpersonal difficulties |
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Axis V:
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Global Assessment of Functioning (GAF)
Ex: 23/42 |
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GAF
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Global Assessment of Functioning
Gives an indication of the person’s best level of psychological, social and occupational functioning. Scale of functioning set from 1-100. 100: Superior Functioning in a wide range of activities. Most of use are around 90. A score of 10: Persistent danger of severely hurting self or others OR persistent inability tot maintain minimal personal hygiene or serious suicidal act with clear expectation of death. Usually will see 2 scores. What it is now and the highest within the last year. It’s very subjective. If you have a high GAF, you may not be able to obtain specific care. |
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The Preconscious Mind
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thoughts that are unconscious at the particular moment but are not repressed and therefore available for recall. Basically, it’s memory.
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The Conscious Mind
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includes everything that we are aware of. We can think and talk about this mind consciously.
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The Unconscious Mind
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a reservoir of feelings, thoughts, urges and memories outside our own awareness. These will influence our behavior and experiences.
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Id
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Present from birth and is entirely unconscious. Instinctive and Primitive. Driven by the pleasure principle and wants immediate gratification. More reflex actions. When these are not received, anger and/or anxiety follows. Tension tries to be resolved through primary process, which is forming a mental image of the desired object as a way of satisfying the need.
Think hungry screaming baby. |
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Ego
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Develops in the 4th or 5th month of life. Problem solver & Reality tester (weighs the costs and benefits of an action before acting). This is responsible for dealing with reality and expresses impulse from the Id in an acceptable manner.
Think hungry kid stealing cookies but still eating them in the kitchen. |
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Superego
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The last to develop. Is the moral component that develops from society and upbringing. The superego seeks perfection and acts as our conscience.
Think hungry kid behaving well and asking mom for a cookie and getting it. (kinda sorta) |
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Defense Mechanisms & Anxiety according to Freud
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Operates on an unconscious level.
May deny, falsify or distort reality to make it easier to deal with. Can be maladaptive. |
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Freud & Nursing
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We can use this information to understand how the formation of personality along with the conscious and unconscious influences. Having individual talk sessions with active listening are important to understand the patient.
Be aware of transference and countertransference. To prevent this be self-aware and know your limitations. |
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Transference
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When the patient sees the nurse and is reminded of someone in their past. So, the begin to react to you as that person rather than who you are.
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Countertransference
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When you, the nurse, have a patient that reminds you of someone else and you react to the client like they are that person.
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Freud Developmental Stage
0-1 year |
Oral
weaning desired outcomes: trust in environment fixation associated with passivity, gullibility, sarcasm and oral habits (no, not that kind) like smoking, nail biting. |
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Freud Developmental Stage
1-3 year |
Anal
toilet training desired outcomes: impulse control fixation associated with anal retentiveness |
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Freud Developmental Stage
3-6 year |
Phallic
Oedipus/Electra complex desired outcomes: identification with same sex parent Lack of successful resolution may result in difficult with sexual identity and authority |
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Freud Developmental Stage
6-12 year |
Latency
desired outcomes: development of skills needed to cope with environment fixations may result in difficulty identifying with others and in social skills (inferiority/inadequacy) |
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Freud Developmental Stage
12+ year |
Genital
desired outcomes: ability to be creative and find pleasure and love in work inability to negotiate this stage could result in difficulties becoming an independent adult and little future goals. |
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Erikson Developmental Stage
Infant |
Trust vs. Mistrust
Needs maximum comfort with minimal uncertainty to trust himself/herself, others, and the environment |
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Erikson Developmental Stage
Toddler |
Autonomy vs. Shame and Doubt
Works to master physical environment while maintaining self-esteem |
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Erikson Developmental Stage
School-Age |
Industry vs. Inferiority
Tries to develop a sense of self-worth by refining skills |
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Erikson Developmental Stage
Adolescence |
Identity vs. Role Confusion
Tries integrating many roles (child, sibling, student, athlete, worker) into a self-image under role model and peer pressure |
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Erikson Developmental Stage
Young Adult |
Intimacy vs. Isolation
Learns to make personal commitment to another as spouse, parent or partner |
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Erikson Developmental Stage
Middle-Age Adult |
Generativity vs. Stagnation
Seeks satisfaction through productivity in career, family, and civic interests |
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Erikson Developmental Stage
Older Adult |
Integrity vs. Despair
Reviews life accomplishments, deals with loss and preparation for death |
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Erikson & Nursing
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This developmental model is an important part of the nursing assessment to see where the client is developmentally. It helps to identify what types of interventions are most likely to be effective.
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Sullivan's theory
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The purpose of all behavior is to get needs met through interpersonal interactions and to decrease or avoid anxiety. It’s a security thing. All behaviors can be observed through interpersonal relationships. Security Operations are the measures an individual uses to reduce anxiety and enhance security.
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Sullivan & Nursing
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His theory was the foundation for Hildegard Peplau’s theory. With the nurse patient dyad, you are both a participant and observer. This means you must be aware of both your own thoughts and feelings. Empathy is very important.
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Maslow's hierarchy of needs
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Humans are active participants in life, striving for self-actualization. The most basic needs must be met before the higher ones can be achieved.
Physiological Needs: food, water, O2, elimination, rest, sex Safety Needs: security, protection, stability, structure, order & limits Love and Belonging Needs: affilitation, affectionate, relationships & love Esteem: competency, achievement, and esteem from others Self-Actualization: becoming everything one is capable of becoming SELF TRANSCENDENCE |
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Maslow & Nursing
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There must be an emphasis on human potential and the client’s strengths. Helps to prioritize nursing actions in the nurse-client relationship.
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Cognitive Behavioral Therapy
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Based on the theoretical principle that how people feel and behave is largely determined by the way they think about the world and their place in it (typically based on previous experiences). Tests distorted beliefs and change way of thinking to reduce symptoms. Postulates that the root of all problems are thoughts rather than emotions. Beck notices that people were censoring their thoughts during things like free association. Looks at faulty thinking techniques such as all or nothing thinking. It’s very effective for anxiety and major depression. Patients are taught to challenge their own negative thinking and substitute it with positive rational thoughts.
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Circadian rhythms
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Experience changes in body temperature and secretion of hormones like corticotropin and cortisol and neurotransmitters like norepinephrine and serotonin. Includes the sleep-wake cycle & the fluctuation of various physiological and behavioral parameters over a 24-hour cycle
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Patient's civil rights
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These are the most basic, there were like 1000 from lecture.
The right to vote The right to civil service ranking The right to receive, forfeit or deny a driver’s license The right to make purchases and enter contractual relationships (unless lost legal capacity) The right to press charges against another person and to be sued The right to humane care and treatment The right to religious freedom and practice The right to social interaction The right to exercise and participate in recreational opportunities |
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Criteria for involuntary commitment
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Danger to self, others or grave disability (unable to provide for own food, clothing or shelter)
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Priority nursing diagnoses- Schizophrenia
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Positive symptoms
Disturbed sensory perception Risk for self-directed or other-directed violence Disturbed thought processes Negative symptoms Social isolation Chronic low self-esteem Ineffective coping Self-care deficit may also be one. |
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Interventions in paranoid schizophrenia during the Acute Phase
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Psychiatric, medical, and neurological evaluation
Psychopharmacological treatment Support, psychoeducation, and guidance Supervision and limit setting in the milieu |
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Interventions in paranoid schizophrenia during the stabilization and maintenance phases
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Milieu management
Activities and groups Safety – staff supervision, reducing stimulation, addressing paranoia, providing constructive diversion, teach and practice coping skills, implement cognitve behavioral approaches and when necessary- seclusion or chemical/physical restraints. Counseling and communication techniques Hallucinations – maintain eye contact, call the patient by name, speak in a louder voice than usual, redirection Delusions- clarifym convey empathy for fears, avoid focus on content of delusion Associative looseness- place difficulty in understanding on yourself, look for recurring topics and themes, summarize/paraphrase communications, tell patient what you do understand. Health teaching and health promotion- both pt and family |
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Symptoms of hallucinations
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Talking to self
Looks like they are listening to someone Claims to see things that aren’t there (sees a train coming at them from down the hall) Claims to smell things that aren’t (smell of something rotting inside them) Claims to taste things that aren’t (tastes the poison they put in the food) Feeling things that aren’t really tangible (feels the bugs all over or feels electric impulses of mind control) |
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Symptoms of movement disorders
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Repetitive, seemingly driven, and nonfunctional motor behavior
Shaking Picking Body Rocking Head Banging (when not at a concert) Etc. **May be a result of extrapyramidal side effects (EPS): akathisia, acute dystonias, pseudoparkinsonism and tardive dyskinesia.*** |
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Symptoms of Neuroleptic Malignant Syndrome
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A life threatening medical emergency, fatal in 10% of cases
Reduced consciousness, increased muscle tone (rigidity) and autonomic dysfunction including: hyperpyrexia labile hypertension tachycardia tachypnea diaphoresis drooling |
