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187 Cards in this Set
- Front
- Back
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self Awareness
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Concept that one exists as an individual separate from other people, with private thoughts. Includes recognition of one's strengths and weaknesses, likes, dislikes, behavior, attitude, and emotions
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Personality traits
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Internal contributing factor to the development of self-awareness. (extrovert, introvert)
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Judgmental
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inflexible and run the risk of neglecting the perception of others, possibly arriving at an opinion based on their own values without enough facts or enough regard for what other people may feel or think
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Factors Influencing Mental Health
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Genetic Characteristics
Nurturing During Childhood Life Circumstances |
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Maslow's hierarchy of needs
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Self actualization
Self Esteem Love Security and Safety Physiologic |
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Self actualization
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Need to be self-fulfilled, learn, create, understand, and experience one's potential
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Interpersonal Communication
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5 levels- The relationship is only as good as the intent of the conversation, pg 10
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Denial
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Unconscious refusal to face thoughts, feelings, wishes, needs, or reality factors that are intolerable
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Displacement
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Unconscious shifting of feelings such as hostility or anxiety from one idea, person, or object to another.
ie: teenage slamming a door when mad |
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Dissociation
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Separation and detachment of a strong, emotionally charged conflict from one's consciousness (sometimes amnesia, sometimes become dif person)
Dissociative Identity Disorder |
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Projection
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Unconscious assignment of unacceptable thoughts or characteristics of self to others
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sublimation
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unconsciousness rechanneling of intolerance or socially unacceptable impulses or behaviors into activities that are personally or socialy acceptable (a socially acceptable outlet)
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Compassion fatigue (burnout)
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when one provides care for others at work and home but loses the ability to take care of ones' self
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Panic attacks
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induce long lasting rise in LDL and total cholesterol in men, placing them at increased risk of cardiovascular disease
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Schizophrenia caused by
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- a virus
- autoimmune phenomena - frontal lobe dysfunction |
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Increased episodes of depression and mania
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causes changes in brain structure and function, which lead to treatments resistant depression (refractory)
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Refractory
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when whenever worked before doesn't any more
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Untreated hypothyroidism
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may play an unheralded role in tx resistance and in the development of rapid cycling in bipolar patients
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Clozaril
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has proven to be a safe, effective drug for psychotic clients with a history of neuroleptic malignant syndrome
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SSRI use
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leads to bone loss in older women
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Brain trauma severity
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is a predictor of personality change in the youth
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Interaction- oriented approach
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Paplau --> based on personal interaction
- view themselves as therapeutic tool and evaluations according to client's response |
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Paplau
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Interpersonal theory
- nurse-client relationships in which problem-solving skills are developed (orientation, identification, exploitation, resolution) |
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Mental Health
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- Accepts self and others
- Is able to cope with or tolerate stress - Is able to form close and lasting relationships - Use sound judgement to make decisions - Accepts responsibility for actions - Is optimistic - Recognizes limitations (abilities and deficiencies) - Can function effectively and independently - Is able to distinguish imagined circumstances from reality - Is able to develop potential and talents to the fullest extent - Is able to solve problems - Can delay gratification - communicates emotions, giving and receiving, working alone as well as with others, acceptable authority, displaying a sense of humor, and coping successfully with emotional conflict |
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Mental Illness
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- feels inadequate
- has poor self-concepts - Is unable to cope - Exhibits maladaptive behavior - Displays poor judgment - Is irresponsible or unable to accept responsibility for actions - is pessimistic - Does not recognize limitations (abilities an deficiencies) - Exhibits dependency needs because of feelings of inadequacy - Is unable to perceive reality - Does not recognize potential and talents because of poor self-concept - Acoids problems rather than coping with them or attempting to solve them - Desires or demands immediate gratification - inability to cope with stress, resulting in disruption, disorganization, inappropriate reactions, unacceptable behavior, and the inability to respond according to the person's expectations and the demands of society. |
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Culture
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shared beliefs, values, behavioral norms, and practices that is common to a group of people sharing a common identity and language.
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Subculture
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smaller group that exists within a larger culture
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Ethnicity
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common ancestral, racial, physical, or national characteristics and who share cultural symbols (language, lifestyle, and religion)
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Ethnocentrism
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Believing and behaving is superior to that of others
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Culture-bound syndrome
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denotes recurrent locality-specific patterns of aberrant behavior and troubling experience that are prominent in folk belief and practice
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Amok
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Dissociative episodes followed by outburst of violence behavior directed at people or objects
(a culture bound syndrome) |
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Ataque de nervios
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Uncontrollable shouting, crying, trembling, and verbal or physical aggression. Occurs frequently as direct result of stressful family event
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Brain fog
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Difficulty concentrating, remembering, and thinking. Associated with challenge or schooling
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Ghost sickness
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Preoccupation with death and the deceased. Bad dreams, weakness, feelings of danger, anxiety, and hallucinations may occur.
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Rootwork
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Illness ascribed to hexing, witchcraft, sorcery, or evil influence of another person. Like a "curse" and have to do certain things to get rid of it.
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Translator
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use of a family member or friend is not appropriate. Dr or nurse is ok.
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Tarasoff decision
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Cases in which violent or self-destructive behavior is identified by the clinician, and cases in which the defendant is not a mental health professional but rather a friend, significant other, or family member who is aware of the potential for danger but neglects to warn the potential victim (must warn person).
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Protective and Advocacy Bill for Mentally Ill Individuals Act of 1986
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- reaceive txs, etc.
- refuse tx- unless endangers - have probable cause hearin within 2 days - Maintain client privacy and confidentiality (HIPAA) - communicate freely with others by letter, telephone, or visits, unless such activities are specifically restricted in ones' tx plan. - have personal privileges (wearing own clothing, maintaining personal appearance in their taste, basic necessities of life) - civil rights (vote, emplyed, drive, marry, etc.) - religious freedoms and education - respect, dignity, and personal identity - continuity of care - access own records - exaplanation of costs and services - obtain aftercare (housing etc.) |
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Grief
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normal, appropriate emotional response to external and consciously recognized loss. Emotional pain that needs to be acknowledged
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Anticipatory grief
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normal grief when person is dying, allows others to get used to the idea, etc.
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Mourning
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outward expression of grief
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bereavement
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sadness, insomnia, poor appetitie, deprivation, desolation
some experience this as part of their grief * best way to help someone who is grieving is to listen, be empathetic, acknowledge the loss, and experience the event at his or her own pace |
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Disenfranchised grief
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experience of individuals whose grief is not acknowledged or supported by their social network or excluded from participating in grief-related rituals
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Types of community mental health services
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- Psychiatric Emergency Care
- Day-treatment Programs - Residential treatment Programs - Psychiatric Home care (homebound, acute or acut exacerbation, needs specialized knowledge or skills of psychiatric RN) - Aftercare and rehabilitation (PACT- programs for assertive Community tx-FACT) |
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Standards of care and the nursing process
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standard I- Assessment
Standard II- diagnosis Standard III- outcome identification Standard IV- Planning Standard V- Implementation Standard VI- Evaluation |
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Comprehensive assessment
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biological, psych, social, cultureal, spirutal, etc.
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focused assessment
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regarding a particular problem
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screening assessment
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mental status exam
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Affect
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observable manifestation of ones emotions or feelings inferred from facial expressions (anger, sadness, or happiness)
- objective |
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Mood
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the presence oof pervasive and sustained emotions or feelings DESCRIBED by the patient
- subjective |
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Congruent
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describes consistency between a persons affect and mood (can also be incongruent or divergent)
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Blocking
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sudden stoppage
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Circumstantiality
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giving unnecessary detail
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Clang association
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punning or rhyming
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Echolalia
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parrot-like repetition
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Flight of ideas
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chance association
verbal skipping from one thought to another. Although talk is continuous, the ideas are fragmented. "I like the color blue. Do you ever feel blue? Feelings can change from day to day" |
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Looseness of association
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relationship between sentences does not make sense. "Mary went swimming. I like turkeys"
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Mutism
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refusal to speak
(catatonic schizophrenia) |
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Neologism
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use of a new word
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Perseveration
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person emits the same verbal response to various questions
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Tangentiality
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appropriate to the general topic but dos not specifically answer the question. Somewhat associated.
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Verbigeration
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meaningless repetition of specific words
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Word Salad
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mixture of words and phrases that lack comprehensive meaning or logical coherence.
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Delusions
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fixed false beliefs not true to fact and not ordinarily accepted by others
"I have a metal plate in my knee that the martians put there..." |
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Hallucinations
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sensory perceptions ( auditory, visual, gustatory, olfactory, tactile in nature)
(there are also command hallucinations) |
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Depersonalization
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feeling of unreality or strangeness concerning self, the environment, or both
some describe out of body experiences viewing themselves from a few feet overhead. May feel like they are going crazy. common with substance abuse. |
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Obsession
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insistent thoughts, recognized as arising from the self. Client usually regards the obsessions as absurd and relatively meaningless. They persist anyways --> CAN'T find relief
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Compulsions
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insistent, repetitive, intrusive, and unwanted urges to perform an act contrary to ones ordinary wishes--> they DO find relief in doing the actions
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Memory
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Recent memory- 2 weeks
long term memory |
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Intellectual ability
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subtract or spell words backward, abstract though
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Insight
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self understanding, clients' insight into their illness or conditions
No insight--> limited insight --> insight |
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Neurovegetative changes
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changes in psychophysiologic functions (sleep patterns, eating patterns, enrgy levels, sexual function, or bowel funtioning)I
f a pt states they didn't sleep and you saw them sleep, they didn't sleep (a highly prevalent problem) |
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Pharmacodynamics
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study of biochemical an dphysiologic effects of drugs and the mechanisms by which the effects are produced.
Effects of drugs on body |
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Pharmacokinetics
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study of movement of drugs and their metabolites through the body (absorption, distribution, metabolism, excretion/elimination)
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Discontinuation (withdrawal) syndrome
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abrupt discontinuation or reduction in dosage of a number of psychotropic drugs can precipitate transient emergence of clinical symptoms with rebound or relapse of original symptoms, uncomfortable new symptoms, or physiologicc withdrawal times
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ADHD med
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Ritalin (only one with street value)
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antianxiety or anxiolytics
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benzos
non-benzos Z-track Buspar |
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Antidepressants
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SSRI
TCA MAOI atypicals herbals |
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mood meds
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acony
antipsychotics lithium Antidepressants antianxiety or anxiolytics toxic range |
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Antipsychotics
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14
EPS Dopamine Serotonin +/- SE's Interactions |
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Parkinson's meds
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artane
benadryl cogentin |
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Anticonvulsants
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Depakote, tegretol, neurontin, topamax, lamictal (side effect of rash), trileptal
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Antipsychotics
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Abilify
geodon risperdal zyprexa |
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Lithium caution
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- salt and water (inverse relationship, have to be careful how much salt they take in and how much water they use)
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Lithium toxicity range
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1.5-2.0 +
range 0.6-1.3 |
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S/E of lithium
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Drowsiness
muscles spasms blurred vision diarrhea dizziness stupor convulsions coma death |
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SSSRIs- antidepressants
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- first line
- Increase risk of suicide/teens and children - Discontinuation syndrome - Prozac, paxil, zoloft (most common 3) lexapro, luvox, celexa |
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Tricyclics- antidepressants
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Elavil (neurogenic pain)
Tofranil (bedwetting) Anafranil (OCD) |
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Atypicals- antidepressants
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Desyrel
Wellbutrin Effexor |
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Herbal antidepressant
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St. Johns Wart
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MAOI- anti depressants
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14 day clearance time
Food restrictions: fermented, pickled, salted, aged - Hypertensive crisis |
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Benzodiazepines- anti-anxiety
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Ativan, klonopin, librium, valium, xanax
- do not stop abruptly - paradoxycal reaction - lethal with alcohol - dependency |
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Non- Benzodiasepines- anti-anxiety
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BuSpar
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SSRIs for ati anxiety
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Prozac, paxil, zoloft
Lexapro, celexa, luvox |
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Antidepressants for antianxiety
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Anafranil (for OCD)*
Effexor |
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Antihistamines for anti anxiety
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Benadryl
Vistaril |
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Herbals for antianxiety
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Valerian
chamomile kava kava |
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ADHD meds
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Ritalin
Adderal Focalin Strattera Concerta |
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Stimulant ADHD meds
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Ritalin
Adderal Focalin Concerta |
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Non-stimulant ADHD meds
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Strattera
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ADHD med S/E
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appetite suppression
Suppress growth hormone Sleep disturbances Increase in pulse and BP CNS overstimulation Arrhythmias Street drug (ritalin has high street value) College students use to study Potentiate antidepressant prescription in tx- resistant depression |
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Meds for aggression
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Depakote, Neurontin (seizure induced aggression)
Clonidine, Tenex, int univ Antianxiety Rx Antipsychotics |
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11 antipsychotics
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- Thorazine (tx of hiccups)
- Compazine (not an antipsychotics, used for N/V) - Mellaril (endocrine-gynocomastia) - Haldol (cocktail) - Prolaxin (Decanoate-oil based so it lasts longer) - Clozaril - Risperidal - Zyprexa - Serroquil (S/E- weight gain) - Abilify - Geodin (metabolic syndrome |
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Dopamine meds (+ schizophrenia signs)
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- Thorazine (tx of hiccups)
- Compazine (not an antipsychotics, used for N/V) - Mellaril (endocrine-gynocomastia) - Haldol (cocktail) - Prolaxin (Decanoate-oil based so it lasts longer) |
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Dopamine and Serotonin meds (Atypicals)
(- and + schizophrenia signs) |
- Clozaril (CBC-agranulocytosis)
- Risperidal - Zyprexa - Serroquil (S/E- weight gain) - Abilify - Geodin (metabolic syndrome |
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About compazine
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not an antipsychotic (used for N/V)
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About Mellaril
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endocrine, gynocomastia
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Side effects of psychotic drugs
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Dry mouth
Sedation Blurred Vision Constipation DECREASED SEIZURE THRESHOLD Elevated prolactin Diminished libido Urinary retention Weight gain Mild ECG changes Photosensitivity Hyperglycemia Increased cholesterol Agranulocytosis extrapyramidal (EPS) Occulogyric crisis (eyes roll back in head) Parkinsonism Akathesia (restless, without sitting) Acute dystonic reactions (muscles tense, repetative movements, abnormal posture) Tardive dyskinesia (lip smacking, etc.)- LONG TERM USE Neuroleptic Malignant Syndrome -Hyperpyrexia -Severe muscle rigidity -Labile P/BP - Altered Consciousness |
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Long term use of neuroleptics can casue
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Tardive dyskinesia- repetative, involuntary, purposeless movements, grimasing, lip smacking, puckering, pursing, rapid blinking, sticking out tongue, licking lips
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What is acute dystonia
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muscle tense, repetative movements, abnormal posture
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Akathesia
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restlessness, without sitting
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Occulogyric crisis
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eyes roll back in head
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What major S/E does Clozaril have
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Agranulocytosis --> reduction of WBCs --> infection
*monitor CBC (In pharm notes, this also causes metabolic syndrome and seizures) |
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About Prolixin
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Decanoate--oil based so lasts a long time
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About Risperdal
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There is an extended release that has sutures that release slowly
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Seroquil S/E
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Weight Gain
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Mellaril S/E
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gynecomastia and lactation
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Metabolic syndrome
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Increased blood sugar (pancreas)
HTN hypercholesteremia Weight gain Increased abdominal girth |
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2 meds at greatest risk are causing metabolic syndrome are:
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Zyprexa and clozaril
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Mood disorders
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Bipolar I and II
Dysthymia (like eyore in winnie the pooh) Depression Cyclothymia (like bipolar but less severe) Season affective disorder (dark climate, no sun) Post partum depression (Baby blues in 3-4 days --> psychosis) |
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Some presenting features of depression
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Anxiety, somatic, complaints, and alcohol, and substance abuse
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Deperssion S/S
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SPACE DIGS
Sleep disturbances Psychomotor Agitation and Appetite (weight gain or loss) Concentration Energy (fatigue) DIGS- getting worse depressed mood interest (anhedonia-markedly diminished interest or pleasure in former activities) guilt suicidal ideation |
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age range for highest suicide risk
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under 19 and older 45
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What is considered a good indicator of suicide? and what is the best indicator?
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good- hopelessness (Beck-self rating)
best- previous attempt |
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coprolalia
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cursing (tourettes)
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Axis I
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Psych Dx- focus of clinical attention
- generalized anxiety, schizophrenia, paranoid type |
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Axis II
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Personality disorders/mental retardation
-borderline personality disorders - profound mental retardation |
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Axis III
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Medical conditions (wounds, etc.)
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Axis IV
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Psychosocial/environmental stressors (educational, occupational, housing, traumatic events, legal problems, access to healthcare services)
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Axis V
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Global assessment of functioning (GAF)
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GAF
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first number is new, second number is the past year
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Oppositional defiant disorder
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angry, talk back, defiant,don't do what tell them
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Conduct disorders
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like defiant but also hurt small children, small animals, and set fires)
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Antisocial personality disorder
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psychopaths, no remorse, can tell ies and won't show on lie detector
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Serotonin Syndrome S/S
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- extreme agitation
- restlessness - confusion - hallucinations - loss of coordination - tachypnea - labile BP - hyperpyrexia - diaphoresis - overactive reflexes - N/V - diarrhea |
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Withdrawal syndrome
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- dizziness
- nausea - sensory disturbances - tremor - dysphoria - anxiety - days to weeks after last dose |
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Delusion of reference
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"people on tv are referring to me, my hair isn't quite right, and everyone will notice"
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Delusion of persecution
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everyone hates me, everyone in room is angry with me, I don't get a fair shake
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Bipolar type I vs. Bipolar type II
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1 is up and down, 2 is up and down but not quite as much
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3 new antipsychotic drugs to add to 11
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Invega
Saphris Tofranil |
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Classic triad of Neuroleptic Malignant syndrome
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hyperpyrexia
rigidity cognitive |
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Signs of Neuroleptic Malignant syndrome
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hyperpyrexia, rigidity, cognitive, labile P/BP, diaphoresis, tremor, dystonia, drowsiness to coma, seizures, arrhythmias
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What is neuroleptic malignant syndrome associated with
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meds that impact on dopamine and perhaps TCA;s- remember compazine
Increased risk when combine with haldol and lithium Once symptoms emerge, may exacerbate rapidly |
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Meds that can cause Serotonin syndrome
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SSRI- Celexa, Prozac, Paxil, Zoloft
SNRI- Desyrel, Effexor NDRIs- wellbutrin (also for smoking) MAOIs- Marplan, Nardil Pain Rx- Fentanyl, Demoral, Talwin, Ultram Anti nausea meds- Reglan, Zofran Antimigraine- Imitrex, Avert, Zomig OTC cough and cold- Robitussin Illegal drugs- XTC, LSD Herbal: St Johns Wart, Ginseng BPD- Lithium |
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tx for tardive dyskinesai
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**no standard treatment!**
treated with Clozoril or Benadryl Sometimes it works and sometimes it doesn't |
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Extrapyramidal symptoms
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- acute dystonia
- acute dyskinesia - pseudoparkinsonism - akathisia - Tardive dyskinesia - neuroleptic malignant syndrome |
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Pseudoparkinsonism
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Motor retardation or akinesia
- masklike and pill rolling tremor, salivation - within first week of tx |
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Akathisia
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motor restlessness
- constant state of movement - difficulty sitting still, or strong urge to move about |
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Acute dystonic reactions
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irregular, involuntary movement/spasms involving muscles in head, neck, trunk, limbs.
- facial grimacing - abnormal eye movements - backward rolling of eyes (oculogyric crisis) |
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Tardive dyskinesia
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- tongue protrusion, cheek puffing, involuntary movements of extremities and trunk
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Labs affected in neuroleptic malignant syndrome
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elevated CPK
elevated WBCs |
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tx for pseudoparkinsonism
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Cogentin (anticholinergic med)
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tx for neuroleptic malignant syndrome
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-Dantrium, Barlodel
(dantrolene) |
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Metabolic syndrome
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hyperglycemia, dyslipidemia, abdominal obesity (all gut, not butt)
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Nursing interventions for pts taking antipsychotics
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- blood pressure
- CBC - serum glucose level - lipid panel - liver function tests - visions tests -personal and family history of metabolic problems - assessment of body mass index and waist circumference - nutritional and activity counseling - admin antacids 2 h before or 1h after - if one dose/day, give PO 1-2h before bed - avoid touching concentrated liquids - no subcu unless specifically ordered, use Z-track, and change needles after filling syringe, - Risperdal only in gluteal Prolaxin and Haldol in deltoid or gluteal - If pt is not compliant, prepare to give meds IM (last longer like 2-4 weeks depends on med) - antipsychotic drugs can induce seizures in those with seizure disorders |
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Dosage range of atypical antidepressant Wellbutrin
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200-1450 mg.day
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Dosage range of atypical antidepressant Desyrel
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25-600 mg.day
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Dosage range of atypical antidepressant Effexor
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75-375
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Antidepressant potentially serious adverse affects
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- seizures due to lowering of the threshold as with the use of buproprion
- Liver disorder due to trazodone - Severe hyponatremia linked to use of SSRIs |
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Guilty but mentally ill
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exhibit clinical symptoms of a psychiatric disorder (pyromania, substance abuse or sexual offenses). Client is responsible for his or her behavior but the act happened cause of the illness.
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ATI
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5% of grade, have to take
Level 3=5points level 2=4 points level 1=3 points below level 1=0 points |
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students role on psych
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observe and learn
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uniform
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white scrub ad blue scrub pants
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GAF scores
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91-100 superior
41-50 serious symptoms |
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Criteria for Baker Act
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- mental illness (not developmental diasbility, intoxication, substance abuse, or antisocial behaviior)
- refused voluntary admission - without care they will harm self or others |
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Who may initiate Baker Act
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Judge
LEO Mental health professional |
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Ex Parte
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must be signed by judge since there is no other professional
court enters the order based on a sworn testimony (written or oral) |
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BA 52
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Involuntary examination form
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BA 32
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Court form to petition for further involuntary treatment
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Within 24h of BA
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psychiatrist must examine pt
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Within 72h of BA
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- released
- voluntary - BA 32 to petition for further involuntary tx is filed--> hearing will be held |
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Marchman Act Criteria
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Substance abuse impaired and because of impairment
Lost power of self control because of substance abuse and either - inflicted or threatened/attempted to inflict physical harm on self or others - is in need of substance abuse service by reason of substance abuse impairment |
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Who can certify a person as incompetent
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in Florida, just a physician
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Incompetent definition
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Judgement is so affected by the illness that can't make decisions on health or mental health
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Delusion of reference of persecution
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police are out to get you, being watched
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Delusion of alien control
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feeling, thought controlled by an outside source (aliens)
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Nihilistic delusion
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The client denies reality of self, part of self or external object. "I have no head"
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Delusion of poverty
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think are poor or going to loose money
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Delusion of grandeur
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think napolean for Jesus
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Somatic delusion
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think have cancer, sickness, etc.
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Axis V
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GAF
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DSM- IV-TR
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Axis, diagnostic classification tool, insurance companies need them
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Restraint rules
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- must be assessed by physician or licensed independant practitioner within first hour
- order is good for 4 hrs - has to be reevaluated q4h and new written or verbal order written |
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deinstitutionalization
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1960s, moving chronically mentally ill pts for state psych hospitals back into community supervised facilities
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Culture Bound Syndrome
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denotes ercurrent locality-specific patterns of aberrant behavior and troubling experience that are prominant in folk belief and practice.
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East Asian Population and CYP2D6
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more than 1/3 of population are "poor metabolizers".. stays in system longer.
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Habeus corpus
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if pt disagrees with hearing, have another hearing and are either discharged or tx.
have probable cause hearing within three court days of admission to secure a speedy recovery from involuntary detention if found sane in a court of law |
