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95 Cards in this Set

  • Front
  • Back

Stages of Grief

Denial


Anger


Bargaining


Acceptance




Length varies from few weeks to years

Anticipatory Grief

Grieving before the actual loss occurs

Maladaptive Responses to Loss

Delayed or inhibited grief: absence of evidence of grief when ordinarily expected


Chronic/prolonged Grieving: Unable to let go of personal possessions, disabling behaviors, unhealthy coping mechanisms


Distorted(exaggerated) grief Response: All symptoms of normal grieving process exaggerated

Normal Grief

Self esteeem intact


opnely expresses anger


misture of good and bad days


able to exp. moments of pleasure


accepts comfort and support from others


maintains feeling of hope


May express guilt feeling sover some aspect of the loss


relates specific feelings of loss


may exp transient physical symptoms

Clinical Depression

Self esteem disturbed


doesn't directly express anger


persistent state of dysphoria


Anhedonia is prevalent


Does not respond to social interaction adn support from others


Feelings of hopelessness prevail


has generalized feelings of guilt


Does not relate feelings to a particular experience


Expresses chronic physical complaints.

Voluntary committment

client or guardian chooses committment to a mental health facility, and has the right to apply for release at any time

Involuntary committment

client enters facility against their will for indefinate period of time. AEB their risk of harm to self or others, or the inability to provide self-care.

Intentional tort

a purposefully wrongful act or injury committed by an entity or persona gainst another person or another person's property.

Example of intentional tort

State laws may vary


Assault


Battery


False Imprisonment

Maslows hierarchy of needs

Physiological- Safety- belongingness and love- esteem-self actualization

Transference

pt unconsciously displaces to the nurse feelings formed toward a person from his or her past. Could be due to appearance or quality that reminds them of

Countertransference

the nurse's behavioral and emotional response to the client. May be r/t unresolved feelings towards significant others from the nurse's past, or they may be generated in response to transference feelings on the part of the client

Primary Intervention

preventative measures for groups that may be at risk but have nto been effected yet

Secondary Intervention

interventions such as early detection for people experiencing symptoms, but may not be permenantly disabled

Tertiary(3rd) intervention

interventions for people who are permanatly effected or imparied

ECT

used for clients who have bipolar disorder with rapid cycling- 4 or more episodes of acute mania in 1 year




Higher risk includes:


Recent MI


History of cerebrovascular accident


Cerebrovascular malformation


Intracranial mass lesion


Increased Intracranial pressure


Hold MAOIs and Bnzos(seizuure inhibiting)

Child Abuse- When to report?

S/S


Unexplained injuries


Child is frightened of adults


child reports injury by parent or caregiver


conflicting or unconvincing explanation for injuires

Somatic Symptom Disorder

physical symptoms suggesting medical disease but without demonstratable organic pathology or mechanism to accou8nt for them.


Why? pts may not have organic disease so they don't identify as having mental disorders and do not seek treatment as a result

Hysteria

SSD- affects mainly women


characterized by recurrent mutliple somatic complaints that are unexplainable by organic pathology


-thought to be associated with repressed anxiety

Dissociation

SSD- splitting off of clusters of mental contents from conscious awareness. a mechanism central to hysterical conversion and dissociative disorder

s/s Bulimia

binge eating


uncontrolled compulsive and rapid ingestion of large amounts of food followed by vomiting or laxitive


low sellf esteem, impulsivity, and difficulty with interpersonal relationships


ow BP, orthostatic HTN, low pulse and low body temp, irregular HR and poor skin turgor


Enlargment of Parotid, dental erosion and carries

s/s Anorexia

Gross distortion of body image, preoccupations with food, refusal to eat


refusal to maintain body weight


intense fear of gaining weight


Postmenarcheal females, amenorrhea(abnormal period)


Many pts. with anorexia nervosa participate in sports and athletic activities


relentless exercise to lose more weight.

Psychotherapies- Cognitive (pg 56 ati)

cognative reframing


changing cognitive distortions can decrease anxiety


priority restructuring


journal keeping


assertiveness training


monitoring thoughts


-helps patient ID negative thoughts that cause anxiety.


Uses both a cognative and behavioral tehapy for clients who have anxiety management issues

Psychotherapies- Behavioral(pg 56 ati)

changing behavior was the key to treating problems


used n phobias, substance use or addictive disorders



Systematic Desensitization

Planned progressive or graduated exposure to snxiety provoking stimuli irl. pt uses relaxation tech during exp

Modeling

therapist or others serve as role models for a cleint, who imitates behavior to improve situaiton

Operant conditioning

Positive reinforcement, rewards for positive behavior

Aversion therapy

negative consequences for negative behavior

Meditation, guided imagery, diaphragmatic breathing, muscle relaxation and biofeedback

Various techniques to control pain, tension, and anxiety

Delirium

pharmalogical management focuses on the treatment of the underlying disorder


antipsychotic or antianxiety medications may be prescribed


Rapid onset

Dementia/Neurocognitive disorder

pharmalogic fous is to increase acetylcholine at synapses- donepezil, rivastigmine and agalantamine




adverse effects include nausea and diarrhea, bradycardia- monitor and provide adequate fluid intake, monitor pulse, watch HR


Contradicted by use of NSAIDS, antihistamines, TCA, and conventional antipsychotics


Gradual onset

Care for Delirium

screen for heart disease, avoid NSAIDs, expect cognitive decline to slow, expect adverse affects


AEB:


rapid personality changes


perceptual disturbances, ie hallucinations and illusions


restlessness and agitation in pt.

care for Dementia

childproof doorlocks


no rugs


secure electrical cords


cleaning supplised shouold be locked up


mattress on floor(fall risk)


light fixtures above stairs to improve visibility(fall risk)

Depression

Therapeutic communication: Make time to spend with pt


make observations rather than asking direct questions


give directions in simple concrete sentences because a client who has depression may have difficulty focusing on and comprehending long windedness

Interventions r/t Suicide- depression

1 to 1


remove harmful objects


ask them regarding command hallucinations


if they want to hurt themselves, others, do they have a plan, means, observe client, ensure all meds are ingested- no pouching or cheeking

Interventions for panic attack

Stay w/ pt.


be calm


simple words


give meds


explore reason once attack subsides



Benzo for long term?

No, addictive, physical/chemical dependance occurs, need to be tapered off

Benzo OD is counteracted by

Flumazenil(Romazicon) antidote

Crisis Intervention

rapid but through biopsychosocial assessment


establish rapport


ID triggering event, prioritize problem, discuss style of coping


encourage feelings


explore options


shift from crisis to resolution

Situational/external Crisis

unanticipated loss or changed experienced in everyday

Maturation/internal

New developmental stages

adventitous crisis

Natrual disasters, crime

s/s of alcohol intoxication

s/s of alcohol withdrawal

Abdminal cramping


vomiting


tremors


restlessness


inability to sleep


+ to the following: BP, HR, temp, Resp


Hallucinations


anxiety


tonic clonic seizures


initiate seizure precautions

s/s of alcohol withdrawal delirium

occurs 203 days after cessation of alcohol and may last 2-3 days- medical emegency. Symptoms may include severe disorientation, psychotic symptoms(hallucination), sever hypertension, dusrhythmias, and delirium. Can progress to death- transferred to er or critical care for monitoring

CAGE assessment

CUT DOWN


ANNOYED BY PEOPLE criticizing your drinking?


Guilty about drinking?
EYE Opening- want to drink?

Medications to support Abstinence/withdrawl for alcohol

Antabuse- causes alcohol aversion( you get sick if you ingest alcohol) Valim, atavan, librium for withdrawl




Revia takes off the cravings, similar to zarcan


Benzos

Meds for opiods

Methadone for treatment (removed the highs and lows


Narcan for OD

Tolerance

the ability to withstand larger amounts of stimulant to achieve desired therapeutic effect

Addiciton

chatracterized by


loss of control due to addictive behavior


participation continues despite continuing associated problems


a tendency to relapse back into the addictive behavior

Withdrawl



when substance is not available, there is a strong urge for desired substance

s/s Wernicke's Encephalopathy

most severe form of thiamine eficiency in alchoholics.


paralysis of the ocular muscles, diplopia, ataxia, and stupor




Thiamine replacement therapy required

Korsakoff's Psychosis

State of confusion, loss of memory, and confabbulation, frequently encountered in pts recovering from Wernicke's

Schizophrenia


how to communicate with actively psychotic pt

Do not feed into delusion


Focus on positive aspect


Keep them safe


reorient them to reality via techniques


Don't argue

Understand prognosis of Schizophrenia

difficult to predict


complete return not common


positive outcomes include good premorbid functioning, later age at onset, female gener, abrupt onset of sumptoms with obvious precipitating factor


associated mood disturbance, rapid resolution of active phase symptoms, no genetic or family dispositions or history

Short term goals

Verbalization of ideas within week, or specified times

Long term goals

Pt will demonstrate independance and behavior consistent prior to onset

positive symptoms of Schizophrenia

alterations in speech


hallucinations


delusions


bizzzare behavior

Negative symptoms of Schizophrenia

affect, alogia-poverty of thought or speech, may only mmble or respond vaguely


anergia- lack of energy


Anhedonia- lack of pleasure or joy


Avolition- lack of motivation

cognitive symptoms of Schizophrenia

Disordered thinking


inability to make decisions


poor problem solving ability


difficulty concentrating to perform tasks


memory deficits


long term and working

Paranoid Schizophrenia

pt has delusions that a person/persons are plotting against them or members of their family

loose associations



pt responses don't relate directly to conversation or what is being asked

neologisms

made up words only the client can understand

World Salad

words jumbled together

clang associations

meaningless rhyming of words

echolalia

pt. repeats words spoken to them

depersonalization

when ones thoughts and feelings seem unreal or not to belong to oneself

Flight of ideas

associative loosness


client may say sentence after sentence, but each sentence may relate to another topic, and the listener is unable to follow the client's thoughts

disorganized Schizophrenia

poor prognosis


disorganized behavior and speech, and disturbed emotional expression

catatonic Schizophrenia

inability to move normally

delusions

false personal beliefs that are inconsistent with theperson's intelligence or cultural background

hallucinations

false sensory perceptions ont associated with external stimuli

tardive dyskinesia

long term use of neuroleptic drugs cuases repetitive involuntary movements, such as grimacing and blinking

akinesia

loss or impairment of the power of voluntary movement(parkinsons)

akathisia

state of agitation, distress, and restlessness that is an occasional side effect of antipsychotic and adtidepressant drugs

anhedonia

unable to feel pleasure

dystonia

involuntary muscle contractions that cause repetitive or twisting movements

Anti-social

exploitive and disregards the rights of others


unlawful actions


deceitful


lacks empathy


manipulative


lacks personal responsibility and aggressive

borderline

unstable identity and relationships


fear of abandonment


splitting behaviors


manipulation


impulsive


self-mutilation and frequent SI



narcissistic

arrogaance


grandiose vies of self and self-importance


need for admiration


lacks empathy


strained relationships


sensitive to criticism

dependant

extremed dependency on others


need of a close relationship- even if abusive


lacks ability to make own decisions

Personality disorder nursing interventions

nurse slef assessment


milieu


safety is priority


use firm supportive approach


set boundaries


consequences

Treatment modalities for personality disorders

medication


cognitive behavioral therapy


dialectical behavior therapy


case management

Bipolar

Lithium 0.8-1.5- watch for signs of toxicity




Valproic Acid(depakote)- nausea vomiting, indigestion, hepatoxicity, pancreatitis aeb n/v, ab pain

Intellectual development disorder

mild- capable of independent living and development of social skills


moderate- can perform some activities independently,, some speech limitation


severe- can be trained in basic hygiene skills, communicates by acting out behaviors


profound- no capacity

Conduct disorder

persistent pattern of habaviorin which the basic rights of others and major age appropriate societal norms or rules are violated - high risk anti social personality isorder

ADD/ADHD pp

Autism Spectrum Disorder- withdrawl of child into the self and into a fantasy world of his or her own creation- more often in boys than girls, onset in early childhood- chaotic




ADHD- developmentally inapprorpriate degrees of inattention, impulsiveness and hyperactivity

Autism pp

Stimulant medications pp

SSRI/cns Stimulants


palpitations, tachycardia


anorexia, weight loss


Nausea, vomiting


constipation


severe liver damage


new or worsened psychiatric symptoms


administer at least 6 hours before bedtime


administer sustatined relaes forms in the morning


pt should be weighted regularly

Paraphilic disorders PP

repetitice or preferred sexual fanasies or behaviors that involve- preference for use of nonhuman object


suffering or humiliation(masochistic)


repetitive sexual activity with nonconsenting partners

Pedophilia PP

Adult desired to have sexual relations witha child, hetero or homo

Gender Dysphoria PP

Gender dysphoria occurs when there isincongruence between biological/assigned gender and one’s experienced/expressedgender. MAN WANTING TO BE WOMEN IS MOST COMMON.

Alternative medicine T

practices that differ from and are used instead of the usual traditional practices

complimentary medicine T

oractices that differ from but are used in conjunction with traditional or conventional medical treatement

Assertiveness training-T

assertive- standing up for one's own rights while protecting the rights of others