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Nurs 243 Exam 2
Ch 3, ch 11, 27
| Question | Answer |
|---|---|
| The nurse is assessing a new patient. Which patient statement would the nurse attribute to a neurobiological basis of mental disease? | “I like to eat all day long.” : Multiple types of brain activity serve as the basis of mental experience and behavior. Disturbances in biological drives, such as overeating or undereating, can be an indication of an underlying psychiatric disorder. T |
| The physician has written orders for four patients. Which medication order would the nurse question? | Ambien, take early in the morning Rationale: Ambien is a short-acting, sedative-hypnotic sleep agent that should be taken at bedtime. BuSpar, which does not have a strong sedative-hypnotic effect, can be taken in the morning. Restoril, a benzodiazepi |
| Which patient statement would require the nurse to provide further teaching? | “Herbal treatments are safe because they are made with all-natural ingredients.” Herbal treatments are not always considered safe; many can interact with traditional pharmaceuticals, causing serious side effects. Gingko biloba can cause bleeding. St. Jo |
| The nurse is caring for a patient who is taking lithium. Which adverse effect would the nurse anticipate? | Confusion Confusion is an anticipated adverse effect of lithium. Other potential adverse effects include polyuria, diarrhea, and hypothyroidism. |
| The nurse understands that norepinephrine is involved with the stimulation of which bodily process? | The “fight-or-flight” response to stress Norepinephrine is the transmitter involved in stimulation of the sympathetic branch of the autonomic nervous system for the “fight-or-flight” response to stress. Dopamine stimulates the hypothalamus to release |
| Norepinephrine is one of several neurotransmitters that are believed to be responsible for major depression. Selective norepinephrine reuptake inhibitors (SNRIs) are designed to prevent to degradation of norepinephrine at the synaptic gap. The theory is t | Serotonin is the “feel-good” neurotransmitter. It is believed to be a major player involved in depression. SSRIs are aimed at increasing serotonin. |
| GABA is a neurotransmitter that has a relaxing effect. Benzodiazepines work to enhance the effects of GABA to help us feel more relaxed. | MAO oxidase is an enzyme believed to break down the group of neurotransmitters known as monoamines (norepinephrine, serotonin, dopamine, and epinephrine). MAO inhibitors are believed to work by exerting their action on this enzyme (not allowing the breakd |
| Blocking the histamine 1 receptors leads to sedation and weight gain, although some patients who are agitated can benefit from the sedation. | Blockage of these receptors leads to a reduction in norepinephrine, which brings about vasodilation. Because of this effect, there is a drop in blood pressure. In addition, α1 receptors are responsible for ejaculation. Blockage of these receptors causes a |
| Blockage of these receptors inhibits acetylcholine, which is an important neurotransmitter involved in memory and organ functioning. Anticholinergic side effects related to antipsychotic medications include blurred vision, dry mouth, constipation, and uri | Dopamine is a neurotransmitter that is believed to be in overabundance in certain areas of the brain that are responsible for hallucinations. |
| A client receiving a psychotropic drug reports to the nurse that he is drowsy all the time and is having difficulty focusing his attention. The nurse will correctly interpret this symptom as related to the drug's effect on the brain's ability to regulate | sleep.A number of psychotropic drugs have side effects that interfere with the brain's ability to regulate sleep alertness. These side effects range from lethargy to extreme drowsiness. As the client's body becomes accustomed to the drug, the drowsiness s |
| A client's communication is marked by loose associations and word salad. Dysfunction of which portion of the brain is responsible for these symptoms? | Cerebrum - The ability to think and speak logically is controlled by the cerebrum. |
| On the basis of the current understanding of neurotransmitters, the nurse can view a client's symptoms of profound depression as likely related in part to | decreased serotonin level. - A lowered serotonin level is highly supported as being related to depression; however, depression is more probably influenced by a number of neurotransmitter abnormalities. |
| A nursing assistant shares with the nurse that a client with schizophrenia is as difficult to communicate with as," someone with Alzheimer's." The nurse offers the following advice: | "His medication targets his disturbed thought and speech patterns. To maximize improvement he will need positive interactions and support." |
| The nurse caring for a client taking risperidone (Risperidal) observes the client carefully for: | napping during the day, a weight gain, and reports of dizziness. H1 blockade has the potential to produce sedation, weight gain, and hypotension. |
| When the nurse cares for a client taking an antipsychotic medication that blocks muscarinic receptors, the nurse would assess for: | blurred vision, dry mouth, and constipation.Anticholinergic effects are the effects produced by atropine: dry mouth, dry eyes, blurred vision, constipation, and urinary retention. Text page: 69 |
| The nurse responsible for the care of a client prescribed clonazepam (klonopin) would evaluate treatment as being successful when the client demonstrates: | ess anxiety γ-Aminobutyric acid is thought to modulate neuronal excitability and anxiety. A drug that increases the effectiveness of γ-aminobutyric acid would result in anxiety reduction. |
| The medication prescribed for a client acts by blocking reuptake of both serotonin and norepinephrine. The nurse evaluates the treatment as successful when observing: | Laughing at a joke Depression is thought to be at least in part caused by lowered levels of serotonin and norepinephrine. Increasing the amount of these transmitters in the brain by blocking reuptake may result in mood elevation. |
| The physician tells a client who demonstrates use of many rituals "We want to do an imaging study that will tell us which parts of your brain are particularly active. We believe the study will help us determine how to treat your symptoms." From this expla | positron emission tomography scan. - A positron emission tomography scan detects brain activity. The other imaging studies are limited to visualization of structures |
| A client is admitted to the hospital with severe depression. The nurse recognizes the possibility that depression may be related to a stress induced hormonal imbalance associated with: | Cortisol - Cortisol is a hormone released during periods of stress. |
| buspar | is a drug that reduces anxiety without having strong sedative hypnotic properties. It is not a cns depressant, no potential for addiction |
| tricyclic antidepressants TCAs | are thought to act primarily by blocking the reuptake of norepinephrine for the secondary amines |
| Selective serotonin reuptake inhibitors SSRIs | prozac, zoloft, paxil, celexa, lexapro and luvox |
| prozac, zoloft, paxil, celexa, lexapro and luvox | SSRIs - preferentially block the reuptake and thus the destruction of serotonin |
| Serotonin Norepinephrine reuptake inhibitors - SNRIs - Effexor (venlafaxine), Cymbalta | Increase both Serotinin and norepinephrine |
| stressors | are psychological or physical stimuli that are incompatible with current functioning |
| Fight or flight response - | is the bodys way of preparing for a situation an individuals perceives as a threat to survival. this response results in increased BP,HR and CO |
| GAS? | General Adaptation Syndrome |
| General Adaptation syndrome occurs in 3 stages | The alarm (acute stress), the resistance stage and the exhaustion stage |
| Explain the alarm (acute) stage of the GAS? | is the initial brief and adaptive response (fight or flight) - the brain cortex & Hypothalamas signal the adrenal gland to rease Catecholamine adrenalin. This increases the Sympathetic system - increase HR, RR, Bp, pupils dilate. Endorphins r released |
| what is the resistance stage of GAS? | adaptation stage - bc it is during this time sustained and optimal resistance to the stressor occurs. Usually stressors r overcome |
| the exhaustion stage of Gas? | when attempts to resist stressor prove futile, and the stress may become chronic, producing a wide array psychological and physiological responses. |
| distress | is a negative draining energy that results in anxiety, depression, confusion, helplessness, hopelessness and fatigue |
| eustress | is a positive beneficial energy hat motivates and results in feelings of happiness, hopeless, and purposeful movement. e.g. much needed vacation, the birth of a baby |
| acute stress can cause? | uneasiness/concern, sadness, suppression of the immune system, increased metabolism, infertility, increased energy, increased cardiovascular one, increased cardiopulmonary tone |
| Prolong stress can cause? | anxiety and panic attacks, depression or melancholia, anorexia or overeating, lowered resistance to infections, leading to opportunistic viral bacterial infections,, hypertension, insulin resistance DM,Amenorrhea, impotence, heart attack, angia. |
| serotonin is a brain catecholamine that plays an important role in | mood, sleep, sexuality, appetite and metabolism |
| Serotonin is a neurotransmitter that is used for depression by? | in by increasing the availability of serotonin. |
| stress influences the immune system such as | corticosteroids are release in response to stress and inhibit the immune system which increase susceptibility to illness |
| stress can also trigger what else? | dissimilar situations -emotional arousal, fatigue, fear,loss,humiliation, loss of blood, extreme happiness, unexpected success |
| physical stressors include | environmental conditions - trauma, excessive cold or heat and physical conditions such as infection, hemorrhage, hunger and pain |
| psychological stressors | include such things as divorce, loss of a job, unmanageable debt, the death of a loved one, retirement and fear of of a terrorist attack as well as changes we might consider positive - marriage, arrival of a new baby unexpected success |
| who create the fight or flight response? | walter cannon |
| what is the fight or flight response? | Body prepares for situation that individual perceives as threat to survival, New research indicates that men and women have different neural responses to stress |
| Who created the GAS? General adaptation syndrome? | Hans Selye |
| What are the 3 stages of GAS? | Alarm or acute stress stage Resistance or adaptation stage Exhaustion stage |
| who created the psychological reactions? | Lazarus |
| What are the psychological reactions? | distress and eustress |
| who created the progressive muscle relaxation technique? | edmund jacobson 1938 |
| what is progressive muscle relaxation technique? | rather simple procedure that elicits a relaxation response - accomplished by tensing groups of muscle begining with the feet and ending with face as tightly as possible for 8 secs and suddenly releasing |
| who was herbert benson 1975 | he expanded on jacobsons work - work influenced by eastern practices focusing on a pleasant mental image in a calm and peaceful environment- allows patient to switch from sympathetic mode to a state of relation. |
| meditation | follows the basic guidelines described for relaxation - training the mind to develop greater calm and then using that calm to bring penetrative insight |
| guided imagery | is a process wherby a person is led to envision images that are both calming and health enhancing and can be used in junction with benson relaxation tech |
| biofeedback | provides immediate and exact information regarding muscle activity brain waves, skin temperature, heart rate, blood pressure and other bodily functions |
| cognitive reframing | cognitive reframing |
| the goal of cognitive reframing is what? | is to change the individuals perceptions of stress by reassessing a situation and replacing irrational beliefs |
| mindfulness | it is based on the premise that we are not aware of ourselves moment to moment but operate on a sort of mental autopilot. happines or lack of happiness is not caused by outside forced but by own own perception and interpretation of reality |
| journaling is | is an extremely useful and surprisingly simple method of identifying stressor. it is a tech that can ease worry and obsession, help identify hopes and fears, increase energy levels and confidence. |
| humor | is a cognitive approach is a good example of how a stressful situation can be turned upside down |
| defense mechanism: altruism | dealing with anxiety by reaching out to others - a nurse who lost a family member in a fire is a volunteer firefigheter |
| defense mechanism:sublimation | dealing with unacceptable feelings or impulses by unconsciously substituting acceptable forms of expression: a person who has feelings of anger and hostility toward his work supervisor sublimates those feelings by working out vigorously at the gym @ lunch |
| defense mechanism:suppresion | voluntarily denying unpleasant thoughts and feelings: a person who lost his job states he will worry about paying his bills next week |
| defense mechanism:Repression | putting unacceptable ideas thoughts and emotions out of conscious awareness: A person who has a fear of the dentist drill continually forgets his dental appointments |
| defense mechanisms: displacement | shifting feelings related to an object, person or situation to another less threatening object, person or situation e.g. a person who is angry about losing his job destroys his child's favorite toy |
| defense mechanisms: reaction formation | overcompensating or demonstrating the opposite behavior of what is felt: a person who dislikes her sister daughter offers to babysit so that he sister can go out of town |
| defense mechanisms: somatization | developing a physical symptom in a place of anxiety - a school age child develops abdominal pain to avoid going to school where he is being bullied |
| defense mechanisms: undoing | performing an act to make up for prior behavior. an adolescent completes his chores without being prompted after having an argument with his parent |
| defense mechanisms: rationalization | creating reasonable and acceptable explanations for unacceptable behavior- a young adult explains he had to drive home from a party after drinking alcohol because he had to feed his dog |
| defense mechanisms: aggression | indirectly behaving aggressively but appearing to be compliant. a person coworkers agrees to take on one of her assignments but then does not meet the deadline |
| defense mechanisms: acting out behaviors | managing emotional conflicts through actions, rather than self reflection. A preschool child is told to share her toys so she throws the toys across the room. |
| defense mechanisms: dissociation | temporarily blocking memories and perceptions from consciusness, an adolescent witnesses a shooting and is unable to recall any details of the event |
| defense mechanisms: devaluation | expressing negative thoughts of self or others. a person who is passed up for a promotion states that the job is not better than the one he currently has |
| defense mechanisms: idealiation | expressing extremely positive thoughts of self or others - a school age boy boasts about his older brother and his accomplishments |
| defense mechanisms:splitting | demonstrating an inability to reconcile negative and positive attributes of self or others - a client tells a nurse that she is the only one who cares abut her yet the following day the same client refuses to talk to the nurse |
| defense mechanisms: projection | blaming others for unacceptable thoughts and feelings - a young adult blames his substance abuse on his parents refusal to buy him a new car |
| defense mechanisms: denial | pretending the truth is not reality to manage the anxiety of acknowledging what is real. a parent who is informed that his sons was killed in combat tells everyone he is coming home for the holidays |
| Violence may be caused | by a family member, a stranger, or an acquaintance or it can come from a human made mass casualty incident such as terrorist attack |
| Natural disaster such as hurricanes and earthquakes can cause | mental health effects comparable to those caused by human made violence |
| Violence against a person with mental illness is more likely to occur when factors such as | poverty, transient lifestyle and substance abuse are present |
| *A person with mental illness is no more likely to harm strangers than anyone else | |
| The factor most likely to cause violence between strangers is | a past history of violence and criminal activity |
| Victims are at the greatest risk for violence when | they try to leave the relationship |
| Factors that make abuse against children are: | The child is under 3 years of age The child is perceived by the perpetrator as being different |
| Older adults within the home may be abused because | they are in poor health or because they exhibit disruptive behavior and because they are dependent on a caregiver. |
| Violence is most common within family groups and most violence is aimed at family and friends rather than strangers | |
| Cycle of Violence – What are the phases: | tension building phase, serious battering phase, honey moon phase and periods of escalation |
| Tension building phase | the abuser has minor episodes of anger and may be verbally abusive and responsible for some minor physical violence. The victim is tense during this stage and tends to accept the blame for what is happening |
| Serious battering phase | the tension becomes too much to bear and serious incident takes place. The victim may try to cover up the injury or may get help |
| Honeymoon phase | the situation is defused for awhile after the violent episode. The abuser becomes loving, promises to change, and is sorry for the behavior. The victim wants to believe this and hopes for a change. |
| Periods of escalation and De-escalation | usually continue with shorter and shorter periods of time between the two. Repeated episodes of violence lead to feelings of powerlessness |
| Physical violence occurs when pain or harm results: | Toward an infant or child, as is the case with shaken baby syndrome (caused by violent shaking of young infants) ■■ Toward a domestic partner, such as striking or strangling the partner ■■ Toward an older adult in the home (elder abuse), such as pushin |
| Sexual violence occurs when | sexual contact takes place without consent, whether the victim is able or unable to give that consent. |
| Emotional violence, which includes | behavior that minimizes an individual’s feelings of self-worth or humiliates, threatens, or intimidates a family member. |
| Neglect, which includes the failure to provide: | Physical care, such as feeding The emotional care, such as interacting with a child, and/or stimulation necessary for a child to develop normally An education for a child, such as enrolling a young child in school Needed health or dental care |
| Economic maltreatment, which includes: | Failure to provide the needs of a victim when adequate funds are available ■■ Unpaid bills, resulting in disconnection of heat or electricity |
| Victim characteristics | Demonstration of low self-esteem and feelings of helplessness, hopelessness, powerlessness, guilt, and shame Attempts to protect the perpetrator and Possible denial of the severity of the situation and feelings of anger and terror |
| Perpetrator characteristics | Possible use of threats and intimidation to control the victim ■■ Is usually an extreme disciplinarian who believes in physical punishment ■■ Possible history of substance abuse ■■ Is likely to have experienced family violence as a child |
| Infants | Shaken baby syndrome – Shaking may cause intracranial hemorrhage. Assess for respiratory distress, bulging fontanelles, and increased head circumference. Retinal hemorrhage may be present. |
| Any bruising on an infant before age 6 months is | suspicious. |
| Assess for unusual bruising, such as on abdomen, back, or buttocks. Bruising is common on | arms and legs in these age groups. |
| Assess the mechanism of injury, which may not be congruent with the physical appearance of the injury. Numerous bruises at different stages of healing may indicate | continued beatings. Be suspicious of bruises or welts that have taken on the shape of a belt buckle or other object. |
| Assess for burns. Burns covering “glove” or “stocking” areas of the hands or feet may indicate | forced immersion into boiling water. Small, round burns may be caused by lit cigarettes. |
| Assess for fractures with unusual features, such | as forearm spiral fractures, which could be caused by twisting the extremity forcefully. The presence of multiple fractures is suspicious. |
| Assess for any bruises, lacerations, abrasions, or fractures in which the | physical appearance does not match the history or mechanism of injury |
| neologisms | are made up words (idiosyncratic uses of existing words) that have meaning |
| Echolalia | is the pathological repeating of anothers words and is often seen in catatonia |
| echopraxia | is the mimicking of movements of another it is also seen in catatonia |
| clang association | is the choce of words based on their sounds rther their meaning often rhyming and sometimes having similar begining |
| word salad | is a jumble of words that is meaningless to the listener - and perhaps to the speaker as wel |
| depersonalization is a | nonspecific feeling that a person has lost his or her identity and that the self is different or unreal. |
| derealization is a false perception that the environment has changed | hallucinations is a false perception that the environment has changed |
| hallucinations | involve perceiving a sensory experience for which no external stimulus exist |
| gustatory | experiencing tastes |
| tactile | feeling bodily sensations |
| affect | is the observable behavior that indicates a persons emotional state. |
| flat | immobile or blank facial expresion |
| blunted | reduced or minimal emotional response |
| inappropriate | emotional response incongruent with the tone or circumstances of the situation |
| bizarre | odd illogical emotional state that is grossly inappropriate or unfounded |
| anergia | lack of energy; passivity lack of persistence at work or school |
| avolition | reduced motivation; inability to initiate task such as social contacts grooming and other activities of daily living ADLS |
| poverty of content of speech | while adequate in amount, speech converys little information because of vagueness or superficiality |
| poverty of speech | reduced amount of speech-responses range from brief to one word answers |
| thought blocking | a sudden interruption in the thought process usually due to internal stimuli |
| anosognosia | an inability to realize they are ill that is caused by the illness itself |
| Schizophrenia is | a group of psychotic disorders that affect thinking, behavior, emotions, and the ability to perceive reality. |
| Schizophrenia probably results from | a combination of genetic and nongenetic factors (injury at birth, nutritional factors, viral infection, and hormonal imbalances). |
| The typical age of schizophrenia onset is | late teens and early twenties, but schizophrenia has occurred in young children and may begin in later adulthood. |
| Type of Schizophrenia Paranoid | Characterized by suspicion toward others. |
| Schizophrenia Paranoid Common Symptoms | Hallucinations, such as hearing threatening voices, and delusions, such as believing oneself president of the United States • Other-directed violence may occur. |
| Type of Schizophrenia Disorganized | Characterized by withdrawal from society and very inappropriate behaviors, such as poor hygiene or muttering constantly to oneself. • Frequently seen in the homeless population. |
| Schizophrenia Disorganized Common Symptoms | • Loose associations • Bizarre mannerisms • Incoherent speech • Hallucinations and delusions may be present but are much less organized than those seen in the client with paranoia. |
| Type of Schizophrenia Catatonic | Characterized by abnormal motor movements. • There are two stages: the withdrawn stage and the excited stage. |
| Schizophrenia Catatonic Common Symptoms | Withdrawn stage • Psychomotor retardation; the client may appear comatose. • Waxy flexibility may be present. • The client often has extreme self-care needs, such as for tube feeding due to an inability to eat. Excited stage • Constant movement, u |
| Type of Schizophrenia Residual | Active symptoms are no longer present, but the client has two or more “residual” symptoms. |
| Schizophrenia Residual Common Symptoms | Anergia, anhedonia, or avolition • Withdrawal from social activities • Impaired role function • Speech problems, such as alogia • Odd behaviors, such as walking in a strange way |
| Type of Schizophrenia Undifferentiated | The client has symptoms of schizophrenia but does not meet criteria for any of the other types. |
| Schizophrenia Undifferentiated Common Symptoms | Any positive or negative symptoms may be present. |
| Schizoaffective disorder | The client’s disorder meets both the criteria for schizophrenia and one of the affective disorders (depression, mania, or a mixed disorder). |
| Brief psychotic disorder – | The client has psychotic symptoms that last between 1 day to 1 month in duration. |
| Schizophreniform disorder | The client has symptoms like those of schizophrenia, but the duration is from 1 to 6 months and social/occupational dysfunction may or may not be present. |
| Shared psychotic disorder – | One person begins to share the delusional beliefs of another person with psychosis. This is also called Folie à Deux. |
| Secondary (induced) psychosis | Signs of psychosis are brought on by a medical disorder, such as Alzheimer’s disease, or by use of chemical substances, such as alcohol abuse. |
| Cognitive symptoms of Schizophrenia | Problems with thinking make it very difficult for the client to live independently. |
| Cognitive symptoms of Schizophrenia Examples | Disordered thinking • Inability to make decisions • Poor problem-solving ability • Difficulty concentrating to perform tasks • Memory deficits ◯◯ Long-term memory ◯◯ Working memory, such as inability to follow directions to find an address |
| Depressive symptoms | • Hopelessness • Suicidal ideation |
| delusions-Ideas of reference | Misconstrues trivial events and attaches personal significance to them, such as believing that others, who are discussing the next meal, are talking about him. |
| delusions-Persecution | Feels singled out for harm by others (e.g., being hunted down by the FBI). |
| delusions-Grandeur | Believes that she is all powerful and important, like a god. |
| delusions-Somatic delusions | Believes that his body is changing in an unusual way, such as growing a third arm. |
| delusions-Jealousy | May feel that her spouse is sexually involved with another individual. |
| delusions-Being controlled | Believes that a force outside his body is controlling him. |
| delusions-Thought broadcasting | Believes that her thoughts are heard by others. |
| delusions-Thought insertion | Believes that others’ thoughts are being inserted into his mind. |
| delusions-thought withdrawal | Believes that her thoughts have been removed from her mind by an outside agency. |
| delusions-Religiosity | Is obsessed with religious beliefs. |
| Alterations in speech-Flight of ideas | Associative looseness • The 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. |
| Alterations in speech-Neologisms | Made up words that only have meaning to the client, such as, “I tranged and flittled.” |
| Alterations in speech-Echolalia | The client repeats the words spoken to him. |
| Alterations in speech-Echolalia | Meaningless rhyming of words, often forceful, such as, “Oh fox, box, and lox.” |
| Alterations in speech-Word salad | Words jumbled together with little meaning or significance to listener, such as, “Hip hooray, the flip is cast and wide-sprinting in the forest.” |
| Hallucinations are sensory | perceptions that do not have any apparent external stimulus. Examples include: |
| Hallucinations are sensory perceptions that do not have any apparent external stimulus. Examples include: ☐☐ Auditory | hearing voices or sounds that may take the form of commands instructing the client to hurt self or others. |
| Personal boundary difficulties | disenfranchisement with one’s own body, identity, and perceptions. This includes: |
| Personal boundary difficulties – disenfranchisement with one’s own body, identity, and perceptions. This includes: | Depersonalization – nonspecific feeling that a person has lost her identity; self is different or unreal. ☐☐ Derealization – perception that environment has changed. |
| Echopraxia | purposeful imitation of movements made by others |
| Negativism | doing the opposite of what is requested |
| Stupor | motionless for long periods of time, coma-like |
| Wavy flexibility | excessive maintenance of position |
| Automatic obedience – | responding in a robot-like manner |
| Stereotyped behaviors | motor patterns that had meaning to client (sweeping the floor) but now are mechanical and lack purpose |
| Standardized Screening Tools | The Global Assessment of Functioning (GAF) scale – helps to determine a client’s ability to perform activities of daily living and to function independently ◯◯ Scale for Assessment of Negative Symptoms ◯◯ Simpson Neurological Rating Scale |
| Atypical antipsychotics are current medications of choice for psychotic disorders, and they generally treat both positive and negative symptoms. | • Risperidone (Risperdal) • Olanzapine (Zyprexa) • Quetiapine (Seroquel) • Ziprasidone (Geodon) • Aripiprazole (Abilify) • Clozapine (Clozaril) |
| • Risperidone (Risperdal) • Olanzapine (Zyprexa) • Quetiapine (Seroquel) • Ziprasidone (Geodon) • Aripiprazole (Abilify) • Clozapine (Clozaril) | • To minimize weight gain advise • Symptoms of agitation, dizziness, sedation, and sleep disruption may occur. Instruct the client to report these side effects to his provider, as the medication may need to be changed. |
| Conventional antipsychotics are used to treat mainly positive psychotic symptoms. | • Haloperidol (Haldol) • Loxapine (Loxitane) • Chlorpromazine (Thorazine) • Fluphenazine (Prolixin) |
| • Haloperidol (Haldol) • Loxapine (Loxitane) • Chlorpromazine (Thorazine) • Fluphenazine (Prolixin) | anticholinergic effects,hypotension |
| Antidepressants are used to treat the depression seen in many clients with schizophrenia. | Paroxetine (Paxil) |
| Paroxetine (Paxil) | Used temporarily to treat depression associated with schizophrenia. |
| Anxiolytics/benzodiazepines are used to treat the anxiety often found in clients with schizophrenia, as well as some of the positive and negative symptoms of schizophrenia. | Lorazepam (Ativan) • Clonazepam (Klonopin) |
| Sexual assault is defined as | pressured or forced sexual contact, including sexually stimulated talk or actions, inappropriate touching or intercourse, incest, and rape (forced sexual intercourse). |
| Rape is a | crime of violence, aggression, anger, and power. |
| The majority of rapists are known to the person who is raped. | Most people who are raped suffer long-term and severe emotional trauma. |
| Rape-trauma syndrome Acute phase – | occurs immediately following the rape and lasts for about 2 weeks and consisting of the following: |
| Initial emotional reaction | An expressed reaction is overt and consists of emotional outbursts,including crying, laughing, hysteria, anger, and incoherence. A controlled reaction is ambiguous;the survivor may appear calm and have blunted affect, but may also be confused, have diffi |
| A somatic reaction occurs later and lasts about | 2 weeks. The client may have a variety of symptoms, including: |
| A somatic reaction occurs later and lasts about 2 weeks. The client may have a variety of symptoms, including: | Bruising and soreness from the attack Muscle tension, headaches, and sleep disturbancesGastrointestinal symptoms (nausea, anorexia, diarrhea, abdominal pain)Genitourinary symptoms (vaginal pain or discomfort)A variety of emotional reactions, including em |
| Long-term psychological effects of sexual assault include: | Flashbacks and other intrusive thoughts about the assaultIncreased activity, such as visiting friends frequently or moving residence, due toa fear that the assault will recur Increased emotional responses (crying, anxiety, rapid mood swings)Fears and phob |
| Compound reaction | Reliance on alcohol or other drugs ■■ Reactivated symptoms of previous conditions, such as physical or psychiatric illness |
| Silent reaction | Abrupt changes in relationships with partners Nightmares ncreased anxiety during interview Marked changes in sexual behavior Sudden onset of phobic reactionsNo verbalization of the occurrence of rape |
| Anger, a normal feeling, is an | emotional response to frustration as perceived by the individual. It can be positive if there is truly an unfair or wrong situation that needs to be righted. |
| Anger becomes negative when it is | denied, suppressed, or expressed inappropriately, such as by using aggressive behavior. |
| Denied or suppressed anger can manifest as | physical or psychological symptoms, such as headaches, coronary artery disease, hypertension, gastric ulcers, depression, or low self-esteem. |
| Aggression | Inappropriately expressed anger can become hostility or aggression.,Aggression includes physical or verbal responses that indicate rage and potential harm to self, others, or property. |
| Comorbidities include | depressive disorders, PTSD, Alzheimer’s disease, and personality and psychotic disorders. |
| Preassaultive | The client begins to become angry and exhibits increasing anxiety, hyperactivity, and verbal abuse. |
| Assaultive | The client commits an act of violence. Seclusion and physical restraints may be required. |
| Postassaultive | Staff reviews the incident with the client during this stage. |
| Seclusion and restraint must be used only | according to legal guidelines and should be the interventions of last resort after other less restrictive options have been tried. |
| ● Risk Factors for aggresion | ◯◯ Past history of aggression, poor impulse control, and violence ◯◯ Poor coping skills, limited support systems ◯◯ Comorbidity that leads to acts of violence (psychotic delusions, command hallucinations, violent angry reactions with cognitive disorder |
| Haloperidol is an antipsychotic agent used to | control aggressive and impulsive behavior. |
| anger | is an emotional response to frustration of desires a threat to ones need or a challenge |
| aggression is | an action or behavior that results in a verbal or physical attack |
| one area of the brain known to be associated with aggression is the | limbic system which mediates primitive emotion and behavior necessary for survival |
| the area of the brain that mediates the anger experiences, judging events as either aversive or rewarding is | amygdala |
| studies have shown a relationship between impulsive aggression and low levels of | serotonin |
| what has also been linked to aggressive outburts | dopamine |
| the three basic type of situations are | develomental/maturational, situational and disasters/adventitious |
| a situational crisis | arises from events that are extra ordinary |
| adventitious crisis | is not a part of everyday life |
| Situational/external | often unanticipated loss or change experienced in every day, often unanticipated, life events |
| Maturational/internal | achieving new developmental stages, which requires learning additional coping mechanisms |
| Phases of a crisis 1 | Escalating anxiety from a threat activates increased defense responses. |
| Phases of a crisis | Anxiety continues escalating as defense responses fail, functioning becomes disorganized, and the client resorts to trial-and-error attempts to resolve anxiety. |
| Phases of a crisis | Trial-and-error methods of resolution fail, and the client’s anxiety escalates to severe or panic levels, leading to flight or withdrawal behaviors. |
| Phases of a crisis | The client experiences overwhelming anxiety that can lead to anguish and apprehension, feelings of powerlessness and being overwhelmed, dissociative symptoms (depersonalization, detachment from reality), depression, confusion, and/or violence against o |
| acute stress can cause;` | UNEASINESSS and concern, sadnes, loss of appetite, suppression of the immune system, increase metabolism and use of body fats, infertility, increased energy mobilization and use, increased cardiovascular tone, increased cardiopulmonary tone |
| prolong stress can sause | anxiety and panic attacks, depression or melancholia, anorexia or overeating, lowered resistance to infections, leading to increase in opportunisitc viral and bacterial infections, insulin resistant diabetes, hypertension, increased fatigue and irritabili |
| stress response - short term effects on the hypotahalamus | fluid losds, increase glucose, decrease inflammation, decrease brain NE |
| Short term effects on the Sympathetic adrenal medulla (SAM) | increase HR, increase respiration, increase NE E , plasma, increase trig, increase plate, decrease kidney, increase blood and increase muscular |
| effective stress busters | sleep, exercise, reduction or cessation of caffeine, music, pets and massage |
| stress is a | universal experience and important concept when caring for any patient in any setting |
| the body responds imilarly wheterh stressors are real or perceived and wheth | |
| the body reacts to anxiety and fear by | arousal of the sympathetic nervous system. speciic symp include rapid hr, increase bp, diaphoresis, peripheral vasoconstriction restlessness, repetitive questioning, feelings of frustration and difficulty concentrating |
| cannon introduced | the fight or flight model fo stress |
| selye introduced the widely known | general adaptation syndrome (GAS) |
| the psychoneuroimmunology model describes the | immune systems response to stress and effect on neural pathways int he brain |
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