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Test 4 Nur 185
Somatoform Disorders, Cognitive Disorders and Anger & Aggression
| Question | Answer |
|---|---|
| When you think of somatoform, what should come to mind? | Physical symptoms without any pathology |
| When you think of dissociative, what should come to mind? | Integration and disorganization; person breaks down into different personalities |
| With somatization, how do physical symptoms occur? | Pt has a great deal of anxiety and no way of relieving it, so it’s repressed and manifests as physical ailment |
| What are some chromic symptoms of somatization? | Pain in regards to GI, sexual, neurological |
| What is pain d/o? | Significant problems with pain that affect social, occupational and other areas of functioning |
| What is the cause of pain interrelated with? | Stressful situations |
| What is the primary gain with pain d/o? | Client avoids unpleasantness whether it’s by avoidance or medication |
| What is the secondary gain with pain d/o? | Client gets emotional support or attention |
| What is hypochondriasis? | Client believes they are seriously ill to the point where the ‘fear’ disables them and they continue to ‘doctor shop’ |
| What d/o usually accompany hypochondriasis? | Anxiety, depression and OCD |
| What is conversion disorder? | A loss or change in body function where the client is unaware that it results from a psychological problem |
| What are some of the impaired body functions that accompany conversion disorder? | Voluntary motor function such as paralysis, difficulty swallowing or sensory functioning |
| When do symptoms occur for conversion disorder? | After extreme psychological stress |
| What is La Bell Indifference? | When the client seems to not be concerned about the paralysis and there’s no patho reason for it; reaction based on what’s happening is totally at odds |
| Can conversion disorder get better? | Yes, sometimes it can get better spontaneously but seizures and tremors may not be resolved |
| What is body dysmorphic disorder? | An exaggerated belief that the body is defective or deformed |
| What somatoform disorder is the most common? | Body dysmorphic disorder |
| What is body dysmorphic disorder commonly associated with? | Depression |
| What personality disorders are commonly associated with? | OCD, schizoid, & narcissistic |
| How do you treat body dysmorphic disorder? | SSRI’s are helpful |
| What are some predisposing factors of somatoform disorders? | Genetics-higher incidence of kids w/parents w/disorder; biochemical-low lvls of sero. & endo.; psychodynamic-ego DM & low self-esteem; family dynamics-limited expression of emotions/conflicts; learning theory-reinforced when pt avoids stressful situations |
| What is dissociative amnesia? | A rare pathologic loss of memory either organic, emotional, dissociative or mixed. May be permanent or limited |
| What type of memory are you unable to recall with dissociative amnesia? | Important personal information |
| What are the five types of disturbances with dissociative amnesia? | Localized amnesia, selective amnesia, continuous amnesia, generalized amnesia & systematized amnesia |
| What is dissociative fugue? | When client unintentionally leaves home or work and goes to completely unfamiliar environment; they are confused about their past and their identity may actually assume a new identity |
| How are some of these clients with dissociative fugue found? | Sometimes they are found wandering and their behaviors land them in the ED |
| How long does dissociative fugue last? | It could last hours to days and then may suddenly resolve on it’s own |
| How common is dissociative fugue? | Not very common at all, it’s rare |
| What is dissociative identity disorder? | Mind shatters into different personalities that are created to protect the core; one personality is evident at a time, are unique, and have different memories & behaviors |
| How do transitions occur in DID? | Usually suddenly, and the personalities have gaps of lost time where they can lose days, months and years |
| With DID, are the personalities aware of one another? | No, usually they aren’t aware of each other until therapy occurs |
| What is depersonalization disorder? | A common and temporary form of detachment from environment or seeing oneself from outside the body |
| What does this phenomena usually occur with? | Schizophrenia, depression to name a few |
| What is derealization and what does it occur with? | Derealization occurs with depersonalization disorder and is when a person’s perception of the environment is altered |
| How does a client feel when they are experiencing a depersonalization disorder? | They feel like they are going crazy, feel anxious and/or depressed |
| What are some predisposing factors associated with dissociative disorders? | Neurobiological-studying chemicals in brain, epilepsy and migraines assoc. with DID; psychodynamic theory-repression of events as a coping mechanism; psychological trauma-overwhelms pt to cope for survival; really can’t pin anything down as to the cause |
| What are some nursing diagnoses for somatoform disorders? | Ineffective coping, fear, disturbed sensory perception, disturbed thought processes, disturbed personal identity |
| How does psychotherapy help with somatoform disorders? | It focuses on personal and social difficulties |
| How does group therapy help with somatoform disorders? | Pts share and accept responsibility; when these things are shared, the pts feel more hopeful and they learn coping strategies |
| How does behavior therapy work with somatoform disorders? | It works with the family and significant others who enable symptoms |
| What psychopharmacology works with somatoform disorders? | Antidepressants (TCA’s) like Elavil help with the pain that accompanies this disorder and anticonvulsants such as Depakote and Valproic acid are used but these meds don’t make the situation 100% better |
| What meds are used with body dysmorphic disorder? | TCA- clomipramine (Anafranil) and (SSRI) fluoxetine (Prozac) |
| With somatoform disorder, which therapy works best? | None, these therapies work best when they are combine with one another |
| How do you treat dissociative amnesia? | Most of the time it will resolve spontaneously when stressful situation is removed, harder cases will used Barbiturate such as Amytal, hypnosis but the pt has to eventually remember the trauma to be able to work through it |
| How do you treat dissociative fugue? | The pt has to come to terms with the trauma with the use of cognitive/group therapy |
| How is dissociative identity disorder treated? | By integration using psychotherapy and having the personalities remember with feeling the trauma; takes years of psychotherapy because sometimes the personalities don’t want to come together |
| How is depersonalization disorder treated? | This is still under study because researchers still don’t know what works best for this disorder |
| What are examples of dementia? | Alzheimer’s, Vascular Dementia, Parkinson’s Disease, Huntington’s Chorea, Pick’s Disease, Creutzfeldt-Jakob Disease |
| Which two examples of dementia are very rare? | Pick’s Disease & Creutzfeldt-Jakob Disease |
| What is the percentage of pts with Parkinson’s Disease that will have dementia? | 60% |
| What is the definition of cognitive disorder? | It is a deficit in memory and cognition where changes take place in functioning |
| What is delirium? | It is a disturbance in cognition, confusion, excitement, disorientation and clouding of consciousness that includes hallucinations and illusions |
| Is Delirium the same as Dementia? | No, actually delirium is actually misdiagnosed as dementia |
| What will a patient will delirium experience? | They may be very confused and become excited, if their routine becomes disrupted, they can become very agitated and have hallucinations and illusions |
| Is it with dementia or delirium that a pt can experience hallucinations and illusions? | Delirium only |
| What is the onset of delirium? | It can have an abrupt onset after head injuries/seizures but a slower onset is more common; duration is brief-symptoms get better but it could evolve into permanent disorder |
| What are the etiologies of delirium? | Can be caused by a general medical condition; substance-induced condition such as with cocaine, methadone; substance-intoxication/withdrawal; multiple reasons |
| Why would methadone cause delirium? | It causes confusion and excitability and when weaned, most cognitive processes should come back; most cases are reversible |
| What is dementia? | A loss of cognition and memory function while maintaining full alert status; impairment-thinking, judgment, impulse control |
| What is primary dementia? | Dementia that is not directly related to any organic illness including Alzheimer’s |
| What is secondary dementia? | Dementia that is related to another disease such as HIV |
| What is the progression of dementia? | Language, personality change, motor activities & 7 stages |
| What are the 7 stages of progression of dementia? | 1-No obvious symptoms, 2-Forgetfulness, 3-Mild Decline, 4-Mild-Moderate Confusion, 5-Early Dementia, 6-Middle Dementia, 7-Severe-Late Dementia |
| What happens in the first stage of dementia? | Pt may be forgetful and have trouble finding a name of something, slight concern to pt who’s developing dementia |
| What happens in the second stage of dementia? | Pt may lose things or forget the names off ppl they know, short term memory may be lost, still other ppl may not notice & pt becomes more and more aware of their inability to remember things |
| What happens in the third stage of dementia? | Interference starts to show up in relationships/job, pts will have less focus on tasks, they may remember deadline but they won’t get things done due to wandering mind & they can’t totally focus, other ppl pt knows start to see something is wrong |
| What happens in the forth stage of dementia? | Pt begins to forget significant events in their life & ppl closest to them, evident confusion, work & social is hard, severe cognitive problems, confabulation, pt's aware they are sicker, may ask for help & begin to get depressed, seems easily lost |
| /What happens in the fifth stage of dementia? | Pt is not able to perform their own ADL’s, very disorientated and start to withdraw |
| What happens in the sixth stage of dementia? | Pt cant name objects they’re using or it’s function, no longer remember the name of ppl close to them, incontinence, insomnia, sun downing, need full supervision |
| What happens in the seventh stage of dementia? | Hospitalized or long-term care facility, have trouble having needs met by family members, very taxing, pt becomes very rigid and resistant to movement |
| What is the progression of Alzheimer’s Disease? | It has a slow onset that is progressive and deteriorating, incurable, as pt reaches later stages the immune system is compromised; pathos are tangles and plaques |
| What is affected with vascular dementia? | Blood vessels are affected |
| What is vascular dementia? | It’s high uncontrolled blood pressure that is also to be a common factor in causation; the vessels will constrict & rupture and cause small areas of the brain to have a stroke |
| What will happen to the areas of the brain that are affected by vascular dementia? | The areas will degenerate and affect the area that that particular part of the brain controls; can happen in different portions of the brain |
| How is vascular dementia different from Alzheimer’s Disease? | It has a more abrupt onset, they are small strokes that destroy parts of the brain; common signs are weakness of extremities, small steps and speech difficulty |
| What is HIV Dementia? | The virus leads to brain infections and may also cause dementia during the end stage; pt can’t make reasonable judgments |
| What are the stages of HIV Dementia? | They almost follow the same course as the other stages of dementia with discernible to confusion; behavioral changes and psychoses |
| What are other types of Dementia due to? | Head trauma, Lewy Body Disease, Parkinson’s Disease, Huntington’s Disease, Picks’s Disease, Creutzfeldt-Jakob Disease, General Medical Conditions, Substance-induced Persisiting & Multiple Etiologies |
| What is Lewy Body Disease? | Named after a scientist who was trying to figure out the causes for Parkinson’s disease who found these pts had proteins that were taking the dopamine and depleting it which caused dementia |
| What is one of the first signs of Lewy Body disease? | The pt has trouble sleeping |
| What are early precursors for Lewy body disease? | Gesturing, mumbling, sleepwalking and confusion between the sleep and wake states |
| What is Pick’s disease? | A shrinkage of lobes of the brain and ppl will have problems with dementia; it’s a terminal, faulty cognitive disease |
| What is Creutzfeldt-Jakob disease? | It’s a rare, terminal disease that has ppl experiencing behavioral changes, failing memories and symptoms of dementia |
| What are examples of a general medical condition that can cause dementia? | Problems with the cardiovascular or endocrine functions |
| What are amnesic disorders? | The inability to remember/retain experiences from the past; inability to learn new information & recall previously learned information |
| How are amnesic disorders different from dementia? | Amnesic disorders do not have an impairment in cognitive processes such as abstract thinking/judgment and no personality change |
| Is there confabulation and denial involved with amnesic disorders like there are with dementia? | Yes |
| What are amnesic disorders due to? | Either a general medical condition or substance-induced persisting; take away the substance and disorder is gone |
| How is the nursing process involved with amnesic disorders? | Assess the mental status; physical assessment; labs; EEG, CT, MRI, Cerebrospinal fluid, PET |
| What are all the labs looked at for dementia? | To see if MD can determine the cause of dementia to see if they can treat the pt |
| What are some nursing diagnoses for dementia? | Risk for trauma; disturbed thought processes & sensory perception; impaired verbal communication; self-care deficit |
| What happens if a dementia pt isn’t in a structured environment? | They become agitated and confused |
| What sort of environment should you have for a dementia pt? | Low level stimuli; use same staff; have strict routine of feeding and going to the bathroom; need safe, enclosed place for pacing and wandering |
| How can you prevent sun downing with dementia patients? | Try to keep pts from napping during the day |
| What are the treatment modalities for delirium? | First identify the causes and corrections; remain with pt amid low stimuli; if agitated and aggressive use low-dose neuroleptics; for substance induced delirium MD’s usually prescribe benzodiazepine lorazepam (Ativan) |
| How does glutamate work with dementia? | It causes the release of calcium to increase and disrupt and destroy neuron |
| What is the definition of anger? | An emotional sate that varies in intensity mildly irritated to fury and rage |
| What are the physiological changes with anger? | Pulse and BP are elevated, hormone levels rise as epinephrine and norepinephrine as the body’s prep work for fight |
| Is anger a normal state? | Yes when rights or standards are violated |
| When does violence usually occur with anger? | When the individual loses control of their anger |
| What is the definition of aggression? | A behavior that threatens or injures the victim’s security or self-esteem; want to hurt/harm and almost always punish |
| Is aggression considered negative or positive? | Negative whereas anger may be viewed as positive |
| What are some predisposing factors to anger and aggression? | Modeling; operant conditioning; Neurophysiological disorders; biochemical factors; socioeconomic factors; environmental factors |
| What is operant conditioning? | When behavior is reinforced positively by pleasure reinforcement. Negative reinforcement response to a behavior that prevents an undesirable result |
| What are some Neurophysiological disorders that can predispose one to anger and aggression? | Epilepsy, tumors in the brain, encephalitis; these pathways of normal behavior can be located in diseased area or infected area |
| What are some biochemical factors that can predispose one to anger and aggression? | Cushing’s disease hormonal changes, too little thyroid; PMS not correlated; Hypothesis that epi and norepi may be associated with high levels of violence and acting out but not sure |
| What are some socioeconomic factors that can predispose one to anger and aggression? | High rates of violence in the lowest classes of poverty |
| What are some environmental factors that can predispose one to anger and aggression? | Physical overcrowding, extremely hot temperatures decrease aggression, alcohol, cocaine, amphetamines, hallucinogens and steroids; substances are abused more in lower economic standings |
| What are 3 factors that lead to aggression? | 1. Past history of violence; 2. Client diagnoses-schizo, bipolar (manic phase), borderline and antisocial when not controlled can act out aggressively; 3. Current behavior |
| What is the best intervention for anger and aggression? | Prevention |
| What is uncontrolled anger called seen as? | Negative |
| Is anger part of the natural grieving process? | Yes but it is usually viewed as negative, clients need assistance to understand that anger is an acceptable emotion |
| What is the cause of aggression? | Anger, anxiety, guilt, frustration or suspiciousness |
| What are the ranges of aggression? | Mild (sarcasm), moderate (slam doors), severe (threats of violence), extreme physical acts |
| Is aggression goal-directed? | Yes, it is goal directed with the purpose of doing harm |
| What is intent? | The behavior to inflict harm or destruction |
| What are not considered acts of aggression? | Accidents, which are unintentional harm or destruction |
| What is the one reason aggression is done for? | Aggression is done to harm; doesn’t have to be physical only, can be verbal, mental, etc |
| How can you successfully manage aggression? | By determining which patient will most likely become violent; you need to intervene to defuse the risk of violence |
| What are a couple of nursing diagnoses for aggression? | Ineffective coping and Risk for self-directed or other directed violence |
| What are some important interventions for aggression? | Stay calm; set limits on behavior; journal angry feelings; don’t touch; observe for escalation; sufficient staff on hand; talk down; physical outlets; medication |
| How can you successfully manage aggression? | By determining which patient will most likely become violent; you need to intervene to defuse the risk of violence |
| What are a couple of nursing diagnoses for aggression? | Ineffective coping and Risk for self-directed or other directed violence |
| What are some important interventions for aggression? | Stay calm; set limits on behavior; journal angry feelings; don’t touch; observe for escalation; sufficient staff on hand; talk down; physical outlets; medication |
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