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Mental
Final Exam
| Question | Answer |
|---|---|
| Therapeutic Relationship | -Genuineness:aware of one's feelings w/in the relationship; ability to meet person to person -Empathy: seeing from other person's perspective; communicating this understanding -Positive Regard: respect, assume patient's goodwill |
| Empathy | -Involves active listening to the client and then communicating understanding of what the client is feeling and behaviors associated with those feelings |
| Sympathy | -Implies: pity, compassion, commiseration, condolence -Not very therapeutic -Better to offer empathy |
| Barriers | -Excessive questioning -Giving approval, disapproval -Giving advice -Asking why questions -Changing subjects -False reassurance -Making value judgments |
| Helpful Guidelines | -Speak briefly -When you don't know what to say, say nothing -When in doubt, focus on feelings -Avoid advice -Avoid relying on questions -Pay attention to nonverbal cues -Keep the focus on the client |
| Boundaries: Transference | -Unconscious process of transferring past childhood emotions onto individuals in the present -Accelerated toward a person in authority -Desire for affection or respect, gratification of dependency needs |
| Boundaries: Countertransference | -Nurse displaces onto the patient's feelings in nurse's past -Over identification with the patient |
| Countertransference Reactions | -Rescue: reaching for unattainable goals (giving advice) -Overinvolvement: ignoring peer suggestions (buying gifts) -Overidentification: Increase self disclosure (physical attraction) -Anger: withdrawing (speaking loudly) |
| DSM-IV-TR | -Axis I - mental disorder -Axis II - personality and mental retardation -Axis III - general medical disorder -Axis IV - psychosocial and environmental problems -Axis V - Global Assessment of Functioning |
| Diathesis-Stress Model | -Diathesis: biological predisposition -Stress: environmental stress/trauma -Most accepted explanation for mental illness -Combination of genetic vulnerability and negative environmental stressors |
| Behavioral Therapy | -Modeling -Operant conditioning: pos reinforcement -Systemic desensitization: address specific fears and gradually deal with them -Aversion therapy: punishment -Biofeedback |
| Maslow's Hierarchy of Needs | -Basic Needs -Self-esteem/ Self actualization -Biological/Physiological -Safety -Belongingness/Love -Esteem -Cognitive -Aesthetic -Self-actualization -Transcendence |
| Cognitive Theories | -Rational Emotive Behavioral Therapy: aims to eradicate irrational beliefs, recognize thoughts that aren't accurate -Cognitive Behavioral Therapy: test distorted beliefs and change way of thinking, reduce symptoms; give alternatives |
| Inpatient Psychiatric Care | -Admissions reserved for: suicidal, homicidal and extremely disabled in need of short term acute care |
| Inpatient Admission | -Direct Admission or hosp er dept -Criteria:danger to self/others or unable to care for basic needs -Voluntary:if came in voluntarily can ask to leave and physician can approve/deny -Involuntary(pink slipped)judge decides whether pt can leave or not |
| Partial Hospitalization Program | -Intensive, short term tx w/pt -able to return home each day -Pts receive 5-6h of tx daily -Typically 5d a wk -Average length of stay 2-3wks -Multidisciplinary team |
| Psychiatric Home Care | 4 Requirements -Homebound status of pt -Presence of psychiatric dx -Need for skills of RN -Plan of care under physician |
| Assertive Community Treatment | -For clients w/repeated hospitalizations, severe sx, or inability to participate in traditional tx -Multidisciplinary team -Work w/pts in homes,agencies,hosp or clinics -ACT team provides support and resources on call 24h/d |
| Community Mental Health Centers | -Emergency adult and children's services for those who have no access to private care -Med admin, indiv therapy, psychoeducational and therapy group, family therapy, dual dx tx |
| Primary Drug Classifications | -Antianxiety -Antidepressants -Mood Stabilizers -Antipsychotics -Anticholingerics -Stimulants |
| Destruction of Neurotransmitter | -Immediate inactivation at the postsynaptic membrane by an enzyme -Reuptake into the presynaptic cell where it is recycled or inactivated by an enzyme in the cell |
| Anxiety | -Necessary force for survival -Normal response to an observable fear -Subjective emotional response to stressor -Anixety=emotional response -Fear=cognitive response -Physical response=anxiety and fear |
| Mild Anxiety | -Tension of day to day living -Alert perceptual field -Motivation to learning |
| Moderate Anxiety | -Focus on immediate concerns -Narrow perceptual field -Selective inattention -Butterflies in stomach, facial twitches, trembling lips -ex: 1st day of clinical |
| Severe Anxiety | -Focus on specific detail -Perceptual field is greatly reduced -Frequent SOB, I BP,HR -Dry mouth, upset stomach, D,C, tense musc, restelessness |
| Panic | -Sense of awe,dread, and or terror -Loss of control -Disorganization of the personality -Sweating,restlessness, chest pain, body shaking, N, poor motor coordination |
| Mature Defenses | -Suppression: conscious denial of a disturbing situation or feeling -Sublimination: unconscious process of substituting mature, constitutional/socially acceptable activity for immature, destructive activity; turn a bad thing into a good thing |
| Neurotic Defenses | -Intellectualization: events are analyzed based on remove cold fact w/out passion -Repression: temp/long term exclusion of unpleasant/unwanted experience emotions/ideas from conscious awareness |
| Neurotic Defenses | -Reaction-Formation:unacceptable feelings are controlled and kept out of awareness by developing opp behavior -Undoing:make up for an act -Rationalization:justify illogical ideas actions or feelings by developing acceptable explanations |
| Neurotic Defenses | -Displacement: transference of emotion associated with a particular person to another nonthreatening person,object or situation |
| Immature Defenses | -Regression: reverting to a child like pattern of behavior -Projection: unconscious rejection of emotionally unacceptable features and attributing them to other people,objects or situations; blaming others |
| Psychotic Defenses | -Denial: escaping unpleasant anxiety, causing thoughts feelings wishes or needs by ignoring their existence |
| Panic Attack | -Sudden onset of extreme apprehension or fear -Usually associated w/feeling of impending doom -Palpitations,Chest pain,Breathing difficulties,N,Feeling of choking, Chills, Hot flashes -Many believe they're losing their minds |
| Interventions for panic Attack | -Stay with client -Speak slowly and calmly -Use short,simple sentences -Give brief directions -Decrease excessive stimuli |
| OCD | -Obsessions: recurrent thought,image or impulse that is experienced as intrusive and inappropriate and causes marked anxiety -Compulsion: repetitive behavior or act, the goal of which is to prevent or reduce anxiety |
| OCD: Pharmacological Interventions | -Clomipramine (TCA): helps with anxiety to control obsessions; SE: sedation, anticholinergic, dizziness, tremulousness,HA -Fluvoxamine (SSRI): sedation,dizziness, somnolence, HA, sexual dysfunction |
| Generalized Anxiety Disorder | -Insidious onset -Excessive anxiety and worry -Restlessness -Difficulty concentrating -Irritability -Muscle Tension -Sleep disturbance |
| GAD Risk Factors | -Unresolved conflicts -Cognitive misinterpretation (everything is always awful) -Life stressors |
| GAD Interventions | -Diet/Nutrition -Sleep Patterns -Meds: Benzo-can become addicted Buspirone: few side effects, takes several wks to become effective Anti-depressants (TCAs) very effective |
| PTSD | -Hyperarousal-walk around,very alert -Flashbacks -Numbing -Hypervigilance: walk into room, turn on all lights and look around before entering -Startle Response |
| PTSD: At Risk | -Traumatic incidents in past -Children -Rescue workers -Military -Poor social support -Hx of mental illness -Regard reaction as sign of weakness -Believe others aren't responding sympathetically -Fearing it will happen again -Ruminating |
| Acute Distress Disorder | -Occurs one month after incident -Subjective sense of numbing, detachment or absence of emotional responsiveness -Reduction of awareness of surroundings -Depersonalization |
| Phobias | Irrational fear of a specific object,activity or event -ND: Feat r/t unfounded morbid dread of seemingly harmless situation/object; Anxiety r/t contact w/ feared object/situation |
| Somatoform Disorders | -Experience of somatic symptoms for which no physiological basis can be found -Symptoms aren't considered under voluntary control indiv believes the symptoms are real |
| What Somatoform Disorders are NOT | -Malingering: faking a disorder to achieve some gain -Factitious Disorders: deliberately inducing physical symptoms with no apparent incentive |
| Gains | -Primary: relief from anxiety, used to get attention -Secondary: relief from role function, don't have to do something |
| Conversion Disorder | -Complaints of physical problems or impairments of sensory or motor functions controlled the by the voluntary nervous system, all suggesting a neurological disorder but w/ no underlying cause -Ex: glove anesthesia |
| Pain Disorder | -Complaints of severe pain that has no physiological or neurological basis is greatly in excess of that expected with an existing condition or lingers long after a physical injury has healed -Complaints may be vague not localized |
| Body Dysmorphic Disorder | -Preoccupation w/an imagined physical defect in a normal appearing person or an excessive concern w/ a slight physical defect -Common concerns-hair, nose, face, eyes -Frequent checking in mirror, consultation with plastic surgeons,activity limitations |
| Hypochondriasis | -Persistent preoccupation with fears of having a serious disease even in the face of physical evaluations that reveal no organic problems -Pt appear to be oversensitive to physical sensations -Often occurs with anxiety and mood disorders |
| Dissociative Disorders | -Disorder that arises from a trauma that disrupts the conscious memory and results in a psychological retreat from reality -A retreat from a person's primary identity or perception of self |
| Suicide Risk Factors | -Hx of attempts -Psychosis -Single -Chronic pain/disabling illness -Gender:women - more often attempt/ men - more often succeed -Fam hx -Previous attempts -Loss of someone -Unemployment -Severe financial stress |
| Suicide in Hospitalized Clients | -1st 24h after admission -Immediately preceding discharge: don't want to be discharged -Most common: hanging -Antidepressant: approx 2 wks after beginning antidepressant = increase risk |
| Warning Signs of Suicide | -Depressed patient becomes suddenly calm -Starts giving away favorite objects -Preoccupied with death -Makes out a will -Express hopelessness -Express worthlessness |
| Crisis | -An acute, time limited (6-8wks) phenomenon experienced as an overwhelming emotional reaction to the perception of an event -Results in: struggle far equilibrium and adjustment when the problem seems unsolvable |
| Types of Crisis | -Maturational: normal state in development in which task must be learned but old coping mechanisms are no longer adequate (marriage, baby, college) -Situational: crisis arising from external ($, divorce, lose job) |
| Types of Crisis | -Adventitious: an event that is not part of everyday life (natural disaster, crimes) |
| Schizophrenia | -Delusions -Hallucinations -Disorganized speech -Disorganized catatonic behavior |
| Common Myths about Schizophrenia | -does NOT mean split personality -are NOT unusually prone to violence -NOT caused by family dysfunction |
| DSM-IV Diagnostic Criteria: Schizophrenia | 2 or more of the following during a 1 month period: Delusions, Hallucinations, Disorganized speech, Grossly disorganized/Catatonic behavior, Negative Symptoms |
| Schizophrenia Subtypes | -Paranoid:Delusions of persecution/grandeur -Disorganized:Regressed,silly,inappropriate behav -Catatonic:motor immobility, stupor,excessive purposeless motor activity |
| Schizophrenia Subtypes | -Undifferentiated:indicate schizophrenia but fail to meet criteria -Residual:no active symptoms, continues neg. symptoms |
| Schizophrenia: Neuroanatomical | -Decreased cerebral and cranial size -Lowered numbers of cortical neurons -Decreased volume of brain-reduced brain activity in the frontal lobe. |
| Schizophrenia: Potential Early Symptoms | -Withdrawn from others -Depressed -Anxious -Phobias -Obsessions and Compulsions -Difficulty concentrating -Preoccupation with self |
| Symptoms of Schizophrenia | -Positive: reflects an excess or distortion of normal function, add something to personality -Negative: Reflects a lessening or loss of normal function, take something away |
| Positive Symptoms | -Delusions (religious, ideas of reference,persecution,grandeur, somatic) -Hallucinations -Looseness of association -Echolalia -Concrete thinking -Tangentiality -Neologisms -Circumstantiality -Clang assoc -Word salad |
| Positive Symptoms: Alterations in Behavior | -Extreme motor agitation -Catatonia -Stereotyped Behavior (do what see someone else doing) -Waxy flexibility (make movement and once start they can't stop) -Automatic obedience (no matter what anyone says, do behavior) |
| Negative Symptoms | -Poverty of speech - limited -Affective blunting -Anhedonia -Social withdraw -Apathy -Avolition - no goals -Poor grooming -Attentional Impairment -Anergia |
| Typical Antipsychotics | -Chlorpromazine HCL, Thoridazine, Fluphenazine, Thiothixene, Haloperidol -Block dopamine -Tx of pos symptoms, not neg -Higher incidence of EPS |
| Side Effects of Typical Antipsychotics | -Sedation -Orthostatic Hypotension -Alt. in sex -Increase appetite -Decrease tolerance to alcohol/sedatives -Seizures -Galactorrhea/Amennorhea -Gynecomastia -Jaundice, Agranulocytosis -NMS |
| Neuroleptic Malignant Syndrome | -Hyperthermia -Muscular rigidity (stiffness) -Altered Consciousness -Autonomic dysfunction: HTN, tachycardia, diaphoresis, incontinence -Stop drug and treat symptoms |
| Treatment of NMS | -Withdraw med -Cooling blankets, antipyretics -Dantrolene - muscle relaxer -Bromocriptine - dopamine receptor agonist -Benzodiazepines - relieve anxiety and reduce bp, tachycardia |
| EPS: Acute | -Pseudoparakinsonism (resting tremor, mask like face, shuffle) -Acute Dystonia (intermittent/fixed abnormal, posture of eyes,face,tongue,trunk) -Akathasia (motor restlessness, pacing, rocking,shifting, subjective sense of not being able to sit still) |
| EPS: Late | -Tardive Dyskinesia (abonrmal dyskinetic face, mouth, jaw, movements of extremities) -Tardive dystonia (sustained postures in face, eyes, tongue) -Tardive akathsia (unabative sense of subjective/objective restlessness |
| Anticholinergics | -Benztropine, Trihexphenidyl, Diphenhydramine -Side effects: dry mouth,blurred vision, decrease lacrimation,mydrasis,photphobia, constipation, urinary hesitancy/retention |
| Atypical Antipsychotics | -Blocks D2 receptors(low) and serotonin blockage (high) -Less incidence of EPS -Effective in treating both of the pos and neg symptoms -Risperidone,Olanzapine,Quetiapine,Siprasidone,Apriprazole,Clozapine, Paliperidone |
| Atypical Antipsychotics: Side Effects | -Weight gain -Glucose dysregulation -DM -Hypercholesterolemia -HTN -Decreased self esteem -Sedation -Agranulocytosis (clozapine) -Cardiac arrhythmias -Caution with ALL:risk of mortality in elderly is used for dementia |
| Alcohol and CNS | -Wernike's encephalopathy -Korsakoff's psychosis |
| Alcohol and GI | -Esophagitis -Pancreatitis -Gastritis -Hepatitis -Cirrhosis of liver |
| Alcohol and Pregnancy | -Fetal Alcohol Syndrome |
| Alcohol and Cardiovascular | -MI -CVA |
| Alcohol and Infections | -TB -HIV -Bacterial endocarditis -Asbecesses |
| Alcohol and Respiratory | -Perforated septum -Sinusitis -CA |
| Alcohol and Long term use | -TB -Accidents -Suicide -Homicide |
| Medical Comorbidities: Cocaine, Crack, Narcotics (Heroin), PCP | -IV - infections, sclerosed veins, AIDS, hepatitis, endocarditis, cardiac arrest, coma, seizures, PE -Intranasal - sinusitis, perforated septum -Smoking - Resp. problems |
| What is Addiction? | -Loss of control of substance consumption -Substance use despite associated problems -Tendency to relapse |
| Substance Abuse | One or more in 12 mo -Inability to fulfill major work, home, school -Hazardous situations while impaired -Recurrent legal issues -Continued use despite recurrent social and interpersonal problems |
| Substance Dependence | 3 or more in 12 mo -Tolerance/Withdrawal -Substance taken in larger amts for longer period -Unsuccessful desire to cut down -More time obtaining,using substance -Reduction/Absence of social/work -Continued use despite physical/psychological problem |
| Tolerance and Withdrawal | -Tolerance: need for higher and higher amounts to obtain the desired effect -Withdrawal: Occurs after a long period of continued use so stopping or reducing results in physical and psychological signs and symptoms |
| Blackouts | -Periods of amnesia during which the person appears to function normally but later does not recall the events that transpired -Frequent blackouts can be sign of alcohol dependence/addiction |
| CNS Depressants | -Alcohol -Barbiturates -Benzo -Sedatives |
| CNS Depressants: Intoxication | -Slurred speech -Uncoordinated -Ataxia -Drowsy -Decreased BP -Decreased inhibitions (risk) -Impaired judgment |
| CNS Depressants: OD | -CV depression/arrest -Coma -Shock -Convulsions -Death |
| CNS Depressants: Treatment of OD | -Induce vomiting -Charcoal -Clear airway -IV fluids -Seizure precautions -Romazicon IV |
| CNS Depressants: Withdrawal | -N/V -Tachycardia -Diaphoresis -Anxiety -Tremors -Insomnia -Grand mal sz -Delerium |
| CNS Depressants: Withdrawal Tx | -Tiltrated detox with similar drug -Abrupt withdrawal can lead to death -Only withdrawal that can truly be deadly |
| Alcohol Withdrawal | -Associated with severe morbidity and mortality unlike withdrawal from other drugs -Develop w/in a few hours after cessation (2-8h) -Peak at 24-48h after stop using -Disappear rapidly after peak |
| Alcohol Withdrawal Symptoms | -Anxiety -Anorexia -Insomnia -Hand Tremor -"Shaking Inside" -N/V -Vivid nightmares -Illusions -Sweating -I HR/BP -Psychomotor agitation -Grand mal seizures |
| Alcohol Withdrawal Delirium Tremens | -Medical Emergency - 10% mortality -Peak 48-72h -lasts 2-3d -Altered consciousness -Changes in cognition - memory/ language impairment,disorientation -Perceptual Disturbances - hallucinations, illusions -Fever -I pulse, BP, diaphoresis -Seizur |
| CNS Stimulants | -Cocaine -Crack -Amphetamines -Caffeine -Nicotine -Accelerate normal body function -Dependence develops rapidly -Highs followed by deep depression |
| CNS Stimulants: Signs of Abuse | -Pupil dilation -Dryness oronasal -Excessive motor activity -Tachycardia -I BP -Twitching -Insomnia -Anorexia -Grandiosity -Impaired judgment -Paranoid thinking -Hallucinations -Hyperpyrexia -Convulsions -Death |
| Cocaine, Crack Intoxication | -Dilated pupils -Dryness of oronasal cavity -Excessive motor activity -N/V -Insomnia -Grandiosity -Impaired judgment -Euphoria |
| Amphetamine Intoxication | -Paranoid -Delusions (may last for months) -Psychosis -Hallucinations -Panic level anxiety -Potential for violence |
| CNS: Overdose | -Resp. Distress -Ataxia -Fever -Convulsions -Coma -Stroke -MI -Death |
| CNS: Tx of Overdose | -Antipsychotics -Medical management of fever, convulsions, resp. distress and CV systems |
| CNS: Withdrawal | -Depression -Paranoia -Craving -Lethargy -Anxiety -Insomnia -N/V -Sweating -Chills |
| CNS: Tx of Withdrawal | -Antidepressant -Dopamine agonists -Bromocriptine |
| Marijuana (Cannabis Sativa) | -From Indian hemp plant -THC active ingredient -Depressant/Hallucinogenic -Usually smoked -Desired effects euphoria, detachment,relaxation -Long term:lethargy,anhedonia, trouble concentrating,loss of memory,D motivation -OD&w/drawal rare |
| Opiates | -Opium -Heroin -Demerol -Morphine -Codeine -Methadone -Fentanyl |
| Opiates: Intoxication | -Constricted pupils -D resp. -Drowsiness -D BP -Slurred speech -Psychomotor retardation -Initial euphoria followed by dysphoria -Impaired attention, judgment, memory |
| Opiates: OD | -Possible dilation of pupils -Resp. Depression/arrest -Coma -Shock -Convulsions -Death |
| Opiates: OD Tx | -Narc antagonist (Narcan) |
| Opiates: Withdrawal | -Feels like bad flu -Insomnia -Irritability -Runny nose -Panic -Sweating -Cramps -N/V -Fever -Chills |
| Opiates: Withdrawal Tx | -Methadone: synthetic opiate -Clonodine -Buprenophine: Treat symptoms |
| Hallucinogens:LSD, Mescaline, Psilocybin | -Trip: slowing of time, lightheadedness, images in intense colors, visions in sound -BAD trip: severe anxiety, paranoia, terror, distortions in time and distance |
| Hallucinogens: Phencyclidine Piperidine | -PCP, angel dust, horse tranquilizer, peace pill -Route significant: Oral(1h);IV, sniffing,smoking (5 min) -Symptoms:blank stare, ataxia, musc. rigidity, violence -High dose:hyperthermia,chronic jerk of extrem. HTN, renal fail -Suicidal Ideation |
| Long term use of Hallucinogens | -Result in dulled thinking, lethargy, loss of impulse control, poor memory, and depression |
| Flashbacks | -Transitory recurrence of perceptual disturbance caused by a person's earlier hallucinogenic drug when he or she is in a drug free state -Examples: Club drugs - ecstasy, GHB, Rohypnol, LSD -Can happen with any drug but more common w/ hallucinogen |
| Hallucinogens: Intoxication and OD | -Dilated pupils -Tachycardia -Sweating -Palpitations -Tremors -Uncoordinated -I temp, resp, pulse -Paranoid -Anxiety -Depression/SI -Synesthesia -Depersonalization -Hallucinations -Bizarre behavior -Labile -Violent |
| Hallucinogens: Tx | -Minimal Stimuli -Manage symptoms |
| Inhalants | -Volatile Solvents: spray paint, glue,cigarette lighter fluid, propellant gases used in aerosols, room deodorizers, anesthetics |
| Inhalants: Intoxication/OD | -Excitation followed by drowsiness -Disinhibition -Lightheaded -Agitation -Enhancement of sexual pleasure -Giggling, laughter -Damage to nervous system -Death |
| Inhalants: Tx | -Support affected systems (mostly nervous system) -B12 and folate |
| Club Drugs | -Ecstasy (adam, yabba, XTC) -3,4 methylenedioxy-methamephetamine -Ketamine |
| Club Drug: Effects | -Euphoria -I energy -I self-confidence -I socialability -Psychedelic effects -Dehydration -Fever -Rhabdomyolysis -Acute renal failure -Hepatotoxicity -CV collapse -Depression -Panic attacks -Psychosis -Death |
| Date Rape Drugs | -Flunitrasepam (Rohypno) or Roofies -GHB-y-Hydroxybutyric acid -Rapidly produce: disinhibition, relaxation of voluntary muscles, retrograde amnesia -Alcohol synergistic drug |
| Asst. Guidelines | -Most important Question: When did you last drink/use? -In last year have you ever drunk or used drugs more than you meant to? -Have you felt you wanted or needed to cut down on your drinking or drug use in the last year? |
| Quick Screening Tools (CAGE) | -C - cut down on drug/drinking use? -A - annoyed with criticism -G - guilty about use -E - early morning (eye opener) to get day started -Yes, sometimes or often to 2+ of these and they may have a problem |
| BAL | -Blood Alcohol Level -Legal limit in OH = .08 -How many drinks? 1 or 2 -Lethal BAL = .5 |
| Mood | -A pervasive and sustained emotion that when extreme can markedly color the way the individual perceives the world -A prolonged emotional state that affects a persons life and personality |
| Affect | -The external manifestation of feeling or emotion which is manifested in facial expression, tone of voice, and body language -How an individual presents feelings and mood |
| Major Depressive Disorder Characteristics | -Symptoms interfere with usual functioning -Severe emotional, cognitive, behavioral,and physical symptoms -Hx of one or more major depressive episodes -No hx of manic or hypomanic episodes -At least 60% can expect to have 2nd episode |
| MDD - DSM-IV-TR Criteria -Change in previous functions -Symptoms cause clinically significant distress or impair social, occupational or other important areas of functioning | -5+ occur nearly every day in 2 wk period:Depressed,anhedonia,wt loss/gain,Insomnia/hypersomnia,anergia,motor activity,guilt,indecisiveness,death SI |
| MDD Subtypes | -Psychotic (voices, delusions) -Catatonic -Melancholic -Postpartum onset (4wks after birth) -SAD -Atypical: hypersomnia,overeating -seen in young ppl |
| Dysthymic Disorder | -Chronic depressive syndrome -Present for most of the day -More days than not -At least 2 years -Hosp. rare -Early age of onset, still able to function |
| Depression Epidemiology | -Leading cause of disability in the US -More common in Females -Prevalence unrelated to: ethnicity, edu, income, marital status -Dominates symptom in adolescents- irritability -Depression in elderly - major problem |
| Depression Comorbidity | -Schizophrenia - go on schizo drugs and relieve symptoms but realize they'll have to be on them for the rest of their life and become depressed -Substance abuse -Eating disorders -Anxiety disorders -Personality disorders -Medical disorders - fibromya |
| Depression Etiology | -Biological:genetic,biochemical(serotonin, NE), Alt. in hormonal regulation, Diathesis-stress model -Psychological:Beck's Triad (neg.view of self, world, future), learned helplessness |
| Three Phases in Treatment and Recovery | -The acute phase (6-12wks): psychiatric mngt and initial tx -The continuation phase (4-9mos): tx continues to prevent relapse -The maintenance phase (1+yrs):continuation of antidepressants to prevent relapse;edu=relapse prevention |
| ECT | -Use of electrically induced sz for the tx of severe depression -Indications:Elderly,non responsive to drug therapy -80% effective -Contraindications:severe cardiac disease,HTN,lesions of brain/spinal cord -Side Effects:memory loss transient,confusion |
| ECT Procedure | -6-12txs over 3-4wks -Admin. anticholinergic -Prebreathe O2 -Anesthetic -Air way w/ventilator assist -bilaterlly,unilaterally -Musc contraction -Tonic/Clonic phase(barely noticeable) -Spontaneous breathing w/in 60-120 sec -Regain consciousnes |
| Bipolar Disorder | -Bipolar I Disorder: spans whole spectrum -Bipolar II Disorder: hypomania to sever depression -Cyclothymia: hypomania to mild depression |
| Epidemiology | -Bipolar I more common in males -Bipolar II more common in females -Cyclothymia usually begins in adolescence or early adulthood |
| Etiology | -Biological Factors: genetic, neruobiological, neuroendocrine (adrenal, pit, thyroid) -Psychological factors - drug use -Environmental factors - upper socioeconomic status, higher incidence |
| Bipolar: Lithium Carbonate | -Levels: Therapeutic:0.8 - 1.4; Maintenance:0.4 - 1.3; Toxic: 1.5 - 2.0 -Contraindications: Kidney Disease -Relapse: w/in wks of stopping drug, need to be on it for lifetime -Watch salt, electrolytes |
| Sleep Disorders | -Sleep Deprivation: not getting an optimal amount of sleep every night -Leads to: chronic fatigue, memory problems, energy deficits, mood difficulties, feeling out of sorts |
| Consequences of Sleep Loss | -Excessive sleepiness -Serious enough to: impact social, vocational functioning, increase risk for accident/injury -Comorbidity: sleep apnea - HTN, HF - fewer antibodies can't fight infection, obesity, diabetes; addiction |
| Sleep Requirements | -Varies from individual to individual; most adults require 7-8h each night -Long sleepers: require more than 10h each night -Short sleepers: can function effectively on few than 5h per night |
| Normal Sleep Cycle | -Complex interaction b/w CNS and environment -Non-REM sleep:composed of 4 stages, peaceful, restful -REM Sleep: reduction and absence of skeletal muscle tone,bursts of REM, myoclonic twitches of facial and limb musc, dreaming, ANS variability |
| Regulation of Sleep | -Complex interaction b/w 2 processes: homeostatic process or sleep drive promotes sleep; Circadian process or circadian drive promotes wakefulness -Influenced by endogenous factors (neurotransmitters, hormones) or exogenous factors (light and dark) |
| Dyssomnias | -Primary insomnia -Primary hypersomnia -Narcolepsy -Breathing-related sleep disorders -Circadian rhythm disorders -Dyssomnias not otherwise specified (restless leg syndrome) |
| Primary Insomnia | -Most common sleep complaint -Difficulty with sleep initiation -Sleep maintenance -Early awakening -Non-refreshing nonrestorative sleep |
| Pharmacological Interventions:Primary Insomnia | -Benzo (promote sleep, crisis/short term therapy) -Sonata, Ambien, Lunesta (Atypical): less addcitive, longer term -Antidepressants - sedative effects -Barbiturates - short term -Antihistamines |
| Herbals: Pharmacological Interventions | -Melatonin -Appears to be helpful in treating insomnia in older adults and insomnia r/t circadian rhythm disruption -Risks: Not FDA approved -Forms: Natural from pineal glands of animals- risk of virus; Synthetic - no risk of virus |
| Parasomnias | -Unusual or undesirable behaviors or events -Occur during: sleep/wake transitions, certain stages of sleep; arousal from sleep |
| Depression | -Prevalence varies among reported studies -People can mix up depression and dementia in elderly -Depression and anxiety are the biggest issues in the elderly |
| Predictors of Suicide in Elderly | -Over 65 -Male -Caucasian -Chronic/ uncontrolled pain -Bereavement -Unmarried (widowed/divorced) -Social Isolation -Retirement -Financial difficulty -Hoplessness/helplessness -Alcohol/drug abuse -Major depressive disorder -Hx of previous att |
| Anxiety: Psychological Manifestations | -Apprehension -Fearful -Feelings of dread -Irritable -Intolerant -Panicky/preoccupied -Tense/worried -Phobic -Paranoia |
| Anxiety: Physical Manifestations | -GI/GU:ab pain, anorexia, butterflies, D,V, urinary freq -CV: chest discomfort, diaphoresis, dyspnea, flushing, HTN, pallor -MS: backache, fatigue, musc tension -Neuro: tremolos, dizziness, paresthesia |
| Alcohol and Substance Abuse: Potential Alcohol-related problems | -Fluctuations in ADL and IDL -Self-neglect -Trauma -Wt loss -Dehydration -GI complaints -Incontinence -Confusion -Depression -Legal trouble |
| Delirium | -Disturbance in consciousness and a change in cognition -Develops over a short period of time -Usually reversible if underlying cause identified -Serious, should be treated as a medical emergency |
| Delirium: Diagnostic Criteria | -Impairment in consciousness*** -Elderly - most common in this group, often mistaken as dementia |
| Delirium: Etiology | -Complex and usually multidimensional -Most commonly identified causes: variety of brain alterations, infections, meds, fluid/electrolyte imbalance -Reduction in cerebral functioning -Damage of enzyme systems, bbb or cell membranes |
| Delirium: Etiology | -Reduced brain metabolism: instead of using gray matter use white -Imbalance of neurotransmitters -Raided plasma cortisol level -Involvement of white matter |
| Delirium: Priorities | -Pay attention to life threatening disorders -Rule out life threatening illness -Stop all suspected meds -Monitor vs |
| Delirium: Biological assessment | -Pay special attention to CBC, BUN, creatinine, electroylytes, liver function and O2 saturation |
| Delirium: Pharmacological | -Substance abuse Hx -Assessment of drug combinations -Polypharmacy (greater than 5) -OTC/Herbals - grapefruit |
| Delirium: Psychological Assessment | -Cognitive Changes with rapid onset: fluctuations in LOC, reduced awareness of environment; difficulty focusing, sustaining, or shifting attention; severely impaired memory -May be disoriented to time and place but RARELY person |
| Delirium: Psychological Assessment | -Environmental perceptions altered -Illogical thought content -Behavior change: Hyperkinectic - psychomotor, hyperactivity, excitability, hallucinations; Hypokinetic - lethargic, somnolent, apathetic |
| Dementia: Alzheimer's type | -Degenerative, progressive neuropsychiatric disorder that results in cognitive impairment, emotional, and behavioral changes physical and functional decline and ultimately death -Types:early onset-65 yrs&younger, rapid progression;late onset-over 65 yrs |
| Stages of AD | -Stage 1 (mild) forgetfulness -Stage 2 (moderate) confusion -Stage 3 (moderate to severe) ambulatory dementia -Stage 4 (late) end stage |
| AD: Diagnostic Criteria | -Essential feature-multiple cog deficit -1or more:Aphasia(trouble forming words),Apraxia(cant perform purposeful movements),Agnosia(cant recognize familiar objects),Disturbance of exec func, |
| Later stages of Dementia | -Agraphia (can't rd/write) -Hyperorality(put everything in mouth) -Hypermetamorphosis(touch evrything) |
| AD: Etiology | -Neuritic Plaques (extracellular lesions) -Neurofibrillary tangles -CHolinergic hypothesis - ACh is reduced -Genetic factors - roles of chromosome 1, 14, 21 -Oxidative stress and free radicals -Inflammation |
| Dementia: Priority Care Issues | -Priorities will change throughout the course of the disorder -Initially, delay cognitive decline -Later, protect patient from hurting self -Later, physical needs become the focus of care (nutrition, hydration) |
| Dementia: Pharmacological Interventions | -Cognitive Enhancers - Acetylcholinesterase Inhibitors: work by increasing CNS ach concentrations by inhibiting AcheEl -Donepezil,Tacrine,Rivastigmine,Galantamine -Used to delay cognitive decline -Most common side effects: N,V -Not a cure but can help |
| Later stage medication | -Memantine |
| Dementia: Domain Assessment | -Mood Changes: depression, anxiety, catastrophic reactions -Behavioral responses: apathy, withdrawal, restelessness, agitation, aggression, aberrant motor behavior, disinhibition, hypersexuality -Stress and coping skills |
| Sexual Dysfunction | -a disturbance in the sexual response cycle or pain on sexual intercourse -Nonmedical/ non physiological, it's all mental |
| Types of Sexual Dysfunction | -Sexual Desire:hypoactive sexual desire disorder(r/t body image,no desire to have sex,Sexual aversion (thinking about sex makes you "sick") -Sexual Arousal Disorders:female sexual arousal disorder,male erectile disorder(erectile dysfun,impotence) |
| -Orgasm Disorder:Female orgasmic disorder(inhibited female orgasm or anorgasmia);Male orgasmic disorder (inhibited orgasm, retarded ejaculation); Premature Ejaculation | |
| -Sexual Pain Disorders (not due to med condition):Dyspareunia (pain in labia or vagina during intercourse), Vaginismus (contraction/spasm of vaginal during intercourse) -Sexual dysfunction due to a general medical condition | |
| -Substance-Induced Sexual Dysfunction: alcohol and drugs, prescribed meds (antidepressants, antipsychotics) -Sexual Dysfunction NOS | |
| Medication-Induced Sexual Dysfunction | -Antidepressants and antipsychotics commonly affect 3 phases of normal sexual response cycle: sexual interest (libido), Physiological arousal (including lubrication in women and erection in men), orgasm (and ejaculation in men) |
| Paraphilias | -Recurrent,intense sexually arousing fantasies,sexual urges,or behaviors that involve:preference for use of nonhuman object;sexual activity w/ suffering or humiliation of self or others;repetitive sexual activity w/children or other nonconsenting adults |
| Paraphilias: Types | -Exhibitionism: intentional display of the genitals in public place -Fetishism: use of nonliving objects -Frotteurism: touching or rubbing against a nonconsenting person |
| -Pedophilia:sexual activity with a prepubescent child (13 and younger), perp must be at least 16 and 5 y older than victim -Sexual Masochism (self): sexual satisfaction by being humiliated, beaten, bound or made to suffer | |
| -Sexual Sadism (others): sexual satisfaction form the physical or psychological suffering or humiliation of victim -Neither masochism nor sadism is wrong if it's b/w 2 consenting adults | |
| -Transvestic fetishism: sexual satisfaction is achieved by dressing in the clothing of the opposite sex - cross dressing -Voyeurism: viewing of other people in sexual situations | |
| Gender Identity Disorder | -Strong and persistent cross gender identification -Persistent discomfort about one's own assigned sex -Gender dysphoria: feelings of unease about their maleness or femaleness -Transsexualism: wishes to change anatomical sexual characteristics |
| Categories of Gender Identity Disorder | -Gender Identity Disorder: in children or in adolescents or adults -Gender Identity Disorder NOS -Sexual Disorder NOS |
| Gender Identity Disorder: Interventions | -Psychotherapy -Hormone treatment -Sex reassignment surgery |
| Central Concepts of Family | -Boundaries: diffuse or enmeshed, rigid or disengaged -Triangulation -Scapegoating -Differentiation |
| Functions of a Healthy Family | -Management:adults agree how these functions are to be performed -Boundary:clear, help define roles&allow for differences -Communication:clear/direct messages abt wants/needs |
| Functions of a Healthy Family | -Emotional-supportive:feeling of affection dominate family pattern, members emotional needs are met -Socialization: members flexible in adapting to new roles within the family |
| Dysfunctional Family Patterns | -Management:inappropriate member makes decisions -Boundary:diffuse/enmeshed,thoughts merged together,rigid/disengaged -Comm:manipulate,distract, general,blaming,placating -Emotional-Support:conflict/anger -Socialization:role change difficult, I stress |
| Ecomap | -tool used to diagram relationship qualities of a family system; addresses boundaries and interactions |
| Contraindications: Family Therapy | -If there is physical harm being done (family secret by being brought out will do more harm than good) -If members of family aren't honest -Family members can't keep confidentiality |
| Healthy Boundaries | -Clear = balance -Know where self starts and stops -Maintains separateness -Emphasizes belonging to family system |
| Rigid Boundaries | -Rigid rules, shoulds, little tolerance and understanding -Unable to see another's perspective -Can't connect -Isolated -Disengaged |
| Diffuse Boundaries | -Parent intrusive, overprotective-can't exist without supervision/approval, can't set limits -Easily distracted -Can't separate (try to live through kids) -Enmeshed |
| Resiliency | -Relationship b/w a child's constitutional endowment and environmental factors -Temperament that adapt to change -Ability to form nurturing relations -Distance self from chaos -Social intelligence -Problem solving skills |
| Pervasive Developmental Disorders:Autism | -impairment in social interaction, impairment in communication, restricted repetitive sterotyped patterns of behavior, delay abnormal social interaction, language and imaginative play |
| Pervasive Developmental Disorders: Asperger's Disorder | -Self-injurious/aggressive behavior -Impairment in social interaction -Restricted repetitive pattern -No sign delays in language,development, self help skills, curiosity |
| Pervasive Developmental Disorders: Retts | -Normal until about 5 month -Lack of purposeful hand movement -Severe social disengagement |
| Pervasive Developmental Disorders: Child Disintegrative | -Poorest prognosis -From few months -Personality disinegratives before its even formed -Die at very young age |
| Marked Behavior Disorders: Oppositional Defiant Disorder | -Negativistic hostile and defiant -No violent of other's rights -Pull the cat's tail |
| Marked Behavior Disorders: Conduct Disorder | -Basic rights and societal norms are violated -Psychogenic not biological -Pour gasoline on the cat and set on fire |
| Symptoms of anxiety in children (physical) | -Sweaty palms -Trembling -Muscle aches and tension -Upset stomach -Headaches -Difficulty sleeping -Change in eating habits |
| Symptoms in anxiety in children (mental) | -persistent worry -irrational fears -irritability -lack of social activity -fits of crying |
| Attention-Deficit Hyperactivity Disorder | -Inattention -Hyperactivity -Impulsivity (interrupting people, acts without thinking) |
| ADHD Symptoms | -are in constant motion -squirm and fidget -don't seem to listen -are easily distracted -don't finish tasks |
| Pharmacological management | -Stimulant drugs:adderall, ritalin -physical tolerance can occur -insomnia,anorexia, wt loss, tachycardia, temporary decrease in rate of growth and development |
| Nursing Considerations | -Assess mental status -to reduce anorexia, administer after meals -prevent insomnia, administer 6h before bedtime -drug holiday-titrate med during summer when not in school -avoid OTC -gradual withdrawal |
| Other Disorders | -Tic Disorders: tourette's syndrome, involuntary movements and utterances especially in head and neck -Eating disorders |
| Elimination and Intake Disorders | -Pica: eating substances that shouldn't be eaten (clay,dirt,chalk) -Rumination: chewing excessively -Enuresis: after 5, inappropriate wetting -Encopresis: defecating inappropriately after the age of 4 |
| Mood disorders-depression | -Presentation in kids: irritability, boredom, poor motivation; HA, stomaches; poor concentration; not listless, will play with peers -Teens: hypersomnia, delusions, substance abuse, promiscuity, running away |
| Factors Associated with Adolescent Suicide | -Depression or mania -Antisocial or aggressive behavior -Hx of suicidal behavior in family -Availability of firearms -Incarcerated youths -Shameful event |
| Schizophrenia | -Very rare in kids -Beginning symptoms in adolescence: acute hypochondria,strange fears, school phobia, insomnia, concrete paranoid thinking -Intelligence and Orientation are okay |
| DSM-IV Criteria Anorexia | -Refusal to maintain body wt at or above a minimally normal wt for age and ht (15% wt loss) -Intense fear of gaining wt or becoming fat even though underwt -Body image disturbance, denial of the seriousness of current low wt -Amenorrhea |
| DSM-IV Criteria Bulimia Nervosa | -Recurrent episodes of binge eating (large amounts of food in a discrete period of time, sense of lack of control over eating) |
| DSM-IV Criteria Bulimia Nervosa | -Recurrent inappropriate compensatory behaviors in order to prevent wt gain -Occur on avg at least 2x a wk for 3 mo -Self evaluation in unduly influenced by body shape and wt -Does not occur during episodes of anorexia nervosa |
| Purging Type: Bulimia | -During the current episode the person engages in vomiting or the misuse of laxatives, diuretics, or enemas |
| Non-Purging Type: Bulimia | -During the current episode the person uses other inappropriate compensatory behaviors such as fasting and excessive exercise |
| Anorexia | -Diet out of control -Wt loss -Avoid food to cope -Deny -Rigid and controlled -Avoid sexual issues |
| Bulimia | -Eating out of control -Wt maintenance -Use food to cope -Aware of abnormality -Impulsive, extrovert -Struggle with sexual issues |
| Binge Eating Disorder | -Recurrent episodes of binge eating at least twice per week for 3 months -No use of extreme measures to lose weight -Awareness that eating pattern is abnormal -Fear of not being able to stop eating |
| -Depressed mood&self-deprecating thoughts following binges -No evidence of body image disturbance other than body size dissatisfaction -Episodes not related to AN,BN or physical disorder -Consumption of high calorie, easily ingested food during binge | |
| -Secretive eating during binge -Repeated efforts to diet in an effort to lose weight -Negative affect, which often starts the binge eating -Frequent wt flucuations of greater than 10 lbs caused by alternating binges and dieting | |
| Personality traits of ED patients | -Perfectionism -Social insecurity -Instability -Interoceptive deficits(inability to correctly respond to bodily sensations) -Alexithymia(difficultly naming/expressing emotions) -Immaturity -Compliance -Sense of ineffectiveness in dealing w/the |
| Physiological Symptoms | -Dental concerns -Ulcers/Colitis -Esophageal bleeding/trauma/tears/hair/skin/lanugo hair/rashes/menses -Osteoporosis -Hypothermia -Constipation/Diarrhea |
| Electrolyte Disturbances | -Hypokalemia (most frequently in pts who abuse diuretics and laxatives) -Fatigue,lassitude -Paresthesias -Metabolic alkalosis -Cardiac arrthmias -Hypokalemic nephropathy |
| Complications of Laxative Abuse | -Nonspecific gastrointestinal complaints -Cathartic colon (a pathologic state of colon structure and function) the colon is dilated and distended, inflammation of the mucosa and muscular layers, multiple superficial ulcers, limited reversibility |
| Diuretic Abuse | -Electrolyte disturbances -Excessive loss of fluid: dehydration, thirst, dry mucus membranes, tachycardia, poor skin turgor, postural hypotension -Severe cases: delirium, acute tubular necrosis |
| Most Common Patient Complaints | -Inability to concentrate -Fatigue -Chest pain -Fainting spells -Orthostatic hypotension -Feeling of bloat after eating/drinking anything -Depression -Cold |
| Hospice | -Available to everyone regardless of age,dx, or the ability to pay -Requires a physicians best clinical judgment that the pt is terminally ill w/a life expectancy of 6 mo or less -Pt chooses this rather than curative tx -Ensuring pt dignity and respec |
| Styles of Confronting the Prospect of Dying | -Struggle:living&dying are a struggle -Dissonance:dying isnt living -Endurance:triumph of inner strength -Incorporation:beliefs accommodates death -Coping:working to find a new balance -Quest:seeking meaning in dying -Volatile:unresolved,unresigne |
| Fears of Dying Person | -Loss of control -Pain -Having death prolonged artificially -Submitting to the suffering of death -Palliative nursing returns a sense of control to a dying person as well as hope that uncomfortable symptoms can be alleviated |
| Four gifts of resolving relationships | -important role of hospice care is to encourage families to consent to the inevitability of death -Four gifts: forgiveness,love, gratitude, farewell |
| Loss | -Something of value is actually or potentially: changed or gone |
| Types of Loss | -Actual: identified by others, lost mom or lost pet -Perceived: can't necessarily be verified by others - loss of self esteem -Anticipatory: before a loss happens |
| Circumstances of Loss | -Maturational: results from normal life transitions (empty nest syndrome, retirement) -Situational: specific live event (losing someone, job, house fire) |
| Bereavement | -Mourning: public rituals, external displays -Grief: emotional, physical, spiritual |
| Bereavement | -The social experience of dealing with the loss of a loved one through death -Encompasses grief experience and mourning -Period of time after a loss during which grief is experienced and mourning occurs |
| Mourning | -The culturally patterned behavioral response to loss -What people see -People will show this differently -Process by which people adapt to a loss |
| Grief | -Individual process -Due to a loss of a loved one or cherished object |
| Manifestations of Grief | -Physical -Emotional/Psychological -Cognitive -Behavioral -Spiritual |
| Physical Responses to Grief | -Fatigue -Exhaustion -Insomnia -HA -Tension -Digestive -Medical flare ups -Crying -Tightness in chest, throat -Heartache -Noise sensitivity |
| Emotional/Psychological Responses to Grief | -Shock -Numbness -Sadness -Depression -Hopelessness -Overwhelmed -Powerlessness -Confusion -Anxiety -Abandoned -Anger -Fear -Guilt -Restlessness -Irritability -Loneliness -Freedom -Relief |
| Anticipatory Grief | -Anxiety or sorrow experienced prior to an expected loss or death -Often unrecognized -Nurses should be able to recognize |
| Delayed Grief | -Postponed response in which the bereaved person may have a reaction at the time of the loss but it is not sufficient to the loss -A later loss may trigger a reaction that is out a proportion to the meaning of the current loss |
| Disenfranchised Grief | -A response to a loss or death in which an individual is given the opportunity to grieve or is unable to acknowledge the loss to others -Can't publicly grieve the loss -A mistress, gay partner, healthcare workers, neighbor |
| Dysfunctional Grief | -People fear experiencing the pain of loss therefore grief work is unresolved -Unresolved: prolonged or extended in length and severity of response -Inhibited: suppressed response that may be expressed in other ways, such as somatic complaints |
| Grief vs Depression:Grief | -Relates directly to loss -Sx disappear after the loss if resolved -Sad,angry,hopeless,despair,agitation -Physical symptoms cover wide spectrum -Spiritual beliefs may provide comfort |
| Grief vs Depression: Depression | -Not specifically r/t loss -Must be > 2 mo -Guilt abt things other than death -Cyclic or static -Symptoms get more intense than grief -Anger less seldom expressed -SI much more common -Spiritual beliefs seldom provide context or meaning |
| Factors Influencing Grief: Childhood | -Preschool-fear separation and do not understand finality -5-6y - death is reversible,magical -6-9y-accept finality, see death as destructive -10y-death is inevitable -Teen-intellectualize, but repress feelings |
| Factors Influencing Grief: Early Middle Adult | -Loss and death as normal developmental task |
| Factors Influencing Grief: Older Adult | -Loss of health, function and or independence -Loss of longtime mate -Multiple losses-control,competence, material possessions, important people |
| Five stages of Grief: Kubler Ross Model | 1)Denial 2)Anger 3)Bargaining 4)Depression 5)Acceptance |
| Bereavement Process | -Acute stage (4-8wks) -Shock and disbelief (denial) -Development of awareness (somatic symptoms, anger, guilt, crying) -Restitution |
| -Long-term stage (1-2y) -Most people resolve with support -Broken-heart syndrome (during 1st year of significant other passing, person passes) -Suicide rates higher -Dysfunctional/Unresolved grief | |
| Successful Bereavement | -Accept reality of loss -Share in the process -Adjust to an environment without the deceased -Restructure the family's relationship |
| Effective Coping Skills | -Optimistic attitude -Confronts the issues -Seeks information -Shares concerns -Has capacity for healthy denial -Redefine the situation -Constructive use of distractions |
| Ineffective Coping Skills | -Sees glass as half empty instead of half full -Forgets it happened, minimizes critical health status -Shows tendency to escape or withdraw -Prolonged denial -Feels hopeless -Withdraws, brood overwhelmed |
| Personality Disorder | -Behaviors rigidly maintained -Endure in face of disastrous consequences -Create significant problems in daily living -Onset-adolescence/early adulthood -NOT egosyntonic |
| Categories of Personality Disorders | -Cluster A: odd, eccentric -Cluster B: dramatic, emotional, erratic -Cluster C: Anxious, fearful |
| Cluster A | -Paranoid Personality Disorder -Schizoid Personality Disorder -Schizotypal Personality Disorder |
| Paranoid Personality Disorder | -Suspicious -Distrusting -Hypervigilant -Argumentative -Humorless |
| Schizoid Personality Disorder | -Prefers solitude -Socially Distant -Unmotivated by feedback -Lacks spontaneity -Does not make small talk |
| Schizotypal Personality Disorder | -Uncomfortable around people -Poor social skills -Eccentric -Odd behaviors |
| Cluster B | -Histrionic Personality Disorder -Narcissistic Personality Disorder -Antisocial Personality -Borderline Personality |
| Histrionic Personality Disorder | -Love me, please -Self-centered -Attention seeking -Seductive -Exaggerates and dramatizes |
| Narcissistic Personality Disorder | -Look at me, I'm special -Demands admiration,recognition, attention -Insensitive to anyone except self -Overestimation of abilities and importance |
| Antisocial Personality | -Pattern of disregard for rights of others -Repeated acts that are grounds for arrest -Impulsivity -Repeated physical fights or assaults -Reckless disregard for safety of self or others -Failure to sustain consistent work behavior or $ -Lack of re |
| Interventions: Antisocial Personality | -Set firm, matter of fact limits -Anger control assistance -Avoid preaching or moralizing -Monitor personal feelings -Focus on behaviors |
| Borderline Personality | -Frantic attempts to avoid real/imagined abandonment -Unstable relationships -Unstable sense of self -Impulsivity -Recurrent suicidal behav -Chronic feelings of emptiness -Inappropriate anger -Tranisent paranoid ideation -Self-mutilating behav |
| Reasons for Self-Injury | -Tension release -Return to reality -Establishing control -Security and uniqueness -Influencing others -Neg perceptions -Sexuality -Euphoria -Venting from anger -Relief from alienation |
| Thought Distortions and Corrective Statements | -Catastrophizing- make whatever is going on horrible, bigger deal than it is -Dichotomizing-take things apart without putting it back together -Self-attribution Errors-believe everything is their fault |
| Interventions: Borderline Personality Disorder | -Provide support,empathy -Provide structure -Use consistent approach by all caregivers -Point out when client's attempts to manipulate are counterproductive |
| Cluster C | -Avoidant Personality Disorder -Dependent Personality Disorder -Obsessive-Compulsive Personality Disorder |
| Avoidant Personality Disorder | -Poor self image -Highly sensitive to criticism -High anxiety about being OK, so limits contact with people |
| Dependent Personality Disorder | -Make decisions for me, I'm so helpless -Submissive -Over compliant regardless of cost -Helpless -Passive so does not initiate self care |
| Obsessive Compulsive Personality | -If it's not perfect, I will make it perfect -Rigid and unbending -Get lost in details -Needs to feel in control -Perfectionist -Comfortable with rules,order and conformity -Doesn't interfere with life |
| Content vs Process | -Content: all that is said in the group -Process: structural development of the group |
| Facilitating Roles | Task -Initiator- offers new ideas/outlook -Information seeker-clarify group values -Summarizer-summarize group progress Maintenance -Evaluator-measure group work against standard -Encourager-praise,seeks input |
| -Gate Keeper-Monitors participation of all members to keep communication open -Compromiser-group harmony -Harmonizer-tries to mediate b/w members | |
| Blocking Roles | -Computer-only gives facts -Self confessor-always want to talk about themselves -Big talker-want to hear themselves talk -Clown-make joke/lighten things -Withdrawer-sit there,don't say anything |
| Anger | -An emotional response to one's perception of a situation that is threatening to ones needs -Normal emotion |
| Aggression | -A physical or verbal behavior intended to threaten or injure the victim's security or self esteem |
| Violence | -A hx of violence is the single best predictor of violence -Threats including verbal or written statements that imply harm to a person or property -Physical assault with or without a weapon that results in actual harm -Damage to property |
| Stages of Anger and Aggression | -Feeling of vulnerability -Uneasiness -Anxiety -Anger -Aggression -Violence |
| Signs and Symptoms that usually precede violence | -Limit setting by nurse -Hyperactivity -Increase in anxiety and tension -Verbal abuse -Very loud/soft -Absolute silence -Intoxication of alcohol/drugs -Possession of weapon -Recent hx of violence |
| Stages of Violence: Interventions | -Preassaultive: de-escalation, meds -Assaultive:Restraint, meds, seclusion -Postassaultive: debriefing, documentation |
| Seclusion and Restraint | -Only be used if client is a danger to self/others -When less-restrictive methods have failed -Require physicians order |
| Cycle of Violence | -Tension-building stage: pushing/shoving, verbal abuse,victim doesn't speak up for self, abuser rationalizes abuse, victim tries to make things better -Acute battering stage: physical violence, victim depersonalize situation, both parties in shock |
| -Honeymoon stage: perpetrator feels remorseful, victim believes perp, thinks things will be better -Tension builds and cycle continues | |
| Actual Occurrence of Violence requires: | -Perpetrator -Vulnerable Person -Crisis situation |
| Characteristics of Perpetrators | -Consider their own needs more important than needs of others -Poor social skills -Extreme pathological jealously -May control family finances -Likely to abuse alcohol or drugs -Relationships are usually enmeshed and codependent |
| Characteristics of Abusing Parents | -Hx of violence -Low self esteem -Isolation/suspicious of others -in a crisis situation -rigid expectations -Harsh punishment -Violent outbursts -Substance abuse -Poor impulse control |
| Characteristics of Vulnerable Persons: Children | -Younger than 3 yrs -Perceived as different -Remind parents of someone they don't like -Product of unwanted pregnancy -Interference with emotional bonding b/w parent and child -Don't meet fantasy -Adolescents also at risk |
| Effects of Violence on Children | -Depressive disorders -PTSD -Somatic complaints -Low self esteem -Phobias -Antisocial behaviors -Child/Spouse abuse |
| Effects of Violence on Adolescents | -Poor grades -Difficulty relationships -Legal problems -Promiscuity -Running away from home |
| Characteristics of Vulnerable Persons: Older Adults | -Poor mental or physical health -Dependent on perpetrator -Female, older than 75, white, living with relative -Elderly father cared for by a daughter he abused as a child -Elderly woman cared for by a husband who has abused her in the past |
| Self-Assessment | -It is imperative that nurses assess their own attitudes and feelings about abuse prior to working with families where abuse is present or has occurred |
| Don'ts of Assessment | -Don't judge or accuse -Don't use the words abuse or violence -Don't display horror,anger,shock, or disapproval -Don't force a child or anyone else to remove clothing |
| Sexual Assault | -Any type of sexual activity the victim doesn't want or agree to -From inappropriate touching to penetration -Verbal sexual assault can occur by phone/online -Forced activities: prostitution |
| Rape | -Nonconsensual vaginal and or oral pentration, obtained by force or by threat of bodily harm or when a person is incapable of giving consent -Majority of rapes are perpetrated by someone known to the victim |
| Characteristics of Incestual families | -High incidence of other forms of abuse -Enmeshed -Boundary issues -Role reversal |
| Sexual Abuse/Incest Perpetrator Characteristics | -Low self esteem -Unrealistic dependence needs -Immaturity -Self absorption -Lack of empathy for others -Hx sexual abuse during childhood |
| Sexually Abused Children | -Typically the oldest daughter -Age of onset 6-9 -Secret frequently not revealed until older -Early identification of sexual abuse victims is crucial to the reduction of suffering of abused |
| Forensic Nursing | application of nursing science to public or legal proceedings and scientific investigation and treatment of trauma and/or death of victims and perpetrators of abuse, violence, criminal activity, and traumatic accidents |
| -Provide direct services to crime victims&perp -Consultation services to colleagues in nursing,med&law agencies -Expert court testimony in cases of trauma and/or ?death -Adequacy of service delivery -Specialized dx of specific conditions as r/t nursin | |
| Sexual Assault Nurse Examiner (SANE) | -Care of adult/pediatric victims of sexual assault -Sexual assault response teams (SARTs) -Expert care in acute setting -Advocacy for acute&long-term needs of victim -Referral for counseling for survivors (D long-term effects from assault) |
| Nurse Coroner/Death Investigator | -Public official charged with duty of determining how and why people die -Assessing the deceased through:Understanding the evidence,Discovery of evidence, Preservation of evidence,Use of evidence |
| Terms | -Legal sanity:able to distinguish right from wrong -Legal insanity:presence of major mental disorder -Irresistible impulse:knew act was wrong but couldnt control behavior |
| -Guilty but mentally ill -Competence to proceed:defendant’s present thinking at time of trial | |
| Evaluation | -Federal law prohibits persons from being tried if deemed legally incompetent -Incompetent defendant will be in a mental hospital for treatment to regain competency |
| Witness | -Fact witness – testifies about what was personally seen, heard, performed, or documented regarding a patient’s care -Expert witness – recognized by the court as having a certain level of skill or expertise in a designated area |
| Correctional Nursing: Suicide | -First 24 hours most dangerous-jail -10 times of general public |
| Stressors: Client | -Overcrowding -Double stigmatization -Grief, isolation, loneliness -Violence -Living conditions -Lack of privacy -Segregation |
| Stressors: Nurse | -Violence -Language -Need to be “on guard” -Professional isolation |
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