| 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 |
