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NUR 211 EXAM 1
| Question | Answer |
|---|---|
| freud | believed basic character was developed by age 5. ID, EGO, super ego |
| ID | pleasures self. suppresses ego. "mom and dad arent home lets party" |
| EGO | on the fence between good and bad. "mom and dad said no friends over while they are away. too risky. |
| super ego | conscience. "never disobey your parents" if too rigid = dec self esteem. guilty |
| freud oral stage | birth-18 months. relief of anxiety through oral gratification. sucking, biting, chewing. dependent on the one who carfes for you. |
| freud anal stage | 18mth-3yr. gaining independence and control. if potty training too rigid = stubborness, stingy, miserliness. potty training more permissive = extroverted, productive and altruistic. |
| freud phalic stage | 3-6yrs. identification w parent of same gender. |
| freud latency stage | 6-12yrs, elementary school, group activities, socialization. prefers same sex relationships |
| freud genital stage | 13-20yrs. genital organs mature, libido awakes, focus on relationships and opposite sex |
| sullivan infancy | birth-18mts. satisfaction through oral. sucking, crying, nursing. associated w mouth |
| sullivan childhood | 18mts-6 yrs. child learns interference/delay with satisfaction and learns to accept the wait. |
| sullivan juvenile | 6-9yrs. forming satisfactory relationships through peer groups through competition, cooperation and compromise |
| sullivan preadolescence | 9-12yrs. focus on developing relationships w persons of the same gender for collaboration of love and affection for another person |
| sullivan early adolescence | 12-14yrs. struggles w identity separate from parents. focus relationships w opposite sex. lust |
| sullivan adolescence | 14-21yr. achieve interdependence within the society and formation of lasting intimate relationship of opposite gender. genital organs developing |
| sullivan therory | based on the belief that individual behavior and personality development are the direct result of interpersonal relationships |
| sullivans major components of this theroy | anxiety, satisfaction of needs, interpersonal security |
| anxiety | ones inability to satisfy needs or to achieve interpersonal security. |
| satisfaction of needs | fulfillment of requirements. O2, food, H2O, warmth, tenderness, rest, activity, sexual expression. |
| interpersonal security | feeling associated w relief from anxiety. total well being. |
| Erickson theory | based on the influence of social processes on the development of the personality. studies Soux indians, advocate for child abuse prevention. |
| erickson trust vs mistrust | birth-18mths. need mom in sight. infant learns w needs met...trust. mistrust=dissatisfaction w self/others, suspiciousness, difficulty w interpersonal relationships |
| erickson autonomy vs shame and doubt | can make decisions. autonomy=self-control, ability to delay gratification, confidence. shame/doubt=lack of self confidence, pride, sense of being controlled by others. happens when caregivers set kid up for failure or restrict independence. |
| erickson initiative vs guilt | 3-6yo. initiative=self control, assertiveness, dependability inc, learning. guilt=feeling inadequate, extreme guilt, think evil and deserve punishment, from stifling of achievements as a child, |
| erickson industry vs inferiority | 6-12yo. industry=good work habits, trustworthy, conscientious, wants balance (encouragement in activities, recognition for doing good.) inferiority=difficulty in interpersonal relationships, cant cooperate or compromise |
| erickson identity vs role confusion | 12-20yo. identiy=confidence, emotional stability, view self as a unique individually. career choice, relationships. parents start to relinquish control for child to make more decisions. role confusion=doubt, no relationships, delinquent/rebellious behav |
| erickson generality vs stagnation | 30-65yo. generality=contributing to others, giving of self. stagnation=dont care about others, self indulgent. |
| erickson ego vs despair | 65-death. ego=self acceptance from life goals, has dignity and doesn't fear death. despair=self contempt, disgust over life achievements, angered, death feared |
| mahler theory | based on separation-individuation process of the infant from the maternal figure |
| mahler I. normal autism | birth-1mth. fulfillment of basic needs for survival and comfort |
| mahler II. symbiosis | 1-5mths. development of awareness of external source of need fulfillment. one with mother. |
| mahler III. separation individuation | 5-36mths. "psychological birth" separation from mother. individual. |
| mahler differentiation | 5-10mths. physical movements away from mom. |
| mahler practicing | 10-16mth. advanced locomotor functioning away and to mom. |
| mahler rapprochement | 16-24mth. recognizes mom is a separate person but wants to reestablish closeness but shuns total dependence |
| mahler consolidation | 24-36mth. sees mom as loving/enduring/separate. integrating right/wrong. |
| piaget cognitive develpment | based on the premise that human intelligence is an extension of biological adaptation, or ones ability for psychological adaptation to the environment |
| piaget stage 1: sensorimotor | birth-2yrs. basic needs, objects remain even though not seen w senses. |
| piaget stage 2: preoperational | 2-6yrs. personal experiences are universal. child cant accept differing viewpoints. ability to attribute special meaning to symbolic gestures. bring book to mom to read. |
| piaget stage 3: concrete operations | 6-12yo. logic thinking. reversibility and specialty is established. "poodles are dogs, all dogs are not poodles" |
| piaget stage 4: formal operations | 12-15yo. make and test hypotheses. think and reason. cognitive maturity achieved. |
| mental health | the successful adaptation to stressors for the internal/external environment, evidenced by thoughts, feelings and behaviors that rare age appropriate and congruent w local and cultural norms |
| mental illness | maladaptive responses to stressors form the internal/external environment, aeb thoughts, feelings behaviors that are incongruent with the local and cultural norms and interfere w the individuals social occupation, or physical functioning. |
| a 14 yo not able to remember moms death | repression |
| a man mad at boss goes home and yells at wife | displacement |
| sally upset about work, yells at husband on phone then later buys him lunch | undoing |
| my parents divorced when i was 15 thats why i smoke pot | rationalization |
| a new widow continues to make dead husband some lunch | denial |
| prevention of unacceptable thoughts or behaviors from being expressed by exaggerated opposite thoughts | reaction formation |
| i dont want to think about this right now, ill do it tomorrow | suppression |
| rechanneling unacceptable impulses to tolerable ones. | sublimation |
| avoiding expressing emotions associated w stressful situation | intellectualization |
| covering up a real or perceived weakness by emphasizing one considered more desirableness | compensation |
| sorry im late my husband shut off the alarm | projection |
| plastic surgery to look like angelina jolie | identification |
| separation of thought or a memory from the feeling associated with it | isolation |
| schizo most likely results form | biological, psychological and environmental influences to a person already vulnerable to the illness |
| first phase of schizo: schizoid personality | indifferent, cold, aloof, loners, no close relationships |
| second phase of schizo: prodromal | start neglecting friends, neglect personal hygiene, blunted/inappropriate affect, cant get words out, cant get a sentence together, bizarre ideas, lack of initiative |
| pt with schizo ventricles will be | enlarged on CAT, loss of white brain mater |
| third stage schizo: schizophrenia | active phase, delusions, hallucinations, impairment in work, social relations, and self care, paranoid of people |
| fourth stage schizo: residual phase | symptoms similar to prodromal phase, flat affect, impairment in role functioning are prominent. rule out drugs making pts act this way=urine analysis. |
| disorganized schizo | poor hygiene, disorganized speech/thoughts, cant put sentences together, silliness, incongruous, giggling, bizarre behavior, social integration impaired |
| catatonic schizo (stupor) | dazed, unconscious behavior, dec speech/response, extreme psychomotor retardation, posturing (standing like statue), need specific direction |
| catatonic schizo (excitement) | extreme psychomotor agitation, purposeless movements (must be stopped to prevent injury), shouting, (risk for injury, IM=Proxilin, prn) |
| paranoid schizo | paranoid delusions, argumentative, hostile and aggressive, not trust, think youll hurt them, onset 20-30yo, rambling. check for med making pt do this=urine analysis. Ns dx=disturbed sensory, perceptual, auditory |
| undifferentiated schizo | exhibits all of the symptoms and doesnt fit into a category |
| residual schizo | used to dx a pt w a hx of at least one episode of schizo w prominent psychotic symptoms. live in foster homes, volunteer jobs |
| schizoaffective disorder | symptoms of schizo with mood disorder (manic/depressive) |
| brief schizo | sudden onset pf psychotic symptoms following a severe psychosocial stressor. lasts a day>mth. no hx, just happened. |
| schizophreniform disorder | same symptoms as schizophrenia but lasts at least 1mth but less than 6. |
| delusional disorder | obsessed love(john & Jodi foster), grandious, people out to get them, they are the topic of new casts. reporters are talking directly to them. |
| psychotic disorder due to a general medical condition | hallucination/delusions. dementia=psychosis, deafness can cause orders, steroids=psychotic rage, ammonia levels=psychotic, OD=psychotic event |
| substance induced psychotic disorder | hallucinations/delusions. from effects of a physiological effects of a substance |
| positive symptoms of schizo | delusions, hallucinations, disorganized speech/thinking, grossly disorganized behavior(lost), catatonic behaviors |
| neg symptoms of schizo | affective flattening, alogia(no speech, dec vocab), avolition(inability to initiate goal type behavior) |
| assessment data for schizo | alterations in thinking, perception, behavior, motor symptoms, mood, physical condition |
| IV for hallucinations | encourage involvement in conversation or activity, assess content of hallucination (if command or harmful initiate safety) |
| IV for delusions | dont argue or deny belief, talk about real issues, if paranoid-same staff. food sealed. |
| IV for withdrawn | assist w ADLs, gradually introduce activities, positive feedback, give time alone |
| signs of aggression | inc pacing, clenched fists, tense expression, irritability, agitation, threatening remarks, last thing restraints. |
| IV for aggression | dec stimuli, prn meds(IM Geodon, Zypreza), safe environment, quiet time, approach pt from side, show force. |
| Dopamine hypothesis for schizo | excess of dopamine dt over production, inc release, neuroleptics dec dopamine, low monoamine oxidase inc dopamine |
| drugs for schizo | antipsychotics block dopamine, atypical preferred, others=Lithium, carbamazepine, valium, propranolol to symptomatically treat |
| atypical antipsychotics neuroleptics for schizo | Clozaril, Risperdal, Zyprezsaa, Geodon, Abilify |
| typical antipsychotics neuroleptics for schizo | Haldol, Thorazine |
| antipsychotics EPS effects | pseudoparkinsonism, akinesia, akathisia, dystonia, oculogyric crisis. antiparkinson agents are given for these EPS |
| side effects of antipsychotics for schizo | anticholinergic, N, GI upset, skin rash, sedation, ortho hypo, photosensitivity, dec libido, retrograde ejac, gynecomastia, amenorrhea, wt gain, reduction in seizaure threshold, agranulocytosis, EPS, TD, NMS |
| NMS | drugs that block dopamine receptors disrupt regulatory mechanism in thermoregulatory center in hypothalmus and basal ganglia causing no heat regulation and muscle rigidity. |
| NMS symptoms | high fever, sweating, in P/RR, elevated CPK(muscle damage), hyperkalemia(muscle rigidity), tachy, |
| IV for NMS | stop all drugs, adm Dantroline or Bromocriptine to relax muscles, maintain nutrition/hydration/RR, |
| anticholinergic crisis | confusion, hallucinations, dilated pupils, blurred vision, facial flushing, dry mm, diff swallowing, fever, tachy, HTN, dec bowel sounds, urinary retention, N/V, seizures, coma |
| anticholinergic tx | atropine flush. "hot as a hare, blind as a bat, mad as a hatter, dry as a bone" |
| pseudoparkinsonism symptoms | lead-pipe rigidity, cog wheel rigidity(ratcheting of arm downward), shuffling gait, stooped posture, pill-rolling tremor, perioral tremor or rabbit syndrome(scrunching of nose). |
| drugs for pseudoparkinsonism | Symmetrel, Parlode, Benedryl preventively or prn. |
| pt/family teaching w pseudoparkinsonism meds | sunscreen, no ETOH c neuroleptics, approve OTC w dr, report for labs, risk of meds during reproductive years, do not stop abruptly, dec stress, therapy |
| tx modalities | individual/group therapy, behavioral therapy, social skills training, milieu therapy, family therapy, assertive community treatment |
| assertive community treatment | case management team keeping pt compliant in the home setting to keep pt out of hospital. |
| assertive community treatment team members | psychiatrists, nurses, social workers, vocational rehab therapist substance abuse counselors. 24/7 |
| dispositional Crisis | dog dies, fire |
| anticipated life transition crisis | marriage, retirement, death of spouse |
| traumatic stress crisis | person in car accident |
| maturational/development crisis | becoming a teenager |
| psychopathology crisis | mental illness, break in reality |
| guiding pt thru problem solving | sometimes when people fail they come up c a new goal, make a list, go thru the bene/risks of each item on list, what do you chose, did it work. |
| feelings/responses/predisposing factors to suicide | anger, quilt, depression, tears, isolate, should ofs |
| T or F suicide happens w/o warning | false |
| once suicidal, always suicidal | false |
| suicidal threats are manipulative plays | false |
| improvement in mood after severe depression indicates the risk is over | false |
| the incidence of suicide inc w age in white men | true |
| family history of suicide is a risk factor | true |
| suicide may seen like a solution to a problem | true |
| common reasons for suicide in order of popularity | depression, bipolar, schizo, problems w former intimate partner, previous attempts, ETOH dependence problems |
| risk factors for suicide | tenn-25, >50, white males, single/devorced, helping professionals, hx of previoius attempts, substance use, |
| signs of suicide | giving away personal items, taking care of affairs giving away personal stuff, getting affairs in order |
| PLAID PALS: suicide assess questions | Plan, Lethality, Availability(means to carry out plan), Illness, Depression, Previous attempts, Alone, Loss, Substance abuse/use |
| 3rd leading cause of death in us in age group 15-24 | suicide from dt family discord, disciplinary problems, school concerns, mental heath, depression, unintentional asphyxia |
| native americans and suicide | poverty, poor education, ETOH |
| restraints | least restrictive first, 5 people, check pt/circulation q 15min, position to prevent aspiration, fluids/elimination, document(SOAPIE), remove i restraint at a time. |
| help for abused women | know ur abusers red flags, identify safe areas of the house, come up w a code word, make an escape plane, be ready to leave a t a moments notice, practice, make/memorize emergency contacts |
| survivors of abuse | love/hate relationships, behavioral acting out, personality development, ongoing cycles of abuse |
| 17th century interpretation of mental health | put on boat and sent out to sea to die, bled them, no mental institutions, possessed by devil, moon influenced the mind, burned witches |
| mentally ill advocate. thought pts were treated like animals | dorthea dix 1840 |
| first psych nurse | linda richards 1873 |
| father of psychiatry (SEXUAL ISSUES) | sigmund frued 1900 |
| dec BS cause calmness but siezures | insulin therapy 1935 |
| electro convulsive therapy causes siezures when pts dont tolerate the psych meds "elderly". | ECT 1937. stimulates more neurotransmitters |
| 1st mental health act | 1946 WWII. PTSD |
| psychopharmacology | lithium, Thorazine was invented |
| pt/ns relationship | hildegarde peplau |
| pts had the right to live in the communities | deinstitutionalizations movement 1960s |
| 1960-1990 | community mental health centers act, shorter inpt stays, american psychiatric nurses association, DRGs. |
| community mental health nursing: primary prevention | groups to educate to prevent develpment of disease (DARE) <teaching> |
| secondary prevention | monitoring their care. seeing their SW. <therapy> |
| tertiary prevention | dec residual deficits in chronic illness (obesity>DM>PVD>limb removal) keep BG in check |
| ethical principles: autonomy | can make independent decisions if not court involved |
| beneficence | promoting good for pt |
| nonmaleficence | stemming from negative acts towards others |
| Justice | equal tx to all (have ins=better tx) |
| veracity | adhering to truth. not false documentation |
| ethical concerns in psych ns: | the right to refuse meds unless the pt presents a danger to others and not under court order. go to one on one>isolation>restraints>court gets involved |
| moral distress | pharmacist wont dispense plan B because he doesnt agree w it. |
| client advocacy | tx pt no matter what they have done |
| malpractice | pt not supposed to have belt, hangs self w belt |
| defamation of character: libel | written untruth |
| slander | said something harmful |
| invasion of privacy | in personal stuff w/o cause. has to do w care of pt. pts belongings will be searched |
| assault | threat to harm |
| battery | touching |
| Jahodas characteristics of mental health | pt to have job will have positive attitude, growth, balance in life, autonomy, perception of reality, environmental mastery. |
| US laws: voluntary | unsafe, cant care for self, suicide w plan. (MI law=stay x3days, cant refuse drugs/groups) |
| US laws: involuntary | unsafe behavior, living in squaller, pt w gun/threatening, petitioned (good X10days), pt goes to ER |
| w/in 24hrs | 1st cert is filled x fr in ER, 2nd cert x psychiatrist in unit for invol, w/in 72hrs have to file in court |
| MI law for pt requiring tx | harm to self/others, unable to meet own basic needs, judgment is impaired |
| US mental law: compentancy | the ability of a person to perform certain tasks. declared by the court |
| US mental law: forensic psychiatry | determining guardianship, and if competent to stand trial |
| US mental law: insanity defense | a person by virtue of mental illness cannot know and appreciate the nature of the crime. cant control self dt mental illness |
| rules for DC | when tx goals have been met, when pt is safe, agreement to tx plan for follow-up care, if invol and probate judge finds that pt is not a person requiring tx. |
| duty to warm | file a cert letter to potential victim. |
| 14 yo and up can seek tx w/o parents permission | |
| due process | pt must be informed of procedural processes, decision maker will be impartial, pt has the right to be heard and represented by counsel |
| 4 necessary elements for legal consent | capable of counseling, ability to refuse consent, adequate info for consent or have agreed to waive right to info, consent must not be illegal |
| right to refuse meds | cant give enforceable unless pt is seen as an imminent danger to self or others and not under a court order |
| restraints and seclusion | least restrictive first, need DO, pt must be observed and assessed q 10min for circ, resp, nutrition, hydration, elimination, remove q 2 hrs. |
| somatic therapy | electroconvulsive therapy: for endogenous depression that does not respond to toher therapy. have to be competent to agree/refuse tx. |
| DSM-IV: axis I | clinical syndrome. "why admitted" |
| axis II | developmental or personality disorder. cognitively impaired, socially disorder (sometime empty) |
| axis III | physical disorders. DM, HF, strokes |
| axis IV | severity of psychosocial stressors rated for 1-6. no car/home/family/job, single mom w 4 kids, legal issues |
| axis V | GAF (global assessment functioning) score 1-100. how serious the symptoms are causing them problems |
| need baseline before administering psychotropic drugs | |
| neurotransmitters: dopamine | emotional, attention, pleasure, regulates motor/endocrine activity. too much=mania, too little=parkinsonism like symptoms |
| norepinephrine | fight/flight, mood, more aware. too much=anxious, manic, paranoid, schizo. too little=depressed |
| acetylcholine | HR, muxcle activity, block w anticholinergics |
| serotonin (5-HT) | sleep, pain perception, libido. too much=anxiety, psychosis. too little=depressed |
| GABA | emotional balance, too little=anxiety, irritability, irrational |
| antidepressants | block reuptake of neurotransmitters |
| antipsychotics | block dopamine at post syn site |
| benzodiazepines | facilitate transmission of GABA |
| psychostimulants | inc release of neurotransmitters |
| antianxiety drugs | depresses the CNS. contrindicated w other CNS depressants, eldely, prego, narrow angle glaucoma, shock and coma. no renal/hepatic, hx of drug abuse, ETOH and those depressed/SI |
| antidepressants | ionc concentration of norepinephrine and serotonin inthe body by blocking (tricyclic, tetracyclics, ssri) or inhibiting release of monoamine oxidase |
| serotonin reuptake inhibitors | blocks reuptake of serotonin. serotonin syndrome. highly prescribed. Prozac, Paxil, Zoloft, Luvox, Celexa, Lexapro |
| serotonin syndrome | fever, HTN, altered consciousness, confusion, hallucinations, agitation, drowsiness, muscle rigidity, hyperflexia, TX w Periactin |
| SNRI | dual action-blocks both serotonin and norepi. Effexor, Cymbalta (neuropathy), Pristiq |
| MAO inhibitors | monoamine oxydase. no aged cheese, tyramine, redwine, smoked meats |
| tricyclics | prolongs QT intervals, high OD, limit pills given, Anafranil, Tofranil, Elavil(sleep), Palmelor, Desyrel |
| mood stablizing agents | prevents/tx manic episodes w bipolar, lots of H2O, no lasix, ASA, NSAIDS. lithium, Depakote, Depakene, Trileptal, Neurontin, Lamictal, Tegretol, Topomax, Klonopin |
| antipsychotics | used for acute/chronic psychosis, bipolar mania, hiccoughs, control tics/vocal w tourettes. action unknown |
| dystonia | involuntary muscular movt, spasm of face, arms, legs and neck. |
| pseudoparkinsonism | mimic paarkinsonism. tremors, shuffling gait, drooling, rigidity, pill rolling |
| akathisia | restlesness. urge to move |
| akinesia | musclular weakness or partial loss of muscle mvt |
| neuroleptic malignant syndrome | from neuroleptic drug. severe muscle rigidity, high fever, tachy, fluctuations in BP, sweating, to stupor then coma |
| tardive dyskinesia | bizare facial/tongue mvt, stiff neck, difficulty swallowing. |
Created by:
vstein
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