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NUR 211 EXAM 1

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