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Ch 10-13
Mental Health Nursing
| Question | Answer |
|---|---|
| Agoraphobia | intense fear of open spaces -can be experienced with public transportation, being left alone, or being in the middle of a crowd |
| Anxiety | feelings of uneasiness or apprehension |
| Conversion | transference of anxiety into physical symptoms |
| Eustress | type of stress that results from positive experiences |
| Free-floating Anxiety | anxiety that has no identifiable cause -feeling of "impending doom" |
| Generalized Anxiety Disorder (GAD) | anxiety disorder that has no identifiable cause and that is characterized by excessive worry or severe stress and a feeling of "impending doom" -typically lasts 6 months or longer |
| Hypochondriasis | condition of unrealistic or exaggerated concern over minor symptoms |
| "La Belle Indifference" | inappropriate lack of concern for symptoms |
| Malingering | deliberate faking or exaggerating of symptoms |
| Panic Disorder | condition of having one or more panic attacks, followed by the fear of having others |
| Phobia | irrational fear |
| Post-traumatic Stress Disorder | reaction to witnessing or experiencing severe trauma that was not expected |
| Primary Gain | relief of anxiety by use of defense mechanisms or the act of remaining physically or mentally unhealthy |
| Secondary Gain | response to illness that results in attention, monetary benefits, and the like |
| Signal Anxiety | stress response to a known stressor |
| Somatization | emotional turmoil that is expressed by physical symptoms, often loss of functioning of a body part |
| Somatoform Disorder | physical discomfort that resembles a medical condition that has no logical explanation or medical basis |
| Somatic Symptom Disorder | persistent pattern of excessive and disproportionate thoughts, feelings, and/or behaviors related to somatic symptoms |
| Stress | emotional strain or anxiety |
| Stressor | condition that produces stress in an individual |
| Survivor Guilt | feeling of guilt at being a survivor -often seen in PTSD |
| Depression | an alteration in mood that is expressed by feelings of sadness, despair, and pessimism |
| Dysthymic Disorder | chronic form of depression with somewhat milder symptoms than major depressive disorder |
| Major Depressive Disorder | psychiatric illness characterized by depressed mood or loss of interest or pleasure in usual activities that impacts one's life for at least 2 weeks |
| Mood | an individual's sustained emotional tone, which influences behavior, personality, and perception |
| Postpartum Depression | sudden onset of psychotic symptoms that occurs in a woman after the birth of her baby |
| Bipolar Disorder | disorder characterized by mood swings from profound depression to extreme euphoria with intervening periods of normalcy |
| Cyclothymic | characterized by chronic mood disturbance involving numerous episodes of hypomania and depressed mood |
| Hypomania | mild form of mania that is associated with hyperactivity but is not severe enough to cause marked impairment in social or occupational functioning -hypomanic episode |
| Mania | predominant mood that is elevated, expansive, or irritable with frenzied motor activity -manic episode |
| Lethality | level of risk of death in the suicide method |
| Suicide | the act of purposefully taking one's own life |
| Suicide Attempt | any act with the intention of taking one's own life in which the individual survived |
| Suicide Contract | contract between patient and nurse (or significant other) in which patient will call the designated person when the patient has thoughts of suicide |
| Suicide Ideation | thoughts about harming oneself |
| Suicide Pact | agreement made among a group of people (often adolescents) to kill themselves together |
| Survivor of Suicide | family or friend of an individual who commits suicide |
| What are the four commonly accepted levels of anxiety? | -mild -moderate -severe -panic |
| Generalized Anxiety Disorder (GAD) is diagnosed when excessive worry is related to 3 or more of these symptoms: | -restlessness, -fatigue, -difficulty focusing or not being able to think momentarily, -irritability, -tensed muscles, -sleep difficulties |
| Panic Disorder is diagnosed when 4 or more of these symptoms are present: | -fear, dissociation, GI upset, choking feeling, diaphoresis, chest pain, palpitations, increased pulse, numbness/tingling, shaking/tremors, unsteadiness or feeling faint, feelings of suffocation or unable to catch breath |
| Acrophobia | fear of heights |
| Ailurophobia | fear of cats |
| Carcinomatophobia | fear of cancer |
| Decidophobia | fear of making decisions |
| Nyctophobia | fear of darkness |
| Odontophobia | fear of teeth or dental surgery |
| Soleciphobia | fear of worms |
| Thanatophobia | fear of death |
| Agoraphobia is diagnosed when fear with at least 2 of these 5 situations are present: | using transportation, being in open spaces, being walled in or sealed off, standing in a crowd, or being outside alone |
| Social phobia diagnostic criteria: | -displaying notable anxiety/fear in a social situation -avoiding social circumstances -avoiding circumstances that provoke fear or anxiety -avoiding encounters that will subject person to humiliation |
| PTSD diagnostic criteria (A-D) | A- exposure to traumatic/life-threatening injury/violence B- reliving traumatic experience (flashbacks, dreams) (longer than 1 month) C- avoiding anything that resembles the traumatic event D- noticeable change in mood/thinking at unpredictable times |
| PTSD diagnostic criteria (E-H) | E- alterations in reaction at beginning/end of traumatic event F- persistence of A,B,C,D, E lasting longer than 1 month G- impaired relationships with others (lack of trust) H- impaired relationships not connected to abusing drugs/medical conditions |
| PTSD symptoms: | insomnia, feelings of low self-esteem, depression, self-medication with alcohol and other substances |
| Why is the use of anti-anxiety meds short term when possible? | -due to the strong potential for dependency |
| Somatic Symtom Disorder is diagnosed when this criteria is present: | -more than one somatic symptom that disrupt ADLs -extreme thoughts, behaviors, feelings related to somatic complaint resulting in: persistent thoughts, its seriousness, overly anxious, focusing -state of being symptomatic is persistent at least 6 months |
| Anxiety-related disorders treatment: | psychopharmacology, individual psychotherapy, group therapy, systematic desensitization, hypnosis, guided imagery, relaxation exercises, and biofeedback. |
| Somatic Symptom & related disorders treatment: | treatment focuses on symptoms, psychiatrist, hypnosis, behavior modification, stress management, SSRIs |
| Commonly used medications for anxiety-related disorders: | -alprozolam, -buspirone, -chlordiazepoxide, -clonazepam, -clondine, diazepam, hydroxyzine, -lorazepam, -oxazepam, -prazepam, -zolpidem |
| Commonly used medications for Somatic symptom & related disorders: | -amitriptyline, -buproprion, -doxepin, -fluoxetine, -paroxetine, -sertraline, -trazodone |
| Somatic Symptom Disorder symptoms | -high level of anxiety about health, -excessive time/energy devoted to symptoms, -may or may not have an organic disorder |
| Conversion Disorder symptoms | -loss/decrease in physical functioning that seems to have a neurological connection (paralysis, blindness) -indifference to the loss of function -primary and secondary gain |
| Illness Anxiety Disorder | -"professional patient", -intense fear of becoming seriously ill -preoccupation with the idea of being seriously ill and not being helped--may be concerned about not being taken seriously or evaluated properly |
| Angela is a veteran who served in Iraq. It is very difficult for her to drive though a parking ramp because "there are people hiding behind the pillars! They have guns! Be careful!" Angela is most likely experiencing: | -Post-traumatic stress disorder (PTSD) |
| Ms. T complains of headaches and body pains whenever her husband mentions that the house needs cleaned. This has been a recurring problem for more than 6 months. Ms. T probably is suffering from what kind of disorder? | -somatic symptom disorder |
| Mr. L, who has a severe fear of needles, is hospitalized on your med unit. The lab technician enters to draw blood for the routine CBC, and Mr. L begins to cry out, "Get away from me! I can't breathe! I'm having a heart attack!" Your first response is: | -"Mr. L, relax. Take a few deep breaths. I'll stay with you." |
| Which of the following is not an anxiety disorder? | -depressive disorder, -multiple personality disorder |
| A patient with post-traumatic stress disorder is: | -likely to avoid any stimuli associated with the traumatic event |
| Which of the following is true regarding a phobic disorder? | -it is an irrational fear that is not changed by logic |
| The medication(s) of choice for the treatment of anxiety is (are)? | -alprazolam, -diazepam, lorazepam, buspirone |
| The three subcategories of phobia include all of the following except: | acrophobia |
| What are the 3 subcategories of phobia? | -social phobia, -agoraphobia -specific phobia |
| Which of the following are NOT nursing interventions for people with anxiety disorders? | -maximize stimuli to create diversion from the anxiety -document only positive changes in behavior -discourage activities; activities might only increase a patient' anxiety level |
| What is one of the most common mental disorders in the U.S.? | major depressive disorder (major depression) |
| What chance does a person have of developing a major depressive disorder in their lifetime? | 16.6% chance |
| Major depressive disorder is diagnosed when 5 or more of these symptoms are present for at least a 2 week period, representing a change in functioning: | -sad mood, -sleep disturbances, -increased fatigue, -increased agitation, -feeling guilt/worthlessness, -weight loss/ gain, -decreased interest pleasurable activities, -decreased ability to think/remember/concentrate, -recurrent thoughts death/suicide |
| How is dysthymic disorder characterized? | depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years and 1 year in children |
| Symptoms of dysthymic disorder: | -poor appetite/overeating, -insomnia/hypersomnia, -low energy or fatigue, -low self-esteem, -poor concentration or difficulty making decisions, -feelings of hopelessness |
| Reaction (uncomplicated grief) | -labile -heightened when thinking of loss |
| Reaction (Major depression) | -mood consistently low -prolonged, severe symptoms |
| Behavior (uncomplicated grief) | -variable, shifts from sharing pain to being alone -variable restriction of pleasure |
| Behavior (Major depression) | -completely withdrawn or fear of being alone -persistent restriction of pleasure |
| Anger (uncomplicated grief) | -often expressed |
| Anger (Major depression) | -turned inward |
| Sadness (uncomplicated grief) | -varying periods |
| Sadness (Major depression) | -consistently sad |
| Cognition (uncomplicated grief) | -preoccupied with loss -self-esteem not as affected |
| Cognition (Major depression) | -focused on self -feels worthless; has negative self image |
| History (uncomplicated grief) | -generally no history of depression |
| History (Major depression) | -history of depression or other psychiatric illness |
| Responsiveness (uncomplicated grief) | -responds to warmth and support |
| Responsiveness (Major depression) | -hopelessness -limited response to support -avoids socializing |
| Loss (uncomplicated grief) | -recognizable, current |
| Loss (Major depression) | -often not related to an identified loss |
| Perinatal depression | depression during pregnancy |
| Major depressive disorder with seasonal patter (SAD) | -depression associated with seasonal patterns -symptoms generally worsen during winter, subside during spring and summer -thought to be related to the hormone melatonin |
| Substance-Induced depressive disorder | depressed mood from the physiological effects of withdrawal, intoxication, or after exposure to a substance |
| What are some drugs that can cause depression? | -alcohol, amphetamine or cocaine withdrawal, anabolic steroids, antihypertensives, barbiturates, benzodiazepines, cancer chemotherapeutic agents, opioids, oral contraceptives, smoking cessation agents, corticosteroids |
| Depressive disorders treatment | -combination of pharmacological and psychotherapeutic approaches, better outcomes than either alone. |
| Tricyclics (considerations) | ex. amitriptyline, nortriptyline, desipramine -major side effects: anticholinergic symptoms, dry mouth, urinary retention, constipation, burred vision, sedation. Caution with elderly. Smoking can increase metabolism of tricyclics |
| SSRIs (considerations) | ex.-paroxetine, sertraline, fluoxetine, citalopram -SSRI withdrawal syndrome can occur with sudden discontinuation, includes dizziness, nausea, cholinergic rebound (salivation, loose stool) |
| SNRIs (considerations) | ex.-duloxetine, venlafaxine -monitor for insomnia, restlessness |
| Heterocyclics (considerations) | ex.-buproprion, mirtazapine, trazodone -monitor for dizziness, headache, tachycardia |
| MAOIs (considerations) | ex.-phenelzine, tranylcypromine, isocarboxazid, selegiline transdermal -potentially fatal hypertensive crisis may occur in presence of foods high in tyramine. Special diet must be followed |
| Ms. S is admitted to your medical unit with a diagnosis of dehydration and a history of depression. She tells you, "I just can't eat, I'm not hungry." Your best therapeutic response would be: | -"You aren't hungry?" |
| Your patient has diagnosis of major depressive disorder & has started sertraline 50mg bid. After taking the medication for 3 days, the patient says, "I don't think this medication is working. I don't want to take it any longer." What is the best response? | -"These medications usually take a few weeks to bring about an improvement in your symptoms" |
| Your patient appears withdrawn and depressed. Which of the following would not be an effective intervention? | -be judgmental |
| The nurse who is assessing a patient with major depression would expect to observe which of the following symptoms? | -extreme sadness |
| The nursing interventions for a patient with major depression would include all of the following except: | -reassuring the patient everything will be just fine |
| Your new patient is taking an MAOI for severe depression. What would you tell the Dietary Department about her upcoming meals? | -no processed lunch meat |
| Your patient, Mr. A, had a recent MI and open heart surgery with an uncomplicated recovery. His wife tell you that Mr. A has changed and is now uncommunicative, sad, and discouraged about the future. How would you respond to Mrs. A? | -"Tell me more about the changes in his behavior" |
| Which of the following is not true about depression? | -it is more common in men than in women |
| Manic phase symptoms | -easily distracted, -little need for sleep, -poor temper control/easily agitated, -reckless, elevated mood, involved in activities |
| Bipolar I | classic image of bipolar disorder -full syndrome of manic symptoms and most likely depression episodes |
| Bipolar II | at least one bout of major depression with episodic occurrence of hypomania. -patient may never have experienced full episode of mania |
| Cyclothymic | chronic mood disturbance of at least 2 years duration involving numerous episodes of hypomania and depressed mood but of less intensity |
| Bipolar disorder due to another medical condition | prominent and persistent disturbance in mood characterized by mania that is a direct result of physiological effects of a general medical condition |
| Substance/medication induced bipolar disorder | characterized by elevated, expansive mood with or without depression that is the direct result of the physiological effects of a substance |
| Depressed phase symptoms | -low mood, -difficulty concentrating, -eating problems, -fatigue or lack of energy, -feeling worthless, loss of pleasure in activities, -loss of self-esteem, -thoughts of death and suicide, -trouble sleeping/too much sleep, -pulling away from friends |
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ahoyyitbeaddi
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