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PMH Exam 4
| Question | Answer |
|---|---|
| anger | normal, becomes problem when not expressed or expressed aggressively |
| is anger primary physiological response? | no, it is learned anger and aggression are DIFFERENT anger can come under personal control |
| aggression | how someone expresses anger not appropriate can cause damage |
| what impacts aggression/anger expression | role modeling alcohol use/substance use operant conditioning neurophysiological/tumors/loss of cortex fn biochem |
| positive reinforcement v negative | reinforce by giving them something they want/something neg= taking away something/giving something they dont want |
| nursing intervention for aggression | early intervention/assessment/recognition prodromal s/s= early s/s verbal abuse= if not verbally offensive/dangerous, just ignore first |
| prodromal syndrome of aggression | fast speech abusive language muscle tension |
| Techniques for dealing with aggression | have BACKUP talking down meds restraints STart lowest level to highest level interventions |
| restraints rule | provider needs to check irl within 1 hour q15 min assessments (neuro, extremities) never prn |
| most common way ppl kill themself | firearms |
| KNOW THE MYTH TABLE FOR SUICIDE | |
| women vs men suicide attempt vs success | women attempt more but more men succeed |
| Assess for suicide | distinguish thoughts, plans, and behaviors if they have Hx of self-harm--> separate between suicidal vs non-suicidal self harm (like those in Borderline PD) if they mention self-harm, need to dig deeper |
| what interventions DONT work | Single interventions, including hospitalization, medication alone, and “no-suicide” contracts, are not supported by evidence as effective in reducing suicides. |
| what interventions help with suicide | client needs to be actively engaged in each step of the assessment |
| when assessing about suicide, what is important to clarify? | distinction between suicide, self harm, etc past behaviors, current thought |
| interventions for actively suicidal patient | safe and structured env and suicide watch |
| suicide risk things/patient scenarios | hopelessness and isolation |
| overt vs covert comment | overt= no doubt they wanna kill themself covert= hidden meaning |
| DSM Splits personality disorders into 3 | Weird, Wild, Worried A= weird B= wild, erratic C= worried, anxious, fearful |
| Cluster A- Paranoid Personality Disorders (PPD) | constantly on guard, hypervigilant, trusts no one |
| Cluster A- Schizoid Personality Disorder (they are VOID) | very bleak, empty, wants no relationship with anybody else, cold, |
| Cluster A- Schizotypal (weird) | behavior ODD and ECCENTRIC weird strange ahh beliefs, magical thinking, when under stress may have psychotic like behavior |
| Cluster B- Antisocial Personality Disorder (ASPD) | pattern of socially irresponsible, exploitative, guiltless behavior, conduct disorder like s/s, lack remorse main concern: protect those around them, strict limits, everyone on unit has to be on SAME PAGE about limit/boundaries, consequences |
| ClusterB- Borderline Personality Disorder | high dysf in relationships, chaos, extreme attitudes regarding others, risky behavior, fear of abandonment, highly impulsive everything either 100% good or 100% bad, manipulation, childhood trauma RISK Patient safety, relate to multiple staff member |
| Cluster B- Histrionic Personality Disorder | colorful, dramatic behavior to draw attention to themselves, surface level relationships, exhibitionist/use sexuality to get eyes on them |
| Cluster B- Narcissistic Personality Disorder | I AM THE GOAT, everyone should praise me, lack empathy, exaggerated self-worth, manipulative, exploit others to fulfill own desires |
| Cluster C- Avoidant Personality Disorder | Extreme sensitivity to rejection, withdraw socially but not bc dont want relationship--> so scared of criticism or rejection lots of depression/anxiety |
| Cluster C- Dependent Personality Disorder | MUST have the other person there to help make EVERY decision if they lost the person, they will choose ANYONE else/dont care just hate making decisions by themselves |
| Cluster C- Obsessive Compulsive Personality Disorder (OCPD) | OCD involves distressing, intrusive thoughts (obsessions) and irrational rituals (compulsions). OCPD is a personality disorder characterized by extreme perfectionism, rigidity, and a need for control, often without irrational obsessions |
| Tx for personality disorders | THERAPIES maybe adjunct meds for anxiety/depression but not to treat |
| Dialectical Therapy | borderlione personality disorder |
| group therapy helps with | ASPD- respond a bit better to peer feedback |
| Milieu Therapy | a psychiatric management technique that structures a patient's environment to promote safety, social interaction, and recovery. Key principles include a clean/ordered physical setting, structured daily activities, open communication |
| depersonalization and derealization | depersonalization- disturbance in perception of oneself derealization- alteration in perception of environment like looking at their body from outside view |
| Somatic symptom disorder | head hurts, then stomach hurts, then leg hurts, but NO actual cause found |
| Illness anxiety disorder | unrealistic fear of getting a serious disease huge lvl of anxiety regarding potential to get sick |
| dissociative amnesia | inability to recall important specific moment (usually stressful/ptsd/traumatic) |
| Functional Neurological Disorder | loss or change of sensorimotor functioning (blind, seizure, etc) from stress |
| Dissociative Personality Disorder | 2 or more alters/personalities, highly associated with childhood trauma |
| Factitious disorder | "Munchausen" Pretending to be sick, usually bc they want the attetion |
| dissociative disorder problems | keep safe restore normal though process, wait until they arent going through anything if possible before ed/interv |
| Dissociative amnesia Tx | therapy |
| DID Tx | hella therapy, years of therapy |
| Depersonalization-Derealization Tx | therapy |
| neurocognitive disorder examples | delirium, dementia (sometimes in old people depression looks like both) |
| delirium | disturbance in attention and awareness very distractable, hallucinations/delusions REVERSIBLE abrupt onset hypoactive and hyperactive types |
| mild vs major ncd | mild- allows independent living/adls major- significantly impairs adls/independent activities/live alone safely |
| primary v secondary dementia | primary- dementia main cause/disease secondary- disease (other) causes dementia |
| alzheimers | slow onset, usually aware of development |
| vascular NCD | due to CVD abrupt onset |
| frontotemporal NCD | LOVE sex and carbs |
| NCD due to TBI | amnesia common after TBI repeated head trauma can result in dementia |
| NCD from lewy body disease | Similar to AD Lewy and parkinsons dementia HAS DELUSIONS SOMETIMES (Visual) progressive and irreversible |
| NCD due to parkinson's | very similar to Lewy Body (if movement issue first, parkinsons but if dementia then movement its lewy) visual hallucinations/delusions |
| NCD due to HIV infection | brain infections with opportunistic organisms s/s either barely r perceptible to acute delirium |
| Substance induced NCD | substance reactions, overuse, abuse |
| NCD due to Huntingtons | genetic, huntingtin protein buildup |
| NCD due to prion | misfolded protein, very rapid progression |
| What to do for patient with NCD | allow them to do/maintain independence most... dont do everything for them. keep them safe duh |
| What to assess for people with NCD | assess cause of it (env stimuli, overstim, noises, glassess/hearing aid availability) |
| meds for someone with hyperactive delirium? | NO a lot of times the meds CAUSE it use non-pharm interventions before pharm (unless super agitated or at risk for self/other harm) |
| Meds for NCD? | Acetylcholine is LOW in NCD memantine= dementia lots of other meds phystostigmine= anticholinergic toxicity reversal, acetylcholinesterase inhibitor |
| antipsychotic black box warning | increased death in elderly (people still prescribe tho) |
| aging short vs long term which stays which goes | short- decrease long- stays |
| elderly common neuro issues | NCD, delirium, sleep disorders |
| elderly around world want similar things | respect, identity, etc |
| suicide and elderly | older males, esp, very high risk |
| bereavement | can be loss of ANYTHING, not just death |
| kubler-ross stages | denial, anger, bargaining, depression, acceptance |
| anticipatory griefing | working on grief/prepping ahead of time before actual loss |
| maladaptive grief processes | 1. delayed/inhibited 2. exaggerated/distorted 3. chronic/prolonged |
| delayed grief | denial/dont recognize the loss future, they realize and far removed and have no supp groups |
| exaggerated | INTENSE response to loss that interferes with ADLs/everyday life depression coccurence usually |
| chronic/prolonged | super long and exaggerated response to loss... keeping husbands shoes in doorway for 10 years, not getting rid of clothes, etc "Complicated" |
| normal vs maladaptive grief | loss of self esteem and substance use |
| death response in kids | change what normal looks like, regression or think they can come back or alter school life |
| older adult bereavement overload | so much loss over time can cause depression |
| cultural processes for grief | always assess/ask about specific religious or cultural grief practices to help facilitate grief |
Created by:
andywattana