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mental health PH II

Affect: A feeling or emotion as distinguished from thought, or action (Outward manifestation of a person's feeling or emotions).
Behavior Manner in which a person performs any or all of the activities of daily life. Individuals respond differently to changes in daily activities, such as the change created by illness or hospitalization.
Blocking Cessation of thought production for no apparent reason; May stop and stare in middle of conversation; Can be few of long duration or many of shorter duration
Compulsion Distressing recurring behavior that must be performed to reduce anxiety.
Delirium Change in consciousness that occurs over a short period of time; Acute cognitive disorder that produces a marked change in mental status.
Delusion Loss of multiple abilities, including long and short memory loss, language, and the ability to understand
Dementia Changes in mental status are caused by physical changes in the brain; Chronic and progresses slowly; Irreversible
Dissociation Disconnection from full awareness of self, time, or external circumstances
Exhibitionism Exposure of one's genitals to an unsuspecting person followed by sexual arousal.
Fetishism Use of objects (e.g., panties, leather, rubber sheeting) for the purpose of sexual arousal.
Flight of Ideas Abrupt change of topic in a rapid flow of thought/speech
Grandiosity or Delusions of Grandeur A false belief in which one's own importance is greatly exaggerated.
Hallucination False sensory input with no external stimulus, usually in the form of smells, sounds, tastes, sight, or touch
Labile Dramatic changes in mood, often can be rapid in occurrence.
Lability Open to change; adaptable: an emotionally labile person.
Loose Association Thought disturbances in which the speaker rapidly shifts topics from one unrelated area to another
Mania Extreme emotional state characterized by excitement, great elation, over talkativeness, increased motor activity, fleeting grandiose ideas, and agitated behaviors
Obsession Persistent, recurring, inappropriate, and distressing thoughts
Orientation (reality) Awareness of who you are, who others are around you, your surroundings and awareness of time
Phobia A persistent, abnormal, and irrational fear of a specific thing or situation that compels one to avoid it, despite the awareness and reassurance that it is not dangerous
Posturing freezing in a particular position
Preoccupation Thoughts are preoccupied with difficulty focusing on the present or immediate situation
Psychoanalysis a type of therapy for certain emotional disorders that investigates the workings of the mind; Often the subconscious mind.
Psychosis State of being psychotic; An alteration in mental status caused by loss of contact with reality.
Psychotherapy Any large number of related methods of treating mental-emotional disorders by psychological techniques rather than by physical means
Separation Anxiety Anxiety produced when separated from source of security
Somatic Therapy Treatment of an emotionally ill or incapacitated client by physiological means.
Tardive Dyskinesia A chronic disorder of the nervous system characterized by involuntary jerky movements of the face, tongue, jaws, trunk, and limbs
Tardive Dyskinesia usually developing as a late side effect of prolonged treatment with antipsychotic drug—such as Haldol
Mental Health can be defined as one’s ability to cope with and adjust to the recurrent stresses of every day living.
An individual’s mental health may vary depending on the situation and the available support systems.
Mental illness may be evidenced by a pattern of behaviors that is conspicuous, threatening, and disrupting of relationships or that deviates significantly from behavior that is considered socially and culturally acceptable.
Mental illness or disorder is a manifestation of dysfunction (behavioral, psychologic, and biologic).
Mental illness Risk factors: Genetic; Biological; Environmental; and Cultural.
What is a mentally healthy behavior? A person demonstrating a high level of wellness.
The midpoint of the mental health continuum is regarded as normal mental health, characterized by adequate coping skills, problem solving ability, and satisfactory responses or adjustments to life changes with some growth or possibly some mild regression.
Rationalization A defense mechanism by which your true motivation is concealed by explaining your actions and feelings in a way that is not threatening.
Suppression Conscious exclusion of unacceptable desires, thoughts, or memories from the mind.
Sublimation An unconscious defense mechanism in which unacceptable instinctual drives and wishes are modified into more personally and socially acceptable channels.
Regression Reversion to an earlier or less mature pattern of feeling or behavior.
Denial An unconscious defense mechanism characterized by refusal to acknowledge painful realities, thoughts, or feelings.
Affect the external manifestation of inner feelings or emotions.
Adaptation refers to an individual’s ability to adjust to changing life situations using various strategies.
When did deinstitutionalization occur? During the 1950’s.
Who was the first psychiatric nurse? Linda Richards.
What did the OBRA do? It drastically reduced the funding for the mental health system,put the money into the community to use,caused rapid deinstitutionalization, putting mentally ill patients on the streets, where they could not find work
Define stress and its S/Sx? The nonspecific response of the body to any demand made on it.
Stress S/Sx Increases your heart Oxygen flow to brain and muscles; Increases your breathing rate so more oxygen is available for use; Glucose is released from the; Digestion is all but shut down. Sweat is produced to cool off your body and clean out any impurities.
What is post-traumatic stress disorder? A response to an intense traumatic experience that is beyond the usual range of human experiences;
Experiences such as war, rape, major auto accident, observing someone tortured or being tortured, or witnessing violent death may evoke feelings of terror and helplessness.
At what rate do psychophysiologic disorders occur in females to men? 20 times more in women than in men; Prevalence has increased over the past decade;
different levels of anxiety? Mild: Moderate: Panic: Severe:
level of anxiety Mild: Slight increase in vital signs and an awareness of danger; able to think and make connections; heightened awareness; is ready for action; motivation increased.
level of anxiety Moderate: Feels tension; perception has decreased; remains alert, but only to specific information, prone to arguing,teasing,or complaining; physical signs and symptoms; headache, diarrhea, nausea, vomiting, low back pain along with vital signs increasing.
level of anxiety Severe: Experiences a feeling of impending danger; perceptual field significantly narrows and becomes distorted; communication may be distorted and difficult to understand; feels fatigued, Changes in vital signs may be evident on assessment.
level of anxiety Panic: Feeling of extreme terror; may become immobilized; reality distorted; personality may disintegrate further; could cause harm to self or others.
Anxiety Diagnosis Nursing Interventions: Based on the specific responses and subsequent problems for each individual. Carefully use the assessment findings to target individual symptoms with a goal of helping the patient to develop adaptive coping skills
Anxiety Diagnosis Other treatments: Stress Management/Stress Reduction;
Anxiety Diagnosis Other treatments: Sleep enhancement;
Anxiety Diagnosis Other treatments: Diet and Nutrition - May be abnormally sensitive to caffeine & food additives
Anxiety Diagnosis Other treatments: Insight-based treatment - Identify level of anxiety, identify causes of anxiety, discuss effects of anxiety on self and health;
Anxiety Diagnosis Other treatments: Cognitive-behavior therapy - Help client assess threats as realistic or distorted. Teach positive "self-talk";
Anxiety Diagnosis Other treatments: Problem solving - Assist the client in evaluating patterns of lifestyle and stress;
Anxiety Diagnosis Other treatments: Coping skill identification & development - Explore other approaches to anxiety
Anxiety Diagnosis Other treatments: Behavioral role rehearsal
Anxiety Diagnosis Other treatments: Systematic desensitization;
Anxiety Diagnosis Other treatments: Progressive relaxation;
Anxiety Diagnosis Other treatments: Exercise.
Anxiety Diagnosis Desired outcome: Demonstrates decreased levels of anxiety
Anxiety Diagnosis Desired outcome: Effectively utilizes newly acquired skills to manage anxiety;
Anxiety Diagnosis Desired outcome: Demonstrates increased ability to prevent episodes of anxiety;
Anxiety Diagnosis Desired outcome: Demonstrates increased self-awareness;
Anxiety Diagnosis Desired outcome: Remains safe at all times.
Be creative and innovative when developing and implementing a care plan for the patient with an anxiety disorder.
Never approach the patient in a judgmental way. Always demonstrate kindness, caring, and compassion.
Somatization Disorder: History of vague symptoms related to specific body systems.
Somatization Disorder pain symptoms: Related to different sites or functions e.g., back, joints, chest, extremities, intercourse. (b) Two gastrointestinal symptoms, e.g., bloating, diarrhea, vomiting, intolerance to foods. (c) One sexual symptom, e.g., Erectile or ejaculatory dysfunction, ir
Somatization Disorder pain symptoms: The symptoms cannot be fully explained by a known general medical condition or substance abuse. When there is a related medical condition, the physical complaints or resulting social/occupational impairment are in excess of what would be expected from the
Somatization Disorder pain symptoms: The symptoms are not intentionally produced or feigned (malingering).
Somatization Disorder pain symptoms: Clients often presents with a pattern of frequent hospitalizations for diagnostic workups and multiple surgeries.
Somatization Disorder pain symptoms: Patient presents with headache, back pain, joint pain, and chest pains (4 pain), diarrhea, bloating (2 gastro), erectile dysfunction (1 sexual), weakness in hands (1 pseudoneuro).
Somatoform disorder: Any of a group of disorders characterized by physical symptoms representing specific disorders for which there is no organic basis or known physiological cause, but for which there is presumed to be a psychological basis.
Conversion Disorder: Physical symptoms caused by psychological conflict, unconsciously converted to resemble those of a neurologic disorder.
Conversion Disorder: The most likely Somatoform Disorder to be encountered in a combat situation.
Conversion Disorder: Usually impaired coordination or balance;
Conversion Disorder: Weakness or paralysis of an arm, leg;
Conversion Disorder: Loss of sensation in a part of the body, could involve sight or hearing also;
Conversion Disorder: Generally, this condition spontaneously resolves fairly rapidly. Example: Soldier who becomes paralyzed (not intentional!) in one arm after a traumatic combat experience and is who is expected to shoot his M-16.
What is a conversion somatoform disorder? A disorder involving the loss or alteration of physical functioning, such as paralysis, voice loss, tunnel vision, or seizures, that is the result of a psychological involvement or need rather than a physical illness or disease.
What types of drugs are prescribed for somatoform patients? Antianxiety, antidepressants, and analgesics.
Hypochondriasis: A preoccupation with bodily functions and fears of acquiring or having a serious disease based on misinterpretation of physical symptoms.
Hypochondriasis: Causes significant distress or impairment in social, occupational, or other areas of functioning.
Hypochondriasis: Duration of disturbances is at least 6 months.
Hypochondriasis: Generally reassurance by physician is not relieving to the patient.
Body Dysmorphic Disorder: Preoccupation with a perceived defect in appearance causing significant distress or gross exaggeration of a slight physical defect.
Body Dysmorphic Disorder: Patient believes that even a slight defect is of great concern (real or imagined);
Body Dysmorphic Disorder: May begin in adolescence and appears to occur in men and women equally. Example: Patient with small scar on face becomes consumed with notion that it is a major defect and requires medical intervention and their normal functioning is significantly impair
Pain Disorder: A disorder in which pain is present in one or more anatomic sites and is exclusively or predominantly caused by psychologic factors.
Pain Disorder: The main focus of the patient's attention;
Pain Disorder: Results in significant distress and dysfunction;
Pain Disorder: Relatively common, accounts for 10-15 percent of work disability every year;
Mood disorder: Three Types: (1) Major depressive episode; (2) Manic episode; and (3) Other. Depressive disorders:
Bipolar disorders: (1) Bipolar I and Bipolar II Disorder; (2) Cyclothymic Disorder.
major Depressive Disorder: has a lifetime prevalence of about 15% and as high as 25% for women. (One in every 20 persons per year). It is higher than usual in primary care patients (about 10%). In medical inpatients it reaches 15%.
major Depressive Disorder: Key Point I: The hallmark is a period of altered emotional state in which 5 of 9 major symptoms have been present during the same two week period. The state represents a change from the individual’s former level of functioning.
major Depressive Disorder: Key Point I: Additionally, a depressed mood or lack of interest or pleasure (anhedonia) must be present.
major Depressive Disorder Key Point II: Classic indications for medicating depression are referred to as neurovegetative signs or symptoms, These are defined as specific changes in physical functions related to alterations in the neurotransmitters
Psychopharmacology treatment for anxiety : (1) Antianxiety medications:
Psychopharmacology treatment anxiety General action: (1) Cause generalized CNS depression; (2) Produce tolerance with chronic use; (3) Potential for psychological or physical dependence. (b)
Psychopharmacology treatment anxiety General use: treat anxiety disorders & relief of anxiety s/sx. (c)
Psychopharmacology treatment anxiety Side effects: drowsiness, sedation, fatigue, ataxia, and dizziness. (d)
Psychopharmacology treatment anxiety Example: (1) Anoxiolytics/Sedative hypnotics; Psychopharmacology treatment anxiety Example:
Psychopharmacology treatment anxiety Example: (4) Diphenylmethane antihistamines - Atarax, Vistaril;
Psychopharmacology treatment anxiety Example: (5) Azaspirodecanediona – Buspar; Psychopharmacology treatment anxiety Example:
Psychopharmacology treatment anxiety Example: (8) MAO Inhibitors - Parnate, Nardil.
Psychopharmacology treatment Anxiety Diagnosis specific treatment: (1) Generalized anxiety disorders - Benzodiazepines - most commonly used, antidepressant, nonbenzodiazepine and B blockers all may produce positive results;
Psychopharmacology treatment Anxiety Diagnosis specific treatment: (2) Treatment of panic disorders - Antidepressants, TCAs, MAOIs - need higher doses than used for depression. SSRIs - may initially cause increase in anxiety.
Psychopharmacology treatment Anxiety Diagnosis specifictreatment: Benzodiazipines - quicker relief than antidepressants, therefore often used for the first 4 weeks of treatment.
Psychopharmacology treatment Anxiety Diagnosis specific treatment: (3) Treatment of OCD - Meds decrease 30-60% of symptoms.
Psychopharmacology treatment Anxiety Diagnosis specific treatment: SSRIs are the most effective, (Fluoxetine and fluvoxamine are both approved and is as effective as the older TCA - clomipramine).
Psychopharmacology treatment Anxiety Diagnosis specific treatment: MAOIs may be tried if SSRIs ineffective. Lithium may augment other meds. Anticonvulsants may be helpful in treating OCD especially if there are EEG changes.
Psychopharmacology treatment Anxiety Diagnosis specific treatment: Psychosurgery has been used to treat extremely severe OCD that has not responded to meds and treatment.
Symptom per DMSIV: Depressed mood most of the day, nearly every day. diminished interest or pleasure in all/almost all, activities most of the day/every day.
Symptom per DMSIV: Significant weight loss when not dieting, or weight gain. Insomnia or hypersomnia (excessive sleep) nearly every day. Psychomotor agitation or retardation almost every day.
Symptom per DMSIV: Fatigue or loss of energy almost every day. Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
Symptom per DMSIV: Diminished ability to think or concentrate, indecisiveness, nearly every day.
Symptom per DMSIV: Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
Bipolar I Disorder: It is less common that major depressive disorder and it has a lifetime prevalence of 1%. The notable feature for this disorder is the presence of manic episodes, however, an individual with this type of disorder can have depressed episode.
Bipolar II Disorder: The hallmark for Bipolar II Disorder is the presence of recurrent major depressive episodes with hypomanic (not manic or mixed) episodes.
Treatment of Depression: Treatment for depression varies depending on severity and usually encompasses multiple types of therapy: Pharmacology; Psychotherapy; Somatic Therapy such as Electroconvulsive Therapy (Last resort).
Pharmacologic Treatment of Depression: MAOI (Monamine oxidase inhibitors);
SSRI (Norepinerpherine/Serotonin Reuptake inhibitors).
Atypical Antidepressant Treatment of Depression Medications MOST COMMONLY ENCOUNTERED: Prozac Zoloft Celexa Paxil
Other Antidepressants Treatment of Depression Medications: Tricyclics, Elavil Asendin Norpramin Sinequan Tofranil
MAOIs Treatment of Depression Medications: Nardil Parnate Desyrel.
NSRIs Treatment of Depression Medications: Remeron Serzone Remeron Serzone Effexor Wellbutrin
Psychotherapy Treatment of Depression Individual Therapy; Group Therapy; Milieu Therapy.
ECT: Electroconvulsive Therapy: Treated as Invasive; Performed in the peri-operative area; Requires general anesthesia; Used when depression has not responded to any other combination of therapies.
LAST RESORT. Treatment of Bipolar Disorders: Depakote (Generic: divalproex sodium/valproate) and an antipsychotic combination for stabilization.
Lithium Carbonate formerly the drug of choice for acute manic episodes,
this drug has gone out of appeal now they are using Depakote (Generic: divalproex sodium/valproate) and an antipsychotic Lithium Carbonate.
Lithium A small window between therapeutic dose and toxic level; Poor side effect profile. Carbamazepine (Tegretol)
Valproic Acid (Depakene, Depakote) generally very effective. Side Effects: GI upset is possible must take with food; Increases liver toxicity; Requires frequent monitoring of LFT.
Nursing Diagnosis: A Mania Potential for violence, self directed or directed at others and poor impulse control.
Nursing Diagnosis: A Mania Altered Nutrition insufficient caloric intake related to increased metabolic rate and diminished attention span.
Nursing Diagnosis: A Mania Sensory/Perceptual Alterations R/T diminished attention span. Sleep Pattern Disturbance R/T hyperactivity. Altered Family processes R/T role change.
A Major Depression and Depressed Phase of Bipolar Nursing Diagnosis Ineffective individual coping R/T depression in response to identifiable stressors; Risk for self-directed violence R/T suicidal thinking; Sleep pattern disturbance R/T neuro-vegetative effects of depression; Alteration in Nutrition
Major therapeutic modalities include: Milieu Therapy; Group therapy; Individual therapy; Pharmacotherapy; Electroconvulsive therapy.
Individual nursing interventions are numerous, the following is a partial list: (1) For the depressed patient: Provide for patient safety and environmental safety at all times; Continually evaluate patients potential for self-harm; Establish rapport through shared time and supportive companionship; Personalize care to ensure the patient feels valued as an individu
As a nursing professional, be aware of and in control of feelings and reactions (anger, frustration, sympathy);
Major Depression and Depressed Phase of Bipolar Nursing Interventions Assist the patient to identify misperceptions, distortions and irrational beliefs;
Major Depression and Depressed Phase of Bipolar Nursing Interventions Decrease the importance of unattainable goals; (h) Limit the amount of negative personal evaluations the patient engages in.
Nursing Intervention For the manic patient: (a) Provide for patient safety and environmental safety at all times; (b) Provide simple, truthful responses;
Nursing Intervention For the manic patient: (Be alert for the potential for manipulative behavior; (d) Use a consistent approach by all team members;
Nursing Intervention For the manic patient: (Reinforce the patient's self-control and positive aspects of their behavior; (f) Assist the patient to meet self-care needs (nutrition, sleep, personal hygiene)
Nursing Intervention For the manic patient: (Allow the patient to experience feelings and express them appropriately; (h) Assist the patient with anger management.
What are the lifetime prevalence of Bipolar disorder and Major Depressive Disorder? Both diseases are characterized by episodes of severe cases, followed by periods of normal behavior for the lifetime of the minute.
What is displayed in a hallmark Major depressive disorder? Catatonic symptoms; lack of crying because they feel that their feelings are “beyond crying;” Melancholic symptoms. Thought Disorders:
Depression a mood disturbance characterized by exaggerated feelings of sadness, despair, lowered self-esteem, loss of interest in former activities, and pessimistic thoughts.
Delusion A false, fixed belief that cannot be corrected by feedback and is not accepted as true by others in the culture. Types of Delusions: Delusions of Grandeur; Ideas of Reference; Somatic Delusions; Thought Broadcasting; Thought Insertion; Thought Withdrawal.
Hallucinations A sensory experience without a stimulus or trigger. Thought insertion – belief that ideas are put in their mind. Types: Auditory; Visual; Olfactory; Tactile.
Illusion False interpretation of stimuli. Example: a coat hanging on a coat rack may be seen as a man standing there.
Schizophrenia a large group of psychotic disorders characterized by gross distortion of reality, disturbance of language, and communication, withdrawal from social interaction, and the disorganization and fragmentation of thought, perception, and emotional reaction.
Delirium A rapid change in consciousness/over a short period of time. Can occur at any age. Associated with reduced awareness and attention to surrounding, disorganized thinking, sensory misinterpretation, and irrelevant speech. Delirium may be life threatening.
Symptom Delirium Disorientation; Tremors; Florid delusions;Illusions/hallucinations;Disturbed psychomotor activity; Sleep-wake cycles; Incoherence; Acute mental confusion; Fluctuates during its course;
Symptom Delirium Reversible with Tx of underlying cause.
Dementia A term used to describe an altered mental state secondary to cerebral disease. Results in a slow and progressive loss of intellectual function that is often irreversible. It is irreversible. Dementia Symptoms are slow and progressive:
Types or causes of dementia include: Alzheimer's disease; Vascular dementia (multi-infarct dementia); Picks; Creutzfeldt-Jakob disease; Alcoholic dementia; HIV/AIDS; Huntington's disease; Syphilis, tumors, brain trauma, Parkinson's.
Caring for the Person with Dementia interventions: Adaptive Environment; ADLs; Flexibility; orientation; Validation Therapy; Simplify; Explain and Demonstrate; Reorient; Validate; Slow Down; Avoid Change keep simple routines,Encourage Familiarity,Touch,Encourage Independence,Caring for the Person with Dem
Alzheimer's Disease: Most common form of dementia;
1/2 to 2/3's of all dementias; 35% of people develop Alzheimer's by age 75;
Alzheimer's Disease: The disease is always fatal;
Alzheimer's Disease: Results from neuronal degeneration.
Etiology Alzheimer's Disease: Unknown; Definitive diagnosis is by autopsy; Evidence of pathology on: CT scans; EEGs; Endocrine studies. Duration ranges from 5-25 years.
Alzheimer's Disease STAGE I (early) Duration: 2-4 years. Forgetfulness; mild objective memory deficit; difficulty with novel or complex tasks;
Alzheimer's Disease STAGE I (early) Hypochondriasis; Time disorientation, lack of spontaneity; Poor judgment, blaming others; Sense of helplessness and worthlessness; Difficulty with social adaptation; Catastrophic reactions to stressful events.
Alzheimer's Disease STAGE II (middle) Duration- 2 to 3 years. Moderate to severe objective memory deficit; Disorientation to time and place; Language disturbance; Personality and behavioral changes;
Alzheimer's Disease STAGE II (middle) Constant movement; Paranoia; Hallucinations; Physical abusiveness; Sleep pattern disturbances; Incontinence. Cannot survive without supervision.
Alzheimer's Disease STAGE III (late) Duration- unlimited. Intellectual functions virtually untestable; Verbal communication severely limited; Incapable of self-care; Incontinence of bladder and bowel.
Alzheimer's Disease STAGE IV (terminal) Duration- unlimited. Characterization: Unaware of environment; Mute; Bedridden; Joint contractures; Pathological reflexes; Severe neuromuscular deficits. No cure for Alzheimer's disease.
Medications Alzheimer's Disease: Tacrine (Cognex); Donepezil (Aricept); Vitamin E and ginkgo balboa, supplements.
Schizophrenia: One of the most severe mental illnesses; 1 out of 100 people worldwide; 20,000 diagnosed each year;
Schizophrenia: Strikes men and women equally; Diagnosed in late adolescence to early adulthood.
The neurobiological model Biologic predisposition; Structural brain abnormalities; Genetics; Dopamine theory; Viral theory; Family and environmental influences; Stress vulnerability model; Psychological view.
Brain Changes Enlarged lateral and third ventricles; Enlarged sulci; Brain atrophy; Hypofrontality.
Dopamine hypothesis Leading hypothesis regarding the neurobiology of schizophrenia; Excess of Dopamine in the center of the brain; Lowered Dopamine levels in the prefrontal cortex region.
Schizophrenia Negative symptoms (lacking) Alogia; Affective fattening; Anhedonia; Avolition; Attentional impairment.
Schizophrenia Positive symptoms (Exist) Hallucinations; Delusions; Formal thought disorder; Incoherence; Derailment; Illogical thinking; Repeated instances of bizarre or disorganized behavior.
Schizophrenia Types: Paranoid Type; Catatonic Type; Disorganized Type; Undifferentiated Type; Residual Type.
Schizophrenia STAGES: Prodromal Phase; Prepsychotic Phase; Acute Phase; Residual Phase.
Schizophrenia Treatment: Acute care (hospitalization); Outpatient therapy; Case Management; Social services.
Antipsychotic (neuroleptic) drugs :Clozapine; Risperidone; Olanzapine; Sertindol; Ziprasidone; Quetiapine.
Psychotic symptoms: Hallucinations; Delusions; Paranoia; Agitation; Assaultive behavior; Bizarre ideation; Disorientation; Social withdrawal; Cataonia; Blunted affect; Thought blocking; Insomnia; Anorexia.
Side Effects Of Antipsychotic Meds: Cardiovascular; Anticholinergic; Weight gain; Sexual dysfunction; Blood Disorders; Photosensitivity; Pigment changes; Seizure; Neuroleptic Malignant Syndrome;
Acute Extrapyramidal Syndromes: Dystonia-AKA acute dystonic reaction; Pseudoparkinsonism; Akathesia. Medications for side effects includes: Cogentin; Artane; Symmetril.
NOTE: Give finger food Alzheimer’s and maniac patient.
How do you check your patient’s attention span? Tell the patient to count down numbers.
Is there an evidence to support the genetic basis of schizophrenia? Yes! First-degree relatives are 10 times more likely to develop schizophrenia than the general population. Nursing Diagnoses For Thought Disorders:
Nursing Interventions Of Thought Disorders: Therapeutic nurse/patient relationship; Education; Medication compliance; Monitor nutritional intake; Expression of feelings; Verbal and nonverbal communication; Anxiety identification; Avoid being incorporated; Gently question; Client’s right to feel; Di
The first intervention Of Thought Disorders is to do what? Establish a therapeutic nurse/patient relationship.
What is lithium carbonate used for and what would you monitor for? To treat bipolar disorder, mania, and schizophrenia. The nurse needs to monitor for toxicity, which is a serum level about 1.5mEq/L.
What is electroshock therapy, and when is it used, and where is it used? Administration of electric current to the brain through electrodes placed on the head in order to induce seizure activity in the brain, severe depression. to treat schizophrenia as well. Done on an outpatient basis. Personality Disorders:
Personality Disorders: Cluster B (Dramatic, emotional, erratic, intense individuals(a) Antisocial personality disorder (lawbreakers)(b) Narcissistic personality disorder,Borderline personality disorder, Histrionic personality disorder.
Borderline Personality Disorder: personality disorder, long-standing pattern, instability in interpersonal relationships, behavior, mood, and self-image interfere with social or occupational functioning,cause extreme emotional distress. Has not established self-identity; fears being alo
Dependant Personality Disorder: An individual who is overcooperative from a deep fear of abandonment; cannot carry out a task alone; unable to take responsibility for own ADLs; usually seeks overprotective, dominating, or abusive relationships.
Antisocial Personality Disorder: Has a history of difficulties with personal relationships; does not profit from experience or punishment; has no loyalties to any person, group, or code of ethics; has a tendency to irrational behavior; relies on deceit and manipulation to get his way.
Paranoid Personality Disorder: Characterized by suspicion, secretiveness, distortion of reality, and oversensitivity; thinks others are “out to get” him/her.
Phobia A persistent, abnormal, and irrational fear of a specific thing or situation that compels one to avoid it, despite the awareness and reassurance that it is not dangerous.
Obsessive Compulsive Disorder a psychoneurotic disorder in which the patient is beset with obsessions or compulsions or both and suffers extreme anxiety or depression through failure to think the obsessive thoughts or perform the compelling acts.
What is a self-esteem disturbance? A condition that causes one’s view of himself/herself to be reduced or in some way minimized.
What are the goals of a crisis intervention? Decrease emotional stress and protect the victim; Assist the victim(s) to organize and mobilize resources; Return to precrisis status or higher functional level.
Who experiences schizophrenia and what is the cause of it? Typically occurs in young adulthood, striking both sexes equally, and about 1% of the population. It is caused by disorders in which the ventricles of the brain are larger than normal, with the left ventricle larger than the right, and the cerebral cortex
List the warning signs of suicide: Withdrawing from family or friends; Talking about death, the hereafter, or suicide; Giving away prized possessions; Drug or alcohol abuse; Personality changes, such as unusual anger, boredom, or apathy.
Signs of depression: unusual neglect of appearance; difficulty concentrating on work or school; complaints of physical problems that have no organic cause; disturbed sleeping or eating patterns; loss of self-esteem; feelings of helplessness, hopelessness, extreme anxiety, or
What is agoraphobia? An abnormal fear of open or public places. High anxiety brought on by possible situations in which a panic attack may occur.
personality disorders (3) Cluster C (Anxious and fearful individuals): (a) Avoidant personality disorder; (c) Dependent personality disorder; (d) Obsessive-Compulsive personality disorder.
Describe the different stages of Alzheimers? Begins with gradual decrease in memory, emotional stability, and general functioning. The initial symptoms usually appear between 40 and 60. Intellectual ability and personality functioning gradually decrease. Memory fails markedly. There are muscular
What is the cause of Alzheimer’s and when is it diagnosed? Usually seen in individuals over 60 years of age, caused by
In Alzheimer’s, Cortical neurons are lost, ventricles are enlarged, and senile plaques and neurofibrillary tangles are found in the cortex of the brain.
Elevate plasma of homocysteine are associated with a significantly increased risk for Alzheimer’s disease.
Describe catatonic schizophrenia: A type of schizophrenia characterized by marked disturbances in activity resulting in either generalized inhibition or excessive activity. Antipsychotics (neuroleptics):
Tegretol & depakote- anticonvulsants.
Tricyclics, MAOI, SSRI, wellbutrin antidepressants.
Dalmane, restoril, halcyon- sedative, hypnotics.
List the side effects of Xanax: dizziness, drowsiness, confusion, headache, anxiety, tremors, stimulation, fatigue, depression, insomnia, hallucinations, orthostatic hypotension, ECG changes, tachycardia, hypotension, blurred vision, tinnitus, mydriasis, constipation, dry mouth, nausea,
List the side effects of Haldol: dyspnea, respiratory depression, drowsiness, headache, seizures, confusion, rash, photosensitivity, dermatitis, blurred vision, glaucoma, dry eyes, dry mouth, nausea, vomiting, anorexia, constipation, diarrhea, jaundice, weight gain, hepatitis, urinary re
What is recall? To remember; recollect.
Describe Empathy: Identification with and understanding of another's situation, feelings, and motives.
Describe reality: All of your experiences that determine how things appear to you.
What is formal admission? When a patient meets the criteria to be admitted to a mental health facility and checks in.
What are the criteria to be admitted to a mental health facility and who has authority to hospitalize someone against their will? the risk of harm to self or others. the individual is not able to continue the emotional, physical, or financial support of the vulnerable, mentally disabled person. individual is unable to cope effectively, mental status must then meet the admission crit
The courts are the only authority to hospitalize someone against their will.
Suicide: A successful attempt to end one’s life. (Broad range of behaviors resulting in one’s own death.)
Suicide Attempt: An act that is intended to result in one’s own death, but does not.
Suicidal ideation: thoughts of harming or killing oneself.
Suicidal gesture: an action that appears to be a suicide attempt, but is actually committed to manipulate a situation (for example: superficial cuts on the wrist or a small overdose of medication to avoid deployment).
Suicidal threat: verbal threat to commit suicide; may or may not be accompanied by a gesture or attempt.
Categories Of assessing The Warning Signs of Suicide: Pertinent history: Mood and emotions: Thoughts, beliefs, and perceptions: Relationships and interactions: Physical problems: Appearance and behavior
A. Warning Signs of Suicide: Appearance and behavior: (1) Direct verbalization (“I wish I were dead” or I’m going to kill myself”); (2) Indirect verbal statements (“You’ll never see me again” or asking questions about suicide); (3) Giving away possessions; (4) Agitation; (5) Sudden changes in patterns of eat
B. Warning Signs of Suicide: Mood and emotions: A sudden elevation in mood or a sudden uplifting of depression might be indicative of suicidal plans. The depressed person might gain energy and motivation to actually carry out a plan; always be aware of sudden mood changes. (1) Depression; (2) Despair;
C. Warning Signs of Suicide: Thoughts, beliefs, and perceptions: (1) Disorganized or chaotic thinking; (2) Irrational thinking; (3) Views death as the only option (tunnel vision); (4) Persecutory delusions; (5) Command hallucinations (person hears voices commanding them to hurt of kill self); (6) Excessive guilt; (7) E
D. Warning Signs of Suicide: Relationships and interactions: (1) Social isolation; (2) Withdrawn; (3) Feels alone or abandoned; (4) Recent loss of relationship through death, divorce, or separation; (5) Abrupt change in relationship; (6) Recent termination or interruption of psychiatric treatment.
E. Warning Signs of Suicide: Physical problems: (1) Chronic debilitating illness; (2) Unrelieved pain; (3) Terminal illness; (4) Recent, catastrophic loss of physical ability.
F. Warning Signs of Suicide: Pertinent history: (1) History of suicide attempts, threats, or gestures; (2) Self destruction (drug abuse, reckless acts, self-mutilation); (3) Family history of suicide, suicide attempts, or depression; (4) Recent significant loss.
G. When performing a risk assessment it is very important to determine the intensity of the risk. When performing a risk assessment it is very important to
Nursing interventions common to a patient at risk for suicide: A. Potential for Injury, Risk for Self Harm, and Ineffective Individual Coping.
patient at risk for suicide: The desired outcomes are to keep the patient safe, prevent loss of life, and assist with the development of adaptive and effective coping mechanisms
Anorexia self-starvation in a relentless pursuit of thinness, intense fear of becoming fat, and delusional disturbance of body image; anorexia is potentially life threatening.
Bulimia consuming large quantities of food in a short period of time with inappropriate compensatory methods to prevent weight gain (such as self-induced vomiting, diuretic use, laxative use); to qualify for this diagnosis, binge eating and inappropriate compensa
What is Anorexia Nervosa (include the S/Sx)? A psychophysiological disorder usually occurring in young women that is characterized by an abnormal fear of becoming obese, a distorted self-image, a persistent unwillingness to eat, and severe weight loss.
Anorexia Nervosa It is often accompanied by self-induced vomiting, excessive exercise, malnutrition, amenorrhea, and other physiological changes.
What is the mortality rate of anorexia victims? 5-18% mortality rate
What is Bulimia Nervosa (include the S/Sx)? An eating disorder, common especially among young women of normal or nearly normal weight that is characterized by episodic binge eating and followed by feelings of guilt, depression, and self-condemnation.
Bulimia Nervosa It is often associated with measures taken to prevent weight gain, such as self-induced vomiting, the use of laxatives, dieting, or fasting.
Bulimia Nervosa Feelings of low self-esteem, lack of control, and guilt, anxiety and depression, hoarseness, esophagitis, dental erosion, palate lacerations, and complaints of weakness or fatigue, and labs reveal electrolyte imbalance.
Anorexia Appearance Emaciated
Anorexia Behavior: shame of appearance and not eating High achiever in the academic and occupational setting; Ritualistic behavior surrounding food; eating every third; Spends time with food-oriented activities; frequently shops for food and cooks;
Anorexia Behavior: During meals, tries to hide not eating (for example; moving food around on plate, cutting up food but not eating it, hiding food in pockets);
Anorexia Behavior: (h) Obsessive exercise (possibly in secret); (i) Using laxatives or foods with a laxative effect; (j) Presents an unrealistic picture of his or her eating patterns.
Anorexia Mood and emotion Very high anxiety, following: mealtimes, weight gain, being weighed, any control issue; (b) When under stress, feels the need to starve self even more; (c) Sadness and low self-esteem;
Anorexia Mood and emotion (d) Feels the need to punish self for feelings of pleasure; (e) Appears pleasant and compliant, but is actually sad and angry.
Anorexia Thoughts, beliefs, and perceptions: (a) Distorted attitude toward appearance, weight, and food (to the point where it overrides hunger and reason; (b) Distorted body image; views self as overweight despite being told the opposite; (c) Perfectionist;
Anorexia Thoughts, beliefs, and perceptions: (d) Compulsive and rigid; (e) Views self as helpless and dependent; (f) Great difficulty in making decisions;
Anorexia Thoughts, beliefs, and perceptions: (g) Possible mental status changes from malnutrition; (h) Memory lapses, poor attention span, poor judgment, bizarre behavior; (i) Denies/does not accept the seriousness of low body weight.
Anorexia Relationships and interactions: (a) Introverted; (b) Avoids intimacy and sexual activity; (c) Secretive; (d) Difficulty trusting others; (e) Needs to be in control;
Anorexia Physical responses: (a) Extreme weight loss (weight is less than 85% of that expected for age and height); (b) Cachexia; (c) Fatigue;
Anorexia Physical responses: (d) Loss of hair on head; (e) Develops lanugo (fine body hair covering often seen in infants); (f) Low pulse rate;
Anorexia Physical responses: (g) Low body temp; (h) Low blood pressure; (i) Chronic constipation; (j) Dry skin;
Anorexia Physical responses: (k) Alteration in lab values (low H&H, or high if dehydrated; hypokalemia; high BUN and creatinine); (l) Insomnia; (m) Pedal edema related to malnutrition; Anorexia Physical responses:
Bulimia Appearance and behavior: (a) Weight is normal, slightly overweight, or fluctuates between normal and overweight; (b) Goes into the bathroom shortly; (c) Eats normally or sparingly when in the company of others;
Bulimia Appearance and behavior: (d) Binges in private; (e) Compensatory behaviors follow the binge eating (self-induced vomiting, laxative or diuretic misuse, fasting, excessive exercise); Bulimia Appearance and behavior:
Bulimia Appearance and behavior: (g) Usually functions in a normal capacity; (h) Behavior can be histrionic and impulsive; acting out is common.
Bulimia Mood and emotions: (a) Binge is usually triggered by emotional stress; (b) Binge usually results is a temporary relief from anxiety, but the tension increases as feelings of guilt and remorse build;
Bulimia Mood and emotions: (c) Purging becomes the response behavior (response to feelings of guilt and remorse); (d) Anxiety over appearance and weight;
Bulimia Mood and emotions: (e) Anxiety around mealtimes, especially if patient fears loss of control; (f) Generalized anxiety, depression, and self-disgust.
Bulimia Thoughts, beliefs, and perceptions: (a) Perfectionist; (b) Preoccupation with appearance and weight; (c) Self-critical;
Bulimia Thoughts, beliefs, and perceptions: (d) Very aware that own behavior is not normal; (e) Feels powerless over the binge-purge cycle; (f) Believes that he or she is unable to change; (g) Suicidal thoughts.
Bulimia Relationships and interactions: (a) Overt conflict within the family unit; (b) Goes to great length to keep behavior a secret;
Bulimia Relationships and interactions: (c) Generally social and gregarious; (d) Strong need to be accepted by others; (e) Sexually active;
Bulimia Physical responses: (a) Abdominal pain, malaise, and fluctuating blood sugars if bingeing; (b) Chronic hoarseness, parotid gland enlargement, dental caries, loss of enamel on teeth from vomiting;
Bulimia Physical responses: (c) Skin changes over dome of hand if finger is used to induce vomiting;
Bulimia Nursing Considerations: a. Always treat the medical problem first! b. Dietary /nutrition care consult (patient will most likely be on I & O's and calorie counts); c. Psychosocial and spiritual interventions:
Bulimia Nursing Considerations: Provide safe environment at all times, which includes ongoing assessment, intervention, and evaluation of self-harm / self-mutilation.
Bulimia Nursing Considerations: Create environment of acceptance and facilitate / encourage a trusting and therapeutic nurse-patient relationship.
Bulimia Nursing Considerations: Facilitate a social atmosphere versus a supervisory one, although staying with patient during mealtimes might be necessary. (4) Limit mealtimes because lengthy meals might increase anxiety and result in acting out behaviors.
Bulimia Nursing Considerations: Weigh patient as ordered by physician or dietician, or per nursing SOP. (6) Limit setting; limit dysfunctional behaviors such as: (a) Strenuous exercise; (b) Bulimia Nursing Considerations:
Bulimia Nursing Considerations: Encourage patient to verbalize and discuss positive traits about themselves. (10) Encourage healthy activities that reduce anxiety. (11) Communicate support and empathy to patient.
Bulimia Nursing Considerations: (12) Remain non-judgmental. (13) Consult credentialed mental health providers and pastoral services.
Bulimia Nursing Considerations: (14) Remain very consistent with treatment plan. (15) Patient education and family education.
Bulimia Nursing Considerations: (16) Arrange follow up care with mental health services.
(1) Addiction Compulsive physiological and psychological need for a habit-forming substance. (It is a substance dependence, which is serious enough to call a disease.)
(2) Alcoholism primary chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations.
(3) Dependence Physiological state of adaptation to the specific psychoactive substance. (It is a compulsive or chronic need.)
(4) Withdrawal The physiological and mental readjustment that accompanies the discontinuance of an addictive substance. (i.e., a physiological state that occurs when the substance of which a person is dependent upon no longer used.)
(5) Tolerance The capacity to absorb a drug continuously or in large doses without adverse effect; diminution in the response to a drug after prolonged use. (It is a characteristic of drug addiction that refers to a progressive need for more of the abused substance
(6) Dual diagnosis concurrent existence of both substance abuse and dependency and one or more psychiatric disorders.
(7) CAGE is an acronym for CUT,ANNOYED, GUILTY EYE OPENER,
answering yes or no to indicates that alcohol usage is most likely: (a) Have you ever felt that you ought to CUT down on your drinking?
answering yes or no to indicates that alcohol usage is most likely: (b) Have people ANNOYED you by criticizing your drinking?
answering yes or no to indicates that alcohol usage is most likely: (c) Have you ever felt bad or GUILTY about your drinking?
answering yes or no to indicates that alcohol usage is most likely: (d) Have you ever had a drink first in the morning to steady your nerves or get rid of a hangover EYE OPENER?
Stages of Dependency: Some believe chemical/substance dependence proceeds in three steps: Early stage of Dependency:
Early stage of Dependency: Changes may occur causing user to experience unpleasant effects such as, anxiety, cramping, heart palpitations, changes in libido;
Early stage of Dependency: Denial: (1) Defensive regarding abuse; (2) Socializes with other users; (3) May have legal problems;
Early stage of Dependency: Good prognosis for recovery at this stage;
Middle stage of Dependency: (a) Moderate impairment; (b) Might see S&S of withdrawal; (1) Self-Medicates with substance to feel "normal";
Middle stage of Dependency: Pattern of use is established; (3) May see estrangement from significant other/family;
Middle stage of Dependency: Negative behaviors associated with addiction are seen (lying, stealing, broad swings in mood); (5) Physical health is affected
Middle stage of Dependency: May suffer from blackouts; (7) Financial/legal problems.
Dependency Related Nursing Diagnoses (NANDA): (1) Biological responses: (a) Growth and development, altered; (b) Infection, risk for (diminished immune response); (c) Injury, risk for; (d) Nutrition, altered; (e) Self-care deficit.
Dependency Related Nursing Diagnoses Sensory/perceptual alterations: (a) Sexual dysfunction; (b) Sleep pattern disturbance.
Dependency Related Nursing Diagnoses Cognitive responses: (a) Knowledge deficit; (b) Noncompliance; (c) Altered thought processes.
Dependency Related Nursing Diagnoses Psychosocial responses: (a) Anxiety; (b) Impaired verbal communication; (c) Coping, individual and ineffective.
Dependency Related Nursing Diagnoses Family processes, altered: Alcoholism; (a) Growth and development, altered; (b) Parenting, altered; (c) Self-esteem disturbance; (d) Social isolation; (e) Risk for violence.
Dependency Related Nursing Diagnoses Spiritual responses: (a) Grieving, dysfunctional; (b) Hopelessness; (c) Powerlessness; (d) Spiritual distress.
late stages of Dependency: Dependent user displays severe impairment in all areas of function. late stages of Dependency:
late stages of Dependency: Medical problems worsen, along with malnutrition, liver disease, pancreatitis, toxic psychosis, kidney failure, sexual impotence, and stroke can occur. Personal hygiene is neglected.
Controlled substances: Drugs that have a high possibility for abuse or addiction.
B. Comprehensive Drug Abuse Prevention and Control Act: Regulates the manufacture, distribution and dispensation of drugs that have the potential for abuse.
Comprehensive Drug Abuse Prevention and Control Act: Divided into 5 schedules based on their potential for abuse and physical and psychological dependence.
Controlled Substances Schedule I: 1) High abuse potential. 2) No accepted medical use. 3) Examples: Heroine, Marijuana, and LSD.
Controlled SubstancesSchedule II: 1) Potential for high abuse with severe dependence; 2) Examples: Narcotics, amphetamines, and barbiturates.
Controlled SubstancesSchedule III: 1) Less abuse potential than Schedule II drugs; 2) Potential for moderate dependence; 3) Example: Nonbarbiturate sedatives, nonamphetamine stimulates, limited amounts of certain narcotics.
Controlled SubstancesSchedule IV: 1) Less abuse potential than Schedule III drugs; 2) Limited dependency potential; 3) Examples: Some sedatives and anxiety agents, non-narcotic analgesics.
Controlled SubstancesSchedule V: 1) Limited abuse potential; 2) Examples: Small amounts of narcotics (codeine) used as antitussive or antidiarrheals.
D. Controlled substances handled only by persons with a license.
Smack Heroin, A white, odorless, bitter crystalline compound, C17H17NO(C2H3O2)2, that is derived from morphine and is a highly addictive narcotic.
Blow Cocaine, A colorless or white crystalline alkaloid, C17H21NO4, extracted from coca leaves, sometimes used in medicine as a local anesthetic especially for the eyes, nose, or throat and widely used as an illicit drug for its euphoric and stimulating effect
Ice Methamphetamines, an amine derivative of amphetamine, C10H15N, used in the form of its crystalline hydrochloride as a central nervous system stimulant, both medically and illicitly. What would be the S/Sx of a central nervous system stimulant?
What is tunnel vision? Vision in which the visual field is severely constricted, as from within a tunnel looking out; An extremely narrow point of view; narrow-mindedness.
Why alcohol is called a gateway drug? Because many polysubstance abusers began their pattern of abuse with alcohol abuse.
What is the drug used to treat alcoholism? Antabuse.
Denial: When alcoholic person become chemical dependent, they say they don’t have a problem.
Leadership: Leadership is influencing people—by providing purpose, direction, and motivation—while operating to accomplish the mission and improving organization.
Leaders have power: (a) Explicit and (b) Implied. Dynamics of leadership involves applying ones power for growth or change.
Leadership Qualities include: (a) Be dynamic, enthusiastic, and self-directed; (b) Have a positive self-image; (c) Present themselves as role models to follower;
Leadership Qualities include: (d) Be critical thinkers and responsible decision makers; (e) Value learning and knowledgeable about all aspects of the profession.
Leadership Qualities include: Develop and use resources, to include staff members; (g) Use each other and other health workers as resources; (h) Be politically aware;
Leadership Qualities include: (i) Be flexible - this is a must for all leaders; (j) Be assertive - needed in nearly all leadership situations;
Leadership Qualities include: (k) Practice leadership skills, and develop them continually.
anxiety? Medically unexplained headache or abdominal pain occurs at least once a week in 10-30% of children and adolescents.
Having mood swings from extreme happiness to sadness: Lability
When assessing an anxious client the nurse notices levels of anxiety Mild
Patient exhibiting __________ might be unable to dress and undress him/her self throughout the day. Ineffective coping
T / F Advising the command on mission related matters is a role the army LPN fills as a clinical trainer. False, has to be related to health-care setting (i.e. health teaching, clinical proficiency)
Physiatrist that orders a small amount of anti-anxiety meds prn basis. Psychological dependence.
Defense mechanism exhibited by a person who has lost a child to cancer and volunteers to help cancer patients. Sublimation.
Patient who is able to adjust to new situations is exhibiting (__________?). Healthy.
What is the incidence of schizophrenia? Effects Males and Females equally and 1% of the population.
The law that defines governing practice of nursing? Nurse Practice Act.
A new graduate is attempting to get others to do something necessary. Leadership.
A teenager giving away prize possessions falls under which category of suicide warning signs? Appearances and behavior (not advanced degrees).
What is a suicide ideation? Recurring thoughts of harming or killing oneself.
Leadership type that uses five styles is what kind of leadership? Situational
T / F 23 year old dependant daughter working on master’s degree is eligible for benefits. False undergraduate work only.
What priority does an active duty family member enrolled in Tri-care prime fall into? Secondary (Priority 2).
Best therapeutic environment for a patient that reports seeing ants and spiders in a room? Reality (reassure that nothing is there).
One in every __ people experience a major depressive disorder in his / her lifetime. 20
T / F It is the responsibility of the nurse to involve the family in the case of a suicidal patient. True
Sleep pattern disturbance, self care deficit, and falls risk are best described as __________ needs Biological
What is the second major group? Sensory and perceptional attentions.
What would be an appropriate nursing diagnosis for 23 year old women who has a history of conflict filled relationships and alienation? Ineffective coping.
T / F Delirium is not considered life threatening and does not require immediate attention. False it is life threatening
Manic episodes are categorized under which type of disorder. Mood episodes (a period of alteration in an individual’s normal range of emotion for a period of time.)
Females experience psycho-physiological at a rate disorders at a rate __ times more often than males. 20 times because they take care of the disorder and don’t try to hide it
T / F A patient with psycho-physiological disorder who has not met established goals on NCP will display a preoccupation with frequency of somatic complaints. True
A nurse asks the patient to subtract 8 from 100 and continue to subtract 8 as far as possible. Assess patients attention span testing for it
Consuming large quantities of food (__________?) Bulimia
An individual who starts with a false premise believing to be true. Delusions
A person who exhibits clinging behaviors. Dependant personality disorder.
Understanding the condition and goals of each client is an example of and LPN’s ability to? Manage a shift
T / F As a 91WM6 you will be responsible for [managing supplies and equipment] accountability PMCS’s and determining requirements to accomplish the mission. False
When staff are confused and don’t know what is expected because of? Referring to leadership style) Laessez faire (persons often are confused and unsure of what is expected of them.
What should be the first intervention for a client with schizophrenia? Establish therapeutic nurse patient relationship
What types of food would provide the most nutrition for a bipolar patient who cannot sit still and lost 11 pounds in the last two weeks? Sandwiches, granola bars, fruit, and dark coffee with light sugar, protein non-carbonated.
Conversion type of somatic form disorders often mimic? Neurological symptoms (conversion disorders frequently mimic neurological disorders).
T / F Has healthcare reimbursement of DRG (Diagnostic Related Groupies) cause larger patient to nurse ratio? True LPN now experiences.
T / F Ability to reimburse the health care facility? (Copay or not.) False, cannot turn patients away doesn’t matter if you can pay.
What role is a nurse performing when you are responsible for all general patient care? Team Leader.
Staff members discuss problematic behavior with patient and develops contract to change behaviors. Behavioral therapy
What disease is progressive? (__________) Alzheimer’s
Anti-depressant drug therapy is most effective drug for __________. Depression
What is a progressive need? Tolerance
Effects of the basilic ganglia when complaints and unbalance from repeated exposure to __________. Alcohol
T / F Unemployed and often homeless are early signs of dependence. False (late signs)
A client has broken a unit role and is not allowed to have a smoke break, if he / she asks what is the best thing to tell the patient? The rules apply to all, you have broken the rule, you lost your smoke break.
Nursing diagnosis that applies to all eating disorders? Alteration in nutrition, and altered body image.
T / F Remaining consistent with the treatment plan is not an appropriate nursing intervention with eating disorders. False consistency must be there.
Patient looks sad not making eye contact and voluntarily admitted for depression and not sleeping well. Contact supervisor since he may be a danger to himself.
Of current drinkers what % are believed to meet addiction and abuse criteria? 10% addiction, and 7% abuse.
Most important thing a patient prescribed Eskalith? Signs and symptoms of toxicity.
A manic patient staring out window not responding to staff with cuts on forearm what is the best nursing diagnosis? Risk for self directed violence.
Created by: SGT.MOSS