Psych - Test III
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| Demographics of suicide-who is most at risk? What is the incidence? | Over 90% have a psychiatric illness, and over 50% are under active psychiatric or mental health care. 25-34; leading cause of death. 15-24; second. 10-14 and 35-44; third. 45-54; fourth. 55-64; seventh.
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| Self mutilation-what is the motivation? | Attempt to affirm reality, relieve tension, deal with anxiety and stress rather than to die. Only about 10% progress to suicide.
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| What is the cultural/religious influence on suicide rates? How important is resilience? | White and Native American are twice as likely to commit suicide than Black, Hispanic, and Asian/PI. Resilience , regardless of worldview, gave people more reasons to live.
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| The nurse can start suicide precautions in an emergency and… | then follow up with an MD order
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| Suicide assessment…what questions should be asked and how | Be very direct. How bad are things for you? Do you ever think of harming yourself when you’re down? Have you ever thought of taking your own life? How long have you felt this? What is your plan?
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| S/S Suicide Clues or Cries for Help | Give away possessions? Make/change will? Hopeless? Withdraw socially? Sudden, unexplained recovery from a depression?
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| Indication of emotionally disturbed child | behavior problems cause significant impairment in social, academic, or occupational functioning.
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| Conduct disorder-what are the S/S | Aggression to people or animals, destruction of property, deceitfulness or theft, or serious violation of rules.
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| Adjustment Disorder | One or more life changes from losses due to death, relocation, dependence, loss of autonomy, retirement, illness, and financial stress. Cause anxiety, depression, mixed emotions, physical complaints, and withdraw.
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| ADHD Symptoms | inattention to the surrounding environment, and hyperactivity and/or impulsiveness. (must be inconsistent with developmental age.)
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| ADHD treatment | Stimulants and Antidepressants: Dexmethylphenidate hydrochloride (Focalin), Amphetamine (Adderall), Dextroamphetamine sulfate (Dexedrine), Methylphenidate hydrochloride (Ritalin), Atomoxetine (Strattera), Lisdexamfetamine dimesylate (Vyvanse).
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| S/E of ADHD medications | anorexia, weight loss/gain, abd pain, headache, sadness, irritability, insomnia, fatigue, drowsiness, diarrhea, cognitive dulling, tachycardia, hypotension, restlessness, agitation, dry mouth.
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| Autism | Social impairment, Poor friend making, No sharing in enjoyment, No asking about others lives, Delayed communication, Little or no conversation, Inflexible routines.
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| Mental Retardation | Intellectual developmental Disorders. IQ <70. 1% of population. Caused by in utero toxins or chromosomal changes.
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| How to best deal with manipulation of adolescent | A contract = greater sense of control over their own behavior. Written; the form is less important than the way the nurse and client jointly set goals and expectations, carry out the contract, renegotiate terms, and evaluate the final outcome.
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| How to intervene with a violent adolescent | Should be designed to maximize the resilience of clients acting out self-destructive life scripts. If uncomfortable, you compromise your effectiveness.
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| Adolescents and substance abuse. Risk? Symptoms? | Great risk, because most adolescents find it acceptable. < School/work performance, caught, uses during stress or boredom, < in relationships, high alone rather than with others.
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| Roadblocks to elder’s health care | Ageism (age prejudice), Myths, Stigma (“crazy”), Financing
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| Suicidality with elder population-who is at greatest risk | Men, Widowed or divorced, Caucasians, lower class, chronic pain, terminal illness, alcoholics, mental disorders, stroke SE, fear of becoming a burden.
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| When do you know elderly are at suicide risk | Verbal cues (I won’t be around much longer), behavior cues (will, funeral plans, withdrawing, somatic complaints), situational cues (recent move, loss, terminal illness)
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| Elder abuse-how to recognize it | physical (beatings, pain, coercion), neglect (withholding food, fluids, meds, care), exploitation (taking SS/pension checks, possessions, money more than purchase), abandonment, psychological (degrading, threatening, scare tactic)
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| Phases of a group | Forming (beginning), Storming (conflict), Norming (differences expressed, conflicts subsided), Performing (work phase), Terminating (end)
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| What is the Johari window and what does it measure? | Theoretical, represents self-awareness and self-disclosure in relation to other people. (known to self, blind to self, known to others, hidden from others)
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| What is group cohesion? What will strengthen it? What will weaken it? | spirit of common purpose, not born, but made. >Attendance, arrive on time, stay with group, member participation, “we”, enjoy interacting with one another.
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| 3 basic interpersonal needs | Inclusion (need for relationships and others with you. Outgoing/Privacy). Control (need for relationship with regard to power, influence, take charge). Affection (need for relationship with others with regard to love and affection. Love and be loved).
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| 3 interpersonal group phases | inclusion phase (in/out), control phase (top/bottom), and affection phase (near/far)
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| What are the curative factors of group therapy | Instilling hope, Universaliy, Imparting information, Altruism, Corrective recapitulation of the primary family group, Development of socializing tech, Imitative behavior, Interpersonal learning, Group cohesiveness, Catharsis, Existential factors.
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| Instilling hope | Optimism, improvement
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| Universality | Not alone, similar pain/struggles
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| Imparting information | Advice, strategies, resources
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| Altruism | You are important to others, Gain from giving
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| Corrective recapitulation of the primary family group | Revisiting and correcting events in a supportive environment, Completing unfinished business
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| Development of socializing techniques | Gaining social skills from lowest to sophisticated
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| Imitative behavior | Observing and trying behaviors that might work for you
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| Interpersonal learning | You are you author, and you alone have the power to change things, Adapt and take perspectives other than your own
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| Group cohesiveness | “we”, Included, and accepted in a meaningful way
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| Catharsis | Express feelings, and get relief in a supportive group
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| Existential factors | Actually “being” with others, self-realization
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| What are the advantages of group therapy | stimuli/feedback from multiple sources, testing ground.
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| Family Dynamics and Characteristics | Roles, boundaries, power structure, relationship strains or conflicts.
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| Family boundaries | Rigid (clear, direct, may limit meaningful relationships) or Diffuse (conflicting, not clear, over-involvement in each other’s lives)
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| Deviations in the Adult partner’s coalition | Schism (pick sides), Skew (one mate severely dysfunctional), Enmeshment (fast tempo, one over controlling, and anxious over possibly loosing control), Disengagement (abandonment)
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| Family assessment | Demographics, Medical/Mental Hx, Interactional Data, Family Burdens
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| What is NAMI-what is the benefit | grassroots, mutual-help, advocacy, and support organization of families, consumers, and friends of people with severe mental disorders.
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| Principles of cognitive functioning | What people think affects how they feel. What people think is often based on thinking habits. If we change out thinking, we can effect a change in out feelings.
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| Attributions | perceived causes that may or may not be objectively accurate.
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| Modeling | imitating another in the expectation that one will receive rewards.
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| What is the goal of cognitive therapy | to alter maladaptive thoughts
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| What causes aggression | drug/alcohol abuse, mental illness, inability to deal with crises, possession of weapons, downsizing, absence of workplace violence prevention programs.
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| What are verbal and nonverbal signs and symptoms of aggression | Clenched jaws/fists, dilated pupils, intense stare, flushed, frown, glare, smirk, pacing, threatening harm, loud/demanding tone of voice, abrupt silence, sarcastic remarks, pressured speech, illogical responses, yelling, screaming, fear, suspicion.
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| Pharmacologic interventions for aggression…what are they? | Often antipsychotic meds. Atypical antipsychotic medication like Haldol, prolixin, or Thorazine used unless the person is known to be prone for side effects. If that is the case-anatypical antipsychotic medication may be used like zyprexa, risperdol, etc…
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| What are nursing interventions for the aggressive client | calm, unhurried approach, don’t touch, respect personal space, active listening, discuss other means of releasing tension and physical energy, protect others, role-model, communicate desire to help, relaxation, imagery, thought stopping, thought control.
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| What are some ways to de-escalate the patient | Dibersion, exercise, change of surroundings, relaxation, music, quiet periods, quiet walk, reciting phrases or counting
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