RN Program test 2 - Psych
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
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| personal space | 18 inches - 3 feet
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| intimate space | 10-18 inches
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| social space | 3-5 feet
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| 3 Phases of the Nurse-Patient Therapeutic Relationship | orientation, working, termination - some have 4th-pre-orientation
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| what are some things a nurse discusses in the orientation period | establish contact
define roles and rules
confidentiality
ID pt. needs
ID goals
ID strengths/weaknesses
establish trust rapport
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| describe the working phase r/t a threapeutic relationship | put plan into action
work together to solve problems and meet goals
evaluate and revise plan
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| skills to use during the working phase of a therapeutic relationship | clarification
validation
confrontation
empathy
respect
genuineness
advocacy
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| what are the goals for the working phase of a therapeutic relationship? | id support systems
positive coping behaviors
positive self concept
promote independence
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| what are three things you do during the termination phase of a relationship | D/C plans, summerize experiences, say good-byes
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| Behaviors that diminish the Therapeutic Relationship | Boundary violation
Sympathy
Encouraging dependency
Non-acceptance
Avoidance
Not being genuine
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| when you ask someone to do something and they don't want to | resistance
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| congruent | appearance and internal mood match; crying and feeling sad.
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| incongruent | someone's appearance and mood do not match. Being at a funeral and laughing and saying everything is great when you're really sad inside
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| what are some factors r/t non-verbal communication? | personal appearance, facial expressions ,posture and gait, gestures, proxemics, touch, eye contact
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| when in the 1900's did psychotropics become available? | 1950's - Lithium Thorazine
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| what year did the Community Mental Health Act pass and become effective | 1963 - deinstitutionalization of state mental hospitals: release from state hosp develop community services…..problems
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| during direct care, what are some of the roles and responsibilities | promotes self care, assist w/ADLs communication, interpersonal relations
examine behaviors, test alternatives
teach meds/ tx’s
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| Primary level of care | altering risk factors to hinder the development of MI
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| secondary level of care | reduce the effect of Mental Illness: screening crisis intervention
suicide prevention
counseling
short term hospitalization
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| tertiary level of care | minimizing long term effects of MI; rehab
vocational training
aftercare programs IOP partial hospitalization/ day tx
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| look at chart on page 324 in HESI book | Denial, Displacement, Intellectualization, passive-aggression, projection, reaction formation, regression, repression, suppression, undoing
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| impairment in functioning due to a social, psychologic, genetic, physical, chemical, or biologic disturbance | mental illness
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| lying on a couch and talking to therapist | Psychodynamic treatment
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| Behavioral framework | learned behavior:shaped by environment
reward and punishment
change environment, change behavior
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| Cognitive framework | Changing expectations, beliefs, memory, thinking - treatment: changes in thinking = changes in behavior
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| Neuro-Biomedical Model | neurotransmitters and receptors
serotonin
norepinephrine
dopamine
GABA
psychotropics
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| milieu therapy | planned use of people, resources, and activities in the environment to assist in improving interpersonal skills, social functioning & ADLs. Here and now. Realities of today, limit setting, client makes decisions ~ healthcare.
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| family therapy | goal is to decrease family confilct and anxiety and to develope appropriate role relationships.
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| Patients interact within group: roles, rules established. Act out conflicts and solutions Types: education, supportive, psychotherapy, self-help | group therapy
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| the stages of group therapy | forming, storming, norming, conforming, adjourning
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| r/t group therapy: forming |
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| r/t group therapy: review pg 325 |
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| r/t group therapy: |
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| r/t group therapy: |
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| r/t group therapy: |
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| this type of tx induces tonic-clonic seizure and is usually 3-12 tx | ECT
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| event that overwhelms previously useful coping behaviors | crisis
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| what are the phases of a crisis | problem-solving, trial and error, relief behaviors, severe disorginization
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| 5 steps of crisis intervention | ID the problem, list alternatives, choose an alternate, implement the plan, evaluate
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| what you are feeling on the INSIDE | mood
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| your outward display of emotions | affect
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| R/T DSM-IV: Axis I | clinical d/o, substance abuse (major depression)
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| R/T DSM-IV: Axis II | personality d/o, mental retardation (borderline personality d/o)
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| R/T DSM-IV: Axis III | medical conditions (HTN, DM)
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| R/T DSM-IV: Axis IV | Psychosocial stressors (Severe r/t chronic financial stress, loss of job)
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| R/T DSM-IV: Axis V | Global Assessment of Functioning (Current GAF 30, past year GAF 70)
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| review slides for drug information - 74-82 | DANG DRUGS!!
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| what is hardiness? | how the event is perceived: commitment, challenge, control
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| Process of learning how to live with the inevitable life stressors people encounter by learning how to cope effectively and positively | stress management
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| Vague feeling of apprehension, terror, or dread arising from identified or unidentified stressors | anxiety
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| unpredictable, recurrent attacks of intense anxiety/fear that interfere with daily living. | panic d/o - more common in women
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| unrealistic, excessive, persistent anxiety about 2 or more life events. Coping is inadequate. | anxiety d/o
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| common physiologic responses to anxiety | increased HR & BP, rapid, shallow respirations, dry mouth, tight feeling in throat, tremors, muscle tension, anorexia, urinary frequency, and palmar sweating
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| persistent, intrusive thought, emotion or urge, unable to ignore | obsessions
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| performance of repetitious, uncontrollable purposeful act to prevent some future event | compulsions
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| r/t OCD, what are some interventions | allow time for rituals (initially):
then set limits, gradually dec. time
Explore meaning of the ritual
encourage socially acceptable outlets non confrontational
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| interventions r/t panic | stay with patient/ protect
remain calm
short simple sentences
quiet environment
physical activity may release tension
meds
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| Somatoform Disorders | Conversion
Hypochondriasis
Somatization
Pain Disorder
Body Dysmorphic
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| Dissociative Disorders | Amnesia
Fugue
Dissociative Identity
Depersonalization
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| pattern of behavior relating to self or others | personality
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| personality d/o are when traits become what? | inflexibility, inaffective relationships, maladaptive coping
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| 4 areas that deviate r/t maladaptive coping |
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| when do people with a personality d/o seek tx? | in a CRISIS: depression, bipolar crisis, other axis 1
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| Personality d/o is an Axis ___ problem | II
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| always be on alert for _____ | manipulation
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| r/t personality d/o, avoid ____ | power struggles
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| r/t personality d/o help the pt identify ___ ___ | maladaptive coping
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| r/t PD, the RN should do what? | be consistent, set standards/limits
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| 4 reasons why you would not tx PD in an outpatient setting | Safety issues
Psychotic
Axis 1
Crisis
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| Axis II is grouped into three clusters. What is in Cluster A? | BEHAVIOR: ODD OR ECCENTRIC
1. Paranoid
2. Schizoid
3. Schizotypal
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| characteristics of a paranoid pt: | SUSPICIOUS
MISTRUSTS OTHERS,
HYPERSENSITIVE
LACK SENSE OF HUMOR,
SECRETIVE, ARGUMENTATIVE
AFFECT COLD, SARCASTIC, ALOOF
CONTROLLING
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| interventions r/t a paranoid pt | formal approach, straightforward, on time, involve in care plans, validate ideas before taking action
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| characteristics of a schizoid | INTROVERT, LONER, SHY,
INDIFFERENT TO PRAISE / CRITICISM.
ALOOF
INABILITY TO FORM SOCIAL. REL.
FOCUS ON OBJECTS RATHER THAN PEOPLE
RICH FANTASY LIFE
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| interventions r/t a schizoid | Improve community functioning
Referrals
Case management: 1 person
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| characteristics r/t a SCHIZOTYPAL | ODDITY OF THOUGHT,
PERCEPTION, SPEECH,
AFFECT
ECCENTRIC
MAGICAL THINKING
HIGHLY ANXIOUS
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| interventions r/t schizotypal | develope self care & social skills, improve community functioning, role play, teach to be "normal"
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| what d/o are in cluster B? | antisocial, borderline, narcissistic, Histrionic
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| characters of an antisocial pt | DISREGARDS RIGHTS OF OTHERS
AGGRESSIVE / VIOLENT
ILLEGAL ACTIVITIES
NO GUILT
MANIPULATIVE
DISREGARDS AUTHORITY
IMPULSIVE
EXPLOIT OTHERS
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| interventions r/t antisocial pts | limit setting, matter of fact, anger management, time outs/leave the situation, positive feedback
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| characters of boderline personality d/o | prob w/identity & mood, unstable interpersonal relationships, "splitting" , "pits" staff, manipulation, abandonment issues, self mutilization, suicidal
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| interventions r/t borderline pts | maintain safety, coping strageties, reshape thinking, structured time
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| characters of a NARCISSISTIC pt | GRANDIOSE
EGOTISTICAL
LIKES ATTENTION
EXAGGERATES
LACK OF EMPATHY
EXPLOITS OTHERS, FEEL DESERVES SPECIAL TX
SUPERIOR ATTITUDE
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| interventions r/t narcissistic pt | straight forward, consistent, limit setting
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| characters of a HISTRIONIC | HYSTERICAL, DRAMATIC, THEATRICAL
EXTROVERTED, SEEKS ATTENTION
OUTBURSTS, TANTRUMS, OVERREACTS TO MINOR EVENTS
IMMATURE
SOMATIC C/O
LABILE MOOD
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| interventions r/t histrionic | Appropriate feedback: social skills, dress, communication, non verbal behaviors
Role play social situations
Assertive communication
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| Cluster C d/o.... | ANXIOUS OR FEARFUL
1. Dependent
2. Avoidant
3. Obsessive-compulsive
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| characters of dependent d/o | LACKS SELF- CONFIDENCE
ALLOWS OTHERS TO MAKE DECISIONS
SUBMISSIVE, PASSIVE
LIKES TO PLEASE OTHERS
LOW SELF- ESTEEM
ANXIOUS
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| interventions r/t dependent pts | Help verbalize feelings
Id strengths
Help with daily living/functions
Teach p/s and d/m skills
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| characters of a avoident pt | TIMID, WITHDRAWN
HYPERSENSITIVE TO CRITICISM
DESIRES RELATIONSHIPS BUT
AFRAID
FEARFUL
RELUCTANT TO GET INVOLVED
LO SELF ESTEEM
INHIBITED
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| interventions with an avoident pt | Support and reassurance
Positive self talk
Cognitive restructuring
Social skills
Be patient
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| characters of OBSESSIVE-COMPULSIVE d/o | PREOCCUPIED W/ RULES
ORGANIZATION, TRIVIA, DETAILS
PERFECTIONIST, INFLEXIBLE, FORMAL
CONTROLLING, HARSH, UNFORGIVING
CAN’T EXPRESS EMOTIONS
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| interventions with OBSESSIVE-COMPULSIVE d/o | Cognitive restructuring
Realistic goal setting
Take risks
Practice negotiation
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| issues r/t anorexia | control, preoccupation, rigid and restrained, hi-achievers, low self-esteem
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| what is the tx goal for anorexia | restore healthy weight, restore healthy eating patterns, correct electrolyte imbalances
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| long term goals r/t anorexia | IMPROVE SELF ESTEEM
IMPROVE BODY IMAGE
PARTICIPATE IN LONG TERM THERAPY
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| meds r/t eating d/o | SSRI's (Prozac-60-80mg/day), Lithium(lessens the "denial"), TCA(Imiparamine-decrease bing), Elavil(>weight gain), Zyprexa, Avoid antianxiety meds & Wellbrutrin(lowers seizure threshold)
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| desired outcomes r/t anorexia | ideal wt, adeq calories, good turgor, normal menstrual cycle
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| desired outcome r/t bulemia | no binge/purge, normal eating pattern, comfort w/ body
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| Persistent, pervasive, intense lowering of mood | depression
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| type I bipolar d/o | 1 or more acute manic episodes with depression
Both: hi income, hi educated, intelligent, creative, artistic
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| type II bipolar d/o | Major depressive episode with hypomania. No acute mania.
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| flight of ideas: | going from one thing to the next, can't stay focused on one thing
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| psychotic disorder involving difficulty with reality testing and relatedness | Schizophrenia
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| Schizophrenia characterized by Bleuler's 4 A's | affect, associations, autism, ambivalence(hard time making decisions)
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| Features of Schizophrenia (+) | Disordered thoughts: loose associations, flight of ideas
Language disturbance: tangentiality, neologisms, word salad, incoherence
Loss of function: withdrawal, poor ADL’s
Delusions
Hallucinations
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| neologisms | creating new words
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| word salad | jumbled words that together make no sense
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| false, fixed belief that cannot be changed by reason | delusion
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| false SENSORY perception | hallucination
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| (-) features of schizophrenia | Flat Affect
Poverty of speech
Apathy
Anhedonia
Social isolation
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| when will you see the s/s of alcohol withdrawal? | 4-12 hours after last drink
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| define delirium tremens | 12-36 hours after last drink, tachycardia, tachypnea, diaphoresis, marked tremors, hallucinations, paranoia
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| medication r/t alcohol withdrawal | Antabuse - SE-hypotension, weakness, chest pain, Ativan, Valium, Librium, Campral
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| look at slides 145 - 150 | meds
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| effects of hallucinogens | Dilated pupils, ˆ BP / P bizarre behavior, altered perceptions or feelings, insomnia, paranoia
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| general nursing care r/t drug overdose include | ABG’s, blood & UDS
O2,intubation,ventilator
Cardiac monitor/EKG
Restraints
Induce vomiting/gastric lavage if drug ingested
Activated charcoal
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| what med can block the effects of opiates | Naltrexone
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| what med can be used for Heroin abstinence | Methadone
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| this modification changes ineffective behavior patterns, focuses on consequences of actions rather than peer pressure | behavior modification
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| unconscious faiulure to acknowledge an event, thought, or feeling that is too painful for conscious awareness | denial
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| "kick the cat" - transference of feelings to another person or object | displacement
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| using reason to avoid emotional conflicts | intellectualization
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| attributing one's own thoughts or impulses to another person | projection
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| a person who dislikes animals does vounteer work at an animal shelter | reaction formation
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| involuntary exclusion of a painful thought or memory from awareness | repression
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| intentional exclusion of feelings and ideas | suppression
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| 3 common complaints after and ECT | headache, nausea, muscle soreness
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| day to day stressors, allows for logical thought and problem solving, pt will appear calm and in control = ____ anxiety | mild anxiety
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| client becomes restless, speech rate increases, client becomes wordy = ____ anxiety | moderate anxiety
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| stimulate causes fight or flight response, impairs concentration and problem solving ability = ____ anxiety | Severe anxiety
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| perception of reality is greatly distorted; unable to concentrate, overwhelmed, loss of control = ____ anxiety | Panic
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| what are some common physiologic responses to stress/anxiety | >HR, >BP, rapid shallow resp, dry mouth, tight feeling in throat, tremors, muscle tension, anorexia, urinary frequency, palmar sweating
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| acrophobia | fear of heights
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| agoraphobia | fear of crowds or open places
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| claustrophobia | fear of closed in spaces
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| nyctophobia | fear of the dark
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| thanatophobia | fear of death
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| examples of benzodiazepines | valium, xanax, ativan, librium
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| what are benzodiazepines used for? | reduce anxiety, induce sedation
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| Side effects of Benzodiazepines | drowsiness, ataxia,dizziness, irritability, blood dyscrasias
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| when is the best time to interact with an OCD pt? | right after ritual is finished...anxiety is at lowest point
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| what are some anxiety-reducing behaviors that can be taught | deep breathing, visualization, meditation, exercise and relaxation.
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| lack of concern over physical illness | La belle indifference
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| decrease in anxiety resulting frfom the ability to deal with a stressful situation | primary gain
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| rewards obtained from the sick role; sympathy, freedom from certain responsibilities | secondary gain
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| name two NON-benzodiazepines | BuSpar, Ambien
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| sudden temporary inablity to recall extensive personal information | psychogenic amnesia
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| when would you expect to see a case of psychogenic amnesia? | after a traumatic event, threat of death or injury, natural disaster
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| psychogenic fugue | a person suddenly leaving home or work with the inability to recall his or her identity.
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| fear of "going crazy", temporary loss of one's reality and ability to feel and express emotions | depersonalization
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| the last developmental task for a person. | death
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| types of death | natural, sudden, suicide
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| stages of preparing for expected death | denial, anger, bargaining, depression, acceptance
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| stages of grief | Shock, disbelief, rejection, or denial, 2.Resolution - up to 1 year or more
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| this PD is socially detaced, shy, and introverted. they avoid interpersonal relationships | schizoid personality
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| this PD has interpersonal deficits, eccentricities and odd beliefs, socially isolated | schizotypal personality
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| this PD is aggressive acting out behavior, clever and manipulative, self centered goals, emotionally immature | Antisocial personality
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| has disturbances r/t self image and sexual, social, and occupational roles. Makes suicidal gestures, overly dependent on others, unable to problem solve. | borderline personality
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| seeks attention by overreacting and exhibiting hyperexcitable emotions, "drama queen" | histrionic personality
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| perceives self as all-powerful and important, is critical of others, arrogant, self-love | narcissistic personality
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| socially inhibited, feels inadequate, hypersensitive to negative criticism | avoidant personality
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| low self-esteem, sees self as stupid, dependent on others to meet needs | dependent personality
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| cold and rigid towards others, attempts to control self by controlling others or environment | obsessive-compulsive personality
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| r/t bulimics, monitor electrolytes, especially ____ | potassium
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| this is a test used for degree of depression. It is positive if post test levels of _____ is greater than 5mg/dl | dexamethasone-suppression test (DST), cortisol
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| decreased ____ and _____ are indicative of depression | serotonin and norepinephrine
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| give examples of anticholinergic effects | dry mouth, blurred vision, constipation, urinary retention
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| examples of tricyclics | Elavil, Tofranil, Aventyl, Ludiomil
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| examples of side effects r/t MAO-inhibitors | impotence, tachycardia, dizziness, dry mouth, HTN crisis-severe HTN, headache, chest pain, fever, sweating, N/V
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| there are certain foods that trigger interactions with MAO-inhibitors. What is in the food and name some of the foods. | Tyramine, aged cheese, red wine, beer, beef and chicken liver, yeast, yogurt, sory sauce, chocolate, bananas
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| examples of SSRI's. | Prozac, Paxil, Zoloft, Lexapro
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| serotonin syndrome has to have 3 symptoms by definition, name some of the symptoms | rapid onset of AMS, agitation, myoclonus, hyperreflexia, fever, shivering, diaphoresis, ataxia, diarrhea
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| examples of nontypical antidepressants | Wellbutrin, Remeron
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| example of S/NRIs | Cymbalta, Effexor
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| common S/E for antianxiety meds | sedation, drowsiness
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| common S/E for antidepressants | anticholinergic effects, postural hypotension
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| common S/E for MAO's | HTN Crisis, diet restrictions (tyramine)
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| specific concerns/problems r/t Lithium | renal function assessment and monitoring
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| specific concerns/problems r/t Phenothiazines | extrapyramidal effects; tardive dyskinesia, photosensitivity
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| symptoms of mania r/t mood | euphoric, grandiose, unstable, self-confident
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| symptoms of mania r/t thoughts | flight of ideas, pressured speech, paranoid, psychotic
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| symptoms of mania r/t behavior | hyperactive, hyperverbal, manipulative, risky behaviors, colorful, poor grooming, wild energy
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| nursing interventions r/t mania | limit stimuli, firm, direct, consistent limits, high protein finger foods(on the go)
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| name of most common mood stabilizer | Lithium
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| how does Lithium work? | balances neurotransmitters in brain, regulates nerve impulses and balances mood swings
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| early signs of Lithium toxicity | D/V, drowsiness, muscle weakness, lack of coordination. Others:slurred speech, confusion, decreased BP.
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| Therapuetic level for Lithium | 0.5 - 1.5mEq/L
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| Other nursing implications r/t Lithium | Watch Na levels, keeps salt usage consistent, diuretics are contraindicated
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| examples of anticonvulsant mood stabilizers and what do they do? | Depakene, Tegretol, Lamictal. increase GABA in CNS
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| One noted side effect of Lamictal | Rash
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| what activities are good for a manic pt | noncompetitive physical activities that require use of large muscle groups
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| characterized by a distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days and present for most of the day nearly every day. | hypomania
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| define grief | personal, individual experience of a loss
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| define mourning | outward appearance of grief
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| what are some of things can affect the intensity and duration of grief | age, developmental stage, coping ablilities, support systems, culture, spiritual beliefs
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| true or false: the stages of dying are fluid and can be experienced in any order | True
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| symptoms of uncomplicated grief | sadness, anger, anxiety, guilt, shock, crying ect...
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| what is complicated grief? | no resolution of grief; chronic, delayed, exaggerated, masked
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| risk factors for complicated grief | social factors, relationship hx, death of a child, multiple losses, lack of faith system
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| describe death as seen as a preschooler | death is temporary, reversible, magical thinking
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| describe death as seen as a school-age child | irreversible, sad, inevitable, like details ( honesty, avoid cliches, give choices, listen, touch)
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| describe death as seen as a adolescent child | adult like view of death, inevitable, irreversible but distant event (loving confrontation, open communication)
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| how does a preschooler react to dying? | feel punished, angry, labile
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| how does a school age child react to dying? | why me? guilt, fear, vulnerable
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| how does an adolescent react to dying? | adult awareness, sad, bitter, isolated
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| describe delirium | acute process that if tx, is usually reversible. Sudden onset. Tx=correct the causitive d/o (infection, drug reaction, head trauma)
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| describe dementia | cognitive impairments characterized by gradual, progressive onset; irreversible. judgement, memory, abstract thinking and social behavior are affected.
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| WERNICKES-KORSAKOFF SYNDROME are due to ___ and ___ | alcoholism and Vit B deficiency
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| hallmark signs of dementia and Alzheimers | memory impairment, aphasia, apraxia, agnosia(recognizing everyday objects)
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| there are 3 stages of Alzheimers; stage 1 | memory loss, forgets recent events, trouble with words "you know that thingamagig"
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| there are 3 stages of Alzheimers; stage 2 | 2-12 years. loss of cognitive, motor skills, past memory is OK-recent memory not good. May start wandering, sleep disturbances(sundowners)
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| there are 3 stages of Alzheimers; stage 3 | profound dementia, complete nursing care, 8 mos - 5 years. death due to UTI, pneumonia, malnutrition
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| how/what do you need/see for a diagnosis in a child with a d/o? | behavior inappropriate for age, deviates from normal and creates a funcitional impairment
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| what are the three impairments of autism spectrum d/o | social impairment, communication impairment, ususual behaviors
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| characteristics of autism | Delayed socialization
Stereotypical behaviors
Rigid, intolerant to change
Communication problems, Limited eye contact
Minimal mood expression
Min. pretend play
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| strengths of a child with autism | Visual
Predictable
Patterns
Numbers/letters
Computers
Music
Books
Special interests
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| Rett's d/o | multiple deficits after a period of normal development
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| three characteristics of ADHD | inattention, impulsiveness, hyperactivity (increase of dopamine)
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| examples of conduct d/o | aggression to animals or people, vandalism, lying, theft, breaking the rules, lack empathy
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| s/s: mood instability, impulsivity, irritability, hyperactivity, sleep disturbances; r/t children | bipolar d/o.
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| how would a Dr begin to diagnose a child with bipolar d/o | daily mood chart, pattern over time. Looks like ADHD.
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| True/False: Assault on a patient can be a nurse forcing a pt to take a medication. (without touching the pt-verbally) | TRUE - assault is a mental or physical threat
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| True/False: An example of battery can be if you perform CPR on an DNR pt. | TRUE. touching, with or without the intent to do harm.
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| After death, a client has the right to be unobserved, exluded from unwarranted operations, and protected from unathorized touching of the body. This is an example of what? | Falls under invasion of privacy.
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| 6 rights of a hospitalied pt are discussed in the HESI book. What are they? | Right to: 1.wear own clothes and have money on them. 2.own storage space for use. 3. see visitors daily. 4.access to phone, ability for private calls. 5. get and send mail. 6. refuse shock/lobotomy tx.
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| how long can a pt be required to stay at a facility if someone applied for an emergency addmission? | A medical or judicial approval is required to detain anyone over 24 hours
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| according to the HESI book, there are 5 things that a person cannot do if they are delared incompetent. | vote, make contracts or wills, drive a care, sue or be sued, hold a professional license.
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| who is responsible to explain a surgical procedure to the pt? | the provider
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| psychiatric d/o characterized by thought disturbance, altered affect, withdrawal from reality, regressive behavior, difficulty w/communication, impaired interpersonal relationships. | schizophrenia - TOO MUCH DOPAMINE=TOO many signals
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| which type of schiophrenia is characteried by stupor, rigidity, posturing(waxy flexibility), negativism, potential for violence | catatonic
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| type of schiophrenia characterized by incoherence, flat affect, disorganied, unusual mannerisms, no delusions | Disorganized
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| type of schiophrenia characterized by delusions, hallucinations r/t a single theme or both, potential for violence if delusions are acted on. | Paranoid
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| type of schiophrenia characterized by being socially withdrawn, inappropriate affect, eccentric or peculiar behavior, no current psychotic behavior exhibited. | Residual
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| type of schiophrenia characterized by prominent delusions and hallucinations, incoherence and grossly disorganized behaviors. failure to meet other criteria for other types | undifferentiated
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| belief that conversations or actions of others have reference to the client | Ideas of reference
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| lack of clear connection from one thought to the next | looseness of association
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| echolalia | constantly repeating what is heard
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| neologism | creating new words
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| thinking based on facts vs abstract and intellectual points | concrete thinking
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| false sensory perception usually visual or auditory | hallucinations
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| misinterpretations of external environment | Illusions
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| false, fixed beliefs that cannot be changed by reason. | delusions
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| feelings or mood | affect
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| repeating another persons movements | echopraxia
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| nursing interventions r/t a schizophrenic | stress reality, avoid agreeing with inaccurate communications, assist w/ ADLs, nonjudgemental, set limits, avoid stressful situations,structure time for activities.
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| nursing interventions r/t delusions | encourage recognition of distorted reality, divert attention to reality based object, avoid arguing, no touching, meds(antipsychotics, antiparkisonians)
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| nursing inverventions r/t hallucinations | protect from injury, pay attn to content of hallucin, avoid arguing, "you appear to be listening to something", make frequent but brief remarks to break up hallucn, antipsychotics, antiparkisonians.
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| use Bleuler's four A's to help remember the important characteristics of schizophrenia, what are the four A's? | Autism(preoccupied w/self), Affect(flat), Associations(loose), Ambivalence(diff. making decisions)
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| what is a sign of increased command hallucinations? | increased motor activity and/or erratic responses to staff and other clients. -increased potential for aggressive behavior.
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| what meds are used to control hallucinations and delusions, and bizzare behavior? | antipsychotics - block excess dopamine
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| side effects for traditional antipsychotics (Phenothiazines) | orthostatic hypotension, weight gain, anticholinergic effects, extrapyramidal effects(pseudoparkinsonism, akathisia, dystonia, tardive dyskinesia) Photosensitivity
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| nursing implications r/t phenothiazines | 2-3 weeks for therapeutic effects, supine for 1 hour after administration, avoid alcohol, sedatives and antacids.
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| what are some side effects of Haldol? | severe extrapyramidal reactions, leukocytosis, blurred vision, dry mouth, urinary retention
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| Prolixin Decanoate is a long lasting nonphenothiazine, how often would a pt get this medication? | Prolixin can be given every 7-28 days and can take up to several months to get steady-state drug levels.
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| Clozaril is an atypical antipsychotic drug. What unique side effects do this med have and you should watch for? | agranulocytosis. Also: drowsiness and dizziness, GI symptoms, neuroleptic malignant syndrome. Monitor WBC for 1st 6 months then biweekly
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| what are characteristics of agranulocytosis in psychotropic drugs? | sore throat, fever, chills: gargle, use lozenges, and analgesics
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| characteristics of Parkisonism (1-4 wks after initiation of meds) | rigidity, shuffling gait, pill rolling, hand movements, tremors, dyskinesia, mask-like face.
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| characteristics of Akathisia (1-6 wks after initiation of meds) | Restlessness, agitation, and pacing. Sudden difficulty sitting still. (rule out anxiety: ask pt, "are you having trouble sitting still?"
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| Characteristics of dystonia (1-2 days after initiation of tx) | Limb and neck spasms, uncoordinated, jerky movements, difficulty speaking and swallowing, rigidity and muscle spasms.
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|
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| characteristics of tardive dyskinesia (develops late in tx) | involuntary tongue and lip movements, blinking, choreiform movements of limbs and trunk.
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|
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| characteristics of neuroleptic malignant syndrome? | high fever, tachycardia, stupor, ^ Respirations, severe muscle rigidity - Emergency situation!
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|
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| characteristics of serotonin syndrome? | confusion, disorientation, autonomic dysfunction.
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|
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| examples of anticholinergic effects | dry mouth, blurred vision, tachycardia,nasal congestion, constipation, urinary retention, orthostatic hypotension
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|
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| cogentin is an antiparkinsonian drug, what are some side effects of these meds? | antihcolinergic effects, drowsiness, headaches, urinary hesitancy, memory impairment
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|
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| benzodiazapines have 2 types of dosing strategies, what are they? | fixed dose; example q6hrs. 2: symptom triggered; dose r/t scale & s/s
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|
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| how early can s/s of alcohol withdrawal present? s/s such as anxiety, nausea, iinsomnia, tremors, hyperalertness, restlessness, and sudden or gradual increase of VS | 4-6 hours
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|
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| delirium tremors (DTs) may appear ___ to ___ hours after the last drink. | 12-36
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|
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| what are delirium tremors? | tachycardia, tachypnea, diaphoresis, marked tremors, hallucinations, paranoia, (possible grand mal seizures)
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|
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| _____ syndrome is irreversible and usually follows delirium tremens associated w/alcoholism. | Korsakoff
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|
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| a severe d/o occuring in chronic alcoholics that is probably due to lack of Vit B (thiamine). It may escalate Korsakoff syndrome and tx w/ thiamine chloride | Wernicke syndrome
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|
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| what is the preferred tx medication for alcoholics? | Antabuse - severe side effects if alcohol is consumed while taking this med. Also:librium or Antivan(antianxiety meds)
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|
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| what are the side effects of drinking alcohol while taking Disulfiram(antabuse)? | N/V, Hypotension, headaches, rapid pulse and respirations, flushed face and blood-shot eyes, confusion, chest pain, weakness, dizziness
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|
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| what kind of diet and Vitamins would you want to give to an alcoholic pt? | high protein diet, limit caffeine, and Vit B1 and B complex
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|
||||
| what are some examples of antianxiety drugs? | Benzodiazepines: valium, serax, ativan
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|
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| what kind of defense mechanisims are used by chemically dependent clients? | denial and rationalization are the two most common coping styles used
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|
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| what is the basic priority for a chemically dependent pt? | nutrition
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|
||||
| what are the three phases of intimate-partner violence? | I:tension, II: episode/explosion, III:Honeymoon
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|
||||
| describe the Tension stage of r/t abuse. | the woman tries to avoid the stressful triggers
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|
||||
| describe the Explosion stage r/t abuse. | this is the actual account; the abuse; shock and denial
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|
||||
| describe the "honeymoon" stage of abuse | the abuser is very apologetic, promises change, brings gifts
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|
||||
| the basic difference between delirium and dementia is that delirium is ___ and ___, whereas dementia is ____ and ____. | acute and reversible, gradual and permanent
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|
||||
| what are some causes of delirium? | infection, drug reaction, sustance abuse, electrolyte imbalance, head trauma, sleep deprivation
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|
||||
| nursing interventions for confused elderly patients should be what? | maintaining pt's health and safety, encouraging self care, reinforce reality("good Monday morning mr smith), engage in simple tasks and activities to build self-esteem
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|
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| what are some things you need to consider r/t a child w/possible ADHD? | how many friends do they have?, normal behaviors/developmental tasks, feelings? watch for change.
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|
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| what are some notable side effects r/t stimulants for an ADHD pt? | Tourette's syndrome, tachycardia, palpations, angina, anorexia, weight loss, nausea, abd pain
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|
||||
| there are three basic levels to manage ADHD. Briefly what are they? | Primary: Headstart, Secondary: Screening, Therapy: family/individual
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|
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