NURS 358 Exam 2

What body part is compared to patients with autism to those who do not have autism?

brain-based differences

How does autism affect patients from childhood to adulthood?

impacts growth and development throughout life

What are the two factors that the DSM 5 use to define autism?

Core symptoms include difficulties with social communication and interaction, and restricted, repetitive patterns of behavior, interests, or activities

What type of genetic condition is autism?

polygenetic; many genes are involved, not just one

What is epigenetics?

how environmental factors can affect how genes operate; seen in autism

Is there a cure for autism?

no, people are born with autism; skills can be gained but does not undo genetic condition

What do autism traits result from?

autism brain diversity

What is ableism?

discrimination against disabled people (e.g. not hired due to disability, no wheelchair accessibility, service dogs denied with owner, treats person as if immature for age, “dumb down” language, assumptions on sexual pleasures)

What is implicit bias?

attitudes and ideas about disability that impact your interactions with a disabled person

What is disability language?

conveys biases and attitudes and has an impact on self-advocates

What is models of disability?

informs what you might “do” about a disability

What is high functioning language?

describes an autistic person who can function well in society and has good language skills; term should be avoided

What is low functioning language?

describes autistic person who has lots of autism traits, struggles with language, and “does not function well in society”; term should be avoided

What is functional limitation?

some characteristic of a person that limits functioning in an area of life

What is presuming competence?

assume people can do things they want to do, express themselves, and make choice, but support may be needed

What is the opposite of presuming competence?

infantilization

What are characteristics that may determine someone to have a hypersensitive sensory issue?

extremely sensitive to ordinary sounds, unable to tolerate certain sounds, painful reaction to ordinary lights, feel sick from food odors, scented products, smell of people; unable to tolerate touch, textures, proximity; avoid movements or get dizzy easily

What are characteristics that may determine someone to have a hyposensitivity sensory issue?

craves and seeks out sensory inputs, intense focus on sensory detail of environment, desire deep pressure or certain touch of objects, cannot sense body in space, needs to spin, rock, pace

How should we as nurses meet and treat the individual?

wherever the patient is at, whether it is on the floor, chair, under the table

What are “stim toys” and how can it be used as a sensory strategy?

squishy ball, play-doh, light stick the patient can hold

What is an example of reduced exposure to accommodate to sensory issues?

antibiotics given once a day rather than every 6 hours

What tricks can be used for sensory avoiders?

juice/candy to drown out unwelcome taste, ear plugs to drown out noises, mask for smells, sunglasses/eye patch, distractors (puzzle), hide-away spaces

What tricks can be used for sensory seekers?

small balls/fidget toys, pot pourrie or scented bracelets, lotion, small sand bags/squishy pillows, gum/candy, places to lean or push (wall), heavy blankets

What are 10 examples of communication challenges?

no speech, use of speech but loses speech under stress, uses behavior as communication, echolalic, lack tone of voice, long time to process verbal information, long time to answer questions, not able to answer open-ended questions, struggle to interpret another person’s message, struggle to use body language

What is echolalic?

repetition of question instead of answering it

What do people with autism rely on?

routine, rituals, set schedules, clear rules

What are 5 ways autism affects development?

not able to do age-expected activities/daily life tasks, not understand/comprehend age-typical material, unable to interact socially at chronological age, not always correlated to cognitive level (IQ)

Why may a patient with autism express aberrant behavior?

underlying medical conditions that need treatment'; pain or discomfort; due to atypical communication, sensory sensitivities, immature development

What does the meaning of flipped reactions mean for patient with autism?

calm when sick and aggressive when better (or reverse); extreme pain from minor injury but no pain sensation for a more severe injury

How is disability viewed in the medical model?

want to fix the person, think disability is tragic, disability needs to be cured, fixed, or eradicated completely

How is disability viewed in the social model?

need to fix negative stigma in society, provide accommodation, services to improve quality of life

How is disability viewed in the neurodiversity model?

values neurodiversity, services to help person contribute unique attributes, interests, skills

What is psychosis?

state of mind in which a person’s capacity for recognizing reality, communicating, and interacting with others is impaired (diminished ability to function)

What is the prevalence of schizophrenia?

1% of general population

What is the onset of schizophrenia?

late teens early adulthood (18-30)

What are the potential causes of schizophrenia?

genetics, biochemical dysfunction (neurotransmitters), physiological factors, psychosocial factors

What does genetic vulnerability mean in terms of schizophrenia?

relatives of individuals with schizophrenia have higher probability of developing the disease (identical twins have 50%, fraternal twins additional 15%)

What is the neurotransmitter dysregulation in schizophrenia?

dopamine hypothesis where too much is produced resulting in the positive symptoms

What are the potential etiology of schizophrenia?

neurodevelopment, sociocultural and environmental factors, stress, drugs

What are the diagnostic criteria of schizophrenia in the DM-5-TR?

2 or more of the following present for significant portion of a 1-month period

* delusions
* hallucinations
* disorganized speech
* grossly disorganized or catatonic behavior
* negative symptoms

What are conditions that may mimic schizophrenia?

space occupying lesion (brain tumor, an organic nature of the brain), LSD, amphetamines, alcohol withdrawal, syphilis, infections

What are the 3 types of schizophrenia?

paranoid, disorganized, catatonic

What are positive symptoms?

things that are present but should not be there, resulting in an excess or distortion of normal function; thoughts and feelings “added on” to a person’s experience

What are examples of positive symptoms?

auditory hallucinations, somatic delusions (“something crawling on their skin”; think they’re pregnant or have cancer), erotic delusions (think someone is inlove with them, typically stalkers), persecutory delusions (think someone is out to get them), referential delusions (messages are intended for them from TV, radio, etc.), thought disorders (need to ask a lot of questions/disorganized); grandiose (“superpowers”)

What are negative symptoms?

things that are “taken away” or reduced

What is typically the first sign of schizophrenia?

negative symptoms

What are examples of negative symptoms?

flat affect (absence of emotions); anhedonia (loss of pleasure); asociality (social withdrawal); alogia (poverty of speech/sparse); avolition (lack of energy); apathy (lack of emotion)

What are mood disturbances experiences in schizophrenia?

depressed mood, hopelessness, worthlessness, SI

What are some cognitive impairments seen in schizophrenia patients?

memory resulting in forgetfulness and difficulty learning; attention affecting completion of tasks/distractible; executive functioning affecting decision making (getting dressed), abstract thinking (take words literally), and problem solving (start things and can’t finish them)

What is the goal nurses want to see for their schizophrenia patients who have the inability to trust (paranoia and delusional thinking)?

demonstrate increased trust with others by tolerating eating meals w/ peers in kitchen

What are ways to manage schizophrenia?

cognitive-behavior therapy, patient and family education

What 3 things are involved in CBT?

emotions (what we feel affects how we act and think); thoughts (what we think affects how we feel and act); behaviors (what we do affects how we think and feel)

How should nurses implement effective communication for patients with schizophrenia, who may also be dealing with psychosis (impaired memory/attention, formal thought disorder)?

simple, direct, one-step directions/statements

How should a nurse respond to a schizophrenic patient how asks “do you hear the voices”?

communicate that they are not experiencing the same stimuli (in this case hearing voices) that the pt is reporting AND should convey that they do believe the patient is hearing voices

***Review typical and atypical medications***

What is the ideology of why schizophrenic pts taking antipsychotics experience side effects?

schizophrenic pts have an increase of dopamine, where meds that are given are dopamine antagonists, but sometimes dopamine levels “bottom out”

What are the 4 EPS symptoms a patient may experience when taking antipsychotics?

dystonic reactions (muscle contractions)'; pseudoparkinsonism (mimics parkinson); akathisia (severe restlessness); tardive dyskinesia (muscle movement of face and __is not reversible)__

What is NMS?

life threatening condition that occurs due to a complete blockade of dopamine (s/s: fever, autonomic instability, rigid muscles)

How may psychosocial rehab help schizophrenic patients?

provides support and structure; vocational and social skills training; socialization; teaches life skills to manage self in community

What are chronic managements for stable schizophrenic patients?

individual psychotherapy; group psychotherapy; self-help groups; support groups; follow up care (medical comorbidity)

What is a crucial patient and family teaching for exacerbations of schizophrenia?

early s/s of relapse; should be made aware of symptoms triggersW

What is the difference between schizophrenia and schizoaffective disorder?

schizoaffective disorder is classified as a mood disorder where schizophrenia does not have mood being a dominant part of the disorder

What is Serious Mental Illness?

biological life-long disorders that significantly affect one’s level of functioning

What are other terms of SMI?

Broad-Based Mental Illness; Severe and Persistent Mental Illness; Biologically-Based Mental Illness

How many people in the U.S live with SMI?

11\.3 million

What are some common SMI’s?

major depressive disorder; bipolar disorder; schizophrenia; schizoaffective disorder; panic disorder; PTSD; boderline personality disorder; antisocial personality disorder

Where did older adults receive care prior to modern hospitals?

state institutions (living in extended period of times) where care was poor (custodial and regimented); human rights were commonly violated

What is the LOS for younger adults?

< 6 days

What is the goal for short-term hospitalizations for young adults?

stabilize pt related to acute safety needs

What is a common cycle seen in young adults w/ SMI?

brief recovery → non-compliance → relapse

What do young adults have an increased risk for?

incarceration, homelessness, substance misuse, unemployment

How may patients with SMI experience trouble during remission?

exacerbations of SMI

How may remission feel for patients with SMI?

may be symptom free, or may experience chronic deteriorating course where symptoms wax and wane but never remit

How may SMI overwhelm an individual?

erodes ability to cope, loss of social skills, loss of social support when needed the most

What is the goal for the Rehabilitation Model of Care?

stabilize the disability by focusing on managing the pt’s deficits, dependence, and learning to live with the deficits

What does the Recovery Model focus on?

achieving pt goals, strengths and abilities - all to have meaningful productive lives

How does comorbid conditions (HTN, DM, obesity, CVD) affect pt’s with SMI?

3x more risk for premature death, die > 25 years prematurely, behaviors

What are factors contributing to poor physical health in patient’s with SMI?

failure to seek healthcare, expressing health concerns in unclear manner, noncompliance w/ meds, poor diet, smoking, inability to afford care, criminal victimization

What are 3 common affects seen with substance abuse in patient’s with SMI?

increases risk of relapse, impairs judgement, decreases impulse control

What 2 factors result in a stigma around mental health illnesses?

lack of understanding and incorrect beliefs, resulting in fear and avoidance

What does NAMI seek to resolve stigma about mental illnesses?

improve understanding and acceptance though public education

What is Insurance Parity?

provides mental health coverage equal to that for physical healthcare required under the Affordable Care Act

What is anosognia?

inability to recognize one’s illness due to the illness itself affecting those with SMI

How long can it take for an individual with SMI to recognize their symptoms and acknowledge their MI?

months or years

How many individuals are not receiving treatment or not adhering to treatment plan for SMI?

50%, increasing the risk of relapse

What are some causes of non-adherence?

anosognoia, side effects, med costs, lack of trust in providers, stigma

Why may side effects be distressing for a patient?

may cause involuntary movements, diabetes, weight gain, sedation, sexual dysfunction

What are 5 evidence-based treatment approaches?

CBT, cognitive enhancement therapy, family support and partnerships, social skills training, vocational rehabilitation services

What is the definition of a mood disorder?

prolonged emotional state that influences an individual’s whole personality and life functioning; psychiatric disorders that are characterized by persistent mood disturbance

What is the most common psychiatric illness?

mood disorder

What is it critical for clinician to differentiate with depression?

normal (lost a partner and is depressed for 4 weeks) vs pathological (2 years later and experiencing SI)

What is the definition of major depressive disorder?

person is sad with depressed mood or irritable much of each day for two or more weeks presenting with clear change from previous functioning

How do symptoms of major depressive disorder cause significant change?

impairment or distress in social, occupational, school, recreational, or relational functioningW

What are symptoms of major depression?

anhedonia (almost always present), appetite changes (weight loss), sleep disturbance (insomnia which is more common, or hypersomnia), restlessness/psychomotor retardation, fatigue, feeling worthless, guilty, hopeless, helpless (increase suicide risk), inability to think clearly/maintain concentration, difficulty making decisions, thought of death or suicide attemptsW

What are common classifications of major depression?

mild, moderate, severe, recurrent, w/ or w/o psychotic symptoms

What is the #1 psychological disorder in the U.S?

major depression

What age is depression prevalent?

onset at any age but typically begins in mid twenties and thirties

Is depression more common in men or women

women

Is depression treatable?

yes, pts often return to fully functioning levels

What are some risk factors for depression?

prior episodes of depression, family hx, prior suicide attempts, medical comorbidity (cancer, HIV/AIDS), lack of social support, stressful life events, personal hx of sexual abuse, current substance abuse