Psychiatric Nursing Review Flashcards

Flashcards for Psychiatric Nursing Review

What are obsessions in the context of OCD?

Thoughts, impulses, or images that persist and recur, so that they cannot be dismissed from the mind.

What are compulsions in the context of OCD?

Ritualistic behaviors an individual feels driven to perform in an attempt to reduce anxiety; must be repeated and have rigid rules.

What are two main treatments for OCD?

Cognitive-behavioral therapies (systematic desensitization and implosion therapy) and medications (antidepressants).

What are characteristics of obsessive personality disorder?

Inflexibility about the way things must be done and devotion to productivity.

What are characteristics of narcissistic personality disorder?

Exaggerated sense of self-worth and lack of empathy.

What neurobiological actions occur in the brain during panic and extreme anxiety?

Amygdala stimulates the limbic system when there is no threat; GABA and serotonin are decreased in GAD, and epinephrine is increased.

Which class of medication is most likely given to reduce an anxiety attack?

Anxiolytics, antidepressants, and antihypertensives.

List at least 4 DSM-5 criteria for Generalized Anxiety Disorder.

Trembling/sweating, SOB/chest pain, nausea, dizziness, numbness, derealization/depersonalization, fear of losing control, fear of dying.

What is the role of defense mechanisms?

Coping styles that protect and maintain self-image by blocking feelings, conflicts, and memories; used to block trauma and suppress it.

What occurs during an acute episode of conversion disorder?

Unexplainable change in body function, symptoms go from mind to body.

What is the difference between factitious disorder and somatic symptom disorder?

Factitious disorder involves secondary gain (awareness of fabricating symptoms to gain something), while somatic symptom disorder does not involve secondary gain.

What is the difference between illness anxiety disorder and somatic symptom disorder?

Illness anxiety disorder is an inaccurate interpretation of physical symptoms leading to fear of having a serious disease, while somatic symptom disorders are characterized by physical symptoms suggesting medical disease without demonstrable organic pathology.

What is Dissociative Identity Disorder (DID)?

Formerly known as Multiple Personality Disorder; two or more personalities in one person, one more dominant than the other.

What is trauma-informed care?

Knowing and being aware of the patient’s trauma and avoiding triggers that may worsen it. Build trust and rapport.

List characteristics of PTSD.

Reliving event, anxiety, numbed responsiveness, nightmares, depression, survivor’s guilt, partial amnesia, substance abuse, relationship problems.

Give PTSD interventions and evaluation of interventions for adults with PTSD (GOALS).

pt will not harm self or others, begin healthy grief process toward resolution, healthy coping strategies, perform self-care activities independently within the level of ability Cognitive behavioral therapy: the individual will recognize and modify trauma-related thoughts and beliefs; modify the relationship between thoughts and feelings

Define derealization.

Disturbed perception of environment.

Define depersonalization.

Disturbed perception of self.

Explain mindflight in children experiencing trauma.

It reduces disturbing feelings and awareness of the event as a way of coping, a defense mechanism and survival strategy.

What makes one’s personality a “disorder”?

When these traits become rigid and inflexible and contribute to maladaptive patterns of behavior or impairment in functioning (affects one's work, relationships, and other areas of life).

What are characteristics of Obsessive-Compulsive Personality?

Inflexibility about the way in which things must be done; devotion to productivity.

List the cluster the following personality disorders belong to (Cluster A): paranoid, schizoid, schizotypal

Cluster A: odd or eccentric

List the cluster the following personality disorders belong to (Cluster B): antisocial, borderline, narcissistic, histrionic.

Cluster B: dramatic, emotional, erratic

List the cluster the following personality disorders belong to (Cluster C): avoidant, dependent, obsessive-compulsive

Cluster C: anxious, fearful

Describe splitting done by the BPD patient.

Primitive ego defense mechanism. View things in extremes. Everything is either good or bad. Clients with BPD either idealize or devalue the nurse and others. Attempt to get the nurses mad at one another.

List important areas to address during assessment of patients with personality disorders.

Pay close attention to cognitive, affective, interpersonal, and impulse control areas

List suicide risk factors

Single/Divorced, Gender: women attempt more, but men succeed more (they use a more lethal means), Risk increases with age (45-54 and 85 or older) children, bullying is most likely the cause, social classes, ethnicities

SAD PERSONS scale

S: sex male? A: age D: depression P: previous attempt E: excessive alcohol R: rational thinking loss S: social supports lacking O: organized plan N: no partner S: sickness

List reasons why clients cut/harm themselves

It’s a release of emotional pain, and they lack the coping skills

What are common behaviors and symptoms upon returning from combat?

Migraine HA, Memory impairment, Hypervigilance, Insomnia, Jitteriness, Aggressive behaviors, Substance use

Describe symptoms of TBI

Problems with cognition, Problems with behavior or mental health, Seizures, Language and communication problems, Social functioning, Long-term risk of Alzheimer’s disease or Parkinson’s disease

Describe symptoms of PTSD

Re-experiencing the trauma through flashbacks, nightmares, and intrusive thoughts, Intensive efforts to avoid activities, Chronic negative emotional state, Aggressive, reckless, or self-destructive, Hypervigilance, Angry outbursts, problems with concentration, and sleep disturbances

Give nursing interventions for TBI

Protection from injury and self-harm, Assisting caregivers to prevent frustration and burnout

Give nursing interventions for PTSD

Adaptive progression through the healthy grieving process, No harm to self or others

What are psychological signs of eating disorders?

Suicidal ideation, self-harm behaviors, excessive laxative, emetics, diuretics, street drugs, severe depression, psychosis

List personality traits of persons with Anorexia Nervosa (AN)

Rigid and perfectionist

List Symptoms of AN

Sx: gross distortion of body image, preoccupation with food, refusal to eat, hypothermia, bradycardia, hypotension, edema, lanugo, metabolic changes, amenorrhea

List physical criteria to hospitalize a client with AN

Weight loss of over 30% over 6 months and malnourished, Below 75% of IDW, Rapid decline in weight, Failure in outpatient tx, Hypothermia <96.8F, HR <40 bpm, SBP <70 mm Hg, Hypokalemia <3 or other electrolyte disturbance not corrected by oral supplementation

List the most common causes of death in eating disorders

CARDIAC DISORDERS

Why is sleep important to mental health?

Inadequate sleep leads to mood disturbances, memory problems, and overall cognitive dysfunction, Individuals with pre-existing mental disorders often fall below baseline function when getting inadequate sleep

List the danger of inadequate sleep

Excessive sleepiness that leads to dangerous situations, such as falling asleep while driving, Doubles the risk of developing obesity, DM, HTN, heart disease, stroke, depression, and substance abuse

What is the role and function of the forensic psychiatric nurse

Assess sociocultural influences on the individual patient, family, and community to provide clients with comprehensive psychosocial care. They help victims of crime cope with their emotional wounds and assist in the assessment and care of mentally ill offenders

Difference between normal bereavement and major depressive episode following a loss

Normal bereavement: Waves or pangs of grief associated with thoughts or reminders of the deceased that are likely to spread further apart over time, Emptiness and loss are accompanied by occasional pleasant emotions. Major depressive episode: Negative emotions experienced continually over time, Pervasive depressed mood and the inability to anticipate happiness or pleasure

Terms: loss, grief, bereavement, mourning

Loss: experience of separation from something of personal importance, Grief: natural emotional response to loss, Bereavement: period of grief and mourning following the death of a loved one, Mourning: expression of deep sorrow for someone who has died

Tasks of mourning a loss

1. Accept the reality of the loss 2. Express the pain of grief 3. Adjust to an environment without the deceased loved one 4. Memorialize or give meaning to the loss 5. Re-organize and move forward

Examples of disenfranchised grief

Loss of a person that others don’t recognize as painful, such as an ex-spouse, abusive partner, Loss of a person whom an individual took care of professionally in the role of a doctor or nurse, Death by suicide

Nursing interventions for the grieving

Listen, Sit quietly with them, Therapeutic presence, Seek to understand how they feel

What NOT to say to acutely grieving persons

“I understand how you feel”, “He’s better off”, Do not tell your own story, Do not redirect the expression of grief because you feel uncomfortable

What patient needs the closest observation for withdrawals?

ALCOHOL

Important Teaching for the patient who takes lithium

Take the medication regularly, Do not skimp on dietary sodium and maintain appropriate diet, Know pregnancy risks, Carry ID noting taking lithium

Therapeutic level of lithium

0.5-1.5 mEq/L

Types of Bipolar Disorder

Bipolar I disorder, Bipolar II disorder, Cyclothymic disorder, Substance-induced bipolar disorder, Bipolar disorder associated with another medical condition

What is the indication for Ritalin (Methyphenidate)? What important side effect should the nurse watch for in children?

Given for ADHD; watch for weight loss

Which medication class is most likely to produce EPS in patients?

First Gen. antipsychotics

Know the sequence of stages in the Cycle of Domestic Violence.

1. Tension-building stage 2. Acute battering stage 3. Honeymoon stage

Review the term “least restrictive environment.”

Always try the least restrictive means before resorting to restraints or seclusion; restrictive means should be ineffective before resorting to a more restrictive intervention

ADHD-what is it and what are the types? Treatments?

Essential behavior pattern is inattention and/or hyperactivity and impulsivity, Types: combined type, predominantly inattentive, or predominantly hyperactive/impulsive, Tx: CNS stimulants (i.e. methamphetamine, methylphenidate)

ASD-Autism Spectrum Disorder - What is it?

According to the APA communication disorders are considered a neurodevelopmental disorder, Predisposing factors: neurological implications, genetics, prenatal and perinatal influences

How to assess personal coping skills of a M.H. patient

Assess behaviors, Do they have effective coping skills?

S/S of Serotonin syndrome

Agitation or restlessness, Insomnia, Confusion, Rapid heart rate and high blood pressure, Dilated pupils, Loss of muscle coordination or twitching muscles, High blood pressure, Muscle rigidity

S/S of Neuroleptic malignant syndrome

muscle rigidity, cogwheeling, high fever, dysphasia, coma, death

Two Primary neurotransmitters in mood and depression

1. Serotonin 2. Dopamine

Programs that assist homeless individuals with mental illness include:

Case management and Assertive Community Treatment