PNUR 1200 Midterm Exam

Repression

defense mechanism - unconscious exclusion of unpleasant or unwanted experiences, emotions or ideas from conscious awareness - burying or forgetting experiences

Compensation

defense mechanism - used to counterbalance perceived deficiencies by emphasizing strengths - making up for inadequacies by developing a desired trait

Sublimination

defense mechanism - unconscious process of substituting mature and socially acceptable activity for immature and unacceptable impulses

Conversion Reaction

defense mechanism - unconscious transformation of anxiety into a physical symptom with no organic cause

Reaction Formation

defense mechanism - when unacceptable feelings or behaviors are controlled and kept out of awareness by developing the opposite behavior or emotion - covering up unacceptable traits by displaying very opposite ones

Mental Health Assessment

ASMTPO - Always Sent Mail Through The Post Office - Appearance, Speech, Memory/Mood, Thoughts, Perception & Orientation

Justice

Ethical Principle - distribute care same across all patients

Beneficence

Ethical Principle - duty to go above and beyond

Non-Maleficence

Ethical Principle - do no harm

Autonomy

Ethical Principle - respecting rights of others to make their own decision, self governing

Paternalism

Ethical Principle - work on behalf of people that cannot speak for themselves

Veracity

Ethical Principle - duty to be honest

Orientation Phase

Phase 1 of Nurse-Client Relationship - develop trust, assessment/data collection, develop nursing diagnosis & goals

Working Phase

Phase 2 of Nurse-Client Relationship - implementing nursing interventions, assist client towards goals

Termination Phase

Phase 3 of Nurse-Client Relationship - evaluate success, provide resources, client returns to self management

Psychoanalytic Theory

Sigmund Freud - focus on finding root of subconscious thoughts and feelings that contribute to maladaptive behaviors

Cognitive Therapy

focuses on reframing the way individuals think and feel about themselves and their circumstances, treats depression, anxiety and eating disorders

Behavioral Therapy

training approach to change behavior - positive reinforcement - modeling/operate conditioning/systemic desensitization/aversion therapy/flooding/thought stopping

Electroconvulsive Therapy (ECT)

electrical current that is applied resulting in grand mal seizure, enhance effects of neurotransmitters (serotonin, dopamine & norepinephrine), severe depression, schizophrenia, manic episodes

General Adaptation Syndrome

(GAS) - Seyle's concept that the body responds to stress with alarm, resistance and exhaustion

Dysphoria

anxiety out of proportion to danger

Signs of Anxiety

WORRY WARTS

Wound Up

Worn out

Absent Mindedness

Restless

Touchy

Sleepless

Generalized Anxiety Disorder

occurs most days for at least 6 months, intensity, frequency and duration of anxiety is far out of proportion to reality, anxiety or severe stress is symptom

Symptoms of Anxiety

Muscle aches, shakes, palpitations, dry mouth, nausea, vomiting, diarrhea, hot flashes, chills, polyuria (frequent urination), insomnia, difficulty swallowing.

Panic Disorder

recurrent and unexpected panic attacks, followed by one month or more worrying about another attack

Panic Attack

intense fear or discomfort, occur without warning and unpredictable, severity peaks within 10 minutes, one attack does not indicate panic disorder, need 4 complaints of symptoms to be considered panic attack

Paresthesia

numbness and tingling

Diaphoresis

profuse sweating

Phobia

irrational fear often recognized as unreasonable, fear of specific object or situation

Social Phobia

persistent fear of social situations in which one might be exposed to the close scrutiny of others and thus be observed doing something embarrassing or humiliating, symptoms last longer than 6 months in people under 18

agoraphobia

An abnormal fear of open or public places, closely associated with panic disorder

Obsession

repetitive thought, urge or emotion

Compulsion

repetitive act that may appear purposeful

PTSD

debilitating condition following extreme physical or emotional traumatic stress

Cognitive-Behavioral Therapy

reduce anxiety by eliminating maladaptive beliefs or behaviors, change thinking patters, change behavioral reaction to anxiety provoking situations, 12 weeks

Medication for anxiety disorders

Benzodiazepine Sedative Hypnotic

Diazepam (valium)

Lorazepam (Ativan)

Clonazepam (Klonopin)

Alprazolam (Xanax)

Chlorodiazepoxide (Librium)

Oxazepam (Serax)

Benzodiazepine Sedative Hypnotic

Generalized anxiety disorders and panic disorders

Alcohol Withdrawal

Insomnia

Muscle Spasms

Seizure Disorders

Bipolar Disorder

chemical imbalance causing extreme mood swings, often not diagnosed until depressive state, treatment with lithium,

Signs of Mania

DIGFAST

Distractibility

Impatience/Irritability

Grandiosity

Flight of Ideas

Activity Level Increased

Sleep Deficit

Talkative

Lithium

0.6-1.2, toxic at level 2, many side effects

Toxicity:

Severe Hypotension

Seizures

Coma

Blurred Vision

EKG changes

Death

Depression

Most common cause of disability, women twice as likely, 2/3 of suicide attributed to depression

Medical Treatment:

Combination Therapy

Antidepressants

Psychotherapy

ECT

Medicate for Depression

Selective serotonin reuptake inhibitors (SSRI)

Tricyclic antidepressant

Monoamine oxidase inhibitors (MAOI)

Atypical antidepressants

Selective Serotonin Reuptake Inhibitors (SSRIs)

Paroxetine (Paxil)

Sertraline (Zoloft)

Escitalopram (Lexapro)

Fluoxetine (Prozac)

Citalopram(Celexa)

increase availability of serotonin, rise and change positions slowly

Tricyclic antidepressants

Amitriptyline(Elavil)

Imipramine(Tofranil)

Nortriptyline (Pamelor)

Sinequan (Doxepin

increase availability of serotonin and norepinephrine, kids

Monoamine Oxidase Inhibitors MAOI's

No Popular Meds

Phenelzine (Nardil)

Tranylcypromine(Parnate)

Isocarboxazid (Marplan)

metabolizes neurotransmitters, do not used with SSRI, Tricyclic or cold medication, avoid foods with tyramine & caffeine, last option

Atypical Antidepressants

Bupropion (Wellbutrin)

Venlafaxine (Effexor)

Duloxetine (Cymbalta)

Trazadone (Desyrel)

Mirtazapine(Remeron

Grandiose Delusion

a person's false belief that he or she possesses great wealth, intelligence, or power

Delusion of reference

events, objects or other people in the immediate environment have a particular and unusual significance

Persecutory Delusion

a person's false belief that someone is plotting against him or her with the intent to harm

Somatic Delusions

believes that ones body is changing in an unusual way, such as growing a third arm

Prodromal phase of Schizophrenia

usually in young adulthood, affects ability to relate to self and others, positive symptoms plateau 5-10 years after diagnosis

Treatment of Schizophrenia

Medications (antipsychotics & anticholinergics), psychotherapy and ECT

Goals: relieve symptoms of psychosis, improve negative symptoms, prevent further episodes, improve function and quality of life

Side Effects of Antipsychotics

Extrapyramidal Effects, Neuroleptic Malignant Syndrome, Anticholinergic Effects (sedative), Cardiac Effects, Weight Gain, Seizures & Photosensitivity

Extrapyramidal Syndrome (EPS)

adverse reactions affecting nervous system, abnormal muscle movement, usually diminishes with lower dosage of drug, Anti-Parkinson drugs like Benztropine can be prescribed to reduce EPS

Dystonia, Pseudo-Parkinsonism, Akathasia, Tardive Dyskinesia

Dystonia

muscle rigidity/spasm

Pseudo-Parkinsonism

stiffness, tremors, shuffling gait

Akathasia

restlessness

Tardive Dyskinesia

irreversible involuntary dyskinetic movements, signs and symptoms may disappear after drug is discontinued, Rhythmic, involuntary movements of tongue, face, mouth, jaw, sometimes extremities,Tongue may protrude, chewing movements, facial grimacing

Typical Antipsychotics

Chlorpromazine (Thorazine)

Fluphenazine (Prolixin)

Haloperidol (Haldol) - common to give in hospitals when really psychotic, one time dose for acute episode

Typically Produced Habit, more effective in treating positive symptoms, common for other issues than schizophrenia

Atypical Antipsychotics

Olanzapine (Zyprexa) - can be used for duel diagnosis for bipolar mood disorders

Aripiprazole (Abilify)

Clozapine (Clozaril) - used for people who do not respond to other therapies, lowers immunity, requires weekly blood monitoring, immediately report weakness, fever, sore throat or flu like symptoms)

Do not cause EPS, ZAC, more effective for negative symptoms

Neuroleptic Malignant Syndrome

Side Effect of Antipsychotics

High Fever

Muscle Rigidity

Unstable BP

Delirium

Tremors

Elevated CPK (breaks down muscles tissue)

Can be life threatening

associative looseness

shift of ideas from one unrelated topic to another

Anhedonia

inability to feel pleasure

Benzodiazepines

The most common group of antianxiety drugs, which includes Valium and Xanax.

against medical advice

when a noncompliant patient leaves a hospital without physician's permission

acute dystonia

Facial grimacing

Involuntary upward eye movement

Muscle Spasms of tongue, face, neck

neologism

new word or expression

Mandatory Reporting

Nurses are mandated to report any suspicion of abuse (child or elder abuse, domestic violence) following facility policy.

involuntary hospitalization

Detaining clients against their will in a psychiatric facility for evaluation and observation when they have been deemed a danger to themselves or others, or are gravely disabled because of a mental disorder.

Chlorpromazine (Thorazine)

Typical Antipsychotics

Fluphenazine (Prolixin)

Typical Antipsychotics

Haloperidol (Haldol)

Typical Antipsychotics

Olanzapine (Zyprexa)

Atypical Antipsychotics

Aripiprazole (Abilify)

Atypical Antipsychotics

Clozapine (Clozaril)

Atypical Antipsychotics

Diazepam (valium)

Benzodiazepine Sedative Hypnotic (anixety medication)

Lorazepam (Ativan)

Benzodiazepine Sedative Hypnotic (anixety medication)

Clonazepam (Klonopin)

Benzodiazepine Sedative Hypnotic (anixety medication)

Alprazolam (Xanax)

Benzodiazepine Sedative Hypnotic (anixety medication)

Chlorodiazepoxide (Librium)

Benzodiazepine Sedative Hypnotic (anixety medication)

Oxazepam (Serax)

Benzodiazepine Sedative Hypnotic (anixety medication)

Paroxetine (Paxil)

SSRI - Depression

Sertraline (Zoloft)

SSRI - Depression

Escitalopram (Lexapro)

SSRI - Depression

Fluoxetine (Prozac)

SSRI - Depression

Citalopram(Celexa)

SSRI - Depression

Amitriptyline(Elavil)

Tricyclic antidepressants

Imipramine(Tofranil)

Tricyclic antidepressants

Nortriptyline (Pamelor)

Tricyclic antidepressants

Sinequan (Doxepin)

Tricyclic antidepressants

Bupropion (Wellbutrin)

Atypical Antidepressants

Venlafaxine (Effexor)

Atypical Antidepressants

Duloxetine (Cymbalta)

Atypical Antidepressants

Trazadone (Desyrel)

Atypical Antidepressants

Mirtazapine(Remeron)

Atypical Antidepressants

paranoid personality disorder

type of personality disorder characterized by extreme suspiciousness or mistrust of others

schizoid personality disorder

a personality disorder characterized by persistent avoidance of social relationships and little expression of emotion

schizotypal personality disorder

Person has several traits that causes interpersonal problems, including inappropriate affect, paranoid/magical thinking, off beliefs ex. Willy Wonka

antisocial personality disorder

A personality disorder in which the person (usually a man) exhibits a lack of conscience for wrongdoing, even toward friends and family members. May be aggressive and ruthless or a clever con artist. must be at least 18 & have conduct disorders by 15 (cruelty to animals), first short term goal is no harm to others

borderline personality disorder

a personality disorder characterized by lack of stability in interpersonal relationships, self-image, and emotion; impulsivity; angry outbursts; intense fear of abandonment; recurring suicidal gestures, more common in women, ex Marilyn Monroe