ATI Mental Health Final Exam Latest Update 2024 With Verified Correct Answers

ATI Mental Health Final Exam Latest Update 2024 With Verified Correct Answers Mental Health - ANS-State of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community. Mental Illness - ANS-medical conditions that affect a person's thinking, feeling, mood, ability to relate to others, and daily functioning Mental Disorders - ANS-Health conditions characterized by alterations in thinking, mood, or behavior associated with distress and/or impaired functioning Beneficence - ANS-The duty to act so as to benefit or promote the good of others Autonomy - ANS-respecting the rights of others to make their own decisions Justice - ANS-the duty to distrubute resources or care equally, regardless of personal attributes Fidelity - ANS-a.k.a. Nonmaleficence maintaining loyaltiy and comitment to the patient and doing no wrong to the ptient Veracity - ANS-one's duty to communicate truthfully Conditioinal Release - ANS-requires outpatient treatment for a specific period to determine the patient's adherence with medicatin protocols, ability to meet basic needs, and abilit to reintegrate into the community Patient's Rights - ANS--right to treatment -right to refuse treatment -right to informed consent -rights surrouding involuntary commitment and psychiatric advanced directives -rights regarding restraint and seclusion HIPAA (Health Insurance Portability and Accountability Act) - ANS- Consent - ANS-permission to do something ANA (American Nurses Association) - ANS-Professional organization for all RNs. Concerned with licensure, collective bargaining and education -defines scope of practice Duty to Warn - ANS-the exception to the client's right to confidentiality; when health-care providers are legally obligated to warn another person who is the target of the threats or plan by the client, even if the threats were discussed during therapy sessions otherwise protected by confidentiality Tort - ANS-a civil wrong for which mone damages may be collected by the injured party Defamation of Character - ANS-wrongfully hurting a person's good reputation -slander (spoken) -libel (written0 False Imprisonment - ANS-restraining an individual or restricting an individual's freedom Assault vs. Battery - ANS-Assault: victim made reasonably afraid that he is about to be battered Battery: harmful or offensive bodily contact When an attacker pulls fist back as if to punch (assault), follows through with the punch (battery) Chapter 51 - ANS-admission is without the patient's consent and is related to presenting as a danger to self or others or they are unable to meet their basic needs -usually only for 72 hrs (business hours) Chapter 51 Patient Rights - ANS-pt. maintain right to: -be free from restraints -informed consent on meds and treatment -refuse meds and treatment Chapter 51 Example Scenarios - ANS-OD on meds Homicidal Suicidal-high lethality Slashing wrists/self harm Chapter 55 - ANS-chronic, long-term protective placement -determined by a judge -must determine that pt is incompetent and unable to care for self -POA/guardian appointed for decisions within protective placement Chapter 55 Example Scenarios - ANS--traumatic brain injury -Alzheimer's/dementia -nonreversible conditions Do psychotropic medications require consent to administer? - ANS-YES BISH -considered a chemical restraint -can violate autonomy Does psychotic thinking inhibit a patient from making informed consent? - ANS-NO BISH -not always, unless they are a danger to themselves or others they are usually still capable of making their own consent for treatment or medications Restraints Should: - ANS--never interfere with treatment -restrict movement as little as is necessary to ensure safety -fit properly -be easily changed to decrease the chance of injury and to provide for the greatest level of dignity *should be the least restrictive with the shortest duration* Chapter 51 vs 55 - ANS-51 -acute -high danger -72 hrs -pt maintains rights 55 -long-term cognitive -nonreversible condition -pt can't make their own decisions 5 Elements to prove Negligence - ANS-1. duty to provide care as defined by a standard (care that should be given) 2. Breach of duty by failure to meet standard (failure to give care that should have been given) 3. Forseeability of harm (knowing that failing to give the proper standard of care may cause harm to the client) 4. Breach of duty has potential to cause harm (failing to meet standard had potential to cause harm-relationship must be provable) 5. harm occurs What should the nurse do if a severely psychotic patient refuses required medication? - ANS-offer the medication with a brief explanation to see if the patient will willingly take it -then follow with written consent to get order for IM injection per MD order What is the priority assessment for a Chapter 51 patient? - ANS-assessing risk for self-harm, suicide, or harm to others ANA Code of Ethics - ANS-The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient. Psychosocial Assessment - ANS-A comprehensive document which looks at the client as a whole person (not as a set of symptoms) and holistically combines the spiritual, emotional, physical, mental, behavioral, and social dimensions. QSEN Competencies - ANS-Patient-Centered Care Teamwork and Collaboration Evidence-Based Practice Quality Improvement Safety Informatics Affect - ANS-behavioral expression of emotion Charting Affect - ANS-*DO NOT chart NORMAL* labile euphoric manic sad, tearful appropriate/inappropriate constricted or blunted flat Charting Attitude - ANS-cooperative/uncooperative friendly/hostile polite indifferent oversensitive negative respectful attentive guarded suspicious defensive Charting Attention - ANS-Normal- focused Abnormal- interupting, unfocused, poor listening, distracted, fidgety Charting Consciousness - ANS-clear, oriented degree of confusion obtunded sedated/lethargic Obtunded - ANS-Less than full alertness (altered level of consciousness), typically as a result of a medical condition or trauma. -depression Charting Rapport - ANS-normal-engaged, good, fair abnormal- poor, indifferent, too engaging Apathy - ANS-a lack of feeling, emotion, or interest, concerns Anhedonia - ANS-inability to experience pleasure -depression Avolition - ANS-lack of energy or dirve Catatonic - ANS-stupor- extreme state of psychomotor retardation, mutism, negativism, and posturing Compulsion - ANS-compelling; strong desire that is difficult to control; irresistible impulse Confabulation - ANS-the unintended false recollection of episodic memories -dementia Congruent - ANS-verbal and nonverbal messages that express the same meaning Delirium - ANS-reversible state of mental confusion with disoriented often with hallucinations incoherent speech and aimless physical activity Delusions - ANS-fixed beliefs that are not amenable to change in light of conflicting evidence Dementia - ANS-progressive impairment of intellectual function that interferes with performing activities of daily living Depersonalization - ANS-Altering of perception that causes people to temporarily lose a sense of their own reality; most prevalent in people with the dissociative disorders. There is often a feeling of being outside observers of their own behavior. -mania Derailment - ANS-person's ideas slip off one track and onto another -completely or minimally unrelated Displacement - ANS-shifting of an emotion from a person or objection from which is was originally intended EPS (extrapyramidal symptoms) - ANS-A variety of signs and symptoms that are often side effects of the use of certain psychotropic drugs, particularly phenothiazines. Three reversible extrapyramidal side effects are acute dystonia, akathisia, and pseudoparkinsonism. A fourth, tardive dyskinesia, is the most serious and is not reversible. -SE of antipsychotic drugs Flight of Ideas - ANS-rapidly changing or disjointed thoughts Hypomania - ANS-A mild manic state in which the individual seems infectiously merry, extremely talkative, charming, and tireless. Ideas of Reference - ANS-incorrect interpretation of casual incidents and external events as having direct personal references Introjection - ANS-The beliefs and values of another individual are internalized and symbolically become a part of the self, to the extent that the feeling of separateness or distinctness is lost. Mania - ANS-a mood disorder marked by a hyperactive, wildly optimistic state Melancholia - ANS-symptoms are exaggerated and has loss of interest or pleasure in virtually all activities Narcissism - ANS-excessive love of one's body or oneself Perseveration - ANS-persistent repetition of the same word or idea in response to different questions Projection - ANS-psychoanalytic defense mechanism by which people disguise their own threatening impulses by attributing them to others Psychomotor Retardation - ANS-overall slowed movements; a general slowing of all movements; slow cognitive processing and slow verbal interaction -demetia, melancholic depression Psychosis - ANS-gross departure from reality, which may include hallucinations and delusions Reaction Formation - ANS-a conscious attitude or behavior that is opposite of what one would really like to have Rationalization - ANS-giving a socially acceptable or logical response to justify an unacceptable or logical one Repression - ANS-involuntarily blocking unpleasant feelings and experiences from one's awareness Ritualistic - ANS-action performed repetitively due to belief system, possibly in connection with a ceremony -OCD Splitting - ANS-unable to integrate and accept both positive and negative feelings Tangential - ANS-inability to get to the point of the conversation -mania Thought Blocking - ANS-sudden halt in the train of thought or in the middle of a sentence -mania Warning Signs of Blurring Nurse-Patient Relationship - ANS-overhelping controlling narcissism nontherapeutic disclosure about personal life poor professional boundaries Transference - ANS-the process where the patient unconsciously displaces to another individual some of their own experiences and emotional reactions that relate to significant figures from childhood ex. you remind me of my mother because... Countertransference - ANS-Tendency of the nurse to displace feelings related to people in his or her past onto a patient Phases of Nurse-Patient Relationship - ANS-Orientation phase Working phase Termination phase Conversion Reaction - ANS-anxiety is transformed into physical symptoms such as heart palpitations, paralysis, or blindness Therapeutic Communication DON'Ts - ANS-ask why give advice give opinions ignore pretend you know use complex medical jargon don't probe speak soft, mumble Denial - ANS-Defense mechanism by which people refuse to accept reality. Suppression - ANS-Conscious, intentional pushing of unpleasantness from one's mind Sublimation - ANS-the unconscious channeling of strong socially unacceptable impulses into socially acceptable impulses Yalom's Curative Factors - ANS-- Altruism - Catharsis - Universality - Interpersonal learning Interpersonal Learning - ANS-occurs when receiving feedback from grp members re: one's bx (input), learning successful ways of relating to group members (output) Catharsis - ANS-relieving of emotions by expressing one's feelings Altruism - ANS-unselfish regard for the welfare of others Cohesiveness - ANS-feeling connected to other members and belonging to the group Universality - ANS-the feeling that one is not alone and that others have similar issues or have been in similar situations Major Depressive Disorder (MDD) - ANS-Psychological disorder involving a significant depressive episode and depressed characteristics, such as lethargy and hopelessness, for at least two weeks. Dysthymic Disorder - ANS-A chronic depression that is insufficient in severity to merit diagnosis of a major depressive episode. Postpartum Depression - ANS-the sadness and inadequacy felt by some new mothers in the days and weeks after giving birth -ranges from 'blues' to full blown psychosis Psychotic Depression - ANS-delusions or hallucinations + depression Melancholic Depression - ANS-is a type of major depressive disorder that is characterized by a loss of pleasure in most or all activities, psychomotor retardation, weight loss, guilt, and insomnia -may be misdiagnosed as dementia -common in older adults Seasonal Affective Disorder (SAD) - ANS-depression that involves recurrent depressive episodes in a seasonal pattern -winter and summer -more common in women -light therapy Euthymic - ANS-normal mood What is the hallmark sign of depression? - ANSworthlessness What mood is suicide considered an only option? - ANShopelessness Medical Conditions that may mimic Depression - ANShypoglycemia hypothyroidism drug induced psychosis Vegetative Signs of Depression - ANS-eating, sleeping patterns bowel habits decreased libido inability to concentrate decreased energy levels Beck Depression Inventory (BDI) - ANS-a questionnaire useful for determining the level of depressive symptoms that a person is reporting Q 1-13 assess psychological Q14-21 assess physical Depression Risk Factors - ANS-Serious losses Difficult relationships Financial problems Unwelcomed stressors Changes in social roles Women 2x as likely Is a decrease in vegatative signs and symptoms a bad thing? - ANS-NO BISH; it's a good thing, means depression is improving Passive Suicide Ideation - ANS-a wish to be dead but does not include active planning about how to commit suicide Active Suicide Ideation - ANS-thoughts about how to commit the act Suicide Assessment (PALS) - ANS-- Suicidality - Plan - Accessibility - Lethality - Hopelessness Prototypical Suicide Victim - ANS-male 50+ retired, lonely multiple chronic mental health issues experiencing life changes with multiple losses s/s may have present as other illness Suicide RED FLAGS - ANS--specific plan -means to carry out -history -lethality -giving away -early stages of antidepressant treatment -increased energy Should you use logic to reinforce a patient's worth? - ANSNO BISH; could come accross as judgemental Why are *tricyclic* antidepressants not commonly used? - ANS-because they are far more lifethreatening to OD on What is the safest classification of antidepressants? - ANS-SNRI (novel or multimodal) Tyramine Foods - ANS-aged cheese (cheddar, blue cheese, swiss cured meats (salami, sausages, pepperoni) sauerkraut, soy sauce, shrimp sauce yeast, fava beans, When are MAOIs prescribed? - ANS-in cases when other antidepressants or ECT have not been successul, they have more serious side effects than other antidepressants Electroconvulsive Therapy - ANS-a treatment that involves inducing a mild seizure by delivering an electrical shock to the brain Adverse Effects of ECT - ANS--Possible cardiovascular effects (arrythmias, tachycardia- monitor EKG and K+) -systemic effects (headaches, anorexia, muscle aches, drowsiness) -cognitive effects such as confusion and memory difficulties Post Procedure ECT Care - ANS-VS with O2 gag reflex cognitive function assess Vagal Nerve Stimulation (VNS) - ANS-a treatment for depression in which an electrical stimulator is surgically implanted next to the vagus and then connected to a pulse generator in the person's chest; like a pacemaker in the heart, the pulse generator can be programmed to deliver electrical pulses at desirable frequencies and currents -alterative to ECT How long does it take for MAOIs to become therapeutic? - ANS-2-4 weeks How long does it take SSRIs to become therapeutic? - ANS-8-12 weeks Postpartum Depression Risk Factors - ANS-Inadequate social support Poor relationship with partner Life and childcare stress Low self-esteem Unplanned pregnancy Anergia - ANS-lack of energy PHQ - ANS-Patient Health Questionnaire -fast assessment for depression What is a good question to ask patients who have gone from passively suicidal to active? - ANS-Why now? (exception to why restriction) High Lethality (Suicide) - ANS-hanging jumping gunshot CO poisoning Low Lethality (Suicide) - ANS-OCT drugs (except Tylenol and AS due to liver distruction) cutting Does asking a patient about suicide increase their risk? - ANS-NO BISH Reverse Room Restriction - ANS-patient is not allowed in room for extended periods during the day and has to be out amoungst people What is the oldest form of antidepressants? - ANStricyclics When is ECT indicated? - ANS-If patient is unresponsive to medications, if the patient is pregnant, or if you need rapid reduction of symptoms (immediate suicide risk, refusal to eat/drink, catatonia). Very good in elderly. It is also used for treatment of manic episodes. What is a good treatment time for ECT? - ANS-20-40 seconds of seizure activity -3 treatments per week with 6-12 total depending on seizure activity ECT Nursing Considerations - ANS--education -misconception address -contraindicated in MI, CVA, increased ICP, low INR -give insulin before if DM Depression Interventions - ANS-ask about feelings and plans to harm self; implement suicide precautions; monitor sleep/nutrition/elimination; assist with ADLs; initiate interaction with client; insist on participation in activities; observe for sudden elevation in mood; assist in identifying support system; encourage discussion of feelings; sit in silence if client isn't talkative Bipolar Etiology - ANS-several genes contribute to the expression strong significance of higher inheritability increase in excitatory neurotransmitters: serotonin, dopamine, norepinephrine Bipolar I Disorder - ANS-a type of bipolar disorder marked by full manic and major depressive episodes -switching process Bipolar II Disorder - ANS-a type of bipolar disorder marked by mildly manic (hypomanic) episodes and major depressive episodes Cyclothymic Disorder (Cyclothymia) - ANS-Milder, chronic form of bipolar disorder Lasts at least 2 years in adults, 1 year in children/adolescents Numerous periods with hypomanic and depressive symptoms Does not meet criteria for mania or major depressive episode Symptoms do not clear for more than 2 months at a time Rapid Cycling Bipolar Disorder - ANS-diagnosis given when a person has four or more cycles of mania and depression within 1 year -more severe symptoms than bipolar I or II -greater resistance to treatment Hypomania vs Mania - ANS-hypomania: a milder form of elevated mood that are less severe and cause less impairment than full mania and (usually) don't require hospitalization Labile - ANS-Changing rapidly and often in moods -mania Mania Symptoms - ANS-DIG FAST. Distractable. Insomina Grandiose. Flight of ideas. Active. Speech pressured. Taking risks. Mania Nursing Interventions - ANS-Develop trusting relationship Self-awareness Administer anti-mania medication Set and enforce limits on inappropriate behavior Redirect patient where appropriate Protect from self-embarrassment Provide for physical safety Provide Balance for activity and rest Facilitate sleep Ensure nutrition Provide Self-care Severe Lithium Toxicity Symptoms - ANSConfusion/hallucinations Nystagmus Dysarthria Fasciculations Valproic Acid Range - ANS-50-125 Lithium Range - ANS-0.6-1.2 Tegretol Therapeutic Range - ANS-4-12 Steven Johnson Syndrome (SJS) - ANS-Severe blistering of the skin, with mucous membrane involvement and fever -can be fatal -SE of Lamictal (anticonvulsnat) Tegretol (Carbamazepine) Toxicity - ANS-Diplopia, ataxia, blood dyscrasias (agranulocytosis, aplastic anemia), liver toxicity, teratogenesis, Stevens-Johnson syndrome What medications can cause Steven's Johnson Syndrome? - ANS-tegretol clozapine clozaril Rule out Mania - ANS-drugs metabolic disorders (hypoglycemia, calcium disfunction) brain abnormalities (tumor) lymes HIV syphilis bad treatment or drug reactions Chapter 48 - ANS-CHIPS--Child in need of protective services Least Restrictive Measures - ANS-PRN meds modifying environment 1:1 sitter room next to nursing station safety checks being in view of staff camera monitoring Unit Milieu - ANS-the overal 'feel' of the unit as to the atmosphere or environment ex. safe, calm Mania Neurotransmitters - ANS-serotinin, norepinephrine, dopamine Depression Neurotransmitters - ANS-norepinephrine and serotonin ECT Teaching - ANS--see improvement after 2nd or 3rd treament -6-12 treatments -explain procedure -SE Bipolar Origin Theories - ANS-biological (gene G72 and G73 on chromosome 13) neurological (epinephrine, epinephrine, and dopamine) Hypomania Characteristics - ANS--does not interfere with daily function -gradual onset -high energy level -sexual talk -fear of euphoria, social, creative -may go without sleeping or eating for long periods leading to fatigue Acute Mania - ANS--interferes with daily functioning -sudden onset -usually 2-3 wks -profanity -flight of ideas -grandiose behavior, inability to focus - to busy to eat, have sex, or sleep Extreme Delirious Mania - ANS--totally out of touch with reality -complete inability to function in normal society -clang associations, delusions, hallucinations -aggressive, aimless motor activity -poor concentration, extremely disorganized -high energy levels -poor decisions (ex. financially) Labile Mood - ANS-Oscillations in mood between euphoria and depression or anxiety. -mania Bipolar Mood - ANS--labile -in-congruent -euphoria -elation -increased psycho-motor activity -fast, pressured speech -agitation and irritability Bipolar Thought Process - ANS--grandiose -delusional -expansive, broad thoughts -tangentiality -sensory perceptions are altered -flight of ideas -clang associations -loose associations Tangentiality - ANS-inability to get to the point of communication due to introduction of many new topics -mania Clang Associations - ANS-rhythmic patterns associated with psychotic speech -mania Loose Associations - ANS-the tendency for one thought to be logically unconnected, or slightly related, to the next -mania -schizophrenia Bipolar Nursing Interventions - ANS--assess for suicidal ideation -stabilize (not eating, sleeping, drinking, etc.) -decrease environment stimulation (structured) -ensure self-care is being done -set consistent limits -recognize splitting/manipulation Bipolar Therapeutic Communication - ANS--firm and matter-of-fact tone, calm tone -simple and concise explanation -avoid jargon and sayings -remain neutral -avoid power struggles Early Lithium Toxicity Levels - ANS-1.5> Late Lithium Toxicity Levels - ANS-2.0-2.5 Early Lithium Toxicity Signs - ANS-n/v/d thirst, polyuria slurred speech muscle weakness Severe Lithium Toxicity Signs - ANS-ataxia large dilute output clonic movements confusion arrhythmia blurred vision Lithium Toxicity Treatment - ANS--hold Lithium -start IV -medication (mannitol, aminophylline, urea) *if severe* -gastric lavage -hemodialysis Lamictal Therapeutic Level - ANS-500 mg/day in divided doses Grandiosity - ANS-an overvaluation of one's significance or importance Lithium is a ____? - ANS-salt; -significant due to electrolyte imbalances Delirium vs Dementia - ANS-Delirium- Acute, dramatic onset, common causes= illness, toxin, withdrawal, usually reversible. Poor attention and fluctuating arousal level. Dementia: Chronic, insidious onset, usually not reversible, attention usually unaffected and normal arousal level. Schizophrenia Disturbances - ANS--hallucinations -depersonalization -derealization -associative looseness -delusions -flat, blunted, ambivalence -lack of concentration -social withdrawal, isolation -no goal directed activities Paranoid Type Schizophrenia - ANS-a psychological disorder characterized by psychosis in the form of hallucinations and/or delusions usually relating to a certain theme Disorganized Type Schizophrenia - ANS-a psychological disorder that is characterized by psychosis in the form of flat or inappropriate affect, disorganized speech, and disorganized behavior Catatonic Type - ANS-marked by striking motor disturbances, ranging from muscular rigidity to random motor activity -waxy flexibility or stupor Undifferentiated Type - ANS-characterized by pronounced delusions, hallucinations, confusion or disorganized thoughts or behaviors Residual Type - ANS-No present prominent delusions, hallucinations, formal thought disorder, or catatonic behaviors Continuing evidence of disorder in milder forms Schizoaffective Disorder - ANS-form of psychotic disorder in which the symptoms of schizophrenia co-occur with symptoms of a mood disorder -only lasts 1-6 months -NOT actually schizophrenia Delusional Disorder - ANS-a psychosis marked by severe delusions of grandeur, jealousy, persecution, or similar preoccupations that are NOT the result of a drug or medical condition -does NOT meet criteria for schizophrenia Positive Symptoms of Schizophrenia - ANS-hallucinations and delusions Negative Symptoms of Schizophrenia - ANS-absence of appropriate behaviors Hallucinations vs Illusions - ANS-physical stimili NOT present in hallucinations and IS present in illusion Delusion - ANS-a false belief, often of persecution or grandeur, that may accompany psychotic disorders Paranoia - ANS-an irrational suspicious mindset or distrust of others -nurse needs to build trust, introduce yourself Associative Looseness - ANS-Fragmented or poorly related thoughts and ideas Neologisms - ANS-Made-up words that typically have only meaning to the individual who uses them. ex. hameesepick is a ham and cheese sandwich with a pickle Echolalia - ANS-automatic and immediate repetition of what others say Word Salad - ANS-flow of unconnected words that convey no meaning to the listener ex. chicken snowing wooden table up plate Mutism - ANS-inability or refusal to speak Concrete Thinking - ANS-thinking about things that are actually experienced ex. " you are pulling my leg"- "no, I haven't touched you" Thought Broadcasting - ANS-a delusional belief that others can hear or know what the client is thinking Thought Insertion - ANS-belief that thoughts are being placed in one's head ex. Jim is making me think these thoughts Echopraxia - ANS-mimicking the movements of another ex. pt smiles when nurse smiles Catatonia - ANS-a state of unresponsiveness to one's outside environment, usually including muscle rigidity, staring, and inability to communicate Waxy Flexibility - ANS-feature of catatonic schizophrenia in which people rigidly maintain the body position or posture in which they are placed by others *monitor circulation in extremities, pain, and fluid levels while in the position for an extended amount of time* Posturing - ANS-odd posing when sitting in a chair or walking for brief periods of time -part of catatonia Inappropriate Affect - ANS-Display of emotions that are unsuited to the situation; a symptom of schizophrenia. Schizophrenia Nursing Interventions - ANS--be calm -consistent and honest -avoid touch -avoid whispering and laughing -do NOT reinforce hallucinations or delusions -reorient to reality -avoid pt being competitive -do NOT embarrass -transition from 1-1 to group slowly -reinforce positive behaviors -encourage verbalization of feelings EPS includes... - ANS-akathisia, akinesia, Tardive Dyskinesia, dystonia, Parkinsonism, and NMS Akinesia - ANS-(a.k.a. bradykinesia) loss or impairment of the power of voluntary movement -symptom of EPS Akathesia - ANS-*most common EPS symptom* motor restlessness Drug-Induced Parkinsonism - ANS-symptoms that mimic parkinsonism such as tremors, rigidity, akinesia, or absence of movement with diminished mental state Dystonia - ANS-condition of abnormal muscle tone -torticollis -oculogyric crisis -writer's cramps -laryngeal-pharyngeal constriction Torticollis - ANS- -most common type of dystonia wryneck; contraction of the cervical neck muscles, producing torsion of the neck Oculogyric Crisis - ANS-uncontrolled rolling back of the eyes -type of dystonia Tardive Dyskinesia Symptoms - ANS-*facing alterations* -lip smacking -grimaces -tongue protrusion -twisting or jerking movements (for pt on antipsychotic meds greater than 6 months) NMS Symptoms - ANS-high fever (101-103) muscle rigidity *increased CPK* dazed mental status mutism fluctuating blood pressure Neuroleptic Malignant Syndrome (NMS) - ANS-a potentially fatal side effect of the high potency antipsychotic medications and other drugs that affect dopamine neurotransmission NMS Treatment - ANS-- STOP drug - cooling blanket and IV fluids -IV Dantrolene or Bromocriptine -symptomatic treatment Dissociation - ANS-a split in consciousness, which allows some thoughts and behaviors to occur simultaneously with others Therapeutic Communication during Hallucinations - ANS-establish trust -listen to description of symptoms -identify signs of drug use -orient to reality -encourage pt to remember when hallucinations began -do NOT explore or ask questions too many times Reference Delusions - ANS-belief that objects, events, or other people have particular significance to them Somatic Delusions - ANS-preoccupations regarding health and organ function Nihilistic Delusions - ANS-involve the conviction that a major catastrophe will occur Thought Withdrawal - ANS-a delusional belief that others are taking the client's thoughts away and the client is powerless to stop it Can you correct delusions by using logic? - ANS-NO BISH EPS Treatment Medications - ANS-anticholinergic (Cogentin, Benadryl) symmetrol (dopamine agonist) benzodiazepines (Ativan, Valium) NMS is a _______ ________ - ANS-NMS is a MEDICAL EMERGENCY -20% die (elderly males more at risk due to inability to secrete properly) Anxiety Neurotransmitters - ANS-increased norepinephrine decreased serotonin and GABA Body Dysmorphic Disorder (BDD) - ANS-mental disorder featuring a disruptive preoccupation with some imagined defect in appearance ("imagined ugliness") Normal vs Abnormal Anxiety - ANS-anxiety is a normal response to stressful events encouraging us to do something to decrease the stressful stimulus vs extreme response to minor stress or anxiety without presence of a stressor Level 1 Anxiety - ANS-'normal'/ mild anxiety/'good' stress -feelings of tension related to day-to-day living; has alert perceptions of what is happening -still able to function ex. late to work Level 2 Anxiety - ANS-'normal'/moderate anxiety/ 'good' stress specific event whereby the individual's perception becomes narrowed, can only focus on a few things and their perception becomes narrowed; displays selective attention ex. waiting on medical test results Level 3 Anxiety - ANS-severe anxiety/ 'abnormal' due to a specific event; however, the individual's perceptual field is greatly reduced and can only focus on a few specific details and is unable to perceive the 'whole' picture of what is going on as they feel things are 'closing in on them' ex. waiting for cancer removal surgery Level 4 Anxiety - ANS-panic attack/abnormal intense fear wiht a sense of dread, terror or that death is imminenet -recurrent, unpredicable -increased cortisol and epinephrine Panic Attack Symptoms - ANS-palpitations tachycardia/pounding heart diaphoresis facial flushing derealization 'out of body experience' How long does a panic attack usually last? - ANS-5-15 minutes How long does a manic phase last? - ANS-2-3wks Anxiety Thought Processing - ANS--decreased concentration -depersonalization -derealization -confused -disoriented -inability to rationalized external stimuli -distorted perception of environment -decreased pain receptors Derealization - ANS-situation in which the individual loses a sense of the reality of the external world -panic attack Anxiety Nursing Interventions - ANS--reduce environmental stimuli -monitor O2 (paper bag for hyperventilation) -reassure safe environment -stay with pt during attack but don't touch -communicate in calm, short, simple, firm statements (making observations, reorient to reality) Antihistamines used for Anxiety - ANS-Atarax or Visaril -no dependence Why would a beta blocker be used for anxiety? - ANSstabilize symptoms such as: -tachycardia -palpitaions -SOB -tremors -hypotension Why is the anxiolytic Buspar a good treatment for anxiety? - ANS-because it does NOT have CNS side effects -non sedating AND is effective with generalized anxiety disorders What is the most common type of phobia? - ANSagoraphobia Agoraphobia - ANS-fear or avoidance of situations, such as crowds or wide open places, where one has felt loss of control and panic Systematic Desensitization - ANS-A type of exposure therapy that associates a pleasant relaxed state with gradually increasing anxiety-triggering stimuli. Commonly used to treat phobias. Nursing Interventions for Systematic Desensitization - ANS-KEY is teaching relation techniques and coping mechanisms BEFORE starting therapy -only move on once MASTERED each stage -may take several years, costly Implosion Therapy (Flooding) - ANS-full exposure to fear inducing stimulus -can be dangerous *needs to be based on pt and in a controlled environment with a professional* Self Talk - ANS-type of therapy that uses the re-framing of one's thoughts by turning a negative statement into a positive statement Obsessions vs Compulsions - ANS-obsessions = persistent intrusive thoughts and impulses (increase stress) compulsions = repetitive tasks (decrease stress) OCD Nursing Interventions - ANS--rubber band -use word STOP -checklist -yoga -setting limits PTSD Symptoms - ANS--flashbacks/dreams/nightmares -avoidance of triggers -repression/selective amnesia -emotional numbing and detachment -paranoid/jumpy -socially isolating, withdrawn -hallucinations from past experiences PTSD Nursing Interventions - ANS--psychotherapy -coping exercises -group therapy -understanding what triggers events -monitor safety and suicide risk -listening Are somatic disorders conscious and manipulative? - ANS-NO BISH; they are unconscious, involuntary and NOT manipulative Muchausen Syndrome - ANS-an affected person fakes the medical problems in order to gain attention. *a.k.a. Somatic Symptom Disorder* Somatic Symptom Disorder - ANS-psychological disorder in which the symptoms take a somatic (bodily) form without apparent physical cause -includes conversion disorder -hypochondriasis Is conversion disorder a type of somatic symptom disorder? - ANS-YES BISH Somatic Symptoms Disorder Nursing Considerations - ANS--mater-of-fact -decrease secondary gains -positive reinforcement -limit time spent on physical symptoms -encourage expression of feeling -diversional activities -consistent (especially between staff members-splitting) Secondary Gains - ANS-benefits from being ill, such as attention Primary Gain - ANS-in psychodynamic theory, the gain achieved when somatic symptoms keep internal conflicts out of awareness Dissociative Amnesia - ANS-characterized by the sudden and extensive inability to recall important personal information -may occur after traumatic experience Dissociative Fugue - ANS-The sudden loss of memory for one's personal history, accompanied by an abrupt departure from home and the assumption of a new identity -John and Jane Doe -can last for hrs or days Dissociative Identity Disorder (DID) - ANS-(multiple personality disorder) disorder occurring when a person seems to have two or more distinct personalities within one body Dissociative Disorder Nursing Interventions - ANS-establish trust -work on coping skills -assess for self harm/suicide risk (one personality may be mad at another) -splitting La Belle Indifference - ANS-Term used to describe the lack of concern over physical illness; seen in conversion reactions Factitious Disorder - ANS-Condition in which a person acts as if he or she has a physical or mental illness when he or she is not really sick. -CONSCIOUS type of conversion disorder DID Causes - ANS--Typically linked to a history of severe, chronic trauma, often abuse in childhood -Closely related to PTSD Substance Abuse Etiology - ANS-learned behaviors (environmental, social, economic) strong genetic link (addiction affects several neurotransmitters) Alternatives to Discipline Treatment Program (ADT) - ANS-assure public protection by promoting earlier identification, requiring immediate removal from the workplace, and evidence-based treatment for nurses with substance use disorder. *for healthcare workers* What substance has BOTH stimulating and depressing effects on the CNS? - ANS-Marijuana (THC) Abuse (Substance) - ANS-habitual or misuse of a drug in situations of real or potential harm that results in health, legal, social, work, school, relationships or family problems with adverse consequences Tolerance - ANS-an acquired resistance to the effects of a drug so that the person needs to increase their dosage/consumption to achieve a given effect -liver less efficient to break down toxins Drug Dependence Symptoms - ANS-(any 3 s/s within a 12 mo. period) -tolerance -withdrawal -unsucessful efforts to cut down -using longer than planed -interference with social/occupational/recreational activities -lots of time spent thinking about next use Physical Dependence - ANS-experience withdrawal symptoms if stops the subtance consumption -characteristic of drug dependence Increased Tolerance - ANS-increasingly difficult to become drunk/high as the ability to consume large quantities and maintain the same amount of functioning -characteristic of drug dependence Drug Dependece Traits - ANS-cravings loss of control physical dependence increased tolerance Symptoms of (Substance) Abuse - ANS-recurrent use resulting in: -failure to meet role obiligaions -physically hazardous situations -legal problems r/t -social or interpersonal problems -has previously NOT met criterea for dependence (per substance basis) Withdrawal - ANS-maladaptive behavior change, with physiological and cognitive signs and symptoms that occur when the blood or tissue concentration of the substance declines in a person who has maintained prolonged heavy use of the substance How much substance use will result in withdrawal? - ANSdaily use for at least several weeks with abrupt cessation or reduction of use within 24 hrs Withdrawal Symptoms - ANS-(needs at least 4+ s/s to qualify as withdrawal) -insomnia/restless -irritability/agitation -anxiety -difficulty concentrating -hallucinations/delirium -increased HR/BP -sweats Where is alcohol metabolized? Absorbed? - ANS-metabolized in the liver -80% absorbed in small intestine What factors affect the rate of alcohol in the blood? - ANSweight height age gender food or water consumed metabolic rate type of drink drinking rate Addiction - ANS-A physiological or psychological dependence on a drug -CHRONIC disease Alcohol Effects on the Body - ANS--malnutrition -vitamin deficiency (Wernicke's encephalopathy) -anemia -dehydration -lots of '-itis' (gastritis, pancreatitis, esophagitis) -primary sex function atropy (ED, testicular atrophy, spontaneous abortion, amenorrhea) -impaired pulmonary function (HF, HTN, abnormal heart size/sounds) -portal HTN -peripheral neuropathy -osteoporosis -cirrhosis -decreased CBC -memory and cognitive impairments -occular muscle tone atrophy (nystagmus, diplopia) Co-Dependency (Co-Alcoholism) - ANS-participation in behaviors by a significant other that aids the alcoholic to maintain the addiction -user is not held accountable for the behavior (Mild to Moderate) Alcohol Withdrawal Symptoms - ANS-sweating -tachycardia, HTN -tremor -anxiety, sensory disturbances, agitation -n/v -HA -sleep disorder delirium tremens (DTs) - ANS-a disorder involving sudden and severe mental changes or seizures caused by abruptly stopping the use of alcohol (Severe/DT) Alcohol Withdrawal Symptoms - ANS-hallucinations -seizures Why do DTs occur usually? - ANS-when alcohol withdrawal treatment is delayed (usually by 24-72 hrs) OR when a pt tries to detox themselves *results in playing 'catch-up' with s/s* Sequence of Withdrawal: Stage No. 1 - ANS-4-6hrs to 36 hrs after last drink: -autonomic hyperactivity (tremors) -anxiety -increased BP -agitation -insomnia -n/v *heavier the consumption the earlier the symptoms occur* Sequence of Withdrawal: Stage No. 2 - ANS-24-72 hrs after last drink: -may see hallucinations (auditory, tactile, visual; persecutory in nature) -tremors/psychomotor agitation *DTs peak at 96 hrs* Sequence of Withdrawal: Stage No. 3 - ANS-96 hrs to 2 wks after last drink: -disorientaton -global confusion -hallicinations -delirium -hyperthermia/perspiration -HTN, tachycardia, tachypnea -generalized tonic-clonic seizures *DTs present- MEDICAL EMERGENCY* Alchol Nursing Considerations - ANS--electrolyte labs (K, Mg- Ca if n/v/d) -seizure precautions -monitor for toxicity (ataxia, nystagmus) -orient to reality -establish trust *highest priority is safety* ETOH - ANS-ethyl alcohol What are common drugs used for supportive care during alcohol withdrawal? - ANS-*Ativan*, Valium, Librium -metabolized in the liver (be careful) -use Ativan due to short acting for acute care Alcoholism Support Groups - ANS-AA NA Frest Start SMART recovery -Alanon (for families around the addict) Alcohol Withdrawal Vitamin Replacements - ANS-Mg Ca Vit E *Thiamine* *Folic Acid*- prevent or delay neuro damage/deficits What happens when you drink alcohol while taking Antabuse? - ANS--severe HA -n/v/d -flushing -hypotension -tachycardia -dyspne -diaphoreis -paliptations -dizzy -confusion *avoid alcohol for >14 days before starting and do NOT use alcohol when taking drug* How does Acamprosate (Campral) work? - ANS-most effective by decreasing craving for alcohol -SE: diarrhea and HA Types of Benzodiazepines - ANS-Valium, Ativan, GHB -colorless and tasteless Types of Barbiturates - ANS-Amytal, Phenobarbital (common) Nembutal Seconal Butabarbital ("amys", "reds", "blues") Sniffing - ANS-inhaling vapors from an open container *lowest concentration in the body* Huffing - ANS-inhaling fumes from a soaked cloth or rag *medium level of concentration in the body* Bagging - ANS-inhaling fumes from a bag to get high *highest concentration in the body* Sudden Sniffing Death Syndrome - ANS-cardiac arrest due to inhalant use that leads to death of the user What are the CIWA categories? - ANS--nausea/vomiting -tactile disturbances -tremor -auditory disturbances -parozysmal sweats -visual disturbances -anxiety -HA, fullness in head -agitation -orientation (clouding of sensorium) *accompanied w/ VS* Etiology of Personality Disorders - ANS--low serotonin are linked to irritability, impulsivity, hypersensitivity -high stress -bad coping -family and cultural influences Personality - ANS-an eduring pattern of behavior that reflects a way of adapting to a particular environment and whatever cultural, ethnic or community standards -conscious and unconscious Healthy vs. Unhealthy Personality Characteristics - ANSunhealthy: -can't see faults -unable to deal with stress -difficulty forming interpersonal realtionship healthy: -can see weaknessess and strengths -seeks balance -accomplishes goals -functional relationships Cluster A Personality Types - ANS-Schizotypal Paranoid Schizoid Cluster B Personality Types - ANS-antisocial, borderline, histrionic, narcissistic Cluster C Personality Types - ANS-avoidant, dependent, obsessive-compulsive Schizotypal Disorder - ANS--interpersonal deficits -cogitive disortions -magical thinking -odd beliefs -difficulty feeling understood or accepted -social isolation Paranoid Disorder - ANS--distrust -suspiciousness of others -hyper vigilant -envious -secretive -suspects without sufficient evidence that others are plotting *avoid touching these patients- use a detached approach* Schiziod Disorder - ANS--social detatchment -self absorbed -cold and indifferent -restricted emotionally -neither desires or enjoys close relationships -'weird' Antisocial Personality Disorder Traits - ANS--disregard for rights of others -manipulative -explitative -frequent boughts with the law (arrest) -no remorse or guilt -very charming and engaging -splitting -self-mutilation -unstabile and intense relationships -unable to estabilsh close interpersonal relationships -impulsive behaviors Borderline Personality Disorder Traits - ANS--impulsive -emotional liability -unstable and intense interpersonal relationships -self-destructive -mood shifts -splitting -self-mutilation -no gols or self direction Narcissistic Personality Disorder Traits - ANS--grandiose sense of self-importance -arrogance -shallow and unstable relationships -need to be treated as 'special' -socially manipulative and exploitive -entitled -prone to rejection and depression Histrionic Personality Disorder Traits - ANS--attention seeking behaviors -emotional liability -superficial and stormy relationships -uncomfortable when not the 'center of attention' -need lots of praise for doing simple things -lack insight to behaviors Avoidant Personality Disorder - ANS--high levels of anxiety -outward fear -low self-worth -strong desire for affection -hypersensitive -unable to feel joy or pleasure in live -withdrawal OCPD - ANS--unable to express affection -superior attitude -perfectionism -cripping preoccupation with trivial details -orderliness and control -cold and rigid Dependent Personality Disorder - ANS--submissive -low self-esteeme -dependency on relationships -extreme self-consciousness -helpless without a relationship Borderline Personality Disorder Nursing Interventions - ANS-*CONSISTENCY with staff, rules, etc.* -all requests to same nurse -confront splitting -matter-of-fact approach -patient may use self-destructive behaviors to get attention -discuss feelings or urges of self-harm Borderline Personality Disorder Therapy - ANS--Dialectal behavioral therapy (CBT) -life-long therapy -frequently jump from therapist to therapist -address suicide attempts Antisocial Personality Disorder Nursing Interventions - ANS-*SET WRITTEN BOUNDARIES* -redirect the conversation -teach socially acceptable coping -confront inappropriate comments and actions directly -be aware of use of defense mechanisms (common defense mechanisms: blame, projection, poor impulse control and manipulation) Anitsocial Personality Disorder Therapy - ANS-*need longterm therapy: but usually is uneffective due to personality type (jail system in&out) -psychodynamic (recognize responsibilities) -cognitive (aware of thought process and rewire) -dialectual (cognitive therapy + religious/spirirutal elements) Narcisistic Personality Nursing Assessment - ANS-consider themselves special -want special treatment -exploit others to meet their own needs -relationships are shallow -prone to depression, rejection and interpersonal difficulties -need admiration from others Histrionic Personality Nursing Assessment - ANS--need to always be the center of attention -may act out if not getting the attention they deserve -need lots of praise for doing normal things -superficial relationships -prone to depressive disorders -lack insight to behaviors -constant shifting of mood -seductive Nursing Interventions for Patients with Altered Thought Process - ANS--do not support paranoia by pretending you understand their concerns -clarify ambiguity -present reality -use a team approach -alternative problem solving methods -assure confidentiality -selt limits -discuss consequences Nursing Interventions for Paranoid Patients - ANS--assign consistent staff -apprach formally -distant mood -keep realistic promises -assertive not aggressive responses -assure confidentiality -be truthful -identify own anxiety and it's influence -approach face-to-face -slow, stead voice -calm movements -present reality Nursing Interventions for Patients with Poor Impulse Control/Violence - ANS--protect patients and others -assess the degree of distructiveness -observe for escalating anxiety with a deescalation plan -keep away from patients who feel victimized -assist patient to recognize impulsive acts -teach strategies to cope with impulsivity (remove self from situation, count to ten, breathe) Nursing Interventions for Patients who Project - ANS-refrain from reacting with anger or hostility -collaborate with healthcare staff to ensure consistency -encourage group activities/ community -assist in identifying triggers and accepting responsibility -praise when accepts reality Nursing Interventions for Splitting - ANS--challenge with realistic responses -correct exaggerations -use therapeutic groups -use productive and maturing activities that help develop coping when patients try to split -challenge perceptions in their relationships Nursing Interventions for Patients who Lie - ANS--assess the degree, frequency, and consequences of the pt use of lies to meet needs -point out descrepancies in stories -use direct and consistent apprach -initiate activities that build self-esteeme -help staff meet needs so pt doesn't resort to lying Nursing Interventions for Patients with Poor Self Conflict/ Helplessness - ANS--assess level of dependence/baseline -list indepenent activities -positive reinforcement contract of behaviors -set small, realistic goals -establish clear boundaries -challange unrealistic, negative beliefs -give simple choices -refrain from advice or problem solving -cognitive restructuring with group therapy -help express feelings -have pt list accomplishments Nursing Interventions for Patients who are PassiveAggressive - ANS--observe nonverbal behaviors that may exhibit anger -assist pt to label negative/angry feelings with passiveaggressive behavior -help identify the source of the anger -acknowledge common hospitalization sources of anger Nursing Interventions for Patients with Self-Care Deficit - ANS--allow plenty of time to complete ADLs -set limits on time spent bathing -reward system (pt based) -refrain from responding negative when they use blame Nursing Interventions for Patients who Isolate - ANS-short, frequent consistent contacts with the pt -gradually introduce into socialization -reverse room restriction -consequences for not participating in group events Eating Disorder Etiology - ANS--neurobiological: serotonin deficiency -genetic and psychological: family and environemntal stressors Common Eating Disorder Traits - ANS--cognitive distortion related to food, eating and body image -highest occurence amoung white females -most prevalent during families with crisis/upheavals -negative media influence -commonly accompanied by depression and anxiety Anorexia Characteristics - ANS--earlier onset (9-10 yrs old) -'thinness' is a HUGE part of their identitiy -weight is decreased -psycho-emotional -believe they are overweight -starving and purging -denial -no shame for behaviors -LANUGO -intolerance to cold -pale skin -osteoporosis -cardiac arrythmias -excessive exercise *more fatal than any other eating disorder* Bulimia Characteristics - ANS--later onset (high school or college) -binging and purgng -body weight usually normal (not a good indiator) -know behavior is not normal, but can't stop -feel ashammed or embarrassed -self-hate -often over-uses laxitives and diuretics -Russell's calluses -esophagitis -hypochloremia and hypokalemia -dental issues -anemia Hospital Admission Criteria for Eating Disorders - ANS-weight loss of 30%+ (6 mo. rapid decline) -severe hypothermia (36C) -HR <40 -BP <70 systolically -K+ <3 -severe electrolyte disturbances Anorexia Nursing Interventions - ANS--monitor daily caloric intake -monitor electrolytes -encourage appropriate excersize level -weight after voiding -weight after same time each day -examine body for weights before weighing -use matter of fact approaah -be aware of refeeding syndrome -discourage food rituals -monitor for cardiac issues and arrhythmias -group therapy -encourage realizing problematic behavior -promote positive body self confidence image Anorexia Labs - ANS-CBC (anemia, low WBC) abnormal TSH low Albumin elevated BUN ketones in urine increased urine specific gravity decreased growth hormone decreased bone density Eating Disorder Therapy - ANS--ECT (severe depression, anxiety, suicidal) -cognitive (realign body perception) -dialectial (cognitive that addresses emotional dysregulation) -group or family therapy *supportive confrontation is the most effective* Bulimia Nursing Interventions - ANS--limit time spent on nontherapeutic discussion -establish trust -confront behavior directly without demeaning or criticizing -help pt ID feeling and thoughts associated with binging/purging -convey genuiness -encourage journaling of thoughts and feeling Bulimia Labs - ANS-sodium, chloride, magnesium *low potassium is most dangerous* low Hgb and Hct Anorexia Complications - ANS-amenorrhea osteoporosis cardiac impairment loss of brain tissue bone marrow function impaired Bulimia Complications - ANS-* tooth decay as the enamel is eroded from the teeth * chronic irritation to the throat * hypokalemia, or low blood potassium levels * dehydration * constipation and other intestinal conditions related to laxative abuse * tears or rupture of the esophagus Alexithymia - ANS-difficulty in experiencing, expressing, and describing emotional responses Childhood Disorders Etiology - ANS--fragile X syndrome (genetic link) -decrease in norepinephrine and serotonin -abuse, poverty, exposure to alcohol and drugs (environmental) Fragile X Syndrome (FXS) - ANS-most commonly inherited cause of intellectual disability and occurs when a DNA series makes too many copies of itself and turns off a gene on the X chromosome Level 1 Autism Spectrum Disorder - ANS-Mild to Severe Autism Level 2 Autism Spectrum Disorder - ANS-Asperger's Syndrome Autism Symptoms - ANS--doesn't enjoy or want physical contact -displays repetitive activities -repetitive movements (spinning, flapping, etc.) -may form unusual attachment to odd objects (rubber band) -doesn't show preference for parents -impaired social interaction Asperger's Syndrome Symptoms - ANS--increased problems with social relationships -problems with empathy -most children are normal intelligence -idiosyncratic interests (fascination with dates or schedules) -markedly clumsy Level 2: Asperger's Treatment - ANS-(similar to autism) -interventions revolve around a structured daily schedule -children should be involved in play therapy 1:1 Inattentive behaviors - ANS--difficulty following instruction -difficulty focusing tasks -forgetting things -losing things -easily distracted -lack of attention to details -disorganized Hyperactivity Behaviors - ANS--difficulty staying seated -running or climbing inappropriately -fidgeting or talking excessively -difficulty being quiet -has trouble waiting -blurting out or interrupting frequently ADD and ADHD Treatment - ANS-*most effective is combination of medication, behavioral therapy, parental and school support* -social skills training -increase self-esteem and reduce loneliness -positive reinforcement -increase interpersonal relationships with peers Tourettes Symptoms - ANS--verbal and motor tics -dysfunctional social and occupational functioning -onset 6-7, peak 10-11 -low-self esteem and self conscious Tourettes Treatment - ANS--Abilify -Propanolol -Haloperiodol *comprehensive bahavioral interventions* Oppositional Defiant Disorder (ODD) Symptoms - ANS-argumentative -persistently testing the limits -angry and restentful -stubborn -initiates conflict Conduct Disorder Symptoms - ANS-*persistant behaviors that violate the rights of others* -behaviors not appropriate for child's age -more severe actions -displacement used -low self esteem -risk taking -lack of feelings -poor peer relationships *often develop into antisocial into adulthood* Disruptive Disorders Treatment - ANS--antipschotics -stimlulants -Clonidine -don't use bribery -work on positive coping skills Separation Anxiety Disorder (SAD) - ANS-A form of anxiety disorder in which the individual displays ageinappropriate, excessive, and disabling anxiety about being apart from his or her parents or away from home. OCD (Children) - ANS--centered upon fear from a catastrophic family event (ex. parent's death) -sexual in nature r/t devorice -types: tichotillomania, excoriation PTSD (Children) - ANS--children may mimic behaviors of trauma -regressive behaviors SAD Treatment Approach - ANS--avoid colluding (coaxing with games or toys) -child must attend school -gradual exposure -don't bribe -set firm and constant limits -Buspar Etiology of Abuse and Violence - ANS- Types of Abuse - ANS-Physical, verbal, psychological, sexual Factors that Influence Anger and Violence - ANS- Pre-Assaultive Stage - ANS-*greatest risk for becoming a victim is <3 yrs, pregnant females, elderly* patient has increased agitation -use empathy -de-escalate -safe environment/mileu Assaultive Stage - ANS-patient is assultive *need to react as quickly as possible* -team approach -only team lead speaks -least restrictive restraints Post-Assaultive Stage - ANS-once individual is not assultive, team needs to review incident with patient -therapeutic communication -consider ethical or legal complications -allow individuals to learn from their behaviors -help ID stressors, triggers Nursing Assessment of Violence - ANS-*history of violence is the best predcctor* -assess for underlying medical cause -assess for demetia v delerium -assess trigger (environement, medictions, fear, safety) (use suppression and repression) Interventions for Violence - ANS--predict times when pt is most likely to act out (shift change, meals, transport) -team approach -avoid personal bias -clear management -calm milieu -increase safety -appropriate limit setting -antipsychotics, antidepressants, antianxiety Common S/S of Abuse - ANS--socially isolated -frequent illnesses -failure to thrives -bruising -sexual issues (UTI, STD, phobias) -emotional (speech issues, difficulty learning, low selfconfidence) Child Abduction - ANS-the act of taking someone else's child -AMBER alert -Code Purple Internet Crimes Against Children - ANS--perpetrator poses as teen or child -acknowledges understanding of problems -condone authority figures -persuade children to do things Shaken Baby Syndrome (SBS) - ANS-Form of maltreatment in which shaking an infant or toddler can cause brain damage, paralysis, or death. Factitious Disorder by Proxy - ANS-a variant of factitious disorder in which a person induces medical or psychological symptoms in another person who is under his or her care (usually a child) Interventions for Abuse/Abduction/Internet Crimes - ANS-CPS -open-ended questions -in privacy -don't advertise children's names on things -monitor computer or technology use -talk with child about dangers -develop a nonthreatening relationship with parent Types of Bullying - ANS-physical, verbal, relational, cyberbullying Interventions for Bullying and School Violence - ANS-decrease suicidal and self-mutilating -process trauma -emotional managment -safe environemtn -privacy respect/boundaries -community resources -holistic approch -advocating -support from school, parents, peers Assessment for Intimate Partner Violence - ANS-increases as partner gains more independence *highest risk is when victim tries to leave the abuser* -media's protrayal of violence and dominance as 'exciting' increased trend for this behavior -substance abuse commonly used by abuser -abuser commonly ovrprotective, concerned -abused is emotionally detached -anxiety or depression is common in abused Interventions for Pregnant Abuse - ANS--encourage women to have counselling prior to labor -lessen number of pelvic exams -pain relief of choice -reduce extra staff during birth Intimate Partner Violence Interventions - ANS--screening -privacy -address guilt and blame felt by the abused -acknowledge patient's decision to stay or leave -arrange for protective services for spouse or children if needed -may need forensic evidence -always supply pt with info to escape even if they are not ready Rape Trauma Assessment (Acute) - ANS--shock, numb, disbelief -difficulty making decisions -disorganized, hysterical , agitated Rape Trauma Assessment (Long-Term) - ANS-(may occur months to years later) -flashbacks -phobias -somatic complaints -nightmares -low self-esteem -depression Elder Abuse and Neglect Signs - ANS--extra clothing to cover bruising -sudden behavior or personality changes -isolation -fear -weight loss -physical injury -sudden transfer of legal or financial power -neglected apperence r environement Elder Abuse Interventions - ANS--ADVOCATE -meet with family -check resources -environment milieu -develop boundaries -holistic approach -build trust -allow grieving and healthy emotional coping Delirium Interventions - ANS--reduce factors adding to delirium -monitor neurological signs -structured activities -simple communicatins -decrease stimului -memory aids -aware of sundowning -ID reversible cause if able PRO and CON of Chemical Restraints - ANS-PRO -control violent behaviors -reduce need for physical restraint -allow for exam and necessary collection of medical data or application of treatment CON -complications (respiratory depression) -sometimes can increase agitation instead of supressing -limits mental status complicating neuro or cognitive exams Focus Group - ANS-A small group of individuals who are led in discussion by a professional consultant in order to gather opinions on and responses to candidates and issues. Informant Interviews - ANS-Direct conversations with individual community members for the purpose of obtaining ideas + opinions Community-Based Nursing - ANS-Acute and chronic care of individuals and families to strengthen their capacity for self-care and promote independence in decision making. Participant Observation - ANS-a research method in which investigators systematically observe people while joining them in their routine activities Windshield Surveys - ANS-Community assessment, the motorized equivalent of a physical assessment for an individual; windshield refers to looking through the car windshield as the nurse in community health drives through the community collecting data. Secondary Analysis - ANS-the analysis of data that have been collected by other researchers Surveys - ANS-Questionnaires and interviews that ask people directly about their experiences, attitudes, or opinions. Community Forums - ANS-Websites that allow members to contact each other, take part in chats or create personal web pages. What defines a healthy community? - ANS--access to healthcare -environmental quality -rate of injury or violence -child, maternal or infant health -reproductive and sexual health -substance abuse -overall physical activity, obesity rates, oral health At-Risk in Community - ANS--young children -poverty -incarcerated (juvinille) -welfare supported -unemployed -foster care -single and underage mothers -school dropouts -homeless Barriers for the Nurse in assessing the Community - ANS-resources -money -access -status cycle Primary Prevention - ANS-Efforts to prevent an injury or illness from ever occurring