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Psychology Midterm Study
Luther College Nursing Department
106
Nursing
Undergraduate 3
10/15/2011

Additional Nursing Flashcards

 


 

Cards

Term
Risk factors for suicide
Definition

 

  • family history of suicide
  • family hx of child maltreatment
  • previous suicide attempt(s)
  • hx of mental disorder, particularly depression
  • hx of alcohol and substance abuse
  • feelings of hopelessness
  • impulsive or aggressive tendencies
  • cultural and religious beliefs
  • local epidemics of suicides
  • isolation
  • barriers to accessing mental health treatment
  • loss
  • physical illness
  • easy access to lethal methods
  • unwillingness to seek help because of the stigma attached to mental health and substance abuse disorders or to suicidal thoughts.

 

Term
Nursing Interventions for Schizophrenia
Definition
  • prevention of relapse
  • promoting communication
  • promoting adherence to treatment
  • assisting with grooming and hygiene
  • promoting organized behavior
  • promoting social interaction and activity
  • promoting social skills and activities
  • promoting reality-based perceptions
  • intervening with delusions
  • promoting family understanding and involvement
  • promoting community contacts
Term

Signs and symptoms anxiety disorder

Physiologic, Psychological, Cognitive Assessments

Definition

Physiologic assessment

  • how often do you experience heart palpitations?
  • do you have difficulty breathing?
  • do you experience muscle tightness?
  • how often do you experience changes in ladder or bowel fxn?
  • how do your symptoms affect your sleep?

 

Psychological assessment

  • do you feel sad and/or hopeless?
  • how often do you lose your temper?
  • Do you enjoy being with other people?
  • How often do you criticize yourself?

 

Cognitive assessment

  • Do you think about the same things over and over?
  • Do you frequently have trouble concentrating on important activities?
  • how often do you worry about the past or future?
  • Do you still enjoy activities that were pleasurable for you in the past?
Term
Interventions for a client with anxiety
Definition
  • use a quiet, calm approach
  • observe the client’s verbal and nonverbal behavior
  • encourage the client to verbalize feelings
  • teach relaxation techniques when the client’s anxiety is at a mild level
  • encourage the client to use relaxation techniques as needed
Term
Panic Disorder
Definition

Recurrent attacks of severe anxiety not originally associated with a stimulus but may result in anticipatory fear and object attachment

  1. symptoms may mimic life-threatening physical illness (heart attack, choking to death)
  2. may be accompanied by agoraphobia (fear of public places, fear of being alone or in a public place where you can’t escape or get help)
  3. first seen in adolescence and more often in women.
Term
Phobic Disorder
Definition
irrational (displaced) fear of an object or situation and the desire to avoid the object or situation to control anxiety. Patients often know their fears are irrational and don’t make sense, but it doesn’t make them feel better to know this
Term
Generalized Anxiety Disorder
Definition

pervasive, persistent, exaggerated anxiety of at least 6 month’s duration without phobias, panic attacks, obsessions, or compulsions

  1. need to rule out physical conditions such as hyperthyroidism and cushing’s disease.
  2. client has little impairment of fxning, but may self-medicate with alcohol or drugs to control anxiety
Term
Obsessive Compulsive Disorder
Definition
recurrent obsessive thoughts (often trivial) that cannot be dismissed; accompanied by an uncontrollable urge to perform (compulsion) certain acts to reduce tension
Term
Post Traumatic Stress Disorder
Definition

a stressor followed by recurrent re-experiencing of the trauma

  1. Categories:
    1. acute: <3mo
    2. chronic: >6months
    3. Delayed onset: not seen until 6mo later
  2. zoloft is effective for treating symptoms
  3. often complain of feeling empty inside
  4. may become psychotic
Term
Acute Stress Disorder
Definition
Development of anxiety and dissociative symptoms (being in a daze, having a sense of numbing or detachment, experiencing depersonalization, derealization, or amnesia) within one month of a traumatic event. Quicker onset and shorter duration that PTSD.
Term
Somatoform Disorders
Definition

recurrent somatic complaints for which there is no organic evidence

  • conversion disorder
  • pain disorder
  • hypochondriasis
  • body dysmorphic disorder
  • somatization disorder
Term
Conversion Disorder
Definition

unconscious psychological conflict is converted into physical symptoms; e.g. paralysis, pseudo seizures, sudden blindness, pseudo pregnancies etc.

Patients gain something form having a conversion disorder

  • Primary gain: the psychologic conflict or need is kept out of conscious awareness
  • Secondary gain: the symptoms help clients avoid distressing activity while still getting support
Term
Pain Disorder
Definition
Pain in the absence of physiologic findings and the presence of possible psychologic issues
Term
Hypochondriasis
Definition
preoccupied with fear or belief that one has a serious disease for which no organic basis can be found. Single body system, lots of complaints
Term
Body Dysmorphic Disorder
Definition
preoccupied with some imagined defect in physical appearance
Term
Somatization Disorder
Definition

(undifferentiated somatoform disorder)-- 6 months of multiple physical symptoms in multiple body systems with no organic base. Most often treated with the nursing intervention of neutrality and setting limits on the amount of time devoted to discussing symptoms. Individuals experience symptoms; e.g. pain. They are not faking or exaggerating symptoms and they are not seeking attention

  • Somatoform disorders
  • factitious disorders
  • malingering
Term
Facticious Disorder
Definition


  • consciously producing symptoms, both physical and psychological.
  • Psychological need to assume sick role
  • deliberately hurting themselves.
  • no secondary gain
Term
Malingering
Definition

faking symptoms

external incentive/secondary gain

Term
Use for Anti-anxiety Medications
Definition
used to help clients cope with moderate to high levels of anxiety. Used in conjunction with adaptive coping skills. Also used to detox from alcohol.
Term
Classification of Anti-Anxiety Medications
Definition

Benzodiazepines

Nonbenzodiazepines

Term
Benzodiazepines
Definition

potentiate the neurotransmitter GABA, producing muscle relaxation

  • Xanax (alprazolam)
  • Ativan (lorazepam)
  • Klonopin (clonazepam)
  • Valium (diazepam)
  • Dalmane (flurazepam)
  • Restoril (temazepam)
Term
Benzodiazepine Side Effects
Definition
  1. Amnesia
  2. Paradoxical reaction: excitement, confusion, agitation
  3. Drowsiness, fatigue, ataxia, lightheadedness
  4. risk for falls
  5. withdrawal syndrome
Term
Examples of nonbenzos
Definition

buspar

lunesta

ambien

sonata

Term
Method of action: Nonbenzos
Definition
effects serotonin receptors rather than binding with GABA
Term
Buspar
Definition

Nonbenzodiazepine

No abuse/dependence potential

non-sedating

not use for "as needed" use

takes 2-3 weeks to see effects

no issues with drug interactions with other CNS drugs

Term
Withdrawal symptoms Benzodiazepines
Definition
  • anxiety
  • insomnia
  • irritability
  • fatigue
  • nausea
  • depression
  • ataxia
  • blurred vision
Term
Definition: Personality Disorder
Definition
rigid, persistent, and maladaptive behavior patterns of perceiving, thinking, and relating
Term
Characteristics common to all three clusters of PD
Definition
  1.  lack of insight (clients view their problems as separate from themselves)
  2. external responses to stress- they try to change the environment rahter than changing themselves
  3. failure to accept consequences for own behavior
  4. all experience painful feelings
Term
Cluster A Personality Disorders
Definition

Odd and eccentric behaviors

  1. Paranoid
  2. Schizoid
  3. Schizotypal
Term
Cluster B Personality Disorders
Definition

Dramatic/Emotional

  1. Borderline Personality Disorder
  2. Histrionic Personality Disorder
  3. Antisocial Personality Disorder
  4. Narcissistic Personality Disorder

These often co-occur with mood disorders, alcohol and drug abuse, or dependence and somatization disorders

 

Term
Cluster C Personality Disorder
Definition

Anxious/Fearful

  1. Avoidant PD
  2. Dependent PD
  3. Obsessive-compulsive PD
  4. Passive-agressive PD
Term

Paranoid Personality Disorder

(characteristics and Cluster)

Definition

Cluster A

Characteristics:

  1. suspiciousness and mistrust
  2. rigidity
  3. hypervigilace/guarded behavior
  4. distortions of reality
  5. projection
  6. restricted and labile affect
  7. exclusion or joining in cult-like groups
  8. bears grudges and quick to counterattack
Term

Schizoid and Schizotypal PD

(cluster and characteristics)

Definition

Cluster A

Characteristics

  1. social isolation
  2. blunted affective response
  3. detached from relationships
  4. prefer solitary activities
Term

Borderline PD

(characteristics and cluster)

Definition

Cluster B

  1. Unstable interpersonal realtinships and intense fear of abandonment
  2. Manipulation of others
  3. intense attachments
  4. explosive separations
  5. superficial relationships and chameleon-like behavior
  6. intense anger
  7. identity diffusion about goals and values in life and around areas such as gender identity
  8. splitting-cannot unify "good and bad"
  9. affective instability
  10. impulsivity
  11. marked instability in relationships, mood and self image
Term

Histrionic PD

(characteristics and Cluster)

Definition

Cluster B

  1. dramatic, exhibitionistic, and egocentric responses
  2. dysfunctional interpersonal relationships
  3. provocative and seductive in sexual expression
  4. dysphoric mood
  5. cognitive alterations
  6. impaired health patterns (somatic and dissociative disorders are common to unconsciously call attention to them)
  7. excessive emotionality and attention seeking
Term

Narcissistic PD

(characteristics and cluster)

Definition

Cluster B

  1. grandiosity
  2. mirroring
  3. exhibitionism
  4. labile affective response
  5. dysfunctional interpersonal relationships
  6. promiscuity in sexual expression
  7. feel entitled to special privileges
Term

Avoidant PD

(characteristics and cluster)

Definition

Cluster C

  1. pattern of social withdrawal along with a sense of inadequacy and fear of rejection
  2. hypersensitive to rejection
  3. devalue own achievements
  4. serious, humorless, and shy
  5. do not readily express feelings
Term

Dependent PD

(characteristics and cluster)

Definition

Cluster C

  1. pervasive, excessive, and unrealistic need to be cared for
  2. fear of seaparation
  3. lack of self-confidence and initiative
  4. inability to make decisions
  5. inability to function independently
  6. clinging and demanding behaviors
Term

Obsessive Compulsive PD

(characteristics and cluster)

Definition

Cluster C

  1. excessive dedication to work and perfectionism at the expense of pleasure. this perfectionism is linked to fear and anxiety and an excessive need for order
  2. rigid and stubborn rule following with need for order
  3. self-critical
  4. procrastination and passive-agressive behaviors
  5. potential for depression especially later in life
  6. no spontaneity
  7. poor ability to tolerate mistakes (theirs or others)
  8. difficulty expressing feelings openly
Term
Nursing Interventions for Dealing with Manipulation
Definition
  1. On-going communication with colleagues
  2. Clear, concise, and consistent limit-setting (it is most effective to tell clients the reasons for the rules and they are expected to follow them
  3. Teach client relaxation and to ask directly for what is needed
  4. if complaining that their assigned staff is ignoring them, tell them to speak directly with staff involved, don't triangulate
Term
Nursing Interventions for dealing with Impulsiveness
Definition
  1. Maintain safe environment. Safety is a big concern for staff and patients, especially for cluster B.
  2. develop behavioral contracts (especially no harm contracts)
Term
Nursing Interventions for dealing with Impaired Social Interactions
Definition
  1. confront client's illogical perception of others
  2. start with 1:1 interaction and move slowly to groups
  3. assertiveness training. Teach healthy ways to meet needs. Not demanding things out of a sense of entitlement, but through assertive communications
  4. use role-playing and group process
Term
Nursing Interventions for dealing with Self-Destructive Behavior
Definition
  1. maintain a physically and psyhcologically safe milieu
  2. initiate no-harm contracts
  3. be alert to the potential for suicide
Term
Nursing interventions for aggressive behaviors
Definition
  1. maintain a safe milieu
  2. teach client to differentiate between anger and aggression and to appreciate other's needs
  3. use limit setting and assertiveness training. Tell them the reasons for the rules and tell them they are expected to follow the rules
  4. avoid personalizing client's aggression
Term
Nursing Interventions for chronic low self-esteem
Definition
  1. use cognitive behavioral techniques, journaling, exercise, and relaxation skills
  2. identify client's strengths
  3. provide unconditional positive regard
Term
Definition: Defense Mechanisms
Definition
automatic psychological processes that protect the self by allowing the person to deny or distort a stressful event or to restrict awareness and reduce the sense of emotional involvement
Term
Why are defense mechanisms used?
Definition
When a person is unable to ward off stress or reduce tension in the usual way, anxiety mounts as the person feels increasingly inadequate to cope with the situation.
Term
What is the purpose of Defense mechanisms?
Definition
To lessen uncomfortable feelings of anxiety and to prevent pain regardless of cost.
Term
List of Defense Mechanisms
Definition
  1. Repression
  2. suppression
  3. dissociation
  4. identification
  5. introjection
  6. projection
  7. denial
  8. fantasy
  9. rationalization
  10. reaction formation
  11. displacement
  12. intellectualization
Term
Definition: Denial (defense mechanism)
Definition

blocking out painful or anxiety-inducing events or feelings

 

example: a manager tells an employee he may have to fire him. On the way home, the employee shops for a new car.

Term
Definition: Displacement (defense mechanism)
Definition

Discharging pent-up feelings on people less dangerous than those who initially aroused the emotion

 

example: a student who has received a low grade on a term paper blows up at his girlfriend when she asks about his grade

Term
Definition: Dissociation (defense mechanism)
Definition

handling emotional conflicts, or internal or external stressors, by a temporary alteration of consciousness or identity

 

example: a woman has amnesia for the events surrounding a fatal car crash when she was the speeding driver

Term
Definition: Fantasy (Defense mechanism)
Definition

symbolic satisfaction of wishes through nonrational thought.

 

example: a student struggling through grad school thinks about a prestigious, high-paying jobs she wants

Term
Definition: Identification (Defense Mechanism)
Definition

unconscious assumption of similarity between oneself and another.

 

example: after a hospitalization for minor surgery, a girl decides to become a nurse.

Term
Definition: Intellectualization (Defense Mechanism)
Definition

Separating an emotion from an idea or thought because the emotional reaction is too painful to be acknowledged.

 

example: a man learns he has cancer. He studies the physiology and treatment of cancer without experiencing any emotion.

Term
Definition: Introjection (Defense Mechanism)
Definition

acceptance of another's values and opinions as one's own

 

example: a woman who prefers a simple lifestyle assumes the materialistic, prestige-oriented values of her husband.

Term
Definition: Projection (Defense Mechanism)
Definition

attributing one's own unacceptable feelings and thoughts onto others.

 

example: a man who is quite critical of others thinkgs that people are joking about his appearance

Term
Definition: rationalization (Defense Mechanism)
Definition

falsification of experience through the construction of logical or socially approved explanations of behavior

 

example: a man cheats on his income tax return and tells himself that it's alright because everyone does it.

Term
Definition: Reaction Formation (Defense Mechanism)
Definition

unacceptable feelings disguised by repression of the real feeling and by reinforcement of the opposite feeling.

 

example: a woman who dislikes her mother in law is always very nice to her.

Term
Definition: Repression (Defense Mechanism)
Definition

unconsciously keeping unacceptable feelings out of awareness

 

example: a man is jealous of a good friend's success but is unaware of his feelings

Term
Definition: Suppression (Defense Mechanism)
Definition

Consciously keeping unacceptable feelings and thoughts out of awareness.

 

example: a student taking an exam is upset about an argumetn with her boyfriend but puts it out of her mind so she can finish the test.

Term
What is included on Axis I?
Definition
  • adult and child clinical disorders
  • conditions that are not attributable to a mental disorder that are a focus of clinical attention
  • additional codes
  • clinically significant behaviors or psychological syndrom or pattern that occurs.
Term
What is included on Axis II?
Definition
  • personality disorders
  • mental retardation
  • NO diagnosis
  • maladaptive personality traits
Term
What is included on Axis III?
Definition
  • General medical conditions
  • record of physical disorders and med conditions
  • lack of information = "deferred"
Term
What is included on Axis IV?
Definition
  • psychosocial and environmental problems that may affect the diagnosis and treatment of mental disorders
Term
What is included on Axis V?
Definition
  • Global assessment of functioning (GAF score)
Term
MANIC EPISODE
Definition

Moodswings

Active, Agressive

"Nothing is Wrong" (Denial)

Irritable, impulsive, intrusive behavior

Can't Sit Still

 

Euphoric mood

Poor judgment; provocative behavior

Increased Sexual interest

Substance abuse

Omnipotent Feelings

Decreased Need for sleep

Endless Energy

Term
Nursing Interventions: Lithium
Definition
  • Monitor lithium levels in blood
  • assess for signals of exacerbation of symptoms
  • maintains normal sodium and water intake
  • not recommended for those with impaired renal fxn, sodium restricted diets, or those with congestive heart failure
  • Lithium toxicity= blood value >1.5
  • Narrow therapeutic range (0.6-1.2)

 

Term

MDD:

 

SIGECAPS

Definition

Sleep (increased or decreased)

Interest (diminished interest or pleasure in activities)

Guilt and worthlessness

Energy (decreased)

Concentration (impaired)

Appetite (increased or decreased)

Psychomotor changes (retardation or agitiation)

Suicide

Term
Bipolar I Disorder
Definition

consists of one or more manic mixed episodes, and the course of illness can be accompanied by major depressive episodes

Term
Bipolar II disorder
Definition

Consists of one or more major depressive episode accompanied by at least one hypomanic episode.

Term
Mania
Definition

characterized by an abnormal and persistently elevated, expansive, or irritable mood lasting at least one week, significantly impairing social or occupational functioning, and generally requiring hospitalization.

 

must also be accompanied by at least 3 additional symptoms such as:

  • grandiosity
  • decreased need for sleep
  • pressure of sleep
  • flight of ideas
  • distractibility
  • increased involvement in goal-directed activities
  • psychomotor agitation
Term
Hypomania
Definition

less extreme form of mania that is not severe enough to markedly impair functioning or require hospitalization. People feel wonderful and "on top of the world" and do not recognize changes in themselves. No psychotic features

Term
Mixed episode
Definition
both mania and depression are present nearly every day in rapidly alternating succession over a period of at least a week. These clients are often agitated, suffering from insomnia and appetite disturbances and may exhibit suicidal and psychotic thinking. Clients suffer more psychic pain than do individuals who are in a state of mania. Clients seek help more readily.
Term
Cyclothymic Disorder
Definition
  • Clients suffering for at least 2 years from "chronic, fluctuating mood disturbances involving numerous periods of hypmanic symptoms and numerous periods of depressive symptoms.
  • must be free of severe symptoms that qualify for the diagnosis of manic disorder or MDD.
  • individuals are often considered moody, unpredictable or tempermental.
Term
Types of Antidepressants
Definition
  • TCAs
  • SSRIs
  • SNRIs
  • NRIs
  • trazodone/desyrel
  • mirtazapine/remeron
  • MAOI
  • nefazodone/serzone
Term
Common Side Effects of SSRIs
Definition
  • headaches
  • nausea
  • anxiety
  • insomnia
  • dizziness
  • tremor
  • sweating
  • dry mouth
  • decreased appetite
  • sexual dysfunction (esp in men)
Term
SSRI Meds
Definition
  • fluoxetine (prozac)
  • paroxetine (paxil)
  • sertraline (zoloft)
  • cialopram (celexa)
  • fluvoxamine (luvox)
  • escitalopram (lexapro)
Term
Common side effects of TCAs
Definition
  • sleepiness (Helpful for insomnia)
  • weight gain
  • seizures
  • hypotension
  • heart conduction defects
  • blurred vision
  • constipation
  • urinary hesitancy
  • sexual dysfunction
Term
Disadvatages of TCAs
Definition
  • high rates of noncompliance
  • highly fatal in overdose situations
  • interacts with other CNS drugs
Term
Bupropion (Wellbutrin)
Definition
  • currently the only antidepressant without serotonin activity; it acts as a norepinephrine and dopamine reuptake inhibitor
  • no weight gain or sexual dysfunction
  • improves energy and concentration
  • low fatality in overdose
  • watch for seizures with hx of bulimia
Term
Side effects of Bupropion (Wellbutrin)
Definition
  • insomnia
  • agitation
  • seizures
  • tremors
  • dry mouth
  • constipation
Term

Venlafaxine (Effexor)

Desvenlafaxine (Pristiq)

Definition
  • SNRI
  • side effects: overall well tolerated with minimal hypotension or weight gain; may elevate BP
Term
Duloxetine (Cymbalta)
Definition
  • SNRI
  • treats depression, peripheral neuropathy and fibromyalgia
  • expensive
  • side effects: anticholinergic, plus decreased appetite, fatigue, sweating, and erectile dysfunction
Term
Mirtazapine (Remeron)
Definition
  • not a reuptake inhibitor
  • acts to increase norepi and serotonin release
  • fewer problems with sexual dysfunction
  • side effects: sedation, weight gain, constipation
Term
MAOI Meds
Definition
  • isocarboxazid (Marplan)
  • Phenelzine (Nardil)
  • tranylcypromine (parnate)
  • emsam patch
Term
Positive Symptoms of Schizophrenia
Definition
  1. hallucinations
  2. delusions
  3. disorganized speech and thoughts
  4. disorganized behaviors
Term
Negative symptoms of schizophrenia
Definition
  • flat affect
  • alogia
  • avolition
  • anhedonia
  • apathy
Term
Alogia
Definition
poverty of speech
Term
Avolition
Definition
inability to pursue and persist in goal-directed activities
Term
Anhedonia
Definition
inability to express pleasure
Term
Apathy
Definition
indifference
Term
Preventing Relapse of Schizophrenia
Definition
  • antipsychotic medications with psychosocial approaches
  • clinical and family monitoring for prodromal symptoms
  • group therapy
  • community treatment
  • cognitive-behavioral therapy
  • social skills training
Term
traditional antipsychotics
Definition
agents that block dopamine receptors in the brain and alter dopamine release and turn over
Term
examples of traditional antipsychotics
Definition
  • haldol
  • prolixin
  • loxitane
  • thorazine
Term
Atypical Antipsychotics
Definition
agents that block dopamine and serotonin receptors. The blocking of both may account for the increase efficiency of these drugs in improving the negative symptoms of schizophrenia
Term
Examples of Atypical Antipsychotics
Definition
  • clozaril
  • risperdal
  • geodon
Term
Adverse Side Effects of Antipsychotics
Definition
  • EPS/movement disorders
  • acute dystonic rxns or muscle spasms
  • parkinsonian reactions
  • akathisias
  • tardive dyskinesia
  • neuroleptics malignant syndrome
Term
Acute Dystonic Reactions or Muscle Spasms
Definition

Side effect of Antipsychotics

  • of mouth and torso lasting from min to hrs
  • occurs with high potentcy antipsychotics (haldol, prolixin, navane, stelazine)

treat with benadryl and cogentin

 

occurs within five days of starting meds

 

Term
Parkinsonian Reactions
Definition

side effect of Antipsychotics

  • mask-like facial expression
  • shuffling gait
  • drooling
  • finger and hand tremors
  • cogwheel rigidity

occurs 5-30 days after start

 

treat with IM cogentin or Artane

 

Term
Akathisias
Definition

Side effect of Antipsychotic

  • motor restlessness
  • agitation-- irresistible urge to move lower extremities

occur within 5wks of treatment

 

Term
Tardive Dyskinesia
Definition

Antipsychotic Adverse Reaction

  • results from long term use of antipsychotics
  • 20-30% people affected
  • facial twitches
  • small tongue tremors
  • abnormal jaw mvmnts
  • thrusting and rolling of tongue
  • lip licking and smacking
  • chewing and sucking mvmnts
  • difficulty swallowing
Term
Neuroleptic Malignant Syndrome
Definition

Adverse Reaction of Antipsychotics

  • severe muscle rigidity/spasms
  • altered consciousness
  • catatonia
  • stupor
  • high fever
  • increased respirations
  • diaphoresis
  • urinary retention or incontinence
  • tachycardia
Term
Risperdal
Definition

Atypical Antipsychotic

lactation in men and women

Term
Geodon
Definition

atypical antipsychotic

can create heart palpitations due to elongation of QT interval so baseline and periodic EKGs are necessary

Term
Clozaril
Definition

Atypical antipsychotic

  • can precipitate life threatening agranulocytosis (requires regular blood draws to check WBC)
  • increased risk for seizures
  • side effects: sedation, weight gain, hypersalivation
  • Last resort
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