Shared Flashcard Set

Details

Mental Health test 2
na
203
Nursing
Not Applicable
03/14/2011

Additional Nursing Flashcards

 


 

Cards

Term
biological causes of mental illness
Definition
genetics
nutrition
infectious processes
neurotransmitter imbalances in brain
Term
psychiatric disorders have been described differently across ______________
Definition
generations
Term
similar psychiatric symptoms may have considerably different _____________
Definition
causes
Term
population genetics
Definition
inheritance of illness
Term
molecular genetics
Definition
disorders develop from altered genes interacting to create a risk factor which is expressed as an illness in difficult life circumstances (may be transient)
Term
extrapyramidal motor system
Definition
nerve trunk connecting thalmus to basal ganglia, controls muscle tone reflexes, automatic motor mvts like walking
Term
brain stem
Definition
emits serotonin
(depression and fibromyalgia)
Term
frontal lobe
Definition
motor speech function, personality, executive functions
Term
limbic system
Definition
memory and emotional behavior
Term
limbic midbrain nuclei
Definition
pleasure center, may be involved in addiction
Term
plasticity of brain
Definition
compensates for loss of fx
nerve signals may be rerouted
cells learn new fx
nerve tissues may be regenerated
Term
small molecules that directly and indirectly control the opening or closing of ion channels
Definition
neurotransmitters
Term
reduce the membrane potential and enhance the transmission of the signal btwn neurons
Definition
excitatory NTs
Term
NTs that slow down nerve impulses
Definition
inhibitory
Term
psychotropic meds work by...
Definition
blocking uptake or reuptake of NTs
Term
presynapse (axon)
Definition
stores NTs
releases NTs when excited
Term
synapse (cleft)
Definition
space btwn presynapse and postsynapse
Term
post synapse (dendrite)
Definition
receives impulse when transmitted
releases NTs after impulse if received
Term
dopamine (DA) functions
Definition
cognition, motor, invol motor mvts, neuroendocrine functions
Term
over-activity of dopamine is implicated in what?
Definition
schizophrenia and other psychosis
(some with increased DA and some with decreased)
Term
use of which substances causes DA release?
Definition
amphetamines
cocaine
Term
serotonin (5-HT) functions
Definition
appetite, sleep, mood, pain perception, vomiting, hallucinations
Term
underactivity of serotonin
Definition
depression
bulimia
OCD
Term
dysregulation of serotonin is implicated in...
Definition
anxiety, violence, schizoaffective and personality disorders
Term
norepinephrine (NE) functions
Definition
mood states
learning and memory
Term
under-activity of NE
Definition
depression
Term
NE is depleted in...
Definition
Alzheimer's and Korsakoffs' syndrome
Term
NE is impaired in...
Definition
anxiety and addiction
Term
acetylcholine (Ach)
Definition
higher intellectual functioning
memory
Term
Ach under-activity
Definition
Alzheimer's
Term
melatonin is synthesized from __________ and is implicated in ______ _______ _______ when in shortage
Definition
serotonin
seasonal affective disorder and sleep/wake cycle
Term
Gamma-aminobutyric acid (GABA) is an....
Definition
inhibitory NT (decreases neurotransmission
Term
low levels or fewer GABA receptors causes more susceptibility to ...
Definition
anxiety disorders
seizures
Term
What increases GABA function for antianxiety, anticonvulsant, sedative and muscle relaxant properties?
Definition
Benzodiazepines
Term
GABA action is destroyed by what?
Definition
chronic use of alcohol
Term
excitatory NT names
Definition
glutamate and aspartate
Term
glutamate and aspartate are implicated in which mental disorder?
Definition
Kindling phenomenon see in bipolar
Term
Changes in the sensitivity of receptors is caused by:
Definition
effect of drugs on receptor site
disease that affects receptor site
Term
Interventions to regulate NTs
Definition
meds
ECT
cognitive therapy
alternative therapy (relaxation, biofeedback)
Term
explores interaction btwn CNS, endocrine and immune systems; impact of stress on these interactions; impact of psychological and medical interventions
Definition
Psychoneuroimmunology (PNI)
Term
PNI evidence
Definition
decreased WBCs after marathon, sleep deprivation, space flight, death of spouse, depression
increased stress decreases natural killer cells
Term
chronobiology
Definition
study and measure of time structures of biologic rhythms
Term
pharmacogenetics
Definition
custom drugs based on genetic profiles to avoid side effects
Term
changes in sleep patterns r/t depression
Definition
more rapid onset of REM and decrease in delta sleep
Term
evoked potentials measure...
Definition
brain response to stimulus
Term
pre-orientation phase
Definition
get report
Term
orientation phase
Definition
first meeting
confidentiality
testing relationship
ends when pt begins identifying problems
Term
working phase
Definition
id problem
problem solving
Term
resolution phase
Definition
problems resolve
relationship ends
Term
transference
Definition
unconscious inappropriate intensity of feelings on the part of the patient
nurse must confront distorition or reality and facililtate awareness
Term
countertransference
Definition
inappropriate intensity of nurse's feelings
nurse must increase self-awareness
Term
the process of understanding one's own beliefs, thoughts, motivations, biases, and limitations, and recognizing how they affect others
Definition
self-awareness
Term
Johari's Window quadrant 1
Definition
open quadrant known to self and known to others
Term
quadrant 2
Definition
blind quadrant
known to others but not known by self
Term
quadrant 3
Definition
hidden quadrant
private life space, personal secrets
Term
quadrant 4
Definition
unknown
unconscious self and unknown to others
Term
increasing self-awareness
Definition
listen to self, to others
reveal to others imp. aspects about self
Term
therapeutic communication
Definition
ongoing process of interaction in which meaning emerges
Term
parent--
adult--
child--
Definition
attitudes and behaviors taught
logical, rational, realistic
feelings from childhood
Term
complementary transaction
Definition
adult to adult, respectful
Term
crossed transaction
Definition
one party as an adult and one as the parent
Term
ulterior transaction
Definition
appears to be adult to adult but in reality the client is asking for parenting from the nurse, but does not really want i tso rejects all ideas suggested
Term
in therapeutic communication, the _____________ should be the focus
Definition
patient
Term
self-disclosure should only be used if it is __________
Definition
therapeutic
Term
instead of giving advice...
Definition
ask questions so they figure it out themselves
Term
choosing the best response begins with _____ and ______ the patient's communication
Definition
assessing, interpreting
Term
explicitly checking out on'e own thoughts or feelings with another person
Definition
validation
Term
nonverbal behaviors
Definition
space
vocal cues
action cues
object cues
Term
potential boundary violations
Definition
role
time
place
money
gifts
clothing
language
self disclosure
post discharge social
physical
Term
altruism
Definition
dedicating life to meeting needs of others
Term
autistic fantasy
Definition
excessive day dreaming as a substitute for human relationships, more effective action, or problem solving
Term
isolation of affect
Definition
separating of ideas from the feelings originally associated with them
Term
projective identification
Definition
ex: child is mat at parent, who in turn becomes angry at the child but may be unsure why. Child then feels justified at being angry at parent.
Term
reaction formation
Definition
substituting behavior, thoughts, or feelings that are diametrically opposed to one's own unacceptable thoughts or feelings
Term
splitting
Definition
compartmentalizing opposite affect states and failing to integrate the positive and negative qualities into cohesive images
Term
sublimation
Definition
channeling potentially maladaptive feelings or impulses into socially acceptable behavior
Term
analysis of patient interaction should include:
Definition
symbolism
content themes
communication blocks
Term
characteristics of cognitive behavioral techniques
Definition
evidenced based
goal oriented
practical
collaborative
open
homework, measurements
active
short term
Term
classical conditioning (Pavlov)
Definition
stimulus-response
involuntary
useful for phobias
Term
Operant conditioning (Skinner)
Definition
use of reinforcement
voluntary behavior is learned
activity is strengthened or weakened by consequences
tokens
Term
negative reinforcer
Definition
controlling or avoiding an unpleasant stimulus with increased desirable behavior
Term
Which reinforcement schedule is most effective?
Definition
variable ratio
Term
response cost
Definition
penalty for undesirable behavior
ex: losing allowance
Term
extinction
Definition
eliminate behavior by ignoring or not rewarding it
Term
three cognitive processes involved in the development of mental disorders
Definition
cognitive triad (thoughts abt self, world, future)
cognitive distortions (shoulds, oughts...)
schema (personal filter)
Term
cognitive behavioral therapy
Definition
Aaron beck
people are disturbed by perceptions, not actual events
Term
Rational Emotive Behavior Therapy
Definition
Activating event
Belief system
Consequences of belief system
Dispute unreasonable expectations
Effective outlook development
Albert Ellis
Term
3 types of cognitive behavioral strategies
Definition
anxiety reduction
cognitive restructuring
learning new behavior
Term
anxiety reduction strategies
Definition
relaxation
biofeedback
desensitization
flooding
Term
in vitro
in vivo
Definition
exposure to imagined stimulus (pictures)
real stimulus (snake)
Term
cognitive restructuring
Definition
monitor thoughts
questioning evidence
examining alternatives
what if?
reframing
Term
thought stopping
Definition
part of cognitive restructuring
stop negative thinking
use an image, sensation or circumstance
Term
to learn new behaviors:
Definition
model
shape (prompt, time out)
token economy
social skills training
role play
contracting
aversion therapy
positive imagery
psycho-educational resources
humor
Term
dialectical behavior therapy
Definition
accepting maladaptive behavior while working to change them and teach skills
Term
solution-focused brief therapy
Definition
assists in exploring life w/o problem
id and amplify change
create new reality
focus on achievement of specific, concrete and achievable goals
Term
selective abstraction
Definition
focusing on details but not on other relevant information
Term
arbitrary inference
Definition
drawing negative conclusion without supporting evidence
Term
_________ disorders are associated with high levels of impairment in occupational, social and physical functioning
Definition
mood
Term
potential causes of mood disorders
Definition
substance induced or non-psychiatric medical conditions like hypothyroid or hyperthyroid
Term
major depressive disorder (MDD) definition
Definition
depressed mood/loss of interest or pleasure in nearly activities for AT LEAST 2 WEEKS, plus 4 additional symptoms
Term
additional symptoms of MDD
Definition
sleep disorder
interest deficit
guilt
energy deficit
concentration deficit
appetite disorder
psychomotor retardation or agitation
suicidality
Term
dysthymic disorder criteria
Definition
depressed mood for most days for at least 2 years PLUS 2 or more:
sleep disorder
guilt
energy deficit
concentration deficit
appetite disorder
poor self esteem
Term
mood in depressed children may be _____ rather than _____
Definition
irritable, sad
Term
group with the highest suicide rate
Definition
elderly
Term
How may mood disorder present in children?
Definition
anxiety, somatic symptoms, behavioral changes including suicide
Term
SAD diagnostic criteria
Definition
at lease 2 episodes in 2 consecutive years
Term
theories of depression
Definition
serotonin dysfunction
adrenal pituitary dysfunction
cytokines
Term
results of glucose hypometabolism in frontal lobe
(R hemisphere vs. L hemisphere)
Definition
R = mania
L= depression
Term
mood disorder treatment goals
Definition
reduce signs and symptoms
improve occupation and psychosocial fx.
reduce relapse
safety
Term
mood disorder assessment components
Definition
thorough history (family, relationships, work, edu, abuse)
complete med list
mental status exam
neurovegetative symptoms (low energy, lack of sleep, appetite/wt changes)
Term
treatment for MDD, mania or schizophrenia that is resistant to meds
Definition
ECT
Term
side effects and adverse effects of ECT
Definition
hypo-or HTN, brady/tachycardia, minor arrhythmias
HA, nausea, muscle pain
Term
Vagus nerve stimulation use
Definition
small generator in chest as adjunctive tx of severe depression that is unresponsive to four or more adequate antidepressant tx
Term
when starting antidepressants, complete relief of symptoms may take
Definition
weeks
Term
antidepressants should not be _____ _____ due to uncomfortable symptoms that may result
Definition
discontinued abruptly
Term
why do you need to assess for suicidal ideation when pts first begin taking antidepressants?
Definition
at first energy increases, but they don't feel better
Term
SSRIs treat...
Definition
obsessive/compulsive behavior
depression
anxiety
Term
SSRI names + doses
Definition
Prozac (fluoxetine) 20mg daily
Paxil (sertraline) 20-50mg daily
Zoloft (paroxetine) 50-100mgbid
Celexa (citalopram) 20mg daily
Lexapro (escitalopram) 10mg daily
Term
SSRI side effects
Definition
low anticholinergic and sedative effects
anxiety, nervousness, HA
insomnia, drowsiness, fatigue
tremor, diaphoresis, dizziness, nausea
diarrhea, rash, hives
Term
other drugs that cause Serotonin syndrome
Definition
l-tryptophan
lithium
cocaine, ecstasy, antimigraine preps
antiemetics
cough suppresants
amphetamines
Term
symptoms of serotonin syndrome
Definition
myoclonus, diaphoresis, restlessness
diminished consciousness, elevated mood, rigidity
coma, seizures, high fever
Term
prevention of serotonin syndrome
Definition
2-4 weeks between MAOIs and SSRIs
Term
tx of serotonin syndrome
Definition
DC drug, IV fluids, seizure precautions
cooling blanket
dantrolene sodium (decreases temp by relaxing muscles)
benzos
Term
TCAs act on a variety of ________ systems, including ______ and ________ reuptake systems
Definition
neurotransmitter, norepinephrine, serotonin
Term
two disadvantages to using TCAs
Definition
more serious side effects
higher lethal potential (10-30x nl dose)
Term
prototype TCAs
Definition
amitriptyline (Elavil)
imipramine (Tofranil)
Term
TCA action
Definition
blocks reuptake of NE and/or 5HT by the axon correcting the deficit of NE and 5HT
Term
low sedation TCAs
Definition
amoxapine (Asendin)
nortriptyline (Pamelor)
desipramine (Norpramin)
Term
medium sedation TCAs
Definition
imipramine (Tofranil)
doxepin (Sinequan)
maprotiline (Ludiomil)
Term
high sedation TCAs
Definition
amitryptilene (Elavil)
clomipramine (Anafranil)
Term
common TCA SEs
Definition
anticholinergic effects
sedation, orthostatic HoTN
dizziness, wt gain, sexual SEs
tremors, N/V/D
Term
MAOI prototypes + action
Definition
phenelzine (Nardil)
tranylcypromine (Parnate)
blocks monoamine oxidase from inactivating NE, DA, 5HT and results in increased brain amine levels at synapse
Term
disadvantages of MAOIs
Definition
less effective than TCAs
hypertensive crisis too dangerous
numerous interactions
*used when unresponsive to other meds
Term
MAOI adverse effects
Definition
anticholinergic effects
NE blocked =hypertensive crisis
-severe HA, stiff neck, N/V, fever
Term
when on MAOIs, you must avoid what?
Definition
tyramine: OTC cold and wt reduction meds, aged cheeses, red wine, sherry, draft beer, pepperoni, salami, pickled herring, sauerkraut
Moderation: chocolate, raisins, yogurt, avocado, aspartame, cottage and cream cheeses
Term
serotonin antagonist reuptake inhibitor (SARI): name and action
Definition
trazodone (Desyrel) selectively blocks reuptake of serotonin
Term
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
Definition
venlafaxine (Effexor)
duloxetine (Cymbalta)
nefazodone (Serzone)
disipramine (Norpramin)
low dose inhibits serotonin uptake, mod-high dose inhibits norepinephrine, higher doses DA uptake is added
Term
NDRI: norepinephrine-dopamine reuptake inhibitor
Definition
bupropion (Wellburtin, Zyban)
*smoking cessation
Term
tetracyclics
Definition
mirtazapine (Remeron)-antagonizes serotonin receptors
maprotoline hydrochloride-blocks NE reuptake
Term
most commonly used mood stabilizers
Definition
antimania drugs
anticonvulsants
Term
lithium carbonate: definition, use, onset
Definition
naturally occurring e-lyte
1st line for slow-cycle bipolar, will need entire life
5-7 days, may be 2 weeks or longer
Term
SE of lithium
Definition
tremors, twitches, metallic taste, GI and GU distress, fatigue, lethargy, wt gain
watch for kidney damage and hypothyroidism q6mos
Term
serum lithium levels (therapeutic and toxic)
Definition
monitor weekly till stable
therapeutic .5-1.5mEq
toxic 1.5-4.0
Term
lithium teaching needs
Definition
report flu-like symptoms, any illness that causes fluid/e-lyte loss
do not take dose if more than 2 hours late
Term
valproic acid (Depakote): use, SE
Definition
anticonvulsant used as mood stabilizer
GI distress, change in appetite, tremor, sedation, wt gain, hair loss increased risk of bleeding
Term
carbamazepine (Tegretol): use, SE
Definition
effective in pts with no response to lithium or pts with secondary mania
dizziness, confusion, drowsiness, GI distressed, vision problems, photosensitivity, hepatotoxicity, agranulocytosis or aplastic anemia-monitor WBCs
DC gradually
Term
memory trick for therapeutic drug levels (mood stabilizers)
Definition
Lithium 0.8
Tegretol 8.0
Depakote 80
D
Term
lamotrigine (Lamictal): use, SE
Definition
rapid cycling and depressed phase of bipolar
skin rash, sedation, vision problems, dizziness, N/V
DC immediately if rash is noted
Term
Bipolar treatment
Definition
need attention to depression b/c is more prevalant than mania, BUT antidepressants sometimes worsen illness.
Use mood stabilizers
Term
What condition is easily confused with mania?
Definition
Hyperthyroidism
Term
def and diagnosis of manic episode
Definition
manic episode: persistently elevated, expansive or irritable mood for a duration of at least 1 week PLUS
three of:
inflated self-esteem or grandiosity
decreased need for sleep
more talkative/pressured speech
flight of ideas or racing thoughts
distractibility
increase in goal-directed behavior or psychomotor agitation
excessive pleasurable activities that have high potential for consequences
Term
Bipolar I definition
Definition
combination of major depression and full manic episode (large swings)
or
mixed episodes (small switches)--at least 1 week
Term
Bipolar II definition
Definition
combination of major depression and hypomania (less severe form)--at least 4 days
Term
cyclothymic disorder
Definition
presence for at least 2 years hypomanic symptoms and periods of depressive symptoms that aren't a major depressive episode
Term
in children with bipolar, what usually presents first?
Definition
depression
Term
what is the hallmark of childhood bipolar disorder?
Definition
intense rage (2-3 hours)
Term
symptoms of bipolar in children younger than 9 exhibit more what?
Definition
irritability and emotional lability
Term
Older children with bipolar present with more what?
Definition
euphoria and grandiosity
Term
How do elderly exhibit bipolar?
Definition
confusion and disorientation
Term
late onset bipolar is more likely r/t...
Definition
secondary mania from illness, tx, or substance abuse
Term
gender differences in bipolar
Definition
males more manic
females more depression and rapid cycling
Term
kindling of bipolar
Definition
subthreshold stimulation of a neuron generates an action potential, over time episode cycles are shorter and shorter
*good reason for using anticonvulsants
Term
bipolar nsg assessment
Definition
changes in sleep/eating/sexual habits
thyroid fx
drug list
MSE
stress and coping
risk assessment
cultural views of mental illness
Term
bipolar nsg interventions
Definition
physical care
mood stabilizers + antidepressants
being in a tx relationship to have someone to recognize signs
ECT
cognitive behavior techniques
adjunctive therapy
safety
Term
bipolar desired outcomes
Definition
sleep 6-8h/night
stabilization on meds
nutrition/hydration
coping
no self harm
nl sensory perception
relapse prevention
family understanding and support
Term
psychoanalysis definition
Definition
study of unconscious , directs pts to talk freely about problems under hypnosis
Term
id (libido)
Definition
source of instinctual drives
life instincts/constructive drives (sexual)
death instincts/destructive (aggression)
operates on pleasure, disregard for others
Term
ego
Definition
use of reason and intellect to meet id demands
operates on reality
weighs actions and consequences
Term
superego (conscience)
Definition
right and wrong
morals
evaluates and judges behavior
Term
elements of psychoanalytic
Definition
object relations/attachment to caregiver
neurosis
transference
countertransference
Term
goals of psychoanalysis
Definition
work through conflicts to a healthier resolution and mature adult fx (long term process)
Term
Karen Horney: feminine psychology
Definition
rejected trad belief that women have penis envy
rather women are disadvantaged b/c of authoritarian culture
Term
Melanie Klein developed...
Definition
play therapy techniques
-child patterns self after another person
Term
Henry Stack Sullivan:what was his focus?
who did he influence?
Definition
interpersonal relations, instincts and drives are less important
Influenced Peplau and psychiatric nsg
Term
Maslow's Hierarchy
Definition
Self-actualization
esteem
love and belonging
safety and security
physiologic and survival
Term
how do psychodynamic theories apply to nsg?
Definition
therapeutic interpersonal relationship is a core of MH nsg.
Understand: defense mechanisms, (counter)transference, internal objects, Maslow's hierarchy
Term
Carol Gilligan and Jean Baker Miller's dev theory
Definition
girls development is more related to attachment within relationships than boys
Term
Developmental theories and nsg
Definition
girls may not follow a developmental path, and therefore models may not apply
Term
social distance
Definition
degree to which values of formal org and primary group members differ
Term
balance theory and nsg
Definition
develop, deliver and evaluate services within the framework of formal and informal support systems
Term
in nsg, use role concepts to understand...
Definition
group interaction
role of pt in family and community
Term
milieu therapy approaches are based on what?
Definition
pts assumption of a role within the psychiatric environment
Term
Leininger's Sunrise Theory is based on what?
Definition
transcultural health care
care that is culturally based
Term
Hildegarde Peplau's theory
Definition
The power of empathy
emphasizes social/interpersonal experiences
abnl behavior best understood by analyzing relationship with others
Term
examples of milieu therapy
Definition
adventure based counseling
social learning program
CBT program
Term
components of social learning
Definition
containment (decrease triggers)
support (prompts and cues)
structure (scheduling)
involvement
validation
Term
goal of psychiatric nsg
Definition
maximize the pt's positive interactions with the environment, promote wellness and enhance self-actualization
Term
domains of psychiatric care
Definition
direct care: counseling, intervention, group work, teaching, meds
communication: care plans, documentation, meetings
management: committees, delegation, mentorship, evaluation, QI
Term
standards of professional practice
Definition
quality of care
performance appraisal
education
collegiality
ethics
collaboration
research
resource use
Term
examples of basic practice
Definition
RN, case manager, nurse managers
RN-PMH
Term
tools of psych nursing practice
Definition
self
clinical reasoning and reflection
care plans
Term
ethics of psych nsg
Definition
autonomy
beneficence
justice
nonmaleficence
paternalism-make decisions for the good of pt
veracity-tell the truth
fidelity-keep promises
Term
which two orgs improve MH nsg and delivery of services?
Definition
American Psychiatric Nurses Association (APNA)
Intl Society of Psych-MH Nurses (ISPN)
Term
five MH disciplines
Definition
RN
Marriage and family therapy
social work
psychology
psychiatry
Term
challenges of psychiatric nsg
Definition
knowledge development, dissemination, application
stigma
access to care/expense
impact of technology
Term
EBP is the conscientious use and integration of:
Definition
best research evidence
clinical expertise
patient values in making decisions about care
Term
EBP process (6 steps)
Definition
define question
collect evidence
appraise evidence
integrate conclusion into practice
evaluate
Term
Hierarchy of Research
Definition
1. Meta-analysis of RCTs
2. Randomized controlled trials
3. non-random controlled trials
4. Cohort, Case controlled, other quasi-exp. study
5. Descriptive studies
6. Expert opinion based on clinical experience
Term
4 Categories of outcome indicators in evaluation
Definition
clinical
functional
satisfaction
financial
Term
Which historical figure was wrongly diagnosed with bipolar when he probably had porphyria?
Definition
King George III
Term
What famous inventor struggled with depression after an head injury? He also had many complications from meds.
Definition
Wilbur Wright
Term
What famous author committed suicide at age 59 after being plagued with mental breakdowns and hallucinations of voices? (possible bipolar diagnosis)
Definition
Virginia Woolf
Term
brad's cousin
Definition
claire
Supporting users have an ad free experience!