Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
124 Cards in this Set
- Front
- Back
Milieu therapy
|
assists in improving interpersonal skills, social functioning, performing ADL; focus on here & now; uses limit setting; involves client making decisions in own care; support privacy & autonomy; provide clear expectations
|
|
Behavior modification
|
change ineffective behavior patterns; focuses on the consequences of actions rather than peer pressure; uses positive & negative reinforcement; role modeling & teachnig new behavior
|
|
Family therapy
|
identifies entire family as client; concept of family as a system of parts forming whole; focus on patterns of interactions; identifying family roles; goal is to decrease family conflict and anxiety
|
|
Crisis intervention
|
directed at resolution of immediate crisis; crisis may develop when previously learned coping mechanisms are ineffective in dealing; individual usually in state of disequilibrium; if client is in panic state be very directive; goal is to return to precrisis level of functioning
|
|
Purpose of therapeutic interaction
|
allow clients autonomy to make choices when appropriate; give facts only-no opinions
|
|
Forbidden phrases in client interaction
|
you should, you'll have to, you can't, if it were me I'd, why don't you, I think you, it's the policy on this unit, don't worry, everyone..., why?, just a second, I know...
|
|
Question of nurse-client confidentiality
|
some information must be shared with other team memberes for the client's safety and optimal therapy
|
|
Denial
|
unconscious failure to acknowledge an event, thought, or feeling too painful for conscious awareness
|
|
Displacement
|
transference of feelings to another person/object
|
|
Identification
|
attempt to be like someone or emulate the personality/traits/behaviors
|
|
Intellectualization
|
using reason to avoid emotional conflicts
|
|
Introjection
|
incorporation of values or qualities of an admired person or group into one's own ego structure
|
|
Isolation
|
separation of unacceptable feeling/idea/impulse
|
|
Passive-aggression
|
indirectly expressing aggression toward others with a facade of overt compliance
|
|
Projection
|
attributing one's own thoughts or impulses to another person
|
|
Rationalization
|
offering an acceptable, logical explanation to make unacceptable feelings/behavior acceptable
|
|
Reaction formation
|
development of conscious attitudes & behaviors that are the opposite of what is really felt
|
|
Regression
|
reverting to an earlier level of development when anxious
|
|
Repression
|
involuntary exclusion of a painful thought or memory from awareness
|
|
Sublimation
|
substitution of an unacceptable feeling by a more socially acceptable one
|
|
Suppression
|
intentional exclusion of feelings & ideas
|
|
Undoing
|
communication or behavior done to negate a previously acceptable act
|
|
Cognitive therapy
|
replacing a client's irrational beliefs and distorted attitudes; short-term therapy
|
|
Electroconvulsive Therapy
|
electrically induced seizures for psych purposes; used for severe depression; may also be used for suicidal clients
|
|
Nursing care for ECT
|
avoid using the word "shock;" give anticholinergic 30 minutes before treatment to decrease secretions; give quick-acting muscle relaxant before to prevent muscle or bone damage; have emergency/crash cart in the room
|
|
Nursing care after ECT
|
maintain patent airway; check VS q15min; reorient after waking; common complaints: HA, muscle soreness, nausea
|
|
Mild Anxiety
|
associated with everyday life; increased levels of sensory awareness/alertness; thoughts are logical; cilent appears calm/controlled
|
|
Moderate Anxiety
|
motivate learning; be attentive/focus & problem solve; dulls perception of sensory stimuli; increased speech rate & volume; restlessness; may be converted into physical sx
|
|
Severe Anxiety
|
stimulates fight or flight; disorganized sensory stimuli; distorted perceptions; impaired concentration/problem-solving; selective attention; verbalization of emotional pain; causes tremors & increased motor activity
|
|
Panic
|
perception grossly distorted; unable to differentiate real from unreal; unable to concentrate or problem-solve; feel overwhelmed & helpless; lose control/ability to function; elicit behavior that may be angry/aggressive/withdrawn; immediate intervention
|
|
Generalized Anxiety Disorder
|
unrealistic, excessive, or persistent anxiety & worry about two or more life circumstances; neurobiochemical & psychodynamic theories
|
|
GAD Assessment
|
severe anxiety, motor tension, autonomic hyperactivity, vigilance & scanning (difficulty concentrating, etc), on edge, low self-esteem
|
|
Panic disorders/phobias
|
discrete periods of intense fear or discomfort; irrational fear of external object, activity, situation; chronic condition; transfers anxiety or fear from its source to a symbolic object, idea, situation
|
|
Agoraphobia
|
fear of crowds or open places
|
|
Nursing assessment for panic d/o/phobia
|
coping styles, autonomic hyperactivity, panic attacks that usually peak at 10min but can last up to 30 minutes; disruption in personal life; possible use of alcohol/drug
|
|
Nursing interventions for panic d/o/phobia
|
establish trust, safe environment, draw client's attention away from feared object/situation; discuss alternative coping strategies & encourage use; substitute positive thoughts; assist in desensitizing client; may use SSRIs; decrease intake of caffeine & nicotine
|
|
OCD
|
anxiety associated with repetitive thoughts (obsession) or irresistible impulses (compulsion)
|
|
OCD Assessment
|
coping styles to control anxiety; magical thinking; evidence of destructive/hostile/aggressive/delusional thought; intereference with normal activities; safety issues; recurring intrusive thoughts; recurring, repetitive behaviors
|
|
OCD Interventions
|
provide for physical needs; allow performance of compulsive activity with attention to safety; establish a routine; avoid punishing and criticizing; admin SSRIs/TCAs
|
|
Zolpidem (Ambien)
|
short-term treatment of insomnia; give with food 1-1.5h before bed
|
|
PTSD Assessment
|
anxiety; anxiety manifested in symptomatic behavior; responses to anxiety (shock, anger, panic, denial); self-destructive behavior; visible reminders of trauma
|
|
Somatoform
|
characterized by the expression of unexplained physical symptoms that have no physical basis; physical sx thought to be unconscious expression of internal conflict; occur more often in women; children may learn that physical complaints are acceptable coping strategy-secondary gain; may abuse analgesics without relief
|
|
Somatization disorder
|
recurrent somatic complaints with no medical pathology present
|
|
Hypochondriasis
|
belief in and fear of having a disease including misinterpretation of physical signs as proof of presence of disease
|
|
Conversion disorder
|
characterized by transferring a mental conflict into a physical sx for which there is no organic cause
|
|
Somatoform Assessment
|
preoccupation with pain/bodily function for 6 mos or more; history of doctor shopping; absence of emotional concern; elevated VS; fear of serious disease; excess use of analgesics; social/occupational impairment
|
|
Somatoform interventions
|
nonjudgmental attitude; help client identify needs met by sick role; encourage use of anxiety-reducing techniques
|
|
La belle indifference
|
lack of concern over physical illness
|
|
Primary gain from somatoform
|
decrease in anxiety from ability to deal with stressful situation
|
|
Secondary gain from somatoform
|
rewards obtained from the sick role
|
|
Dissociative disorders
|
alteration in the function of consciousness, personality, memory, identity; may be sudden/temporary or chronic/gradual; persons afflicted handle stress by splitting from the situation & going into fantasy state
|
|
Psychogenic amnesia
|
sudden temporary inability to recall extensive personal info; usually occurs after traumatic event; most common dissociative disorder
|
|
Psychogenic fugue
|
characterized by person suddenly leaving home/work with inability to recall his/her identity so this involves flight as well as loss of memory; rarely occurs; excess alcohol use may contribute
|
|
Dissociative identity disorder
|
presence of 2+ distinct personalities; personalities emerge during stress
|
|
Depersonalization
|
characterized by a temporary loss of one's reality & ability to feel/express emotions; client has fear of "going crazy;" client describes sense of "strangeness" in environment
|
|
Nursing interventions with Dissociative disorders
|
reduce environmental stimuli; stay with client during periods of depersonalization; demonstrate acceptance of client's behavior; document emergence of different personalities; implement suicide precautions if needed; encourage client to identify stressful situations that cause transition from one personality to another; help client identify effective coping
|
|
Cluster A: Paranoid: Personality Disorder
|
characterized by suspicious, strange behavior that may be precipitated by stressful event; may manifest as intense hypochondriasis
|
|
Paranoid personality
|
pervasive & long-standing suspiciousness; mistrusts others; projects blame for own problems onto others; hostile dialogue
|
|
Schizoid personality
|
socially detached, shy, introverted; avoids interpersonal relationships; emotionally detached, introverted, unresponsive, autistic thinking; says little, appears withdrawn
|
|
Schizotypal personality
|
interpersonal deficits; eccentricities; odd beliefs; socially isolated
|
|
Interventions for Cluster A Personality Disorder
|
est trust; be honest; follow through on commitments; avoid talking/laughing where client can see you but not hear you
|
|
Cluster B: Dramatic, Emotional Personality Disoder
|
antisocial, borderline, histrionic, narcissistic
|
|
Antisocial personality
|
aggressive, acting-out behavior with no remorse; clever & manipulative; emotionally immature & impulsive; ineffective interpersonal skills; belligerent
|
|
Borderline personality
|
disturbances regarding self-image & sexual/social/occupational roles; impulsive/self-damaging behavior, suicidal gestures; overly dependent on others; tends to view others as all good or all bad (splitting); self-critical/demanding/whiny/manipulative/argumentative
|
|
Histrionic personality
|
seeks attention by overreacting & exhibiting hyperexcitable emotions; overly dramatic, seeks attention; chaotic relationships; loud, excitable, overreactive, attempts to draw attention to self
|
|
Narcissistic personality
|
perceives self as all-powerful & important; critical of others; exaggerated feeling of self-importance & self-love; needs attention/admiration; preoccupied with power/appearance; exploits others
|
|
Cluster C: Anxious, Fearful Personality Disorders
|
avoidant; dependent; obsessive-compulsive
|
|
Avoidant personality
|
socially inhibited; feels inadequate; hypersensitive to criticism/rejection; longs for relationships
|
|
Dependent personality
|
unreasonable wishes & wants; expresses needs in a demanding, whining manner; passive without accepting responsibility for own behavior; low self-esteem; dependent on others to meet his/her needs
|
|
Obsessive-Compulsive personality
|
attempts to control self through the control of others or the environment; shows inattention to new facts or different viewpoints; cold & rigid to others; is a perfectionist/inflexible/stubborn; excessively neat & clean;
|
|
Anorexia nervosa
|
voluntary refusal to eat & maintain minimal weight for height/age; distorted body image & fear of obesity; 15-20% of those diagnosed die; associated with parent/child conflicts about dependency issues; possible causes: dysfunctional family system, unrealistic expectations, ambivalence of maturation & independence
|
|
Assessment of Anorexia
|
skeletal appearance, distorted body image, hair loss, dry skin, irregular heart beat, decreased pulse, decreased BP, amenorrhea, dehydration & F&E imbalance
|
|
Interventions for Anorexia
|
monitor weight/VS/electrolytes; provide structured/supportive environment; set time limit for eating; monitor after meals for vomiting; monitor activity level; devise behavior-modification; monitor activity & assess for weakness/fatigue/pathologic fractures
|
|
Bulimia Nervosa
|
eating d/o characterized by eating excessive amounts of food followed by self-induced purging by vomiting/misuse of laxatives/diuretics/fasting/excess exercise; usually report lack of control over eating & binging
|
|
Nursing interventions for Bulimia
|
monitor weight/VS/electrolytes; structured/supportive environment; assist client to learn strategies for coping; encourage expression of anger; promote family therapy
|
|
Depressive disorders
|
pathologic grief reactions ranging from mild to severe states
|
|
Mild Depression
|
feel sad; difficulty concentrating & performing usual activities; difficulty maintaining usual activity level
|
|
Moderate Depression
|
feelings of helplessness & powerlessness; decreased energy; sleep pattern disturbances; appetite/weight changes; slowed speech/thought/movement
|
|
Severe Depression
|
feelings of hopelessness/worthlessness/guilt/shame; despair; flat affect; indecisiveness; lack of motivation; change in physical appearance; suicidal thought; possible delusions/hallucinations; sleep/appetite disturbances; loss of interest in sexual activity; constipation
|
|
Depression Assessment
|
determine type of depression (exogenous/endogenous); determine degree of depression; determine current suicide risk; arrange lab tests
|
|
Exogenous
|
caused by a reaction to environmental or external factors
|
|
Endogenous
|
caused by internal biologic deficiency
|
|
Depression interventions
|
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
|
|
Suicide Precautions
|
obtain history (previous attempt is increased risk); be aware of major warning signs: giving away possessions & previously depressed client is suddenly happy
|
|
Evaluate suicide intent
|
directly as client about intent; ask about plans; identify method chosen--more lethal=greater risk of attempt; determine availability of method chosen
|
|
Interventions for suicide
|
express concern for client; tell client you'll share info with treatment team; offer hope; never leave suicidal client alone
|
|
Bipolar Disorder
|
manifested by mood swings involving euphoria, grandiosity, and inflated sense of self-worth; according to DSM-IV-TR client must have at least one episode of major depression--client may cycle
|
|
Assessment of Bipolar
|
assess nutrition/hydration; level of fatigue; danger to self/others
|
|
Interventions of Bipolar
|
maintain client's physical health, provide safe environment; decrease environmental stimulation; implement suicide precautions; consistent approach to minimize manipulative behavior; avoid giving attention to bizarre behavior; meet needs ASAP; provide small, frequent feedings of food that can be carried; praise self-control; promote family involvement
|
|
Schizophrenia
|
thought disturbance, altered affect, withdrawal from reality, regressive behavior, difficulty with communicatoin, impaired interpersonal relationships
|
|
Catatonic schizophrenia
|
stupor, rigidity, posturing, negativism, excitement, potential for violence
|
|
Disorganized schizophrenia
|
incoherence, flat/inappropriate affect, disorganized behavior, usunual mannerism, socially withdrawn, no delusions
|
|
Paranoid schizophrenia
|
systemized delusions/hallucinations related to single theme; ideas of reference; potential for violence if acting upon delusions
|
|
Residual schizophrenia
|
socially withdrawn; inappropriate affect; eccentric/peculiar behavior; absence of prominent delusions & hallucinationsn; no current psychotic behavior
|
|
Undifferentiated
|
prominent delusions & hallucinations; incoherence & grossly disorganized behaviors; failure to meet criteria for other types
|
|
Assessment schizophrenia
|
assess for thought process disturbance: symbolism, delusions, ideas of reference; note form of verbal communication; assess for disturbance in perception; assess for disturbance in affect; assess for disturbance in behavior; assess for disturbance in interpersonal relationships
|
|
Interventions schizophrenia
|
est trust; sit with mute clients; provide safe environment; assist with hygiene/ADL; matter of fact approach; use clear, simple, concrete terms; accept/support client feelings; reinforce congruent thinking; stress reality; avoid arguing or agreeing with inaccurate communications; set limits on behavior; avoid stressful situations; structure time for activities; encourage client to identify positive characteristics of self; praise socially acceptable behavior; avoid dependent relationship
|
|
Delusional client
|
encourage recognition of distorted reality; divert focus to reality; do not agree with/support delusions; avoid arguing about delusion; avoid physically touching client; admin antipsychotic drugs; admin antiparkinsonian drugs
|
|
Hallucinating client
|
protect client from injury that might result from following voices; avoid denying or arguing withclient about hallucination; discuss observations with client; make frequent but brief remarks to interrupt hallucinations; admin antipsychotic drugs; admin antiparkinsonian drugs
|
|
Alcoholism Assessment
|
patterns indicative of alcoholism; family history; dependency, yet resentfulness of authority; impulsive/abusive behavior; impaired judgment/memory loss; incoordination, slurred speech; mood varying between euphoria & depression; intoxication based on BAL; alcohol w/d sx; chronic alcohol related illness
|
|
Symptoms of alcohol withdrawal
|
begin shortly after drinking stops (4-6h); anxiety/nausea/insomnia/tremor/hyperalertness/restlessness; increase in all VS; DT may appear 12-36h after last drink: tachycardia, tachypnea, diaphoresis, marked tremors, hallucinations, paranoia; grand mal seizures
|
|
Antabuse
|
severe side effects occur if alcohol is consumed; teach client what to expect if alcohol is consumed; be aware that some alcoholics use the side effects to punish themselves for drinking
|
|
Interventions for alcoholism
|
safety, nutrition, hygiene, rest; provide care during withdrawal; implement suicide risk if necessary; rehab: direct, matter-of-fact attitude, confront manipulations, set firm limits, short-term goals, decrease loneliness, group/family therapy
|
|
Child Abuse Indicators
|
injuries not congruent with child's developmental age/skills; injuries not correlated with stated cause; delay in seeking medical care
|
|
Assessment for Child Abuse
|
bruises in unusual places; bruises/welts caused by belts/cords/etc; burns; whiplash injury; bald patches; fractures in various stages of healing; failure to thrive; torn/stained/bloody underclothes; genital lacerations; bedwetting; STDs; parent seeing child as different; parent using child to meet own needs; parent seldom touching/responding to child; child appearing frightened/withdrawn in presenceof parent/adult; family history of moving/unstable employment/marital discord/family violence; one parent answering all questions
|
|
Interventions for Child Abuse
|
nurses legally required to report all cases of suspected child abuse to the appropriate local or state agency; take photos of injuries; establish trust & care for physical problems; recognize own feelings of disgust/contempt for parents; support need for family therapy
|
|
Intimate-Partner Violence
|
usually a tension-releasing action; persons act more violently when drinking/drugs; relationship usually characterized by extreme jealously & issues of power & control ; often begins during pregnancy or occurs more frequently in pregnancy
|
|
Assessment for Intimate-Partner Violence
|
delay between time of injury & time of tx; anxious when answering questions about injury; ab injuries in pregnancy; looks to abuser for answers to questions related to injuries; depression/SI; feels responsible for provoking abuser; low self-esteem; abrasions/cuts/lacerations/sprains/black eyes; somatoform complaints; concurrent use of alcohol/drugs
|
|
Interventions for Intimate-Partner Violence
|
est trust; use nonjudgmental approach; treat physical injuries; document; provide crisis intervention; assist with referral to shelter if desired; assist with contacting authorities to press charges if desired; interview abused partner when abuser isn't present
|
|
Elder Abuse
|
an that causes injury or exploitation or neglect to older adult; underreported; majority of abuse is committed by spouses & children
|
|
Assessment for Elder Abuse
|
bruises on upper arms; broken bones caused by falls; dehydration/malnourishment; overmedication; poor hygiene; improper medical care; withdrawn behavior; behavior that may be demanding/belligerent/aggressive; repeated visits to health care agency for injuries & falls; injures that don't correlate with stated cause; misuse of money by children/guardian
|
|
Rape/Sexual Assault
|
act of aggression, not passion
|
|
Assessment for Rape
|
physical assessment; emotional status; coping behavior; support system; details of assault
|
|
Interventions for Rape
|
communicate nonjudgmental acceptance; provide physical care to treat injuries; give clear/concise explanations of all procedures to be performed; document using *exact* words; notify police & encourage victim to prosecute; collect/label evidence carefully in presence of witness; notify rape crisis team/counselor; allow discussion of feelings; advise of potential for venereal disease/pregnancy/HIV; provide info about care; support client/family/friends
|
|
Delirium
|
acute; usually reversible; recognized by sudden onset; occurs in response to specific stressors; treatment of choice is correction of causative disorder
|
|
Dementia
|
chronic; gradual, progressive onset; irreversible; judgment/memory/abstract thinking/social behavior affected; seen in: alzheimer, multiinfarctions (brain), huntington chorea, parkinson, MS, brain tumors, wernicke-korsakoff syndrome (chronic alcoholics)
|
|
ADD
|
developmentally inappropriate attention, impulsiveness, hyperactivity
|
|
ADD Assessment
|
physical assessment; more prevalent in boys; failure to listen/follow instruction; difficulty playing quietly/sitting still; disruptive/impulsive behavior; distractibility to external stimuli; excess talking; shifting from one unfinished task to another; underachievement in school
|
|
ADD Interventions
|
decrease environmental stimuli; set limits on behavior; safe/comfortable environment; initiate a behavior contract to help child manage own behavior; admin meds
|
|
Conduct disorder
|
antisocial behavior characterized by violation of laws, societal norms, & basic rights of others without feelings of remorse
|
|
Oppositional defiant disorder
|
characterized by behavior that fails to adhere to established norms, but doesn't violate the rights of others
|
|
Conduct disorder assessment
|
physical fighting, running away, lying, stealing, cruelty to animals, frequent truancy, vandalism, arson, use of alcohol/drugs
|
|
Oppositional defiant disorder assessment
|
argumentativeness, blaming others for own problems, defying rules/authority; using obscene language, acting resentful/vindictive
|
|
Interventions for conduct/oppositional defiant disorder
|
assess cues for escalating behavior; nonauthoritarian approach; avoid why questions; initiate a show of force with a child out of control; use a quiet room when external control is needed; clarify expressions/jargon; teach to redirect angry feelings; implement behavior modification; role-play new coping strategies
|