{"id":110804,"date":"2023-07-28T11:17:22","date_gmt":"2023-07-28T11:17:22","guid":{"rendered":"https:\/\/learnexams.com\/blog\/?p=110804"},"modified":"2023-07-28T11:17:43","modified_gmt":"2023-07-28T11:17:43","slug":"rasmussen-mental-health-final-exam-latest-2023-2024-real-exam-all-100-questions-and-correct-answersagrade","status":"publish","type":"post","link":"https:\/\/www.learnexams.com\/blog\/2023\/07\/28\/rasmussen-mental-health-final-exam-latest-2023-2024-real-exam-all-100-questions-and-correct-answersagrade\/","title":{"rendered":"RASMUSSEN MENTAL HEALTH FINAL EXAM LATEST 2023-2024 REAL EXAM ALL 100+ QUESTIONS AND CORRECT ANSWERS|AGRADE"},"content":{"rendered":"\n

What type of patients go to memory care?<\/a><\/p>\n\n\n\n

Dementia or Alzheimers<\/a><\/p>\n\n\n\n

What type of environment is a memory care unit?<\/a><\/p>\n\n\n\n

Locked unit, 24-7 supervision.<\/a><\/p>\n\n\n\n

What type of activities do you implement to interact with memory care patients?<\/a><\/p>\n\n\n\n

Activities that help them to recall their past-show old photos, ask questions like what was your first job? where did you grow up? what was your parents names?<\/a><\/p>\n\n\n\n

If a patient is not engaged in a group of people sharing photos what might they be feeling?<\/a><\/p>\n\n\n\n

Depressed, Isolated, Angry<\/a><\/p>\n\n\n\n

Can a social worker make a decision about placement for an elderly person if that person has living family members, a POA?<\/a><\/p>\n\n\n\n

No, they cannot make the decision. Nurses must educate family about decisions.<\/a><\/p>\n\n\n\n

What does agnosia mean?<\/a><\/p>\n\n\n\n

Inability to interpret sensations and hence to recognize things, typically as a result of brain damage.<\/a><\/p>\n\n\n\n

Example of something that could cause agnosia?<\/a><\/p>\n\n\n\n

TBI, vascular dementia.<\/a><\/p>\n\n\n\n

Characteristics of delirium.<\/a><\/p>\n\n\n\n

Rapid in onset, 24-72 hours, related to infection, NOT common with aging.<\/a><\/p>\n\n\n\n

What is an important intervention for patients with delirium?<\/a><\/p>\n\n\n\n

Reorient them.<\/a><\/p>\n\n\n\n

What are the primary characteristics of borderline personality disorder?<\/a><\/p>\n\n\n\n

splitting people (Pitting a group against each other). Self-defeating cycle of behavior.<\/a><\/p>\n\n\n\n

What do you give a patient who has overdosed on PCP?<\/a><\/p>\n\n\n\n

Benzodiazepine<\/a><\/p>\n\n\n\n

Example of a benzodiazpine antidote?<\/a><\/p>\n\n\n\n

Flumazenil<\/a><\/p>\n\n\n\n

What type of personality disorder might a patient who still lives at home at 30 and depends on their mother for everything, have?<\/a><\/p>\n\n\n\n

dependent personality disorder<\/a><\/p>\n\n\n\n

Give an example of a positive statement made by a recovering alcohol that made signal that they are getting better?<\/a><\/p>\n\n\n\n

I will identify things that trigger my cravings<\/a><\/p>\n\n\n\n

Symptoms of patient with suspected opioid abuse\/overdose?<\/a><\/p>\n\n\n\n

Contracted pupils, increased HR, shallow Resp., increased temp (but not always).<\/a><\/p>\n\n\n\n

What do you give a opioid overdose patient?<\/a><\/p>\n\n\n\n

Narcan (Naloxone)<\/a><\/p>\n\n\n\n

S\/S of acute alcohol withdrawal?<\/a><\/p>\n\n\n\n

Everything is increased! RR, BP, Temp, HR, delerium<\/a><\/p>\n\n\n\n

Characteristics of histrionic personality disorder?<\/a><\/p>\n\n\n\n

Mania, melodramatic, manipulative, emotional attention seeking behavior, often seductive and flirtatious.<\/a><\/p>\n\n\n\n

Interventions for histrionic personality disorder patient<\/a><\/p>\n\n\n\n

They are very manipulative. Set fine lines, do not offer relationship advice, avoid situations where they are the center of attention.<\/a><\/p>\n\n\n\n

Possible fatal complications of patient withdrawing from CNS stimulant<\/a><\/p>\n\n\n\n

Respiratory failure, suicide, and depression.<\/a><\/p>\n\n\n\n

What is a hypochondriac?<\/a><\/p>\n\n\n\n

Someone who thinks that everything is wrong with them. Ex. their acute headache is caused by a brain tumor.<\/a><\/p>\n\n\n\n

How does cocaine stimulate the body? What do cocaine users use to combat these effects?<\/a><\/p>\n\n\n\n

It is an upper. Alcohol-allows them to sleep.<\/a><\/p>\n\n\n\n

Characteristics of borderline personality disorder<\/a><\/p>\n\n\n\n

Split people apart and are very manipulative.<\/a><\/p>\n\n\n\n

Interventions for nurses dealing with borderline personality disorder patients<\/a><\/p>\n\n\n\n

Keep all the staff on the same page. Set limits and rules.<\/a><\/p>\n\n\n\n

What is a personality disorder in general? What type of issues do these patients have?<\/a><\/p>\n\n\n\n

When people rely on others to make decisions. They have difficulties in their social life, work, relationships, family problems. Place the blame on others. Many go undiagnosed.<\/a><\/p>\n\n\n\n

What is conversion disorder?`<\/a><\/p>\n\n\n\n

Something psychological happens and it then manifests somatically. Ex. Someone has fake blindness<\/a><\/p>\n\n\n\n

What is the difference between objective and subjective data?<\/a><\/p>\n\n\n\n

Subjective is what the patient tells you, objective is what you see and obtain from the physical assessment of the patient.<\/a><\/p>\n\n\n\n

What is somatoform disorder?<\/a><\/p>\n\n\n\n

A mental illness that causes bodily symptoms that cannot be tracked back to any specific cause.<\/a><\/p>\n\n\n\n

Are the symptoms real for a patient with somatoform disorder?<\/a><\/p>\n\n\n\n

Yes, the symptoms are real. It is frustrating because many doctors will perform tests but find nothing. Many go undiagnosed.<\/a><\/p>\n\n\n\n

What are younger patients with body image problems at risk for?<\/a><\/p>\n\n\n\n

Suicide<\/a><\/p>\n\n\n\n

A nurse caring for a patient with borderline personality disorder should try to find out what?<\/a><\/p>\n\n\n\n

What the patients secondary gains are. What are they trying to get? Attention? Money? Pain pills?<\/a><\/p>\n\n\n\n

Characteristics of an antisocial personality disorder patient in a locked setting with other clients?<\/a><\/p>\n\n\n\n

Manipulative, aggressive, angry, yelling.<\/a><\/p>\n\n\n\n

What is a main cause of death for anorexia nervosa patients?<\/a><\/p>\n\n\n\n

Cardiac problems d\/t potassium imbalances *hypokalemia<\/a><\/p>\n\n\n\n

What is re-feeding syndrome?<\/a><\/p>\n\n\n\n

Occurs when malnourished patient begins to receive nourishment again. Severe change in intake and electrolyte increases cause heart to work harder and can cause dysrhythmias.<\/a><\/p>\n\n\n\n

What is the difference between bulimia and anorexia?<\/a><\/p>\n\n\n\n

Bulimia is the binging of food and then purging. Anorexia is starving self from food.<\/a><\/p>\n\n\n\n

If you’re throwing up and or taking a laxative? What electrolyte might be out of balance?<\/a><\/p>\n\n\n\n

Potassium<\/a><\/p>\n\n\n\n

What are hallucinations?<\/a><\/p>\n\n\n\n

Experiences that are real to the patient but are not actually real.,<\/a><\/p>\n\n\n\n

What should you do for a patient that is having hallucinations?<\/a><\/p>\n\n\n\n

Make sure they have everything they need (Glasses, hearing aid etc), keep lights on in room, do not place large clocks or calendars on the walls.<\/a><\/p>\n\n\n\n

What type of med would a dr. give a cognitive impaired elderly client who pulled out all of her tubes?<\/a><\/p>\n\n\n\n

Atypical antipsychotic<\/a><\/p>\n\n\n\n

How long til we see complications with patients withdrawing from alcohol?<\/a><\/p>\n\n\n\n

24 to 48 hours.<\/a><\/p>\n\n\n\n

When giving narcan, what should you monitor closely?<\/a><\/p>\n\n\n\n

VS, at least every 15 min. Stay with patient!<\/a><\/p>\n\n\n\n

What would you give a patient with a heroin overdose? What would we expect to improve?<\/a><\/p>\n\n\n\n

Narcan. HR and Resp<\/a><\/p>\n\n\n\n

OD heroin patient receives narcan, 1 hr. later present with abd cramps, goose bumps. What is going on?<\/a><\/p>\n\n\n\n

Symptom of narcotic absence. “withdrawal”<\/a><\/p>\n\n\n\n

What should the nurse do for a sexual assault victim?<\/a><\/p>\n\n\n\n

Make sure counseling is available for them, set up an appointment<\/a><\/p>\n\n\n\n

Who is at the highest risk for physically abusing a nurse?<\/a><\/p>\n\n\n\n

A patient with dementia or a delusional patient<\/a><\/p>\n\n\n\n

What type of meds do ADHD patients receive?<\/a><\/p>\n\n\n\n

CNS stimulant<\/a><\/p>\n\n\n\n

Early signs of autism in kids?<\/a><\/p>\n\n\n\n

Isolation, not loving towards people, nonverbal, doesn’t like to be touched, difficult relationship with parents<\/a><\/p>\n\n\n\n

Can restraints be PRN?<\/a><\/p>\n\n\n\n

NO!! Must clarify with doctor.<\/a><\/p>\n\n\n\n

What is lorazepam (Ativan) used for?<\/a><\/p>\n\n\n\n

Anxiety disorder or preop sedation.<\/a><\/p>\n\n\n\n

Side effects of lorazepam (Ativan)<\/a><\/p>\n\n\n\n

Drowsiness, respiratory depression, dizziness, lethargy, physical dependence<\/a><\/p>\n\n\n\n

Contraindications of lorazepam (Ativan)<\/a><\/p>\n\n\n\n

Angle closure glaucoma, hx of drug dependence, pre-existing CNS depression, severe hypotension, and sleep apnea<\/a><\/p>\n\n\n\n

Lithium therapeutic range<\/a><\/p>\n\n\n\n

0.5-1.5<\/a><\/p>\n\n\n\n

Levels of maslow hierarchy of needs?<\/a><\/p>\n\n\n\n

Physiological needs, safety, love & belonging, self-esteem, self-actualization.<\/a><\/p>\n\n\n\n

Rights of voluntary and involuntary admission patients to mental health?<\/a><\/p>\n\n\n\n

Have the right to refuse meds, refuse treatments, and the right to informed consent.<\/a><\/p>\n\n\n\n

What vitamin isn’t absorbed when taking an MAOI?<\/a><\/p>\n\n\n\n

Tyramine<\/a><\/p>\n\n\n\n

Characteristic of patient with body dysmorphic disorder?<\/a><\/p>\n\n\n\n

Preoccupied with an image of a defective body part resulting in obsessional thinking and compulsive behavior, such as mirror checking and camouflaging.<\/a><\/p>\n\n\n\n

Theraputic Communication Technique (TCT) Silence:<\/a><\/p>\n\n\n\n

using silence allows for meaningful relfection<\/a><\/p>\n\n\n\n

(TCT) accepting:<\/a><\/p>\n\n\n\n

conveys an attitude of reception and regard<\/a><\/p>\n\n\n\n

(TCT) Giving recognition:<\/a><\/p>\n\n\n\n

Acknowledging indicates awareness<\/a><\/p>\n\n\n\n

(TCT) Offering self:<\/a><\/p>\n\n\n\n

Making oneself available on an unconditional basis, increasing the clients feeling of self-worth<\/a><\/p>\n\n\n\n

(TCT) offering general leads:<\/a><\/p>\n\n\n\n

Allows the person to take direction in the discussion indicates that the nurse is interested in what comes next. (“go on”, “and then?”)<\/a><\/p>\n\n\n\n

(TCT) giving broad openings:<\/a><\/p>\n\n\n\n

clarifies that the lead is to be taken by the patient (“Where would you like to begin?”)<\/a><\/p>\n\n\n\n

(TCT) Making observations:<\/a><\/p>\n\n\n\n

Calls attention to the person’s behavior, encourages the person to notice behavior and to describe thoughts and feelings for mutual understanding. Helpful for mute or withdrawn people.<\/a><\/p>\n\n\n\n

(TCT) Encouraging description of perception:<\/a><\/p>\n\n\n\n

Increase the nurse’s understanding of the patient’s perceptions. Talking about feelings and difficulties can lessen the need to act them out inappropriately<\/a><\/p>\n\n\n\n

Non-therapeutic communication (NTC) Giving premature advice<\/a><\/p>\n\n\n\n

Assumes the nurse knows best and the patient cannot think for self.<\/a><\/p>\n\n\n\n

(NTC) Minimizing feelings:<\/a><\/p>\n\n\n\n

Indicates the nurse is unable to understand or empathize with the patient. The patient’s feelings or experiences are being belittled.<\/a><\/p>\n\n\n\n

What is beneficence?<\/a><\/p>\n\n\n\n

The duty to act as a benefit or to promote the good of others.<\/a><\/p>\n\n\n\n

What is autonomy?<\/a><\/p>\n\n\n\n

Respecting the rights of others to make their own decisions<\/a><\/p>\n\n\n\n

What is justice?<\/a><\/p>\n\n\n\n

The duty to distribute resource or care equally, regardless of personal attribtutes.<\/a><\/p>\n\n\n\n

What is fidelity (nonmaleficence)<\/a><\/p>\n\n\n\n

Maintaining loyalty and commitment to the patient and doing no wrong to the patient<\/a><\/p>\n\n\n\n

What is veracity?<\/a><\/p>\n\n\n\n

One’s duty to communicate truthfully.<\/a><\/p>\n\n\n\n

What does a patient lose when they are admitted d\/t suicide attempt\/ideation?<\/a><\/p>\n\n\n\n

Right to privacy.<\/a><\/p>\n\n\n\n

What are negative symptoms?<\/a><\/p>\n\n\n\n

A lack of feelings or behaviors that are usually present. Losing interest in daily activities, lack of feeling or emotion, having little emotion or inappropriate feelings in certain situations, agnosia.<\/a><\/p>\n\n\n\n

What are positive symptoms?<\/a><\/p>\n\n\n\n

Feelings or behavior that are not usually present. Delusions, hallucinations, disorganized speech and behavior.<\/a><\/p>\n\n\n\n

What do atypical antipsychotics treat?<\/a><\/p>\n\n\n\n

Negative symptoms.<\/a><\/p>\n\n\n\n

Examples of atypical antipsychotics<\/a><\/p>\n\n\n\n

Clozapine, risperidone, olanzapine, aripiprazole, ziprasidone, and quetiapine.<\/a><\/p>\n\n\n\n

SE of atypical antipsychotics<\/a><\/p>\n\n\n\n

fewer EPS symptoms, temp, increased wt, glucose, and triglycerides<\/a><\/p>\n\n\n\n

Three types of crisises?<\/a><\/p>\n\n\n\n

Situational\/external, maturational\/internal, and adventitious<\/a><\/p>\n\n\n\n

What is a situational .external crisis?<\/a><\/p>\n\n\n\n

Often unanticipated loss or change.<\/a><\/p>\n\n\n\n

What is maturational\/internal crisis?<\/a><\/p>\n\n\n\n

Achieving new developmental stages, which requires learning additional coping mechanisms.<\/a><\/p>\n\n\n\n

What are adventitious crisis?<\/a><\/p>\n\n\n\n

The occurrence of natural disasters, crime, or national disasters.<\/a><\/p>\n\n\n\n

What is a particular drug of choice for alzheimers?<\/a><\/p>\n\n\n\n

Donepezil (Aricept) or rivastigmine (Exelon)<\/a><\/p>\n\n\n\n

Characteristics of pt. with borderline personality disorder?<\/a><\/p>\n\n\n\n

Instability of affect, identity, and relationships, as well as splitting behaviors, manipulation, impulsiveness, and fear of abandonment, often tries self injury, possibly suicidal.<\/a><\/p>\n\n\n\n

Bipolar suddenly D\/C lithium. What could happen?<\/a><\/p>\n\n\n\n

symptoms of mania or hypomania. May be worse than when they 1st started the med.<\/a><\/p>\n\n\n\n

2 things for the tx of alcohol dependency<\/a><\/p>\n\n\n\n

Detox, then rehab<\/a><\/p>\n\n\n\n

Healthy defense mechanisms (4)<\/a><\/p>\n\n\n\n

Altruism, sublimation, suppression, and humor.<\/a><\/p>\n\n\n\n

What is altruism?<\/a><\/p>\n\n\n\n

Healthy defense mechanism. Emotional conflicts and stressors are addressed by meeting the needs of others.<\/a><\/p>\n\n\n\n

What is sublimination?<\/a><\/p>\n\n\n\n

Healthy defense mechanism. An unconscious process of substituting constructive and socially acceptable activity for strong impulses that are not acceptable in their original form.<\/a><\/p>\n\n\n\n

What is suppression?<\/a><\/p>\n\n\n\n

The constant denial of a disturbing situation or feeling.<\/a><\/p>\n\n\n\n

What are the intermediate defenses? (4)<\/a><\/p>\n\n\n\n

Repression, displacement, reaction formation, reationalization<\/a><\/p>\n\n\n\n

What is repression?<\/a><\/p>\n\n\n\n

Intermediate Defense. cornerstone of defense mechanisms and is the first life of defense against anxiety. Exclusion of unpleasant experiences, emotions, or ideas from conscious awareness.<\/a><\/p>\n\n\n\n

What is displacement?<\/a><\/p>\n\n\n\n

Intermediate defense. Transfer of emotions associated with a particular person, object, or situation to another person object or situation that is nonthreatening.<\/a><\/p>\n\n\n\n

What is reaction formation?<\/a><\/p>\n\n\n\n

Intermediate defense. Unacceptable feelings or behaviors are kept out of awareness by developing the opposite behavior or emotion.<\/a><\/p>\n\n\n\n

What is rationalization?<\/a><\/p>\n\n\n\n

Intermediate defense. Consists of justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations that satisfy the teller as well as the listener.<\/a><\/p>\n\n\n\n

What are the immature defenses? (4)<\/a><\/p>\n\n\n\n

Passive aggression, splitting, projection, denial.<\/a><\/p>\n\n\n\n

What is passive aggression?<\/a><\/p>\n\n\n\n

Indirectly and unassertively expressing aggression towards others. Expressed through procrastination, failure, inefficiency, and illness that affects others more than oneself.<\/a><\/p>\n\n\n\n

What is splitting?<\/a><\/p>\n\n\n\n

The inability to integrate the positive and negative qualities of oneself or others<\/a><\/p>\n\n\n\n

What is projection?<\/a><\/p>\n\n\n\n

A person unconsciously rejects emotionally unacceptable personal features and attributes them to other people objects or situations.<\/a><\/p>\n\n\n\n

What is denial?<\/a><\/p>\n\n\n\n

Escaping unpleasant realities by ignoring their existence.<\/a><\/p>\n\n\n\n

In regards to the MMSE? What does it focus on?<\/a><\/p>\n\n\n\n

Cognitive screening tool used to screen for dementia<\/a><\/p>\n\n\n\n

S\/S of depression<\/a><\/p>\n\n\n\n

depressed mood, insomnia, excessive sleeping, indecisiveness, decreased ability to concentrate, suicidal ideation, increase or decrease in motor activity, increase or decrease in wt. and agnosia.<\/a><\/p>\n\n\n\n

Who influence peplau?<\/a><\/p>\n\n\n\n

Influenced by Sullivan’s interpersonal relationship theory.<\/a><\/p>\n\n\n\n

What was peplau’s theory?<\/a><\/p>\n\n\n\n

Interpersonal theory of nursing. Nurses therapeutic use of self during the nurse-patient interaction had a direct impact on the outcome of the patient’s well-being.<\/a><\/p>\n\n\n\n

What is impulsive behavior?<\/a><\/p>\n\n\n\n

Common in borderline personality disorder. tendency to act w\/o thinking about the consequences of your actions<\/a><\/p>\n\n\n\n

Characteristic of conversion disorder<\/a><\/p>\n\n\n\n

Marked by symptoms or deficits that affect voluntary motor or sensory functions.<\/a><\/p>\n\n\n\n

Symptoms of conversion disorder.<\/a><\/p>\n\n\n\n

Involuntary movements, seizures, paralysis, abnormal gait, anesthesia, blindness, and deafness. Symptoms cannot be lnked back to a certain cause.<\/a><\/p>\n\n\n\n

Foods high in tyramine<\/a><\/p>\n\n\n\n

aged cheese, cured meats, smoked or processed meats, pickled or fermented foods, sauces, soybeans, peas, dried or overripe fruits, alcoholic beverages.<\/a><\/p>\n\n\n\n

Difference between compassion and empathy?<\/a><\/p>\n\n\n\n

Compasson-sympathetic feeling towards other w\/o attempt to know their feeling or understand suffering. Empathy-imagine another’s problem coupled with strong feeling for that person.<\/a><\/p>\n\n\n\n

Preferred questionnaire for possible alcohol abuse?<\/a><\/p>\n\n\n\n

MAST (Michigan alcoholism screening testing) MAST-G for geriatrics<\/a><\/p>\n\n\n\n

What is dopamine?<\/a><\/p>\n\n\n\n

NT-involved in cognition, motivation, and movement. Controls emotional responses and the brain’s reward and pleasure center. Stimulate the heart and increases blood flow to vital organs.<\/a><\/p>\n\n\n\n

With what diseases does dopamine increase? decrease?<\/a><\/p>\n\n\n\n

increase-schizophrenia decrease-Parkinson’s disease and depression<\/a><\/p>\n\n\n\n

What is serotonin?<\/a><\/p>\n\n\n\n

NT found in the brain and SC. Regulate mood, arousal, attention, behavior, and body temp.<\/a><\/p>\n\n\n\n

With what diseases does serotonin increase? Decrease?<\/a><\/p>\n\n\n\n

Increase-anxiety. Decrease-depression<\/a><\/p>\n\n\n\n

What is norepinephrine?<\/a><\/p>\n\n\n\n

NT that Plays a role in regulating mood.<\/a><\/p>\n\n\n\n

With what diseases does norepinephrine increase? Decrease?<\/a><\/p>\n\n\n\n

Increase-mania, anxiety, and schizo. Decrease-depression<\/a><\/p>\n\n\n\n

What is GABA?<\/a><\/p>\n\n\n\n

NT that reduces anxiety, excitation, and aggression. May play a role in pain perception, anticonvulsant and muscle relaxing properties, may impair cognition, and psychomotor functioning.<\/a><\/p>\n\n\n\n

With what diseases does GABA increase? Decrease?<\/a><\/p>\n\n\n\n

Increase-reduction in anxiety. Decrease-increase in anxiety, mania, and schizophrenia<\/a><\/p>\n\n\n\n

What is glutamate?<\/a><\/p>\n\n\n\n

Plays a role in learning and memory.<\/a><\/p>\n\n\n\n

What is primary prevention?<\/a><\/p>\n\n\n\n

Aims to prevent disease or injury before it ever occurs.<\/a><\/p>\n\n\n\n

What is secondary prevention?<\/a><\/p>\n\n\n\n

Aims to reduce the impact of a disease that has already occurred.<\/a><\/p>\n\n\n\n

What is tertiary prevention?<\/a><\/p>\n\n\n\n

Soften the impact of an ongoing illness or injury that has lasting effects.<\/a><\/p>\n\n\n\n

EX. of primary prevention<\/a><\/p>\n\n\n\n

legislation and enforcement to ban or control the use of hazardous products, ed. about healthy and safe habits, immunizations<\/a><\/p>\n\n\n\n

Ex. of secondary prevention<\/a><\/p>\n\n\n\n

regular exams, screening, exercise programs to prevent further heart attacks.<\/a><\/p>\n\n\n\n

Ex. of tertiary prevention<\/a><\/p>\n\n\n\n

Cardiac\/stroke rehab programs, support groups, vocational rehab programs<\/a><\/p>\n\n\n\n

What is dystonia?<\/a><\/p>\n\n\n\n

Abnormal muscle tone resulting in muscular spasm and abnormal posture, d\/t neurological disease or side effect of meds<\/a><\/p>\n\n\n\n

What is alprazolam (Xanax) used for? SE?<\/a><\/p>\n\n\n\n

Antianxiety\/sedative. SE: drowsiness, respiratory depression, dizziness, lethargy, physical dependence<\/a><\/p>\n\n\n\n

Contraindications for alprazolam (Xanax)<\/a><\/p>\n\n\n\n

Angle closure glaucoma, hx of drug dependence, pre-existing CNS depression, severe hypotension, and sleep apnea.<\/a><\/p>\n\n\n\n

What is amphetamine (Adderall) used for? SE?<\/a><\/p>\n\n\n\n

CNS stimulant used for ADHD. SE: insomnia, restlessness, wt. loss, dysrhythmias, and hypertension<\/a><\/p>\n\n\n\n

Names of common benzos<\/a><\/p>\n\n\n\n

Clonazepam, diazepam, alprazolam, lorazepam, chlordiazepoxide, flumazenil, clorazepate, and oxazepam<\/a><\/p>\n\n\n\n

Indications for benzos<\/a><\/p>\n\n\n\n

Anxiety, seizure disorders, insomnia, muscle spasm, alcohol withdrawal, anesthesia.<\/a><\/p>\n\n\n\n

SE of benzos<\/a><\/p>\n\n\n\n

CNS depressant-sedation, light headed, drowsiness, respiratory depression, dizziness, lethargy, and physical dependence<\/a><\/p>\n\n\n\n

What is buspirone (buspar) used for?<\/a><\/p>\n\n\n\n

Anxiety, OCD, panic disorders, and PTSD<\/a><\/p>\n\n\n\n

SE of buspirone (buspar)<\/a><\/p>\n\n\n\n

Dizziness, nausea, headaches, lightheadedness, and agitation<\/a><\/p>\n\n\n\n

What is chlorpromazine (Thorazine)?<\/a><\/p>\n\n\n\n

First gen antipsychotic used for positive symptoms of schizophrenia.<\/a><\/p>\n\n\n\n

SE of chlorpromazine (Thorazine)<\/a><\/p>\n\n\n\n

EPS symptoms, orthostatic hypotension, NMS<\/a><\/p>\n\n\n\n

What is codeine?<\/a><\/p>\n\n\n\n

Opioid used for mild pain and is sometime in cough meds<\/a><\/p>\n\n\n\n

What is disulfiram (Antabuse) used for?<\/a><\/p>\n\n\n\n

Treatment of alcohol abuse as an aversion therapy.<\/a><\/p>\n\n\n\n

What is lithium used for? SE of toxicity?<\/a><\/p>\n\n\n\n

Bipolar disorder; tremors, ataxia, confusion, convulsion, nausea, and vomitting<\/a><\/p>\n\n\n\n

Examples of MAOIs (3)<\/a><\/p>\n\n\n\n

Phenelzine (nardil), tranylcypromine (parnate), and isocarboxazid (Marplan)<\/a><\/p>\n\n\n\n

What should you watch for when administering narcan?<\/a><\/p>\n\n\n\n

Increased BP, tremors, hyperventilation, nausea, vomiting<\/a><\/p>\n\n\n\n

What is nortriptyline (pamelor)?<\/a><\/p>\n\n\n\n

Tricyclic antidepressant.<\/a><\/p>\n\n\n\n

SE of nortriptyline?<\/a><\/p>\n\n\n\n

Sedation, orthostatic hypotension, decreased libido, dry mouth, urinary retention, and cardiac dysrhytmias<\/a><\/p>\n\n\n\n

Example of opioids?<\/a><\/p>\n\n\n\n

Codeine, hydrocodone, and oxycodone<\/a><\/p>\n\n\n\n

SE of opiods<\/a><\/p>\n\n\n\n

Respiratory depression, urinary retention, confusion, constipation, nausea, vomiting, orthostatic hypotension, drug dependence<\/a><\/p>\n\n\n\n

S\/S of opioid overdose<\/a><\/p>\n\n\n\n

Resp depression, pin point pupils, coma<\/a><\/p>\n\n\n\n

What is rivastigmine (Exelon) used for?<\/a><\/p>\n\n\n\n

Combat symptoms of alzheimers disease. Slows progression of disease-not a cure<\/a><\/p>\n\n\n\n

Adverse reactions of rivastigmine (Exelon)?<\/a><\/p>\n\n\n\n

Nausea, diarrhea, and bradycardia`<\/a><\/p>\n\n\n\n

What is selegiline used for? Contraindications?<\/a><\/p>\n\n\n\n

Parkinsons disease. Not to be used with SSRIS or trycicylics-serotonin syndrome.<\/a><\/p>\n\n\n\n

SE of selegiline?<\/a><\/p>\n\n\n\n

Serotonin syndrome, confusion, dizziness, hallucinations, insomnia, sedation, nausea, dry mouth, and abd pain<\/a><\/p>\n\n\n\n

Examples of SSRIs (3)<\/a><\/p>\n\n\n\n

Fluoxetine, sertraline, and paroxitine<\/a><\/p>\n\n\n\n

SE of ssris<\/a><\/p>\n\n\n\n

fewer anticholinergic effects than tricylic agents and nausea and vomitting<\/a><\/p>\n\n\n\n

Examples of Tricyclic antidepressants (4)<\/a><\/p>\n\n\n\n

amitriptyline (Elavil), doxepin (Sinequan), notriptyline (pamelor), imipramine (tofranil<\/a><\/p>\n\n\n\n

What are tricyclic antidepressants used for?<\/a><\/p>\n\n\n\n

Depression, bipolar disorder, fibromyalgia, neuropathic pain, OCD, ADHD, and chronic insomnia.<\/a><\/p>\n\n\n\n

SE of tricyclic antidepressants?<\/a><\/p>\n\n\n\n

Sedation, orthostatic hypotension, decrease libido, dry mouth, urinary retention, and cardiac dystrhytmias.<\/a><\/p>\n\n\n\n

What is valproic acid (Depakote) used for?<\/a><\/p>\n\n\n\n

Seizure disorder also used for manic episodes with bipolar patients<\/a><\/p>\n\n\n\n

What effect does valproic acid have on neurotransmitters?<\/a><\/p>\n\n\n\n

Increases levels of GABA<\/a><\/p>\n\n\n\n

SE of valproic acid?<\/a><\/p>\n\n\n\n

Suicidal thoughts, agitation, dizziness, hepatotoxicity, pancreatitis, hypothermia, and tremors.<\/a><\/p>\n\n\n\n

Adolescence suicidal behavior<\/a><\/p>\n\n\n\n

Males are more likely to use a lethal method<\/a><\/p>\n\n\n\n

Anxiety levels<\/a><\/p>\n\n\n\n

Mild, moderate, severe and panic<\/a><\/p>\n\n\n\n

Mild<\/a><\/p>\n\n\n\n

is positive, healthy.<\/a><\/p>\n\n\n\n

Severe<\/a><\/p>\n\n\n\n

hypervigilant, cannot focus, sleep.<\/a><\/p>\n\n\n\n

Panic<\/a><\/p>\n\n\n\n

physical symptoms, can’t breathe, chest pain, decline in function. Autonomic nervous system<\/a><\/p>\n\n\n\n

Conversion Disorder<\/a><\/p>\n\n\n\n

trauma and stressors throughout your life. You keep not listening to your symptoms and your panic, anxiety and fear makes your body shut down. You stop walking, having seizures but there is no medical reason.<\/a><\/p>\n\n\n\n

GAD<\/a><\/p>\n\n\n\n

being worried, fearful and can’t control it for 6mo, more days of anxiety than not. Insomnia, irritability<\/a><\/p>\n\n\n\n

Acute Stress Disorder<\/a><\/p>\n\n\n\n

per the DSM-5, lasts 0-30 days. Example: divorce, lost employment<\/a><\/p>\n\n\n\n

PTSD<\/a><\/p>\n\n\n\n

night terrors, constantly thinking about the event, won’t go to the area where the event happened. Starting at day 31<\/a><\/p>\n\n\n\n

ASD vs PTSD<\/a><\/p>\n\n\n\n

less than 30 days is ASD. Trauma hasn’t been resolved is PTSD at 31+ days<\/a><\/p>\n\n\n\n

Anorexia<\/a><\/p>\n\n\n\n

ask during the interview what kind of upbringing they had. Usually very strict and overbearing parents.

The person is a “perfectionist”. Person would like very put together: hair done; make-up done. They need to be in charge<\/a><\/p>\n\n\n\n

Bulimia<\/a><\/p>\n\n\n\n

they start to get better when they start to talk about their feelings.<\/a><\/p>\n\n\n\n

OCD<\/a><\/p>\n\n\n\n

DSM-5: impairs daily living.<\/a><\/p>\n\n\n\n

Group therapy<\/a><\/p>\n\n\n\n

provide feedback, patients learn from each other<\/a><\/p>\n\n\n\n

Family therapy<\/a><\/p>\n\n\n\n

support system, education.<\/a><\/p>\n\n\n\n

Therapy for Narcissistic\/escalation<\/a><\/p>\n\n\n\n

Milleu therapy – Call for backup, keep everyone safe<\/a><\/p>\n\n\n\n

Behaviors and emotions therapy<\/a><\/p>\n\n\n\n

Behavior is treated w\/ behavioral therapy.
Emotions is treated w\/ cognitive therapy.
Emotions & behavior: treated w\/ both<\/a><\/p>\n\n\n\n

Personality Disorders<\/a><\/p>\n\n\n\n

use behavioral therapy. Setting up the rules, boundaries and stick to it.<\/a><\/p>\n\n\n\n

Opposite Defiant Disorder<\/a><\/p>\n\n\n\n

set up positive consequences<\/a><\/p>\n\n\n\n

Systematic Desensitization therapy (aversion therapy)<\/a><\/p>\n\n\n\n

expose the person to their fear little by little<\/a><\/p>\n\n\n\n

Borderline Personality Disorder<\/a><\/p>\n\n\n\n

symptoms: fear of being along, abandonment.
Splitting

– take the person from the group and staff talks to them on how to enforce their boundaries

Self-harm – keep pt safe, one to one<\/a><\/p>\n\n\n\n

Anti-social & Conduct Disorder<\/a><\/p>\n\n\n\n

they are move violent. Call for back up, keep safety. Milleu therapy<\/a><\/p>\n\n\n\n

Mandating Reporting<\/a><\/p>\n\n\n\n

tell them you are a mandated reporter. You need to notify the agency, even if the patient begs you not to.<\/a><\/p>\n\n\n\n

Medication used for personality\/eating disorders (1st line)<\/a><\/p>\n\n\n\n

There is no meds! Therapy is what is used<\/a><\/p>\n\n\n\n

Responsibility in victim of domestic violence<\/a><\/p>\n\n\n\n

Educate on the cycle of violence.
Document and report.<\/a><\/p>\n\n\n\n

Cycle of violence<\/a><\/p>\n\n\n\n

1. Rising tension 2. Acute (battering) 3. Honeymoon<\/a><\/p>\n\n\n\n

Someone comes to the ER having a panic attack<\/a><\/p>\n\n\n\n

ask if Pt has an addiction Hx, do not give Benzos, let MD know<\/a><\/p>\n\n\n\n

Anxiety meds<\/a><\/p>\n\n\n\n

Acute: benzos. Chronic: SSRIs, TCAs ( Amitripyline – Elavil \/ Imipramine – Tofranil – ends in INE-IL: hard on the heart: blocks, heart attack, elderly, MAOIs: foods (Phenalzine – Nardil), Buspar (buspirone): only med for chronic anxiety, prophylactic<\/a><\/p>\n\n\n\n

anti-psychotic med interventions<\/a><\/p>\n\n\n\n

manage the side effects of the meds, TD and EPS, dystonia, akathisia<\/a><\/p>\n\n\n\n

Kids Death & Dying<\/a><\/p>\n\n\n\n

10-12yo: they understand that death is final<\/a><\/p>\n\n\n\n

Elderly Death & Dying<\/a><\/p>\n\n\n\n

bereavement overload<\/a><\/p>\n\n\n\n

Oppositional defiant disorder<\/a><\/p>\n\n\n\n

buttheads, stubborn<\/a><\/p>\n\n\n\n

Semantic symptom disorder<\/a><\/p>\n\n\n\n

patient is so focused on their physical symptoms that it starts to affect their mental health<\/a><\/p>\n\n\n\n

Mahler<\/a><\/p>\n\n\n\n

We use our emotions as the reward\/punishment for actions of others.

– Over the years can lead to personalities disorders (mostly borderline)
– Like\/love the person when they do something good, but the love is taken away whey the client does something that does not make them proud.<\/a><\/p>\n\n\n\n

Factitious disorder<\/a><\/p>\n\n\n\n

makes other sick in order to get attention

fake something for secondary gain<\/a><\/p>\n\n\n\n

Depersonalization<\/a><\/p>\n\n\n\n

feeling disconnected\/detached from one’s own body and thoughts<\/a><\/p>\n\n\n\n

Derealization<\/a><\/p>\n\n\n\n

feeling disconnected\/detached from one’s surrounding<\/a><\/p>\n\n\n\n

Dissociative Amnesia<\/a><\/p>\n\n\n\n

lack of memory surrounding traumatic event<\/a><\/p>\n\n\n\n

Dissociative Identity Disorder (DID)<\/a><\/p>\n\n\n\n

multiple personalities?

involve problems with memory, identity, emotion, perception, behavior and sense of self.<\/a><\/p>\n\n\n\n

ADHD interventions<\/a><\/p>\n\n\n\n

small-short tasks that the child repeats. Tell the child something and they repeat back

boundaries, schedule, follow a board
Med in the AM after breakfast<\/a><\/p>\n\n\n\n

Abuse of children (characteristics)<\/a><\/p>\n\n\n\n

bruises in different stages of healing,
cannot attest for injuries
objective data – such as half healed broken bone mandates reporting<\/a><\/p>\n\n\n\n

agoraphobia<\/a><\/p>\n\n\n\n

fear or avoidance of situations, such as crowds or wide open places, where one has felt loss of control and panic<\/a><\/p>\n\n\n\n

Somatoform disorder<\/a><\/p>\n\n\n\n

make themselves sick to have gain of something. Want a disability check, want you to feel sorry for them.<\/a><\/p>\n\n\n\n

Dissociative Fugue<\/a><\/p>\n\n\n\n

someone has a traumatic event and forgets their life. They relocate and move over, person will move across the country, have multiple families\/identities. They make up stories, fill up the blanks<\/a><\/p>\n\n\n\n

Anticipatory Grief<\/a><\/p>\n\n\n\n

mourning for something you know that is coming<\/a><\/p>\n\n\n\n

Inhibited (delayed)<\/a><\/p>\n\n\n\n

person is fine while they are busy, takes a while to sink in<\/a><\/p>\n\n\n\n

Distorted (exaggerated)<\/a><\/p>\n\n\n\n

blows out of proportion<\/a><\/p>\n\n\n\n

Prolonged (chronic)<\/a><\/p>\n\n\n\n

someone who never gets over the loss (elderly married for X years, loss of a child)<\/a><\/p>\n\n\n\n

Your patient has superficial wounds on her arm and has admitted to self-harming. After cleansing her wounds what should you do next?<\/a><\/p>\n\n\n\n

Ask her to write what she was thinking and feeling right before she self-harmed so that she can discuss it with you when completed.<\/a><\/p>\n\n\n\n

What would not<\/strong> be included in the plan of care for an in-patient anorexic patient<\/a><\/p>\n\n\n\n

\u00b7 Eating alone in their room for comfort
\u00b7 Weighing the patient per their request
\u00b7 Providing patient extra fluids per their request<\/a><\/p>\n\n\n\n

How should the RN handle manipulative behavior from their patient<\/a><\/p>\n\n\n\n

\u00b7 Tell the patient their behavior is unacceptable
\u00b7 Tell the patient of consequences of continued manipulative behavior<\/a><\/p>\n\n\n\n

Which of the following would warrant sending an anorexic patient to the hospital<\/a><\/p>\n\n\n\n

\u00b7 BP 86\/60
\u00b7 Persistent bradycardia
\u00b7 Hypothermia<\/a><\/p>\n\n\n\n

Traits of schizoid personality<\/a><\/p>\n\n\n\n

\u00b7 Inability to establish relationships
\u00b7 Can be seen as eccentric, isolated and lonely
\u00b7 Can invest enormous energy in non-human interests<\/a><\/p>\n\n\n\n

Why is it important to ask women if they are or have experienced domestic violence?<\/a><\/p>\n\n\n\n

To help identify patients who might not otherwise ask for help<\/a><\/p>\n\n\n\n

Which medication is used to treat opioid toxicity or overdose?<\/a><\/p>\n\n\n\n

Narcan (Naloxone) (Short acting; administer Q2 & might need to be administered for a few days, monitor airways, monitor vitals every 15mins)<\/a><\/p>\n\n\n\n

Potential characteristics of victims of elder abuse<\/a><\/p>\n\n\n\n

\u00b7 Most often diagnosed in older adults who have depression, alcohol or drug abuse, dementia or a psychiatric disorder
\u00b7 May dismiss injuries as accidents
\u00b7 Age related syndromes may often result is frailty and functional decline, making older adults less able to protect themselves.<\/a><\/p>\n\n\n\n

Safety considerations in a potentially violent milieu or violent patients<\/a><\/p>\n\n\n\n

\u00b7 Know how to call for help or where panic button is located
\u00b7 Ensure enough space between you and the patient (one arm’s length)<\/a><\/p>\n\n\n\n

Possible signs of caregiver role strains<\/a><\/p>\n\n\n\n

\u00b7 Significant weight loss in a short period of time (>20lbs in < 2 months)
\u00b7 Loss of interest in their hobbies
\u00b7 Sleep problems<\/a><\/p>\n\n\n\n

What question can you ask to assess recent memory<\/a><\/p>\n\n\n\n

What did you eat for lunch today?<\/a><\/p>\n\n\n\n

Histrionic Personality disorder interventions<\/a><\/p>\n\n\n\n

Therapies can include psychodynamic psychotherapy, cognitive-behavioral therapy, group therapy, and interpersonal therapy.

Teach social skills; provide factual feedback about behavior<\/a><\/p>\n\n\n\n

Borderline personality disorder interventions<\/a><\/p>\n\n\n\n

Promote safety; help client to cope and control emotions; cognitive structuring techniques; structure time; teach social skills<\/a><\/p>\n\n\n\n

Somatoform disorder interventions<\/a><\/p>\n\n\n\n

-Providing health teaching.
-establish a daily routine that includes improved health behaviors.
-Assisting the client to express emotions.
-Teaching coping strategies.<\/a><\/p>\n\n\n\n

Cognitive distortions related to eating disorders<\/a><\/p>\n\n\n\n

Cognitive distortions are inaccurate or exaggerated thoughts or thought patterns.
Cognitive distortions about food, weight, and body image are a core symptom of both anorexia nervosa and bulimia nervosa and are experienced by many other people as well.<\/a><\/p>\n\n\n\n

Shoulds<\/a><\/p>\n\n\n\n

demands that you place on yourself such as thinking “I should have done better” or “I must be perfect.”

Regarding eating disorders, “shoulds” might include thoughts about needing to exercise, what foods should\/shouldn’t be eaten, or what you should weigh.<\/a><\/p>\n\n\n\n

All or Nothing Thinking<\/a><\/p>\n\n\n\n

black and white thinking
perfectionistic tendencies something is either completely okay or wrong<\/a><\/p>\n\n\n\n

Overgeneralizing<\/a><\/p>\n\n\n\n

It occurs when you believe that a negative experience or situation describes your life completely.

EX: believing that a relapse means that you will never recover fully, rather than seeing it as a temporary setback.<\/a><\/p>\n\n\n\n

Catastrophizing<\/a><\/p>\n\n\n\n

Any time you believe that a situation is so bad that you simply cannot survive it<\/a><\/p>\n\n\n\n

Labeling<\/a><\/p>\n\n\n\n

Is a distortion that attempts to place people and things in specific categories.

Ex: “I’m such a loser,” “I have no self-control”<\/a><\/p>\n\n\n\n

Rejecting the Positive<\/a><\/p>\n\n\n\n

cognitive distortion focused only on the negative aspects of something and reject anything positive<\/a><\/p>\n\n\n\n

Unfavorable Comparisons<\/a><\/p>\n\n\n\n

Many people with eating disorders compare the way they look, what they weigh, and how much they eat to the people around them.<\/a><\/p>\n\n\n\n

Blaming and Personalizing<\/a><\/p>\n\n\n\n

personalizes – everything is their fault
blames – everything is someone else’s fault.<\/a><\/p>\n\n\n\n

Signs and Symptoms of Anorexia Nervosa<\/a><\/p>\n\n\n\n

\u00b7 Terror of gaining weight
\u00b7 Preoccupation with thoughts of food
\u00b7 View of self as fat even when emaciated
\u00b7 Peculiar handling of food: cutting into tiny bits, pushing pieces around plate
\u00b7 Possible development of rigorous exercise regimen
\u00b7 Possible self-induced vomiting, use of laxatives, use of diuretics
\u00b7 Self-worth judged by their weight
\u00b7 Controls eating to feel powerful or to overcome feeling helpless

under weight
strict upbringing<\/p>\n\n\n\n

signs and symptoms of bulimia<\/a><\/p>\n\n\n\n

\u00b7 Binge eating behavior
\u00b7 Self-induced vomiting, laxative, or diuretic use after bingeing
\u00b7 History of anorexia nervosa
\u00b7 Depression
\u00b7 Problems with interpersonal relationships, self-concept
\u00b7 Increased anxiety and compulsivity
\u00b7 Controls\/undoes weight after bingeing

normal weight or slightly over weight<\/p>\n\n\n\n

signs and symptoms of binge eating<\/a><\/p>\n\n\n\n

\u00b7 Frequent episodes of eating more than what may be considered a normal amount of food
\u00b7 Rapid eating
\u00b7 Eating until uncomfortably full
\u00b7 Eating large amounts of food without being physically hungry
\u00b7 Eating with excessive discretion due to feelings of embarrassment at the quantity of food being consumed
\u00b7 Feelings of guilt after overeating
\u00b7 Weight fluctuation, usually gain
\u00b7 Feelings of low self-esteem
\u00b7 Loss of sexual desire
\u00b7 Frequent dieting
\u00b7 Variant of compulsive overeating
\u00b7 Similar to bulimia but no compensatory mechanisms used
\u00b7 Usually associated with bipolar, depressive disorder, anxiety, substance use<\/p>\n\n\n\n

Dissociative Disorder examples<\/a><\/p>\n\n\n\n

conditions that involve disruptions or breakdowns of memory, awareness, identity, or perception.

A sort of defense mechanism<\/a><\/p>\n\n\n\n

Narcissistic personality disorder<\/a><\/p>\n\n\n\n

an inflated sense of their own importance, a deep need for excessive attention and admiration, troubled relationships, and a lack of empathy for others<\/a><\/p>\n\n\n\n

Avoidant personality disorder<\/a><\/p>\n\n\n\n

-social discomfort and avoidance of interpersonal contact
-may be extremely shy, fear ridicule, and be overly concerned with looking foolish<\/a><\/p>\n\n\n\n

Antisocial personality disorder<\/a><\/p>\n\n\n\n

disregard for other people

tend to lie, break laws, act impulsively, and lack regard for their own safety or the safety of others.<\/a><\/p>\n\n\n\n

Histrionic personality disorder<\/a><\/p>\n\n\n\n

characterized by a pattern of excessive attention-seeking behaviors, usually beginning in early childhood, including inappropriate seduction and an excessive desire for approval.<\/a><\/p>\n\n\n\n

Dependent personality disorder<\/a><\/p>\n\n\n\n

is described as the need to be cared for by others.

results in submissive and clingy behavior, a fear of separation, and difficulty making decisions without reassurance from others<\/a><\/p>\n\n\n\n

Paranoid personality disorder<\/a><\/p>\n\n\n\n

Cluster A

Characterized by a pervasive pattern of unwarranted distrust and suspicion of others that involves interpreting their motives as hostile or harmful.<\/a><\/p>\n\n\n\n

types of dissociative disorders<\/a><\/p>\n\n\n\n

o Dissociative identity disorder
o Dissociative amnesia
o Depersonalization\/derealization disorder<\/a><\/p>\n\n\n\n

Assessment of someone with Bulimia- what would you find?<\/a><\/p>\n\n\n\n

\u00b7 Routine labs: CBC with differential, serum chemistry and thyroid profiles, and urine chemistry microscopy testing.
\u00b7 Episodic binge eating
\u00b7 Use of diuretics, laxatives, vomiting, and exercise.
\u00b7 Abdominal and epigastric, Amenorrhea
\u00b7 Painless swelling of the salivary glands, hoarseness, throat irritation or lacerations, and dental erosion.
\u00b7 calluses of the knuckles or abrasions and scars on the dorsum of the hand, resulting from tooth injury during self-induced vomiting
\u00b7 The patient’s psychosocial history may reveal an exaggerated sense of guilt, symptoms of depression, childhood trauma (especially sexual abuse), parental obesity, or a history of unsatisfactory sexual relationships.<\/p>\n\n\n\n

Cluster A<\/a><\/p>\n\n\n\n

\u00b7 Odd or eccentric behavior, suspicious, cold, withdrawn, irrational
\u00b7 They include paranoid personality disorder, schizoid personality disorder and schizotypal personality disorder.<\/a><\/p>\n\n\n\n

Cluster B<\/a><\/p>\n\n\n\n

\u00b7 Dramatic, emotional behavior, attention-seeking, labile, shallow, increased rates of substance use and suicide.
\u00b7 They include antisocial personality disorder, borderline personality disorder, histrionic personality disorder and narcissistic personality disorder.<\/a><\/p>\n\n\n\n

Cluster C<\/a><\/p>\n\n\n\n

\u00b7 Anxious, fearful behavior, tense, overcontrolled, depressed
\u00b7 They include avoidant personality disorder, dependent personality disorder and obsessive-compulsive personality disorder.<\/a><\/p>\n\n\n\n

Signs of opiate overdose<\/a><\/p>\n\n\n\n

Respiratory failure, slow breathing, small pupils, unresponsiveness, or blue skin from poor circulation<\/a><\/p>\n\n\n\n

Alcohol withdrawal symptoms and treatment<\/a><\/p>\n\n\n\n

\u00b7 Mild symptoms usually show up as early as 6 hours after you put down your glass. They can include: Anxiety, shaky hands, headache, nausea, vomiting, insomnia, sweating.
\u00b7 More serious problems range from hallucinations about 12 to 24 hours after that last drink to seizures within the first 2 days after you stop. You can see, feel, or hear things that aren’t there.<\/p>\n\n\n\n

Types of Child Abuse and Physical and Behavioral Indicators<\/a><\/p>\n\n\n\n

\u00b7 Physical abuse
\u00b7 Physical neglect
Sexual abuse<\/a><\/p>\n\n\n\n

Behavioral Indicators of child abuse<\/a><\/p>\n\n\n\n

\u00b7 Fear of going home.
\u00b7 Extreme apprehensiveness or vigilance.
\u00b7 Pronounced aggression or passivity.
\u00b7 Flinching easily or avoiding touch.
\u00b7 Abusive behavior or talk during play.
\u00b7 Unable to recall how injuries occurred.
Account of injuries is inconsistent with the nature of the injuries<\/a><\/p>\n\n\n\n

Nurse’s responsibility regarding suspected child abuse<\/a><\/p>\n\n\n\n

Mandatory reporting<\/a><\/p>\n\n\n\n

Disulfiram (Antabuse)<\/a><\/p>\n\n\n\n

used to treat chronic alcoholism.

Causes unpleasant effects:
flushing of the face, headache, nausea, vomiting, chest pain, weakness, blurred vision, mental confusion, sweating, choking, breathing difficulty, and anxiety.

These effects begin about 10 minutes after alcohol enters the body and last for 1 hour or more.<\/p>\n\n\n\n

Patient teaching for disulfiram<\/a><\/p>\n\n\n\n

\u00b7 Keep all appointments with your doctor
\u00b7 Carry an ID card stating that you are taking it
\u00b7 Do not come in contact with or breathe the fumes of paint, paint thinner, varnish, shellac, and other products containing alcohol.

Exercise caution when applying alcohol-containing products (e.g., aftershave lotions, colognes, and rubbing alcohol) to your skin. These products, in combination with disulfiram, may cause side effects<\/p>\n\n\n\n

Naltrexone (ReVia)<\/a><\/p>\n\n\n\n

is a special narcotic drug that blocks the effects of other narcotic medicines and alcohol used to treat narcotic drug or alcohol addiction and is taken orally in tablet form.<\/a><\/p>\n\n\n\n

Naltrexone (ReVia) – patient teaching<\/a><\/p>\n\n\n\n

\u00b7 Advise patients that if they previously used opioids, they may be more sensitive to lower doses of opioids and at risk of accidental overdose
\u00b7 Advise patients will not perceive any effect if they attempt to self-administer heroin
\u00b7 Emphasize that administration of large doses of heroin or any other opioid to try to bypass the blockade and get high while on REVIA may lead to serious injury, coma, or death.
\u00b7 Patients should be off all opioids, including opioid-containing medicines, for a minimum of 7 to 10 days before starting REVIA in order to avoid precipitation of opioid withdrawal.
\u00b7 Advise patients that they should not take REVIA if they have any symptoms of opioid withdrawal.
\u00b7 Advise patients that they may experience depression while taking REVIA Advise patients that dizziness may occur with REVIA treatment, and they should avoid driving or operating heavy machinery until they have determined how REVIA affects them.<\/p>\n\n\n\n

Elder abuse<\/a><\/p>\n\n\n\n

Elder abuse is “a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person.”<\/a><\/p>\n\n\n\n

Types of elder abuse<\/a><\/p>\n\n\n\n

Physical abuse, emotional abuse, neglect, abandonment, sexual abuse, financial abuse<\/a><\/p>\n\n\n\n

interventions for agnosia<\/a><\/p>\n\n\n\n

Agnosia is a rare disorder whereby a patient is unable to recognize and identify objects, persons, or sounds using one or more of their senses despite otherwise normally functioning senses.

Nursing Intervention: Correct misconceptions<\/a><\/p>\n\n\n\n

Confabulation<\/a><\/p>\n\n\n\n

Confabulation is the creation of false memories in the absence of intentions of deception<\/a><\/p>\n\n\n\n

Ageism<\/a><\/p>\n\n\n\n

Ageism is stereotyping and\/or discrimination against individuals or groups on the basis of their age.<\/a><\/p>\n\n\n\n

Trust vs. Mistrust<\/a><\/p>\n\n\n\n

birth to 18m<\/a><\/p>\n\n\n\n

Identity vs Role Confusion<\/a><\/p>\n\n\n\n

12 – 20y<\/a><\/p>\n\n\n\n

Autonomy vs Shame\/Doubt<\/a><\/p>\n\n\n\n

18m – 3y<\/a><\/p>\n\n\n\n

Intimacy vs Isolation<\/a><\/p>\n\n\n\n

20 – 30y<\/a><\/p>\n\n\n\n

Initiative vs Guilt<\/a><\/p>\n\n\n\n

3 – 6y<\/a><\/p>\n\n\n\n

Generatively vs Stagnation<\/a><\/p>\n\n\n\n

30 -65y<\/a><\/p>\n\n\n\n

Industry vs Inferiority<\/a><\/p>\n\n\n\n

6 – 12y<\/a><\/p>\n\n\n\n

Ego Integrity vs Despair<\/a><\/p>\n\n\n\n

65y +<\/a><\/p>\n\n\n\n

Autism Spectrum Disorder<\/a><\/p>\n\n\n\n

This is a complex neurobiological, developmental disorder. It generally appears during the first 3 years of life and affects the normal development of social interaction and social skills. Children with ASD should be referred to early intervention programs so communication and behavioral symptoms are identified. Often treatment includes a behavior management with positive reinforcement. The family\u2019s strengths and needs must be identified and supported.<\/p>\n\n\n\n

It is Classified According to Three Levels Depending on the Degree of Assistance and support Needed<\/strong><\/p>\n\n\n\n

Level 1: requires support<\/p>\n\n\n\n

Level 2: requires substantial support<\/p>\n\n\n\n

Level 3: requires very substantial support<\/p>\n\n\n\n

Symptoms<\/strong><\/p>\n\n\n\n

Deficits in social relatedness<\/p>\n\n\n\n

Disturbances in developing and maintaining relationships<\/p>\n\n\n\n

Stereotypical, repetitive speech<\/p>\n\n\n\n

Obsessive thoughts on specific objects or adherence to routines\/rituals<\/p>\n\n\n\n

Hyperactivity or hypo activity to sensory input<\/p>\n\n\n\n

Extreme resistance to change<\/p>\n\n\n\n

Dissociative symptoms<\/a><\/p>\n\n\n\n

symptoms include the experience of detachment or feeling as if one is outside one’s body, and loss of memory or amnesia.

are frequently associated with previous experience of trauma.<\/a><\/p>\n\n\n\n

orientation<\/a><\/p>\n\n\n\n

what phase?
atmospere established, nurse role is defined, contract containing date, time, place of meeting, confidentiliaty is discussed. terms of termination discussed, atmosphere of trust<\/a><\/p>\n\n\n\n

maslows hierarchy of needs<\/a><\/p>\n\n\n\n

cannot be on a level higher than a level that you have not completed<\/a><\/p>\n\n\n\n

working<\/a><\/p>\n\n\n\n

what phase?
maintain relationship, gather more data, promote problem solving skills, facilitate behavior change, evaluate problems and goals<\/a><\/p>\n\n\n\n

termination<\/a><\/p>\n\n\n\n

what phase?
summarizes goals and objectives achieved, how to incorperate into daily life, echanging memories, by sharing this phase with patient is shows you care<\/a><\/p>\n\n\n\n

negligence<\/a><\/p>\n\n\n\n

ethical principle- act or omission of an act that breaches the duty of due care and results in injury<\/a><\/p>\n\n\n\n

autonomy<\/a><\/p>\n\n\n\n

ethical principle- respecting the rights of others to make own decisions, such as the right to refuse medications<\/a><\/p>\n\n\n\n

justice<\/a><\/p>\n\n\n\n

ethical principle- duty to distribute resources and care equally, spending time with each patient equally<\/a><\/p>\n\n\n\n

beneficence<\/a><\/p>\n\n\n\n

ethical principle- the duty to act as to benefit or promote the good of others such as spending extra time with a highly anxious patient<\/a><\/p>\n\n\n\n

fidelity<\/a><\/p>\n\n\n\n

ethical principle- maintaining loyalty and commitment to the patient and doing no wrong, maintaining expertise in nursing cares through education demonstrates fidelity<\/a><\/p>\n\n\n\n

veracity<\/a><\/p>\n\n\n\n

ethical principle- duty to communicate truthfully describing medications in a truthful and non misleading way for example<\/a><\/p>\n\n\n\n

committed<\/a><\/p>\n\n\n\n

rights for what kind of patient?

freedom from unreasonable restraints
right to informed consent
right to refuse medication<\/a><\/p>\n\n\n\n

SSRI<\/a><\/p>\n\n\n\n

what kind of antidepressant?

Fluoxetine (Prozac) Sertaline (Zoloft) Paroxetine (paxil)
serotonin syndrome citalopram (celexa) Escitalopram (lexapro) fluvoxamine (luvox)
side effects: increased serotonin nausea, vomiting<\/a><\/p>\n\n\n\n

MAOI<\/a><\/p>\n\n\n\n

what kind of antidepressant?
Phenelzine (nardil) Tranycryomine (parnate)
hypertensive crisis with tyramine foods
hypertensive crisis if ingested with tyramine (beer, wine, aged cheese, organ meat, avacados<\/a><\/p>\n\n\n\n

TCA<\/a><\/p>\n\n\n\n

what kind of antidepressant?
Amitriplytene (Elavil) Imipramine (Tofanil)
Cardiotoxic clomipramine (anafranil) desipramine (norpramin) doxepin (sinequan) maprotiline (ludiomil)
increased norephinephrine anticholinergic effects<\/a><\/p>\n\n\n\n

mental illness<\/a><\/p>\n\n\n\n

low self esteen and self concept
unable to relate to others
incapable to relate to others
unable to distinguish between reality, fantasy and imagination<\/a><\/p>\n\n\n\n

mental health<\/a><\/p>\n\n\n\n

being comfortable with yourself
feeling good about relationships with others
being able to meet the demands of life<\/a><\/p>\n\n\n\n

0.4-1<\/a><\/p>\n\n\n\n

therapeutic level of lithium
signs
slight hand tremor
mild thirst
weight gain
nausea<\/a><\/p>\n\n\n\n

early<\/a><\/p>\n\n\n\n

early, advanced or severe lithium toxicity?
above 1.5 mEq\/L
nausea
vomiting
diarrhea
thirst
poly urea
slurred speech muscle weakness
*hold meds, draw lithium level and adjust dose<\/a><\/p>\n\n\n\n

advanced<\/a><\/p>\n\n\n\n

early, advanced or severe lithium toxicity?
1.5-2 mEq\/L
course hand tremor
persistant GI upset
mental confusion
muscle hyper irritability
EEG changes
incoordination

hold meds, Blood level drawn, adjust dose, administer emetic ,gastric lavage, mannitol, aminophylline hasten lithium excretion<\/a><\/p>\n\n\n\n

severe<\/a><\/p>\n\n\n\n

early, advanced or severe lithium toxicity?
2-2.5+
ataxia
serious EEG changes
blurred vision
clonic movements
large urine output
tinnitus
blurred vision
seizures
stupor
Hypotension
coma
death usually by pulmonary complications

hold meds, Blood level drawn, adjust dose, administer emetic ,gastric lavage, mannitol, aminophylline hasten lithium excretion hemodyalisis<\/p>\n\n\n\n

mild<\/a><\/p>\n\n\n\n

mild, moderate, severe or panic anxiety?
heightened perceptual fields
alerd and see hear and grasp what is happening in the environment
able to identify issues that are disturbing and producing anxiety
able to work effectively towards a goal<\/a><\/p>\n\n\n\n

moderate<\/a><\/p>\n\n\n\n

mild, moderate, severe or panic anxiety?
has narrow perceptual field
grasps less of what is happening
can attend to more if pointed out by another
able to solve problems but not at optimal ability
benefits from guidance of others<\/a><\/p>\n\n\n\n

severe<\/a><\/p>\n\n\n\n

mild, moderate, severe or panic anxiety?

has greatly reduced visual field
focuses on details or one specific details
attention scattered
completely absorbed with self
may not be able to attend to events in the environment even when pointed by others
unable to see connections between events or details
has distorted perceptions<\/p>\n\n\n\n

panic<\/a><\/p>\n\n\n\n

mild, moderate, severe or panic anxiety?
unable to focus on the environment
experiences the utmost state of terror and emotional paralysis fells like they “cease to exist”
may have hallucinations or deslusions that take place of reality
may be mute or have psychomotor agitation leading to exhaustion
shows disorganized or irrational reasoning<\/p>\n\n\n\n

repression<\/a><\/p>\n\n\n\n

defense mechanism
man forgets wife birthday after a marital fight
maladaptive
women is unable to enjoy sex after having pushed out of awareness sex abuse as a child<\/a><\/p>\n\n\n\n

sublimation<\/a><\/p>\n\n\n\n

defense mechanism
women who is angry with her boss rights a story about a heroic woman (almost always is constructive)
no maladaptive behaviors<\/a><\/p>\n\n\n\n

regression<\/a><\/p>\n\n\n\n

defense mechanism
four year old boy with a new brother starts sucking his thumb and wanting a bottle
maladaptive
man who losses promotion starts complaining to others, does sloppy work misses appointments and is late for meetings<\/a><\/p>\n\n\n\n

displacement<\/a><\/p>\n\n\n\n

defense mechanism
patient criticizes a nurse after their family didn’t visit
maladaptive
child who cannot acknowledge fear of father becomes fearful of animals<\/a><\/p>\n\n\n\n

projection<\/a><\/p>\n\n\n\n

defense mechanism
man who is unconsciously attracted to other women teases his wife about flirting
maladaptive
woman who has repressed an attraction for other woman refuses to socialize for fear of being hit on<\/a><\/p>\n\n\n\n

compensation<\/a><\/p>\n\n\n\n

defense mechanism
short man becomes assertive and verally loud and accelerates in business
maladaptive
someone drinks alcohol when self esteem is low<\/a><\/p>\n\n\n\n

reaction formation<\/a><\/p>\n\n\n\n

defense mechanism
recovering alcoholic constantly preaches about the evils of alcohol
maladaptive
mother who is unconsciously hostile towards daughter is overprotective and interferes with the daughters normal growth and development.<\/a><\/p>\n\n\n\n

denial<\/a><\/p>\n\n\n\n

defense mechanism
man reacts to death “no! I don’t believe it, the doctor said she was fine.”
maladaptive
a woman whos husband died 3 years ago still keeps his clothes in the closet and speaks about him in present tense.<\/a><\/p>\n\n\n\n

conversion<\/a><\/p>\n\n\n\n

defense mechanism
student is unable to take a final due to a terrible headache
maladaptive
man becomes blind after seeing his wife flirt with other men<\/a><\/p>\n\n\n\n

undoing<\/a><\/p>\n\n\n\n

defense mechanism
after flirting with her male secretary a woman brings her husband tickets to a show.
maladaptive
man with ridged belief’s and repressed sexuality is driven to wash his hands when around attractive women<\/a><\/p>\n\n\n\n

rationalization<\/a><\/p>\n\n\n\n

defense mechanism
“I didn’t get this raise because the boss doesn’t like me.”
maladaptive
father things his son was fathered by another man and excuses his malicious acts by saying he is lazy and disobedient which is not the case.<\/a><\/p>\n\n\n\n

identification<\/a><\/p>\n\n\n\n

defense mechanism
five year old girl wears moms dress and shoes and meets dad at the door.
maladaptive
young boy thinks the town pimp with money is someone to emulate<\/a><\/p>\n\n\n\n

introjection<\/a><\/p>\n\n\n\n

defense mechanism
after his wifes death husband complains of chest pains and difficulty breathing, the same symptoms his wife had before she died.
maladaptive
young child whos parents were overcritical and belittling grow up thinking she is inferior.<\/a><\/p>\n\n\n\n

suppression<\/a><\/p>\n\n\n\n

defense mechanism
business man faces divorce in morning, and gives a good speech in the afternoon with total concentration
maladaptive
a woman who feels a lump in her breast shortly before vacation puts the info in the back of her mind until after returning from vacation<\/a><\/p>\n\n\n\n

positive<\/a><\/p>\n\n\n\n

positive or negative schizophrenia symptoms?

hallucinations
delusions
disorganized speech
bizarre behavior<\/a><\/p>\n\n\n\n

negative<\/a><\/p>\n\n\n\n

positive or negative schizophrenia symptoms?
blunted affect
poverty of thought
avolition (decreased motivation)
anhedonia (unable to experience joy)<\/a><\/p>\n\n\n\n

NMS<\/a><\/p>\n\n\n\n

extrapyramidal symptoms (EPS) or Neuroleptic malignant syndrome (NMS)?
severe muscle rigidity, oculogyric crisis (eyes rolled up in the head) flexor-extensor posturing, hyperpyrexia of above 103 degrees. autonomic dysfunction HTN, tachy, diaphoresis, incontinence
treatment
stop neuroleptic, transfer to medical unit, administer dantrolene, cool body to reduce fever maintain hydration, correct electrolyte imbalance<\/p>\n\n\n\n

EPS<\/a><\/p>\n\n\n\n

extrapyramidal symptoms (EPS) or Neuroleptic malignant syndrome (NMS)?
pseudoparkinsonsim stiff and stooped posture, shuffling gait, drooling tremor, acute dystonic reactions: contractions of tongue, face, neck and back (tongue and jaw first)
akathisia (restlessness)
Tardive Dyskinesia-rolling tongue blowing, smacking, licking, spastic facial distortion

treatment: trihexyphendyl (artane) benxzotropine (Cogentin)
benedryl, DC of neuroleptic
no known treatment for tardive dyskinesia, screening every three months.<\/p>\n\n\n\n

conversion disorder<\/a><\/p>\n\n\n\n

marked by symptoms or deficits that affect voluntary motor or sensory functions and that suggest a medical condition

However, the dysfunction does not correspond to current scientific understanding of known neurological and medical illnesses. The symptoms are neither voluntarily controlled nor culturally sanctioned. Many patients show a lack of emotional concern about the symptoms

symptoms are involuntary movements, seizures, paralysis, abnormal gait, anesthesia, blindness, and deafness.<\/p>\n\n\n\n

personality disorder<\/a><\/p>\n\n\n\n

describes what condition?

\u2022Inflexible and maladaptive responses to stress. Individuals have difficulty responding flexibly and adaptively to the environment and to the changing demands of life. They often are unable to cope with stress and react by using maladaptive behaviors, which exposes the disorder.
\u2022Disability in work and personal relationships, which is generally more serious and pervasive than the similar disability found in other disorders.

Individuals with PDs assume that everyone thinks and functions as they do; therefore, within relationships they do not view their behavior as a problem; they do not see a need to make changes or accommodate others. They believe that they are normal and that others have a problem

\u2022Avoidance and fear of rejection
\u2022Blurring of boundaries between the self and others so that closeness seems to lead to fusion, which may terrify both parties
\u2022Insensitivity to the needs of others
\u2022Demanding and fault finding
\u2022Inability to trust
\u2022Lack of individual accountability
\u2022Passive-aggressive traits
\u2022Tendency to evoke intense interpersonal conflict: People with PDs fail to see themselves objectively, and they lack the desire to alter aspects of their behavior to enrich or maintain important relationships. Relationships are often marked by intense emotional upheavals and hostility that lead to serious interpersonal conflict, and in some cases violence (self-violence or violence toward others).
\u2022Capacity to “get under the skin” of others: People with PDs often have an uncanny ability to merge personal boundaries with others, which has an intense and undesirable effect on others.<\/p>\n\n\n\n

alcohol<\/a><\/p>\n\n\n\n

early signs of withdrawal develop within a few hours after cessation they peak after 24 to 48 hours and then rapidly and dramatically disappear
the person may appear hyperalert, manifest jerky movements and irritability, startle easily, and experience subjective distress often described as “shaking inside.” Grand mal seizures may appear 7 to 48 hours after cessation

\u2022Autonomic hyperactivity (e.g., tachycardia, diaphoresis, elevated blood pressure)
\u2022Severe disturbance in sensorium (e.g., disorientation, clouding of consciousness)
\u2022Perceptual disturbances (e.g., visual or tactile hallucinations)
\u2022Fluctuating levels of consciousness (e.g., ranging from hyperexcitability to lethargy)
\u2022Delusions (paranoid), agitated behaviors, and fever (temperatures of 100\u00b0 to 103\u00b0 F)<\/p>\n\n\n\n

bulemia<\/a><\/p>\n\n\n\n

interventions for?

1. Assess mood and presence of suicidal thoughts\/behaviors.
2. Monitor physiological parameters (vital signs, electrolyte levels) as needed.
3. Explore dysfunctional thoughts that maintain the binge\/purge cycle
4. Educate the patient that fasting can lead to continuation of bingeing and the binge\/purge cycle, emphasizing its self-perpetuating nature.
5. Monitor patient during and after meals to prevent throwing away food and\/or purging.
6. Acknowledge the patient’s overvalued ideas of body shape and size without minimizing or challenging patient’s perceptions.
7. Encourage patient to keep a journal of thoughts and feelings<\/p>\n\n\n\n

anorexia<\/a><\/p>\n\n\n\n

engage in self-starvation, express intense fear of gaining weight, and have a disturbance in self-evaluation of weight and its importance.

often experience amenorrhea

\u2022 Weight loss more than 30% over 6 months \u2022 Rapid decline in weight \u2022 Inability to gain weight with outpatient treatment \u2022 Severe hypothermia caused by loss of subcutaneous tissue or dehydration (body temperature lower than 36\u00b0 C or 96.8\u00b0 F) \u2022 Heart rate less than 40 beats per minute \u2022 Systolic blood pressure less than 70 mm Hg \u2022 Hypokalemia (less than 3 mEq\/L) or other electrolyte disturbances not corrected by oral supplementation \u2022 Electrocardiographic changes (especially dysrhythmias)

Milelu therapy:
These modalities are designed to normalize eating patterns and to begin to address the issues raised by the illness. The milieu of an eating disorder unit is purposefully organized to assist the patient in establishing more adaptive behavioral patterns, including normalization of eating.<\/p>\n\n\n\n

milieu therapy<\/a><\/p>\n\n\n\n

is an extremely important consideration for the nurse working with a patient who should feel comfortable and safe. Milieu management includes orienting patients to their rights and responsibilities, selecting specific activities that meet patients’ physical and mental health needs, and ensuring that patients are maintained in the least restrictive environment. Among other things, it also includes that patients are informed in a culturally competent manner about the need for limits and the conditions necessary to remove them.<\/p>\n\n\n\n

depression<\/a><\/p>\n\n\n\n

A thorough medical and neurological examination helps determine if the depression is primary or secondary to another disorder. Depression can be secondary to a host of medical or other psychiatric disorders, as well as medications. Essentially, evaluate the following:

\u2022If the patient is psychotic
\u2022If the patient has used drugs or alcohol
\u2022If comorbid medical conditions are present
\u2022If the patient has a history of a comorbid psychiatric disorder (e.g., eating disorder, borderline personality disorder, anxiety disorder)<\/p>\n\n\n\n

hypothalamus<\/a><\/p>\n\n\n\n

part of the brain that maintains homeostasis. It regulates temperature, blood pressure, perspiration, libido, hunger, thirst, and circadian rhythms, such as sleep and wakefulness.<\/a><\/p>\n\n\n\n

brain stem<\/a><\/p>\n\n\n\n

Basic vital life functions occur through the here composed of the midbrain, pons, and medulla<\/a><\/p>\n\n\n\n

cerebellum<\/a><\/p>\n\n\n\n

part of brain that mainly a coordinator of motor function. However, it also interacts with the cerebrum in higher cognitive functions such as speech memory, facial recognition, visual attention, and awareness<\/a><\/p>\n\n\n\n

thalamus<\/a><\/p>\n\n\n\n

Located above the brainstem, the blank serves as a major relay station for sensory impulses on their way to the cerebral cortex.<\/a><\/p>\n\n\n\n

fight or flight<\/a><\/p>\n\n\n\n

a survival mechanism by which our body and mind become immediately ready to meet a threat or stress. sends signals to the adrenal glands, releasing epinephrine (or adrenaline). The circulating adrenaline increases heart rate, elevates blood pressure, increases blood flow to the skeletal muscles, and increases muscle tension. Respirations also increase, bringing more oxygen to the lungs, which is then sent to the brain, increasing alertness.<\/p>\n\n\n\n

reframing<\/a><\/p>\n\n\n\n

technique to reduce stress

1. Changes the way we look at and feel about things.
2. There are many ways to interpret the same reality (e.g., seeing the glass as half full rather than half empty).
3. Reassess the situation. We can learn from most situations by asking some of the following questions:

\u2022”What positive thing came out of the situation\/experience?”
\u2022”What did you learn in this situation?”
\u2022”What would you do differently next time?”

4. Considering life from another person’s point of view can help dissipate tension and develop empathy. We might even feel some compassion toward the person.

\u2022”What might be going on with your (spouse, boss, teacher, friend) that would cause him\/her to say\/do that?”
\u2022”Is he\/she having problems? Feeling insecure? Under pressure”?<\/p>\n\n\n\n

sleep<\/a><\/p>\n\n\n\n

stress reduction tecnique
1. Chronically stressed people are often fatigued.
2. Go to sleep 30 to 60 minutes earlier each night for a few weeks.
3. If still fatigued, try going to bed another 30 minutes earlier.
4. Sleeping later in the morning is not helpful and can disrupt body rhythms<\/a><\/p>\n\n\n\n

sleep<\/a><\/p>\n\n\n\n

stress reduction technique

1. Exercise can dissipate chronic and acute stress.
2. It is recommended for at least 30 minutes, three times a week.<\/a><\/p>\n\n\n\n

no coffee<\/a><\/p>\n\n\n\n

1. Such a simple measure can lead to more energy, fewer muscle aches, and greater relaxation.
2. Wean yourself off coffee, tea, colas, and chocolate drinks.<\/a><\/p>\n\n\n\n

stress<\/a><\/p>\n\n\n\n

ways to reduce?


1. Engage in meaningful, satisfying work.
2. Live with and\/or love whom you choose.
3. Associate yourself with gentle people who affirm your personhood.
4. Guard your personal freedom, especially your freedom to:

\u2022Choose your friends.
\u2022Live with and\/or love whom you choose.
\u2022Think and believe as you choose.
\u2022Structure your time as you desire.
\u2022Set your own life goals.<\/p>\n\n\n\n

roberts seven stage<\/a><\/p>\n\n\n\n

\"Image:<\/figure>\n\n\n\n

situational<\/a><\/p>\n\n\n\n

what kind of crisis

arises from an external rather than an internal source. Often the crisis is unanticipated. Examples of external situations that can precipitate a crisis include loss of a job, death of a loved one, unwanted pregnancy, a move, change of job, change in financial status, divorce, and severe physical or mental illness.<\/p>\n\n\n\n

environmental<\/a><\/p>\n\n\n\n

what kind of crisis?

may result from (1) a natural disaster (e.g., floods, fires, tornadoes, earthquakes), (2) a national disaster (e.g., war, riots, airplane crashes), or (3) a crime of violence (e.g., rape, assault, murder in the workplace or school, bombings, or spousal or child abuse). Every disaster is a unique challenge.<\/a><\/p>\n\n\n\n

crisis<\/a><\/p>\n\n\n\n

assessment for what?

1. Identify whether the patient’s response to the crisis warrants psychiatric treatment or hospitalization to minimize decompensation (suicidal behavior, psychotic thinking, and violent behavior).
2. Determine if the patient is able to identify the precipitating event.
3. Assess the patient’s understanding of his or her present situational supports.
4. Identify the patient’s usual coping skills and determine what coping mechanisms may help the present situation.
5. Determine whether there are certain religious or cultural beliefs that need to be considered in assessing and intervening in this person’s crisis.
6. Assess whether this situation is one in which the patient needs primary intervention (education, environmental manipulation, or new coping skills), secondary intervention (crisis intervention), or tertiary intervention (rehabilitation).<\/p>\n\n\n\n

crisis<\/a><\/p>\n\n\n\n

interventions for?

1. Assess for any suicidal or homicidal thoughts or plans.
1. Safety is always the first consideration.
2. Take initial steps to make patient feel safe and to lower anxiety.
2. When a person feels safe and anxiety decreases, the individual is able to problem solve solutions with the nurse.
3. Listen carefully (e.g., make eye contact, give frequent feedback to make sure you understand, summarize what patient says at the end).
3. When a person believes that someone is really listening, this can translate into the belief that someone cares about the person’s situation and that help may be available. This offers hope.
4. Crisis intervention calls for directive and creative approaches. Initially the nurse may make phone calls (arrange babysitters, schedule a visiting nurse, find shelter, contact a social worker).
4. Initially a person may be so confused and frightened that performing usual tasks is not possible at that moment.
5. Assess patient’s support systems. Rally existing supports (with patient’s permission) if patient is overwhelmed.
5. People are often overwhelmed and nurses need to take an active role.
6. Identify needed social supports (with patient’s input) and mobilize the most needed first.
6. Patient’s needs for shelter help with care for children or elders, medical workup, emergency medical attention, hospitalization, food, safe housing, and a self-help group are determined.
7. Identify needed coping skills (problem solving, relaxation, assertiveness, job training, newborn care, improving self-esteem).
7. Increasing coping skills and learning new ones can help with current crisis and assist with minimizing future crises.
8. Plan with patient interventions acceptable to both counselor and patient.
8. Patient’s sense of control, self-esteem, and compliance with plan are increased.
9. Plan regular follow-up to assess patient’s progress (e.g., phone calls, clinic visits, home visits as appropriate).
9. Plan is evaluated to see what works and what does not work.<\/p>\n\n\n\n

primary<\/a><\/p>\n\n\n\n

primary, secondary or tertiary care in a crisis?


promotes mental health and reduces mental illness to decrease the incidence of crisis. On this level, the nurse can:

\u2022Work with an individual to recognize potential problems by evaluating the stressful life events the person is experiencing.
\u2022Teach individual specific coping skills, such as decision making, problem solving, assertiveness skills, meditation, and relaxation skills, to handle stressful events.
\u2022Assist an individual in evaluating the timing or reduction of life changes to decrease the negative effects of stress as much as possible. This may involve working with a patient to plan environmental changes, make important interpersonal decisions, and rethink changes in occupational roles.<\/p>\n\n\n\n

secondary<\/a><\/p>\n\n\n\n

primary, secondary or tertiary care in a crisis?

establishes intervention during an acute crisis to prevent prolonged anxiety from diminishing personal effectiveness and personality organization. The nurse’s primary focus is to ensure the safety of the patient. After safety issues are addressed, the nurse works with the patient to assess the patient’s problem, support systems, and coping styles. Desired goals are explored and interventions planned. Secondary care lessens the time a person is mentally disabled during a crisis. Secondary-level care occurs in hospital units, emergency departments, clinics, or mental health centers, usually during daytime hours.<\/p>\n\n\n\n

tertiary<\/a><\/p>\n\n\n\n

primary, secondary or tertiary care in a crisis?

provides support for those who have experienced a severe crisis and are now recovering from a disabling mental state. Social and community facilities that offer tertiary intervention include rehabilitation centers, sheltered workshops, day hospitals, and outpatient clinics. Primary goals are to facilitate optimal levels of functioning and prevent further emotional disruptions. People with severe and persistent mental problems are often extremely susceptible to crisis, and community facilities provide the structured environment that can help prevent problem situations<\/p>\n\n\n\n

grief<\/a><\/p>\n\n\n\n

nursing interventions for?

1. Use methods that can facilitate the grieving process (Robinson, 1997).
a.Give your full presence: use appropriate eye contact, attentive listening, and appropriate touch.
b.Be patient with the bereaved in times of silence. Do not fill silence with empty chatter.
a. Talking is one of the most important ways of dealing with acute grief. Listening patiently helps the bereaved express all feelings, even ones he or she feels are “negative.” Appropriate eye contact helps to convey the awareness that you are there and are sharing the person’s sadness. Suitable human touch can express warmth and nurture healing. Inappropriate touch can leave a person confused and uncomfortable.
b. Sharing painful feelings during periods of silence is healing and conveys your concern.
2. Know about and share with the bereaved information about the phenomena that occur during the normal mourning process, because they may concern some people (intense anger at the deceased, guilt, symptoms the deceased had before death, unbidden floods of memories). Give the bereaved support during the occurrence of these phenomena and a written handout for reference.
2. Although the knowledge will not eliminate the emotions, it can greatly relieve a person who is thinking there is something wrong with having these feelings.
3. Encourage the support of family and friends. If no supports are available, refer the patient to a community bereavement group. (Bereavement groups are helpful even when a person has many friends or much family support.)
3. Friends can help with routine matters. For example:
\u2022Getting food into the house
\u2022Making phone calls
\u2022Driving to the mortuary
\u2022Taking care of the kids or other family members
4. Offer spiritual support and referrals when needed.
4. Dealing with an illness or catastrophic loss can cause the most profound spiritual anguish.
5. When intense emotions are in evidence, show understanding and support (see Table 25-4).
5. Empathic words that reflect acceptance of a bereaved individual’s feelings are healing (Robinson, 1997).<\/p>\n\n\n\n

grief<\/a><\/p>\n\n\n\n

stages of what?

denial, anger, bargaining, depression, and acceptance

1.Shock and disbelief
2.Denial
3.Sensation of somatic distress
4.Preoccupation with the image of the deceased
5.Guilt
6.Anger
7.Change in behavior (e.g., depression, disorganization, or restlessness)
8.Reorganization of behavior directed toward a new object or activity<\/a><\/p>\n\n\n\n

alzheimers meds<\/a><\/p>\n\n\n\n

galantamine hydrobromide (Razadyne), rivastigmine tartrate (Exelon), and donepezil hydrochloride (Aricept)

These are called cholinesterase inhibitors that help dely the progression of the disease in the mild to moderate stage<\/a><\/p>\n\n\n\n

alzheimers meds<\/a><\/p>\n\n\n\n

Memantine hydrochloride (Namenda), an N-methyl-d-aspartate (NMDA), is an antagonist at the NMDA-glutamatergic ion channels. This drug works by blocking the toxic effects associated with excess glutamate and regulates glutamate activation. It is the first drug to target symptoms of AD during the moderate to severe stages of the disorder<\/p>\n\n\n\n

alzheimers<\/a><\/p>\n\n\n\n

a complex disease that begins to damage the brain long before the symptoms appear. AD affects processes that keep the neurons healthy, such as (1) communication, (2) metabolism, and (3) repair. In a healthy brain neurons are supported by microtubules, which guide nutrients and molecules between the cell body and the axon terminals. A special protein called tau protein is responsible for the stability of the microtubules. In AD tau protein is subjected to chemical changes, which result in neurofibrillary tangles and cause disintegration of the microtubules, thus collapsing the neuron’s transport system. This disintegration of the neuron transport system results in malfunction of communication between neurons, and eventually leads to neural cell death. It is the destruction and death of the cells that causes memory failure, personality changes, problems in carrying out daily activities, and other features of the disease<\/p>\n\n\n\n

dementia<\/a><\/p>\n\n\n\n

<\/p>\n\n\n\n

interventions for?

1. Always identify yourself and call the person by name at each meeting.
1. Patient’s short-term memory is impaired\u2014requires frequent orientation to time and environment.
2. Speak slowly.
2. Patient needs time to process information.
3. Use short, simple words and phrases.
3. Patient may not be able to understand complex statements or abstract ideas.
4. Maintain face-to-face contact.
4. Verbal and nonverbal clues are maximized.
5. Be near patient when talking, one or two arm-lengths away.
5. This distance can help patient focus on speaker as well as maintain personal space.
6. Focus on one piece of information at a time.
6. Attention span of patient is poor and patient is easily distracted\u2014helps patient focus. Too much data can be overwhelming and can increase anxiety.
7. Talk with patient about familiar and meaningful things.
7. Self-expression is promoted and reality is reinforced.
8. Encourage reminiscing about happy times in life.
8. Remembering accomplishments and shared joys helps distract patient from deficit and gives meaning to existence.
9. When patient is delusional, acknowledge patient’s feelings and reinforce reality. Do not argue or refute delusions.
9. Acknowledging feelings helps patient feel understood. Pointing out realities may help patient focus on realities. Arguing can enhance adherence to false beliefs.
10. If a patient gets into an argument with another patient, stop the argument and separate individuals. After a short while (5 minutes), explain straightforwardly to each patient why you had to intervene.
10. Escalation to physical acting out is prevented. Patient’s right to know is respected. Explaining in an adult manner helps maintain self-esteem.
11. When patient becomes verbally aggressive, acknowledge patient’s feelings and shift topic to more familiar ground (e.g., “I know this is upsetting for you, because you always cared for others. Tell me about your children.”).
11. Confusion and disorientation easily increase anxiety. Acknowledging feelings makes patient feel more understood and less alone. Topics patient has mastery over can remind him or her of areas of competent functioning and can increase self-esteem.
12. Have patient wear prescription eyeglasses or hearing aid.
12. Environmental awareness, orientation, and comprehension are increased, which in turn increases awareness of personal needs and the presence of others.
13. Keep patient’s room well lit.
13. Environmental clues are maximized.
14. Have clocks, calendars, and personal items (e.g., family pictures or Bible) in clear view of patient while he or she is in bed.
14. These objects assist in maintaining personal identity.
15. Reinforce patient’s pictures, nonverbal gestures, X’s on calendars, and other methods used to anchor patient in reality.
15. When aphasia starts to hinder communication, alternate methods of communication need to be instituted.<\/p>\n\n\n\n

Hypothalamus
Maintains homeostasis: regulates temperature, blood pressure, perspiration, libido, hunger, thirst, and circadian rhythms (sleep and wakefulness)<\/p>\n\n\n\n

Neurons
Initiate signals and conduct electrical impulses<\/p>\n\n\n\n

Synapse
where electrical impulses pass from presynaptic neuron to the postsynaptic neuron<\/p>\n\n\n\n

Milieu Therapy
-Structuring the daily routine to offer physical safety and predictability, thus reducing anxiety over the the unknown
-Providing daily activities to promote sharing and cooperation
-Providing therapeutic interactions, including one-on-one nursing care and behavior contracts
-Including the patient in decisions about his or her own care<\/p>\n\n\n\n

Mental health vs. mental illness
Exist on a continuum- dynamic, shifting, ranging from mild to moderate to severe
Health= successful performance of mental functions, resulting in ability, to engage in productive activities and enjoy fulfilling relationships, adapt to change, and cope with adversity
Illness= medical conditions that effect a person’s thinking, feeling, mood, ability to relate to others, and daily functioning<\/p>\n\n\n\n

Maslow’s hierarchy of needs
Physiological needs- food, O2, water, sleep, sex and temp
Safety needs- security, protection, freedom from fear, anxiety and chaos, need for law order and limits
Belonging and love needs- intimate relationships
Esteem needs-
Self-actualization<\/p>\n\n\n\n

Peplau’s theory of interpersonal relations
AKA Psychodynamic nursing
Nature of nurse-patient relationship strongly influence the outcome for the patient<\/p>\n\n\n\n

Erikson’s stages of development
Trust vs mistrust
Autonomy vs shame\/doubt
Initiative vs guilt
Industry vs inferiority
Identity vs role confusion
intimacy vs isolation
Generativity vs self-absorption
Integrity vs despair<\/p>\n\n\n\n

Non-verbal behaviors
body behaviors
facial expressions
eye cast
voice-related behaviors
observable autonomic physiological responses
personal appearance
physical characteristics<\/p>\n\n\n\n

Techniques that Enhance Communication
Using silence
accepting
giving recognition
offering self
offering general leads
giving broad openings
placing the events in time or sequence
making observations
encouraging description of perception
encouraging comparison
restating
reflecting
focusing
exploring
giving information
seeking clarification
presenting reality
voicing doubt
seeking consensual validation
verbalizing the implied
encouraging evaluation
attempting to translate into feelings
suggesting collaboration
summarizing
encouraging formulation of a plan of action<\/p>\n\n\n\n

Nontherapeutic Techniques
Giving premature advice
Minimizing feelings
Falsely reassuring
Making value judgments
Asking “why” questions
Asking excessive questions
Giving approval; agreeing
Disapproving; disagreeing
Changing the subject<\/p>\n\n\n\n

Boundaries
Signs: overhelping, controlling, narcissism
Transference and countertransferance<\/p>\n\n\n\n

Orientation phase
Establish rapport
Parameters of relationship
Formal\/informal contract
Confidentiality
Termination begins (time-frame set)<\/p>\n\n\n\n

Working phase
Maintain relationship
Gather further data
Promote patient’s problem-solving skills, self-esteem, and use of language
Facilitate behavioral change
Overcome resistance behaviors
Evaluate problems and goals-redefine as needed
Promote practice and expression of adaptive behaviors<\/p>\n\n\n\n

Termination phase
Summarizing goals and objectives achieved
Discuss patient how patient can incorporate
Review situation<\/p>\n\n\n\n

Autonomy
Respecting the rights of others to make their own decisions
Ex. ackowledging the patient’s right to refuse medication<\/p>\n\n\n\n

Justice
Ethical principle- duty to distribute resources and care equally- spending equal time with patient
Ex. ICU nurse spending equal time with suicidal patient and patient with a brain aneurysm<\/p>\n\n\n\n

Beneficence
The duty to act so as to benefit or promote the good of others
Ex. spending extra time to help calm an extremely anxious patient<\/p>\n\n\n\n

Fidelity
(Nonmalficence) Maintaining loyalty an commitment to the patient and doing no wrong to patient
Ex. Maintaining expertise in nursing skill through nursing education demonstrates fidelity to patient care<\/p>\n\n\n\n

Veracity
One’ duty to communicate truthfully
Ex. Describing the purpose and side effects of psychotropic medications in a truthful non-misleading way<\/p>\n\n\n\n

Negligence
Failure to act
Carelessness, forseeability of harm<\/p>\n\n\n\n

Involuntary admission rights
patient retains freedom from unreasonable bodily restraints, right to informed consent, right to refuse medication<\/p>\n\n\n\n

Rights of voluntary admission
the right to demand and obtain release<\/p>\n\n\n\n

Psychiatric Nursing Assessment
Establish rapport
Obtain an understanding of the current problem or chief complaint
Review physical status and obtain baseline vitals
Assess for risk factors affecting the safety of the patient or others
Perform a mental status examination
Assess psychosocial status
Identify mutual goals for treatment
Formulate a plan of care that prioritizes the patient’s immediate conditions and needs
Document data in a retrievable format<\/p>\n\n\n\n

Neuroleptic Malignant Syndrome
Fever
Severe Muscle rigidity
Confusion
Agitation
Increase pulse and blood pressure
Life threatening<\/p>\n\n\n\n

Key symptoms of schizophrenia<\/p>\n\n\n\n

    \n
  1. Positive symptoms: Psychotic symptoms are the most obvious (e.g., delusions, hallucinations, and perceptions that are not based on reality).\u2217<\/li>\n\n\n\n
  2. Negative symptoms: Include poverty of thought, loss of motivation, inability to experience pleasure or joy, feelings of emptiness, and blunted affect.\u2217<\/li>\n\n\n\n
  3. Cognitive symptoms: Include the inability to understand and process information, trouble focusing attention, and problems with working memory. The cognitive disturbances also account for the inability to use language appropriately (which is manifested by speech; e.g., looseness of association). These are the symptoms that most profoundly affect the individual’s ability to engage in normal social\/occupational experiences.\u2217<\/li>\n\n\n\n
  4. Mood symptoms: Depression, anxiety, dysphoria, suicide, and demoralization.\u2217<\/li>\n\n\n\n
  5. Grossly disorganized or catatonic behavior<\/li>\n\n\n\n
  6. Characterological symptoms: Most often people with schizophrenia are isolated or alienated from others. These patients have deep feelings of inadequacy and poorly developed social skills.<\/li>\n<\/ol>\n\n\n\n

    Positive schizophrenia symptoms
    Hallucinations
    Delusions
    Bizarre Behavior
    Positive formal thought disorder and speech patterns<\/p>\n\n\n\n

    Negative Schizophrenia Symptoms
    Affective Flattening
    Alogia
    Avolition, Apathy
    Anhedonia, Asociality
    Attention Deficits<\/p>\n\n\n\n

    Second Generation Antipsychotics
    Clozapine- Schizophrenia
    Risperdone- Schizophrenia
    Paliperidone- Schizophrenia and schizoaffective disorder
    Olanzapine- Schizophrenia and agitaition
    Quetiapine- Schizophrenia
    Ziprasidone- Schizophrenia and acute agitation
    Iloperidone
    Asenapine- Schizophrenia
    Lurasidone
    Brexipiprazole<\/p>\n\n\n\n

    First- Generation Antipsychotics
    Haloperidol- Schizophrenia and acute agitation
    Trifluoperazine- Schizophrenia
    Fluphenazine- Schizophrenia and other psychotic disorders
    Loxapine- Only schizophrenia
    Perphenazine- Schizophrenia
    Chlorpromazine- Schizophrenia, other psychotic disorder
    Thioridazine- treatment resistant schizophrenia only<\/p>\n\n\n\n

    Personality Disorders
    Personality traits tend to be inflexible and unpredictable
    Coping strategies tend to be primitive and immature
    Have difficulty perceiving and interpreting the world and others around them
    Inappropriate emotional response and impulse control<\/p>\n\n\n\n

    Conversion Disorder
    One or more symptoms of impaired motor sensory function. Findings are incompatible with or an exaggeration of recognized neurological conditions not better explained by another mental or medical disorder.<\/p>\n\n\n\n

    Conduct Disorder
    Childhood\/Adolescent Disorder
    Bullies or intimidates others
    Initiates physical fights
    Has used a weapon
    Physically cruel to people or animals
    Steals
    Forced sexual activity
    Deliberate fire-setting
    Destruction of property<\/p>\n\n\n\n

    Signs and Symptoms of Anorexia<\/p>\n\n\n\n

      \n
    • Terror of gaining weight<\/li>\n\n\n\n
    • Preoccupation with thoughts of food<\/li>\n\n\n\n
    • View of self as fat even when emaciated<\/li>\n\n\n\n
    • Peculiar handling of food:<\/li>\n\n\n\n
    • Cutting food into small bits<\/li>\n\n\n\n
    • Pushing pieces of food around plate<\/li>\n\n\n\n
    • Possible development of rigorous exercise regimen<\/li>\n\n\n\n
    • Possible self-induced vomiting; use of laxatives and diuretics<\/li>\n\n\n\n
    • Cognition is so disturbed that the individual judges self-worth by his or her weight<\/li>\n\n\n\n
    • Controls what he or she eats to feel powerful to overcome feelings of helplessness<\/li>\n<\/ul>\n\n\n\n

      Signs and Symptoms of Bulimia<\/p>\n\n\n\n

        \n
      • Binge eating behaviors<\/li>\n\n\n\n
      • Often self-induced vomiting (or laxative or diuretic use) after bingeing<\/li>\n\n\n\n
      • History of anorexia nervosa in one fourth to one third of individuals<\/li>\n\n\n\n
      • Depressive signs and symptoms<\/li>\n\n\n\n
      • Problems with:<\/li>\n\n\n\n
      • Interpersonal relationships<\/li>\n\n\n\n
      • Self-concept<\/li>\n\n\n\n
      • Impulsive behaviors<\/li>\n\n\n\n
      • Increased levels of anxiety and compulsivity<\/li>\n\n\n\n
      • Possible chemical dependency<\/li>\n\n\n\n
      • Possible impulsive stealing<\/li>\n\n\n\n
      • Controls\/undoes weight after bingeing, which is motivated by feelings of emptiness<\/li>\n<\/ul>\n\n\n\n

        Complications of Anorexia<\/p>\n\n\n\n

          \n
        • Bradycardia<\/li>\n\n\n\n
        • Orthostatic changes in pulse rate or blood pressure<\/li>\n\n\n\n
        • Cardiac murmur\u2014one third with mitral valve prolapse<\/li>\n\n\n\n
        • Sudden cardiac arrest caused by profound electrolyte disturbances<\/li>\n\n\n\n
        • Prolonged QT interval on electrocardiogram<\/li>\n\n\n\n
        • Acrocyanosis<\/li>\n\n\n\n
        • Symptomatic hypotension<\/li>\n\n\n\n
        • Leukopenia<\/li>\n\n\n\n
        • Lymphocytosis<\/li>\n\n\n\n
        • Carotenemia (elevated carotene levels in blood), which produces skin with yellow pallor<\/li>\n\n\n\n
        • Hypokalemic alkalosis (with self-induced vomiting or use of laxatives and diuretics)<\/li>\n\n\n\n
        • Elevated serum bicarbonate levels, hypochloremia, and hypokalemia<\/li>\n\n\n\n
        • Electrolyte imbalances, which lead to fatigue, weakness, and lethargy<\/li>\n\n\n\n
        • Osteoporosis, indicated by low bone density<\/li>\n\n\n\n
        • Fatty degeneration of liver, indicated by elevation of serum enzyme levels<\/li>\n\n\n\n
        • Elevated cholesterol levels<\/li>\n\n\n\n
        • Amenorrhea<\/li>\n\n\n\n
        • Abnormal thyroid functioning
          Hematuria<\/li>\n\n\n\n
        • Proteinuria<\/li>\n<\/ul>\n\n\n\n

          Complications of Bulimia<\/p>\n\n\n\n

            \n
          • Cardiomyopathy (rare occurrence due to diminished protein synthesis, malnutrition)<\/li>\n\n\n\n
          • Cardiac dysrhythmias<\/li>\n\n\n\n
          • Sinus bradycardia<\/li>\n\n\n\n
          • Sudden cardiac arrest as a result of profound electrolyte disturbances<\/li>\n\n\n\n
          • Orthostatic changes in pulse rate or blood pressure<\/li>\n\n\n\n
          • Cardiac murmur; mitral valve prolapse<\/li>\n\n\n\n
          • Electrolyte imbalances<\/li>\n\n\n\n
          • Elevated serum bicarbonate levels (although can be low, which indicates metabolic acidosis)<\/li>\n\n\n\n
          • Hypochloremia<\/li>\n\n\n\n
          • Hypokalemia<\/li>\n\n\n\n
          • Dehydration, which results in volume depletion, leading to stimulation of aldosterone production, which in turn stimulates further potassium excretion from kidneys; thus there can be an indirect renal loss of potassium as well as a direct loss through self-induced vomiting<\/li>\n\n\n\n
          • Severe attrition and erosion of teeth producing irritating sensitivity and exposing the pulp of the teeth<\/li>\n\n\n\n
          • Loss of dental arch<\/li>\n\n\n\n
          • Diminished chewing ability<\/li>\n\n\n\n
          • Parotid gland enlargement associated with elevated serum amylase levels<\/li>\n\n\n\n
          • Esophageal tears caused by self-induced vomiting<\/li>\n\n\n\n
          • Severe abdominal pain indicative of gastric dilation<\/li>\n\n\n\n
          • Russell’s sign (callus on knuckles from self-induced vomiting)<\/li>\n<\/ul>\n\n\n\n

            Eating disorder Hospital Admission Criteria
            Physical Criteria<\/p>\n\n\n\n

              \n
            • Weight loss more than 30% over 6 months<\/li>\n\n\n\n
            • Rapid decline in weight<\/li>\n\n\n\n
            • Inability to gain weight with outpatient treatment<\/li>\n\n\n\n
            • Severe hypothermia caused by loss of subcutaneous tissue or dehydration (body temperature lower than 36\u00b0 C or 96.8\u00b0 F)<\/li>\n\n\n\n
            • Heart rate less than 40 beats per minute<\/li>\n\n\n\n
            • Systolic blood pressure less than 70 mm Hg<\/li>\n\n\n\n
            • Hypokalemia (less than 3 mEq\/L) or other electrolyte disturbances not corrected by oral supplementation<\/li>\n\n\n\n
            • Electrocardiographic changes (especially dysrhythmias)
              Psychiatric Criteria<\/li>\n\n\n\n
            • Suicidal or severely irrepressible, self-mutilating behaviors<\/li>\n\n\n\n
            • Uncontrollable use of laxatives, emetics, diuretics, or street drugs<\/li>\n\n\n\n
            • Failure to comply with treatment contract<\/li>\n\n\n\n
            • Severe depression<\/li>\n\n\n\n
            • Psychosis<\/li>\n\n\n\n
            • Family crisis or dysfunction<\/li>\n<\/ul>\n\n\n\n

              Nursing Diagnosis for Somatic Symptom Disorders
              Inability to meet occupational, family, or social responsibilities because of symptoms<\/p>\n\n\n\n

              Inability to participate in usual community activities or friendships because of psychogenic symptoms<\/p>\n\n\n\n

              Ineffective coping<\/p>\n\n\n\n

              Ineffective role performance<\/p>\n\n\n\n

              Impaired social interaction<\/p>\n\n\n\n

              Ineffective relationship
              Dependence on pain relievers; distortion of body functions and symptoms; presence of secondary gains by adoption of sick role
              Powerlessness<\/p>\n\n\n\n

              Disturbed body image<\/p>\n\n\n\n

              Pain (acute or chronic)
              Inability to meet family role function and need for family to assume role function of the somatic individual
              Interrupted family processes<\/p>\n\n\n\n

              Ineffective sexuality pattern
              Assumption of some of the roles of the somatic parent by the childrenImpaired parentingShifting of the sexual partner’s role to that of caregiver or parent and of the patient’s role to that of recipient of careRisk for caregiver role strainFeeling of inability to control symptoms or understand why he or she cannot find help
              Chronic low self-esteem<\/p>\n\n\n\n

              Spiritual distress
              Development of negative self-evaluation related to losing body function, feeling useless, or not feeling valued by significant othersInability to take care of basic self-care needs related to conversion symptom (paralysis, seizures, pain, fatigue)Focus on self-care deficit (hygiene, dressing, feeding, toileting)Inability to sleep related to psychogenic pain Disturbed sleep pattern<\/p>\n\n\n\n

              Alcohol Withdrawal
              Early signs in a few hours
              Peaks within 24 to 48 hours
              Rapidly and dramatically disappears unless it progresses to delirium
              Irritability and “shaking inside”
              Grand mal seizures possible in 7 to 48 hours after cessation
              Illusions
              ^BP, ^HR, jerky movements, small pupils, irritable<\/p>\n\n\n\n

              TABLE 19-4
              Alcohol Withdrawal Delirium \u2217
              Drug\/Purpose
              Sedatives :
              Benzodiazepines \u2020
              Chlordiazepoxide (Librium)\/
              Provides safe withdrawal and has anticonvulsant effects; chlordiazepoxide and diazepam are cross-addicting
              Diazepam (Valium) \/
              Has anticonvulsant qualities
              Not metabolized in the liver Seizure Control:
              Carbamazepine (Tegretol), or valproic acid (Depakote)\/
              Helps reduce withdrawal symptoms and the risk of seizures
              Magnesium sulfate \/
              Increases effectiveness of vitamin B1 and helps reduce postwithdrawal seizures
              Thiamine (vitamin B1 ) \/
              Given intramuscularly or intravenously before glucose loading to prevent Wernicke’s encephalopathy
              Alleviation of Autonomic Nervous System Symptoms (ANS):
              Beta blockers (propranolol) or alpha blockers (clonidine) \/
              May help reduce ANS hyperactivity (e.g., tremor, tachycardia, elevated blood pressure, diaphoresis) but should only be used with benzodiazepine
              Most effective in short time<\/p>\n\n\n\n

              Inhalants
              Volatile solvents (e.g., paint thinners, glues, gasoline, dry cleaner fluid)
              Gases (e.g., butane, propane, nitrous oxide)
              Nitrates (e.g., isoamyl, isobutyl, commonly known as “poppers”)
              Aerosols (e.g., spray paint, hair or deodorant sprays, fabric protector sprays, vegetable oil sprays)<\/p>\n\n\n\n

              Inhalant Intoxication Effects
              Similar to alcohol: Slurred speech, lack of inhibitions, euphoria, dizziness, drunkenness, violent behavior<\/p>\n\n\n\n

              Overdose Effects of Inhalants
              Liver and brain damage, heart failure, respiratory arrest, suffocation, coma, death
              Capable of interfering with oxygen supply to vital organs by destroying oxygen-carrying ability of red blood cells; associated with fatal cardiac rhythm
              Long-term use can lead to deterioration of myelin sheath of nerve fibers, resulting in muscle spasms and tremors, or even permanent difficulty with basic movements such as walking, bending, and talking<\/p>\n\n\n\n

              Treatment for Inhalants
              Support affected systems
              Neurological symptoms may respond to vitamin B12 and folate<\/p>\n\n\n\n

              Interventions for Impulse Control Disorders<\/p>\n\n\n\n

                \n
              1. Guide the person to understand and practice tension reduction and stress control strategies such as stress avoidance, correction of negative self-talk, and breathing control exercises.<\/li>\n\n\n\n
              2. Promote the progressive substitution of alternate, less maladaptive responses to tension, such as applying pressure to one’s scalp with a thumb rather than pulling out one’s hair.<\/li>\n\n\n\n
              3. Assist the person to explore feelings associated with the impulses, such as shame, fear, or guilt, and to manage these feelings adaptively.<\/li>\n\n\n\n
              4. Assist the person to identify the consequences of his or her actions (e.g., “How do other people respond when you _<\/strong>?” “Tell me what things are like the day after you’ve set a fire,” “Imagine you set the fire: what do you think will happen in the days and weeks that follow?” [anticipatory fantasy])<\/li>\n\n\n\n
              5. Educate the person that drugs and alcohol may increase impulsiveness through disinhibition or impairment of judgment; educate the person regarding the effect of “triggers,” that is, circumstances that evoke tension or impulses (e.g., going to bars).<\/li>\n\n\n\n
              6. Pathological gamblers may respond well to group therapy; organizations such as Gamblers Anonymous (www.gamblersanonymous.org) provide significant assistance through support, education, and practical tips on managing gambling impulses and other concerns.<\/li>\n\n\n\n
              7. Persons with trichotillomania can benefit from special hair styling, hair weaves, or other cosmetology assistance; they may require considerable support in order to access such resources, however, because of embarrassment.<\/li>\n<\/ol>\n\n\n\n

                Impulse Control Disorders
                A decreased ability to resist an impulse to perform certain acts
                Intermittent explosive disorder, kleptomania, pyromania, gambling disorder, trichotillomania<\/p>\n\n\n\n

                Primary Crisis Care
                Promotes mental health and reduces mental illness to decrease the incidence of crisis<\/p>\n\n\n\n

                Secondary Crisis Care
                Establishes the intervention during an acute crisis to prevent prolonged anxiety from diminishing personal effectiveness and personality organization<\/p>\n\n\n\n

                Tertiary Crisis Care
                Provides support for those who have experienced a severe crisis and are now recovering from a disabled mental state<\/p>\n\n\n\n

                Situational Crisis
                Arises from an external source, frequently unanticipated
                Ex. job loss, death of a loved one, move, divorce<\/p>\n\n\n\n

                Adventitious (Disasters) Crisis
                Catastrophic violent event not a part of every day life
                Ex. natural disasters, national disasters, crimes of violence<\/p>\n\n\n\n

                Interventions for People in Grief<\/p>\n\n\n\n

                  \n
                1. Use methods that can facilitate the grieving process (Robinson, 1997).
                  a. Give your full presence: use appropriate eye contact, attentive listening, and appropriate touch.
                  b. Be patient with the bereaved in times of silence. Do not fill silence with empty chatter.<\/li>\n\n\n\n
                2. Know about and share with the bereaved information about the phenomena that occur during the normal mourning process, because they may concern some people (intense anger at the deceased, guilt, symptoms the deceased had before death, unbidden floods of memories). Give the bereaved support during the occurrence of these phenomena and a written handout for reference.<\/li>\n\n\n\n
                3. Encourage the support of family and friends. If no supports are available, refer the patient to a community bereavement group. (Bereavement groups are helpful even when a person has many friends or much family support.)<\/li>\n\n\n\n
                4. Offer spiritual support and referrals when needed.<\/li>\n\n\n\n
                5. When intense emotions are in evidence, show understanding and support<\/li>\n<\/ol>\n\n\n\n

                  what does the amygdala control?
                  fight or flight response processes fear and amxiety<\/p>\n\n\n\n

                  frontal lobe
                  controls thought process, reasoning, decision making, voluntary movement<\/p>\n\n\n\n

                  primary depression
                  due to family history, female gender, 40+, posrpartum, chronic illness, stressful life events<\/p>\n\n\n\n

                  secondary depression
                  resulted from another mental health disorder or debilitating chronic illness (person is depressed because of their decline in physical or mental function)<\/p>\n\n\n\n

                  nursing interventions and assessment tools for alcohol adiction
                  risk for suicide
                  keep them safe
                  blood alcohol level
                  seizure precautions<\/p>\n\n\n\n

                  meds:
                  disulfiram, naltroxone, chloroliazepoxide<\/p>\n\n\n\n

                  Hippocampus
                  a neural center located in the limbic system; helps process explicit memories for storage<\/p>\n\n\n\n

                  Busipirone (Buspar)
                  SARI
                  Tx anxiety
                  side effects: anxiety, nausea, HA, dizziness, tardive dyskinesia
                  not habit forming<\/p>\n\n\n\n

                  Lithium levels
                  maintainence: 0.4-1.3
                  toxic: ^ 1.5
                  signs and symptoms: slurred speech, course tremor, thirsty, nausea, vomiting<\/p>\n\n\n\n

                  Neuroleptic Malignant Syndrome
                  muscle rigidity
                  confusion
                  agitation
                  ^temp
                  ^pulse
                  ^BP<\/p>\n\n\n\n

                  Patient teaching nortriptyline
                  dry mouth
                  constipation
                  drowsiness
                  blurred vision<\/p>\n\n\n\n

                  Comorbidities with anorexia\/bulimia
                  depression
                  OCD
                  Social phobia
                  anxiety<\/p>\n\n\n\n

                  Effective Therapeutic Communication
                  Silence
                  Active listening
                  Open-ended questions
                  Clarifying
                  Offering general leads\/broad opening statements
                  Showing acceptance and recognition
                  Focusing
                  Asking questions
                  Giving information
                  Presenting information<\/p>\n\n\n\n

                  Psych nurse assessment
                  Establish rapport
                  Obtain an understanding of current problem<\/p>\n\n\n\n

                  Involuntary admission
                  Must be a danger to self or others or unable to meet basic needs
                  Still obtain basic rights
                  Lose right to leave<\/p>\n\n\n\n

                  Involuntary suicide admission
                  Lose right to privacy<\/p>\n\n\n\n

                  Beneficence
                  duty to promote good<\/p>\n\n\n\n

                  Autonomy
                  respecting rights of others to make their own decisions<\/p>\n\n\n\n

                  Justice
                  equal care<\/p>\n\n\n\n

                  Fidelity
                  do no wrong<\/p>\n\n\n\n

                  Veracity
                  truthfulness<\/p>\n\n\n\n

                  Antidepressant drugs
                  SSRI<\/p>\n\n\n\n

                  Antidepressants
                  First-line therapy
                  Can affect sexual performance, dry mouth, mild nausea, loose bowel movements<\/p>\n\n\n\n

                  Serotonin syndrome
                  Abdominal pain, diarrhea, sweating, fever, tachycardia, low blood pressure, altered mental state<\/p>\n\n\n\n

                  Tricyclic antidepressants
                  Inhibits the reuptake of norepinephrine and serotonin by the presynaptic neurons in the CNS increasing the<\/p>\n\n\n\n

                  MAOIs
                  Treat depression<\/p>\n\n\n\n

                  Bipolar I disorder
                  at least 1 week long manic episode that results in excessive activity and energy<\/p>\n\n\n\n

                  Bipolar II disorder
                  low-level mania alternates with profound depression
                  social and occupational impairment
                  euphoric and dysphoric episodes<\/p>\n\n\n\n

                  Cyclothymia
                  symptoms of hypomania alternate with symptoms of mild to moderate depression for at least 2 yrs in adults and 1 yr in children
                  social and occupational impairment<\/p>\n\n\n\n

                  First-line for bipolar
                  Lithium carbonate<\/p>\n\n\n\n

                  Lithium therapuetic level
                  0.4-1.3 mEq\/L
                  pt must be able to follow up for blood testing<\/p>\n\n\n\n

                  Lithium toxicity
                  1.5 mEq\/L
                  diaphoresis, weakness, nausea, diarrhea<\/p>\n\n\n\n

                  Defense Mechanisms
                  compensation
                  conversion
                  denial
                  displacement<\/p>\n\n\n\n

                  Buspiron
                  only antianxiety that isn’t addicting<\/p>\n\n\n\n

                  PTSD symptoms
                  intrusive thoughts
                  nightmares
                  flashbacks
                  efforts to avoid thoughts and feelings
                  feeling detached
                  depression
                  feelings of guilt
                  irritability or angry outbursts
                  hypervigilance
                  hypersensitivity
                  headache
                  disrupted sleep, insomnia<\/p>\n\n\n\n

                  PTSD medications
                  sertraline (Zoloft)
                  paroxetine (Paxil)
                  both SSRIs<\/p>\n\n\n\n

                  PTSD nursing interventions
                  counseling
                  support services<\/p>\n\n\n\n

                  Hypothalmus controls what?
                  heart rate
                  breathing<\/p>\n\n\n\n

                  Who first identified anxiety as an important concept and developed the anxiety model?
                  Hildegard Peplau<\/p>\n\n\n\n

                  Levels of anxiety
                  mild
                  moderate
                  severe
                  panic<\/p>\n\n\n\n

                  Positive Schizophrenia symptoms
                  something that is not normally there<\/p>\n\n\n\n

                  Negative Schizophrenia symptoms
                  something you should have that’s missing<\/p>\n\n\n\n

                  Neuroleptic malignant syndrome
                  combination of hyperthermia, rigidity, and autonomy dysregulation<\/p>\n\n\n\n

                  Akasthia
                  psychomotor restlessness evident in pacing or fidgeting<\/p>\n\n\n\n

                  Pseudoparkinsonism
                  medication induced tremor,<\/p>\n\n\n\n

                  When did conventional antipsychotics become available?
                  1950s<\/p>\n\n\n\n

                  Atypical antipsychotics
                  tendency to cause significant weight ga<\/p>\n\n\n\n

                  Serotonin-dopamine antagonists
                  Abilify (Apiprazole)
                  Clozaril (Clozapine)
                  Zyprexa<\/p>\n\n\n\n

                  Personality disorders
                  pathological personality characteristics
                  exhibits impairment in self-identity or self-direction and interpersonal functioning
                  maladaptive behaviors<\/p>\n\n\n\n

                  Cluster A disorders
                  odd\/eccentric
                  paranoid
                  schizoid
                  schiotypal<\/p>\n\n\n\n

                  Cluster B disorders
                  set limits and boundaries
                  consistent<\/p>\n\n\n\n

                  Cluster C disorders
                  anxious\/fearful
                  avoidant personality disorders
                  dependent personality disorder
                  obsessive-compulsive<\/p>\n\n\n\n

                  Eating disorders
                  anorexia
                  bulimia
                  binge eating
                  priority is to identify triggers<\/p>\n\n\n\n

                  Anorexia symptoms<\/p>\n\n\n\n

                  \n

                  30% of body weight within 6 months
                  temperature below 36 degree C (98.6 degree F)
                  lenuga
                  refuse to maintain a minimally normal weight for height
                  express intense fear of gaining weight
                  loss of appetite is rare<\/p>\n<\/blockquote>\n\n\n\n

                  Bulimia symptoms
                  hypokalemia
                  Russel’s sign
                  engage in repeated episodes of binge eating followed by inappropriate compensatory behaviors
                  self-induce vomiting<\/p>\n\n\n\n

                  Binge eating
                  feel ashamed after binging
                  feeling of being out-of-control<\/p>\n\n\n\n

                  Somatoform disorders
                  somatic symptom disorder
                  illness anxiety disorder
                  conversion disorder
                  factitious disorder<\/p>\n\n\n\n

                  Assessment guidelines for the chemically impaired
                  withdrawal syndrome
                  overdose that warrants medical attention
                  suicidal thoughts or other self-destructive behaviors
                  physical complications related to drug abuse
                  explore interests in doing something about drug or alchol<\/p>\n\n\n\n

                  Nursing diagnoses
                  risk for suicide<\/strong>
                  risk for other-directed violence
                  imbalanced nutrition: less than body requirements
                  disturbed thought processes
                  disturbed sleep patterns
                  ineffective health maintenance
                  hopelessness
                  ineffective airway clearance
                  ineffective breathing pattern<\/p>\n\n\n\n

                  Central Nervous System depressants
                  alcohol
                  opioids<\/p>\n\n\n\n

                  Alcohol withdrawal
                  develop within a few hours after cessation or reduction of intake, peak after 24-48 hrs<\/p>\n\n\n\n

                  Illusion
                  misinterpretation of reality<\/p>\n\n\n\n

                  Delusion
                  not based on reality<\/p>\n\n\n\n

                  Pharmacological interventions treatment of alcoholism
                  Naltrexone (ReVia)
                  Acamprosate (Campral)
                  Topiramate (Topamax)
                  Disulfiram (Antabuse)<\/p>\n\n\n\n

                  Cognitive and degenerative disorders
                  dementia\/Alzheimers<\/p>\n\n\n\n

                  Etiology of Alzheimer’s disease
                  Neuronal degeneration
                  starts in hippocampus – short term memory<\/p>\n\n\n\n

                  Alzheimer’s pharmacology
                  cholinesterase inhibitors
                  donepezil
                  galantamine
                  rivastigmine<\/p>\n\n\n\n

                  Delirium
                  Fast onset
                  Caused by a medical problem
                  Fluctuating levels of consciousness<\/p>\n\n\n\n

                  Four cardinal features of delirium
                  abrupt onset
                  s\/s fluctuate
                  disorganized thinking and poor executive functioning
                  altered awareness, inability to focus, sustain or shift attention
                  disorientation, delusional thinking, and hallucinations
                  anxiety and agitation<\/p>\n\n\n\n

                  Features of dementia
                  slow onset
                  short term memory deficit
                  difficulty finding words or communicating
                  difficulty reasoning or problem-solving<\/p>\n\n\n\n

                  Crisis
                  normal coping mechanisms fail
                  profound disruption of normal psychological homeostasis
                  results in inability to function as usual<\/p>\n\n\n\n

                  Types of crisis
                  maturational
                  situational
                  adventitious<\/p>\n\n\n\n

                  Crisis nursing interventions
                  Patient safety
                  Reduction of anxiety<\/p>\n\n\n\n

                  Age related disorders
                  conduct disorder
                  impulse control disorder<\/p>\n\n\n\n

                  Suicide
                  Modified Sad Persons Scale<\/p>\n\n\n\n

                  Suicidal assessment
                  lethality of suicide plan
                  do they have access to means<\/p>\n\n\n\n

                  Prioritizing suicide risk
                  how quickly would they die<\/p>\n\n\n\n

                  Suicide risk factors
                  psych disorders accompany 90% of suicides
                  50x higher for schizophrenics
                  alcohol or substance abuse
                  increasing age
                  race (white=2\/3)
                  religion (Catholics are less likely)
                  marriage (divorced are higher risk)
                  profession (professionals higher risk)
                  physical health<\/p>\n\n\n\n

                  Suicide interventions
                  teamwork and safety
                  counseling
                  health teaching and health promotion
                  case management
                  pharmacological interventions (SSRI-less issues with OD)
                  post-vention for survivors of completed suicides<\/p>\n\n\n\n

                  What is the most predictive feeling of increased suicide risk?
                  hopelessness<\/p>\n\n\n\n

                  Cycle of violence
                  tension building stage
                  acute battering stage
                  honeymoon stage<\/p>\n\n\n\n

                  Id
                  pleasure principle
                  reflex action
                  primary process
                  preconscious<\/p>\n\n\n\n

                  Ego
                  problem solver
                  reality tester
                  conscious<\/p>\n\n\n\n

                  Superego
                  moral component
                  unconscious<\/p>\n\n\n\n

                  Erikson’s ego theory
                  trust vs mistrust
                  autonomy vs shame-doubt
                  initiative vs guilt
                  industry vs inferiority
                  integrity vs despair<\/p>\n\n\n\n

                  transference
                  client views nurse as having characteristics of another person in the client’s life<\/p>\n\n\n\n

                  countertransference
                  nurse displaces characteristics on the client from another person in his\/her past<\/p>\n\n\n\n

                  compensation
                  makes up for perceived deficiencies and cover up shortcomings to protect the mind from recognizing them<\/p>\n\n\n\n

                  conversion
                  unconscious transformation of anxiety to a physical symptoms<\/p>\n\n\n\n

                  denial
                  escaping unpleasantness by ignoring its existence<\/p>\n\n\n\n

                  displacement
                  transference of emotions to a nonthreatening person, object, or situation<\/p>\n\n\n\n

                  dissociation
                  disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment<\/p>\n\n\n\n

                  identification
                  attributing to oneself the characteristics of another<\/p>\n\n\n\n

                  intellectualization
                  process in which events are analyzed based on remote cold facts and without passion, rather than incorporate feelings or emotions in the process<\/p>\n\n\n\n

                  introjection
                  process by which the outside world is incorporated into a person’s view of the self<\/p>\n\n\n\n

                  projection
                  unconscious rejection of emotionally unacceptable features and attributing them to other people, objects, or situations<\/p>\n\n\n\n

                  rationalization
                  justifying illogical or unreasonable justifying ideas, actions, or feelings by developing acceptable explanations that satisfy the teller as well as the listener<\/p>\n\n\n\n

                  reaction formation
                  unacceptable feelings or behaviors are controlled and kept out of awareness by developing the opposite behavior or emotion<\/p>\n\n\n\n

                  repression
                  first line psychological defense against anxiety-temporary or long term exclusion of unpleasant or unwanted experiences, emotions or ideas from conscious awareness<\/p>\n\n\n\n

                  splitting
                  inability to integrate the positive and negative qualities of oneself into a cohesive image<\/p>\n\n\n\n

                  sublimation
                  unconscious process of substituting mature, constructive, and socially acceptable activity for immature, destructive, and unacceptable impulses<\/p>\n\n\n\n

                  undoing
                  most commonly seen in children
                  a person makes up for an act fro or feeling<\/p>\n\n\n\n

                  suppression
                  conscious denial of a disturbing situation or feeling<\/p>\n\n\n\n

                  regression
                  reverting to an earlier pattern of behavior<\/p>\n","protected":false},"excerpt":{"rendered":"

                  What type of patients go to memory care? Dementia or Alzheimers What type of environment is a memory care unit? Locked unit, 24-7 supervision. What type of activities do you implement to interact with memory care patients? Activities that help them to recall their past-show old photos, ask questions like what was your first job? […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[],"tags":[],"class_list":["post-110804","post","type-post","status-publish","format-standard","hentry"],"_links":{"self":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/110804","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/comments?post=110804"}],"version-history":[{"count":0,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/110804\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/media?parent=110804"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/categories?post=110804"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/tags?post=110804"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}