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254 Cards in this Set
- Front
- Back
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CHAPTER ONE
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(Ignore this card)
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MSE
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Mental Status Examination
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Obtundation
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The client needs to be lightly shaken to elicit a response, but she may be confused and slow to respond
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Stupor
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The client require spainful stimuli to elicit a brief response. She may not e able to respond verbally
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Decorticate rigidity
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Flexion and internal rotation of upper-extremity joints and legs
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Decerebate rigidity
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neck and elbow extension, wrist and finger flexion
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What three areas does the Glasgow Coma Scale assess?
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Eye, verbal, and motor response
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What is the best score on the Glasgow Coma Scale?
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15
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What score on the Glasgow Coma Scale indicates that the client is comatose?
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3
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HEADSS
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Psychosocial assessment tool of risk factors in the adolescent: Home, Education/employment, peer group Activities, Drugs, Sexuality, and Suicide/depression
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MPQ
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McGill Pain Questionnaire
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PAINAD
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Pain Assessment in Advanced Dementia
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Axis I
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Clinical disorders and other conditions that may be a focus of clinical attention
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Axis II
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Personality disorders and mental retardation
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Axis III
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General medical conditions
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Axis IV
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Psychosocial and environmental problems
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Axis V
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GAF scale
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GAF scores of 80-100 indicate
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normal or near-normal function
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GAF scores of 60-80 indicate
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moderate problems
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GAF scores of 40 and below indicate
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serious mental disability and/or functioning impairments
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A GAF score of 50/80 indicates
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a present GAF score of 50 and previous score of 80 in the past year
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CHAPTER TWO
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(Ignore this card)
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MH patients have the right to
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humane Tx and care; voting; and due process of law
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Tort
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A wrongful act or injury committed by an entity or person against another person or another person's property. Can be used to decide liability issues.
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Voluntary commitment
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Client is not required to take medications or treatment, and can leave at any time
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Involuntary (civil) commitment
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Client enters against will; judge may determine the need for commitment; several physicians must certify that the condition requires commitment
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Emergency involuntary commitment
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Client is hospitalized to prevent harm to self or others
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Observational / Temporary Involuntary Commitment
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Client is in need of observation, diagnosis, and Tx plan
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Long-term or formal involuntary commitment
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Must be imposed by court, length varies but usually around 60 - 180 days. Sometimes there is no set release date
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Does a client under involuntary commitment have the right to refuse Tx?
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Yes, unless they have been judged incompetent after a hearing
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Assault
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Making a threat to a client's person
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Battery
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Touching a client in a harmful or offensive way
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Types of intentional torts include (3)
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false imprisonment, assault, battery
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CHAPTER THREE
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(Ignore this card)
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Intrapersonal communication
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Talking to self
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Interpersonal communication
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Talking between 2 or more people in a group
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Public communication
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Communication that occurs within large groups of people
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Transpersonal communication
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Communication that addresses an individual's spiritual needs and provides interventions to meet those needs
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List the types of effective communication
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silence, active listening, open-ended questions, clarifying techniques, offering general leads, broad opening statements, Showing acceptance and recognition, focusing, asking questions, giving information, presenting reality, Summarizing, Offering self, Touch
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List the types of clarifying techniques
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Restating, Reflecting, Paraphrasing, Exploring
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Restating
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Therapeutic technique in which nurse uses the client's exact words
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Reflecting
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Therapeutic technique in which nurse directs the focus back to the client
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Paraphrasing
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Therapeutic technique in which nurse restates the client's feelings and thoughts for the client to confirm what has been communicated
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Exploring
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Therapeutic technique in which nurse gathers more information regarding important topics mentioned by the client
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Focusing
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Therapeutic technique in which nurse helps the client to concentrate on what is important
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List barriers to effective communication
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Asking irrelevant questions, offering personal opinions, giving advice, giving false reassurance, minimizing feelings, changing the topic, asking 'why' questions, offering value judgments, excessive questioning, responding approvingly or disapprovingly
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CHAPTER FOUR
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(Ignore this card)
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List the four healthy defense mechanisms
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Altruism, sublimation, humor, suppression
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List the six intermediate defense mechanisms
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Repression, reaction formation, somatization, displacement, rationalization, undoing
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List the eight immature defense mechanisms
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Projection, acting-out behaviors, dissociation, devaluation, idealization, splitting, passive aggession, and denial
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Altruism (as a defense mechanism
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Dealing with anxiety by reaching out to others
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Sublimation
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Dealing with unacceptable feelings or impulses by unconsciously substituting acceptable forms of expression
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Suppression
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Voluntarily denying unpleasant thoughts and feelings
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Repression
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Putting unacceptable ideas, thoughts, and emotions out of conscious awareness
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Displacement
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Shifting feelings related to an object, person, or situation to another less threatening object, person, or situation
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Reaction formation
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Overcompensating or demonstrating the opposite behavior of what is felt
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Somatization
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Developing a physical symptom in place of anxiety
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Undoing
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Performing an act to make up for prior behavior
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Rationalization
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Creating reasonable and acceptable explanation for unacceptable behavior
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Passive aggression
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Indirection behaving aggressively but appearing to be compliant
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Acting-out behaviors
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Managing emotional conflicts thorugh actions, rather than self-reflection
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Dissociation
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Temporarly blocking memories and perceptions from consciousness
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Devaluation
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Expressing negative thoughts or self or others
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Idealization
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Expressing extremely positive thoughts of self or others
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Splitting
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Demonstrating an inability to reconcile negative and positive attributes of self or others
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Projection
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Blaming others for unacceptable thoughts and feelings
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Denial
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Pretending the truth is not reality to manage the anxiety of acknowledging what is real
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The phases of the therapeutic relationship are
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Orientation, Working, Termination
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Transference
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occurs when the client views a member of the helath care team as having characteristics of another person who has been significant to the client's personal life
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Countertransference
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occurs when a health care team member displaces characteristics of people in her past onto a client
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CHAPTER SIX
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(Ignore this card)
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NAMI
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National Alliance on Mental Illness
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HMOs
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Health Maintenance Organizations
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PPOs
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Preferred Provider Organizations
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MBHOs
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Managed Behavioral Healthcare Organizations
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Primary Prevention
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promotes health and prevents mental health problems from occurring
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Secondary Prevention
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Focuses on early detection of mental illness
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Tertiary Prevention
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focuses on rehabilitation and prevention of further problems in clients previously diagnosed
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Assertive Community Treatment (ACT
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Includes nontraditional case management and treatment by an interdisciplinary team for a caseload of clients with severe mental illness who are noncompliant with traditional treatment; provides crisis intervention, assistance with independent living, and information regarding resources for necessary support services.
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Psychosocial rehabilitation programs
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Provide a structured range of programs for clinents in am mental health setting, including residential services and day programs for older adults for whom care is provided
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CHAPTER SEVEN
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(Ignore this card)
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Classical psychoanalysis
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a therapeutic process of assessing unconscious thoughts and feelings, and resolving conflict thorugh talking to a psychoanalyst for many sessions and over months to years
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Why is psychoanalysis (classical) not often used?
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Due to the long length of time required
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Free association
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spontaneous, uncensored verbalization of whatever comes to a client's mind
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How is psychotherapy different from classical psychoanalysis
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involves more verbal therapist-to-client interaction
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How is psychodynamic psychotherpay different from psychoanalysis
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oriented more to the client's present state rather than his early life
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IPT - Interpersonal PsychoTherapy
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used for clients with specific problems; can improve interpersonal relationships, communication, role-relationships, bereavement
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Cognitive therapy
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based on the cognitive model, which focuses on individual thoughts and behaviros to solve current problems; treats depression, anxiety, eating disorders, and other issues that can be improved by changing a client's attitude toward life experiences
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Behavioral therapy
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believes that changing behavior is key to treating problems such as anxiety and depression; based on the theory that behavior is learned and has consequences
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Cognitive reframing
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The client is helped to look at irrational cognitions in a more realistic light and to restructure those thougths in a more positive way; assists clients to identify negative thoughts that produce anxiety, examine the cuase, and develop supportive ideas that replace negative self-talk
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Modeling
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the therapist or others serve as role models for the client, who learns improved behavior by imitation
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Operant conditioning
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positive rewards are given for positive behavior
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Systematic desensitization
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planned, progressive, or graduated exposure to anxiety-provoking stimuli in real-life situations, or by imagining events that cause anxiety
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Aversion therapy
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a maladaptive behavior is paired with a punishment or unpleasant stimuli to change the behavior
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Flooding
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exposting a client, while accompanied by a therapist, to a reat deal of undesireable stimuli in an attempt to turn off the anxiety response
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Response prevention
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preventing a client from performing a compulsive behavior with the intent that anxiety will be diminished
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Thought stopping
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teaching a client, when negative thoughts or compulsive behaviors arise, to say or shout 'stop' and substitute a positive thought
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CHAPTER EIGHT
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(Ignore this card)
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Group norm
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the way the group behaves during sessions, and over time, it provides structure for the group
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Subgroup
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small number of people within a larger group who function separately from the group
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Three types of group roles
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Maintenance, Task, and Individual roles
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Maintenance roles
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members who take on these roles tend to help maintina the purpose and process of the group
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Task roles
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members take on very tasks within the group processes
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Individual roles
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these roles tend to prevent teamwork, because individuals take on roles to promote their own agenda
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Placating
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One member takes responsibility for problems in order to keep peace at all costs
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Scapegoating
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a member of the family with little power is blamed for all problems within the family
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Triangulation
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a third party is drawn into the relationship with two members who relationship is unstable
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Multigenerational issues
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these are emotional issues or themes within a family that continue for at least three generations, such as a pattern of addiction
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CHAPTER NINE
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(Ignore this card)
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GAS
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general adaptation syndrome = fight or flight response
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PMR - progressive muscle relaxation
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a person trained in this method can help a client attain complete relaxation within a few minutes of time
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Assertiveness training
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One technique teaches the cleint to assert his feelings by describing a situation or behavior that causes stress, stating his feelings about the behaavior or situation, and then making a change
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CHAPTER TEN
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(Ignore this card)
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How MIGHT ECT work?
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theory suggests that ECT may enhance the effects of neurotransmitters (serotonin, dopamine, and norepinephrine) in the brain
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List two groups of depressed patients for whom ECT may be an option
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(1) clients for whom the risks of other treatments outweigh the risks of ECT, (2) clients who are actively suicidal and for whom there is a need for rapid therapeutic response
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What types of schizophrenic patients require ECT?
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types that are less responsive to neuroleptic medications (catatonic, shizoaffective disorders)
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What types of manic patients require ECT?
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bipolar disorder with rapid cycling (4 or more episodes of acute mania within 1 year) and very destructive behavior - typicallly have poor response to lithium therapy
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List four contraindications for ECT
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Recent MI, Hx of CVA, cerebrovascular malformation, intracranial mass lesion
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What type of depression is ECT not useful for?
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situational depression
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The typical course of ECT Tx is what
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3 times/week for a total of 6-12 Tx
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What medications should be d/c-ed before ECT?
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any meds that affect seizure threshold; MAOIs and lithium 2 weeks before
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Why should severe HTN be controlled in the ECT patient?
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a short period of HTN occurs STAT after the ECT
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Any cardiac conditions, such as dysrhythmias, should be monitored and treated before ECT
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(Please ignore this side of the card)
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What medication is given 30 minutes before ECT and what does it do?
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IM injection of atropine sulfate or robinul (Glycopyrrolate) to decrease secretoins and counteract any vagal stimulation
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When is ECT administered?
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early in the AM after the client has fasted for 8-12 hours
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A short-acting anesthetic is administered before ECT, such as what
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methohexital (Brevital) via IV bolus
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A muscle relaxant is administered after the anesthetic to the ECT patient, such as
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succinylcholine (Anectine)
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How long is an ECT stimulus applied?
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0.2-0.8 seconds
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Following ECT, when does the client be transferred back to the mental health unit?
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30-60 minutes
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What happens to heart rate baseline during ECT?
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rises by 25% in procedure and early recovery
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What happens to B/P in ECT?
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initially falls and then rises, lowering to normal after procedure
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What S/S occur following ECT?
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HA, muscle soreness, nausea
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CHAPTER ELEVEN
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(Ignore this card)
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What is GAD and how long does it last?
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Generalized Anxiety Disorder, 6 months
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What is acute stress disorder?
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exposure to a traumatic event causing numbing, detachmnet, and amnesia about the event for not more than 4 weeks following the event
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Anxiety disorders are more likely to occur in men or women?
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Women
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How long do panic disorders last?
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15-30 minutes
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Systematic desensitization
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begins with mastering of relaxation techniques, then client is exposed to increasing levels of an anxiety-producing stimulus and uses relaxatoin to overcome the resulting anxiety.
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Flooding
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exposing the client to a great deal of anxiety-producing stimuli in order to turn off the anxiety response
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Response prevention
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focuses on preventing the client from performing a compulsive behavior with the intent that anxiety will be diminished
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CHAPTER TWELVE
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(Ignore this card)
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MDD stands for what and how long do the S/S last?
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Major depressive disorder - five specific S/S lasting for a minimum of 2 weeks, occur at least every day for most of the day
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Describe MDD with atypical features
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S/S include chagnes in appetite or weight gain, excessive daytime sleepiness
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Describe MDD with postpartum onset
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episode begins within 4 weeks of childbirth
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Describe MDD with seasonal characteristics
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Seasonal affective disorder (SAD) which occurs during winter and may be treated with light therapy
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Describe MDD with chronic features
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a depressive episode that lasts over 2 years
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Describe the three phases of MDD
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(1) acute - severe symptoms of depression; (2) maintenance - increased ability to function; (3) continuation - remission of S/S
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Who are depressive disorders more common in?
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2x as common in females between the ages of 15 and 40 than in males
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Depression is very common in the elderly and is sometimes confused with dementia. What S/S of depression might be confused with dementia?
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memory loss, confusion, behavioral problems such as social isolation or agitation
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Serotonin deficiency is a risk factor for what?
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depression
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Anergia
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lack of energy
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Psychomotor retardation
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slowed physical movement, slumped posture
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Psychomotor agitation
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restlessness, pacing, finger tapping
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St. John's Wart is used to relieve what?
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S/S of mild depression
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What are adverse effects of St. John's Wart?
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photosensitivity, skin rash, rapid heart rate, GI distress, abdominal pain
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What can occur if St. John's Wart is taken with SSRIs?
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serotonin syndrome
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What is light therapy used for?
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it is the first-line Tx for SAD, inhibits nocturnal secretion of melatonin
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Describe light therapy?
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exposure of the face to 10,000-lux light box for 30 minutes a day, once or in 2 divided doses
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What is TMS?
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transcranial magnetic stimulation - a new therapy using electromagnetic stimulation of the brain; it may be helpful for depression that is resistant to other forms of Tx
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What is VNS
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Vagus nerve stimulation - an implanted device that stimulates the vagus nerve, it can be used for clients who have depression that is resistant to at least 4 antidepressant medications
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CHAPTER THIRTEEN
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(Ignore this card)
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When do bipolar disorders usually emerge?
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in late adolescence/early adulthood
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Children are not usually diagnosed with bipolar disorders until when?
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after the age of 7
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Describe the phases of bipolar disorder
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(1) acute - acute mania; (2) maintenance - increased ability to function; (3) continuation - remission of S/S
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Hypomania is a less severe episode of mania that lasts how long?
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at least 4 days
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What is a mixed episode of bipolar disorder?
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a manic episode and an episode of major depression experienced at the same time - marked impairment in functioning and may require admission to an acute care mental health facility to prevent self-harm or other-directed violence
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What is rapid cycling of bipolar disorder?
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four or more episodes of acute mania within 1 year
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Bipolar I disorder
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The client has at least one episode of mania alternating with major depression
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Bipolar II disorder
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The client has one or more hypomanic episodes alternating with major depressive episodes
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Cyclothymia
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The client has at least 2 years of repeated hypomanic episodes alternating with minor depressive episodes
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What may lead to a relapse episode of mania in bipolar disorder?
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use of substances (ETOH, drugs, caffeine)
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How much sleep does a client with mania require?
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a minimum of 4-6 hours
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CHAPTER FOURTEEN
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(Ignore this card)
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Paranoid schizophrenia
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characterised by suspicion toward others
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Disorganized schizophrenia
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characterized by withdrawal from society and very inappropriate behaivors (poor hygiene, muttering constantly); frequently seen among the homeless; S/S include loose associations, bizarre mannerisms, incoherent speech, hallucinations and delusions (much less organized that those in clients with paranoid type)
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Schizoaffective disorder
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the client's disorder meets both the criteria for schizophrenia and of the affective disorders (depression, mania, or a mixed disorder)
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Brief psychotic disorder
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the client has psychotic S/S that last between 1 day to 1 month in duration
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Schizophreniform disorder
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the client has S/S like those of schizophrenia, but the duration is from 1-6 months and social/occupational dysfunction may not be present
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Shard psychotic disorder
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AKA 'Folie a Deux'
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Secondary (induced) psychosis
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S/S of psychosis are brought on by a medical disorder or by use of chemical substances
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Positive S/S of schizophrenia
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These S/S are normal processes, but at abnormal levels - hallucinations, delusions, alterations in speech, bizarre behavior, such as walking backward constantly
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Negative S/S of schizophrenia
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These S/S refer to a lack of normala processes - flat affect, alogia, avolition, anhedonia, anergia
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ideas of reference
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misconstrues trivial events and attaches personal significance to them, such as believing that others are talking about him
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thought broadcasting
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believes that her thought are heard by others
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thought insertiion
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believes that others' thoughts are being inserted into his mind
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Thought withdrawal
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Believes that her thoughts have been removed from her mind by an outside agency
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Word salad
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words jumbled together with little meaning or significance to listener
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Clang association
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meaningless rhyming of words, often forceful
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Flight of ideas
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Associative looseness
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What are personal boundary difficulties and what are two types?
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disenfranchisement with one's own body, identity, and perceptions. Includes depersonalization and derealizataion
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Depersonalization
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nonspecific feeling that a person has lost her identity; self is different or unreal
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Derealization
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perception that environment has changed
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Wavy flexibility
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excessive maintenance of positoin
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Negativism
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doing the opposite of what is requested
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CHAPTER FIFTEEN
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(Ignore this card)
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Describe the three clusters of personality disorders
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(A) odd or eccentric; (B) dramatic, emotional, erratic; © anxious or fearful
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Splitting is commonly associated with which disorder?
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borderline personality disorder
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Cluster A personality disorders
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paranoid, schizoid, schizotypal
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Cluster B personality disorders
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antisocial, borderline, histrionic, narcissistic
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Cluster C personality disorders
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avoidant, dependant, obsessive-compulsive
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Dialectical behavior therapy
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a cognitive-behavioral therapy used for clients with borderline personality disorder; focuses on gradual behavior changes and provides acceptacne and validation for these clients, who are very frequently suicidal and have self-mutilating behaviors
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CHAPTER SIXTEEN
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(Ignore this card)
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What are cognitive disorders characterized by?
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the disruption of thinking, memory, processing, and problem solving
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List some risk factors for cognitive disorders
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physiological chagnes, family genetics, infections (HIV/AIDS), tumors, substance abuse, drug intoxication, drug withdrawal
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What are risk factors for Alzheimer's disease?
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advanced age, female gender, prior head trauma, family history of alzheimer's disease, trisomy (Down syndrome)
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What happens to VS in delirium?
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may be unstable and abnormal due to medical illness
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What happens to VS in dementia?
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stable unless other illness is present
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What causes dementia?
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generally caused by a chronic disease, such as Alzheimer's disease, or is the result of chronic ETOH abuse, may be caused by permanent trauma, such as head injury
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List and describe the stages of Alzheimer's
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(1) no impariment, (2) very mild cognitive decline, which may be normal age-related changes, or very early signs of Alzheimer's disease, (3) mild cognitive decline, including problems with memory or concentration that may be measurable in clinical testing or during a detailed medical interview, (4) moderate cognitive decline that is clearly detected during a medical interview, (5) moderately severe cognitive decline, (6) severe cognitive decline, (7) very severe cognitive decline
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Confabulation
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the client may make up stories when questioned about events or activities that she does not remember - an unconscious attempt to save self-esteem and prevent admitting that she does not remember the occasion
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Perseveratoin
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the client avoids answering questions by repeating phrases or behavior - an unconscious attempt to maintain self-esteem when memory has failed
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Amnestive disorder may be secondary to what?
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substance abuse or another medical condition - there is normally no personality change or impairment in abstract thinking
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Changes due to amnestic disorders include what?
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decreased awareness of surroundings, inability to learn new information despite normal attention, inability to recall previously learned information, possible disorientation to place and time
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What is the effect of estrogen therapy on Alzheimers?
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may prevent it, but it is not useful in decreasing the effects of pre-existing dementia
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CHAPTER SEVENTEEN
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(Ignore this card)
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Substance abuse is diagnosed over how long?
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12 months
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Tolerance
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the need for higher and higher doses of a substance to achieve the desired effect
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Withdrawal
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the stopping or reduction of intake that results in specific physical and psychological signs and symptoms
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What defense mechanism is commonly used by clients who have substance abuse problems?
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denial
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Legally intoxicated is described as
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Blood Alcohol Concentration (BAC) of 0.08% (80g/dL)
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Death from ETOH could occur at what levels?
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levels greater than 0.35% (350 g/dL)
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What are two serious effects of excess alcohol?
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respiratory arrest and peripheral collapse
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What are several effects of chronic alcohol?
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direct cardiovascular damage, erosive gastritis, GI bleeding, acute pancreatitis
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When do effects of ETOH withdrawal occur?
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usually start within 4-12 hours of the last intake, peak after 24-48 hours, and then suddenly disappear
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What are S/S of ETOH withdrawal?
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abdominal cramping, vomiting, tremors, restlessness and inability to sleep, increased VS, and tonic-clonic seizures
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ETOH withdrawal delirium may occur when?
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2-3 days after cessation of ETOH
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How long does ETOH withdrawal delirium last?
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2-3 days
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What are the S/S of ETOH withdrawal delirium?
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severe disorientation, psychotic symptoms (hallucinations), severe HTN, cardiac dysrhythmias, delirium, may progress to death
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What is the antidote to Benzodiazepine toxicity?
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flumazenil (Romazicon)
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What are the withdrawal S/S of Benzodiazepines?
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anxiety, insomnia, diaphoresis, HTN, possible psychotic reactions, seizure activity
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What is the antidote for barbiturate toxicity?
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There is none
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What are the milder S/S of barbiturate withdrawal?
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the same as those seen in ETOH withdrawal
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What are the severe S/S of barbiturate withdrawal?
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possibly life-threatening convulsions, delirium, and cardiovascular collapse similar to that of ETOH withdrawal
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What are the toxic effects of chronic cannabis use?
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lung cancer, chronic bronchitis, and other respiratory effects; in high doses, paranoia
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What are the withdrawal S/S of cannabis
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depression, possibly
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What are examples of cannabis
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MJ or hashish, which is more potent
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What are the S/S of mild cocaine toxicity
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dizziness, irritability, tremor, blurred vision
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What are the S/S of severe cocaine toxicity
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hallucinations, seizures, extreme fever, tachycardia, HTN, chest pain, possible cardiovascular collapse and death
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What are the S/S of cocaine withdrawal
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depression, fatigue, craving, excess sleeping or insomnia, dramatic unpleasant dreams, psychomotor retardation or agitation
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What are the S/S of amphetamine toxicity?
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impaired judgment, psychomotor agitation, hypervigilance, extreme irritability, acute cardiovascular effects (tachycardia, increased B/P)
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What are the S/S of amphetamine withdrawal?
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craving, depression, fatigue, sleeping
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What is the antidote for opioids
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naloxone (Narcan) by IV
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What are examples of opioids
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heroin, morphine, hydromorphone (Dilaudid)
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Opioid withdrawal causes an abstinence syndrome. What are the S/S?
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begins with sweating and rhinorrhea progressint to piloerection (goosebumps), tremors, irritability followed by severe weakness, N/V, pain the muscles and bones, and muscle spasms. Lasats 7-10 days but not fatal
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What are examples of inhalants?
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amyl nitrate, nitrous oxide, solvents
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What are the toxic effects of inhalants?
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CNS depression, symptoms of psychosis, respiratory depression, possible death
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What are the withdrawal S/S of inhalants
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none
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What are the examples of hallucinogens
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lysergic acid diethylamide (LSD), mescaline (peyote), phencyclidine piperidine (PCP)
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What are the toxic effects of hallucinogens
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panic attacks, flashbacks occurring intermittently for years
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What are the withdrawal S/S of hallucinogens?
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None
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What medications are used for ETOH withdrawal?
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valium, ativen, tegretol, catapres
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What meds are used for ETOH abstinence?
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antabuse, revia, campral
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what meds are used for opioid withdrawal
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methadone, catapres, subutex, buprenorphine + naloxone
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What meds are used for nicotine withdrawal?
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bupropion, nicotine replacement therapy
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