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ATI proctored Mental Health
Terms in this set (125)
What are cognitive symptoms of psychotic disorders
-inability to make decisions
-poor problem solving ability
-difficult concentrating to perform tasks
Misconstrues trivial events and attaches personal significance to them, such as believing that others, who are discussing the next meal, are talking about them
ideas of reference
Feels singled out for harm by others (being hunted down by FBI)
Believes that she is all powerful and important like a god
believes that his body is changing in an unusual way, scubas growing a third arm
May feel that her spouse is sexually involved with another individual
Believes that a force outside his body is controlling him
believes that her thoughts are heard by others
believes that others thoughts are being inserted into his mind
Believe that her thoughts have been removed form her mind by an outside agency
is obsessed with religious beliefs
The client may say sentence after sentence but each sentence may relate to another topic and the listeniner is bale to follow the clients thoughts
flight of ideas
Made up words that have meaning only to the client such as i tranged and flitted.
What are the standardized screen tools for psychotic disorders
-Global assessment of functioning scale
-scale for assessment of negative symptoms
-brief psychiatric rating scale
-Brief psychiatric rating scale
-abnormal involuntary movement scale (AIMS)
What antidepressants are prescribed for psychotic disorders
-monitor for SI
-Notify for deepened depression
-Do not stop abruptly
What are the anxiolytics/ bento's used for psychotic disorders?
-need to get blood tests for ANC
-use caution in older adults
What are the personality disorders in cluster A
(Odd and eccentric traits)
Characterized by odd beliefs leading to interpersonal difficulties, an eccentric appearance, and magical thinking or perceptual distortions that are not clear delusions or hallucinations
Dealing with anxiety by reaching out to others.
Ex: a nurse who lost a family member in a fire is a volunteer firefighter
Dealing with unacceptable feelings or impulses by unconsciously substitute acceptable forms of expression.
Ex: a person who has feelings of anger and hostility toward his work supervisor sublimates those feelings by working out vigorously a the gym during his lunch period
Voluntarily denying unpleasant thoughts and feelings.
Ex: A person who has lost his job states he will worry about paying his bills next week
Putting unacceptable ideas, thoughts, and emotions out of conscious awareness.
Ex: a person who has a fear of the dentist's drill continually "forgets" his dental appointments.
What are healthy defense mechanisms?
alturism and sublimation
what are intermediate defenses
What are immature defenses
Shifting feelings related to an object, person, or situation to another less threatening object, person, or situation
Ex: A person who is angry about losing his job destroys his child's favorite toy
Overcompensating or demonstrating the opposite behavior of what is felt.
Ex: a person who dislikes her sisters daughter offers to babysit so that her sister can go out of town
Performing an act to make up for prior behavior.
Ex; An adolescent completes his chores without being prompted to after having an argument with his parents.
creating reasonable and acceptable explanations for unacceptable behavior
Ex: A young adult explains he had to drive home from a party after drinking alcohol because he had to feed his dog.
temporarily blocking memories and perceptions from consciousness
Ex: an adolescent witnesses a shooting and is unable to recall any details of the vent
demonstrating an inability to reconcile negative and positive attributes of self or others
Ex:a client tells a nurse that she is the only one who cares about her, yet the following day the same client refuses to talk to the nurse
Blaming others for unacceptable thoughts and feelings
Ex: a young adult planes his substance use disorder on his parents refusal to buy him a new car
pretending the truth is no reality to manage the anxiety of acknowledging what is real.
Ex: A parent who is informed that his son was killed in combat tells everyone he is coming home for the holidays.
Orientation phase of a therapeutic relationship includes what?
-Introduction to client and state purpose
-Set the contract: meeting time, place, frequency, duration and date of termination
-build trust by establishing expectations and boundaries
-set goals with the client
-explore the clients ideas, issues, and needs
-explore the meaning got testing behaviors
-enforce limits on testing or other inappropriate behaviors
Working phase of a therapeutic relationship includes what?
-perform ongoing assessment
-facilitate the clients expression of needs and issues
-encourage pt to problem solve
-promote self esteem
-foster positive behavioral change
-explore and deal with resistance and other defense mechanisms
-recognize transference and countertransference
-reassess goals and plan
-remind client of termination date
Termination phase of a therapeutic relationship includes what?
-provide pt tine to discuss thoughts and feelings about termination
-discuss the clients experience with separation and loss
summarize goals and achievements
-review memories of work in the sessions
-express own feelings
-discuss ways to incorporate new healthy behaviors
matinaing limits of final termination
What is included in cognitive reframing
A therapist or others serve as a role models for a client, who imitates this modeling to improve behavior
The client receives positive rewards for positive behavior positive reinforcement
This therapy is the planned, progressive, or graduate exposure to anxiety providing stimuli in relief situation, or by imagining events that case anxiety during exposure the client uses relaxation
Pairing of a maladaptive behavior with a punishment or unpleasant stimui such as a bitter taste or mild electric shock as punishment for behaviors such as alcohol use disorder violence self mutilation and thumb sucking
This therapy uses various techniques to control pain tension and anxiety
meditation, guided imagery, diaphragmatic breathing, muscle relaxation, and biofeedbacks
exposing a client while in the company of a therapist to a great deal of an undesirable stimulus in an attempt to turn off the anxiety response
preventing a client from performing a compulsive behavior with the intent that anxiety will diminish
teaching a client, when negative thoughts or compulsive behaviors arise, to say or shout, "stop" and substitute a positive thought. this goal over time is for the client to use the command silently
This style supports group interacting and decision making to solve problems
the group process progresses without any attempt by the leader to control the direction
The leader completely controls the direction and structure of the group without allowing group interaction or decision making to solve problems
some group members or the leader may have goals different from the stated group goals that may disrupt group processes
Initial phase of group development includes:
define the purpose and goals of the group
-leader sets tone of respect, trust and confidentiality
-members get to know each other and the group leader
-there is a discussion about termination
Working phase of group development includes:
promote problem solving skills to facilitate behavior changes. Power and control issues may dominate in this phase.
-group leader uses therapeutic communication to encourage group work toward meeting goals.
-members take informal roles within the group, which may interfere with or favor group progress toward goals.
Termination phase of group development includes:
This makes the end of group sessions
-group members discuss termination issues
-the leader summarizes work of the group and individual contributions.
one member takes responsibility for problems to keep peace at all costs
a member of the family with little power is blamed for problems within the family
a third party is drawn into the relationship with two members whose relationship is unstable
These are emotional issues or themes within a family that continue for atlas three generations such as a pattern of substance use or addictive behavior when the families is under stress, dysfunctional grief pattern triangulation patterns and divorce
The body's response to an increased demand. The first stage is initial adaptive response aka fight or flight mechanism. If it is prolonged maladaptive responses can occur
General adaptation syndrome
What are the fight or flight responses or adaptive responses?
-unhappiness or sorrow
-increased respiratory rate, HR, CO, BP
-depressed immune system
What are the prolonged stress or maladaptive responses?
-depression, chronic pain, sleep disturbances
-weight gain or loss
-increased risk for MI/ Stroke
-poor diabetes control, hypertension, fatigue, irritability, decreased ability to concentrate
-increased risk for infection
What screen tools do you use for Stress management?
life changing events questionnaire
-Lazarus Cognitive Appraisal
who can ECT be used on?
- pt that has rapid cycling of acute manic episodes
- schizophrenia spectrum disorders that are less responsive to neuroleptic meds such as schizoaffective disorder
High risk pt with ECT
- hx of CVA
-intracranial mass lesion
-increased intracranial pressure
What is ECT not successful in?
What meds should be discontinued before ECT
usually 2 weeks ahead of time
What is injected before ECT to decrease secretions and counteract any vagal stimulation?
atropine sulfate or robinul
what short acting anesthetic is used for ECT
brevital IV bolus
What muscle relaxant is used
Electrical stimulus time vs seizure time
0.2-0.8 for electrical stimulus
25-60 for seizure activity
complications of TMS
-tingling sensation at the site of the electromagnet
-seizures are rare but a potential
complications of VNS
-throat or neck pain
-dyspnea with exertion
What standardized screen tools would be used for anxiety disorders?
-Hamilton rating scale for anxiety
-modified speilberger state anxiety scale
-Yale brown obsessive compulsive scale
-hoarding scale self report
-national stressful events survey
What is the first line of treatment for anxiety disorders?
-SSRI such as zoloft
Then they can also benefit from antidepressants, sedative hypnotic anxiolytics such as valium, non barbiturate anxiolytics such as buspar, beta blockers, antihistamines.
What are the standardized screen tools for depressive disorders?
-Hamilton depression scale
-beck depression inventory
-geriatirc depression scale (short form)
-zung self rating depression scale
What SSRI's are used for depression?
What TCA's are used for depression?
What MAOI's are used for depression
What Atypical antidepressants are used for depression?
What SNRI's are used for depression?
When patient is taking SSRI for depression what client teaching needs to be done?
-may cause nausea, headache and CNS stimulation (agitation, insomnia, anxiety)
-sexual dysfunciton may occur
-observe for serotonn syndrome
-No st. Johns wort
What are affective symptoms
What client teaching is needed with a depressive patient when they are taking TCA?
-Change positions slowly
-Chew sugarless gum, eat foods high in fiber, increase fluids to reduce anticholinergic effects
What client teaching is need with a depressive patient taking MAOI's
- avoid tyramine foods
-avoid all medications including OTC talk to DR first
What client teaching is needed with a depressive patient that is taking atypical antidepressants
- watch for HA, dry mouth, GI distress, constipation, increased HR, nausea restlessness or insomnia. Notify DR
-dont give to seizure patients
What client teaching is needed with a depressive patient that is taking SNRI's
-adverse effects include nausea, weight gain, and sexual dysfunction
the client has at least one episode of mania alternating with major depression
The client has one or more hypomanic episodes alternating with major depressive episodes
The client has atlas 2 years of repeated hypomanic manifestations that do not meet the criteria for hypomania episodes alternating with minor depressive episodes.
Risk factors of Bipolar
-Genetics having an immediate family member who has a bipolar disorder
-psychological such as a stressful event or major life event
-physiological such as neurobiological or neuroendocrine disorder.
-substance use disorder
What are the standardized screening tools for Bipolar disorders?
-The mood disorders questionnaire.
What medications are given for patients that have bipolar disorder?
-Mood stabilizers: Lithium
-Anticonvulsants that act as mood stabilizers: Depakote, Klonopin, Lamictal, nuerontin, Topaz
-Benzo's: Ativan, for sleep
-Antidepressants such as Prozac to manage depression
The client has psychotic thinking or behavior present for atlas 6 months. Areas of functions including school or work, self care, and interpersonal realties are significantly impaired
the client has impairments of personality functioning. However impairment is no as severe as with schizophrenia
Schizotypal personality disorder
The client experiences delusional timing for atlas 1 month. Self or interpersonal function is not markedly impaired
What atypical antipsychotics would be prescribed for patients with psychotic disorders?
These treat both negative and positive symptoms
Report agitation, dizziness, sedation, and sleep disruption may occur.
What are the conventional antipsychotics for psychotic disorders
Minimize anticholinergic effects
get up slowly
the client has psychotic manifestations that last between 1 day to 1 mont in duration
brief psychotic disorder
The client has manifestation similar to those of schizophrenia, the but duration is from 1 to 6 months and social occupation dysfunction may or may not be present
What are the risk factors of personality disorders?
-comorbid substance use disorders
-hx or nonviolent and violent crime
-childhood abuse or trauma
-development factors with a direct link to parenting
-Genetic and Biochemical factors
What are the common pathological personality characteristics in a personality disorders
-Inflexibility/maladaptive responses to stress
-compulsiveness and lack of social restraint
-inability to emotionally connect in social and professional relationship
-tendency to provoke interpersonal conflict
-ability to merge personal boundaries with others.
the clients disorder meets both the criteria for schizophrenia and depressive or bipolar disorder
The client experiences psychosis within 1 month of substance intoxication or withdrawal. May be caused by medications intend for therapeutic use
Substance induced psychotic disorder
Characterized by distrust and suspiciousness toward others based on unfounded beliefs that others want to harm, exploit, or deceive the person
Characterized by emotional detachment, disinterest in close relationships and indifference to praise or criticism; often uncooperative
What are the personality disorders in Cluster B
Characterized by instability of affect, identity, and relationships, as well as splitting behaviors, manipulations, impulsiveness, and fear of abandonment; often tries self injury
Characterized by arrogance, grandiose views of self importance, the need for consistent admiration and a lack of empathy for others that strains most relationships; often sensitive to criticism
characterized by emotional attention-seeking behavior in which the person needs to be the center of attention often seductive and flirtations
Characterized by disregard for others with exploitation, repeated unlawful actions, deceit, and failure to accept personal responsibility
What personality disorders are in cluster C
Characterized by perfectionism with a focus on orderliness and control to the extent that the individual may not be able to accomplish a given task
Characterized by extreme dependency in a close relationship with a n urgent search to find a replacement when one relationship ends
Characterized by social inhibition and avoidance of all situations that rear interpersonal contact, despite wanting close relationships due to extreme fear of rejection;often very anxious in social situations
clients who have dependent and histrionic personality disorders often benefit from
assertiveness training and modeling
Clients who have schizoid or schizotypal personality disorders ten to
isolate themselves the nurse should respect this need
What medications maybe used for personality disorders
What is dialectical behavior therapy used on what type of patient
risk factors for cognitive disorders
-hepatic or renal failure
-fluid and elctrolyte imbalances
-Substance use or withdrawal
*More communion older adult clients and clients in and intensive care unit.
Ris factors for neurocognitive disorder and Alzheimer's disease
-disorder of the neurological system
-prior head trauma
-family history of Alzheimer's disease and or down syndrome
Standardized screening tools for cognitive disorders
-Functional Dementia Scale
-Mental or Mini Mental staus Examination
-Functional Assessment Screening tool
-Global Deterioration Scale
-Blessed dementia Scale
What medications would you give for a patient that has Delirium
What medications would you give for a patient that has a neurocognitive disorder
What are the adverse effects of neurocognitive disorder medications
What are the medications for anxiety disorder (Benzo)
What are the atypical anxiolytic