Crisis is a temporary state of disequilibrium in which an individual's usual
coping mechanism or problem-solving methods fail.
Milieu is a physical and social environment in which an individual
lives.
Milieu therapy focuses on positive physical and social environmental
manipulation to produce positive change.
Seclusion is the placing a client alone in a specially designed room
that protects the client and allows for close supervision. Seclusion is the
last selected measure in a process to maximize safety to the client and others.
Suicide is the ultimate act of self-destruction in which an individual
purposefully ends his or her own life.
The goal of the nurse-client relationships is to assist the client to
develop problem-solving abilities and coping mechanism.
Preinteraction, orientation, working and termination are the four phases
of therapeutic nurse-client relationships.
Successful communication includes appropriateness, efficiency,
flexibility and feedback.
Mental health is a lifelong process of successful adaptation to
changing internal and external environment.
Coping mechanism and defense mechanism are used by the client to
decrease anxiety.
Safety is the most important priority in managing the milieu.
Interpersonal psychotherapy is a treatment modality that uses a
therapeutic relationship to modify the client's feelings, attitudes and
behavior.
Behavior therapy is a treatment approach that uses the principles of
Skinnerian (operant conditioning) or Pavlovian (classical conditioning)
behavior theory to bring about behavioral change.
The behavior therapy beliefs are that most behaviors are learned.
Aversion therapy is a form of behavior therapy whereby negative
reinforcement is used to change behavior.
Modelling is behavioral therapy whereby the therapist acts as a role
model for specific identified behaviors so that the client learns through imitation.
Cognitive therapy is an active, directive, time-limited, structured
approach used to treat a variety of disorders, including anxiety, depression,
and phobias.
Cognitive therapy is based on the principle that how individuals feel
and behave is determined by how they think about the world and their place in
it.
In group therapy involves a therapist and, ideally, five to eight
members.
In psychoanalytical group psychotherapy the therapist holds a main position.
The three ego states of the individual are examined in transactional
analysis.
Rational emotive therapy is a type of cognitive therapy in which the
therapist focuses on how irrational beliefs and thoughts contribute to
psychological distress.
In Rogerian therapy the therapist goal is to help the members to
express their feelings toward one another during group session.
Gestalt therapy emphasis is on the “here and now “.
Gestalt therapy emphasizes self-expression, self-exploration, and
self-awareness in the present.
Anxiety is a subjective experience that includes feelings of apprehension,
uneasiness, uncertainty, or dread.
If a client experiences anxiety, immediate actions are to provide a
calm environment, decrease environmental stimuli, and stay with the client.
Phobias is irrational fear of an object or situation that persists,
although the person may recognize it as unreasonable.
By phobia client defense mechanism commonly used include repression and
displacement.
Astraphobia is the fear of electrical storms.
Mysophobia is the fear of dirt and germs.
Nyctophobia is the fear of darkness.
Pyrophobia is the fear of fires.
Xenophobia is the fear of strangers.
Always stay with the client experiencing anxiety to promote safety and
security. Never force the client to have contact with the phobic object or
situation.
Obsessions is the preoccupation with persistently intrusive thoughts
and ideas.
Somatoform disorders are characterized by persistent worry or
complaints regarding physical illness without supportive physical findings.
Conversion disorder, somatization disorder and hypochondriasis are the
somatoform disorders.
Hypochondriasis is the preoccupation with fears to having a serious
disease. No evidence of physical illness exists.
In somatization disorder the client has multiple physical complaints
involving numerous body systems.
Dissociative disorder is a disruption in integrative functions of
memory, consciousness, or identity.
Dissociative identity disorder (multiple personality), dissociative
amnesia, dissociative fugue and depersonalization disorder are the example of
dissociative disorder.
In dissociative identity disorder two or more fully developed, distinct
and unique personalities exist within the client.
In dissociative amnesia the client inability to recall important personal
information because it provokes anxiety. Memory impairment may range from
partial to almost complete.
In dissociative fugue the client assumes a new identity in a new
environment.
Depersonalization disorder is an altered self-perception in which one's
own reality is temporarily lost or changed.
Nurse provide high calorie finger food and fluids to mania client.
Nurse monitor a depressed client closely for the signs of suicidal
ideation.
Schizophrenia is a group of mental disorders characterized by psychotic
features (hallucinations and delusions), disordered thought process, and
disrupted interpersonal relationships.
Disturbance in affect, mood, behavior, and thought process occurs in
schizophrenia.
Alogia is the poverty of thought.
Avolition is the loss of motivation.
Anhedonia is the inability to experience pleasure or joy.
Echolalia is the repeating the speech of another person.
Echopraxia is the repeating the movements of another.
Waxy flexibility is an having one's arms or legs placed in a certain
position and holding that same position for hours.
In circumstantiality the client before getting to the point or
answering a question, client gets caught up in countless details and explanations.
Confabulation is the filling a memory gap with detailed fantasy by the
teller.
Flight of ideas is the constant flow of speech in which client jumps
from one topic to another in rapid succession.
Confabulation is commonly seen in organic conditions such as Korsakoff's
psychosis.
In neologism the client makes up words that have meaning only for the
individual.
Thought blocking is the sudden cessation of a thought in the middle of
a sentence.
Word salad is the mixture of words and phrases that has no meaning.
Delusions is a false belief held to be true, even when there is evidence
to the contrary.
Delusions of grandeur is the false belief that one is a powerful and
important person.
Delusions of persecution, in which the client believes that he or she
is being harassed, threatened, or persecuted by some powerful force.
Clang association is the repetition of the words or phrases that are
similar in sound but in no other way.
Mutism is the absence of verbal speech.
Verbigeration is the purposeless repetition of words or phrases.
For a client with hallucinations, safety is the first priority.
Suspiciousness, hostility, delusions, auditory hallucinations, anxiety
and anger, aloofness, persecutory themes and violence are the features of
paranoid schizophrenia.
Psychomotor disturbance, immobility, stupor, waxy flexibility, excessive
purposeless motor activity, echolalia, automatic obedience and stereotyped or
repetitive behavior are the features of catatonic schizophrenia.
Client with paranoid disorder exhibits suspiciousness and mistrust of
others.
Client with paranoid disorder may have grandiose and persecutory
delusions.
Nurse do not whisper or laugh in front of a client with a paranoid
disorder because the client will think that nurse is talking about or laughing
at him or her; this increases the paranoia.
Schizoid personality disorder is characterized by an inability to form
warm, close social relationships.
Histrionic personality disorder is characterized by overly dramatic and
intensely expressive behavior.
Narcissistic personality disorder is characterized by an increased
sense of self-importance and preoccupation with fantasies and unlimited
success.
Borderline personality disorder is characterized by instability in
interpersonal relationships, unstable mood and self-image, and impulsive and
unpredictable behavior.
Autism, attention deficit hyperactivity disorder, dementia and
Alzheimer's disease are the cognitive impairment disorders.
In dementia long-term and short-term memory loss occur, with impairment
in judgment, abstract thinking, problem-solving ability and behavior.
Most common type of dementia is Alzheimer's disease.
Agnosia is the failure to recognize or identify familiar objects
despite intact sensory function.
Aphasia is the language disturbance in understanding and expressing
spoken words.
Apraxia is the inability to perform motor activities, despite intact
motor function.
Providing a safe environment is a priority in the care of the client
with Alzheimer's disease.
Transvestism is the obsession with wearing clothing of the opposite
gender.
Frotteurism is an intense sexual arousal or desire when rubbing against
a nonconsenting person
A client with an eating disorder experiences an altered body image.
Michigan alcohol screening test (MAST), drug abuse screening test
(DAST), and CAGE screening questionnaire are the tools available to assess a
substance abuse disorder.
Vitamin B deficiency in alcohol abuse client cause peripheral
neuropathies.
Thiamine deficiency in alcohol abuse client cause Korsakoff's syndrome.
Early signs of alcohol withdrawal develop within a few hours after
cessation of alcohol intake.
Alcohol withdrawal signs peak after 24 to 48 hours and then rapidly
disappear.
Chlordiazepoxide is the most commonly prescribed medication for acute
alcohol withdrawal.
Alcohol withdrawal delirium is a medical emergency. Death can occur
from myocardial infraction, fat emboli, peripheral vascular collapse,
electrolyte imbalance, aspiration pneumonia, or suicide.
Instruct the client who is on disulfiram (Antabuse) therapy to avoid
the use of substance that contain alcohol, such as cough medicines, rubbing
compounds, vinegar, mouthwashes, and aftershave lotions. The client needs to
read the labels of all products.
Alcohol, benzodiazepines, and barbiturates are act as a depressant,
sedative, or hypnotic.
Flumazenil is the antidote for benzodiazepines overdose.
Amphetamines, cocaine, and crack are act as a CNS stimulant.
Crack is a free form of cocaine that can be smoked.
Naloxone is the opioids antagonists.
Lysergic acid diethylamide (LSD), mescaline, psilocybin (Mushrooms),
and phencyclidine (PCP) are the hallucinogens.
Marijuana is also called cannabis sativa.
When psychiatric disorder and substance dependence are present
together, it is often referred to as dual diagnosis.
Crisis is a temporary state of severe emotional disorganization caused
by failure of coping mechanisms and lack of support.
In crisis the ability for decision making and problem solving is inadequate.
Maturational, situational and adventitious are the types of crisis.
Grief is a natural emotional response to loss that individuals must experience
as they attempt to accept the loss.
Loss is the absence of something desired or previously thought to be
available.
Mourning is the outward and social expression of loss.
Bereavement includes the inner feelings and the outward reactions of
the survivor.
The usual course of electro convulsive therapy (ECT)
is 6 to 12 treatments given 2 to 3 times per week.
Electro convulsive therapy is given in client with major depressive and
bipolar depressive disorders, manic client who resist to lithium and antipsychotic
medication, client with schizophrenia (specially catatonia), client with schizoaffective
syndromes and psychotic client.
Nurse maintain NPO status after midnight or at least 4 hours before
treatment of electro convulsive therapy.
Nurse removed hairpins, contact lenses, and dentures before electro
convulsive therapy. Take the baseline vital signs.
Short acting anesthetic such as methohexital sodium or thiopental sodium
are administered before ECT.
Succinylcholine is a muscle relaxant that is given to client with ECT.
Throughout the ECT procedure, 100% oxygen by mask via positive pressure
is administered.
In ECT an electrical stimulus is administered; the seizure should last
30 to 60 seconds.
Major side effects of ECT includes confusion, disorientation and
short-term memory loss.
Restraints require a written prescription by a physician, which must be
reviewed and renewed every 24 hours.
Restraints and seclusion should not be used as punishment or for the
convenience of the health care staff.
The most vulnerable person for violence is children and older adults.
Children younger than 6 years of age are most vulnerable to abduction.
Tricyclic antidepressants block the reuptake of norepinephrine at the
presynaptic neuron; used to treat depression.
Tricyclic antidepressant use with MAOIs can cause hypertensive crisis.
The tricyclic antidepressant clomipramine may be used to treat
obsessive-compulsive disorder.
Citalopram, escitalopram, fluoxetine, fluoxetine, paroxetine, and sertraline
are the example of SSRIs.
Amitriptyline, clomipramine, imipramine, nortriptyline, protriptyline
and trimipramine are the tricyclic antidepressant.
Inform the client that antidepressant medication may take several weeks
to produce the desired effect.
Monoamine oxidase inhibitors (MAOIs) inhibit the enzyme monoamine
oxidase, which is present in the brain, blood platelets, liver, spleen, and
kidney.
Client with MAOIs hypertensive crisis treated with phentolamine
antidote.
Nurse instruct the client about foods that contain tyramine. Consuming
tyramine-containing foods when taking an MAOIs can cause hypertensive crisis.
Isocarboxazide, phenelzine, tranylcypromine, and selegiline are the
monoamine oxidase inhibitors.
Therapeutic drug serum level of lithium is 0.6 to 1.2 mEq/L.
Banana, beef or chicken liver, coffee, tea, chocolate, aged cheese,
papaya, red wine, beer, sherry, soy sauce and yogurt are the tyramine
containing foods.
Symptoms of lithium toxicity begin to appear when the serum lithium level
is 1.5 to 2 mEq/L.
Benzodiazepines have anxiety-reducing, sedative-hypnotic, muscle-relaxing,
and anticonvulsants actions.
Benzodiazepines are contraindicated in client with acute narrow-angle
glaucoma.
Alprazolam, chlordiazepoxide, clonazepam, diazepam, flurazepam, lorazepam,
and midazolam are the benzodiazepines.
Buspirone is a nonbenzodiazepine anxiolytic medication.
Flumazenil is the antidote for benzodiazepines toxicity.
Barbiturates has the inhibitory synaptic action of the neurotransmitter
GABA.
Amobarbital sodium, butabarbital sodium, pentobarbital sodium, phenobarbital
sodium and secobarbital sodium are the barbiturates.
Chloral hydrate, eszopiclone, and zolpidem are the sedative-hypnotic.
Avolition means a person show little participation in work or have
little interest in socialization.
Antipsychotic medication improves the thought processes and the
behavior of the client with psychotic symptoms, specially client with
schizophrenia.
Antipsychotic medication affects dopamine receptors in the brain,
reducing the psychotic symptoms.
Typical antipsychotics are more effective for positive symptoms of
schizophrenia, such as hallucinations, aggression, and delusions.
Atypical antipsychotics are more effective for the negative symptoms of
schizophrenia, such as avolition, apathy, and alogia.
Chlorpromazine, fluphenazine, haloperidol, loxapine, molindone,
pimozide, thiothixene, and trifluoperazine are the example of typical
antipsychotics medication.
Aripiprazole, clozapine, olanzapine, quetiapine, risperidone, and
ziprasidone are the example of atypical antipsychotics medication.
Neuroleptic malignant syndrome is a complication of neuroleptic
(antipsychotic) medications.
CNS stimulants are used to treat the attention deficit hyperactivity disorder.
Amphetamine, atomoxetine, and methylphenidate are used to treat ADHD.
Acetylcholinesterase inhibitors may be used in client's with
Alzheimer's disease.
Donepezil, rivastigmine, galantamine, tacrine, and memantine are the
medications used to treat Alzheimer's disease.
Memantine is a N-methyl-D-aspartate (NMDA) receptors antagonist used to
treat Alzheimer's disease.
Mini mental status examination (MMSE) assess the cognitive impairment
of the client.
The client score 24-30 in mini mental status examination represents no
cognitive impairment.
Score between 18 to 23 in mini mental status examination represents
mild cognitive impairment.
Score between 0 to 17 in mini mental status examination represents
severe cognitive impairments.
Frigidity is the absence for sexual activity.
A patient who has a phobic disorder uses self-protective avoidance as
an ego defense mechanism.
Al-Anon is a support group for families of alcoholics.
Echolalia is parrotlike repetition of another person’s words or
phrases.
Common causes of child abuse are poor impulse control by the parents
and the lack of knowledge of growth and development.
Phobic disorders are treated with desensitization therapy, which
gradually exposes a patient to an anxiety-producing stimulus.
A labile affect is characterized by rapid shifts of emotions and mood.
A person who has borderline personality disorder is demanding and judgmental
in interpersonal relationships and will attempt to split staff by pointing to
discrepancies in the treatment plan.
Creative intuition is controlled by the right side of the brain.
Settings limits is the most effective way to control manipulative behavior.
Violent outbursts are common in a patient who has borderline personality
disorder.
When working with a depressed patient, the nurse should explore
meaningful losses.
Anxiety is nonspecific, but the fear is specific.
Free-floating anxiety is anxiousness with generalized apprehension and pessimism
for unknown reasons.
Catharsis is the expression of deep feelings and emotions.
Reactive depression is a response to a specific life event.
Ritualism and negativism are typical toddler behaviors. They occur
during the developmental stage identified by Erikson as autonomy versus shame
and doubt.
A person who has an IQ of less than 20 is profoundly retarded and is
considered a total-care patient.
Reframing is a therapeutic technique that’s used to help depressed patients
to view a situation in alternative ways.
Re-examination of life goals is a major developmental task during
middle adulthood.
The three stages of general adaptation syndrome are alarm, resistance,
and exhaustion.
The nurse can use silence and active listening to promote interactions with
a depressed patient.
A person who has paranoid personality disorder projects hostilities
onto others.
Disulfiram (Antabuse) is administered
orally as an aversion therapy to treat alcoholism.
Denial is the defense mechanism used by a patient who denies the reality of an event.
Memory disturbance is a classic sign of Alzheimer's disease.
Stress management is a short-range goal of psychotherapy.
Depression is the most common psychiatric disorder.
Clinical signs of lithium toxicity are lethargy, nausea and vomiting.
Extrapyramidal symptoms include parkinsonism, dystonia, akathisia, and tardive dyskinesia.
Hypnosis is used to treat psychogenic amnesia.
A maladaptive response to stress is drinking alcohol or smoking excessively.
Improved concentration is a sign that lithium is taking effect.
The three stages of general adaptation syndrome are alarm, resistance, and exhaustion.
In the late stages of dementia the remote memory may be impaired.
Insufficient fluid intake, and sodium causes the lithium toxicity in client with lithium therapy.
0 Comments