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2011-09-26 14:51:29


Ch 14,18
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  1. In of deep relaxation an individual can slow respiration 4-6 breathes per minutes and slow heart rate as mush as 24 beats per minute, blood pressure decreases, eye contrict, muscle tension decreases, blood vessels in periphery dilate increasing temperature and feeling of warth on extremities
  2. Alpha activity
    a state of altered conciousness, increase creativity, memory and the ability to concentrate
  3. Beta activity
    when ones is mentally alert and actively thinking
  4. Methods of achieving relaxation
    • Deep breathing exercises
    • Progressive relaxation
    • Modified or passive progressive
    • Meditation
    • Mental imagery
    • Physical exercise
    • Biofeedback
  5. Biofeedback relaxation technique
    • is the use of intrumentation to become aware of process in your body that you usually do not notice and help them bring then under voluntary control
    • it gives you info on HR, BP, brain wave activity, skin conductivity, muscletension,skin surface temperature
    • -- helpful to treat spastic colon, hypertension, migrane headaches, muscles spams, pain, anxiety, stuttering, and teeth grinding
  6. Physical exercise can reduce anxiety and depression, involving which hormones?
    Vigorous exercise has shown to increase levels of beta endorphins ( endorphis act as natural narcotics and mood elevators), and monoamines (serotonin, norephinephrine, and dopamine, all have indicated in mood regulation
  7. Low density physical exercise
    • little benifit on cardiovascular system but it can help in preventing obesity, relieve muscular tension, prevent muscles spams, and increase flexibility
    • -accomplish by slow walking, house cleaning, shopping, light gardening, and weight lifting
  8. Suicide is not diagnose or a disorder, its a behavior. Approximately 95% of all persons who commit suicide have a diagnosed menatl disorder
  9. Suicide leading cause of death in age
    Ages 15-24 3rd
    Ages 25-44 5th
    Ages 45-64 8th
    -the rates rise sharply during adolescence and peak between 40-50 and levels down and rise again in remaining years left of life.
    ( White males, age 80 are at highest risk)
  10. Gender in suicide
    -woman attempt more to suicide but men succed more often because they use lethality means vs woman using lighter ways. Guns are usually chosen for suicide. Woman seek professional help more than men increaing suicidal in men again.
  11. Religion with suicide
    • -suicide rates among Roman Catholics are lower than Protestants and Jews
    • - loweer suicidal rates with people who are affiliated with religion
  12. Individual with the highest and lowest social class have higher suicidal rates than middle class
    -with regard that suicidal rates are higher among physicians, artist, dentist, law enforcement officers, lawyers, and insurance agents
  13. Which ethnicity have a higher suicidal rate?
    • White
    • followed by Native Americans, African Americans, Hispanic Americans, and Asians Americans
  14. -suicide is higher among idividuals with mood disorders ( major depression and bipolar),
    -suicide risks is higher during early in treatment with antidepressents because it returns the client energy bringing the ability to act on self destructive wishes
    -severe insommia, psychosis specially with command hallucinations poses high risks
    - homosexuals
    -family history of suicide,
    -attemted suicide already
  15. Predisposing factors theories of suicide
    • Anger turned inward
    • Hopelessness
    • Desperatioon and guilt
    • History of aggression and violence
    • Shame and Humiliation
    • Developmental stressors
  16. Egoistic suicide
    individual feels apart from the mainstream of society, does not feel part of any cohesive group such as family or churh
  17. Altruistic suicide
    • opposite from egositic
    • - the individual as an excess intregation for a group ( religious, cultura, ect...) sacrificing their lifes
  18. Anomic suicide
    occurs in responce to change that occur in an individuals life such as divorce, loss of job), disrupt feelings of relatedness to the group
  19. Some studies revealed a deficiency _________ in depressed clients that attempted suicide
  20. Questions a nurse have to ask and have answered while conducting a suicidal asssessment
    • How serious is the intent?
    • Does the person have a plan?
    • -where
    • How lethal are the means?
    • - if so what type
    • -if gun, does the person have a gun...bullets
    • -if pills, what kind
    • Has the individual ever attempted suicide before?
    • Does the individual have a support group?
    • Does the individual have any coping strategies?
  21. Behavior clues on someone who is planning to suicide
    • giving away prized possesions
    • getting financial affairs in order
    • writing suicide notes
    • sudden lift in mood
  22. Verbal clues on someone who is planning to suicide
    • -may be expressed direct or indirect
    • Direct
    • I want to die
    • Im going to kill myself
    • Indirect
    • This is the last time you'll see me
    • I wont be here much longer for the doctor to have to worry about me
    • I dont have anything worth living for
  23. Unconditioned response....
    Unconditioned stimulus
    Conditioned response and stimulus
    • Unconditioned response is basically integrated(reflected) within us...ex the dogs salivated( unconditioned response) when they began to eat(unconditioned stimulus)....
    • Conditioned is more learned behavior....the dogs salivated when the bell was rang..
    • Pavlov experiment
  24. Operant conditioning vs classical conditioning
    Operant is more focus on the consequences that occur after a behavior vs that classical that focuses on the behavior or the action taken
  25. Stimulus
    is an enviromental event that interacts with and influences an individuals behavior
  26. Reinforcer
    a stimulus that preceds or follow a behavior is called a reinforcer
  27. Types of reinforcers
    • Positive- when an reinforcer stimulus increases the probabilty that a behavior will recur
    • (+ reinforcer- the child gets a allowance for cleaning her room)
    • Negative- is increasing the probability that a behavior will recur by removal of an undesirable reinforcing stimulus (- reinforcer...the child does bot receive a scolding from parent
    • Aversive or punisher- a stimulus that follows a behavior response and decreases the probability that the behavior will recur ( the child does not clean her room and gets a scolding from mother)
  28. Discriminative stimuli
    • stimuli that precede a behavioral response and predict that a particular reinforcement will occur
    • - this are under control of the individual
  29. Techniques for modifying client behavior
    • Shaping
    • Modeling
    • Premack Principle
    • Extinction
    • Contingency Contracting-
    • Token economy
    • Time out
    • Recipricol inhibitation
    • Overt sensitization
    • Cover sensitization
    • Systematic desensitization
    • Flooding
  30. Shaping
    in shaping the behavior of another, reinforcements are given to increaseingly closer proximations to the desired reponses...ex the child who is autistic and is rewarded after watching the teacher lips while reading...rewarded again for making the sound in imitation...awarded again everytime he/she gets closer to the goal behavior
  31. Modeling
    • refers to the learning of new behaviors by imitating the behaviors of others
    • - it can be adaptive and malaptive behaviors
  32. Premark Principle
    • this technique works as response 1 can serve as a positive reinforcement for response 2
    • -girl talking on the telephone and wont do HW...but parents tell her if she does her HW she can talk on the phone, increasing the chances that she will do her HW
  33. Extinction
    • is the gradual decrease in frequency or disappearance of a response when the positive reinforcement is withheld
    • ex..the child who is ignore while throwing a tantrum and the parents ignore him and the behavior decreases more and more
  34. Reciprocal inhibitation
    eliminates a behavior by introducing more adaptive behaviors, ex..relaxation
  35. Overt sensitization
    • -alcohol patients- (antabuse) disufiram given to individual who wish to stop drinking, if they drink then they get severe nausea, headache...with this most likely they are not going to want to drink again
    • is a type of aversion therapy that produces unpleasant consequences for undersirable behavior
  36. Covert sensitization
    relies on the individuals imaginary to produce unpleasant symtoms rather than medication so individual can learn not to do certain behaviors
  37. Systematic sensitization vs flooding
    • Systematic-individuals overcome their fears of phobic stimulus, in a Systematic way....physically..step by step...ex...the elevator
    • -if the patient has heart problems or psychological adaption can do this by imaginary called Flooding
  38. Cognitive therapy
    • it was originally used for depressed clients, but todays is used for a range of emotional disorders
    • highly structured and last for 12-16 weeks
    • -psychotherapy based on the concept of pathological mental processing, the focus of the treatment is on the modification of distorted cognitions and maladaptive behaviors
  39. Automatic thoughts
    • thoughts that occur rapidly in response to a situation and without rational analysis
    • -this thoughts are ofter negative and based on erroneous logic
  40. Types of automatic thoughts
    • Arbitrary Inference
    • Overgeneralization (Absolutistic thinking)
    • Dichotomous thinking
    • Selective Abstraction (Mental filter)
    • Magnification
    • Minimization
    • Catastrophic thinking
    • Personalization
  41. Arbitrary Inference
    the individual automatically comes to a conclusion about an incident without the facts to support it or even despite of the contradictory evidence that support it....(mal pensados)
  42. Dichotomous thinking
    • individual views situation in terms of all or nothing or good and bad
    • ex. frank submitted an article to a nursing journal and the editor does accept it but ask frank to rewrite a portion of it....Frank thinks he is a bad writer in despite of his paper being accepted...
  43. Selective abstraction ( mental filter)
    • is a conclusion that is based on only selected portion of the evidenc, the selected portion is usually negative evidence ir what the individuak views as a failure, rather than any succes that as occure
    • ex. Jackie is accepted to all the colleges she applied but one and very upset and dwells over it even though she got accepted to the rest...
  44. Magnification
    exaggerating the negative significance of an event
  45. Minimization
    • underevaluing the positive significance of an event
    • .ex...Mr G calles grandaughter to come for a visit but she tells him she cant go bacause she as to attend an important meeting. Grandaughter calls Mr.G twice the same day to see how Mr. G is doing and he is still thinking that she doesent care about him
  46. Catastrophic thinking
    always thinking the worst will occur without considering the possiblity of more likely positive outcomes
  47. Schemas
    • Core belief...this come from individuals fundamental beliefs and assumptions , they develope early in life
    • -they can be adaptive or maladaptive, and more difficult to modify
    • 2 categories
    • *helplessness
    • *unlovability
  48. Techniques of cognitive therapy
    • Didactic ( Educational) Aspects
    • Cognitive Techniques
    • Behavior Intervention
  49. Cognitive technique
    • recognizing and modifying automatic thoughts and recognizing and modifying schemas
    • -types
    • socratic questioning-the therapist questions the client about her situation, the client is asked to describe her feeling associated with specific situation
    • imagenary and role play- if socratic questioning does not produce the desired result then the client is guided through imagenary exercise...if their is a strong relatioship with the client and therapist then role play can be assume
    • Thought recording- most used...the client is to ask to keep a written record of situations, it can be recorded in a 2 or 3 column recording
  50. Didactic
    • in this expectations of both the client and the therapist is provided
    • -the individual is given videos, reading assigments to reinforce learning
  51. Examples of schemas
    • Helplessness- No matter what I do I will fail
    • Unloveability- Im stupid. No one would love me
  52. Modifying automatic thoughts and schemas
    • generating alternatives- help the client see a broader range of possibilities than had originally been considered the therapist guides the client in generating alternatives
    • Examining the evidence-
    • Decatastrophing- the client is encouraged to review coping strategies adaptively
    • Reattribution- clients who are depressed tend to blame themselves for everything that happened in their life even if not in fault, with this the client can reverse this...using socratic questioning and testing the automatic thoughts
    • Daily record of dysfunctional thoughts (DRDT)
    • Cognitive rehearsal- mental imagery
  53. Behavioral interventions
    • Activity scheduling-clients are asked to keep a daily log
    • Graded task assignments- the task is broken down into subtasks that clients can complete one step at a time
    • Behavioral rehearsal
    • Distraction
    • Miscillaneous techniques- such as breathing
  54. Serotonin
    • plays a role in sleep and arousal, libido, appepite, mood, aggression, and pain perception.
    • Decrease level- depression
    • Increase lever- anxiety
  55. Norephinephrine
    • neurotransmitter that produces activity at the sympathetic postsynaptic nerve terminal in the ANS resulting in the fight or flight, responses in the effector organ.
    • -metabolize and inactivated be the enzymes monoamine oxidase MAO and catechol -O-methyl COMT
    • functions as mood regulation, cognition, perception, locomotion, cardiovascular functioning, and sleep and arousal
  56. Antidepressants
    • they way the work is that they block the reupttake of neurotransmitter, primary the reuptake of seratonin and norephinephrine
    • reuptake is the process in which the neurotransmitter is reabosorb into the presypnaptic neuron from which it was released
    • -this drug depress subcortical levels of the CNS particular the limbic system and reticular formation
  57. GABA gamma-aminobutyric acid
    prevents postsypnaptic excitation, interrupting the progression of electrical impulses at tje sypnaptic junction....slowing down body activity
  58. Antianxiety agents
    • -this are used to treat clients with anxiety disorders, acute alcohol withdraw, skeletal musvles spams, convulsive d/o, status epilepticus, and preoperative sedation...similar effect of GABA]
    • -depresses the CNA system....rememeber if depressed to much it can cause mild sedation to hypnosis to coma except Buspiron (Buspar) that produces desire effects without depressing the CNS
  59. Antianxiety drugs
    • Benzodiazepines
    • also called anxiolytics and minor tranquilizers
    • -contraindication
    • cannot be taken with other CNS depressant drugs, pregnant woman, lactating, narrow angle of glaucoma, shock, coma
    • -increase effect- slcohol,barbiturates, narcotics, antipsychotics, antidepressants, antihistamines, neuromuscular blocking agents, cimetidine, or disulfiram, herbs such as vilerian, kava,
    • decrease effects with cigarrets, caffeine
  60. Some nursing diagnoses for patient taking antianxiety
    • Risk for injury related to
    • seizure/panic anxiety/acute agitation from alcohol withdraw
    • risk for actvity intolerance related to side effects of sedation and lethargy
    • risk for acute confusion related to aaction of he medication
  61. The nurse should assess and have knowledge of this side affects of antianxiety
    • Drowsiness, confusion, and lethargy
    • Tolerance, physical and psychological dependence
    • - let the client know that they should not withdraw medication abruptly, it can cause depression, insomnia, increase anxiety, abdominal and muscle cramps, tremors, vomiting, sweating, convulsions, and delirium
    • Ability to potentiate the effects of other CNS depressants, such as alcohol
    • Possibility to aggravating symptomsin depressed clients.
    • -assess mood daily, and precautions for suicide
    • Orthostatic hypotension
    • Paradoxial excitement
    • Dry mouth
    • Nausea and vomiting
    • Blood dyscrasias
    • - symtoms such as sore throat, fever, malaise, easy bruising, unusual bleeding should be reported to the physician
    • Delayed onset (buspirone only)
    • informed the client that there is a delayed on the onset of the medication/ 10-2 weeks
  62. Buspirone
    its an antianxiety medication but the difference from benzodiazepines is that they are not addicting
  63. Antidepressants
    • used in the treatment of dysthymic disorder, major depression with melancholia or psychotic symptoms, depression associated with organic disease, alcoholism, schizophrenia, or mental retardation, depressive phase or bipolar, and depression accompanied by anxiety
    • it can treat bulimia nervosa, premenstrual dysphoric disorder
    • it works by increasing serotonin and norephinephrine, and or dopamine leves by blocking the reuptake of these neurotansmitters
  64. Antidepressants medications contraindications
    • clients with acute recovery of MI, glaucoma, hypersensitive, hepatic, renal, or cardiac insufficiency- dosage should be decrease, clients with benign prostatic hypertrophy , and individuals who have seizures ( may decrease threshold)
    • - when the client mood begin to lift then be extra careful, patient might have suicidal plans
  65. Types of antidepressants
    • Tricyclics
    • SSRI selective seraronin reuptake inhibitors
    • MOI monoamine oxidase inhibitors
  66. MOI monoamines oxidase inhibitors
  67. MAO monomine oxidase
    includes norephinephrine, seratonin, histamine, dopamine
  68. Tricyclic antidepressants interactions
  69. SSRI interactions
    may decrease the effects of digoxin and buspirone
  70. Antidepressants medication side effects
    • dry mouth
    • sedation
    • nausea
    • discontinuation syndrome
    • blurred vision
    • constipation
    • urinary retention
    • orthostatic hypotension
    • reduction in threshold in seizures
    • tachycardia, arrhythmias
    • photosensitivity
    • weight gain
    • insomnia, agitation
    • headaches
    • sexual dysfunction
  71. MAOIs diet
    do not consume aged cheese, colas, tea, wine, smoked and processed meats, beef or chicken liver, canned figs, soy sauce, over ripped and fermeted foods, pickled dering, yogurt, diet pills
  72. trazodone can cause penile erection
    • increased renal excreation may occur with acetazolamide, osmotic diuretic, and theophylline
    • decrease with antiinflammatory drugs and thiazide diuretics
  74. Lithium
    • blood samples should be monitor twice a week do to its toxicity potential
    • 1.5 mEq/L begin to appear in blood
    • lithium as the similar composition as sodium, so sodium levels should be maintain 2500-3000 of fluids
  75. lethium serum levels
    • 1.5-2 mEq/L blurred vision,, ataxia, tinnitus, nausea, vomiting, diarrhea,
    • 2.0-3.5- excessive output of diluted urine, increasing tremors, muscular irritabilit, psychomotor retardation, mental confusion, giddiness
    • 3.5 impaired consciousness, nystagmus, MI, oliguria, anuria, cardiovascular collapse
  76. treatment of intractable hiccoughs (chlorpromazine
    control of tics such as the Tourettes disorder (haloperidol, pimoside)
  77. Electroconvulsive therapy
    • 2 million people world wide used this alternative
    • usually white females middle aged
    • it is usually the last type of method that is used if medications are not working
    • -it is used in patients with major depression, mania, schizophrenia,
    • - it was tried with patient with OCD and personality disorder but had little effect
  78. Contraindication of ECT
    • it increases intracranial pressure due to the increase levels if CSF that may lead to brain stem herniation
    • It also triggers the vagus nerve, it can lead to an MI to patient with cardiac problems,
    • extra precautioous with client with hypertension, cardiovascular problems, CHF, severe osteoporosis, chronic pulmonary disorder
  79. Action of ECT
    it is thought to increase levels of some types of neurotransmitter such as norephinephrine, seratonin, dopamine, also glutamate, and gaba
  80. Side effects of ECT
    • temporary memory loss and confusion
    • irreversible brain damage
  81. some client have memory loss after 7 months
  82. ECT imlementation
    • Ensure to have a consent
    • Lab , ECG, X-ray
    • Record vital signs 1hr before
    • 30 minutes before procedure administer medication, the usual order is Atropine sulfate ir glycopyrrolate (Robinul), this are usually given to decrease chances of aspiration or counteract the effects of the vagus nerve
    • Muscular relant is given such as (succinycholine chloride( Anectine) but this paralysis respiratory muscles so patient needs O2 during and after procedure
  83. --Client is instructed NPO 6-8 hrs prior to procedure
  84. Allopathic medicine
    this type of medicine historically thought in the US medical schools
  85. Alternative medicine
    interventions that differ from traditional ones or conventional biochemical treatment of disease
  86. Complementary medicine
    is an intervention that is diffent from or conjuction with traditional ir conventional medical treatment
  87. Conventional medicine focuses on the physical or material part of the person body such as bones,muscles, ect....vs alternative that is more than the body but spiritually
  88. Types of complementary therapies
    • Herbal medicine
    • Acupuncture and acupressure
    • Diet and nutrition
  89. Physical activity
    • to manage weight you should do 60 min of moderate to vigorous exercise
    • to sustain weight loss 60-90 min
    • and do not exceed calorie intake for both
  90. Its important to remember that half daily serving of grain should be whole grains
  91. Fats intake 20-35% intake
    10% no more of saturated
  92. Carbohydrates should compromise 45-64% of total calories
  93. Sodium Chloride < 2300mg/daily, about 1teaspoon a day
  94. Subluxation
    when vertebrae if the spinal column become displaced they may press on a nerve and interfere with the normal nerve transmission
  95. Adjustments
    manipulating the vertebrae back to normal position
  96. Black cohosh
    • relief for menstrual cramps, improve mood, claming effect. have similar action estrogen
    • -toxic in large dosage causing stifness trembling, deahaches, nausea
  97. Cascara sagrada
    • relief constipation
    • -do not use during pregnancy
  98. Chamomile
    as a tea is effective as a mild sedative in the reielf of insomnia, may aid in digestion, relieve menstreual cramps, and upset stomach
  99. Echinacea
    stimulates the immnune system
  100. Fennel
    used to eased stomaches and to aid digestion, used in tea to stimulate appetites in people with anorexia
  101. Feverfewer
    • prophylaxis and treatment of headaches
    • -some individuals may experience temporary mouth ulcers
  102. Ginger
    easy stomachaches and to aid digestion and powder ginger capsule can help in preventing motion sickness
  103. Ginkgo
    • used ti treat senility, short term memory loss and peripheral insufficiency, dilates blood vessels
    • -usual dosage 120mg/day
  104. Ginseng
    the ancient chinese saw this herb as one that increased wisdom and longevity. Current studies support a possible effect on the cardiovascular system. Action is uknown
  105. Hops
    used in the cases if bervousness, mild anxiety, and insomnia. Also may relieve the cramping associated with diarrhea
  106. Kava kava
    • used to reduce anxiety while promoting mental acuity
    • dosage 150-300mg/bid
    • can cause liver damage and should not be taken over 3 months w/o doctor order
  107. Passion flower
    treat nervousness and insomnia, depress the CNS to produce mild sedation
  108. Peppermint
    • used in teas to relieve upset stomach and headachesand as a mild sedative.
    • oil perppirment is also used for inflammation of the mouth, pharynx , and bronchous
  109. Psyllium
    • are popular bulk laxative commonly used for chronic constipation
    • useful in treatement of hypercholesterolemia
  110. Scullcap
    as a sedative for mild anxiety and nervousnss
  111. St. Johns wort
    used in treatment of mild to moderate depression, may block the reuptake of serotonin and norephinephrine and have a mild MAO inhibiting affect 900mg/day
  112. Valerian
    used to treat nervousness and insomnia producces restful sleep w/o hangover, similar to benzodiazepines but without addicting effect
  113. Dysthymic
    its a severe depression but not worse than major depression
  114. Fluoxetine
    • Fluoxetine (also known by the tradenames Prozac, Sarafem, Fontex) is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class. It is manufactured and marketed by Eli Lilly and Company. In combination with olanzapine it is known as Symbyax.
    • Fluoxetine is approved for the treatment of major depression (including pediatric depression), obsessive-compulsive disorder (in both adult and pediatric populations), bulimia nervosa, panic disorder and premenstrual dysphoric disorder.[
  115. Peplau 5 subroles for nurses
    • Stranger
    • Resouce person
    • Leader
    • Teacher
    • Surrogate
  116. Three theories of teching
    • behaviortist
    • cognitive
    • humanistic
  117. Behaviorist leraning
    • is based on the believe that there is a direct assiciatio between events or ideas
    • its deine as a change in performance including habits, or procedures in response to condition,
    • -learned though repeated , contingencies...
  118. Cognitive theory
    • based on the assumption that learners interact with their enviroments, focusing on the whole rather then the parts
    • storing information
  119. Humanistic theory
    • involves beung human in the process
    • learners trust each other to be competent human being who both learn through the process of self discovery
  120. Domains of learning
    • Affective-includes attitudes, feeling, and values, to make a change. ex diet in obesse person
    • Cognitive- involves knowlege and the thought process within the individuals intellectual ability
    • Psychomotor- is the processing and demonstration of behaviors, the info as intellectually been process and the individuals displays motor behavior
  121. The adult learner
    • Build on previous experiences
    • Focus on immediate concerns first
    • Adapt the teaching to the lifestyle
    • Make the client an active participant
  122. Teaching children
    • Birth to 2- Sensiromotor development
    • Age 2-7 Preoperational development
    • Age 7-12 Concrete operational thoughts development
    • Age 12-18 Formal operations development
  123. Older adults should not be teached as if they were children, this can offent the older client
    - intellectual abilities of older people do not decline but do become obsolote
  124. Healthcare providers must prepate material at the lowest possible reading level-preferred 6th grade or lower....according to reports the average adult reads to the 8th grade level
  125. Developing an outcome
    • who-----the client
    • will perform---action verb based on domain of learning
    • what---criteria
    • how well---accurately
    • by when---time
    • ex.Mr.t(who), will list( actions) fieve food that should be avoided while taking MAO inhibitors (what will be measured) usign handouts provided (conditions) by the end of the teaching lesson
    • ---cannot use understand and know