Psych Block 4

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Author:
nporter44
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193624
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Psych Block 4
Updated:
2013-01-21 16:27:39
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Psych block Test One
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Description:
Anxiety, coping mechanism, crisis phases
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  1. Does culture play a part in being anxious or not?
    • YES!
    • Cultural heritage or teaching may determine what is experienced as stressful, how the stress is expressed & what methods are used to deal with it. 
  2. What are the 9 immature defense mechanisms?
    • - passive aggressive
    • - acting out
    • - dissociation
    • - devaluation
    • - idealization
    • - regression
    • - splitting
    • - projection
    • - denial
  3. What is eustress?
    stress experienced as positive
  4. What is distress?
    Stress resulting from harm, loss, threat, difficulty.

    Detrimental to health.
  5. What is stress?
    non-specific response to any demand for adaptation.
  6. How long can someone experience crisis?
    • 6 weeks-ish
    • people can't tolerate it for much longer than that.
  7. How many phases of crisis are there?

    Describe Phase 1
    4

    #1 problem or conflict threatens self concept, sense of adequacy.
  8. Describe phase 2 of crisis.
    • stress continues
    • trial & error of coping/defense mechanisms.
  9. Describe phase 3 of crisis.
    Panic is when trial & error fails

    Flight or withdrawal used
  10. Describe phase 4 of crisis.
    If the problem still not resolved and anxiety continues to be overwhelming at severe panic levels, serious personality disorganization occurs.

    Suicide, depression, subtances, violence
  11. What are some stress reduction methods?
    • - Group or social support
    • - meditation
    • - self hypnosis
    • - creative imagery
    • - breathing exercises
    • - proper nutrition
  12. What is cognitive reframing?
    • - Finding alternative ways to view ideas, events & situation.
    • - What you think is what governs your emotions.
  13. In regards to self awareness what must the nurse be aware of?
    • - Own values
    • - possible prejudices or counter transference
    • - confront psychological issues- "areas remaining unhealed."
  14. What is the difference between anxiety and fear?
    - Anxiety is a reaction to an unspecified danger

    - fear is a reaction to a specific danger
  15. what are the 2 main goals of crisis intervention?
    • - Safety
    • - Anxiety reduction

    (care, listen, monitor feelings, therapeutic communication, summarize often)
  16. Name 5 mature defense mechanisms?
    • - Altruism
    • - Sublimation
    • - Humor
    • - Suppression
    • - Compensation
  17. What are the 6 less mature defense mechanisms (neurotic)
    • - Repression
    • - Displacement
    • - Reaction formation
    • - Conversion/Somatization
    • - Undoing
    • - Rationalization
  18. What is dissociation?
    Interruption in some aspect of cognitive function so as to cut oneself off from a painful awareness.

    • "Out of body experience"
    • completely lose track of time
  19. What is Reaction Formation?
    - Shifting of distressing emotion to its opposite.

    "yay! I'm getting divorced, let party!"
  20. What is conversion/somatization?
    Shifting energy of stress or anxiety into physical symptoms.
  21. What is undoing?
    - Trying to "undo" by doing the opposite behavior.

    i.e. becoming altruistic after murdering someone.
  22. What is rationalization?
    • - justification
    • - self deception - making an unacceptable behavior seem acceptable. 
  23. What is passive aggressive?
    - Resistance is covert

    Procrastination, ineffectiveness, stubbornness
  24. What is acting out?
    Potentially destructive

    rather than processing feelings and talking, acts them out. 

    Physical harm to person when angry.
  25. What is devaluation?
    May be to self or others.

    i.e. putting someone else down so person looks good by contrast.
  26. What is idealization?
    Overvaluing; putting on a pedestal.

    When they fall off, own self esteem suffers as well. 
  27. What is regression?
    Reverting back to behavior from an earlier time; comforting but less mature.

    Throws a temper tantrum because someone ate your cookie.
  28. What is splitting?
    Unable to see good and bad together - only black & white, all or nothing.
  29. What is projection?
    See in others what you cannot tolerate to see in self.
  30. What is denial?
    Unconscious, refusal to accept reality or fact.  Acting as if a painful event thought or feeling did not exist. 
  31. What is altruism?
    Meeting needs of others not martyrdom.
  32. What is sublimation?
    substitution of aggressive and sexual impulses into socially acceptable behavior. 

    Like exercise!
  33. What is using humor as a defense mechanism?
    laughing at, making jokes about painful feelings or situations.
  34. What is suppression?
    Intentionally putting aside a painful or distressing situation or feeling. 

    Only truly conscious mechanism!
  35. What is compensation?
    Avoiding feelings of inferiority due to personal deficits by excelling in another area. 

    She's good at sewing but I'm good at cooking.
  36. If you force a patient to take their meds, what are you committing?
    Battery!

    unless DTS/DTO
  37. If a patient refuses their meals & you tell them you'll give it to them in a shot, what are you doing?
    Committing assault!
  38. Anxiety assessment intensity:
    Describe Mild.
    • - restlessness
    • - irritability
    • - tension relieving behaviors-fidgeting, nail biting, finger tapping
    • - mild sense of discomfort
    • - heightened mental focus, alertness!
  39. Anxiety assessment intensity:

    Describe moderate.
    • - muscle tension
    • - heart pounding
    • - ^ HR & RR
    • - tremors, voice trembling
    • - G.I. cramping or nausea
    • - selective inattention
    • - can still learn & problem solve; helps if another present.
    • (Difficult to accomplish Daily Life)
  40. Anxiety assessment intensity:

    Describe Severe.
    • - somatic symptoms worsen, HA, dizziness
    • - insomnia
    • - hyperventilation
    • - feeling of impending doom
    • - dazed and confused
    • - problem solving & learning not possible
    • - reduced perceptual field
  41. Anxiety assessment intensity:

    describe panic
    • - severe trembling
    • - dilated pupils
    • - hyperactive or immobilized
    • - may be unable to speak coherently
    • - may hallucinate or be dillusional
    • - experience total terror
    • - may run or be danger to self or others
  42. What are the types of anxiety?
    - Normal, necessary for survival, motivation

    - Acute, "State of anxiety" r/t specific situation, loss, or crisis

    - Chronic, "trait anxiety", not able to trust that they will be okay.  s/s overreaction, chronic fatigue, insomnia, discomfort in relationships & everyday life.
  43. What are the stages of GAS? (General Adaptation Syndrome)

    Describe each stage.
    • 1. Alarm reaction - "fight or flight" prepares body for physical activity, decreases effectiveness of immune system
    • 2. Resistance - body adapts i.e. anorexia = v desire for physical activity
    • 3. Exhaustion - resistance is reduced, immune system is collapsed & heart attach r/t HTN
  44. Who is Hans Hugo Bruno Selye?

    What did he do?
    • "Father of stress"
    • coined the term stress
    • came up with GAS (General Adaptation Syndrome)

    response to stress is whole body, not just local.
  45. What is the DSM IV?
    - A diagnostic manual with 5 axis' & over 300 diagnoses.
  46. What is included in Axis 1 of DSM IV?

    Give an example.
    • Major clinical disorder
    • - bipolar, schizophrenia, alcohol dependence, MDD, PTSD, GAD
  47. What is in Axis II of the DSM-IV?

    Give example.
    Personality disorders & Mental retardation

    - obsessive compulsive personality disorder
  48. What is included in Axis III of the DSM-IV?

    Give an example.
    General medical conditions

    -arthritis, HTN, diabetes, hepatitis
  49. What is Axis IV of the DSM-IV?

    Give an example
    Environmental/Psychosocial factors

    - Divorce, unemployed, no transportation
  50. What is Axis V of the DSM-IV?

    Give example.
    GAF- Global assessment of functioning, 2 numbers represented as a fraction.

    • 1st # - what the assessor has gauged your current functioning level (1-100).
    • 2nd # - What the assessor has deemed your past years functioning level (1-100) prior to incident.
  51. What are the legal requirements for an involuntary admission?
    • - Admission initiated by someone else
    • - 2 or more MD's needed to determine need
    • - Need to be DTS and or DTO (danger to self or others)

    + Right to a hearing if admitted +
  52. Name the benzos to be given for anxiety.

    What is the #1 concern?
    • Xanax - alprazolam
    • Librium - chlordiazepoxide
    • Valium - diazepam
    • Tranxene - clorazepate
    • Ativan - lorazepam
    • Serax - oxazepam

    They are addicting!  To be used short term
  53. Besides benzos, what other drugs can be used for anxiety?
    • Buspar
    • Benadryl
    • Vistaril
    • Inderal
  54. What are the 4 types of crisis'?
    • Maturational crisis - new development stage reached w/o completing the previous 1.
    • Life transitions - new developmental stage reached with no experience: 1st day of school
    • Advantitious crisis - Disaster!
    • Situational crisis - external situation where one is not prepared to go thru.  Death of a loved one.
  55. In caring for someone with anxiety or crisis what should the nurse avoid?
    • - Needing to be needed!
    • - Pts need to do for themselves

    Don't set unrealistic goals for the pt. or yourself.
  56. What are the 3 levels of care with crisis intervention?
    - Primary

    - Secondary

    - Tertiary
  57. With crisis intervention what is involved in primary care?
    • Prevention
    • - Recognize potential problems in relation to how pt. normally handles stress
    • - Teach coping skills: meditation, relaxation, problem solving, decision making
    • - Assist pt. in evaluating the reaction of life changes to decrease stress
  58. In crisis intervention what is involved in the secondary level of care?
    Reduce stressors during a crisis "damage control".

    • Assess w/client her/his problems, coping methods, support & resources
    • Set goals
    • Plan interventions
  59. With crisis prevention, what is involved with the tertiary level of care?
    • usually in structural environment.
    • Goal: Prevent further deterioration & regain optimal functioning

    • Includes - rehab centers, intensive outpatient programs, partial hospital programs
    • More restrictive environment
  60. What are the 11 patient rights in a psych setting?
    • - right to treatment
    • - right to refuse
    • - Least restrictive environment
    • - communicate w/ ppl outside
    • - right to no unnecessary restraints
    • - right to independent psych eval and status review
    • - right to protection from abuse
    • - right to have an informed consent & withdrawal
    • - Right to confidentiality of records
    • - Right to due process
    • - Right to individualized treatment plan
  61. When can a nurse give meds to a psych patient?
    An informed consent

    *Except if pt. is a danger to self or others*
  62. In regards to legal issues & psych, what are the confidentiality mandates?
    • Can't give status updates!
    • Someone looking for a psych patient needs to be directed to administration.  
  63. In regards to legal issues, what must the nurse report?
    Abuse, suicide, intent to harm.

    • Duty to warn - the person, the person being threatened and the police
    • *Never promise to keep secrets*

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