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What is Axis 1?
- Axis 1: The presenting problems
- eg: BPD (bi-polar disorder), or Schitzophrenia
What is Axis 2?
- Axis 2: the chronic or long-term problems that are not going to be corrected
- eg: mental retardation, personality disorders
What is Axis 3?
- Axis 3: general medical conditions
- eg: DM, HTN, COPD, hypothyroidism
What is Axis 4?
- Axis 4: current stressors...the "why now"
- eg: divorce, death in the family, recent medical dx...
What is Axis 5?
- Axis 5: Global Assessment of Functioning (GAF) score
- eg: 40 (current) 65 (last year)
What is the GAF?
- GAF= Global Assessment of Functioning= overall assessment within 10 ranges of
- 1) severity of symptoms OR
- 2) level of functioning
- -if discrepancy exists GAF reflects worse of the 2, don't give benefit of the doubt!
- -if second GAF scale # is used it should be labeled w/ time period...eg 45 (current) 60 (past year)
What are the 3 phases of group work?
- 1) orientation
- 2) working
- 3) termination
What is the group leader and group members responsibility in the orientation phase?
leader: set up atmosphere of respect, confidentiality, and trust
group: get to konw one another, issues of joining a group, acceptance, rejection, sexual attratction, posistion in the gorup
What is the group leader and group members responsibility in the working phase?
leader: encourage members to cooperate w/ each other and handle conflict, keep group focused on therapeutic goals of individual members
group: issues of leadership, power and control, develops functional norms (eg. sit in circle, come on time), and a sense of group identity, grapples w/ completing a task, developing competance and trust
Discuss the nurse's awareness during the working phase
- -become sensitive to the roles clients assign to you (transference)
Trust Development- consistency is key w/ actions and words
What is the leader and the members responsibility during the termination phase of group?
leader: acknowledge the contributions of each member and the experience as a whole
group: prepare for the seperation and for the future, endings, loss, loneliness, death, saying goodbye (tendancy to avoid goodbyes by not showing up, making vague future plans, etc)
Instillation of hope
feeling hopeful about one's life
feeling that one is not alone
imparting of information
- giving appropriate help to other members
- eg: "I've spent all this time talking about me. Lou needs to talk about his visit w/ his dad, let's focus on him"
releasing feelings and emotions, like a cleansing
coming to understand what life is about
What are the ABC's of cognitive behavioral therapy?
- A= Activating Event +
- B= Beliefs, or aotomatic thoughts =
- C= Consequences, feelings
- a pt. w/ psychosocial difficulties haas negavive B
eliefs that cause neg. C
onsequences. W/ CBT we want to change their B
eliefs to positive/adaptive ones
What are some other CBT techniques?
- -daily mood charting
- -tracking pleasant events
- -learning behavioral skills
- -examining and changing neg. thoughts
RN's can assume respoonsibility for what groups?
- -med education
- -symptom management
- -stress management
Advance Practice Nurses can assume responsibility for what groups?
- -same as the RN +
- -family therapy
What are the basic diagnostics for anorexia?
- -age of onset 14-16 yrs
- -50% co-morbidity w/ OCD
- -main diffs from bulemia=
- 1) refusal to attain or maintain minimal body weight for age and height, pt. <85% of normal BMI
- 2) perceptual distrubances (pt. sees themself as fat- doesn't know there is a problem)pt. ego-cyntonic (they feel like they're fine)
- 3) Amenorrhea-after menarche, females miss at least 3 consecutive periods or befre menarche the menstral cycle is delayed
- -concern about weight often increases as weight decreases
What are the basic diagnostics for anorexia?
- -age of onset 18-24yo
- -pt usually w/in normal weight range
- -pt. recognizes there is a problem but feels helpless to correct it
- -pt. feels sense of relief after purging, release of tension and anxiety, depression follows episode (post-binge remorse or guilt)
What are some lab findings of anorexic pt?
- -hematology: anemia, leukopenia
- -chemistry: incr. BUN, hypercholeserolemia, metabolic alkalosis (incr. serum bicarb), hypochloremia, hypokalemia, metabolic acidosis
- -EKG: sinus brady, dysrhythmias (can lead to cardiac arrest)
What are some lab findings of a pt. w/ bulemia?
- -metabolic alkalosis- d/t loss of stomach acid
- -metabolic acidosis- d/t diarrhea
- -hypokalemia, hyponatremia, hypochloremia
- -elevated serum amylase