Mental Health Final Exam review PDF

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Exam 3 NUR 2459 Study Guide – Winter 2021 Helpful Resources and Practice Questions -Psychiatric Success Book (found in the Library)- ch 5, 6,11,12,14,15 -Davis Essential Book Questions (also found in the NUR 2459 Tab in the library)- ch 7, 8, 13,14,15,16,17,19 Do the questions PW put out Tami Lecture https://rasmussen.webex.com/recordingservice/sites/rasmussen/recrding/0385c79b74ab4d5fb8ebdd0a0a712fa1/ playback

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Exam 3 Study Guide We will continue to build on ALL of the first and second exam insights further advancing our knowledge, skills and attitudes with communication, ethics, Legal, therapies, barriers, boundaries, safety considerations, Patients’ rights, HIPPA, defense mechanisms, communication techniques (therapeutic communication), dosage and calculation, and etc… ● Defense mechanisms o

Altruism- dealing with anxiety by reaching out for others. It is very cold and a man takes off his jacket and gives it to someone who cannot afford a coat.

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Compensation- covering up a real or perceived weakness by emphasizing a trait one considered more desirable. Someone who is too small to make the wrestling team becomes a talented member of the debating team.

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Denial– refusing to acknowledge the existence of a real situation or feelings associated. A woman who drinks alcohol daily, refuses to acknowledge she has a problem.

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Displacement- shifting feelings related to an object, person, or situation to another less threatening object, person or situation. A man is angry with his boss and when he comes home, he yells at his children.

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Projection-attributing one's unacceptable thoughts and feelings onto another who does not have them. A woman has feelings for someone other than her husband, but blames him for being unfaithful. Identification- conscious or unconscious assumption of the characteristics of another individual or group.The student nurse imitates the nurturing actions of the instructor. Intellectualization-separation of emotions and logical facts when analyzing or coping with a situation or event. A wife is moving far away from her family because of her husband’s job transfer. She explains to her family all the advantages of the move. Rationalization- creating reasonable and unacceptable explanations for unacceptable behavior. A boy justifies cheating in a card game because he said everyone cheats. Reaction formation- preventing unacceptable thoughts or behaviors from being expressed by exaggerating opposite thoughts or types of behaviors. A girl is angry with someone, but expresses exaggerated friendliness when she sees her. Regression- sudden use of childlike or earlier developmental behaviors that do not correlate with age or developmental stage. An adult throws a temper tantrum when she doesn’t get her way. Repression- unconsciously putting unacceptable feelings, ideas and thoughts out of awareness. No memory. A trauma victim is unable to remember anything about his accident. Suppression- voluntary denying or putting away stressful feelings.A student states, “I’ll worry about that exam tomorrow.” Conversion- responding to stress through the unconscious development of physical manifestations of illnesses. A girl is unable to speak just before she is to try out for chorus. Splitting-demonstrating an inability to reconcile negative and positive attributes of self to others. Someone says she has the best friend ever, until her friend is not able to attend her party. Then she says she never wants to see her again. Sublimation-dealing with unacceptable feelings or impulses by unconsciously substituting acceptable forms of expression. A mother whose child has cystic fibrosis, develops a support group for other parents with children diagnosed with the illness. Undoing-performing an act to make up for prior behavior. A man argues with his wife and the next day brings her flowers.

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● Dosage and Calculation questions ● Understand the Nursing Process for these topics (Goals, interventions) to be able to answer the questions related to the topics below: ■ New Material will include topics from weeks 7 through week 10

Module 7 - Nursing Care for Clients with Personality Disorders and Eating Disorders ● Review Chapters 31-32 and Module 7 Review PPT ● Review Module 7 Content in Blackboard Understand the Nursing Process for these topics (Goals, interventions) to be able to answer the questions related to the topics: Personality Disorders (Anti-social, Dissociative, Dependent, Borderline, Histrionic, Avoidant, Paranoid) and Nursing Interventions ● Cluster A: odd or eccentric ○ Paranoid Personality Disorder: pattern of mistrust and suspiciousness of others and misinterpretation of others motives as malevolent. They are constantly on guard, hypervigilant, and ready for any real or imagined threat. They are tense, irritable and are immune and insensitive to the feelings of others. They avoid interactions and hold a grudge about people trying to take advantage of them. They are very sensitive and may distort reality and try to test others and do not accept responsibility for others behaviors. ○ Schizoid Personality Disorder: profound defect in ability to form relationships and are often seen by others as eccentric, isolated, or lonely and will be socially withdrawn. may be cold, aloof, and indifferent and may be in solitary and want to work in isolation. May be shy or anxious around others and cannot be lighthearted. Cannot experience pleasure. Bland and constricted ○ Schizotypal Personality Disorder: Aloof and isolated and are bland and apathetic. They may experience magical thinking, ideas of reference, illusions and depersonalization and have superstitions. May have bizarre speech patterns and may not be able to orient themselves logically. May have psychotic symptoms under stress such as hallucinations or delusions but only last briefly. May gesture and talk to themselves as if they live in their own world. ● Cluster B: dramatic, emotional or erratic ○ Antisocial Personality Disorder: socially irresponsible, exploitative and guiltless behaviors that reflect a general disregard for the rights of others. They may manipulate others, break laws, and may have trouble with employment and stable relationships. They may have violated rights since age 15, not conform to social norms, lying and deceitful, impulsive, reckless for themselves and others irresponsible, are in lots of physical fights or assaults, lack or remorse. ■ When things go their way, they will act charming and cheerful, but can change quickly. ■ May be associated with a prior conduct disorder, ADHD, or oppositional defiant disorder, linked to infant temperament, child maltreatment or abuse, younger they have had lots of tantrums and may bully others as they grow up.

■ May cause a safety concern to themselves or others and go into substance abuse. ■ Family dynamics may play a role in developments as the parents of this type of child may tease them, abuse them, or neglect them. ■ Interventions: ● Convey an accepting attitude toward the client. ● Explore with client alternative ways to handle frustration. ● Explain acceptable behaviors and consequences of violation of rules. ● Enforce limit-setting on unacceptable behaviors. ● Clearly explain client expectations. ● Give positive feedback and rewards for acceptable behavior. ● Provide an appropriate milieu environment. ● Help the client gain insight into his or her own behavior. ● Talk about past client behaviors. ● Help identify ways the client has exploited others. ● Explore the client would feel if circumstances were reversed. ● Assure clients that while behaviors may be unacceptable, the client is valued. ■ Treatments: ● Family therapy is a good option to help the family know how to care for their child while growing up with the disorder to protect them from causing extra harm and to set limits for the child. ● Medications: often used to control aggression. Psychostimulants, clonidine, depakote ○ Borderline Personality Disorder: they are always in a state of crisis, have mood swings, are very labile, thrive on chaos and generate it too, may have a single dominant disorder that can cause agitation or anger. May self mutilate, have unstable image of self, will have unstable relationships, self damaging behaviors, may have recurrent suicide beahvior, gestures or threats, chronic emptiness. Unable to be alone, will have a pattern of clinging and distancing. ■ Splitting will commonly be used: they will view their life situations as either all good or all bad and may devalue other people. May lead to anger and frustration between staff members. ■ Manipulation may cause any behavior to become a way of achieving a final result. May play individuals ■ Safety concerns with the self mutilating as the cutting, burning and bruising can lead to bleeding and death. ■ Associated with chronic depression and BPD due to neurochemical dysregulation of serotonin and norepinephrine in the brain. ■ Childhood trauma may contribute. ■ Theory of object relations states a client with a borderline personality may become fixed on the rapprochement phase and show separation and

autonomy from the mom who may feel threatened by the increasing independence. ■ Interventions: ● Create a trusting relationship. ● Observe client’s behavior frequently. ● Establish a safety contract with the client. ● Care for wounds matter-of-factly. ● Encourage verbalization of feelings. ● Provide a safe environment. ● Act as a role model. ● Encourage appropriate expressions of anger. ● Enforce limit-setting on acting-out behavior ● Encourage independence and give positive reinforcement. ● Rotate staff. ○ Prevents inappropriate attachments. ○ Prevents feelings of abandonment. ○ Prevents splitting behaviors by clients. ○ Prevents staff burnout. ■ Treatment: antipsychotic medications, SSRIs, mood stabilizers to treat the symptoms only! ○ Histrionic Personality Disorder: Colorful, dramatic, and extroverted behavior in excitable, emotional people. Emotional attention seekers, often flirtatious/seductive to validate their attractiveness and gain approval or acceptance. Failure to evoke the attention and approval they seek causes them to feel dejected and anxious. They also have difficulty maintaining interpersonal relationships as they are superficial and fleeting. Difficulty paying attention to details. Wants to be well liked and popular. May have provocative interactions with others. ■ May have a link to inheritance or learning based on performing approved or adminered behaviors. ○ Narcissistic Personality Disorder: They have an exaggerated self worth, lack empathy and are hypersensitive to the evaluation of others. They believe they have the right to special consideration. Self centered and lacking humility, exploits others for self desire fulfillment. Do not perceive the behavior as being inappropriate, feel they get special privileges. Usually cheery and optimistic, unless they do not receive positive feedback from others, causing them to be raging, shame, humiliated and aggressive. May try to rationalize their perception of perfection. ■ May be based on inheritance, an environment where the parent lives their lives through their child and expects the child to achieve things they do not achieve, possess what they did not possess, and have a life better than theirs. Not subjected to restrictions on their parental lives, but believes they are better than everyone else. ● Cluster C: anxious or fearful

○ Avoidant Personality Disorder: extremely sensitive to rejection and is socially withdrawn. They have a strong desire to have a companion but the extreme shyness and fear of rejection may create the need for unusually strong desire for companionship and acceptionace. They are awkward in social situations, may be timid or withdrawn, but those with closer relationships may learn of their sensitivities, touchiness and mistrustful qualities. Slow speech, frequent hesitations, fragments when talking, may have confusion or irrelevant digressions. Lonely and express feelings of unwantedness and view others as critical, betraying or humiliating. Want a close desire with others because of fears of being rejected. ■ May be based on childhood neglect and abandonment and fears of the world being a hostile place. ○ Dependent Personality Disorder: lack of self confidence and extreme reliance on others to take responsibility for them, sometimes to the point of intense discomfort with being alone for even brief periods. They tend to allow others to make decisions, feel helpless when they are alone, act submissively, subordinate needs to others, tolerate mistreatment, demean oneself to get acceptance, and fail to function adequately with situations requiring dominant behaviors. Lacks self confidence, passive to desires of others, over generous and thoughtful but will underplay their own attractiveness and achievements, pessimistic, discouraged and rejected, will let others make important decisions, may not be able to care for self when a relationship ends, avoid positions of responsibility. ■ May be based on nutrances from attachment to one source of an overprotective parent and refusal to give up autonomy. ○ Obsessive Compulsive Personality Disorder: serious, overly discipline, perfectionistic, preoccupation with following rules. Inflexible in ways things should be done and intense fear of making mistakes when making decisions, may have obsessions and compulsions, concern with organization and are rigid when rules may be bent, will be social with authority figures, but may have hostility underneath. ■ Will commonly use reaction formation, isolation, rationalization, and undoing. ■ May be from an overly controlled environment and live to imposed standards of conduct for their parents and will learn what to do to avoid punishment and what they can do to get attention and praise. ■ Differences between obsessive-compulsive disorder (OCD) and obsessivecompulsive personality disorder (OCPD) ● OCD symptoms change in severity over time, whereas OCPD reflects an overly rigid personality style that remains unchanged over a lifetime. ● The obsessions and compulsions associated with OCD, an anxiety disorder, are attempts to control extreme anxiety. ● OCPD is not associated with the obsessions and compulsions that are prominent in OCD

○ Both carry out repetitive behaviors. Underlying motive is very different ■ Clients with OCD might be compelled to repeatedly write out lists with the motivation being prevention of a catastrophe, thereby avoiding excessive anxiety ■ Clients with OCPD would likely write out lists, but the motivation would be to increase efficiency and productivity. ● Clients with OCD want to alleviate their symptoms. ● Clients with OCPD see nothing wrong with their behavior and feel that “other people” are the problem. ○ Medications: often used to treat the symptoms with personality disorder but to not cure the disorder. Theory of Psychosocial Development – Erikson: According to Erikson, a person’s personality continued to evolve throughout the lifespan. The successful or unsuccessful completion of each stage affects the person moving to the next phase. Based on meeting strengths- healthy, maladaptation- too much, malignancy- too little. ● Stage 1: Infancy (0 -1.5 yr) ○ Trust vs. Mistrust ■ Develops a sound basis for relating to and trusting others. ● Strength: hope ● Maladaptation: sensory maladaptation (infants may be too needy). ● Malignancy: withdrawal from not enough stimulation. ● Stage 2: Early Childhood (1.5 – 3 yr) ○ Autonomy vs. shame and doubt ■ Develops a sense of self-control and adequacy. ● Strength: will ● Maladaptation: shameless/ willfulness ● Malignancy: Compulsion ● Stage 3: Preschool (3-6 yr) ○ Initiative vs. Guilt ■ Develops the ability to initiate one’s own activities and has a sense of purpose. ● Strength: purpose ● Maladaptation: ruthlessness ● Malignancy: inhibition ● Stage 4: School Age (6-12 yr) ○ Industry vs. inferiority ■ Developing social, physical and school skills. ■ Develops competence and ability to work.

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● Strength: Competence and good self esteem with potential to excel ● Maladaptation: Narrow virtuosity- focus on one thing and they get good at it but bad at all the other things ● Malignancy: Inertia: not good at anything at all Stage 5: Adolescence (12-20 yr) ○ Identity vs. role confusion ■ Develops a sense of personal identity ● Strength: fidelity or commitment to plan for the best of themselves ● Maladaptation: fanaticism, over exhibition, actions will show the extreme towards their identity ● Malignancy: Lost, no identification and will blame the self. Stage 6: Early Adulthood (20-35 yr) ○ Intimacy vs. isolation ■ Develops an ability to love deeply and commit. ● Strength: love- sharing love for themselves and caring about others ● Maladaptation: Over extended, promiscuous, based on the self too much ● Malignancy: Exclusivity or being too isolated Stage 7: Middle Adulthood (35-65 yr) ○ Generativity vs. self-absorption ■ Develops an ability to give and care for others. ● Strength: Growth, mentorship, active in hobbies, involvement ● Maladaptation: overextended, burnout, trying too hard too much ● Malignancy: rejectivity or giving up Stage 8: Later years (65-death) ○ Integrity vs. despair ■ Has a sense of integrity and fulfillment ● Strength: wisdom, health to place on others ● Maladaptation: presumption and domineering ● Malignancy: despair

Anorexia Nervosa ● Symptoms ○ Morbid fear of obesity ○ Distortion of body image ○ Preoccupation of food ○ Refusal to eat ● Physiological Symptoms ○ Hypothermia ○ Bradycardia

○ Hypotension ○ Edema ○ Lanugo (neonatal-like hair growth on the body) ○ Amenorrhea ○ Metabolic changes ● Treatments ○ Behavior Modification: ■ Gives autonomy to the client. A contract for rewards or privileges based on weight gain is created for the client, which allows the client to have input into their care plan. The client maintains control over eating, the amount of exercise pursued, and even whether or not to induce vomiting. ● Cognitive behavior therapy (CBT) and dialectical behavior therapy (DBT) have also been successful at treating anorexia nervosa bulimia nervosa, and binge eating disorder ○ The Maudsley Approach (family treatment) ■ 1. Phase I: weight restoration ● The parents are actively engaged in establishing the rules and guidelines around eating. Parents often need lots of support during this phase due to frequent power struggles with the client. Once the the client accepts the parental demands for increased food intake, he/she begin to show steady weight gain, and the client and family both experience reduced anxiety ● Phase II : The client takes control of maintaining weight gain. Once he or she demonstrates the ability to maintain above 95% of ideal weight ● Phase III: Developing a healthy self-identity with cognitive behavior therapy and dialectical behavior therapy ○ 3. Drug Therapy ■ Drug therapy in combination with cognitive behavioral therapy has shown to be more beneficial than drug therapy alone. Fluoxetine (SSRI) can help with weight gain and depression, however, there is a risk of increased suicidal ideations.

Bulimia Nervosa ● An episodic, uncontrolled, compulsive, rapid ingestion of large quantities of food over a short period (bingeing) ● Episode is followed by inappropriate compensatory behaviors to rid the body of the excess calories (...