NUR 371 Final Exam Objectives PDF

Anxiety and Obsessive Compulsive Disorders 1. Understand and identify anxiety levels and their corresponding nursing intervention o Mild ▪ Normal day to day ▪ Helps us focus and increase information processing ▪ Beneficial...

Anxiety and Obsessive Compulsive Disorders 1. Understand and identify anxiety levels and their corresponding nursing intervention o Mild ▪ Normal day to day ▪ Helps us focus and increase information processing ▪ Beneficial ▪ Learning can occur ▪ Symptoms Feelings of discomfort Restlessness Irritability Tension-relieving behaviors (nail-biting, foot/finger tapping, fidgeting ▪ Ex: exam or job interview o Moderate ▪ Perceptual field narrows, attentions to detail decreases, information processing decreases ▪ Help might be needed by other to point out information ▪ Learning can still occur but is not as optimal ▪ HR and RR increase ▪ Tension occurs ▪ Pt may report their heart is pounding/racing ▪ Symptoms GI upset Headache Feeling the need to urinate ▪ Voice quivers, hand or other body parts shaking/tremors o Severe ▪ Perceptual field is greatly reduced ▪ Fovus is on one detail or scattered details ▪ Even with help, the patient struggles to ground themselves in the environment and to refocus ▪ Learning and problem solving are not possible at this level ▪ Symptoms Headache Nausea Insomnia Trembling Hyperventilation Sense of impending doom ▪ Potential agitation/more irritability ▪ You need to lower their anxiety before teaching/learning can happen  o Panic ▪ Most extreme level ▪ Unable to process the environment ▪ Losing touch with reality ▪ Potential hallucinations ▪ Erratic and uncoordinated movement ▪ Patient may feel they are dying, frightened, can’t move ▪ Exhaustion ▪ No learning and problem solving can occur ▪ Need to lower anxiety first ▪ Safety! 2. Recognize the difference between body dysmorphia, OCD, generalized anxiety, and social anxiety o Body dysmorphia ▪ Patients have a normal appearance Either focused on an imagined defect or exaggerate a real defect Compulsivly mirror check or camouflage Often have overwhelming emotions of disgust, shame, and depression Suicide risk is high Many keep disorder secret for a long time Seems to be related to OCD Comorbidities: social anxiety, OCD, substance use * patients with this disorder are concered with specific body parts while patients with an eating disorder are concered with their weight overall o OCD ▪ Obsessions Thoughts that are upsetting/disturbing to the patient Cannot be dismissed from the mind Cause immense anxiety ▪ Compulsions Ritualistic behaviors in response o the anxiety to self-soothe Can be related or unrelated to the obsession These only provide temporary relief ▪ Physical and sexual abuse in childhood are risk factors ▪ 76% of time co-occurs with another anxiety disorder ▪ Comorbidities: anxiety, tic disorders, MDD, bipolar, eating disorders ▪ Occurs on a continuum o Generalized Anxiety ▪ Excessive worry about many things ▪ Worry is not appropriate for the situation  ▪ Avoidance, needing to overly prepare, or questioning the relationships and decisions are common behaviors ▪ Sleep disturbance is common ▪ Growing up with an overprotective parent or ACEs can increase risk ▪ Comorbidities: MDD or other types of anxiety o Social anxiety ▪ Social phobia ▪ “stage fright: - fear of public speaking/performing ▪ The person begins to avoid situations that might involve eating/drinking in front of others, speaking, etc. ▪ Overly shy, a child may rely on a parent to speak for them ▪ Children may complain of physical symptoms to avoid school/social setting ▪ Chronic social isolation can lead to MDD ▪ Comorbidities: MDD, Bipolar, Body dysmorphia, selective mutism, autism 3. Understand priority nursing intervention during a panic attack o You are safe o We are here to help o Calmly talk about things in the environment using simple statements o Take a seat on the bench right here 4. Be able to formulate a nursing diagnosis for OCD o Example: anxiety related to persistent thoughts about bacteria, germs, and first as evidence by inability to control compulsive cleaning 5. Recognize maladaptive and ineffective coping strategies o Defense mechanisms ▪ Rationalization Justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations that satisfy the teller and the listener ▪ Reaction formation Unpredictable feelings or behaviors are controlled and kept out of awareness by developing the opposite emotion or behavior Personality Disorders 1. Identify the nursing diagnosis for all PDs a. 2. Differentiate between schizophrenia and schizotypal a. With schizotypal personality disorder, the person can be made aware of the misinterpretations of reality 3. Report the nursing priority intervention for schizotypal a. Nursing care i. Respect their need for isolation  ii. Prepare for conspicuousness iii. Careful assessment of symptoms that need interventions 1. Suicidal ideation iv. Be aware of sensitive to strange beliefs and practices 4. Define the priority nursing intervention for Borderline Personality Disorder a. Therapeutic relationship – building trust b. Be aware of manipulative behaviors c. Keep clear and consistent boundaries d. Set and keep limits e. Straightforward communication f. One point of contact g. A common trigger is fear of abandonment associated with progress and discharge 5. Evaluate what Borderline Personality Disorder patient statement shows that the treatment is effective a. We know it Is effective when the patient says they had self-harm thoughts and chose to come to you instead of acting on the thoughts 6. Determine an appropriate nursing therapeutic reaction to impulsivity a. “Let’s consider the positives of stopping to think before acting” 7. Identify which patient behavior requires limit setting a. When the patient attempts to staff split, one point of contact helps eliminate this 8. Define why the interprofessional team must meet to maintain a therapeutic milieu related to provocation a. Objectivity – remind yourself that they are sick, this is a disorder, they are in the hospital for a reason b. Prevention of provocation 9. Select common triggers for patients with Borderline Personality Disorder a. Fear of abandonment associated with progress and discharge 10. Define the nursing therapeutic interventions for manipulation a. Manage manipulation by setting clear boundaries b. If there is bullying it can be handled more directly and privileges can be removed and expectations can be re-established 11. Identify an example of a Dialectical Behavior Therapy nursing action a. Dialectal behavior therapy i. Mindfulness 1. E mental state achieved by focusing one’s awareness on the present moment, while calmly acknowledging and accepting one’s feelings, thoughts, and bodily sensations ii. Deep breathing + relaxation iii. Distress tolerance iv. Building coping strategies for when they are triggered v. Evidence-based therapy developed to treat chronically suicidal people with BPD 12. Describe nursing interventions to support individuals with Antisocial  a. Complete self-assessment related to bias b. Be aware that answers to assessment questions may not be truthful c. Manage manipulative behaviors by setting clear boundaries d. One point of contact e. Distrust, hostility, and the inability to connect with others will impact the therapeutic relationship f. Provide realistic choices g. Diversionary activities can help with aggressive feelings or behaviors i. Journaling, video games, talking, seclusion 13. Define the characteristics of Avoidant Personality Disorder a. Extremely sensitive to rejection, feel inadequate, socially inhibited, avoid interpersonal contract b. Preoccupied with rejection, humiliation, and failure c. Shy, low self-esteem, feelings of inferiority d. May be social in protected environments e. If the support system fails, they can have depression, anxiety, and anger 14. Recognize the characteristics of obsessive-compulsive personality disorder a. Limited emotional expression, stubbornness, perseverance, indecisiveness b. Preoccupation with orderliness, perfectionism, and control c. Associated with increased relapse rates of depression and an increase is suicidal risk d. Rigid, inflexible standards for self and others e. Rehearse social interaction responses f. Goal-seeking behavior, preoccupation with g. Different than obsessive compulsive disorder h. Unhealthy focus on perfectionism – they “know” they are right 15. Differentiate between Schizotypal, Avoidant, Borderline, and Narcissistic Personality a. Schizotypal i. Strange, magical thinking, odd beliefs, strange speech patterns ii. Inappropriate affect iii. Both personality disorder AND a schizophrenia spectrum disorder iv. Severe social deficits v. Extreme anxiety, paranoia, overly suspicious b. Avoidant i. Extremely sensitive to rejection, feel inadequate, socially inhibited, avoid interpersonal contact ii. Preoccupied with rejection, humiliation, and failure iii. Shy, low self-esteem, feelings of inferiority iv. May be social in protected environments v. If support system fails, they can have depression, anxiety, and anger c. Borderline i. Sever impairments in functioning ii. Patterns marked by instability, impulsivity, identify or self-image distortions  iii. Unstable interpersonal relationships iv. Self-destructive behaviors v. Chronic suicidal ideation vi. Antagonism manifested by anger, hostility, and irritability d. Narcissistic i. Entitlement, exaggerated y belief of ones own importance, lack of empathy ii. Weak self-esteem, hypersensitive to criticism iii. Need for constant admiration, exploitations of others, poor relationships iv. Intense shame, fear of abandonment v. Antagonism, grandiosity, attention-seeking behaviors 16. Disorder diagnostic criteria, priority nursing diagnosis, and priority nursing interventions Childhood Neurodevelopmental 1. Be able to develop a nursing diagnosis that is applicable to children diagnosed with autism spectrum disorder a. Psychopharmacology i. 2nd generation antipsychotics 1. Tx autism associated agitations 2. Risperdal 3. Abilify ii. SSRI 1. Target mood and anxiety b. Therapies for ASD i. Applied behavioral analysis (ABA) 1. Encourage positive behavior, discourages negative behaviors c. Evaluation i. ASD Level 1 1. Requiring support 2. Difficulty initiating social interactions ii. ASD level 2 1. Requiring substantial support 2. Social interactions limited to narrow special interests iii. ASD level 3 1. Requiring very substantial support 2. Severe deficits in verbal and nonverbal social communication skills d. Dx i. Common diagnostic test 1. Autism Diagnostic Observation Schedule (ADOS-2) e. Nursing Dx i. Impaired communication ii. Social-emotional reciprocity  iii. Impaired relationships iv. Risk for impaired socialization 2. Recognize medications given for Attention-deficient hyperactivity disorder a. Stimulants i. Methylphenidate (Ritalin) ii. Methylphenidate ER (Concerta) iii. Amphetamine salts (Adderall) iv. Lisdexamfetamine (Vyvanse) b. Non-stimulants i. SNRI Atomoxetine (Strattera) c. Alpha 2 adrenergic agonists d. Mood stabilizers, alpha-adrenergic agonists, antipsychotics for aggression 3. Correctly identify the appropriate intervention to aid children with ADHD in improving relationships a. Interventions for learning needs i. 504 1. Provides accommodations in a general classroom setting 2. With appropriate documentation, students can receive assistance to succeed 3. Might involve extra testing time, audiobook, specific seating arrangements ii. IEP 1. Much more specialized and rigorous process to evaluate, formalize, and implement 2. Involves multiple staff members 3. Requires more documentation and decision making from school 4. Understand and differentiate between different eating disorders and their symptoms a. Anorexia Nervosa i. Intense fear of gaining weight ii. People with anorexia nervosa experience differences in taste, appetite, and satiety iii. May purge 1. Forced vomiting, laxative use, excessive exercise iv. Difficult to treat v. Assessment 1. Pt do not usually have problem with behavior 2. Lanugo: fine downy hair 3. Mottled and cool skin 4. Low BMI 5. Amenorrhea vi. Manifestations 1. Low eight 2. Amenorrhea 3. Yellow skin  4. Cold extremities 5. Peripheral edema 6. Muscle weakening 7. Constipation 8. Abnormal lab values (low thyroxine levels, hypokalemia) 9. Cardiac abnormalities (hypotension, bradycardia, heart failure) 10. Impaired renal function 11. Anemic pancytopenia 12. Decreased bone density vii. Patient behavior 1. Maladaptive behavior exhibited out of fear or shame for eating food and gaining weight is called – compensatory behavior 2. Cutting food into small bits 3. Pushing food around plate 4. Smearing food on clothes while eating, into napkin b. Bulimia i. Repeated episodes of binge eating (eating 1500-5000 calories within any 2-hour period) followed by compensatory behaviors (purging) ii. More likely to express anger, mood changes iii. Assessment 1. Obsessed with body 2. Obsessed with food 3. Binge eating behavior 4. Possible hx of anorexia 5. Hiding food 6. Loss of control binge-purge cycles 7. Vomiting 8. Frequent bathroom use after meals 9. Impulsive behavior 10. Tend to express more anger c. Binge Eating i. Tx 1. SSRIs 2. SNRIs 3. Vyvanse (stimulant) d. Feeding disorders 5. Understand and differentiate between different neurodevelopmental disorders and their symptoms a. Autism Spectrum Disorder i. Complex neurobiological development disorder usually appears within the first 3 years of life ii. Savant syndrome: low IQ but brilliant in some areas iii. Strong genetic component iv. DSM  1. Persistent deficits in social communication 2. Restricted, repetitive patterns or behavior, interests, or activities 3. Sx must be present in the early developmental period 4. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning 5. These disturbances are not better explained by intellectual disability b. Attention Deficit Hyperactivity disorder i. Inattention 1. Fails to give close attention to details – makes careless mistakes 2. Difficulty sustaining attention 3. Does not seem to listen when spoken to directly 4. Does not follow through instructions and fails to finish difficulty organizing tasks and activities 5. Easily distracted ii. Hyperactivity and impulsivity 1. Fidgets, squirms 2. Leaves seat inappropriately 3. Runs about or climbs inappropriately 4. Unable to engage in leisure activities quietly 5. Talks excessively 6. Blurts our answers 7. Interrupts or intrudes c. Oppositional defiant disorder (ODD) i. Some oppositional behavior and contrariness can be normal, when it exceeds what is socially acceptable it becomes disordered ii. Affects both amotions (anger/irritation) and behaviors (argumentative/defiance) iii. Must impair life and functioning iv. Comorbidity 1. ADHD 2. Depressive Disorders d. Intermittent Explosive Disorder (IED) i. Pattern of behavioral outburst characterized by an inability to control one’s aggressive impulses ii. Go from rage to remorse e. Conduct Disorder i. Persistent pattern in which rights of other are violated, and societal norms disregarded ii. Like antisocial personality 6. Correctly identify and differentiate between impulsivity and hyperactivity 7. Determine appropriate patient outcomes related to eating disorders a. Diagnosis i. Anorexia  1. Nursing dx a. Imbalanced nutrition b. Impaired low nutritional intake c. Decreased cardiac output d. Risk for injury e. Risk for imbalanced fluid volume f. Disturbed body image g. Ineffective coping h. Chronic low self esteem i. Powerlessness j. Anxiety ii. Bulimia 1. Nursing dx a. Decreased cardiac output b. Disturbed body image c. Ineffective coping d. Powerlessness e. Chronic low self-esteem f. Social isolation b. Outcome and planning i. Anorexia 1. Hospitalization if a. Extreme electrolyte imbalance b. Weight below 75% of ideal body weight ii. Bulimia 1. Hospitalization if a. K+ < 3.2, Na