Chapter 10:
● eustress/distress
○ Eustress is beneficial stress
■ Motivates people to develop skills they need to solve problems and meet
personal goals
○ Distress is bad stress
■ Causes problems both emotionally and physically
■ Can cause confusion, trigger depression, instill
helplessness/hopelessness and cause fatigue, and more
● HPA-what it consists of and what it does
○ Hypothalamic-pituitary-adrenal axis
○ Cascade of endocrine pathways that respond to specific negative feedback loops
involving the hypothalamus, anterior pituitary gland, and adrenal gland
○ Mediates the effects of stressors by regulating numerous physiological
processes, such as metabolism, immune responses, and the autonomic nervous
system
● PTSD
○ What should patient avoid
■ Places, people, sounds, smells that are triggers
○ What are symptoms
■ Intrusive reexperiencing of the initial trauma
● Flashbacks, nightmares, unwanted distressing memories of the
event, feelings of unreality
■ Avoidance
● Avoid all memories and feelings as well as people or places that
might recall the event
■ Persistent negative alterations in mood and cognition
● Distorted cognitions about themselves and others, (fear, guilt) and
feelings of detachment
■ Alteration and arousal and activity
● Irritability, angry outburst, self-destructive behavior, exaggerated
startle response, hypervigilance, sleep difficulties
○ “Red flag” statements
■
○ Spouses/caregivers- encouraging taking care of self and providing ongoing
support
■
Chapter 11:
● Social phobias- what medication class is used to treat?
○ SSRI
● Displacement/denial
○ Displacement~ unconscious defense mechanism whereby the mind substitutes
either a new aim or a new object for goals felt in their original form to be
dangerous or unacceptable
○ Denial~ conscious refusal to perceive that painful facts exist
● What behavior could indicate OCD?
○ Obsessions:
■ Unwanted, intrusive, persistent ideas, thoughts, impulses, or images that
cause significant anxiety or distress
○ Compulsions:
■ Unwanted, ritualistic behavior the individual feels driven to perform to
reduce anxiety
● Levels of anxiety:
○ Mild
■ Occurs in normal experience of everyday living
■ Person’s ability to perceive reality is brought into sharp focus
■ A person sees, hears, and grasps more information and problem solving
becomes more effective
■ A person may display physical symptoms such as slight discomfort,
restlessness, irritability, or mild tension-relieving behaviors (biting finger
nails, foot or finger tapping, fidgeting)
○ Severe
■ Patient’s perceptual field is greatly reduced
■ May focus on one particular detail or many scattered details
■ Person will have difficulty noticing events occurring in the environment,
even when they are pointed out by others
■ Learning and problem-solving are not possible at this level, patient may
be dazed and confused
■ Behavior is automatic and aimed at reducing or relieving anxiety
■ Often complain of increased severity of somatic symptoms (headache,
nausea, dizziness, insomnia), trembling, pounding heart
■ Most classic symptoms are hyperventilation and sense of impending
dread
● Buspar (benefits of, why would you give it instead of something else?)
○ Decreased side effect profile
● Altruism
○ Healthy defense mechanism
○ Emotional conflict and stressors are addressed by meeting the needs of others.
The person receives gratification either vicariously or from the response of others
● Sublimation
○ Healthy defense mechanism
○ Unconscious process of substituting constructive and socially acceptable activity
for strong impulses that are not acceptable in their original form. (i.e., a man with
strong hostile feelings may become an athlete)
● Communicating with patient during panic
○ Firm, short statements
● Irrelevant topics, focusing
○
● Nursing diagnosis priority for patient with high-level motor activity
○
● PRN for anxiety
○ Benzodiazepines
○ Used to relieve symptoms such as sleep disturbance, agitation, anxiety,
impulsivity, anger, heightened emotional lability, and transient psychosis
● What to avoid with anxiolytics
○ Substance use problems
Chapter 12:
● La Belle’s indifference
○ Conversion disorder
○ Lack of concern
● Care planning for somatic symptom patient
○ Nursing assessment: History and course of past symptoms; current physical and
mental status
○ Assess for secondary gains (benefits derived from symptoms)
○ Ability to communicate emotional needs
○ Nurse assessment of medications used
● Secondary gains
○ Benefits derived from symptoms
● What meds are usually given for somatic symptom
○ Anxiolytics
● Nursing outcomes for amnesia patient
○
Chapter 13:
● Avoidant/dependent
○ Avoidant
■ Cluster C
● Feelings of low self-worth
● Hypersensitive to criticism or rejection
● Avoid situations requiring socialization; withdrawal
● Fearful of disappointment or ridicule
● Inhibited, reluctant to express irritation or anger, even when
justified
● Social phobia
○ Dependent
■ Cluster C
● Belief in inability to survive if left alone
● Excess need to be taken care of
●Solicit caretaking through clinging and submission
●Perversely, excessively submissive
●Intense fear of separation and being alone
●Tolerant of poor, even abusive relationships
●If relationship does end, the individual has an urgent need to get
into another
● Inability to make decisions without excessive reassurance
● Knowing when BPD treatment is effective
○
● Consistent limits
○
● BPD meds
○ Anticonvulsants, mood stabilizers, anxiolytics
Chapter 14:
● Bulimia:
○ Repeated episodes of binge eating followed by inappropriate compensatory
behavior such as self-induced vomiting, misuse of laxatives, diuretics, or other
medications, fasting or excessive exercise
■ Hypokalemia
● Most serious consequence
■ What is prominent in physical assessment?
● Russell sign: Callus on knuckles from self-induced vomiting
● Parotid enlargement will be seen on physical assessment
because of hyperstimulation of salivary gland from induced
vomiting
■ Triggers to binge eating
●
● Anorexia:
○ Intense, irrational belief about their shape and their weight, and in self-starvation,
express intense fear of gaining weight, and have a disturbance in self-evaluation
of weight (2 types, 1 where the client restricts intake, the other where they will
binge and then purge)
■ Physical criteria for hospital admission
● Weight loss more than 30% over 6 months
● Rapid decline in weight
● Inability to gain weight with outpatient treatment
● Severe hypothermia caused by loss of subcutaneous tissue or
dehydration (body temp lower than 36℃ or 96.8 ℉)
● Heart rate less than 40 beats per minute
● Systolic blood pressure less than 70 mmHg
● Hypokalemia (less the 3 mEq/L) or other electrolyte disturbances
not corrected by oral supplementation
● ECG changes (especially dysrhythmias)
■ Cachexia/lanugo
● Cachexia
○ Severely underweight with muscle wasting
● Lanugo
○ Growth of fine, downy hair on back and face
■ Refeeding syndrome and what to monitor
● Potentially catastrophic complication where the demands of the
replenished circulatory system overwhelm the capacity of the
nutritionally depleted cardiac muscle and cause cardiovascular
collapse
● Monitor cardiovascular system
■ Signs and symptoms
● Orthostatic changes
● Bradycardia
● Cardiac murmur
● Sudden cardiac arrest
● Prolonged QT interval
● Acrocyanosis
● Symptomatic hypotension
● Leukopenia
● Lymphocytosis
● Carotenemia
● Hypokalemic alkalosis
● Electrolyte imbalances
● Osteoporosis
● Fatty degeneration of liver
● Elevated cholesterol levels
● Amenorrhea
● Abnormal thyroid functioning
● Hematuria
● Proteinuria
Chapter 15:
● Patient teaching for SSRI and TCA:
○ Serotonin is first-line therapy
○ What to report to provider
■ SSRI: increased suicidal thoughts
■ TCA:
○ Time lag
■ SSRI: can take 7-28 days for effects to start, up to 6-8 weeks for full
effects
■ TCA:
○ How to manage postural hypotension
■ Change positions slowly
● Communication:
○ Nonverbal
■ Looking downward, no eye contact, body language
○ Verbal
■
● Major depressive disorder:
○ Monitoring patient inconspicuously
■
● Postpartum Depression
○ Other directed violent
■
● MAOI
○ Hypertensive crisis
■ From tyramine-rich foods
○ Diet-what to avoid?
■ Smoked or processed meats, pickled or fermented foods
○ Over the counter medications- what to avoid
■ St Johns Wort, couch and cold meds
● Anhedonia
○ In ability to feel/express pleasure
