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Hello Class of 2007, Welcome to our blog community. This is our area to share information, resources, ask and answer questions. You will have fellow students, past students, and many other assets available to you through this site. Everyone is encouraged to discuss and problem solve here. Check back frequently as we post sample questions and links to relevant sites. We are on the same journey, let's discover it together.
Hello Class of 2007, Welcome to our blog community. This is our area to share information, resources, ask and answer questions. You will have fellow students, past students, and many other assets available to you through this site. Everyone is encouraged to discuss and problem solve here. Check back frequently as we post sample questions and links to relevant sites. We are on the same journey, let's discover it together.
2 comments:
21. Discuss the phenomenon of “visualizations” as part of the grieving process. (p615)
The bereaved brings up, thinks and talks about numerous memories of the deceased. The memories are positive. This process goes on with great sadness. The idealization of the deceased lets the bereaved relive the gratifications associated with the deceased and helps resolve any quilt the bereaved feels concerning the deceased. The bereaved may also take on many of the mannerisms of the deceased through identification. Identifications serves the purpose of holding on to the deceased. Preoccupation with the dead person can continue for many months before it lessens.
-i.e. A man whose wife has very recently died states, " I just can't stop thinking about my wife. Everything I see reminds me of her. We picked up this seashell on our honeymoon. I remember every wonderful moment we had together. The pain is so great, but the memories just keep on coming." His friends notice that when he talks, his hand gestures and expressions are very like those of his recently deceased wife.
22. Describe characteristics of Attention Deficit Hyperactive Disorder (ADHD).
(p222 ATI)
a) Inattention : An inability to focus for periods of time and ready distractibility.
- Fails to pay close attention to details
- Frequent, careless mistakes in schoolwork or other activities
- Often does not listen when spoken to directly
- Loses things necessary to complete tasks or activities
- Easily distracted by extraneous detail
- Forgetful
- Avoid activities that require concentration
- Poor handwriting
b) Hyperactivity and impulsivity : Excessive or exaggerated motor movement with an inability to control impulses or delay gratification
- Fidgets and squirms
- Excessive talking
- Inappropriate or exaggerated motor movement
- Difficulty remaining seated or quiet
- Interrupts and intrudes on others
- Often blurts out answers inappropriately
c) Impaired social interations :
Children with ADHD are often labeled as "bad" by other children, parents, and teachers. They may have trouble relating to peers or making friends.
- Child often engages in dangerous activities with little to no consideration
- Anxiety
- Depression
- Difficulty in school and/or with the law
- Impaired verbal communication
- Lack of academic success; poor academic progress
23. Discuss adolescent reactions of parents’ divorcing and appropriate nursing interventions. (p648)
- Factors associated with child adolescent and depression are physical and sexual abuse, neglect, homelessness, parental marital discord, divorce or separation of parents, learning disabilities, chronic illness, conflicts with family or peers and rejection from family and peers.
- Overall interventions for disorders
- Treatment is used in variety of settings; inpatient, outpatient, residential, day treatment, outreach programs in school and home visits.
24. Describe autistic disorders, conduct disorders, oppositional defiant disorders.(p640)
Three presenting symptoms of Autism:
1) Impairment in communication and imaginative activity
- Language delay or total absence of language
- Immature grammatical structure, pronoun reversal, inability to name objects
- Stereotypical or repetitive use of language (echolalia, use of idiosyncratic words, inappropriate high pitched squealing of giggling, repetitions of phrases, unusual babbling or clicking
- Lack of spontaneous make-believe play
- Failure to imitate
2) Impairment in social interactions
- Lack of responsiveness to and interest in others, lack of eye to eye contact and facial expression, indifference to or aversion to affection and physical contact, failure to be cuddled or comforted, lack of seeking to share enjoyment, interest, achievement and activities. Failure to develop cooperative play or imaginative play with others.
3) Markedly restricted, stereotypical patterns of behavior, interest and activities.
- Rigid adherence to routines and rituals with catastrophic reactions to minor changes in them or to changes made in the environment. i.e. moving furniture
- Stereotypical and repetitive motor mannerisms (hand or finger flapping, clapping, rocking , dipping, swaying, spinning, dancing around, walking on toes, head banging or hand biting.) Preoccupation with certain repetitive activities (pouring water or sand, spinning wheels on toys, twirling strings) that is abnormal intensity or focus
-Other abnormalities in behavior
Conduct disorder (p643-44)
- This is characterized by persistent pattern behavior in which the rights of others and age-appropriate societal norms or rules are violated.
- Childhood onset conduct disorder occurs prior to age 10 years and is found mainly in males, who are physically aggressive, have poor peer relationships and shows little concern for others and lack of feeling guilt or remorse.
This is identified by 4 types of behavior :
1. Aggression toward people and animals
2. destruction of property
3. Deceitfulness and theft
4. Serious violation of rules
Oppositional Defiant Disorder (p643)
- This is a recurrent pattern of negativistic, disobedient, hostile, defiant behavior toward authority figure without serious violations of the basic rights of others. Such children exhibit persistent stubbornness and argumentativeness, persistent testing of limits, an unwillingness to give in or negotiate and a refusal to accept blame for misdeeds.
25. What childhood circumstances are most closely linked to dissociative identity disorder. (264)
- This is an unconscious defense mechanism to protect the individual against overwhelming anxiety and aspects of the self may emerge as distinct personalities mostly adult females caused by childhood history of severe physical or sexual abuse.
- Childhood abuse : experienced an important early loss (such as death of a parent); serious medical illness; very stressful event (i.e. Required many hospitalizations and operations during childhood).
26. Describe characteristics of “resiliency” in children and factors that support resiliency. (p 637)
A resilient child has :
1. A temperament that can adapt to change in the environment
2. The ability to form nurturing relationship with other adults when a parent is not available
3. The ability to distance oneself from the emotional chaos of the parent or family
4. Good social intelligence
5. The ability to develop and use problem solving skills
27. Describe the sleep disorders of sleep paralysis,k sleep-related bruxism, night terror disorder, and REM sleep behavior disorder. (Box 33-6 p 663)
- These are the primary sleep disorders of PARASOMNIAS - characterized by unusual or undesirable behaviors that intrude into sleep or occur at the threshold between waking and sleeping.
- Sleep paralysis - characterized by a sudden inability to perform voluntary movement either at the onset of sleep or on awakening from sleep.
- Sleep-related bruxism- which is teeth grinding that occurs throughout the night but most prominent in stage 2 of sleep.
- Night terror disorder - nightmares are long, frightening dreams from which people awaken scared. They almost always occur during rapid eye movement (REM) sleep and usually after a long REM period late in the night. For some people this is a lifetime condition, for others nightmares occur at times of stress and illness.
- REM sleep behavior disorder - a chronic, progressive condition found mostly in men and characterized by the loss of atonia during REM sleep followed by emergence of violent and complex behaviors. The client is acting out his or her dreams. This disorder poses significant risk to the client as well as to the client's bed partner.
28. Describe characteristics of adult attention deficit hyperactivity disorder. (p643-44)
- The behavior of people with ADHD goes beyond occasional fidgeting, disorganization and procrastination. For them, performing tasks can be so hard that it interferes with their ability to function at work, home, school or socially.
- In adult, the problem is often an inability to structure their lives and plan simple daily tasks. Thus, inattentiveness and restlessness often become secondary problems.
- Attention-deficit/hyperactivity disorder, combiner type is characterized by symptoms of inattention, impulsivity and hyperactivity with childhood onset, although the condition may not have been diagnosed then. Hyperactivity symptoms tend to be less noticeable in adults.
- Adults' symptoms may manifest themselves differently from children. Often the most prominent characteristic in ADHD adults is difficulty with executive functioning, which is the brain activity that oversees the ability to monitor a person's own behavior by planning and organizing. Other symptoms observed in adults include inattention, impulsivity and restlessness as well as frequently accompanying behavioral, learning and emotional problems.
Hyperactivity and Impulsivity - Excessive or exaggerated motor movements with an inability to control impulses or delay gratification.
- Fidgets and squirms
- Excessive talking
- Inappropriate or exaggerated motor movement
- Difficulty remaining seated or staying quiet
- Interrupts and intrudes on others
- Difficulty waiting
- Often blurts out answers inappropriately
29. Discuss the diagnosis of gender identity disorder and possible medical therapeutic interventions. (p.608-81)
Occurs when the individual's biological and psychological gender identity do not match. Childhood patterns of cross-gender interest are noted with increasing intensity of gender dysphoria occurring in adolescence and adulthood. Individuals with gender identity disorder do not consider themselves homosexuals. Some seek sexual reassignment. This involves living in the cross-gender role; hormonal therapy, legal and social arrangement and surgery.
30. Discuss suicide risk in elderly clients.
(p 708-09)
- highest prevalence of suicide occurs in elderly white males - changes in occupational status and measures of success in men at the time of retirement and thereafter. (may lose status, influence, and contact with fellow workers in the community).
- The Protestant white male older than 85 year old, living alone in his home is at highest risk.
- Feelings of hopelessness, uselessness and despair.
- For older adults, suicide may be seen as a final gesture of control at a stage when independence is at risk or activities are limited.
- Widowhood, acute illness, family history of suicide, chronic sleep problems, alcoholism, depression, and losses (i.e. personal loss, economic and social).
- Multiple losses accompanying the aging process, increasing stress at a time when the older adult may be the most vulnerable and least able to cope with stress and thus precipitating a depressive state.
- May older adults are able to function despite their losses. Those who give in may do so because of hopelessness.
31. Describe side-effects of tricyclic antidepressants that should be closely observed for in the elderly. (p. 346-48)
Start low, go slow. Prevent fall caused by dizziness, sedative effects and orthostatic hypotension.
32. Review common alternative treatments such as aromatherapy, vitamin megadoses, acupuncture, herbs and homeopathy and massage. (p754-63)
33. Describe the purpose and common side effects (if any) of ginko, valerian, SAMe and St. John’s Wort.
- Ginko : For memory loss and emotional instability. Well tolerated with rare nonspecific side effects of GI distress, HA and allergic skin reactions. Has anticoagulant effects.
- Valerian : Brewed as tea. Has sedative, tranquilizing and sleep-inducing effects. Safe at recommended dose. Side effects are HA and upset stomach. At higher than recommended dose, side effects include blurred vision and severe HA. Drug interactions are with other sedative- hypnotic agents, the sedative effect of valerian may potentiate the effects of other CNS depressants.
- SAMe : S-Adenosyl methionine is sold as dietary supplement and used for depression and other mood disorders. Common side effects are GI distress and people with bipolar are at risk of developing manic symptoms.
- St. John's Wort : For mild to moderate depression and pain. Becoming popular because of the low cost, no need for prescription and the less side effects than traditional antidepressants. Combining St. John's with SSRI is contraindicated because it can result in serotonin syndrome ( tremor, hypertonicity, autonomic dysfunction, hyperthermia and even death).
34. Define the following:
Loose associations
- A pattern of thinking that is haphazard, illogical and confused, and in which connections in thought are interrupted; it is seen primarily in schizophrenic disorders (positive symptoms).
- i.e. Nurse: are you going to the picnic today ? Client : I'm not an elephant hunter, no tiger teeth for me. i.e. Client: Do you play golf? Nurse : sometimes. Client : two turtles. It is important to let the client know if you do not understand. Clear messages and complete honesty are an important part of working with clients w/ loose associations which is commonly seen in schizophrenia.
Neologisms
- a word that a person makes up that has meaning only for that person; often
part of a delusional system (positive symptoms).
- i.e. "I want all the vetchkisses to leave the room and leave me be." In people with schizophrenia this represents a disruption in thought processes.
Anhedonia
- The inability to experience pleasure (negative symptoms).
Concrete thinking
- Thinking grounded in immediate experience rather than abstraction. There is an overemphasis on specific detail as opposed to general and abstract concepts.
- i.e. During an assessment, nurse might ask what brought the client to the hospital. Client will answer a cab. When asked " people in glass houses shouldn't throw stones" the client with schizophrenia will say don't throw stones or the window will break. Answer is literal with no abstract reasoning. (positive reasoning).
Thought withdrawal
- The belief that thoughts have been removed from one's mind by an outside
agency.
- i.e. " the devil takes my thoughts away and leaves me empty." This is a common
delusion in schizophrenia (positive symptoms).
Thought insertion
- The belief that thoughts of others are being inserted into one's mind. i.e. "they make me think bad thoughts."
Aphasia
- Loss of language ability, which progresses with the disease. Initially, the person has difficulty finding the correct word, then is reduced to a few words, and finally is reduced to babbling or mutism.
Apraxia
- Loss of purposeful movement in the absence of motor or sensory impairment. The person is unable to perform once familiar and purposeful tasks. i.e. in apraxia of gait, the client loses the ability to walk. In apraxia of dressing, client is unable to put clothes on properly.
Anhedonia
- Lack of pleasure in acts that are normally pleasurable.
Agnosia
- Loss of sensory ability to recognize objects. i.e. the person may loose the ability to recognize familiar sounds (auditory agnosia). (visual or tactile agnosia) inability to recognize familiar objects. Eventually, client are unable to recognize loved ones or even parts of their own bodies.
Confabulation
- Making up stories or answers to maintain self-esteem when the person does not remember. Unlike lying, confabulation is an unconscious attempt to maintain self-esteem.
Akathisia
- Motor inner driven restlessness (tapping foot incessantly, rocking forward and backward in chair, shifting weight from side to side.)
Tardive dyskinesia
- Onset is months to years. Protruding and rolling tongue, blowing, smacking, licking, spastic facial distortion. No known treatment: discontinuing the drug does not always relieve symptoms. Possible 20% of clients taking these drugs for > 2 years may develop tardive dyskinesia. Nurses and doctors should encourage client to be screened for tardive dyskinesia at least every 3 months.
Pedophilia
-involves sexual activity with a prepubescent child. Predator must be at least 16 y/o and at least 5 yrs older than the victim.
Exhibitionism
- Intentional display of the genitals in public. Done more for the shock value.
Fetishism
- A sexual focus on objects such as shoes, gloves, pantyhose, and stockings that are intimately associated with the human body.
Voyeurism
- PEEPING TOM. Viewing of other people in intimate situations. Need I say more !
Impulsivity
- Blurts out answers before question has been completed. Has difficulty waiting for own turn. Interrupts, intrudes in others conversations and games.
Hyperactivity
- Fidgets, is unable to sit still or stay seated in school or at other activities. Runs and climbs excessively in inappropriate situations. Has difficulty playing quietly in leisure activities. Acts as if "driven by a motor", constantly on the go. Talks excessively.
Inattention
- Has difficulty paying attention in tasks or play. Does not seem to listen, follow through, or finish tasks. Does not pay attention to details and makes careless mistakes. Is easily distracted, loses things and is forgetful in daily activities. (symptoms worsen in situations requiring sustained attention).
Defiance
- A state of opposition; willingness to flight; disposition to resist; contempt of opposition.
Oppositional Defiant Disorder (ODD)
- A pattern of negativistic, hostile, and defiant behavior lasting at least six months during which four or more of the following are present:
1. Often loses temper
2. often argues with adults
3. often actively defies or refuses to comply with adults' requests or rules
4. often deliberately annoys people
5. often blames others for his or her mistakes or misbehavior
6. is often touchy or easily annoyed by others
7. is often angry and resentful
8. is often spiteful and vindictive
The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.
Thank you :D
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