Exam # 1 Review
What is resilience
What is the DSM-5 – The diagnostic and statistical manual of mental disorders, 5th edition. The current official
guidebook for categorizing and diagnosing psychiatric mental health disorders in the United States. Used by
psychiatrists, psychiatric nurse practitioners, therapists, and other clinicians as a guide for assessing, diagnosing,
and planning care.
-lists specific diagnostic criteria for each mental disorder
Stages of Development
Sensorimotor (birth – 2 y/o)
-basic reflexes become purposeful movements
-9 months: object permanence
Preoperational (2-7 y/o)
-language development with concrete thinking
-egocentric thinking: expect people to view the world as they do
Concrete Operational (7-11 y/o)
-logical thinking and abstract problem solving
-see another’s point of view and see many solutions to a problem
-conservation: two small cups = 1 large cup
-classify objects by characteristics, order object in a pattern, understand reversibility
Formal Operational (11 y/o – adulthood)
-conceptual reasoning and puberty occur at same time
-abstract thinking and problem-solving ability like those of an adult
Infant: Trust vs. Mistrust
Toddler: Autonomy vs. Shame/Doubt
Preschooler: Initiative vs. Guilt
School-Age Child: Industry vs. Inferiority
Adolescent: Identity vs. Role Confusion
Young Adult: Intimacy vs. Isolation
Middle-Aged Adult: Generativity vs. Stagnation
Older Adult: Integrity vs. Despair
Peplau’s Theory – the nurse nurse-patient relationship “facilitates forward movement” for both the nurse and
the patient. The phases of the nurse-patient relationship are interlocking and overlapping.
Preorientation phase: the thoughts and feelings related to the first clinical session. Mild to moderate anxiety can
be experienced.
Orientation Phase: can last for a few meetings or can extend over a longer period. An atmosphere is established
for rapport to grow. Responsibilities of nurse and patient are defined. Confidentiality is discussed. Patient
problems are discussed, and goals are agreed on.
Working Phase: gives the patient the opportunity to experience anxiety and demonstrate dysfunctional
behaviors in a safe setting while learning more adaptive behaviors.
,-maintain the relationship
-gather data
-promote problem solving skills
-facilitate behavioral change
-evaluate problems and goals
Termination Phase: discussed during first interview and during working phase. May occur at discharge or when
clinical rotation ends.
-summarize goals
-discuss incorporating goals into daily life
-exchange memories
Principles of systematic desensitization: based on classical conditioning. Learned responses can be reversed
by first promoting relaxation and then gradually facing anxiety-provoking stimulus. Successful in dealing with
extreme fear.
Neurotransmitters: a neurotransmitter is a chemical messenger between neurons by which one neuron triggers
another. 4 major groups
Monoamines (biogenic amines)
-dopamine, norepinephrine, serotonin
*Dopamine involves cognition, motivation, and movement. Controls emotional responses, brains reward and
pleasure centers, stimulates the hear, increases blood flow to vital organs.
-drugs that stimulate dopamine activity such as amphetamines induce psychotic symptoms
-drugs that block dopamine receptors such as haloperidol have antipsychotic effect
Amino acids: GABA and glutamate balance brain activity.
Peptides: hypothalamic CRH modulate or adjust general brain function
Cholinergics (ACTH): ACTH balances dopamine. ACTH controls skeletal muscle movement, arousal,
memory, and the sleep-wake cycle. ACTH is deficient in Alzheimer’s. Treatment are drugs that inhibit ACTH
breakdown.
AChE – donepezil, galantamine, rivastigmine: delay cognitive decline
What is a PET scan: positron emission tomography. Shows activity of the brain. A radioactive substance is
injected, travels to the brain, and appears as a bright spot on scan. Detects O2 utilization, glucose metabolism,
blood flow, neurotransmitter-receptor interaction.
-Schizophrenia: decreased metabolic activity in frontal lobes, dopamine system dysregulation, blockade of
dopamine receptors with antipsychotic medications.
-Depression: blockade of serotonin transporter receptors with antidepressant medication
-Alzheimer’s disease: reduction in nicotinic receptor subtype
Prefrontal Cortex – the most anterior part of the frontal cortex.
-involved in moderating social behaviors, goal setting and planning, and personality
-disrupted sensory filtering in schizophrenia is associated with alterations between thalamus and prefrontal
cortex
-OCD: hyperactivity in prefrontal cortex
, What is CT scan: series of Xray images is taken of brain, and computer analysis produces slices provoking a 3
D like reconstruction of each segment.
-schizophrenia: gray-matter reduction and ventricle abnormalities.
Dopamine blocking agents: MAO – monoamine oxidase – destroys monoamines.
Prozac – SSRI – antidepressant
-indications: depression, OCD, panic disorder
SSRI’s: inhibit reuptake of serotonin which makes it stay longer in the synapses. B/c it is selective there are
fewer side effects b/c they don’t inhibit receptors for other neurotransmitters.
-too much serotonin can result in anxiety, insomnia, sexual dysfunction, and Gi upset.
-fluoxetine: Prozac
-sertraline: Zoloft
-paroxetine: Paxil
Registered Nurse RN https://www.youtube.com/watch?v=iRs9tbUAHAc
-Treat depression, OCD,
-block reuptake of serotonin
-serotonin is an inhibitory neurotransmitter
-symptoms improve 1-1.5 months
-taper off slowly
-suicidal thoughts
-interactions with other meds. Avoid MAOI’s, certain opioids, OTC cold meds, triptans, St. John’s Wort.
-Side effects: n/v, erectile dysfunction, weight gain, insomnia, dry mouth
Patient Rights
Autonomy
Dignity and respect
Justice
Communication/Verbal/nonverbal
Transference/Nontransference
Transference occurs as the patient projects intense feelings onto the therapist r/t unfinished work from previous
relationships. Safe expression of these feelings is crucial to successful therapy.
Orientation phase of a nurse/client relationship
Orientation Phase: can last for a few meetings or can extend over a longer period. An atmosphere is established
for rapport to grow. Responsibilities of nurse and patient are defined. Confidentiality is discussed. Patient
problems are discussed, and goals are agreed on.
Theories
What is resilience
What is the DSM-5 – The diagnostic and statistical manual of mental disorders, 5th edition. The current official
guidebook for categorizing and diagnosing psychiatric mental health disorders in the United States. Used by
psychiatrists, psychiatric nurse practitioners, therapists, and other clinicians as a guide for assessing, diagnosing,
and planning care.
-lists specific diagnostic criteria for each mental disorder
Stages of Development
Sensorimotor (birth – 2 y/o)
-basic reflexes become purposeful movements
-9 months: object permanence
Preoperational (2-7 y/o)
-language development with concrete thinking
-egocentric thinking: expect people to view the world as they do
Concrete Operational (7-11 y/o)
-logical thinking and abstract problem solving
-see another’s point of view and see many solutions to a problem
-conservation: two small cups = 1 large cup
-classify objects by characteristics, order object in a pattern, understand reversibility
Formal Operational (11 y/o – adulthood)
-conceptual reasoning and puberty occur at same time
-abstract thinking and problem-solving ability like those of an adult
Infant: Trust vs. Mistrust
Toddler: Autonomy vs. Shame/Doubt
Preschooler: Initiative vs. Guilt
School-Age Child: Industry vs. Inferiority
Adolescent: Identity vs. Role Confusion
Young Adult: Intimacy vs. Isolation
Middle-Aged Adult: Generativity vs. Stagnation
Older Adult: Integrity vs. Despair
Peplau’s Theory – the nurse nurse-patient relationship “facilitates forward movement” for both the nurse and
the patient. The phases of the nurse-patient relationship are interlocking and overlapping.
Preorientation phase: the thoughts and feelings related to the first clinical session. Mild to moderate anxiety can
be experienced.
Orientation Phase: can last for a few meetings or can extend over a longer period. An atmosphere is established
for rapport to grow. Responsibilities of nurse and patient are defined. Confidentiality is discussed. Patient
problems are discussed, and goals are agreed on.
Working Phase: gives the patient the opportunity to experience anxiety and demonstrate dysfunctional
behaviors in a safe setting while learning more adaptive behaviors.
,-maintain the relationship
-gather data
-promote problem solving skills
-facilitate behavioral change
-evaluate problems and goals
Termination Phase: discussed during first interview and during working phase. May occur at discharge or when
clinical rotation ends.
-summarize goals
-discuss incorporating goals into daily life
-exchange memories
Principles of systematic desensitization: based on classical conditioning. Learned responses can be reversed
by first promoting relaxation and then gradually facing anxiety-provoking stimulus. Successful in dealing with
extreme fear.
Neurotransmitters: a neurotransmitter is a chemical messenger between neurons by which one neuron triggers
another. 4 major groups
Monoamines (biogenic amines)
-dopamine, norepinephrine, serotonin
*Dopamine involves cognition, motivation, and movement. Controls emotional responses, brains reward and
pleasure centers, stimulates the hear, increases blood flow to vital organs.
-drugs that stimulate dopamine activity such as amphetamines induce psychotic symptoms
-drugs that block dopamine receptors such as haloperidol have antipsychotic effect
Amino acids: GABA and glutamate balance brain activity.
Peptides: hypothalamic CRH modulate or adjust general brain function
Cholinergics (ACTH): ACTH balances dopamine. ACTH controls skeletal muscle movement, arousal,
memory, and the sleep-wake cycle. ACTH is deficient in Alzheimer’s. Treatment are drugs that inhibit ACTH
breakdown.
AChE – donepezil, galantamine, rivastigmine: delay cognitive decline
What is a PET scan: positron emission tomography. Shows activity of the brain. A radioactive substance is
injected, travels to the brain, and appears as a bright spot on scan. Detects O2 utilization, glucose metabolism,
blood flow, neurotransmitter-receptor interaction.
-Schizophrenia: decreased metabolic activity in frontal lobes, dopamine system dysregulation, blockade of
dopamine receptors with antipsychotic medications.
-Depression: blockade of serotonin transporter receptors with antidepressant medication
-Alzheimer’s disease: reduction in nicotinic receptor subtype
Prefrontal Cortex – the most anterior part of the frontal cortex.
-involved in moderating social behaviors, goal setting and planning, and personality
-disrupted sensory filtering in schizophrenia is associated with alterations between thalamus and prefrontal
cortex
-OCD: hyperactivity in prefrontal cortex
, What is CT scan: series of Xray images is taken of brain, and computer analysis produces slices provoking a 3
D like reconstruction of each segment.
-schizophrenia: gray-matter reduction and ventricle abnormalities.
Dopamine blocking agents: MAO – monoamine oxidase – destroys monoamines.
Prozac – SSRI – antidepressant
-indications: depression, OCD, panic disorder
SSRI’s: inhibit reuptake of serotonin which makes it stay longer in the synapses. B/c it is selective there are
fewer side effects b/c they don’t inhibit receptors for other neurotransmitters.
-too much serotonin can result in anxiety, insomnia, sexual dysfunction, and Gi upset.
-fluoxetine: Prozac
-sertraline: Zoloft
-paroxetine: Paxil
Registered Nurse RN https://www.youtube.com/watch?v=iRs9tbUAHAc
-Treat depression, OCD,
-block reuptake of serotonin
-serotonin is an inhibitory neurotransmitter
-symptoms improve 1-1.5 months
-taper off slowly
-suicidal thoughts
-interactions with other meds. Avoid MAOI’s, certain opioids, OTC cold meds, triptans, St. John’s Wort.
-Side effects: n/v, erectile dysfunction, weight gain, insomnia, dry mouth
Patient Rights
Autonomy
Dignity and respect
Justice
Communication/Verbal/nonverbal
Transference/Nontransference
Transference occurs as the patient projects intense feelings onto the therapist r/t unfinished work from previous
relationships. Safe expression of these feelings is crucial to successful therapy.
Orientation phase of a nurse/client relationship
Orientation Phase: can last for a few meetings or can extend over a longer period. An atmosphere is established
for rapport to grow. Responsibilities of nurse and patient are defined. Confidentiality is discussed. Patient
problems are discussed, and goals are agreed on.
Theories
