Medical Conditions, Interpersonal Violence, and Personality Disorders, Exams of Nursing

Download Medical Conditions, Interpersonal Violence, and Personality Disorders and more Exams Nursing in PDF only on Docsity! NUR 206-Exam 3 with 98 Terms Correctly Answered for 2024 Update. Cardiomyopathy - ANS •disease that affects heart muscle's ability to pump effectively •primary abnormality of heart muscle that affects it's structural or functional characteristics Dilated Cardiomyopathy - ANS •most common •inherited (1/3) •chemical exposure •common occurrence in 20-60 yo •men > women •muscle becomes thinner and weaker as it dilates •SOB, fatigue, LE edema, JVD Hypertrophic Cardiomyopathy (HCM) - ANS •↓ compliance of LV and hypertrophy •usually inherited •also sec to HTN •muscle mass enlarges, leading to small LV volume •septal hypertrophy may inhibit outflow Restrictive Cardiomyopathy (RCM) - ANS •rigid ventricular walls that restrict heart's ability to stretch and fill w/ blood •usually acquired as result of amyloidosis (build up of protein) •↓ compliance (expansion) •diastolic dysfunction and HF Arrythmogenic Right Ventricular Dysplasia (ARVD) - ANS •↑ risk of ventricular dysrhythmias sec to thickening of cardiac muscle •usually hereditary •can cause sudden cardiac death in young adults and athletes Unclassified Cardiomyopathy - ANS •peripartum cardiomyopathy (PPCM) •rare but serious •usually seen in last months of pregnancy or up to 5 months PP •risk factors = multiple pregnancies, obesity, poor nutrition, HTN, some meds Stenosis vs. Regurgitation - ANS *Stenosis* •narrowing of valve or artery *Regurgitation* •backflow of blood into atria during ventricular systole Conditions that Lead to Valvular Heart Disease - ANS •congenital •valvular stenosis •valvular insufficiency •HTN •age •atherosclerosis •infection •MI Clinical Manifestations of Valvular Heart Disease - ANS •SOB (mitral/aortic) •weakness/lightheadedness (mitral/aortic) •chest discomfort (any?) •edema of LE (tricuspid/pulmonic) •palpitations (any?) •rapid weight gain (tricuspid/pulmonic) Valvular Heart Disease Treatment and Interventions - ANS *Medication* •BB •ACE inhibitors •nitrates •diuretics •calcium channel blockers •statins •hydrazeline *Interventions* •low Na+ diet •weight management •↓ stress •↑ physical activity •stop smoking Left Sided Heart Failure - ANS •forward effects •fatigue •activity intolerance •dizziness/syncope •pulmonary congestion/edema •orthopnea/PND •S3,S4 heart sounds Right Sided Heart Failure - ANS •backward effects •edema •JVD •liver engorgement •GI issues •nocturia •Cor Pulmonale (RV failure d/t pulmonary HTN, edema, etc.) •anasarca (generalized edema) Cardiac Output - ANS •CO (ml/min) = HR (beats/min) x SV (ml/beat) •knife wounds •gunshot injuries •cuts •bruises •behavioral indications •complete health hx •emotional state Abuse Nursing Diagnosis - ANS •risk for trauma •risk for self harm •powerlessness •post-trauma syndrome •risk for sexual dysfunction •social isolation Abuse Nursing Planning - ANS •client will be safe and free from harm •client will ask for help in safe resolving abuse •client will convey feelings of fear, helplessness, anger, etc. •client will report SI •client will acknowledge that they're not responsible for abuse •client will practice healthy coping mechanisms Abuse Nursing Implementation - ANS •dependent on pt's willingness to accept help •report abuse when appropriate •promote safety •establish therapeutic relationship •facilitate communication •promote empowerment Rape Clinical Manifestations - ANS *Physical Injuries* •swelling, redness, lacerations to vagina or anus •injuries to throat, bruises, broken bones, etc •defensive injuries •internal injuries •long term complications (back/pelvic pain, headaches, STDs, etc) *Immediate Response* •feelings of shock, guilt, embarrassment, helplessness, etc. •hesitant to trust others •feeling need to shower (advise against) •denial *Long-Term Response* •accept that rape occurred •emotional responses •emotional distress can trigger use of unhealthy coping mechanisms Rape Trauma Collaborative Care - ANS •interdisciplinary care begins immediately after rape *Diagnostic Tests* •vaginal, oral, anal swabs for DNA collection •scrapings under fingernails •combing through pubic hair •victim's clothing *Pharm Therapies* •emergency contraception •penicillin (syphilis) •azithromycin (chlamydia) •ceftriaxone and azithromycin/doxycycline (gonorrhea) •metronidazole or tinidazole (trichomoniasis) *Nonpharm Therapies* •support groups •therapy •counseling Rape Nursing Assessment - ANS •ensure client's safety •major injuries assessed first •pt's response to rape •work to comfort and empower victim Rape Nursing Diagnosis - ANS •risk for infection •rape-trauma syndrome •fear •acute pain •powerlessness •risk for ineffective coping •low self-esteem •disturbed self-concept Rape Nursing Planning - ANS *Short-Term Goals* •client will receive treatment for injury •client will participate in follow up care •client will follow a safety plan following relapse *Long-Term Goals* •client will control over-remembering event •client will work towards affect tolerance •client will gain master over symptoms •client will reconnect with and trust others •client will discover some kind of meaning to event Rape Nursing Implementation - ANS •place pt in private room •treat injures in order of severity •determine if pt showered or changed clothes •help pt relay details of event •explain every step of evidence collection •provide referrals to social work, support groups, authorities •STD testing PTSD - ANS •trauma or stressor related disorder that evolves after exposure to traumatic/overwhelming event which one's physical health was endangered *Includes* •reactive attachment disorder •disinhibited social engagement disorder •acute stress disorder •adjustment disorder PTSD Etiology - ANS •more likely to occur/be longer lasting when stressor is of intentional human action *Flashback* •often triggered by daily events •usually occurs w/in 3mo of event *Etiology* •exposure to overwhelming stressors can occur at any time/age •childhood trauma, abuse, molestation •diagnosed PTSD in symptoms last > 1mo •1/2 of affected individuals experience complete resolution of symptoms w/in 3mo PTSD Risk Factors - ANS •severity of event •little to no social or psychological support following event •additional stressors immediately following event •presence of preexisting mental illness PTSD Clinical Manifestations - ANS •may lose touch w/ reality while having flashback •depression •hyperarousal & hypervigilance *Children* •different than adults •under 6 may relive trauma through play or drawings •may behave recklessly or aggressively •may withdraw from interacting w/ others PTSD Therapies - ANS *Pharm* •used as adjunct to psych treatment •desire for immediate/total relief may foster abuse/dependency •benzos •TCA •SSRIs •lithium •BB •inflated self esteem •lack of sleep •talkative •racing thoughts •distractibility •↑ activity •excessive impulsiveness *Hypomania* •less extreme form of mania that isn't severe enough to markedly impair fxning or require hospitalization •pts feel "on top of the world" and don't recognize changes in self •lasts 4 days or more •no psychotic features Bipolar I vs Bipolar II - ANS *Bipolar I* •mania + major depression *Bipolar II* •hypomania + major depression Bipolar Across Lifespan - ANS *Children* •mood and behavioral changes •lengthily, violent temper tantrums •take on multiple tasks at once *Adolescents* •average age of 1st episode is 18 •lifetime prevalence is 0-3% *Pregnant Women* •5-10x more likely to experience episode if already diagnosed •slowly taper off meds •close monitoring necessary *Older Adults* •verify no medical or substance etiology if 1st episode happens at this age •prone to med SE, may need lower doses Bipolar Comorbidities - ANS •anxiety •ADHD •personality disorder •CVD •DM2 •family hx •drug use •high stress •major life-altering event Bipolar Cyclical Features - ANS *Rapid Cycling* •4 episodes w/in 1 year w/ >2mo of partial or full remission *Cyclothymic Disorder* •when pts sustain ≥ 2 years of chronic fluctuating mood disturbance Bipolar Treatment - ANS *Pharm* •mood stabilizers (lithium) •anticonvulsants •atypical antipsychotics •antidepressants *Nonpharm* •exercise •St. Jon's wort •SAMe •vit B •tyrosine •melatonin •omega 3's •acupuncture Nursing Considerations After Suicidal Patient Statement - ANS •promote immediate safety •use CSSRS or other screening tool •notify dr, case manage, social worker, referral to mental health •↑ pt knowledge Prioritizing Care After Suicide Attempt - ANS •↓ pt's risk for self-directed violence •ensure pt is watched at all times •encourage verbalization of emotions and concerns •encourage attendance of family or group therapy •teach effective coping skills •teach how to seek help if needed Systemic Inflammatory Response Syndrome (SIRS) - ANS •whole body inflammatory process resulting in acute critical illness •can result from infections or noninfectious cause (burns, trauma, etc.) Sepsis - ANS •SIRs resulting from infection •can occur as complication of any infection Severe Sepsis - ANS •sepsis w/ acute associated organ failures Septic Shock - ANS •persistently low MAP despite adequate fluid resuscitation •bacteremia → septicemia → septic shock Refractory Septic Shock - ANS •persistently low MAP despite vasopressor therapy and adequate fluid resuscitation Sepsis Portal of Entry - ANS •urinary system •respiratory system •GI system •integumentary system Sepsis Risk Factors and Prevention - ANS *Risk Factors* •hospitalization •debilitating chronic illness •poor nutritional status •invasive procedures •surgery •age •immunocompromised •infants w/ infectious process *Prevention* •monitor pts closely for early s/s •careful w/ cancer and immunocompromised pts •pneumococcal immunizations •aseptic technique w/ catheters and IVS Sepsis Clinical Manifestations - ANS •fever or hypothermia (above 38 or below 46) •tachycardia (>90) •tachypnea (>20) •PaCO2 <32mmHg •peripheral vasodilation •mental status changes •septic shock *Lab Results* •WBC >12 or <4 •bands >10% •lactate >2 •creatinine >2 or doubled from baseline •platelets <100 •INR > 1.5 or aPTT >60 sec Sepsis Lifespan Considerations - ANS *Infants* •diagnostic testing to r/o sepsis if under 3 mo •temp instability •abdominal distension •poor feeding •lethargy •resp distress •hepatomegaly •vomiting and/or jaundice *Older Adults* •cardiac changes ↓ compensatory response to septic shock •fever •wheezing *Children w/ Active Infection* •fatigue •cough •↓ appetite •weight loss •etc. *Older Adults* •symptoms often vague TB Tests - ANS *PPD* •shows exposure to TB •diagnosis latent and active TB *Blood* •IGRA •more specific diagnostic *Sputum Culture and CXR* •definitive •use CXR if had +PPD in past TB Pharm Therapy - ANS •goal is to make noncommunicable, ↓ symptoms, follow therapy •lasts 6-12 mo *Isoniazid (INH)* •drug of choice for prophylaxis and 1st line defense for treating active disease *Rifampin* •used in combo w/ INH •↑ metabolic rate of liver *Pyrazinamide* •given w/ INH and rifampin for 1st 2 months •hepatotoxic *Ethambutol* •added to initial treatment or substituted for INH •↓ development of resistance *Streptomycin* •not used as much, causes kidney and ototoxicity TB Nursing Assessment - ANS •health hx •physical exam •ask questions to identify at risk groups *Latent TB Screening Questions* •collect demographic info •review medical record •question past TB hx •compliance w/ previous TB treatment? •born outside US TB Nursing Diagnosis - ANS •fatigue •imbalanced nutrition •deficient knowledge •ineffective therapeutic regimen management •risk for infection •deficient community health •social isolation TB Nursing Planning - ANS •pt demonstrates behaviors that reduce risk of contamination to other •pt describes required treatment and follow up care •pt has adequate resources to obtain necessary meds and supplies TB Nursing Implementation - ANS •provide pt education •promote effective therapeutic regimen management •↓ risk of infection TB Nursing Evaluation - ANS •pt considered non-infectious when they have 3 consecutive sputum cultures, compliant w/ treatment for 3 wks, symptoms have improved Factors Influencing Self-Concept, Self-Esteem, Self-Awareness - ANS •personal identity •body image •role performance •health status Role Performance and Self-Concept - ANS •role strain or role conflicts can produce embarrassment, ↑ stress, ↓ self-esteem Antisocial Personality Disorder - ANS *Characteristics* •impulsive •lack remorse •lack empathy •easily agitated, aggressive, controlling *Therapies* •group therapy •anger management therapy •psychodynamic therapy •antidepressants, mood stabilizers, anti anxiety, antipsychotics Avoidant Personality Disorder - ANS *Characteristics* •extreme social discomfort •hypersensitive •intense anxiety r/t socialization •internalizes negative comments from others *Therapies* •social skills training •CBT •group therapy •antidepressants, anti anxiety Borderline Personality Disorder - ANS *Characteristics* •extreme risk taking •impulsive •self injury, SI •anxiety •consistently low mood •unstable relationships d/t mistrust of others *Therapies* •schema-focused therapy •dialectical behavior therapy •CBT •group therapy •antidepressants, anti anxiety, antipsychotics, mood stabilizers Dependent Personality Disorder - ANS *Characteristics* •need to be under control of dominant other •insecure about making decisions •chronic sense of inadequacy *Therapies* •psychotherapy •antidepressants, anxiolytics Histrionic Personality Disorder - ANS *Characteristics* •flamboyant, seductive in behavior/appearance •sexually manipulative •demands to be center of attention •seeks excitement and activity *Therapies* •psychotherapy •no group therapy Narcissistic Personality Disorder - ANS *Characteristics* •grandiosity •rage •depression/anxiety •manipulative •lack of empathy *Therapies* •CBT