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What is Axis 1?
- Axis 1: The presenting problems
- eg: BPD (bi-polar disorder), or Schitzophrenia
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What is Axis 2?
- Axis 2: the chronic or long-term problems that are not going to be corrected
- eg: mental retardation, personality disorders
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What is Axis 3?
- Axis 3: general medical conditions
- eg: DM, HTN, COPD, hypothyroidism
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What is Axis 4?
- Axis 4: current stressors...the "why now"
- eg: divorce, death in the family, recent medical dx...
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What is Axis 5?
- Axis 5: Global Assessment of Functioning (GAF) score
- eg: 40 (current) 65 (last year)
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What is the GAF?
- GAF= Global Assessment of Functioning= overall assessment within 10 ranges of
- 1) severity of symptoms OR
- 2) level of functioning
- -if discrepancy exists GAF reflects worse of the 2, don't give benefit of the doubt!
- -if second GAF scale # is used it should be labeled w/ time period...eg 45 (current) 60 (past year)
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What are the 3 phases of group work?
- 1) orientation
- 2) working
- 3) termination
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What is the group leader and group members responsibility in the orientation phase?
leader: set up atmosphere of respect, confidentiality, and trust
group: get to konw one another, issues of joining a group, acceptance, rejection, sexual attratction, posistion in the gorup
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What is the group leader and group members responsibility in the working phase?
leader: encourage members to cooperate w/ each other and handle conflict, keep group focused on therapeutic goals of individual members
group: issues of leadership, power and control, develops functional norms (eg. sit in circle, come on time), and a sense of group identity, grapples w/ completing a task, developing competance and trust
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Discuss the nurse's awareness during the working phase
- -Roles:
- -become sensitive to the roles clients assign to you (transference)
Trust Development- consistency is key w/ actions and words
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What is the leader and the members responsibility during the termination phase of group?
leader: acknowledge the contributions of each member and the experience as a whole
group: prepare for the seperation and for the future, endings, loss, loneliness, death, saying goodbye (tendancy to avoid goodbyes by not showing up, making vague future plans, etc)
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Instillation of hope
feeling hopeful about one's life
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Universality
feeling that one is not alone
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imparting of information
sharing info
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altruism
- giving appropriate help to other members
- eg: "I've spent all this time talking about me. Lou needs to talk about his visit w/ his dad, let's focus on him"
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catharisis
releasing feelings and emotions, like a cleansing
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existential resolution
coming to understand what life is about
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What are the ABC's of cognitive behavioral therapy?
- A= Activating Event +
- B= Beliefs, or aotomatic thoughts =
- C= Consequences, feelings
- a pt. w/ psychosocial difficulties haas negavive Beliefs that cause neg. Consequences. W/ CBT we want to change their Beliefs to positive/adaptive ones
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What are some other CBT techniques?
- -daily mood charting
- -tracking pleasant events
- -homework
- -learning behavioral skills
- -examining and changing neg. thoughts
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RN's can assume respoonsibility for what groups?
- -med education
- -sexuality
- -dual-diagnosis
- -multifamily
- -symptom management
- -stress management
- -community
- -self-care
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Advance Practice Nurses can assume responsibility for what groups?
- -same as the RN +
- -psychotherapy
- -family therapy
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What are the basic diagnostics for anorexia?
- -age of onset 14-16 yrs
- -50% co-morbidity w/ OCD
- -main diffs from bulemia=
- 1) refusal to attain or maintain minimal body weight for age and height, pt. <85% of normal BMI
- 2) perceptual distrubances (pt. sees themself as fat- doesn't know there is a problem)pt. ego-cyntonic (they feel like they're fine)
- 3) Amenorrhea-after menarche, females miss at least 3 consecutive periods or befre menarche the menstral cycle is delayed
- -concern about weight often increases as weight decreases
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What are the basic diagnostics for anorexia?
- -age of onset 18-24yo
- -pt usually w/in normal weight range
- -pt. recognizes there is a problem but feels helpless to correct it
- -pt. feels sense of relief after purging, release of tension and anxiety, depression follows episode (post-binge remorse or guilt)
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What are some lab findings of anorexic pt?
- -hematology: anemia, leukopenia
- -chemistry: incr. BUN, hypercholeserolemia, metabolic alkalosis (incr. serum bicarb), hypochloremia, hypokalemia, metabolic acidosis
- -EKG: sinus brady, dysrhythmias (can lead to cardiac arrest)
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What are some lab findings of a pt. w/ bulemia?
- -metabolic alkalosis- d/t loss of stomach acid
- -metabolic acidosis- d/t diarrhea
- -hypokalemia, hyponatremia, hypochloremia
- -elevated serum amylase
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