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Praxis exam study semester 2 --


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What are the potential impacts of Co-existing mental health and substance use problems (CEP)?
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higher rates of suicide higher rates of homelessness poor relationships with family and friends poor physical health

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What are the potential impacts of Co-existing mental health and substance use problems (CEP)?
Higher rates of suicide higher rates of homelessness poor relationships with family and friends poor physical health
What is OARS in the use to developing therapeutic relationship when talking to someone with CEP?
Open questions affirmation reflective listening summary reflection
What are the 6 stages of change to identify the likelihood of someone wanting to change?
Pre-contemplation contemplation preparation action maintenance relapse or lapse
What is harm reduction in people who drugs or alcohol ?
About reducing short and longer term harms associated with substance use and gambling - not about the absence to the substance but more about reducing the harm it may cause. Goals can be to support the person to: change how substances are used change how substances are accessed cut down on the amount used  cut down on the frequency of use sustain controlled use
What is the FRAMES model for brief intervention of someone with substance or alcohol use?
Feedback - from screening process responsibility advice menu options empathy self-efficacy
After doing a brief intervention you should conclude the conversation by using the SEW acronym, what does this mean?
S- SUMMARISE - a summary of the person's statements in favour of change E- EMPHASISE - emphasise strengths and their ability to make changes W- WHAT? - what agreement has been reached?
What is acute alcohol withdrawal?
Occur when someone who regularly drinks suddenly stops or significantly reduces their alcohol intake - nervous system is hyperactive
What is Delirium Tremens in acute alcohol withdrawl?
Medical emergency - extreme symptoms. extreme confusion extreme agitation seizures fever
What is the CIWA-AR scale screening tool for acute alcohol withdrawl?
Used to assess the extent of withdrawal someone is experiencing - used to support the use to benzos to manage the symptoms of withdrawl
How does Disulfiram (Antabuse) work to help people remain absence from alcohol?
Produces irreversible inhibition of aldehyde dehydrogenase (ALDH). Aldehyde dehydrogenase is the enzyme responsible for the oxidation of acetaldehyde (which is a metabolite of ethanol).
What are the nursing considerations for disulfiram?
Prescribed only with full consent of tangata whaiora, therefore education about the medication and its interactions with alcohol is paramount. Dietary considerations – food containing, or prepared with, alcohol (e.g, sauces, vinegars, desserts). Over the counter (OTC) products which may contain alcohol, E.g., cough medicine, mouth wash, after shave, perfumes. Check for alcohol content.
What is the point of the methadone program?
To support opiate withdrawl so that they no longer need to access illicit opioids such as heroin or morphine derivatives - pure opiate agonist, replaces opiate use in dependence. stabilization (reduces the desire for taking other drugs), replacement (substitute for other opioids), reduction (reduces withdrawal symptoms)
What is the mode of action of methadone?
Binds to opiate receptors in the cns
What are some symptoms of methadone intoxication?
Can be fatal - slow breathing constipation drowsniness
Emergency treatment of opioid overdose?
Assess ABC call for help place in recovery position airway and oxygen given naloxone
What is the purpose of Substance Addiction (Compulsory Assessment and Treatment) Act, 2017?
Enable persons to receive compulsory treatment if they have a severe substance addiction and their capacity to make decisions about treatment for that addiction is severely impaired
How does substance addiction compulsory treatment help a person?
A) protect them from harm b) facilitate a comprehensive assessment of their addiction; a c) stabilise their health through the application of medical treatment (including medically managed withdrawal) d) protect and enhance their mana and dignity and restore their capacity to make informed decisions about further treatment and substance use e) facilitate planning for their treatment and care to be continued on a voluntary basis; and f) give them an opportunity to engage in voluntary treatment.
A person may be subject to compulsory treatment under this Act only if?
(a) the person has a severe substance addiction (b) the person’s capacity to make informed decisions about treatment for that addiction is severely impaired (c) compulsory treatment of the person is necessary (d) appropriate treatment for the person is available.
What are the features of a SEVERE substance addiction?
A) neuro-adaptation to the substance (b) craving for the substance (c) unsuccessful efforts to control the use of the substance (d) use of the substance despite suffering harmful consequences.’
What is human development?
The physical, social, psychological, cognitive, emotional, cultural and spiritual development and acculturation that happens at different points in our lives
What are the tasks of adolescence?
-Transition from child to adult, learning skills for later life, self-reliance and confidence, development close relationships with peers and the formation of personal identity  -Identity develops over time and is part of the makeup of an individual’s overall sense of self.  -Most important part of life because of the risk taken as they trail different perspectives of self
What is gender identity?
Person’s own sense of identification as male, female, neither, both, or somewhere in between and is a key part of human development.
What is Anatomical Sex (biological sex)?
Is comprised of things like genitals, chromosomes, hormones, body hair, and more. But one thing it’s not: gender.
What is gender expression?
Ways you present gender, through your actions, clothing, demeanor, and more. Your outward-facing self, and how that’s interpreted by others based on gender norms
Developing sexual and romatic attachment is a key developmental task of adolescence and includes?
Body image sexual orientation how we experience intimacy, touch, and love sexual experiences, thoughts, ideas, and fantasies
What are some recommendations to make gender diversity inclusive?
Clear Pathway for gender affirming health care Address discrimination in health care and respect gender diversity Support schools to be safe and inclusive Support health and wellbeing initiatives led by trans and non binary people
What risk factors can predispose children to long term problems in adolescence and adulthood?
Exposure to parental stress/violence Poverty Physical, emotional and sexual abuse maternal depression
What are protective factors that significantly reduces the risk of problems in later life?
Nurturing loving relationships positive parenting support from siblings and peers
What is attachment disorder?
Occurs when an attachment relationship is impaired in some way - does not develop the skills necessary to build meaningful relationships as infant develops
What is fetal alcohol spectrum disorder? (FASD)
Umbrella term that occurs due to maternal use of alcohol during pregnancy that causes damage to the fetus (ethanol crosses the placenta and toxins accumulate in the fetus) - most common cause of intellectual disorders
What are the possible effects of FASD?
Brain damage, developmental delay and social, emotional, behavioural and mental disabilities. poor growth facial abnormalities
FASD often present with of social, emotional, and behavioural difficulties. what are these?
Frequently seen by others as intrusive, overly talkative, and generally unaware of social cues and conventions. Poor social judgment and poor socialization skills are common and difficulty establishing friendships Hyperactivity, short attention spans. Memory problems, thus creating further setbacks to adaptive functioning and academic achievement later on
What is Attention Deficit Hyperactivity Disorders?
Are behavioural problems where the child lacks or has insufficient control over behaviour that is expected in a given setting and is appropriate to the child’s age - One of the most common childhood mental health disorders (affects boys more)
FASD can lead to many other impacts on the client and the family such as?
Stigma reluctant to seek health services guilt lack of understanding of the condition
What are the usual symptoms of ADHD?
Difficulty paying attention and staying focused (inattention) difficulty controlling behaviour (impulsivity) hyperactivity (over-activity).
What are autism spectrum disorders?
Life-long developmental disability which affects communication and social interaction and is associated with a lack of flexibility in thought and action - Children with ASD all share some difficulty in making sense of their world
What are conduct disorders?
Clustering of behavioural difficulties that is dissimilar to age-appropriate norms. These behaviours include hostility to others, aggression, rule infractions, defiance of adult authority and violations of social and cultural norms
What are the three key elements of severe behavioral conduct disorders?
- Severe - at an intensity and rate that is outside the levels of behavioural difficulties normally found in children of the same age. - Persistent across contexts (at home, at school, and in other social situations and over time) - Antisocial – involving repeated violations of societal and age-appropriate norms that result in a negative impact on family, early childhood centres, school, peers, self etc.
What is school phobia/refusal
Severe difficulty attending school resulting in prolonged absence
What can school phobia result from?
- Severe emotional upset - At home with parents knowledge - separation anxiety -
What is the purpose of a HEADSSS assessment?
Psychosocial screening tool designed to work with young people to discover the context of a presenting complaint to a health professional - also assists with developing therapeutic relationship and strength based plan
What does HEADSSS stand for?
Home, Education and Employment, Eating and Exercise Activities and peers, Drugs, Sexuality, Suicide and depression, Safety, Spirituality
What are the three harms that need to be disclosed to someone else during a HEADSSS assessment?
(1) Someone might harm you, (2) You might harm yourself, (3) You might harm someone else. If I need to discuss your issues with someone else, I will try to let you know about that first
Which people may be at a higher risk of self harm?
Females Children and young people who have experienced ACES LGBTIQ community People who live in state care, prisons or secure institutions
What is the self-harm cycle?
People experience emotional suffering, they are unable to regulate their emotions which then becomes too overloaded, this emotional overload causes people to panic and use self harm to regulate their emotions, this causes temporary relief but then the person often feels a sense of shame
What are some reasons people self harm?
Temporarily relieves intense feelings, pressure or anxiety; provides a sense of being real, being alive - of feeling something other than emotional numbness; to draw attention for help
What are some distraction techniques to suggest people to try rather than self harm?
- write down thoughts and feelings on paper then screw the paper up - mindfulness techniques - flicking rubber band against skin - excercise
What are some nursing considerations for people who self harm?
Show compassion Respect what the person is telling you, even if you don’t understand it Stay emotionally neutral Listen, even if it makes you uncomfortable
What is anorexia nervosa?
An eating disorder defined by a restriction of energy intake relative to requirements, which leads to significantly low body weight - Patients with this eating disorder will have a fear of gaining weight along and a distorted body image with the inability to comprehend the seriousness of their condition
What are some potential health concerns for someone with anorexia? (malnutrition)
Loss of muscle tissue – low creatinine Hypotension - dehydration Electrolyte deficiencies Gi tract unable to tolerate normal food Bone marrow – fewer wbc – dampen immune response Fewer rbc – low energy – anemia Fewer platelets – easy bleeding and bruising Osteoporosis Dry skin Brain atrophy seizures, confusion
What is bulimia nervosa?
An eating disorder characterized by binge eating until they feel extremely full, followed by inappropriate compensatory behaviour to get rid of the calories (purging) - usually of normal weight or over weight rather than under weight
What is orthorexia?
An obsession with eating foods that one considers healthy. Person systematically avoids specific foods that they believe to be harmful.
What is ARFID: Avoidant/Restrictive Food Intake Disorder?
A person with ARFID has issues eating certain foods, which leads to inadequate nutritional intake
What is Psychodynamic psychotherapy for eating disorders?
Requires understanding the root cause of the illness, the motives and drivers. Behaviours are expressions of underlying needs, therapy offers alternative ways for an individual to get their needs met
What is acceptance and commitment therapy? (ACT)
Changing actions rather than thoughts and feelings, accepting that pain and anxiety are a part of life. ACT identifies core values and commits to creating goals that fulfil these values.
What gene mutation does cystic fibrosis affect?
CFTR gene - which is located on chromosome 7. This gene is responsible for making a protein called Cystic Fibrosis Transmembrane Conductance Regulator
What is the CTFR gene responsible for and what happens when there is a mutation in that gene?
Controls movement of chloride ions in and out of cells. Mutation in the gene cause the CFTR protein to malfunction or not be made at all, leading to a buildup of thick mucus and flattened cilia which cant sweep away the mucous, which in turn leads to persistent lung infections, destruction of the pancreas, and complications in other organs.
How does CF affect the respiratory system?
Mucus and other debris can’t be moved out of the system effectively and the mucus becomes thick and sticky, clogging up the airways and creating the colonization for bacteria leading to infection
How does CF affect the GI system?
Pancreatic duct that transport pancreatic enzymes out of the pancreas become blocked with mucus. The enzymes build up in the pancreas instead of reaching the digestive system (specifically, the lumen of the gut), causing the pancreas to become inflamed.
If the pancreas become blocked and does not secrete enzymes, how does this affect absorption?
Impaired absorption of fats, proteins and vitamins A, D, E & K
What are the common symptoms of CF affecting the GI system?
Abdominal pain and cramps Greasy stools Constipation Gastric reflux Poor weight gain and growth
What is Cystic Fibrosis Related Diabetes (CFDR) ?
The effect on the pancreas can lead to cell death which can then lead to hyperglycemia as the pancreas stops producing insulin
How does CF lead to metabolic alkalosis?
High loss of sodium and chloride (acid) from sweat, gut, bronchial mucosa, saliva and tears leads to chloride depletion Depleted chloride leads to excessive bicarbonate (base) resorption, leading to metabolic alkalosis
How can CF be diagnosed?
New born metabolic screening (Guthrie Heel Prick Test) – looks for an enzyme called Immunoreactive Trypsinogen (IRT) Sweat test - measures the amount of salt (sodium and chloride) in the baby’s sweat – an abnormally high level of chloride can indicate CF Blood test – To identify their CF gene mutations
What are the specific nutritional needs for someone with CF?
Salt Fat-soluble vitamins (A, D, E, K) Calcium Calories
When would enteral tube feeding be considered in people with CF?
Individual has poor appetite Nausea or vomiting causing decreased calorie intake Difficulty gaining weight
Treatments aimed at relieving symptoms, reducing complications and improving quality of life. What are some possible treatments?
Mucous thinning drugs (hypertonic saline) Bronchodilators (to relax smooth muscles in airways) Antibiotics to treat and prevent infections Stool softeners
What are some nursing considerations when caring for someone with CF?
Patient and family education Respiratory support Administering medications Assisting to meet nutritional needs Provide psychosocial support Isolating CF patients from other CF patients or patients with infective respiratory conditions
IvACAFTOR is a new medication to treat the underlining cause of CF, how does this work?
Improves the function of the defective transmembrane conductance regulator (CFTR) protein which improves regulation of salt and water absorption and secretion
How does CF affect the cystic fibrosis transmembrane conductance regulator (CFTR) protein?
Affects chloride and sodium ions, mainly chloride channels on cell membranes. This prevents chloride and sodium movement into and out of cells which causes mucous to become dehydrated and thick
What is the meaning of sexuality?
Sexuality describes the whole way a person goes about expressing themselves as a sexual being
What are the possible outcomes of porn use?
Promotes a sense of sexual entitlement amongst boys objectification of women in porn. increased risky & unprotected sexual practices, higher rates of sexual harassment & forced sex, willingness to engage in casual sex
What are some sexual offences?
Sexual offences include sexual violation (vaginal, anal or oral penetration) and indecent assault
What is sexual violence?
Unwanted acts of sexual contact or attempt to obtain a sexual act by violence or coercion
What is the ALLOW method health professionals can use if they believe someone has experienced sexual violence or has questions about sexual health?
ASK - permission to ask - be direct LEGITAMIZING - normalizing, generalizing, use statistics, provide information LIMITATIONS - role and what is possible, brief intervention, sexual history and refer on OPEN CONVERSATIONS - letting ppl know its okay to talk about this WORK TOGETHER & FOLLOW UP
The Sexual Assault Assessment and Treatment Service Provides forensic and medical care to survivors of sexual abuse and assault. what is the services three roles?
Clinical role – to look after the well-being of the patient Forensic role – to collect evidence and document injuries Legal role – to be an expert witness in the medicolegal process
What is child sexual abuse?
When another person uses a child for sexual gratification - can be exposure, showing pornography, touching, oral sex, sexual intercourse, or any other sexual act Usually involves the use of threats, coercion, manipulation, bribery or force
What is child sexual exploitation?
Children and young people receive something (such as food, accommodation, drugs, alcohol, cigarettes, affection, gifts, or money) as a result of performing, and/or others performing on them, sexual activities.
If a person discloses they have experienced sexual abuse, what are the 5 principals to follow?
Let them know you believe them. • Let them know you’re glad they told you. • Let them know you’re sorry it happened. • Let them know it’s not their fault. •Let them know you’ll help/get help
What should nurses do if they are concerned a child has experienced acute sexual abuse?
ASSESS RISK – immediate protection DOCUMENT, DOCUMENT, DOCUMENT CONSULT, CONSULT, CONSULT other staff referral to oranga tamarki and or police should be made asap
What is a risk?
Uncertain event or condition that, if it does occur, can present a positive or a negative effect
The most commonly identified areas of risk are?
Risk to self through Suicide, self-harm or neglect, risk of violence to others and risk of victimisation.
What are static risk factors for suicide?
Do not change. They include developmental factors such as genetic make up, personality type (internal) and the person’s past environment such as childhood trauma (external) = propensity for long term risk
What are dynamic risk factors for suicide?
A change in mental state (internal) and current situational environment (external) = fluctuating nature of risk
What are the three major components of risk ?
1) Likelihood : the probability and the possibility 2) Outcome: it needs to be adverse 3) Time: How close is the event to happening
Face to face interview is an important assessment to help prevent suicide. what are the highest risk factors identified during the clinical assessment?
- Suicide intent (purpose of killing self) - And the degree of planning involved - And the availability and ease of access to the means
What risk factors may contribute to the risk of suicidal behavior?
History of trauma Isolation/lack of social support History of alcohol and substance abuse