Exam 4: NSG 3450/ NSG3450 (2026 Updated) Nursing Practice – Mental Health | Comprehensive Questions & Answers | 100% Correct Solutions | Grade A – Galen

Exam 4: NSG 3450/ NSG3450 (2026 Updated) Nursing Practice – Mental Health | Comprehensive Questions & Answers | 100% Correct Solutions | Grade A – Galen Q. what is the primary prevention for abuse? ANSWER decrease stress, improve coping skills, and decrease risk factors. Q. With assault victims what should you always work to do? ANSWER establish trust and build rapport to encourage them to open up about feelings. Q. what are the steps that should be followed if a chemical restraint is used? ANSWER assessing the client and documenting the event. Q. what is the most common form of family violence? ANSWER neglect Q. what to assess for with potential victims of abuse? ANSWER violence indicators, level of anxiety and coping response, family coping patterns, support system, suicidal/homicidal potential, drug/alcohol use, and ask directly if they are being hurt. Q. How abusers think ANSWER current relationship is the closest they have had, their needs are priority, lack of supportive relationships, and need others to fulfill their needs. Q. why is group therapy effective for abuse victims? ANSWER provides supportive environments Q. what do you do when doing a rape kit on a victim? ANSWER every step told in detail, NEVER LEAVE THEM ALONE, informed consent first, and skip parts if they wish to skip. Q. Anger and aggression does what? ANSWER puts one at higher risk for CVA, HTN, CVD, MI, and inflammation. Q. what is the procedure to deal with agitated, yelling, or aggressive patients? ANSWER removes others from area, have staff on standby for de-escalation, stay out of their personal space. Q. when does a patient become a threat? ANSWER when they make verbal and physical threats. Q. what happens if we do not give space of a patient? ANSWER this can make them become defensive or aggressive. Q. Abusive perpetrator characteristics? ANSWER poor coping skills, use of harsh punishments (more towards children), temper outbursts, and hx of alcohol abuse. Q. safety plan items to take are? ANSWER meds, births certificates, 1 change of clothing, medical records, drivers license, and money. Q. when do you know sexual assault victims are on the road to recovery? ANSWER sleeping without nightmares, thinking of pre-assault practices, and able to turn to others for support. Q. personality disorders; cluster A ANSWER Odd-eccentric Q. personality disorder; cluster b ANSWER erratic/dramatic Q. personality disorder; cluster c ANSWER anxious, fearful Q. What cluster does Dependent Personality Disorder belong to? ANSWER Cluster C Q. What is a common fear associated with Dependent Personality Disorder? ANSWER Fear when making choices Q. What do individuals with Dependent Personality Disorder fear regarding relationships? ANSWER Fear of separation Q. What do individuals with Dependent Personality Disorder typically want from others? ANSWER They want others to do things for them Q. What is the treatment of choice for Dependent Personality Disorder? ANSWER Psychotherapy Q. How do individuals with Dependent Personality Disorder typically behave in response to demands? ANSWER They do things that are demanded of them Q. What is a key characteristic of narcissistic personality disorder? ANSWER Lack of empathy Q. How do individuals with narcissistic personality disorder often view themselves? ANSWER They have an inflated view of self Q. What is a common behavior of individuals with narcissistic personality disorder regarding criticism? ANSWER They are sensitive to criticism Q. What feeling do individuals with narcissistic personality disorder often experience? ANSWER Entitlement Q. Why is narcissistic personality disorder difficult to treat? ANSWER Individuals need to want to change Q. what cluster does narcissistic personality disorder belong to? ANSWER cluster B Q. What is Histrionic Personality Disorder classified as? ANSWER Cluster B Q. How do individuals with Histrionic Personality Disorder typically cope with their symptoms? ANSWER By using sexual acting out Q. What behavior is often associated with individuals who have Histrionic Personality Disorder? ANSWER Exaggerating symptoms Q. What are two common colloquial terms for individuals with Histrionic Personality Disorder? ANSWER Bed hoppers and drama queens Q. borderline personality disorder (cluster b) ANSWER plays one against another- remind that all staff provide good care; feelings of emptiness. Q. what cluster is borderline personality disorder belong to? ANSWER cluster b Q. What is a key characteristic of antisocial personality disorder? ANSWER Deceit for personal gain Q. What is a common trait of individuals with antisocial personality disorder regarding remorse? ANSWER Lack of remorse Q. What type of gratification do individuals with antisocial personality disorder typically focus on? ANSWER Self-gratification Q. How do individuals with antisocial personality disorder often behave impulsively? ANSWER Impulsive behavior Q. What type of behavior can individuals with antisocial personality disorder exhibit? ANSWER Aggressive or violent behavior What is a social impact of antisocial personality disorder on others? Encouraging others to be aggressive What is a significant emotional deficit in individuals with antisocial personality disorder? Lack of empathy What cluster is antisocial personality disorder? Cluster B paranoid personality disorder (cluster a) suspicious, hypervigilant, controlling in relationships-and can be violent What cluster does paranoid personality disorder fall under? cluster A avoidant personality disorder (cluster C) social isolation and fear of HUMILIATION. avoidant personality disorders falls under what cluster? cluster C schizotypal personality disorder (cluster A) need alone time, magical thinking what cluster does schizotypal personality disorder belong to? cluster A schiziod personality disorder (cluster A) eccentric, odd behavior, dont like people. What cluster does Schizoid personality disorder belong to? cluster a obsessive-compulsive personality disorder (cluster C) compulsive-rigid standards, unaware thoughts are unreasonable; focus on perfection. what cluster does obsessive-compulsive disorder belong to? cluster C what to address when a antisocial PD is showing negative behaviors? when stealing others food (should aways be addressed first), and preventing harm to others what to not doe with borderline PD patients? never leave items they can self-harm with; can be impulsive. what personality disorder is at biggest risk for suicide and self harm in and out of hospital? borderline personality disorder what to do when splitting behaviors occur? teamwork, limit setting, and setting strict boundaries. borderlines are VERY EMOTIONALLY UNSTABLE (LABILITY) and manipulative with others what to expect with schizophrenia? to see one psychotic symptom with negative symptom Negative symptom of schizophrenia (Absences of qualities that should be present); inability to enjoy activities (anhedonia), social discomfort, lack of goal-directed behavior. positive symptoms of schizophrenia (presence of symptoms that shouldn't be there) hallucinations, delusions, paranoia, disorganized or bizarre thoughts, behaviors, or speech. clang associations the stringing together of words that rhyme but have no other apparent link word salad Incoherent mixture of words, phrases, and sentences neologism new word or expression loose associations A common thinking disturbance in schizophrenia, characterized by rapid shifts from one topic of conversation to another. Also known as derailment. what are the nursing actions to patients in restraints? hourly food and fluid offerings when is verbal de-escalation necessary? at the start of agitation Neuroleptic Malignant Syndrome (NMS) a potentially fatal, idiosyncratic reaction to an antipsychotic (or neuroleptic) drug. common side effect and client teaching is a must. Signs and symptoms of NMS High temp is cardinal signal, unstable vital signs, muscle rigidity, and nurses must watch for delirium. what is priority data collection regarding family history? what is important and always needing to know psych history to know how to treat. antipsychotic drugs 1st gen and 2nd gen abnormal EPSE and repetitive movements (1st gen more side effects and 2nd gen has less side effects). after determining the elderly safety what is next? think maslow's, monitor nutrition what to teach the elderly? encourage yearly disposal of expired meds or meds not being taken. illusion false perceptions of real stimuli (can be re-oriented to truth)- visually related. delusion false ideas not based in reality (cant convince otherwise)- perceptually related (what they perceive) hallucination see or hear things that are not there and others do not see/hear what to do when dementia get argumentative? separate then distract them age-related changes (not dementia) irritable when routine disrupted, occasional bad choices, difficulty finding correct words, forget but remember later. sudden onset of confusion/disorientation do an assessment and get a full set of vitals to rule/out delirium. Alzheimer's early stage still fully functional, though have some short term memory issues, impaired learning, apathy and depression (use strategies to reorient). Alzheimer's Moderate Stage visual/spatial and language deficits, psychotic features, agitation and wandering (starts to need caregiver) Alzheimer's late stage gait disturbance, poor judgement, disorientation, confusion, incontinence, difficulty speaking/swallowing/walking (will most likely end up in a facility). Donepezil side effects (Alzheimer's med) GI upset is main side effect, syncope, bradycardia, and diarrhea. what to do with despondent/overwhelmed patients always assess for suicidality (even in child/teen) and priority intervention for suicidal is developing a safety plan Autism Spectrum Disorder (ASD) lack of social interest in others- cardinal sign; start seeing between ages 1-3 Stimulants for ADD have side effects of: insomnia (we dont give after 4pm) appetite suppression- monitor weight/growth char; can use finger foods to encourage eating. headache, abdominal pain, and lethargy. dyslexia impairment of the ability to read words dyscalculia difficulty with math dysgraphia writing expression receptive language disorder difficulty understanding or following directions expressive language disorder trouble finding or using the right words social communication disorder issue using verbal/non-verbal interactions socially. stuttering disorder hesitation and repetition of words What are the characteristics of Tourette's syndrome? Sudden, nonrhythmic, rapid motor movements and vocalizations that can be verbal, motor, or both. When does Tourette's syndrome typically occur? Before age 18. How does Tourette's syndrome change over time? Tics can change locations over time or decrease. What are some psychological risks associated with Tourette's syndrome? Risk for low self-esteem, self-consciousness, and rejection by peers. All medications for child must be? FDA approoved Oppositional Defiant Disorder (ODD) are angry and irritable (often grown out of this with established boundaries, if not goes into conduct disorder)- ages 3-8 conduct disorders violates the rights of others, aggressive, have no remorse (if left untreated, will grow into antisocial personality disorder)- age 10 through adolescence. Intermittent Explosive Disorder (IED) inability to control aggressive behavior, remorseful (anything can trigger). can be child or adult males. child with PTSD drawing pictures of self in negative ways is a response to trauma. this is a nonverbal way of expressing difficult emotions roles of forensic nurse ID and assess victims, create treatment plans, collect, document, preserve evidence, and follow-up on referrals. SANE (sexual assault nurse examiner) care of ped or adult victim of sexual assault nurse coroner/death investigator assessing the deceased thru understanding, discovery, preservation and use of evidence. forensic psychiatric nurse roles nurse psychotherapist, forensic nurse examiner, competency evaluator, fact/expert witness, consultant, hostage negotiator, criminal profiler. correctional nursing care for those with serious mental illness caught in cycles of homelessness, psych hospitalizations, and imprisonment. anger is An emotional response to frustration of desires, threat to one's needs (emotional or physical), or a challenge Aggression is: Action or behavior that results in verbal or physical attack neurotransmitters in aggression low levels of serotonin, dopamine, GABA, noradrenaline trauma informed care based on the notion that disruptive patients often have histories that include violence and victimization Pharm interventions haldol 50mg, ativan 5 mg, and diphenhydramine 2mg max amount of time in restraints/seclusion? 4 hours or renewal of restraint order must be done primary prevention for abuse is measures taken to prevent occurrence of abuse secondary prevention of abuse is early intervention in abusive situations to minimize their disabling or long-term effects. tertiary prevention for abuse often occurs in mental health settings, involves nurse facilitating the healing and rehabilitative process by counseling individuals and families, for an optimal level of safety. sexual assault and sexual violence is what? 2nd most violent crime in the us. SART Sexual Assault Response Team delusional disorder a psychotic disorder in which the primary symptom is one or more delusions schizophreniform disorder symptoms of schizophrenia present for less than 6 months What are the key symptoms of schizophrenia? Delusions, hallucinations, gross disorganization or catatonia, and negative symptoms. How long must symptoms persist to diagnose schizophrenia? At least 6 months. What percentage of individuals are at risk for developing schizophrenia? 80%. Is schizophrenia genetic? Yes, it has a genetic component. What type of impairment is associated with schizophrenia? Functional impairment. schizoaffective disorder Psychotic disorder featuring symptoms of both schizophrenia and major mood disorder. Symptoms of EPS abnormal movement disorder rapid and irregular movement causes by first generation psych meds targeted dyskinesia caused by 1st gen meds Anger An emotional response to frustration of desires, threat to one's needs (emotional or physical), or a challenge. Aggression Action or behavior that results in verbal or physical attack. It is not okay to be aggressive. Which units see the most violence from patients? Psychiatric units, geriatric units, and intensive care units, Emergency Room. Risk Factors for Anger, Aggression, and Violence. Hypertension and cardiovascular disease including myocardial infarctions and ischemic strokes. Comorbidity for anger, aggression, and violence Individuals with PTSD and substances abuse have issues with aggression. Individuals with bipolar disorder have difficulty with anger and aggression during remission. It coexists in individuals with depression, anxiety, psychosis, and personality disorders. Etiology: Neurobiological factors to anger, aggression, and violence Brain tumors, Alzheimers, disease, temporal lobe epilepsy, and traumatic injury to certain parts of the brain result in changes to personality that could include increased violence. Which area of the brain is associated with aggression? The limbic system which is located beneath the cerebrum on both sides of the thalamus. It is responsible for combining higher mental functions and primitive emotions into one system, learning, and the formation of memories. What is the emotional center of the brain? The amygdala! it helps evaluate the emotional content of experiences. It helps the brain to recognize potential threats and whether to activate the fight or flight response. Which cortex is an important role in aggressive behavior? The prefrontal cortex is the area of the brain that is responsible for executive functions. Executive functions allows us to distinguish between good and bad, consequences of actions, goal-directed behaviors, and suppressing socially unacceptable activities. Which neurotransmitters play a role in anger and aggression? Serotonin can both inhibit and stimulate aggressive behavior, depending on the part of the brain being measured. Dopamine's impact on reward-seeking behaviors may increase aggression. Serotonin and dopamine can sometimes enhance aggression and sometimes reduce impulsivity that leads to aggression. GABA the main inhibitory neurotransmitter may reduce aggressiveness, its absence may increase impulsivity and aggressive responses. Anger Behavioral Theory Is a learned response to environmental stimuli. Anger Social Learning Theory Researchers demonstrated that children learn aggression by observing and imitating behaviors of others, especially if that that behavior is rewarded. Predictors of Violence (Signs and Symptoms) Hyperactivity: most important predictor of imminent violence (pacing or restlessness). Increase anxiety and tension, clenched jaw or fist, rigid posture, fixed or tense facial expression, mumbling to self (patient may have shortness of breath, sweating, and rapid pulse). Verbal abuse: profanity, argumentativeness. Loud voice, change of pitch, or very soft voice, forcing others to strain to hear. Stone silence. Intense eye contact or avoidance of eye contact. Recent acts of violence, including property violence. Alcohol or drug intoxication. Possession of a weapon or object that may be used as a weapon (fork or knife). Isolation that is uncharacteristic. Milieu characteristics conducive to violence: Overcrowding, staff inexperience, provocative or controlling staff, poor limit setting, arbitrary revocation of privileges. General Assessment for a patient experiencing anger. Patient will exhibit increased demands, irritability, frowning, redness in the face, pacing, twisting of the hands, or clenching and unclenching of the fists are all signs of irritation. Speech may either be increased in rate and volume or may be slowed, pointed, and quite. Trauma-informed Care It is based on the notion that disruptive patients often have histories that include violence and victimizations. This care focuses on the patients past experiences of violence or trauma and on the role these experiences currently play in their lives. Anger and Aggression Assessment Guidelines A history of violence is the single best predictor of future violence. Patients who are delusional, hyperactive, impulsive or predisposed to irritability are at higher risk for violence. Major factors associated with violence can be assessed with these questions (Does the pt have a wish or intent to harm?, Does the pt have plan?, Does the patient have demographic risk factors: male, aged 14-24, low socioeconomic status, inadequate support system, and prison time). Aggression by patient occurs most often in the context of limit-setting by the nurse. History of limited coping skills, including lack of assertiveness or use of intimidation, indicates a higher risk of using violence. Nursing Diagnoses for Anger, Aggression, and Violence Risk for other-directed violence, Risk for self-directed violence, Ineffective coping, Stress overload. Outcomes for aggression Identifies when angry, identifies alternatives to aggression, refrains from verbal outbursts, avoids violating others personal space, maintains self-control. Expresses feelings, verbalizes suicidal ideas, refrains from suicide attempts, plans for the future. Identifies ineffective and effective coping, uses support system, uses new coping strategies, engages in personal actions to manage stressors effectively. Deescalation Techniques Maintain the patients self-esteem and dignity. Maintain calmness (you and pt). Assess the pt and the situation. Identify stressors and stress indicators. Respond as early as possible. Use a calm clear tone of voice. Invest time, remain honest. Determine what the patient considers to be needed, identify goals. Avoid invading personal space, in time of high anxiety, personal space increases. Avoid arguing, use several clear options, use genuineness and empathy, be assertive (NOT AGGRESSIVE) do not take chances maintain personal safety. Drug used for acute management of violent behavior. Antianxiety Agents (Benzodiazepines): Lorazepam (Ativan), Alprazolam (Xanax), Diazepam (Valium) First Generation Antipsychotics: Haloperidol (Haldol), Perphenazine, Chlorpromazine (Thorazine), Loxapine (Adasuve). Second Generation Antipsychotics: Risperidone (Risperdal), Olanzapine (Zyprexa, Zydis), Ziprasidone (Geodon) Combinations: Haloperidol (Haldol) Drugs used for long-term management of chronic aggression SSIR's: for the population that is depressed, anxiety, personality disorder, dementia, and intellectual disability Lithium: for the population that is intellectual disability, conduct disorder, antisocial personality, bipolar disorder, and prison inmates. Anticonvulsants : Schizophrenia, prison inmates, antisocial/ borderline personality, conduct disorders, and bipolar disorders Gabapentin: patients with co-existing anxiety disorder and personality disorder. Benzodiazepines: should have underlying component of anxiety. Second-generation antipsychotics: Schizophrenia, psychosis, and mania. Beta-blockers: organic brain disease, brain injury, dementia, intellectual disability. Psychostimulants: ADD/ADHD in children and adults. Guidelines for Use of Mechanical Restraint: Indications for Use To protect the patient from self-harm. To prevent the patient from assaulting others. Seclusion Involuntary confinement alone in a room that the patient is physically prevented from leaving. Restraints Any manual method, physical or mechanical advice, material, or equipment that restricts freedom of movement. Guidelines for Use of Mechanical Restraint: Legal Requirements Multidisciplinary involvement, appropriate healthcare provider's signature according to state law, patient advocate or relative notification, seclusion/restraint discontinued as soon as possible. Guidelines for Use of Mechanical Restraint: Documentation Patient's behavior leading to restraint/seclusion. Least-restrictive measures used before restraint. Interventions used and patients responses interventions. Plan of care for restraint/seclusions use implemented. Ongoing evaluations by nursing staff and appropriate healthcare providers. Guidelines for Use Mechanical Restraint: Clinical Assessments Patient's mental state at time of restraint, physical examination for medical problems possibly causing behavioral changes, needs for restraints. Guidelines for Use Mechanical Restraint: Observation Staff in constant attendance, complete written record every 15 minutes, monitor vitals signs, assess range of movement, observe blood flow in hands/feet, observe that restraint is not rubbing, provide for nutrition, hydration, and elimination. Guidelines for Use Mechanical Restraint: Release Procedure Patient must able to follow instructions and stay in control, termination of restraints, and debrief with patients. Guidelines for Use Mechanical Restraint: Restraint Tips Physical holding of a patient against will is a restraint, 4 side rails up is a restraint expect in seizures precautions, keeping a patient in their room by physical interventions is seclusion, tucking sheets in so tightly patient cannot move is a restraint, orders for seclusion/restraint cannot be PRN (as needed). NIC Interventions for Anger-Control Assistance Establish basic trust and rapport with patient. Use calm, reassuring approach. Determine appropriate behavioral expectations for expression of anger, given patient's level of cognitive and physical functioning. Limit access to frustrating situation until patient is able to express anger in an adaptive manner. Encourage patient to seek assistance from nursing staff or responsible others during periods of increasing tension. Monitor potential for inappropriate aggression and intervene before its expression. Prevent physical harm if anger is directed at self or others (restrain and remove potential weapons). Provide reassurance to patient that nursing staff will intervene to prevent patient from losing control. Use external controls (physical or manual restraint, timeouts, and seclusion) as needed to calm patient who is expressing anger in a maladaptive manner. Feelings that may precipitate anger Discounted, embarrassed, frightened, found out, guilty, humiliated, hurt, ignored, inadequate, insecure, unheard, out of control of the situation, rejected, threatened, tired, vulnerable Caring for a patient in general hospital setting Patient loses their autonomy and control. When the stress is combined with the uncertainty of illness, a patient may respond in ways that are not usual for them. Nurse must do an assessment and ask family members if their anger is normal for them. Interventions for patients whose usual coping strategies are healthy involve finding ways to reestablish or substitute similar means of dealing with the hospitalization. This problem solving occurs in collaboration with the patient interactions that demonstrate the nurse acknowledges the patients distress, validates it as understandable under the circumstances, and indicates a willingness to search for solutions. Patients with marginal coping skills. Patient with maladaptive coping skills are poorly equipped to use alternatives when their initial attempts to cope are unsuccessful or are inappropriate. Such patients frequently manifest anger that moves quickly from anxiety to aggression. For these patients anger and violence are particular risks in inpatient settings. These patients have the personality styles that externalize blame (they see the source of their discomfort and anxiety as being outside themselves, relief must therefore also come from an outside source-nurse or medication). Interventions include a deck of cards, magazines, action comics, and video games. (Generally, distractions that are colorful and do not require sustained attention work best, although this caries according to the patients interests and abilities). Three interventions with a patient who has moderate anxiety (avoided a punitive or demeaning response that might have fueled escalation of the patient's anger, taught a number of strategies, provide the patient with choices and this more control). If things get too out of hand you can leave the room when verbal abuse begins, discuss non-illness related topics/reinforcing nonabusive communication, and have the patient on a predictable routine. Caring for patients in inpatient psychiatric settings Two most significant predictors of violence are a history of violence and a history of impulsivity. Nurses must work with patients to recognize early signs of anger and to teach patients strategies to manage the anger and prevent aggression. Caring for patients with cognitive deficits. These patients are particularly at risk for acting aggressively. (Delirium, dementias, Alzheimer's, brain injury) Traditional approaches to disorientation and to the agitation it can cause have relied heavily on reality orientation and medication (low dose antipsychotic and discontinued with delirium clears) Catastrophic Reaction Patient who is having severe agitation such as screaming, striking out, and crying due to having a cognitive disorder experiences. Ways to keep nurses staff safe while working Avoid wearing dangling earrings or necklaces. Ensure that there is enough staff for backup. Only one person should talk to the patient, but staff needs to maintain unobtrusive presence in case the situation escalates. Always know the layout of the area. Correct placement of furniture and elimination of obstacles or hazards are important to prevent injury if the patient requires physical interventions. Do not stand directly in front of the patient or in front of the doorway, this position could be interpreted as confrontational. It is better to stand off to the side and encourage the patient to have a seat. If a patients behavior begins to escalate, provide feedback. "You seem to be very upset." Such an observation allows exploration of the patients feelings and may lead to de-escalation of the situation. Avoid confrontation with the patient, either through verbal means or through a "show of force" security guards. Verbal confrontation and discussion of the incident must occur when the patient is calm. A show of force by security guards may serve to escalate the patient's behavior, therefore security personnel are better kept in the background until they are needed to assist. Physical abuse Is the infliction of physical pain of bodily harm such as slapping, punching, hitting, choking, pushing, restraining, biting, throwing things, and burning. Sexual Abuse Is any form of sexual contact or exposure without consent or in circumstances in which the victim is incapable of giving consent. Sexual abuse is also referred to as sexual assault or rape. Emotional abuse Is the undermining of a person's self-worth. This may include constant criticism, humiliating, diminishing one's abilities, name-calling, intimidating, isolating, and damaging relationships with others. Neglect Is the failure to provide for physical, emotional, educational, and medical needs. Economic abuse Controlling a person's access to economic resources making an individual financially dependent. Forbidding school attendance or employment keeps a person dependent. Perpetrator To any member of a household who is violent toward another member such as parents, partners, siblings, and extended family members. This individuals often see their own needs as more important than anyone else. Vulnerable Person Is the family member that is getting abused. Survivor Is a term used to recognize the recovery and healing process that follows victimization and does not have the connotation of passivity that victim has. Comorbidity of violence Anxiety, Depression, and Suicidal ideation. Crisis situation is a situation that puts stress in a family with a violent member who abuses in some way. Characteristics of Perpetrators Considers their own needs more important than the needs of others. Poor social skills, extreme pathological jealously, and may control family finances The most common form of abuse is what? Neglect is the most common. Acts of Communion Are deliberate and intentional. They include sexual and emotional abuse. Act of Omission Also known as neglect occurs when a child basic physical, emotional or educational needs are not met or when a child is not protected from harm. It includes physical neglect, emotional neglect, medical and dental neglect, educational neglect, and inadequate supervision, and exposure to violence. Epidemiology for Child Abuse Occurs more in girls and the younger the child is the more vulnerable. Risk factors/Characteristics for Vulnerable Children Younger than the age of 3, a child with special needs or seen as different. The child reminds the perpetrator of an ex, child from unwanted pregnancy and no emotional bonding with mother. Characteristics of Abusive Parents A history of abuse, neglect, or emotional deprivation as a child. Family authoritarianism, low self-esteem, feelings of worthlessness, depression, poor coping skills, social isolation (may be suspicious of others), involvement in a crisis situation, unrealistic expectations of children behaviors, frequent use of harsh punishment, history of severe mental illness, such as schizophrenia, violent temper outburst, expects the child to satisfy needs for love, support, and reassurance, projection of blame onto the child for parents trouble, inability to seek help from others, perception of the child as bad or evil, history of alcohol or drug abuse, feeling of little or no control over life, low tolerance for frustration, poor impulse control. Tension-Building Stage Begins with minor incidents such as pushing, shoving, and verbal abuse. During this time the victim often ignores or accepts the behavior due to fear of escalation. Abusers then rationalize that their behavior is acceptable. As the tension builds, both participants may try to reduce it. The abuser may try to reduce the tension with the use of alcohol or drugs, and the victim may try to reduce the tension by minimizing the importance of incidents. Victim feels as if they are walking on eggshells and accepts blame. While the abuser is on edge all the time and little things set them off. Acute battering stage Occurs when the tension peaks. It is usually triggered by an external event or by the abuser's emotional state. Some experts believe that the victim may actually provoke the incident to remove the tension and fear and to move on to the honeymoon phase. Honeymoon Stage The abuser usually demonstrates kindness and loving behaviors. The abuser, at least initially, feels remorseful and apologetic and may bring presents, make promises, and tell the victim how much she is loved and needed. The victim usually feels needed and loved and hopes for change. Legal proceedings or plans to leave initiated during the acute battering stage may be abandoned. Characteristics of Vulnerable Persons: Women Pregnancy may trigger or increase violence due to focus no longer being on the male partner. Violence may escalate when wife makes move toward independence. Greatest risk for violence when the woman attempts to leave the relationship. Characteristics of Vulnerable Older Adult Poor mental or physical health, dependent on perpetrator, female, older than 75 years, white, living with a relative. Elderly father cared for by daughter he abused as a child, and elderly woman cared for by a husband who has abused her in the past. Assessment for Child/older adult/partner violence Screen all patients for possible abuse. Symptoms may be vague and can include chronic pain, insomnia, hyperventilation, or gynecological problems. All questions should include elicit a history such as family coping patterns, support systems, level of anxiety and coping responses, sexual abuse, family violence, and drug use or abuse. ALL QUESTIONS SHOULD BE ASKED WITH THE VICTIM ALONE. Interview Guidelines that should be done Do: Conduct the interview in private, be direct, honest, and professional, use language the patient understands, ask the patient to clarify words not understood, be understanding, be attentive, inform the patient if you must make a referral to Children's or Adult Protective Services, and explain the process. Assess safety and help reduce danger (at discharge). Interview Guidelines that should Not be done Try to prove abuse by accusations or demands, display horror, anger, shock, or disapproval, of the perpetrator or situation. Place blame or make judgements. Allow the patient to feel at fault or in trouble. Probe or press for answers the patient is not willing to give. Conduct the interview with a group of interviewers. Verbal approaches Tell me about what happened to you? Who takes care of you? What happens when you do something wrong? How do you and your partner/caregiver resolve disagreements? What do you do for fun? Who helps you with your children/parents? What time do you have for yourself? How do you discipline your child? Common Presenting Problems of Victims of Abuse- Emergency Department Bleeding injuries, especially to head and face. Internal injuries, concussions, perforated eardrum, abdominal injuries, severe bruising, eye injuries, strangulations marks on neck. Back injuries, broken or fractured jaw, arms, pelvis, ribs, clavicle, legs. Burns from cigarettes, appliances, scalding liquids, acids. Psychological trauma, anxiety, attacks of hyperventilation, heart palpitations, severe crying spells, suicidal tendencies, miscarriages. Common Presenting Problems of Victims of Abuse- Ambulatory Care Settings Perforated eardrum, twisted or stiff neck and shoulder muscles, headache. Depression, stress-related conditions (insomnia, violent nightmare, anxiety, extreme fatigue, eczema, loss of hair). Talk of having "problem" with husband or son, describing person as very jealous, impulsive, or an alcohol or substance user. Repeated visits with new complaints, bruises of various ages and specific shapes (fingers, belt). Common Presenting Problems of Victims of Abuse- Any Setting Signs of stress due to family violence, emotional, behavioral, school, or sleep problems and increase in aggressive behavior. Injuries in a pregnant woman and recurrent visit for injuries attributed to being "accident-prone" Shaken Baby Syndrome Leading cause of death as a result of physical abuse, usually occurs in children younger than 2 years old. Injuries are a result of the brain moving in the opposite direction as the baby's head. Factors to Assess During a Home Visit- For A Child Responsiveness to infant's signals. Caregiver's facial expressions in response to infant. Playfulness of caregiver with infant. Nature of physical contact during feeding and other caretaking activities. Temperament of infant. Caregiver's history of harsh discipline or abuse as a child. Parental attitudes: Feelings of inadequacy as a parents, unrealistic expectations of child, fear of doing something wrong, attribution of negative qualities to newborn, misdirected anger, continued evidence of isolation, apathy anger, frustration, projection, and adult conflict. Environment conditions: sleeping arrangements, child management, home management, use of support (formal and informal). Need for immediate services for situational (economics, child care), emotional, or education information: information about hotlines, baby-sitters, homemakers, parent groups, information about child development, information about child care and home management services. Factors to Assess During a Home Visit- Older Adult Absence of or lack of access to basic necessities (food, water, medications), unsafe housing, lack of or inadequate utilities, ventilation, space, poor physical hygiene, lack of assistive devices, such as hearing aids, eyeglasses, wheelchair, medications mismanagement (outdated prescriptions, unmarked bottles) Factors that put the person at greater risk for homicide The presence of a gun in the house, alcohol and drug misuse, history of violence on the part of the perpetrator in other situations, extreme jealousy and obsessiveness on the part of the perpetrator. When maintaining accurate records what is needed. Verbatim statements of who caused the injury and when it occurred, a body map to indicate size, color, shape, areas, and types of injuries with explanations, and physical evidence of sexual abuse, when possible. Assessment Guidelines for Family Violence Signs and Symptoms of victims of abuse, potential for abuse vulnerable families (some indicators of vulnerable parents who might benefit from education and instruction in effective coping techniques), physical, sexual and/or emotional abuse and neglect and economic maltreatment of older adults, family coping patterns, patients support system, drug or alcohol use, suicidal or homicidal ideas, posttraumatic syndrome. Diagnosis for child/older adult/partner violence Safety is the number one concern. Risk for suicide, pain, risk for infection, rape-trauma syndrome, anxiety, fear, hopelessness, powerlessness, situational and chronic low self-esteem, ineffective individual coping, dysfunctional family process, impaired parenting, disabled family coping, caregiver role strain, and ineffective role performance. What are nurses legally mandated to do when it comes to violence towards the patient Nurses are legally mandated to report suspected or actual cases of child and vulnerable adult abuse. Primary Prevention of Abuse Consist of measures taken to prevent the occurrence of abuse. Identifying individuals and families at high risk, providing health teaching, and coordinating supportive services to prevent crises. Specific strategies are: reducing stress, reducing the influence of risk factors, increasing social support, increasing coping skills, increasing self-esteem. Secondary Prevention of Abuse Involves early intervention in abusive situations to minimize their disabling or long-term effects. (Screening programs, participate in the medical treatment of injuries resulting from violent episodes, coordinate community services to provide continuity of care) Tertiary Prevention of Abuse Often occurs in mental health settings involves nurses facilitating the healing and rehabilitative process by counseling individuals and families, providing support for groups of survivors, and assisting survivors of violence to achieve their optimal level of safety, health, and well-being. Therapy for Perpetrators Is most effective when it is court-mandated because the perpetrator is more likely to complete the course of treatment. What are indicators of violence when it comes to assessing for physical abuse? A series of minor complaints, such as headaches, back trouble, dizziness, and accident (especially falls). What are overt signs of battering? Bruises, scars, burns, and other wounds in various stages of healing, particularly around the head, face, chest, arms, abdomen, back, buttocks, and genitalia. Completed Rape Is defined as penetration no matter how slight of the vagina or anus with any body part or project or oral penetration by a sex organ of another person without consent of the victim. Attempted Rape Are threats of rape or intention to rape that is unsuccessful. Sexual Assault/Sexual Violence Are broad terms that encompass unwanted sexual advances and sexual harassments to stranger rape, marital rape, date rape, drug-facilitated sexual assault, incest, human sex-trafficking's, and female genital mutilation. Which race/ethnicity is more likely to be raped Women who identify themselves as multiracial are the most likely to be raped followed by American Indian/Alaskan Native and African American non-Hispanics. Acute stress disorder Is a psychiatric reaction to a serious trauma such as witnessing a death, suffering a serious injury, or sexual violence such as sexual assault. Symptoms begins immediately after attack and persist at least 3 days and can extend for up to a 1 month. Posttraumatic Stress Disorder Can last longer than 1 month and is normally the next step to acute stress disorder if symptoms do not go away. Must have depersonalization and derealization. Depersonalization Feeling detached from one's mental processes or body. Example is affected pt. may feel like they are in a dream that their bodies are not real or that time is moving slowly. Derealization Feeling like surroundings are unreal. This symptom is characterized by a feeling that the world around the individual is unreal, dreamlike, distant, or distorted. Long-term effects of sexual assault Depression, suicide, anxiety, and fear, low self-esteem, sexual dysfunction, and somatic (physical) complaints. Victims of incest experience what type issues Negative self-image, depression, eating disorders, personality disorders Characteristics of sexual abuse psychiatric patients Depression, anxiety disorder, chemical dependency, suicide attempts, self-mutilation, compulsive sexual behavior, and psychosis-like symptoms. Guidelines for Medical Forensic Exam Provide patient-centered care, include prioritizing these patients, ensuring patient privacy, providing culturally responsive care, accommodating support people as needed, using age-appropriate language, assessing and respecting patient priorities, and integrating medical and evidence collection procedures. Sexual Assault Nurse Examiners (SANEs) RNs with specialized training in care for sexual assault patients. Demonstrated competency in conducting medical and legal evaluations. Ability to be an expert witness in court. Part of the sexual assault response team (SART) General Assessment for Sexual Assault Victims Assess the level of anxiety, coping mechanisms, available support systems, signs and symptoms of emotional trauma, and signs and symptoms of physical trauma Best Practice Guidelines for Examination Head to toe physical assessment, observing for signs of injury. Detail genital examination, observing for signs of injury. Evidence collection and preservation. Documentation of physical findings (both written and photo documentation). Treatment, discharge planning, and follow-up care. Rape-trauma syndrome Sustained and maladaptive response to a forced, violent sexual penetration against the victim's will and consent. Defining Characteristics of Rape-Trauma Syndrome Shame, guilt, helplessness, powerlessness, dependence, low self-esteem, depression, mood swings, aggression, anger, agitation, revenge, substance abuse, suicide attempts, anxiety, fear, disturbed sleep, nightmares, sexual dysfunction, muscle tension, hyper-alertness, dissociation, disorganization, shock, confusion, phobias, paranoia. Revictimization The trauma of the examination itself because the patient may experience it as another violation of her body. Sexual Assault Victims Survivors characteristics in recovery Sleeping well with few instances of episodic nightmares or broken sleep. Eating as they did before the rape. Being calm and relaxed or only mildly suspicious, fearful, or restless. Getting support from family and friends. Generally positive self-regard about themselves. The abuse or only mild instances of somatic reactions. Returning to pre-rape sexual functioning and interest. What do follow-up visit provide for the patient who experience sexual assault Detect new infections acquired during or after assault. Complete hepatitis B vaccinations if indicated. Complete counseling and treatment for other STD. Monitor side effects and adherence to post-exposure prophylactic medication if prescribed. Forensic Nursing The application of nursing science to public or legal proceedings. The application of the forensic aspects of health care combined with the bio-psycho-social education of the registered nurse in the scientific investigation and treatment of trauma and/or death of victims and perpetrators of abuse, violence, criminal activity, and traumatic accidents. Forensic Nursing Functions Provide direct services to crime victims and perpetrators of crime. Consultation services to colleagues in nursing, medical, and law-related agencies. Expert court testimony. Offer input on policy changes in the corrections setting. Offer evaluation services for inmates. Forensic Nurse Generalist Baccalaurearte, associate degree, or diploma may acquire additional knowledge and skills, by completing a certificate program, assessment and treatment of victims and perpetrators of violence. Advanced practice forensic nurse Graduate education with a comprehensive focus in forensic nursing. Advanced practice forensic nurses may also have obtained credentials as a clinical nurse specialist, certified nurse-midwife, or nurse practitioner. Doctor of nursing practice (DNP) May evaluate and apply evidence-based forensic practice for the improvement of education, clinical practice, systems management, and nursing leadership. Doctor of Philosophy (PhD) Prepares nurses to initiate and conduct research in an area of forensics to advance nursing science and to ultimately enhance the practice of forensic nursing . Roles of the Forensic Nurse Identification and assessment of victims. Creation of appropriate treatment plans. Collection, documentation, and preservation of potential evidence. Care of adult and pediatric victims of sexual assault. Sexual assault nurses examiners (SANE) training course is typically 5 days (40 contact hours) Nurse Coroner/Death Investigator Public official charged with duty of determining how and why people die. Nurse Coroner/Death Investigator's judgements are based on: History, symptomatology, autopsy results, toxicology, other diagnostic studies, evidence revealed in other aspects of the case. Legal sanity Able to distinguish right from wrong Legal insanity presence of a major mental disorder McNaughton Rules-Irresistible Impulse Knew act was wrong but could not control behavior. Forensic Nurse-Fact and Expert Witness Routinely used medical malpractice cases. Recognized by the court as having a certain level of expertise in a designated area. Forensic Nurse-Hostage Negotiator Being on call around the clock to assist law enforcement officers on the scene. Providing suggestions regarding negotiation techniques. Assessing the mental status of the perpetrator. Providing a link to mental health agencies. Participating in a critique of the hostage incident. Assessing released hostages. Assessing the stress level of the hostage negotiator. Providing training in communication skills to law enforcement officers. Criminal Profiler-Forensic Nurse Attempts to provide law enforcement officials with specific information about the type of individual who may have committed a certain crime. Forensic Nurse- Correctional Nurse Advanced education and clinical practice as a forensic nurse. Defined by location of the work or legal status of the patient. Provides treatment and services for inmates with chronic mental health diagnoses. Custody versus caring debate Forensic Psychiatric Nursing Functions Psychotherapist, forensic nurse examiner, competency evaluator, fact or expert witness, consultant to law enforcement agencies or the criminal justice system, hostage negotiator, criminal profiler. Schizophrenia Refers to altered cognition, altered perception, and/or an impaired ability to determine what is or is not real. There is no different when it comes to race, culture or social status. DSM-5 Criteria for Schizophrenia Two or more of the following each present for a significant portion of time during a 1-month period (or less if successfully treated). Delusions Hallucinations Disorganized speech (frequent derailment or incoherence). Grossly disorganized or catatonic behavior. Negative symptoms (diminished emotional expression or avolition). Continuous disturbances for at least 6 months. Comorbidity for Schizophrenia Substances use disorders, particularly alcohol and marijuana occur in nearly half of affected individuals along with nicotine dependence. Anxiety, depression, and suicide co-occur frequently in schizophrenia (suicide attempts are most common within 3 years of diagnosis). Physical illnesses are more common among people with schizophrenia than in the general population (may see poor nutrition, poor health maintenance behaviors). Polydipsia is compulsive drinking of excess fluids it can cause hyponatremia also known as water intoxication. Biological Factors of Schizophrenia- Genetic disorders are inherited and comes from epigenetic factors. Biological Factors of Schizophrenia- Neurobiological Dopamine theory: the first-generation antipsychotic (haloperidol and chlopromazine), block the activity of dopamine-2 receptors in the brain and reduce symptoms such as hallucinations and delusions. Symptoms reduction suggested that dopamine plays a significant role in psychosis. Other neurochemical hypotheses: Second-generations (atypical) antipsychotics block serotonin and dopamine, which suggest that serotonin may play a role in schizophrenia as well. Biological Factors of Schizophrenia- Brain Structure Abnormalities Structural differences may be due to errors in neurodevelopment or errors in the normal pruning of neuronal tissue that happens in late adolescence and early adulthood. Inflammation or neurotoxic effects from factors such as oxidative stress, infection, or autoimmune dysfunction may also alter the brains structure. Getting MRI's, CT scans, PET scans demonstrate what kind of structural brain abnormalities? Reduced volume in the right anterior insula (may contribute to negative symptoms). Reduced volume and changes in the shape of the hippocampus. Accelerated age-related decline in cortical thickness. Gray matter deficits in the dorsolateral prefrontal cortex area. thalamus, and anterior cingulate cortex, as well as in the frontotemporal, thalamocortical and subcortical-limbic circuits. Reduced connectivity among various brain regions. Neuronal overgrowth in some areas, possibly due to inflammation or inadequate neural pruning. Widespread white matter abnormalities (in the corpuscallosum) Dopamine Pathways in Schizophrenia- Mesolimbic pathway Reward motivation emotions and positive symptoms of schizophrenia. Dopamine Pathways in Schizophrenia- Mesocortical pathways Relevant to cognitive functions and executive and negative symptoms of schizophrenia. Dopamine Pathways in Schizophrenia- Nigrostriatal Normally responsible for purposeful movement. Dopamine Pathways in Schizophrenia- Tuberoinfundibular Normally responsible for regulation pf prolactin. Phases of Schizophrenia- Prodromal Mild changes in thinking, reality testing, and mood, insufficient to meet the diagnostic criteria for schizophrenia. Symptoms appear a month to more than a year before the first full-blown episode of the illness. Speech and thought may be odd or eccentric. Anxiety, obsessive thoughts, and compulsive behaviors may be present. Deterioration in concentration, school or job performance, and social functioning are accompanied by distressing thoughts, suspiciousness, memory impairment, and signification disorganization in speech or behavior. Pt. may feel that they are not right or something strange is happening. Phases of Schizophrenia- Acute Later symptoms vary from few and mild to many and disabling. Symptoms such as hallucinations, delusions, apathy, social withdrawal, diminished affect, anhedonia, disorganized behavior, impaired judgement, and cognitive regression result in functional impairment. As symptoms worsen the person has difficulty coping, and symptoms once concealed become apparent to others. Increased support or hospitalization may be required. Phases of Schizophrenia- Stabilization Symptoms are stabilizing and diminishing and there is movement toward a previous level of functioning (baseline). Care in an outpatient mental health center or partial hospitalization program (which includes many of the services offered in inpatient mental health units, but without an overnight stay in the hospital) may be needed. The person may receive care in a residential crisis center (similar to a mental health unit but based in the community and less restrictive in nature) or a staff-supervised residential group home or apartment. Phases of Schizophrenia- Maintenance or Residual The condition has stabilized and a new baseline is established. Positive symptoms are usually absent or significantly diminished, but negative and cognitive symptoms continue to be a concern. Ideally, recovery with few or no residual symptoms will occur, and the patient is again able to live independently or with family. Positive Symptoms The presence of something that should not be present. Symptoms include hallucinations, delusions, paranoia, or disorganized or bizarre thoughts, behaviors, or speech. Negative Symptoms The absence of something that should be present. Symptoms include the inability to enjoy activities, social discomfort, or lack of goal-directed behavior. Cognitive Symptoms Subtle or obvious impairment in memory, attention, thinking (disorganized or irrational thoughts), judgements, or problem solving. Affective Symptoms Symptoms involving emotions and their symptoms. Associative Looseness Looseness of association results from haphazard and illogical thinking where concentration is poor and individuals loosely associated their thoughts. Word Salad The most extreme form of associative looseness, is a jumble of words that is meaningless to the listener (throat hoarse strength of policy highlighters on a boat reigning supreme) Clang association Is choosing words based on their sound rather than their meaning and often involves worlds that rhyme or have a similar beginning sound (on the track...have a big Mac or Click, clack, clutch, close) Neologisms Are words that have meaning for the patient but a different or nonexistent means to others. Echolalia Is a pathological repeating of another words, occurring perhaps because the patient thought processes are so impaired that he/she is unable to generate speech of their own. Circumstantiality Including unnecessary and often tedious details in conversation but eventually reaching the point. Tangentiality Wandering off topic or going off on tangents and never reaching the point. Cognitive Retardation Generalized slowing of thinking which is represented by delays in responding to questions or difficulty finishing thoughts. Pressured Speech Urgent or intense speech resists allowing comments from others Flighting of ideas Moving rapidly from one thought to the next, often making it difficult for others to follow the conversation. Symbolic Speech Using symbols instead of direct communication (demons are sticking me with needles- meaning the patient is experiencing sharp pain) Thought Blocking A reduction or stoppage of thought by hallucinations can cause this. Thought insertion the uncomfortable belief that someone else has inserted thoughts into the brain. Thought Deletion A belief that thoughts have been taken or are missing. Magical Thinking- positive symptoms Believing that thoughts or actions affect others. This is common and usually nonpathological in children (wearing pajamas inside out to make it snow, or because I was mad at him, he fell down) Paranoia an irrational fear, ranging from mild (wary, guarded) to profound (believing irrationally that another person intends to kill you.) Fear may result in defensive actions, harming another person before that person can harm the patient Auditory hallucinations hearing voices or sounds (most common) Visual hallucinations seeing people or things Olfactory hallucinations Smelling odors Gustatory hallucinations experiencing tastes Tactile hallucinations feeling bodily sensations (feeling an insect crawling on ones skin) Illusions misperceptions or miniterpretations of a real experience (A man sees a coat on a shadowy coat rack and believes its a bear) Depersonalization A feeling of being unreal or having lost identity. Body parts do not belong or the body has drastically changed. Derealization A feeling that the environment has changed (everything seems bigger or smaller) Catatonia a pronounced increase or decrease in the rate and amount of movement. Excessive motor activity is purposeless and accompanied by echolalia and echopraxia. The most common form is when the person moves little or not at all. Waxy flexibility Maintaining a given posture inappropriately usually seen in catatonia. (When the nurse raises the arm, the patient continues to hold this position in a statue-like manner. Motor retardation A pronounced slowing of movement. Motor agitation Excited behavior such as running or pacing rapidly, often in response to internal or external stimuli. The agitation can put the patient at risk for exhaustion, running into traffic or others at risk at being knocked down. Stereotyped behaviors Repetitive behaviors that do not serve a logical purpose Echopraxia The mimicking of movements of another. Negativism A tendency to resist or oppose the request or wishes of others. Impaired impulse control A reduced ability to resist ones impulses. (Interrupting in the group setting or throwing unwanted food on the floor. It can increase the risk of assault) Gesturing or Posturing Assuming unusual and illogical expressions (often grimaces) or positions. Boundary impairment An impaired ability to sense where ones body or influence ends and another begins. (A patient might stand too close to others or might drink anothers beverage, believing that because it is near, it is theirs. Anhedonia A reduced ability or inability to experience pleasure in everyday life. Avolition Loss of motivation, difficulty beginning and sustaining goal-directed activities, reduction in motivation or goal-directed behavior. Asociality Decreased desire for, or comfort during, social interaction. Affective blunting Reduced or constricted affect Apathy A decreased interest in, or attention to, activities or beliefs that would otherwise be interesting or important. Alogia Reduction in speech, sometimes called poverty or speech. Flat Immobile or blank facial expression Blunted Reduced or minimal emotional response Constricted Reduced in range or intensity (shows sadness or anger but no other moods) Inappropriate Incongruent with the actual emotional state or situational (laughing in response to a tragedy) Bizarre Odd, illogical, inappropriate, or unfounded, includes grimacing. Extrapyramidal Symptoms (EPS) Side effects such as restlessness, involuntary movements, and muscular tension produced by antipsychotic medications. Acute Dystonia Sudden, sustained contraction of one or several muscle groups, usually of the head and neck. Can be frightening and painful, but unless they involve muscles affecting the airway, which is rare, they are not dangerous. However they can cause significant anxiety and should be treated promptly. It can be treated with anticholinergic medications (anti-parkinsonian drugs) that have their own distressing side effects (anticholinergic toxicity) Akathisia A motor restlessness that causes pacing, repetitive movements, or an inability to stay still or remain in one place. It can be severe and distressing to patients. It can be mistaken for anxiety or agitation. Sometimes more of the drug that caused the akathisia is mistakenly given, which makes the side effect worse. A tardive form can persist despite treatment. Tardive Dyskinesia (TD) a late-onset, irreversible neurologic side effect of antipsychotic medications; characterized by abnormal, involuntary movements such as lip smacking, tongue protrusion, chewing, blinking, grimacing, and choreiform movements of the limbs and feet Anticholinergic Toxicity Dry mouth, decrease peristalsis, mydriasis (or prolonged pupil dilation), non reactive pupils, hot dry skin, hyperpyrexia without sweat, tachycardia, agitation, unstable vital signs, delirium, seizure, repetitive motor movements. Hold meds, emergency cooling, medical transfer, consult prescriber. Pseudoparkinsonism A temporary group of symptoms that looks like Parkinson's Disease: tremor, reduced accessory movements (arms swinging when walking), gait impairment, reduced facial expressiveness (mask facies), and slowing of motor behavior (bradykinesia). Neuroleptic Malignant Syndrome (NMS) Occurs in about 0.2% to 1% of patients who have taken first-generation antipsychotics/second-generation and is characterized by reduced consciousness and responsiveness, increased muscle tone (generalized muscular rigidity), and autonomic dysfunction (hyperpyrexia is the main feature; temp above 103) along with tachypnea, increasing BP and pulse. First-Generation Antipsychotics Traditional dopamine (D2 receptor) antagonists also know as typical antipsychtics. Chlorpromazine, Haloperidol (Haldol), F