Week 4: Boyd - Chapter 10 and 12

Elated/euphoric (mood)

"Up," "on top of the world." Often with increased energy. Common to manic states of bipolar disorder.

beginning stage of group development

- "honeymoon" stage - rapport, getting to know each another - techniques for leading groups - testing by members - conflict

group development stages

- beginning: honeymoon - working - termination

psychoeducation groups

- enhance knowledge, improve skills, and solve problems - the intervention strategies used focus on transmission of information necessary for making some type of change and providing a process for making the change - Recovery-oriented groups facilitate consumer involvement in the educational process and build on the recovery principles

task groups

- focus on completion of specific activities, such as planning a week's menu - when members are strongly committed to completing a task and the leader encourages equal participation, cohesiveness promotes satisfaction and higher performance (Lockhart, 2017) - to complete a task, group cohesiveness is especially important.

termination stage of group development

- grieve for loss of group's closeness - reestablishment of self as individual - summary and future plans

Yalom's therapeutic factors

- instillation of hope - universality - imparting information - altruism - corrective recapitulation of primary family group - development of socializing techniques - imitative behavior - interpersonal learning - group cohesiveness - catharsis - existential factors

group intervention

- key nursing strategy in mental health promotion and recovery - enhance self-understanding - conquer unwanted thoughts and feelings - learn new behaviors - learn from others - vary in purpose

saying good-bye

- members begin to grieve for loss of group - begin to reestablish individual role - some members may try to bring up past issues to prolong or delay end - nurse must focus on ending group and avoid being pulled into working stage issues - reinforce learned skills and remind members of accomplishments

closed group

- members join at one time - no replacement members - group more cohesive - group more likely to dissolve when members drop out

challenging group behaviors

- monopolizer - "yes, but..." - disliked member - silent member - group conflict

open group

- new members join at any time - members leave at any time - new members are at a disadvantage - advantage of this type: the group can continue

decision-making groups

- plan activities, develop unit rules, and select learning materials - the nurse who is leading should observe the process for any signs of groupthink - group members form opinions consistent with the group consensus rather than critically evaluating the situation.

group guideline examples

- sessions begin and end on time - all views are heard and respected; cell phones silenced; no side conversations - only one speaks at a time, no interruptions - emotion is acceptable; aggression is not - disagreement is expressed calmly and objectively - all stay for entire meeting - who we are and what is said -- stays here

working stage of group development

- sharing of ideas - group personality - development of norms - realization of purpose

techniques for leading groups

- support - confrontation - advice and suggestions - summarizing - clarification - probing and questioning - repeating, paraphrasing - reflecting feelings - reflecting behavior

psychotherapy groups

- treat individuals' emotional problems and can be implemented from various theoretic perspectives, including psychoanalytic, behavioral, and cognitive - these groups focus on examining emotions and helping individuals face their life situations - at times, these groups can be extremely intense - provide an opportunity for patients to examine and resolve psychological and interpersonal issues within a safe environment.

group

- two or more people developing interactive relationships - sharing of at least one common goal or issue - more than the sum of its parts - own personality, patterns of interaction, and rules of behavior

mini mental status exam

-orientation of person to time, day, week, year, name, place -ability to perform basic math -short term memory skills -write or copy a simple drawing

nursing intervention groups

1) Medication groups 2) symptom management groups 3) anger management groups 4) self-care groups 5) reminiscence groups

types of groups

1) Psychoeducation groups (formally planned) 2) Task groups (group cohesiveness important) 3) Decision-making groups (possible "groupthink") 4) Supportive therapy groups 5) Psychotherapy groups 6) Self-help groups 7) Age-related groups

A patient is admitted to the unit after an automobile accident. The nurse begins the mental status examination and finds that the patient has dysarthric speech and is lethargic. The nurse's best approach regarding this examination is to: a. Plan to defer the rest of the mental status examination. b. Skip the language portion of the examination, and proceed onto assessing mood and affect. c. Conduct an in-depth speech evaluation, and defer the mental status examination to another time. d. Proceed with the examination, and assess the patient for suicidal thoughts because dysarthria is often accompanied by severe depression.

A

A woman brings her husband to the clinic for an examination. She is particularly worried because after a recent fall, he seems to have lost a great deal of his memory of recent events. Which statement reflects the nurse's best course of action? a. Perform a complete mental status examination. b. Refer him to a psychometrician. c. Plan to integrate the mental status examination into the history and physical examination. d. Reassure his wife that memory loss after a physical shock is normal and will soon subside.

A

During a mental status examination, the nurse wants to assess a patient's affect. The nurse should ask the patient which question? a. "How do you feel today?" b. "Would you please repeat the following words?" c. "Have these medications had any effect on your pain?" d. "Has this pain affected your ability to get dressed by yourself?"

A

Restless, hyperactive (motor)

A compelling need to be in constant movement. Difficult to sit still.

Delusions

A fixed belief that is experienced as odd, strange, or eccentric by others and outside the realm of realistic possibility.

Hallucinations

A perceptual experience that is not experienced by others.

Latent (thought process)

A prolonged period of time between a thought and its verbal expression.

Dissociation (consciousness)

Altered consciousness, a trance-like state, disconnected from emotions. Often occurs in response to painful emotional content. An associated symptom of trauma

During a mental status assessment, which question by the nurse would best assess a person's judgment? a. "Do you feel that you are being watched, followed, or controlled?" b. "Tell me what you plan to do once you are discharged from the hospital." c. "What does the statement, 'People in glass houses shouldn't throw stones,' mean to you?" d. "What would you do if you found a stamped, addressed envelope lying on the sidewalk?"

B

A 45-year-old woman is at the clinic for a mental status assessment. In giving her the Four Unrelated Words Test, the nurse would be concerned if she could not ____ four unrelated words ____. a. Invent; within 5 minutes b. Invent; within 30 seconds c. Recall; after a 30-minute delay d. Recall; after a 60-minute delay

C

A patient has been in the intensive care unit for 10 days. He has just been moved to the medical-surgical unit, and the admitting nurse is planning to perform a mental status examination. During the tests of cognitive function, the nurse would expect that he: a. May display some disruption in thought content. b. Will state, "I am so relieved to be out of intensive care." c. Will be oriented to place and person, but the patient may not be certain of the date. d. May show evidence of some clouding of his level of consciousness.

C

During an examination, the nurse can assess mental status by which activity? a. Examining the patient's electroencephalogram b. Observing the patient as he or she performs an intelligence quotient (IQ) test c. Observing the patient and inferring health or dysfunction d. Examining the patient's response to a specific set of questions

C

During an examination, the nurse notes that a patient is exhibiting flight of ideas. Which statement by the patient is an example of flight of ideas? a. "My stomach hurts. Hurts, spurts, burts." b. "Kiss, wood, reading, ducks, onto, maybe." c. "Take this pill? The pill is red. I see red. Red velvet is soft, soft as a baby's bottom." d. "I wash my hands, wash them, wash them. I usually go to the sink and wash my hands."

C

The nurse is assessing a 75-year-old man. As the nurse begins the mental status portion of the assessment, the nurse expects that this patient: a. Will have no decrease in any of his abilities, including response time. b. Will have difficulty on tests of remote memory because this ability typically decreases with age. c. May take a little longer to respond, but his general knowledge and abilities should not have declined. d. Will exhibit had a decrease in his response time because of the loss of language and a decrease in general knowledge.

C

The nurse is planning to assess new memory with a patient. The best way for the nurse to do this would be to: a. Administer the FACT test. b. Ask him to describe his first job. c. Give him the Four Unrelated Words Test. d. Ask him to describe what television show he was watching before coming to the clinic.

C

Labile (mood)

Capricious, unstable, quickly changing mood.

Logical, coherent (thought process)

Clear, direct connections between content. One idea flows directly into another.

A 19-year-old woman comes to the clinic at the insistence of her brother. She is wearing black combat boots and a black lace nightgown over the top of her other clothes. Her hair is dyed pink with black streaks throughout. She has several pierced holes in her nares and ears and is wearing an earring through her eyebrow and heavy black makeup. The nurse concludes that: a. She probably does not have any problems. b. She is only trying to shock people and that her dress should be ignored. c. She has a manic syndrome because of her abnormal dress and grooming. d. More information should be gathered to decide whether her dress is appropriate.

D

The nurse is assessing orientation in a 79-year-old patient. Which of these responses would lead the nurse to conclude that this patient is oriented? a. "I know my name is John. I couldn't tell you where I am. I think it is 2010, though." b. "I know my name is John, but to tell you the truth, I get kind of confused about the date." c. "I know my name is John; I guess I'm at the hospital in Spokane. No, I don't know the date." d. "I know my name is John. I am at the hospital in Spokane. I couldn't tell you what date it is, but I know that it is February of a new year—2010."

D

Psychomotor retardation, hypoactive (motor)

Decreased activity, slow response to environment, sluggish. For some individuals, this is typical for their personality.

circumstantial (thought process)

Digressions to unnecessary details in thought and speech before communicating the central idea.

Disorganized speech

Disconnected, unintelligible speech.

attention and speed thought processes

Distractible Preoccupied Rumination Latent Racing thoughts

Depressed/dysphoric (mood)

Down, "blue" mood. Often with decreased energy. Irritability or anxiety occurs in some people. Common to depression, anxiety, and depressed states of bipolar disorder.

Grandiose

Ego inflation. Belief that a person can accomplish anything, even outrageous tasks.

Immaculate grooming

Excessive detail is given to one's grooming and/or make-up.

Distractible (thought process)

Focus can shift quickly onto the external environment. This awareness interrupts the present dialogue.

affect

Full/Broad Blunted/Flat Congruent Incongruent

Appearance

How a person is groomed and dressed.

Preoccupied (thought process)

Inattentive to the external environment, internally focused, seems to be thinking deeply.

Apathetic (motor)

Indifference. Laissez-faire attitude accompanied by lack of motor impetus and dulled emotional tone.

memory and consciousness

Intact memory Anterograde amnesia Retrograde amnesia

Coprolalia (speech)

Involuntary use of vulgar or obscene language.

Anhedonia (mood)

Lack of interest and withdrawal from regular and pleasurable activities that one used to enjoy. An associated symptom of depression.

loose associations (thought process)

Little or vague connection is made between concepts; continuous tangential "rabbit-holing." Can be a symptom of schizophrenia.

form of thought processes

Logical, coherent Circumstantial Tangential Loose associations Flight of ideas

flight of ideas (thought process)

Multiple thoughts and ideas are generated spontaneously, without obvious connection. Often occurs in manic states; associated with bipolar disorder.

Racing thoughts (thought process)

Multiple thoughts occurring in a seamless fashion. Often in list form. These thoughts have a pressured quality.

euthymic (mood)

Normal or typical mood. Upbeat, "happy."

Tangential (thought process)

Oblique, digressive, irrelevant speech. The central idea is not communicated

Rumination (thought process)

Preoccupation with a single idea or theme.

speech

Regular rate and rhythm Pressured speech Laconic speech Disorganized speech Coprolalia Echolalia

motor

Relaxed, normal Psychomotor retardation, hypoactive Catatonic Apathetic Restless, hyperactive Agitated

Echolalia (speech)

Repeating or mirroring the speech of another person. For example, repeating back a question instead of answering the question.

regression

Return to a childlike state. The person is unconsciousness and unaware of their regression (if they are aware, it is usually a symptom of manipulation)

Agitated (motor)

Severe anxiety and/or irritation, adrenaline response, preparation for action. Can precipitate anger outbursts or panic attacks. Pacing or hyperventilating can occur.

Catatonic (motor)

Severe immobility.

Overdressed

The person is wearing too much clothing for the context (e.g., time of year and season, formal nature of meeting). In some cases, the clothing worn might indicate other issues (e.g., wearing long-sleeves in summer to hide cutting scars or needle marks).

orientation (consciousness)

To time, place, person, situation

Pressured speech

Uncontrollable, accelerated, excessive talking. Rapid rate and rhythm, difficult to interrupt. The person feels they cannot talk fast enough to get their words out.

judgement

ability to interpret one's environment & situation correctly and adapt one's behavior accordingly

congruent (affect)

appropriate emotional expression to the content being discussed. Considered authentic, genuine, "integrated"

circumstantial thinking

client eventually answers a question, but only after excessive and unnecessary detail

ideas of reference

clients inaccurate interpretations that general events are personally directed directed to him or her, such as hearing a speech on the news feeling that it had personal meaning

thought insertion

delusional belief that others are putting ideas or thoughts into the client's head- ideas are not the clients

thought withdrawal

delusional belief that others are taking clients thoughts away and client is powerless to stop it

thought broadcasting

delusional belief that others can hear or know what the client is thinking

loose associations

disorganized thinking that jumps from one idea to another with little or no evident relation between thoughts

blunted/flat (affect)

dulled range of expression. An associated symptom of depression, brain injury, trauma.

mood

euthymic depressed/dysphoric Elated/euphoric Labile Anhedonia

flight of ideas

excessive amount and rate of speech composed of fragmented or unrelated ideas

hallucinations

false sensory perceptions or perceptual experiences

delusions

fixed, false belief not based in reality

word salad

flow of unconnected words that convey meaning to the listener

broad affect

full range of of emotional expression

thought process

how the client thinks

incongruent (affect)

inappropriate emotional expression to the content being discussed. Considered inauthentic, "superficial."

inappropriate affect

incongruent expression with emotion

blunted affect

little or slow-to-respond facial expression

restricted affect

one type of expression, usually serious or somber

labile

rapidly changing mood

flat affect

showing no facial expression

thought blocking

stopping abruptly mid-sentence, sometimes unable to finish a thought

groupthink (decision-making groups)

tendency of group members to avoid conflict and adopt a normative pattern of thinking that is often consistent with the ideas of the group leader

insight

the ability to understand the true nature of one's situation and accept some personal responsibility for the situation

Confabulation

the act of filling in memory gaps

supportive therapy groups

usually less intense than psychotherapy groups and focus on helping individuals cope with their illnesses and problems.

tangential thinking

wandering off the topic and never providing the requested information

thought content

what the client actually says