NSG 323 Exam 1 PowerPoints

Empathy

(The helping person) who does not condone or approve but attempts to understand the world from the client's perspective in a non-judgmental, uncritical way.

Live Interactive Medium

(remote patient monitoring) provides access to people who otherwise might not receive good medical or mental health care.

Flight of ideas

A continuous flow of speech in which the person jumps rapidly from one topic to another

Tangeniallity

A disturbance in associative thinking in which the individual goes off the topic. When it happens frequently and the individual does not return to the topic, interpersonal communication shuts down

Delusion

A false belief held to be true even with evidence to the contrary (e.g. the false belief that one is being singled out for harm by others)

Anorexia

A medical term that signifies a loss of appetite

Euthymia

A normal mood state

Define transference

A patient unconsciously transfers feelings onto the nurse that are related to people in their past.

Circumstantial speech

A pattern of speech characterized by indirectness and delay before the person gets to the point or answers a question; the person gets caught up in countless details and explanations

Looseness of Association

A pattern of thinking that is haphazard, illogical, and confused, and in which connections in thought are interrupted; it is seen primarily in schizophrenic disorders

Mood

A pervasive and sustained emotion that, when extreme, can markedly color the way the individual perceives the world

Hallucination

A sensory perception (seeing, hearing, tasting, smelling, or touching) for which no external stimulus exists

Pressure of speech

A speech pattern characterized by forceful energy manifested in frantic, jumbled speech as when a manic individual struggles to keep pace with racing thoughts

Anxiety

A state of feeling apprehension, uneasiness, uncertainty, or dread resulting from a real or perceived threat whose actual source is unknown or unrecognized

Apathy

A state of indifference

Catatonia

A state of psychologically induced immobilization at times interrupted by episodes of extreme agitation

Blocking

A sudden obstruction or interruption in the spontaneous flow of thinking or speaking that is perceived as an absence or deprivation of thought

A person in the community asks, "Why aren't people with mental illness kept in state institutions anymore?" A) "Less restrictive settings are available now to care for individuals with mental illness." B) "There are fewer persons with mental illness, so less hospital beds are needed." C) "Most people with mental illness are still in psychiatric institutions." D) "Psychiatric institutions violated client's rights."

A) "Less restrictive settings are available now to care for individuals with mental illness."

Flat

Absence or near absence of any signs of affective expression

Involuntary Commitment

Admission to a psychiatric facility without the client's consent

Who can perform psychotherapy?

Advance practice nurses

Obsession

An idea, impulse, or emotion that a person cannot put out of his or her consciousness; the condition can be mild or severe

Mania

An unstable elevated mood in which delusions, poor judgment, and other signs of impaired reality testing are evident

What is the foundation of the Standards of Practice for Psychiatric -Mental Health Nursing?

Assessment, diagnosis, outcome identification, planning, implementation, coordination of care, health teaching and health promotion, milieu therapy, pharmacological, biological, and integrative therapies.

Select the example of a tort. A) The plan of care for a client is not completed within 24 hours of their admission. B) A nurse gives a PRN dose of an antipsychotic drug to an agitated patient because the unit is short staffed. C) An advanced practice nurse recommends hospitalization for a client who is dangerous to self and others. D) A client's admission status changed from involuntary to voluntary after the client's hallucinations subsided.

B) A nurse gives a PRN dose of an antipsychotic drug to an agitated patient because the unit is short staffed.

A nurse at the mental health center prepares to administer a scheduled injection of haloperidol decanoate (Haldol depot) to a client with schizophrenia. As the nurse swabs the site, the client shouts, "Stop, stop. I don't want to take that medicine anymore because I hate the side effects." What is the best nurse's response? A) Assemble other staff for a show of force and proceed with the injection, using restraint if necessary. B) Stop the medication administration procedure and say to the client, "Tell me more about the side effects you've had. C) Proceed with the injection but explain to the client that there are medications that will help reduce the unpleasant side effects. D) Say to the client, "Since I've already drawn the medication in the syringe, I'm required to give it but let's talk to the doctor about delaying next month's dose."

B) Stop the medication administration procedure and say to the client, "Tell me more about the side effects you've had.

A voluntary hospitalized patient tells the nurse, "Get me the forms for discharge. I want to leave now." What is the nurse's best response? A) "I will get the forms for you right now and bring them to your room." B) "Since you signed your consent for treatment, you may leave if you desire." C) "I will get them for you, but let's talk about your decision to leave treatment." D) "I cannot give you those forms without your health care provider's knowledge."

C) "I will get them for you, but let's talk about your decision to leave treatment."

In a survey on caring in 1998, emerged 3 themes. Explain all 3.

Caring is shown by empathetic understanding, actions, and patience on another's behalf. Caring for one another by actions, words, and being there leads to happiness and touches the heart. Caring is giving of self while preserving the importance of self.

Labile

Characterized by rapid shifts; unstable

Give 9 common "cues" or examples of nonverbal communication.

Common cues are physical appearances, facial expression, body posture, amount of eye contact, eye cast, hand gestures, sighs, fidgeting, and yawning.

What are some examples of cultural considerations?

Communication Styles Use of Eye Contact Perception of Touch Cultural Filters

An adolescent hospitalized after a violent physical outburst tells the nurse, "I'm going to kill my father, but you cannot tell anyone." What is the nurse's best response? A) "You're right. Federal law requires me to keep that information private." B) "Those kinds of thoughts will make your hospitalization longer." C) "You really should share this thought with your psychiatrist." D) "I am obligated to share that information with the treatment team."

D) "I am obligated to share that information with the treatment team."

A client with psychosis became aggressive, struck another client, and required seclusion. Which documentation below is the best? A) Client struck another client who attempted to leave day room to go to the bathroom. Seclusion necessary at 1415. Plan: Maintain seclusion for 8 hours and keep these two clients away from each other for 24 hours. B) Seclusion ordered by physician at 1415 after command hallucinations told the client to hit another client. Careful monitoring of client maintained during period of seclusion. C) Seclusion ordered by MD for aggressive behavior. Begun at 1415. Maintained for 2 hours without incident. Outcome: Client calmer and apologized for outburst. D) Client pacing, shouting. Haloperidol 5 mg given PO at 1300. No effect by 1315. At 1415 client yelled, "I'll punch anyone who gets near me," and struck another client with fist. Physically placed in seclusion at 1420. Seclusion order obtained from MD at 1430.

D) Client pacing, shouting. Haloperidol 5 mg given PO at 1300. No effect by 1315. At 1415 client yelled, "I'll punch anyone who gets near me," and struck another client with fist. Physically placed in seclusion at 1420. Seclusion order obtained from MD at 1430.

In a team meeting a nurse says, "I'm concerned about whether we are behaving ethically in using restraint to prevent one patient from engaging in self-mutilating behavior while the care plan for another self-mutilating patient calls for one-on-one supervision." Which ethical principle most clearly applies to this situation? A) Beneficence B) Autonomy C) Fidelity D) Justice

D) Justice

What is the legal significance of a nurse's action when a client verbally refuses medication and the nurse gives the medication over the client's objection? A) The nurse has been negligent. B) The nurse has committed malpractice. C) The nurse has fulfilled the standard of care. D) The nurse can be charged with battery.

D) The nurse can be charged with battery.

Which individual with mental illness may need emergency or involuntary hospitalization for mental illness? A)The person who resumes using heroin while still taking naltrexone (ReVia). B) The person who reports hearing angels playing harps during thunderstorms. C) The person who does not keep an outpatient appointment with the mental health nurse. D) The person who throws a heavy plate at a waiter at the direction of command hallucinations.

D) The person who throws a heavy plate at a waiter at the direction of command hallucinations.

What does elopement and AWOL mean?

Elopement or AWOL is to leave without being discharged.

Grandiosity

Exaggerated belief in or claims about one's importance or identity

What are some examples of non-therapeutic communications?

Excessive questioning Giving Approval or Disapproval Giving Advice Asking "WHY" Questions Changing the Subject

What are examples of non-verbal communication?

Eye-contact, active listening Personal space Touch Facial Expressions Gestures Body language Personal Appearance

Content and direction of a clinical interview are decided by the examiner. T/F

FALSE

What are examples of therapeutic skills?

Facilitating communication of distressing thoughts and feelings Assisting client's with problem solving to help facilitate activities of daily living (ADL's) Helping clients examine self-defeating behaviors and test alternatives Promoting self-care and independence

Therapeutic Relationship

Focus is on the client's problem and needs Problem-solving identified New coping skills may develop Behavioral change is encouraged

Social Relationship

Friendship Socialization Enjoyment Accomplishment of a task Mutual needs are met, giving advice, helping with dependency needs (lending money). Roles may shift.

Sympathy

Instead of understanding the patient, we feel the feelings of others and objectivity is lost.

What is mental illness?

Mental illnesses are medical conditions that affect a person's thinking, feeling, mood, ability to relate to others, and daily functioning.

Blunted

Mild restriction in the range and intensity of emotional expression

Echolalia

Mimicry or imitation of the speech of another person

There are many tactics to avoid when interviewing a patient. Describe at least 3.

Not argue with the patient, minimize or challenge the patient. Do not give false reassurance. Do not question or probe.

What are some examples of clarifying techniques?

Paraphrasing Restating Reflecting Exploring

What are the 6 QSEN competencies?

Patient centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics.

What are the 4 phases of Hildegard Peplau's Nursing-Client Relationship?

Pre-orientation phase Orientation phase Working phase Termination phase

What are the 3 structural components of a nursing diagnosis?

Problem (unmet need), Etiology (probable cause), Supporting data (signs & symptoms)

What is psychiatric mental health nursing?

Psychiatric mental health nursing is the diagnosis and treatment of human responses to actual or potential mental health problems.

Compulsion

Repetitive, seemingly purposeless behaviors performed according to certain rules known to the client to temporarily reduce escalating anxiety

Males are far more violent than females? T/F

TRUE

Describe what the new technology "telehealth" refers to.

Telehealth refers to the use of electronical information and telecommunication technologies to support long distance clinical healthcare, patient and professional health-related education, and public health and health administration.

What is the DSM-5?

The DSM-5 is the Diagnostic and Statistical Manual of Mental Disorders and categorizes and helps diagnose mental disorders as medical diseases.

Judgement

The ability to make logical, rational decisions

Congruent

The client's affect "matches" the content of his/her/speech

Incongruent

The client's affect does not correspond to the content of his/her speech

Affect

The external manifestation of feeling or emotion, which can be assessed by observing facial expression, tone of voice, and body language

Idea of reference

The false impression that outside events have special meaning for oneself

Recovering from a mental illness is viewed as a personal journey of healing. What is the goal of recovery?

The focus of recovery is to manage symptoms, reduce psychosocial disability, and improve role performance.

What are the 4 aspects or considerations that every nurse needs to know when administering psychotropic medications?

The four considerations are intended action, therapeutic dosage, adverse reactions, and safe blood levels.

What are the 4 basic principles in planning nursing interventions?

The four principles are safe, appropriate, individualized, evidence based planning.

When communicating with a patient in a mental health setting what are the 4 goals to help the patient?

The goals are feeling understood, identifying and exploring problems related to others, discovering healthy ways of meeting emotional needs, and experience satisfying interpersonal relationships.

Perservation

The involuntary repetition of the same thought, phrase, or motor response (e.g. brushing teeth, walking); it is associated with brain damage

Clang association

The meaningless rhyming of words, often in a forceful manner

A chemical restraint is medications used to control an aggressive, violent patient. Name 2 medications most commonly used.

The most frequently used chemical restraints are atypical antipsychotics or high potency typical neuroleptics.

Define countertransference

The nurse unconsciously transfers feelings onto the patient that are related to people in their past.

Describe the difference between the nurse-patient relationship and the nurse-patient partnership

The nurse-patient relationship places the nurse at an unequal status while the nurse-patient partnership allows the nurse and patient to work together as a team on an equal status.

What is the purpose of the Mental Status Exam (MSE)?

The purpose is to evaluate, quantitatively and qualitatively, a range of mental functions and behaviors at a specific point in time.

Intellectualization

The use of thinking and talking to avoid emotions and closeness

Define therapeutic communication.

Therapeutic communication is professional, goal directed, and scientifically based communication.

Insight

Understanding and awareness of the reasons for and meaning behind one's motives and behavior

There are many communication techniques that nurses can use to enhance their nursing practice. Name at least 10.

Using silence, offering self, giving broad openings, restating, reflecting, focusing, exploring, making observations, seeking clarification, voicing doubt, and summarizing.

What are examples of verbal communication?

Words- to clarify our beliefs, values, communicate perceptions and meanings Clarifying techniques Honest or dishonest

NGRI (not guilty by reason of insanity)

after 1993, this person must stand trial upon competency findings but is kept in the forensic unit at the state hospital facilities until such time deemed competent to stand trial

mileu

all inclusive term that recognizes the people, setting, structure, and emotional climate can be holistic and healing

violence

always objectionable act that involves intentional use of force that can result in injury to another person

aggression

an action or behavior that results in a verbal or physical attack

duty to warn

an obligation that may result in breach of confidentiality on the part of the health care worker to warn third parties when they may be in danger from a client

false imprisonment

applying restraints without legitimate reason and/or an order

conscientious objection

care of client collides with own morals, values, and ethics which a nurse can make known upon hire or inform supervisor

breach of duty

conduct that exposes client to unreasonable risk of harm

veracity

duty to communicate truthfully

anger

emotional response to frustration

What is the main function of a forensic nurse?

establish competency and fitness of a psychiatric patient to stand trial in court of law

What is the nursing intervention at the assaultive stage?

medication, seclusion, and/or restraints

What are the stages of violence?

preassaultive stage (client becomes agitated), assaultive stage (client losses control of behavior), post-assultive stage (review with client and help with coping)

Positive Regard

respect, displayed by attitude's and actions

What is our number one goal in the psychiatric setting?

safety, de-escalation techniques

Genuineness

self awareness of one's own feelings

battery

the harmful or offensive touching of another person

Tarasoff vs Regents of University of California

the landmark 1970s case against the University of California that viewed public safety to be more important than privacy in narrowly defined circumstances

milieu therapy

therapeutic modalities that involve a therapeutic community

Nurse-client relationship

to establish repoire with client to understand nurse role as being Safe Reliable Consistent Confidential Appropriate, clear boundaries are identified. Client-Centered care Dignity & Respect Information Sharing Client and family participation Collaboration

What is the nursing intervention at the preassaultive stage?

verbal

What are the stipulations of the use of seclusion and restraint?

written drs orders, confined to specific time-limited periods (AZ state law new order every 3 hours), must be reviewed and documented, must provide for needs, specify restraint and reevaluate consistently