psych test 1

things to consider before seclusion/restraint

DEC stim verbally intervening active listening provide diversion PRN meds p.97

Atomoxetine

NONstimulant treatement for ADHD for 6yrs and older SE: DEC appetite, wt loss, fatigue, dizzy *contraindicated for pts w/ CVD b/c INC BP and HR p.59

Clonidine

NONstimulant treatment for ADHD traditionally used for HTN used for kids 6-17yrs; works best w/ preteens -should be INC slowly and NEVER stopped abruptly -SE: fatigue, irritable, throat pain, insomnia, nightmares, emotional disorder, constipation, INC body temp, dry mouth, ear pain p.59

Guanfacine

NONstimulant treatment for ADHD traditionally used for HTN used for kids 6-17yrs; works best w/ preteens -should be INC slowly and NEVER stopped abruptly -SE: sleepy, low BP, nausea, abd pain, dizzy p.59

GABA

Neurotransmitter used: *anxiety DEC, excitation DEC, aggression DEC, pain perception, anticonvulsant, muscle relaxing, impaired cognition/psychomotor functioning DEC: anxiety, schizophrenia, mania, huntingtons INC: DEC in anxiety p.41 table 3.1

Histamine

Neurotransmitter used: alertness, inflammatory process, gastric secretions DEC: sedation, wt gain p.41 table 3.1

Somatostatin

Neurotransmitter used: altered lvls asso w/ cognitive disease DEC: Alzheimers, lvls of this found in spinal fluid of some depressed pts INC: huntingtons p.41 table 3.1

Substance P

Neurotransmitter used: antidepression, antianxiety, promote/reinforce memory, INC sensitivity to pain Regulates mood and anxiety, pain management p.41 table 3.1

Neurotensin

Neurotransmitter used: antipsychotic properties DEC: lvls of this found in spinal fluid of pts w/ schizophrenia p.41 table 3.1

Glutamate

Neurotransmitter used: excitatory, learning, memory DEC: psychosis INC: prolonged INC state of neurotoxic, neurodegeneration in Alzhiemers, improvement cognitive performance in behavioral tasks p.41 table 3.1

Dopamine

Neurotransmitter used: fine muscle movement, emotion and thought, decision making, stim hypothalamus for hormone release for sex, thyroid, and adrenal DEC: parkinson, depression INC: schizophrenia, mania p.41 table 3.1

(ACH) Acetylcholine

Neurotransmitter used: learning, memory, regulates mania and sex behavior, stim PNS DEC: *ALzheimers, Huntingtons, Parkinsons INC: depression p. 41 table 3.1

Norepinephrine

Neurotransmitter used: mood, attention, arousal, stim sympathetic ANS for fight or flight response DEC: depression INC: mania, anxiety, schizophrenia p.41 table 3.1

Serotonin

Neurotransmitter used: sleep regulation, *hunger, mood states, pain perception, aggression, sex, hormones DEC: depression p.41 table 3.1

content and process

two parts of verbal/nonverbal communication communication that need to be congruent or it wont make sense ex: content- "i need to make a good grade on this test", process- i bought the books and studied hard; these are congruent. -if i had still made that statement yet had not studied then there would be a conflict in the verbal and nonverbal p.141

systematic desensitization

type of behavioral therapy that focuses on pt's fears while using learned relaxation techniques in 4 steps: (1)break down fear into specific cues that causes pt to react, (2)pt exposed to fear little by little; exposure INC till anxiety and fear has ceased, (3)create a hierarchy of fears representing the stages from most to least fearful then use relaxation techniques to work through each step, (4) pt practice techniques everyday p.24

operant conditioning

type of behavioral therapy that uses positive reinforcement to INC desired behaviors -token economy: when desired goals are achieved, pts awarded w/ coins and they can use these coins in exchange for food, luxuries, or privileges. -useful in INC verbal behaviors of mute, autistic, and developmentally disabling children and self care, soc behavior, group participation in severe/mentally ill p.24

aversion therapy

type of behavioral therapy where a negative stimulus is paired with a target behavior suppressing the behavior -treat alcoholism, paraphilic disorders, shoplifting, violent/aggressive behavior, self mutilation -used when a less drastic measure has failed (best for the pt? violate pt rights? best interest of soc?) p.24

modeling

type of behavioral therapy where a pt learns by imitation of a designated role model p.24

therapeutic use of self

use of our unique gifts to promote healing in others p.125

medical record

used to: -provide info on course of pt's care and treatment -provide accurate, complete info about the care a and treatment of pts -give HCPs a way of communication -allow for continuity of care -usefulness is determined by how well it accurately and completely portrays pt's behavior status at the time it was written -pt has the right to see it but it belongs to facility -insurance companies use it to determine which payments they'll make on pt's behalf -utilization review analysts use to eval appropriate use of resources consistent w/ reimbursement schedules -evidence in court, police investigations, etc. which tells pt: damages pain and suffering in personal injury cases while under hospital care, nature and extent of injuries in child/elder abuse, nature/extent of phys/mental disability in disability cases, nature and extent pf injury and rehab potential in worker's compensation cases p.103

SSRIs

usually used to treat OCD, soc anxiety disorder, gen. anxiety disorder, panic disorder, and PTSD -ex: fluoxetine (SE:anorexic and antibulimic effects), sertraline, paroxetine (DONT give to pts w/ narrow angle glaucoma), citalopram, escitalopram, fluvoxamine -blocks reuptake of serotonin thereby making more of this neurotransmitter available -SE: inhibits spinal cord reflexes of orgasm, apathy, low libido, N/V p.51-52

decompensation

deterioration of mental health p.64

eye contacts across cultures

hispanics- avoid eye contact for authority figures as sign of respect japanese- direct eye contact is lack of respect and a personal insult; preferance is to shift gaze down or focus on speaker's neck chinese- shifting gaze down and side to side is polite; direct is only used w/ older adults filipinos- avoid but once caught it must be maintained middle eastern- women eye contact means sexual implications or promiscuity native americans- eye contact disrespectful/aggression german- direct and sustained means person is listening and trusts, somewhat aggressive, in some situations sexual russians, english, blacks, french- eye contact is a norm; see avoiding eye contact as dishonesty "closed" off to giving info, or disinterest haiti- hold eye contact w/ everyone but the poor p.146-147

betty newman

impact of internal/external stress on equilibrium of system; assist pts in creating/using stress coping p.23 table 2.2

Patient Protection and Affordable Care of 2010 (ACA)

improves coverage for most Americans who are uninsured through a combo of medicaid eligibility, creation of health insurance exchange in the state, and "insurance mandate" requiring that ppl w/o coverage obtain it -eliminates med underwriting in individual and small group markets so med hx no longer results in enrollment denials fro preexisting conditions or higher premiums -require all individuals and small group health plans to cover 10 essential health benefits w/ no annual or lifetime dollar limits (covers mental health and addiction) -health insurance w/ mental health benefits available for many individuals who previously has been uninsured -provides prescription coverage for all new individual and small group health plans, including meds to treat behavioral health probs -requires all non-grandfathered health plans including large group plans to cover a range or preventative care at no cost to the pt -young adults stay on parents healthcare till age 26(important since most disorders arise in early 20s). p.9

PMH nurse

p.11 nursing specialty dedicated to promoting mental health through assessment, diagnosis, and treatment of behavioral probs, mental disorders, and comorbid conditions across the lifespan.

mental status exam p.114 box 7.4 psychosoc assessment p.115 box 7.5

the ____ is objective info, while the ____ is completely subjective part of the PMH RN assessment

general adaptation syndrome alarm resistance exhaustion

the ____ stage is the initial brief and adaptive response to the stressor (fight or flight); eyes and ears>soud alarm to amygdala> hypothalamus> SNS or HPA axis -this stage is extremely intense and cant be sustained for long -once the threat is gone the parasympathetic comes in and rest and digest takes place OR if it stays it progresses through this process to the next step the ___ stage also called the adaptation stage b/c pt obtains and sustains optimal resistance to the stressor; recovery, repair, renewal occurs typically; if stressor still there the cycle will cont to final stage the ___ stage occurs when attempts to resist the stressor have proven to be futile; resources depleted,stress chronic, overexposure to cortisol=low immune response -*THIS STEP CAN ACTUALLY CAUSE DEATH!!!!!!!! p.159

mental health parity act of 1996 wellstone-domenici parity act of 2008

the _____ legislation required insurers that provide mental health coverage to offer annual and lifetime benefits at the same lvl provided for medical/surgical coverage; whereas the _____ was enacted for group health plans with more than 59 employees requiring that any plan providing mental health coverage must do so in a manner that is functionally equivalent or on par with coverage of other health conditions pertaining to deductibles, copays, coinsurance, limitations of treatment, and out of pocket expense p.9

enculturation

the culture's worldview, beliefs, values, and practices transmitted to its members as children learning from parents what beliefs, values,behaviors are right/wrong; individuals free to make own choices but w/in confines of rules set -deviations seen as illness -actions seen as healthy in one culture can be seen as illness in another p.81

Examples of long/short term goals for the suicidal pt

table 7.3 p.117

therapeutic communication techniques nontherapeutic communication techniques

table 9.2 p.143-144 table 9.3 p.146

Paliperidone

p.58 2nd generation antipsychotic thats an active metabolite for Risperidone -SE: INC prolactin, orthastatic hypotension, sedation

contributing factors to mental health

'p. 4-5 figure 1.3 -individual attributes: refer to characteristics that are both inborn and learned make us who we are (ex: prenatal alcohol exposure, O2 deprivation at birth) -social/economic circumstances: the earliest social group, the family has biggest impact setting the stage for giving confidence/social skills or anxiety/feelings of inadequacy (ex:school, peers, socio-economic status = resources available like basic needs and education) -environment: political climate and cultural considerations; access and lack of to basic needs, soc and econ policies, cultural beliefs/attitudes/practices (mental health is culturally based so before you judge you have to look at their culture and identify what is considered acceptable/unacceptable for them and what they consider to be a "mental illness"; ex: Japanese think suicide as an act of honor "suicide bombers" are martyrs in contrast to western views)

2nd Generation Antipsychotic

*produce fewer side extrapyramidal syndrome effects and target both "positive" and "negative" S&S of schizophrenia so they're considered first line drug of choice over first generation! -mainly dopamine and serotonin blockers -*INC risk of metabolic syndrome (clozapine and olanzapine highest risk): wt gain from INC appetite from blocking H1 via hypothalamic eating centers, INC glu via block of muscarinic on pancreatic cells causing insulin resistance, and INC triglycerides ex: clozapine, olanzapine, aripiprazole, ziprasidone p.57

Hypothalamus

-controls basic drives like thirst, sex, hunger -links thought and emotion to functions of internal organs -processes sensory info sent to the cerebral cortex -regulate sleep-wake cycles and cerebellums conscious mental activity p.42

PMH nursing responsibilities

-data collection including pt, fam, and other healthcare workers -develop, implement, and eval plans of care -assist supervise mental healthcare workers -keep safe and therapeutic relationship -teaching/health promotion -monitor behavior, affect, mood -keep oversight on seclusion and restraint -coordinate care of treatment team p.72

managing a behavioral crisis

-each member of the team takes part in trying to diffuse the crisis in the early stages -if prevention fails, each team member participates in rapid organized planning to safely manage the situation -nurse serves as team leader in organizing plan and timing of actions and managing concurrent med admins -seclusion, restraint, and emergency meds are last resort> can be done w/o physician present but must obtain order soon p.71

PMH nurse legislation involvement

-involvement in NAMI -vigilant reviewing of local, nat'l legislation affecting healthcare to identify potential detrimental effects on the mentally ill -APNA devote significant energy to monitoring legislative, regulatory, and policy matters affecting PMH -nurses are usually the last to be involved in making policy changes though they could be very effective current political issues: MH parity, discriminatory media protrayal, standardized language and practice, advanced practice issues.

preparing for the interview

-let the pt set the pace for the interview -create a setting enhancing feelings of security -assume same height either sitting or standing -avoid face-to-face; prefer 90-120 degree or side by side so you're able to look away w/o discomfort -position where you dont block the pt in the room but you also want to make sure you have a way out if things get out of hand so dont place pt between you and door p.150

documentation regarding restraint/seclusion

-nurse can restrain/seclude w/o order but must obtain an order as soon as possible -orders NEVER written as PRN or standing -can be renewed for up to 24hr depending on pts age (18+ 4hrs, 9-17 2hr, 9 or younger 1hr) -after 24hrs a physician must come and personally eval the pt -pts must be released immediately when threatening/harmful behavior ceases -RN must document behavior leading up to it, time entered, and time let out, and cont. observation while in and released in intervals of 15-30min for phys needs like food/water/toileting -must be documented on every 15-30 min p.97-98

PMH nurse advocacy

-reports abuse/neglect immediately -upholds pt confidentiality -supports pt's autonomy

safety in PMH settings

-safety needs are identified, individualized interventions begin on admission -staff checks all property and clothing for meds, sharp objects, alcohol -immediate suicide watch is one-to-one while others require documentation on wherabouts every 15min -staff inspects bags and packages from visitors -intimate relationships between pts are prohibited -doorknobs made to hold minimal wt to prevent hanging -windows locked and made of safety glass -safety mirrors -showers nonwt bearing or nonlooping designed showerheads -platform beds instead of hospital beds -doors that open out instead of in to keep pts from barricading themselves in -cont. hinges instead of 3butt hingesb/c hanging -anchored furniture to prevent use as a weapon -drapes mounted to ceiling instead of racks -plumbing fixtures boxed in p.72

pt rights

-treated w/ dignity -involved in treatment planning and care decisions -refuse treatment, including meds -request to leave AMA -protection against hurting oneself or others -timely eval for involuntary hospitalization -legal counsel -vote -communicate by telephone or in person -informed consent -confidentiality -choose or refuse visitors -informed of research and refuse to participate -least restrictive means of treatment -send and retrieve mail and be present during inspection of packages -keep personal belonging unless dangerous -complain through a plainly publicized procedure -participate in religious worship p.70 box 4.2

psych advanced directives

1. designates preferred physician/therapist 2. vistiors/who should not visit 3. preferred facilities/unacceptable facilities 4. consent/lack of consent for admission to psych facility 5. consent/lack of consent for electroshock therapy 6.preferred meds to take/not take 7.appoint someone to make decidions regarding mental health p.97

peplau's model of nurse-pt relationship

1. preorientation phase- recognizing own feelings, investigating your pt (ask staff, go through chart and look at assessments, labs, meds, etc, 2. orientation phase- lasts over a few meetings or longer; initial interview and 1st meeting (intros, who i am and background, purpose of meeting, ask what the pt likes to be called, build rapport, contract either written or stated that tells place, time, date and duration of the meeting and termination of relationship is discussed, explain confidentiality as who will/wont have access to their info) 3. working phase (gather further data, identify prob solving skills and self esteem, edu about the disorder, S&S management, med edu, eval progress) 4. termination phase- discussed during the first interview and working phase (summary of goals achieved in relationship, discuss how to incorporate new coping strategies into daily life, review situations that occured during relationship, exchange memories that help bring closure to relationship), emphasize med edu and when to recognize S&S are getting out of control, recommending self help groups p.130-132 look at table 8.3

admission procedure guidelines

1. voluntary/involuntary commitment doesnt determine pt's right to make informed decisions about healthcare 2. a dx based on DSM-5 3. condition causes immediate crisis situation that less restrictive alternatives couldnt solve 4. reasonable expectation that hospitalization will improve it p.93

Goals for transformed mental health system in the U.S.

1: ppl understand mental health is essential to overall health 2: mental health consumer and fam centered 3: disparities in mental health services eliminated 4: early mental health screenings, assessment, referral to services are common practice 5: excellent mental healthcare delivered and accelerated research 6:tech used to access mental healthcare and info p.8

inpt settings

24hr supervision, therapeutic milieu healing envrionment outcomes are to stabilize S&S to return to community interventions: -short term therapeutic relationship -plan of care w/ attention to sociocultural needs of pt and rintegration to community -admin meds -monitor nutr and self care w/ assistance as needed -health assessment and intervene when needed -offer structured soc activities -plan discharge w/ fam/significant other w/ regard to housing and follow up treatment p.65

risperidone

2nd genderation antipsychotic w/ low potential for agranulocytosis and convulsions -SE: motor difficulties, highest risk for extrapyramidal syndrome, INC prolactin (amenorrhea, galactorrhea, gynecomastia), sexual dysfunction, orthostatic hypotension (watch falls w/ older ppl), sedation, wt gain = NONCOMPLIANCE p.58

Ziprasidone

2nd generation antipsychotic -*CONTRAINDICATED FOR PTS W/ QT INTERVAL PROLONGATION, ACUTE MI, OR HF -take w/ food p.58

Olanzipine

2nd generation antipsychotic -SE: sedation, wt gain, *hyperglycemia w/ new onset type 2, higher risk metabolic syndrome p.58

Quetiapine

2nd generation antipsychotic *H1 blocker =HIGH SEDATION -SE: wt gain and mod chance for metabolic syndrome -low chance for extrapyramidal or prolactin probs -prescribed for sleep usually p.58

Aripiprazole

2nd generation antipsychotic and *only dopamine modulator; in areas of low dopamine it raises it and vice versa -lacks sedation and wt gain p.58

Clozapine

2nd generation antipsychotic thats relatively FREE of motor side effects -SE: *bone marrow suppression and agranulocytosis (low WBC and high ANC measured weekly for 1st 6 wks, then every other week for a another 6mo, then every month thereafter; convulsions p.58

cerebral cortex frontal parietal temporal occipital

Has 4 lobes w/ specific functions ___ lobe handles conscious sedation and initiation of movement; goals, initiate, plan, terminate actions, decision making, insight, motivation, soc judgement, voluntary motor ability ___ lobe deals w/ sensation of touch; recieve and identify sensory info, concept formation and abstraction, proprioception and body awareness, read, math, RT and LT orientation ___ lobe deals w/ sound; language comprehension, stores sound in memory, connects w/ limbic system "emotional brain" to express emotions like sex, aggression , and fear ___ lobe handles vision; interprets visual images, visual asso, visual memories, involved w/ language formation p.43-44 figure 3.5

ADHD

S&S: short attention span, impulsivity, overactivity treatment: psychostimulants (methylphenidate, dextroamphetamine) taht act by blocking reuptake of norep and dopamine and INC monoamines in synapse= inhibit overactive limbic system), nonstimulants (atomoxetine, guanfacine, clonidine) -SEs of psychostims: agitation, exacerbation of psych thoughts, HTN, growth suppression, abuse potential

distress eustress

___ is a negative draining energy that results in anxiety, depression, confusion, helplessness, hopelessness, and fatigue ___ a positive beneficial energy that motivates and results in feelings of happiness, hopefulness, and purposeful movement p.159

ANS and endocrine system

____ and ____ serve as links between the brain and cardiac muscle, smooth muscle, and glands of which the internal organs are composed of p.38

serotonin norep reuptake inhibitors Venlafaxine Desvenlafaxine Duloxetine Levomilnacipran

____ causes HTN r/t specifically to norep reuptake ____ the active metabolite of Venlafaxine so their MOA are the same ____ treat depression, GAD, diabetic peripheral neuropathy, fibromyalgia, chronic musculoskeletal pain ____ greater effect of norep than any other for treating depression; may INC HR and BP p.53

proxemics intimate distance personal space soc distance public distance

____ is 18inches in US for those we feel most safe and trust ____ 18-40inches for personal cmmunication w/ friends/collegues ____ 4-12ft for strangers or acquaintances ____ 12+ft p.151

PMH RN PMH-APRN basic lvl advanced lvl

____ is a nursing grad who possesses a diploma, ADN or BSN and chooses to work in the specialty of PMH. ____ is a licensed RN w/ a MSN or DNP in psych ____ ____ care is coordinating care, health teaching/maintenance, milieu therapy, pharm/bio/integrative therapies ____ ____ care is all of the above plus med prescription and treatment, psychotherapy, and consultation. p.13

pharmacodynamics vs pharmacokinetics

____ is the study of what drugs do to the body and how they do it, including drug action and responses ____ is movement of the drug through the body w/ 4 basic processes: Absorption (how's it absorbed?), Distribution (how's it distributed through the body?), Metabolism (how's it transformed for use and excretion?), Excretion (how's the body excrete it?) -helps maximize drug's benefit by figuring out how to achieve high enough lvl of drug at the site of action while minimizing harm by using the lowest possible dose -helps choose most effective route, dose and schedule p.48

standard of practice for PMH RN standard 3 outcome identification outcome criteria

____ occurs when RN identifies expected outcomes and healthcare consumer's goals for a plan individualized to the healthcare consumer or to the situation ____ are hoped-for outcomes that reflect max lvl of pt health that the pt can realistically achieve through nursing interventions p.116

standard of practice for PMH RN standard 6 eval

____ occurs when Rn evals progress toward attaining expected goals

standards for practice for PMH RNs assessment

____ occurs when a PMH nurse collects and synthesizes comprehensive health data pertinent to healthcare consumer's health/situation -purpose is to: establish rapport, understand CC, review phys status and V/S , assess safety RF, perform mental health exam, assess psychosoc status, identify mutual goals for treatment, make plan of care, document data in retrievable format -child: caregivers best describe behavior, performance and conduct, interpreting words and responses; seperate interview needed when possible abuse; watch child play; ask to draw picture, tell a story -adolescence: highly concerned w/ confidentiality; pt and fam need to know how info sharing is done, who it will be shared w/ and when; *identify RFs is key (HEADSSS interview box 7.2 p.111) -adults: DONT stereotype based on age; DONT assume just b/c a pt is older tey have some type of disability/ impairment but if one does exist the nurse needs to be aware so accomodations can be made for them p.110-111

transference countertransferance

____ occurs when pt unconsciously and inappropriately displaces onto the nurse feelings and behaviors r/t to significant figures in the pt's past; can be positive and not need addressing or hostile which need further exploring ____ occurs when nurse unconsciously displaces feelings r/t significant figures in the pt's past onto the pt p.127 look at table 8.2 p.129

standards of practice for PMH RN standard 2 dx problem focused dx health promo dx

____ occurs when the PMH nurse analyzes the assessment data to determine dx, problems, and areas of focus for care and treatment including lvl of risk made up of: 1. prob/potential prob (unmet need), 2. r/t factors (relay what needs to be changed through the nursing interventions), 3. defining characteristics (objective and subjective data) ____make judgements about undesirable human responses to health condition of life process ____motivation and desire to improve is dx; r/t are not used but defining characteristics are ____ vulnerability that carries a high probability of developing problematic experiences or responses p.115-116

clarifying techniques paraphrasing restating reflecting exploring

____ occurs when you restate the basic content of the pt's message in different usually fewer words ____ is an active listening strategy that helps the nurse understand what the pt is saying; restates the same key words the pt has spoken ____ assists pt to better understand their own thoughts and feelings; make pt aware of inner feelings and make them own them ____ technique that allows nurse to explore important ideas, experiences, or relationships more fully (ex: tell me more, describe..., give me an example of...) p.142

Lvls of Awareness consciousness preconscious unconscious

____ part of the mind is the tip of the iceberg containing all that we are consciously aware of including perceptions, memories, thoughts, fantasies, and feelings ____ controls materials that can be retrieved rather easily by conscious effort ____ all repressed memories, passions, and unacceptable urges lying deep below the surface (ex: memories/emotions asso. w/trauma); usually unable to retrieve w/o the help of a therapist. p.19 figure 2.1

phys stressors psych stressors

____ trauma, excess heat, excess cold ____ divorce, job loss, unmanageable debt, death of loved one, retirement, fear or terrorist attack p.160

Serotonin Antagonist and reuptake inhibitors Nefazodone Trazodone Brexpiprone

_____ blocks serotonin receptors and weakly inhibits reuptake of serotonin and norep -SE: sedation, headache, fatigue, dry mouth, nausea, constipation, dizzy, blurred vision -wt gain and sex dysfunction minimal -*used w/ caution to pts w/ liver failure and NEVER give to those who already have liver issues _____ used to treat insomnia (originally) and major depressive disorder -SE: sedation, dizzy, *orthostatic hypotension, *priaprism _____ used specifically to treat depression that comes w/ schizophrenia -SE: akathisia (inner restlessness and ability to stay still), wt gain p.53

standard of practice for PMH RN standard 4 planning

_____ occurs when the nurse develops plan that prescribes strategies and alternatives to assist the healthcare consumer in attainment of expected outcomes; *using Maslow' hierachy -when doing this, the nurse must consider: safety, compatible and appropriate, realistic and individualized and evidence based p.116-118

blurred boundaries

_____ occurs when the relationship between nurse and pt slips into a soc one or when the nurse's needs are met at the expense of the pt p.127 look at table 8.1

overgeneralization

a cognitive distortion where use a bad outcome as evidence that nothing will ever go right again ex: you get into a car wreck so you suck at driving and should never drive again p.27 table 2.3

Human Genome Project

a 13 yr project completed on the 50th anniversary of the discovery of the DNA double helix that strengthened bio and genetic explanation for psych conditions by: -identifying approx. 20000 to 25000 genes in human DNA -determine sequence of 3 billion chem base pairs that make up DNA -store info in data bases -improve tools for data analysis -address ethical, legal, and social issues that may come w/ the project p.7-8

Nursing diagnosis

a ____ is a clinical judgement concerning a human response to health conditions/life processes or vulnerability for that response by an individual, fam, group, or community -provides a framework identifying appropriate nursing interventions for dealing w/ pt's reactions to the disorder dx by DSM-5. p.12

all or nothing thinking

a cognitive distortion where thinking is black and white and reduces complex outcomes to absolutes ex: I won 2nd place which is good but i didnt get 1st so im a loser p.27 table 2.3

mental health continuum

a conceptualization that finds an even middle ground between mental health and mental illness along points system p.3-4 figure 1.2 -on one end there's mental health "well-being" characterized by adequate to high lvl functioning; experience occasional to mild stresses of everyday life w/o any serious impairment in daily functioning -on the other end there's emotional probs and concerns with mild to mod discomfort and distress and mild or temporary impairment (insomnia, lack of concentration, loss appetite, for example or those with mild depression, gen anxiety disorder, and ADD) -the most severe side of the spectrum there's mental illness where there's altered thinking, mood and behavior that's long term/chronic that range from moderate to diabling (depression, anxiety, schizophrenia for example)

ethnicity

an ethnic groups common heritage and history, and worldview especially in their relationships w/ eachother p.78

resilience

ability and capacity to secure the resources needed to support their well being (ex: child of abuse/neglect seeking help from trusted adult) -DOES not mean that you're not affected by stressors; just means that you can regulate your emotions and not fall victim to negative/self defeating thoughts. p.4-5

oral psychosexual stage

age 0-1 engage in mouth sucking biting and chewing primary conflict is weaning tasks to master gratification of oral needs and begin ego development (4-5mo) desired outcome is trust development knowing needs are met if fixation occurs passive, gullible, dependent, sarcastic, smoker, nailbiter p.21 table 2.1

anal psychosexual stage

age 1-3 engage in expulsion and retention of feces primary conflict is potty training tasks control over instinctual drives, ability to delay immediate gratification to attain future goal desired outcome impulse control if fixation occurs anal retentiveness (stingy, rigid thought patterns, OCD) or anal expulsive (messy, destructive, cruel) p.21 table 2.1

genital psychosexual stage

age 12 and older engage in sexual intercourse tasks satisfy sexual/emotional relationships , emancipation from parents, plan life goals, develop personal identity desired outcome creativity and love in work if fixation occurs derails emotional/finance independence, impaired personal identity/future goals, disrupt ability to form intimate relationships p.21 table 2.1

phalic/oepidal psychosexual stage

age 3-6 engage in masturbation primary conflict is oepidal and electra task identify sex w/ parent of same sex and superego development desired outcome identify sex w/parent if fixation occurs reckless, self assured, narcissistic; if lacking unable to love, difficulty w/ sexual identity p.21 table 2.1

latency psychosexual stage

age 6-12 tasks growth of ego function (soc, intellectual, mechanical) and able to relate and care for others outside of home (peers of same sex) desired outcome develop skills to cope w/ environment if fixation occurs difficult identifying w/ others and soc skills= inadequacy and inferiority p.21 table 2.1

Society's outlook on mental illness

always evolving; shaped by prevailing culture and societal values and reflects changes in cultural norms, societal expectations, political climates, and reimbursement criteria to 3rd party payers p.2

agonist vs antagonist

an ___ drug mimic the effects of neurotransmitters naturally found in the human brain by binding to and stimulating the receptor site an ___ drug blocks neurotransmitters obstructing their action p.49

Therapeutic Milieu

an all inclusive term that describes the pt and staff, setting, structure, and emotional climate as important to healing as it offers sense of security and promotes healing -includes activities rules, reality orientation practices, and environment p.71

Buspirone

antianxiety w/o strong sedative-hypnotic properties; blocks feedback inhibition by serotonin -tolerated better than benzos -NOT a CNS depressant -NO danger of interaction w/ other CNS depressants -SE: dizzy and insomnia p.50

Valproate

anticonvulsant that also treats bipolar disorder -SE: tremors, wt gain, sedation, *thrombocytopenia, *pancreatitis, *hepatic failure, *birth defects (DONT TAKE IF PREGNANT!) -*BLOOD MUST BE DRAWN BEFORE STARTING THIS MED! (liver function test and CBC) -*if on this med, blood lvls must be taken regularly >liver function test, CBC, Valproic acid lvls)

Norep Dopamine reuptake inhibitor (Bupropion)

antidepressant also used for smoking cessation represented by only one drug; NO sexual dysfunction -SE: insomnia, tremor, anorexia, wt loss -contraindicated: bulimia, anorexia, alcohol/sedative withdrawal, seizure disorder p.53

Norep and Serotonin specific antidepressants (Mirtazapine)

antidepressant and antianxiety represented by only one drug ___ which INC norep and serotonin transmission by blocking presynaptic adrenergic autoreceptors -offers minimal sexual dysfunction and improved sleep -SE: sedation, hunger, wt gain p.53

Serotonin Partial Agonist and reuptake inhibitor (Vilazodone)

antidepressant represented by only one drug ____; enhance release of serotonin by inhibiting serotonin transporter and stimulating serotonin receptors through partial agonism -SE: N/V, diarrhea, insomnia -take w/ food and avoid nighttime doses due to insomnia p.53

Lamotrigine

antidepressant used for maintenance therapy for bipolar disorder; works well for depression that accompanies bipolar disorder; modulates GLUTAMATE -SE: *Steven Johnsons (doubles chance of this if taking concurrently with Valproate) p.56

Carbamazepine

antidepressant used to treat acute mania; DEC firing of overexcited neurons by DEC Na channels -*BLOOD LVLS MUST BE CHECKED BEFORE STARTING THIS MED! (CBC, liver function, electrolyte panel) also EKG -*if on this med, blood must be taken regularly to avoid toxicity (>12mcg/mL) -SE: dry mouth, constipation, urinary retention, blurred vision, *orthostatic hypotension, *Steven Johnsons, sedation, ataxia p.56

stressors

any psych or phys stim that evokes a stress response in an organism; can be acute or chronic; can be external or internal p.157

nature vs nurture

asserts that most psych disorders result from a combo of genetic vulnerability and negative environmental stressors p.6

stereotyping

belief that every member of a group are "all the same" p.86

stigma

belief that the overall person with mental illness is flawed characterized by soc shunning, disgrace and shame -brought upon by misconception that mentala nd physical illness are seperate implying psych disorders are "all in the head" and under personal control and indistinguishable from engaging in bad behavior p.6

Herbals Kava Ginko biloba and warfarin

believed to be safer b/c natural or fewer side effects than traditional costly meds many have been found to be non therapeutic and even deadly if taken for long periods of time or in combo w/ chem substances ___ can INC risk for hepatotoxicity ___ and ___ put pt at risk for bleeding p.60

phenomenon of concern for the PMH nurse

box 1.3 p.12 -promote optimal mental and phys health and wellbeing -prevent mental and behavior distress and illness -promote soc inclusion for mental and behavior fragile ppl -co-occurring mental health and substance use disorder -co-occuring mental and phys disorders -alterations in thinking, percieving, communicating, and function r/t psych and phys disease -psych and phys distress resulting from phys, interpersonal, environmental trauma and/or neglect -complex clinical presentation confounded by poverty and poor, inconsistent, toxic environmental factors -psychogenesis and individual vulnerability -alterations in self concept r/t to loss of phys organs/limbs psychic trauma, developmental conflict, injury -individual, fam, group isolation and difficulty w/ interpersonal relations -self harm and self destructive behaviors like mutilation and suicide -violent behavior like phys, sexual, bullying abuse -low health literacy rates contributing to treatment nonadherence

guided imagery

box 10.3 p.166 relaxation technique to focus on pleasant images to replace negative or stressful feelings; self directed or led by recording or practitioner

Members of the interprofessional team

box 4.3 p.71

ANA nursing code of ethics

box 6.1 p.93

medical conditions that mimic psych illnesses

box 7.3 p.113

patricia benner

caring is foundation for nursing; emphasized caring/comfort interventions, importance of nurse-pt relationship, teaching/coaching and bear witness to their suffering through the illness p.23 table 2.2

behavioral therapy

claims that maladaptive behaviors can be changed w/o identifying the underlying cause effective in phobias, alcoholism, schizophrenia, etc. 4 types: modeling, operant conditioning, systematic desensitization, and aversion therapy p.23-24

cholinesterase inhibitors

class of drugs for alzheimers which slows the rate of memory loss and improves memory by inactivating enzyme that breaks down ACH, cholinesterase, leading to less destruction of ACH= higher amount left in synapse. ex: Tacrine (*hepatic toxicity), Donepezil, Galantamine, Rivastigmine p.59

magnification or minimization

cognitive disstortion that exaggerate importance of something (personal fails or success of others) or reducing the importance of something (personal success or failures of others) ex: im alone on a sat. night because i have no friends. when others are alone they choose to be. p.27 table 2.3

b. fortune telling error

cognitive distortion form of jumping to conclusions that anticipates that things will turn out badly as an established fact. ex: ill ask her out but i know itll be aweful

a. mind reading

cognitive distortion form of jumping to conclusions where you infer negative thoughts, responses, and motives of others. ex: youre giving a presentation and someone in the audience is sleeping so you think "he must think im boring" p.27 table 2.3

personalization

cognitive distortion that assumes responsibility for an external event that was outside personal control ex: im sorry the hogs lost hunny. its probably b/c i was here. p.27 table 2.3

mental filter

cognitive distortion that focuses on a negative detail or bad event and allow it to taint everything else ex: you get a performance review and get 5stars across the board and get a 3-4 in management. you become obsessed with the area/comments on your improvement and ignore the rest p. 27 table 2.3

disqualifying the positive

cognitive distortion that maintain a negative view by rejecting info that supports a positive view as being irrelevant, inaccurate, or accidental ex: i just got the job. there must have been no other applicants. p.27 table 2.3

should and must statements

cognitive distortion that's rigid self directives that presume and unrealistic amount of control over external events ex: i believe that my DM pt's CBG is high today b/c im a bad nurse and my pt should be better p.27 table 2.3

labeling

cognitive distortion where a form of generalization where a characteristic/ event becomes definitive and results in an overly harsh labeling of oneself or others ex: i failed the exam so im a failure and i might as well drop out and turn in that mcdonalds application p.27 table 2.3

a. catastrophizing

cognitive distortion where extreme form of magnification where the very worst outcome is the most probable outcome ex: if i dont make the best impression on the boss at the company picnic ill get fired p.27 table 2.3

emotional reasoning

cognitive distortions that draw conclusions based on emotions ex: since im nervous about the test i must not be as prepared as i thought p.27 table 2.3

jumping to conclusions

cognitive distortions that make negative interpretation despite the fact that there is little to no supporting evidence ex: your boo doesnt answer the phone when youve called 5x so he must not love you anymore and is obviously down the street with his side chick and now you gotta shoot em p.27 table 2.3

sister callista roy

cont. adapt phys, psych and soc; assist pts to adapt to cope more effectively w/ change p.23 table 2.2

Cerebellum

coordinates contraction for movements to be accomplished in a smooth directed manner; balance and equilibrium maintenance p.42

cognitive-behavioral therapy

created by Aaron Beck; treat depression, anxiety, phobias, and pain -based on principle that feelings and behaviors are largely determined by the way ppl think about the world and their place in it -cognition based on attitudes/assumptions developed from previous experiences which may be accurate or distorted -ppl have schemas or unique assumptions about themselves, others and the world in general; negative schemas are incompetence, abandonment, evilness, and vulnerability which ppl are not gen. aware of -automatic thoughts/cognitive distortions are rapid unthinking responses based in schemas, intense and frequent w/ depression and anxiety; typically leads to false assumptions and misinterpretations p.25-26

rational -emotive therapy

created by Albert Ellis; remove core irrational beliefs by helping ppl recognize thoughts that are not accurate, sensible, useful and tend to take the form of "shoulds" "oughts" and "musts" -negative thinking is a ABC process: activate event, beliefs about said event, emotional consequence -perception influences all thoughts thus influencing behavior -focus on present attitudes, painful feelings, and dysfunctional behaviors; cannot change the past but we can change now -if beliefs are negative and self deprecating= depression and anxiety p.25

operant conditioning

created by BF skinner; method of learning through rewards and punishment for voluntary behavior; most famous experiment is the Skinner Box -reinforcement causes behavior to happen more frequently; positive (adding something; when hungry rat pressed the lever he got food) and negative (removing something; another rat would get shocked unless he pressed the lever to turn the charge off so he went straight for the lever) to cause behavior more frequently -punishment causes behaviors to occur less frequently, like an unpleasant consequence (driving too fast =speeding ticket which will DEC chances that speeding will occur) -extinction is the absence of reinforcement that DEC behavior by w/holding a reward that has become habitual (you tell a joke but no one laughs you're less likely to tell jokes again) p.23

interpersonal theory

created by Harry Sullivan; belief that humans are driven by need for interaction -loneliness is most painful condition -emphasized early parenteral relationships or significant other (term he coined) is crucial for personality development -purpose of all behavior is to to get needs met through interpersonal interactions reducing/avoiding anxiety -defined anxiety as any painful feeling arising from soc insecurities or prevent bio needs from being satisfied coined the term security operations describing measures to reduce anxiety and INC security; all of these measures used collectively makes up the self system -goal of therapy:DEC or eliminate psych S&S (*especially depression) by improving interpersonal functioning and satisfaction w/ soc relationships; proven successful w/ depression -other issues that respond well to this therapy is grief and loss (bereavement of death, divorce, other), interpersonal disputes (conflicts w/ significant others), role transition (prob change in life status, soc role, vocational role) p.21-22

classical conditioning

created by Ivan Pavlov; found that a neutral stimulus (a bell) was repeatedly paired w/ another stimulus (food that triggered salivation), eventually the sound of the bell alone would elicit salivation in dogs -important to know that these responses are involuntary and not under conscious control or spontaneous choice p.22

behaviorism

created by John B. Watson; believed personality traits and responses (adaptive and maladaptive) are soc learned through classical conditioning -terrible experiment Little Albert: made a loud noise behind a 9mo old everytime he reached for a white rat. soon anytime he saw the white rat w/o the noise he'd cry -concluded that controlling environment could mold behavior and that anyone could be trained to be anything p.23

(NIC) Nursing Interventions Classification

defines a nursing intervention as any treatment that a nurse performs to enhance pt outcomes like direct/indirect care through a series of nursing activities 7 domains: basic phys, complex phys, *behavioral (communication, coping and edu), *safety (crisis and risk management), fam, health system, and community p.12

Psychiatric-Mental Health Nursing: Scope and Standards of Practice

defines specific activities of the PMH nurse. p.12 defines PMH nursing as promoting mental health through the assessment, diagnosis, and treatment of human responses to mental health problems and psych disorders

cultural filters

developed through the process of socialization; through which we listen to the world around us -cultural bias/prejudice that determines what we pay attention to and what we ignore -provide structure for our lives and help us interpret and interact with the world p.148

some origins of mental dysfunction

drugs (LSD, high lvls of prednisone, excess thyroxine and cortisol) infection (encephalitis, AIDS) physical trauma p.45

(NAMI) Nat'l Alliance on Mental Illness

established 1979 pts with mental illness and fam nationwide advocacy group -resisted treatment by doctors w/o pt input and demanded more sayso in their care (demoralizing and implied pts couldn't make their own decisions) -promoted concept of recovery p.6-7

confidentiality

ethical responsibility to prohibit disclosure of privileged info w/o pt's consent p.98

MAIOs

ex: phenelzine, isocarboxazide, selegiline,tranylcypromine, paroxetine (inhibits serotonin reuptake = dangerous lvls left available) antidepressants that have a desired effect in the brain while exerting potential dangerous SEs elsewhere -*AVOID TYRAMINE FOODS>AGED CHEESE, PICKLED/SMOKED FISH, WINE; if not it will accumulate and lead to VASOCONSTRICTION=HTN CRISIS! -*toxicity -avoid any drug that amplifies serotonin or norep (antidepressant and amphetamines)= HTN CRISIS due to accumulation of these neurotransmitters -NO oral decongestants -*pts must be given a list of foods and drugs to avoid p.54-55

cultural syndromes

exist when clusters of S&S occur in specific groups and are recognized by these groups as a known pattern of experience p.83

mental health

first, overrall health is not possible without ? p.2

anxiety

freud believed ___ is an inevitable part of living; it can produce pain and INC tension or produce pleasure and DEC tension p.20

neurons

functions by: respond to stimuli, conduct electrical impulses, release neurotransmitters communicate between eachother using Na and K which are unequal at rest (neg charged internally mostly w/ K while Na on outside) -w/ an impulse, Na channels open and goes in while K goes out and reverses charge from neg to positive inside p.40

Quality and Safety Edu for Nurses (QSEN)

funded by the Robert Wood Johnson Foundation; developed a structure to support the edu of future nurses who possess the knowledge, skill, and attitude to cont. improve safety and quality of healthcare; areas of helathcare promoted: 1: pt centered care- care given in respectful and responsive atmosphere guided by pt's values preferences and needs 2: teamwork and collab- interprofessional team keep open communication, respect and shared decision making 3: evidence based practice- optimal healthcare is resulted from using most current evidence while including pt/fam values/preferences 4: quality improvement- nurses monitor outcomes of care they give; should also be care designers and test changes to result in quality improvement 5: safety- care does NOT equal injury; harm minimized by system effectiveness and individual performance 6: informatics- infor and tech are used to communicate, manage knowledge, mitigate error, and support decision making p.8

dorethea orem

goal of self care; promoting self care activities of pt; especially relevant in the seriously/persistently mentally ill pts p.23 table 2.2

Short Acting hypnotic sleep agents

have sedative effects w/o the anxiety, anticonvulsant, or muscle relaxant effects of benzos -selective for GABA -amnesia and ataxia are common side effects w/ faster onset action than most benzos -teach to take when ready to go to sleep and about the quick onset time ex: *zolpidem, zaleplon, and eszopiclone (has longest duration of action 7-8hr w/ unique SE of bitter taste upon wakening) -tolerance and dependence less than benzos p.50

Serotonin Modulator and Stim (Vortioxetine)

inhibits serotonin reuptake like SSRIs represents by one drug ____; may cause old ppl to have improved cognitive deficits independent of its antidepressant properties -SE: constipation, N/V, *hyponatremia, *hypomania/mania p.53

outpt/community health settings

intermittent supervision, independent living environment w/ self care and safety risks outcomes are to stabilize lvl of functioning in community interventions: -long term therapeutic relationship -plan of care w/ pt and support system w/ attention to sociocultural needs and maintenance of community living -adhere to med regimen -teach/support adequate nutr and self care -assist pt in self assessment -positive soc activities -communicate w/ pt and fam/support system to assess improve lvl of function p.65

1st U.S. Department of Health and Human Services' report on mental health (HHS)

landmark document w/ extensive review of scientific lit in consultation w/ mental health providers and consumers reporting (1)mental health is fundamental to overall health, and (2)there are effective treatments. p.7

Germ theory

late 1800s explanation for mental illness as with other illnesses- that a specific agent in the environment caused them; abandoned quickly b/c lack of evidence p.6

acculturation

learning beliefs, values and practices of their new cultural setting p.85

amygdala and hippocampus

learning, memory, basic drives -*anxiety is derived here due to intense fear causing panic disorder p. 43

informal admission

least restrictive admission; no formal application -pt doesnt pose a substantial threat to self or others -normal pt-caregiver relationship exists -pt free to leave or stay even AMA p.93

informed consent

legal term meaning pt has been provided basic info regarding risks, benefits, and alternatives of treatment: 1. nature of prob 2. nature and purpose of treatment 3. risks and benefits of treatment 4.alternative treatments 5. risk of not consenting 6.proposed success to treatement -pt must volunteer for the treatment -physicians job to get this; RN can witness p.96

(MRI) Magnetic resonance imaging

magnetic field applied to the brain where the nuclei of hydrogen atoms absorb and emit radio waves analyzed by computer providing 3D visualization of the brain's structure in sectional images used to detect brain edema, ischemia, infection, neoplasms, and trauma (*uses are the same as fMRI) -structural image technique -enlarged ventricles, DEC temporal lobe and prefrontal lobe (*findings same as MRI) p. 45 table 3.2

least restrictive alternative doctrine

mandates that the caregivers must take the least drastic actions to achieve a specific purpose p.94

Functional magnetic resonance imaging (fMRI)

measures brain activity indirectly by changes in blood O2 in different parts of the brain as subjects participate in various activities used to detect brain edema, ischemia, infection, neoplasms, and trauma (*uses are same as MRI) -enlarged ventricles, DEC temporal lobe and prefrontal lobe (*findings same as MRI) p.45 table 3.2

diathesis stress model

most acceptable explanation for mental illness; diathesis represents bio predisposistion and stress represents environemental stress or trauma p.6

brainstem limbic system midbrain pons medulla oblongata

most primitive part of the brain and control survival functions like HR, breathing, digestion and sleep ___ major role in emotion and psych function using norep, serotonin, and dopamine as their neurotransmitters ___ pupillary reflex and eye move ___ auditory ___ reflex center that controls balance, HR, Resp, cough, swallow, sneezing, BP, vomit p.40, 43 figure 3.4

hypothalamic-pituitary-adrenal axis

name for the relationship between the brain, pituitary gland, and adrenal glands is particularly important in norm and abnormal mental functions in these steps: 1.hypothalamus release corticotropin-releasing hormones (CRH) 2.CRH stimulates pituitary release adrenocorticotropic hormone 3. Adrenocorticotropin stimulates cortex of each adrenal gland to secrete cortisol -part of a norm response to mental/phys stressors -all 3 hormones influence functions of the nerve cells of the brain p.38-39

neurotransmitter

neuromessenger released from axon terminal at the presynaptic neuron on excitation p.40

tricyclic antidepressants

no longer considered first-line drugs for depression b/c they have more SEs, take longer to reach therapeutic dose, and more lethal w/ overdose -acts by blocking norep from coming into contact w/ degrading enzyme MAO INC lvl of norep in synapse; do the same for serotonin -SE: *anticholinergic effects (blurred vision, dry mouth, tachycardia, urinary retention, constipation), drowsy and sleepy (block H1) =NONCOMPLIANCE -overdose fatal via excess sodium channel blockade =cardiac conduction distrubances ex: nortriptyline, amitriptyline, imipramine p.53-54

joyce travelbee

nurse-pt relationship and importance of communication; affirm suffering and alleviate it w/ communication p.23 table 2.2

cultural competence

nurses adjust their practice to meet their pt's cultural beliefs, practices, needs, and preferences *to meet this, nurses have to meet 5 criteria: -cultural awareness -cultural knowledge -cultural encounters -cultural skills -cultural desire p.85-87

duty to warn

obligation to warn 3rd parties when they may be in danger from the pt; therapists have the duty to protect when the pt presents a serious danger of violence to another; if a pt makes these comments, it must be relayed to other parts of the healthcare team and they must do whatever necessary to protect the 3rd party p.98-99

Worldviews NONverbal communication patterns norms of etiquette cultural belief and value system cultural beliefs and values about health and illness

p. 80 table 5.2 p.81 table 5.3 p.81 box 5.1 p.82 table 5.4 p.82 table 5.5

clinical epidemiology

p.10 broad field examining health and illness at the population lvl using basic epidemiology methods conducted in groups usually defined by illness or S&S or by diagnostic procedure or treatment given for the illness or S&S; includes: - natural hx of illness: what happens if no treatment and prob runs its course - dx tests - observational and experimental studies of interventions used to treat ppl with the illness or S&S

incidence

p.10 conveys info about the risk of contracting a disease; refers to the number of new cases of mental disorders in a healthy population w/in a given time frame (usually annually). *short duration diseases usually have a high number of ____ (many new cases in a given yr) and a low prevalence (not many ppl suffering from it at any given time)

prevalence

p.10 describes the total number of cases new and existing in a given population during a specific period of time regardless of when they became ill *chronic diseases usually have low incidences (ppl drop off of the newly dx list within the yr) and high ___ (multiple ppl suffering from it at a time).

comorbid condition

p.10 presence of 2 or more disorders simultaneously.

untintentional torts negligence malpractice

p.100 unintentional acts against someone resulting in harm/injury ex: negligence, malpractice ____ is the most common type; fail to use ordinary care in any professional or personal situation when having a duty to do so (not questioning a physician's order, not protect pt from harm, not providing pt teaching) ____ special type of negligence; 1.duty,2. breach of duty, 3. cause in fact, 4. proximate cause, 5. damages

common liability issues

p.101 table 6.3

abandonment

p.103 occurs if a nurse doent deliver a pt safely to another HCP before discont. care; nurse doent provide accurate, timely, thorough reporting or when follow-through pf pt care has not occurred; also applies to PMH RNs in home health setting (ex: pt saying theyre suicidal but wont go to hospital you must do what you have to to protect the pt which may be calling police)

nursing assessment model

p.109 figure 7.1

QSEN competencies

p.110 box 7.1 1. pt centered care- pt is source of control/partner in providing compassionate/coordinated care based on respect for pt's values, beliefs, and needs 2. quality improvements- monitor outcomes of care processes and use improvement methods to design and test changes to cont. improve quality and safety 3. safety- minimize risk of harm 4. informatics- use info and tech to communicate, manage knowledge, mitigate error, and support decisions 5. teamwork and collab- function effectively w/in interprofessional team, open communication, mutual respect, shared decision making to achieve quality pt care 6. EBP- use best current evidence w/ clinical expertise and pt/fam preferences

hypothyroidism hyperthyroidism abnorm liver enzymes and chronic renal disease

p.112 _____ =depression _____ =manic phase of bipolar _____ =irritability, depression, lethargy

standard of practice for PMH RN standard 5 implementation standard 5a coordination of care standard 5b teaching and promo standard 5c consultation standard 5d prescriptive authority and administration standard 5e pharm bio and integrative therapy standard 5f milieu environment standard 5g therapeutic relationship and counseling standard 5h psychotherapy

p.118-119 ____ occurs when RN implements the identified plan ____ occurs when Rn coordinates care delivery ____ occurs when RN employs strategies to promo health and safe environment (coping skills, self care activities, prob solving skills, relapse prevention, conflict management, interprofessional relationships, identifying resources in community) ____ occurs when advanced practice RN provides consultation to influence the identified plan, enhancing ability of other clinicians to promote services for healthcare consumers and effect change ____ occurs when advanced practice RN uses prescriptive authority, procedures, referrals, treatments, and therapies in accordance and state and fed law regulations ____ occurs when RN incorporates knowledge of pharm, bio and complementary interventions w/ applied clinical skills to restore pt health and prevent further disabling ____ occurs when RN provides, structures and maintains a safe, therapeutic, recovery oriented environment in collab w/ healthcare team ____ occurs when RN uses therapeutic relationship and couseling to assist pts in recovery by improving and gaining their previous coping abilities, fostering mental health and preventing mental disorder and disability ____ occurs when advanced practice RN conducts individual, couples, group and fam psychotherapy using EBP and RN-pt therapeutic relationships

(NOC) Nursing outcomes classifications

p.12 comprehensive source for standardized outcomes and definitions of these outcomes via a Likert scale 1 (extremely limited, never demonstrated)-5 (not compromised, consistently demonstrated) 7 domains: functional, phys, psychosoc, health knowledge and behavioral, percieved health, family health, community health 4 classes: psych wellbeing, psychosoc adaption, self control, soc interaction

legal considerations for charting

p.120 box 7.6

narrative vs prob oriented charting

p.120 table 7.4

core concepts of pt and fam centered care

p.125 dignity and respect info share pt and fam participation collab in policy and program development

therapeutic nurse-pt relationship

p.125 facilitate communication of distressing thoughts assist pts w/ prob solving to help w/ ADLs help pts eval self defeating behaviors and test alteranatives promote self care and independence promote edu about meds and s&s management promote recovery

nurse-pt relationship

p.125 the ____ is the basis for all PMH nursing treatment approaches regardless of specific goals

therapeutic relationship

p.126 relationship where the nurse maximizes communication skills, understanding of human behaviors, and personal strengths to enhance pt's growth by: -identify pt need and explore them -establish clear boundaries -establish alternate prob solving approaches -help pt establish new coping skills -support behavioral changes

Milieu therapy

p.13 provide, structure, maintain safe therapeutic environment in collab w/ pts, fam, and other healthcare clinicians

future issues for PMH nurses

p.13-14 -edu: need more skilled nurses to care for more acutely ill pts and be ready to discharge pts not exactly "ready" b/c insurance only covers about 3 days. edu for student nurses limited b/c acute care and limited outpt, rotations in gen med centers difficult -aging population: Alzheimers and dementia increase. healthier aging need more home service, retirement communities, and assisted living facilities -cultural diversity: need cultural competent INC; adjust their practice to meet their pt's cultural beliefs, practices, needs, and preferences -science, tech, and electronic healthcare: ethical/legal implications to new tech (regulations on gene testing? who should be allowed to access info? would you want to know if you were at risk for schizophrenia?), telepsychiatry (reach underserved populations or those homebound), websites for MH edu/screening/support, helplines/hotlines

factors that promote pt growth

p.133-134 genuineness- open, honest, authentic interactions empathy-being in the pt's shoes; NOT SYMPATHY positive regard- respect through attitude(willing to work w/ pt) and actions(attending/active listening, suspending value judgements of their own and focusing on the pts)

communication process

p.138-139 figure 9.1 1. stim- person feels need to communicate for info, comfort, advice 2. sender- person send message initiates interpersonal contact 3. message- otherwise known as the info thats sent or expressed to another 4. channel- auditory, visual, tactile, olfactory, or a combo of these 5. reciever- persons recieves and interprets message then responds w/ feedback -feedback verifies that the message that was conveyed was understood correctly "is that what you meant?" or clarifying nonverbal "i noticed you turn away when talking about him. is there s conflict there?" -2 main principles that must be in place are continuity and clarity

factors that affect communication

p.140 personal factors- affect transition or interpretation, language barriers, gender-related beliefs, environmental factors- background noise, lack of privacy, uncomfortable accomodations relationship factors- nurse-pt relationships are complementary b/c there is inequality in roles

double blind messages

p.141 characterized by 2+ mutually contradictory statements given by a person in power. ex: i want to go out with my friends and mom is home alone and she says "yeah go ahead and have fun with your friends.. ill just die alone but you have fun" -i'm stuck in a lose-lose situation cause if i go now i wont have fun and if i stay mom will say "well i said have fun!"

questions open ended questions closed ended questions projective questions miracle questions

p.143 ____ encourage pts to share info about experiences, perceptions, or responses to a situation; help to elicit info; useful in beginning an interview or when a pt is guarded or resistant or establishing rapport ____ used to elicit specific needed info; yes or no questions; most useful in initial interview or interview to obtain results ____ "what ifs"; help pt articulate, explore, and identify thoughts and feelings; strong in helping pt's thinking about probs differently and identify priorities; help imagine thoughts, feelings, and behaviors they might have in certain situations ____ goal setting questions that help pts to see what the future would look like if a particular prob were to vanish; ask these to identify goals the pt would be willing to pursue

touch across cultures

p.148 hispanic, french, italian-love phys contact russian-touch is an improtant part of nonverbal communication used freely w/ close friends chinese-dont like strangers touch german, swedish, british- only a handshake at beginnign and end

counterproductive tactics to avoid

p.150

guidelines for conducting initial interview

p.150 speak softly when you dont know what to say, say nothing. when in doubt focus on feelings avoid advice avoid relying on questions pay attention to nonverbal cues keep focus on the pt

fight or flight

p.158 body's way of preparing for a situation an individual percieves a threat to survival= INC HR, BP, resp, and CO

reactions to acute/chronic stress effects of stress on the body effective stress busters stress and anxiety operationally defined deep breathing exercises cognitive reframing of irrational thoughts

p.160 table 10.1 p.161 figure 10.4 p.163 box 10.1 figure 10.5 p.162 p.165 box 10.2 p.168 table 10.4

coping styles

p.164 1. health sustaining habits - med compliance, proper diet, relax, pacing one's energy 2. life satisfaction - work, fam, hobbies, humor, spiritual, arts, nature 3. soc support 4. effective and healthy responses to stress

biofeedback

p.164-165 relaxation technique that provides immediate and exact info regarding muscle activity, brain waves, skin temp, HR, BP and other bodily functions

deep breathing

p.165 box 10.2 relaxation technique that focuses on taking slow, deep, even breathes

meditation

p.166 relaxation technique that follows the basic guidelines described for the relaxation response by creating a hypometabolic state of quieting SNS -trains the mind to develop greater calm and then using that calm to bring pentrative insight into one's experinces -help to tap into their inner resources for healing and calm their minds and help operate more efficiently in the world -help develop coping strategies, make sensible adaptations under stress, feel more engaged at life

progressive relaxation

p.166 relaxation technique where muscle contraction r/t anxiety is eliminated in an attempt to get rid of the overall anxiety

other ways to relax

p.167-168 phys exercise- protect from harmful effects of stress; DEC depression S&S (yoga> helpful for depression in conjunction w/ meds, tai chi, walking, dancing, cycling, aerobics, water exercise) cognitive reframing- change perception of stress by reassessing a situation and replacing irrational beliefs; goal is to give pt a sense of control over the situation (table 10.4) journaling- extremely useful and surprising way to identify stressors; ease worry and obsession, help identify hopes and fears, INC energy lvls and confidence, facilitate grieving process humor

transference countertransference

p.20 ___ unconscious feeling the PT HAS TOWARD THE HEALTHCARE WORKER that were originally felt in childhood for a significant other; can be positive (affectionate) or negative (hostile) response; encouraged by psychoanalysts to understand original relationships (ex: you remind me exactly of my sister) ___ unconscious feelings the HEALTHCARE WORKER HAS TOWARD THE PT; strong feelings toward the pt is a red flag (if they remind you of someone you dont like then you may react to them as if they were that person

psychodynamic theory

p.20 follows psychoanalytic model using free asso., dream analysis, transference, and countertransferance w/ INC involvement and interaction w/ the pt more freely than traditional. -oriented to here and now; doesnt look at the past -lasts longer than typical; like 20 sessions that insurance wont cover -best candidates are relatively healthy and well functioning who have a clear area of difficulty/intelligence, psych minded, and well motivated for change -at start of therapy the focus area is agreed upon -meet weekly; rapis back and forth between pt and therapist; therapist constantly interjects to stay on topic

defense mechanisms

p.20 wards off anxiety by preventing conscious awareness of threatening feelings; they all operate UNCONSCIOUSLY (except suppression) and they deny, falsify, or distort reality to such a degree that we experience difficulty w/ healthy adjustments and personal growth

Anticonvulsants

p.55 ex: Valproate, carbamazepine, lamotrigine useful in treating bipolar while anticonvulsant properties derive from alterations in electrical conductivity in membranes; act on GLUTAMATE antagonist and GABA agonist

Lithium

p.55 mood stabilizer for bipolar disorder; DEC excitatory GLUTAMATE exerting antimanic effects and stabilizes excitatory effects of the neurons of the brain by interacting w/ sodium-potassium pump -*influence on electrical conductivity = adverse effects and toxicity (*especially CARDIAC-sinus bradycardia and arrhythmias) -*extreme cerebral conductivity=convulsions -*extreme nerve and muscle conduction = tremors and extreme motor dysfunction -SE: polyuria, polydipsia, edema, hypothyroidism and goiter(depression), hyponatremia, ataxia, confusion, N/V/D, -*has low therapeutic index- ratio of lethal dose to effective dose and is a measure of overall drug safety in regard to possibility of overdose or toxicity; lvls must be monitored on a regular basis

Iloperidone

p.58 2nd generation antipsychotic -SE: *orthostatic hypotension that must be titrated for 1st couple of days to reduce, *QT w/o arrhythmia or death

Asenapine

p.58 2nd generation antipsychotic administered *SUBLINGUAL avoiding hepatic metabolism -avoid food/water for 10 min after admin -SE: orthostatic hypotension, sedation

Lurasidone

p.58 2nd generation antipsychotic that *must be taken w/ atleast 350 cal for absorption

chlorpromazine (Thorazine)

p.6 and David's drug guide antiemetic and antipsychotic given PO, IV, or IM alters affects of dopamine in CNS -SE: Neuroleptic malignant syndrome, agranulocytosis, extrapyramidal reaction, tardive dyskinesia -S&S to watch for: low HCT/HGB/leukocyte/granulocyte/platelets, high bilirubin/AST/ALT/alkaline phosphate -Admin: pt recumbent for atleast 30min following admin to prevent hypotension (IV), hiccups (PO), inject in well developed muscle (IM), DONT take within 2hr of antidiarrheal or antacid -teach: abrupt withdrawal may lead to GI distress/ NV/ dizzy/ headache/ tachycardia/insomnia, change position slowly, no driving, no alcohol or CNS depressants, drug impairs body temp regulation so wear sunscreen and longsleeves and avoid extreme temps, rinse mouth constant/oral hygiene/ sugarless candy gum for dry mouth, urine will turn pink to red-brown, call dr if sore throat/fever/unusual bleeding/bruising/ rash/weak/ tremors/visual distrubances/ dark colored urine/ clay stools

recovery

p.6-7, 69 represents concept that everyone, even those with the most severe illnesses like schizophrenia can recover; process of change through where individuals improve their health and wellness, live a self directed life, and strive to reach their full potential with focus on the pt and what they can do.

secondary prevention

p.68 lvl of prevention that aims at DEC prevalence of psych disorders w/ early identification of probs, screenings, and prompt effective treatment -doesnt stop disorder from beginning; delays it or averts progression

tertiary prevention

p.68 lvl of prevention that is the treatment of the disease w/ focus of preventing the progression to severe/disabiling or death -rehab that aims to preserve/restore functional ability

primary prevention

p.68 lvl of prevention that occurs BEFORE any prob takes place and seeks to DEC incidences or rate of new cases -prevent or delay onset of S&S in genetically/predisposed individuals -teaching coping strategies and giving psychosoc support

state hospital

p.69 treatment setting w/ role of treating the most seriously ill pts

cultural norms

p.78 attitudes and behaviors considered normal, typical, or average w/in a group

race

p.78 can be defined biologically, anthropologically, or genetically

culture

p.78 shared beliefs, values, and practices that guide a group's members in patterned way of thinking and acting -*guide pt care practices

worldview

p.78 system for thinking about how the world works and how ppl should act; from this they develop beliefs, values, and practices that guide members how to think and act in different situations

ethnocentrism

p.81 universal tendency for ppl to think that their way of thinking and behaving is the only correct and natural way

cultural explanations

p.83 explanations of symptoms, illness or distress understood w/in the context of a particular culture

cultural idioms of distress

p.83 specific ways of expressing distress that ppl in particular cultures understand

cultural concepts of distress

p.83 take into account the way that groups experience, understand, and communicate problematic behaviors, suffering, or troubling emotions and thoughts

assimilation

p.85 adaptation to new culture quickly; absorbing of new worldviews, beliefs, values, and practices rapidly til they are more natural than the ones they learned in their homeland -children tend to do this quickly while elders maintain their traditional beliefs setting the stage for intergenerational conflict which make some kids feel lost between the 2 cultures and confused about their cultural identity

immigrants, refugees, and cultural minorities

p.85 populations at risk for mental illness and inadequate care

ethical dilemma

p.92 results when there is a conflict between 2 or more courses of action each carrying favorable and unfavorable consequences

ethics

p.92 study of philisophical beliefs about whats right/wrong in society

parity

p.93 fed legislation providing equality for the mentally ill w/ other pts in terms of payments for services from health insurance plans that improves access to treatment

voluntary admission

p.93 pts apply in writing for admission to the facility -pt understands they need treatment and be willing to be admitted -if minor, legal guardian can do it -if 16-18, they can seek help themselves -have right to request and obtain release

involuntary commitment

p.93-94 assisted inpt psych treatment, court ordered admission w/o pt consent by looking at these: 1. mentally illness 2.danger to self or others 3. gravely disabled 4. need treatment but mental illness prevents them from seeking it -pts have right to counsel and go before a judge who may order their release -if not released after this, they can be held for up to 72hrs (varies state to state)

assisted outpt treatment

p.94 court ordered outpt treatment; involuntary outpt commitment

emergency commitment

p.94 temp admission or emergency hospitalization used for: 1. confused pts who cant make own decisions 2. pts so ill they need emergency treatment -purpose is to observe, dx, and treat those w/ mental illness and pose danger to self/others -range from 24-96hr hold then court is held to determine discharge, voluntary admission, or involuntary commitment

conditional release

p.95 requires outpt treatment for specified period to determine if pt follows med regimen, can meet basic needs, and able to reintegrate into community

unconditional release

p.95 termination of pt-institution relationship; court ordered or administratively ordered release by institutional offiials

implied consent

p.96 ex: you approach pt w/ meds and pt shows willingness to take the med

capacity compentency

p.96-97 ____ is a pts ability to make informed decisions ____ is a legal term r/t to degree of mental soundness a person has to make decisions or to carry out specific acts; pts are considered this until proven otherwise; if determined to not be this they must be appointed a legal guardian (1.spouse, 2.adult child/grandchild, 3.parents, 4. adult siblings, 5. adult nieces/nephews, 6. court appointed volunteer guardian

HIPAA

p.98 legally protects pt's right to recieve treatment and have med records kept confidential

tort law

p.99 when a person wrongfully harms another and the injured person seeks money for damages from responsible party; injury can be to person, property or reputation

intentional torts assault battery false imprisonment invasion of privacy defamation of character

p.99-100 ex: assault, battery, false imprisonment, invasion of privacy, defamation of character willful or intentional acts that violate another person's rights or property ____ is intentional threat designed to make someone fearful that you will cause them harm (ex: threats, pretending to hit a pt) ____ is the actual harmful/offensive touching of another person (ex: shoving a pt) ____ occurs when a person is confined in limited area (ex:restraint or seclusion) ____ breaking a pt's confidences or taking pics w/o consent ____ takes place when a provider makes a false statement causing some degree of harm usually to pt's reputation (ex: slander or libel)

writ of habeas corpus

petition pts can file if they believe theyre being held w/o just cause; its a formal written order to free the person -hospital must immediately submit this to the court and they must decide from there whether to deny due process of law p.94

Benzodiazepines

potentiate activity of GABA by binding to a specific receptor on the GABA receptor complex ex: diazepam, clonazepam, alprazolam, lorazepam (when given at lower doses they can be w/o sleep inducing properties) -5 apporved for insomnia called hypnotics: flurazepam, temazepam, triazolam, estazolam, and quazapam -DONT combine w/ alcohol, opiates, tricyclic depressants or other CNS depressants -DONT drive or operate machinery -older adults can result in falls and bone fractures -ataxia is a common SE secindary to the abundance of GABA receptors in the cerebellum p.49

continuum of PMH

primary care (least restrictive) specialty care pt-centered med homes community mental health centers psych home care assertive community treatment intensive outpt programs partial hospitalization programs emergency care crisis stabilization/observation unit gen./private hospital state hospital(most acute) p.65

basic lvl RNs

professionals who pass nursing program and state licensure exam and qualified to work in most gen or specialty area. p.13

behaviorist theory

protested freud's theory that you just are who you are from birth/childhood -no concerns w/ inner conflicts but personality is learned -when behavior changes so does personality through conditioning where you pair a certain behavior with a condition that reinforces or diminishes the behavior's occurrence p. 22

somatization

psych distress is seen as phys probs; typically seen in cultures where there's high stigma asso w/ mental disorders or mind-body is considered one ex: describe feelings of back pain, fatigue, dizzy but says nothing about her sadness and hopelessness p.83

specialized psych care providers

psychiatrist, PMH advanced practice RN (nurse practitioner, clinical nurse specialist), psychologist, soc worker, counselor, other licensed therapist p.65

Nat'l pt safety goals in behavioral health

pt identification- atleast 2 idenfiers use meds safely- maintain and communicate med info for individual served prevent infection- wash hands according to the WHO or CDC guidelines identify pt safety risks- determine which pts most likely to commit suicide p.72

right to refuse treatement

pts may w/hold or w/draw consent at any time even when theyre on involuntary commitment -pts can also retract consent previously given -in terms of immenent threat to self/others pts can be medicated w/o court hearing -after court hearing a person can m=be medicated if: 1. seriously ill 2. function deterioration and exhibiting dangerous behavior 3. benefit of treatment outweigh harm 4. pt ccant make reasoned decisions themselves 5.least restrictive services dont work p.95-96

DSM-5

published by the APA describing criteria for 157 disorders. Categories: neurodevelopmental, schizophrenia, bipolar, depression, anxiety, OCD, trauma and stressor related, dissociative, somatic S&S, feeding and eating, elimination, sleep-wake, sexual, gender dysphoria, disruptive/impulse/conduct, substance/addictions, neurocognitive, personality, paraphilic, other. -keep in mind that the ___ classifies DISORDERS NOT the INDIVIDUAL so its a patient with schizophrenia NOT a schizophrenic - this and the ICD-10-CM are the 2 major classification systems used in the U.S -better than DSM-4 b/c: First three categories now combined to a single axis. Environmental stressors/concerns addressed by specific codes. World Health Organization Disability Assessment Schedule (WHODAS) now used to measure GAF p.11

epidemiology

quantitative study of distribution of mental disorders in human populations p.10 -helps identify high risk groups and risk factors assoc. w/ illness, onset, duration and reoccurrence

Positron-emission tomogrophy (PET)

radioactive substance (tracer) is injected, travels to the brain, and shows up as bright spots on the scan; data is collected by detectors are relayed to a computer which produces images of the activity and 3D visualization of the CNS used for detecting O2 utilization, glucose metabolism, blood flow, neurotransmitter receptor interaction -functional image technique -schizophrenia, INC D2 and D3 receptors in caudate nucleus, abnorms in limbic system, mood disorders, abnorms in temporal lobes, adult ADHD, DEC utilization of glucose -particularly useful in identifying phys and chem changes as they occur in living tissue -for scanning the brain radioactive atom applied to glucose to create nucleotide b/c brain uses glucose for metabolism -in unmedicated schizophrenics, may show DEC use of glucose in frontal lobes b/c thats where reasoning skills take place which is greatly impaired in those w/ this schizophrenia -in ppl w/depression, show DEC activity in prefrontal cortex p.45 table 3.2

health

the WHO describes _____ as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity". p.2

attributes to mental health

rational thinking effective coping resilience self control self awareness developmentally on task spiritual satisfaction happiness and joy self care positive self concept learning and productivity effective communication meaningful relationships p.3 figure 1.1

Electroencephalograph (EEG)

records electrical signals from the brain made by hooking up electrodes to the pt's scalp used to show the state the person is in b/c the characteristics patterns of current differ for each of these states -provides support from a wide range of sources that brain abnorms exist and may lead to further testing p.45 table 3.2

debriefing

refers to a critical conversation and reflection regarding an experience that results in growth and learning p.151

mental illness

refers to psych disorders that have definable diagnoses manifested in significant biologic, developmental, or psych disturbances dysfunctions in mental functioning -in the past was applied to behavior that was strange and different occuring infrequently and deviated from norms which was found to be inadequate suggesting mental health was based on conformity. p.2

basal ganglia

regulate movement p.43

soc relationship

relationship initiated for the purpose of friendship, socialization, enjoyment, or accomplishment of a task and mutual needs are met p.125-126

cerebrum

responsible for conscious perception of external world, our bodies, emotional status, memory, and control of skeletal muscle that allow direction of movement; controls language and communication p.42-43

Sigmund Freud

revolutionized thinking about mental health disorders introducing groundbreaking theory of personality structure, lvls of awareness, anxiety, the role of defense mechanisms, and psychosexual stages; came to believe the vast majority of mental disorders resulted from unresolved issues originating from childhood. p.19

right to treatment

right to quality care by: 1. free from excess/unnecessary meds 2. privacy/ dignity 3. least restrictive environment 4. attorney, clergy and private care providers 5. not to be subjected to lobotomies, electroconvulsive therapy, etc w/o informed consent p.95

(CT) computerized axial tomography

series of xray images of the brain and the computer analysis produces slices providing a precise 3D like reconstruction of each segment used to detect lesions, abrasions, areas of infarct, and aneurysms -structural image technique -schizophrenia, cortical atrophy, 3rd ventricle enlargement, cognitive disorder, abnorms p.45 table 3.2

neurotransmitters in stress

serotonin production becomes too active! -impairs serotonin receptor sites and brain's ability to use serotonin p.159

nonverbal behaviors

table 9.1 p.140 -eyes and mouth hold the biggest clues in how ppl are feeling through emotional decoding -said to be better indicators of feeling than the spoken word -culture may influence (japs and russians hide emotions, americans usually dont) -gender may also play a role (women hide contempt, disgust and anger while men hide surprise and fear)

single photon emission computerized tomography (SPECT)

similar to PET but uses radionuclides that emit y-radiation (photons) that measure various aspects of brain functioning and provides images of multiple layers of CNS (*as does PET) used to detect circulation of CSF O2 utilization, glucose metabolism, blood flow, neurotransmitter receptor interaction (*same as PET) functional image technique -schizophrenia, INC D2 and D3 receptors in caudate nucleus, abnorms in limbic system, mood disorders, abnorms in temporal lobes, adult ADHD, DEC utilization of glucose (*same as PET) p.45 table 3.2

mental health

state of well-being where each individual is able to realize their own potential, cope with norm stresses of life, work productively, and make a contribution to the community. p.2

First Generation Antipsychotics

strong antagonists of the D2 dopamine receptors, muscarinic for ACH, epinephrine, and H1 for histamines; most effective for "Positive/Additive" S&S of schizophrenia like delusions and hallucinations ex: phenothiazine, thioxanthenes, butyrophenones -SE: extrapyramidal syndrome (motor abnorms like dystonia, parkinsons, akathisia, and tardive dyskinesia via dopamine block of basal ganglia), amenorrhea/ galactorrhea/ gynecomastia in both men and women (INC prolactin secretion from anterior pituitary via dopamine block), blurred vision/dry mouth/constipation/urinary hesitancy/ memory (blocking ACH from muscarinic receptors), sedation/ wt gain (blocking H1) p.56-57

bioethics

study of specific ethical questions that arise in healthcare -autonomy> respect pts to make own decisions -beneficience> duty to act to benefit/promote good to others -justice> distribute resources or care equal -fidelity/nonmaleficence> loyalty and commit to pt and do no wrong to them -veracity> honesty p.92

minority status

subset of ppl who think of themselves and are thought of by others as a differentiated group from mainstream by language, religion, race, or nationality -econ and soc disadvantaged p.78

Intensive outpt and partial hospitalization programs

treatment setting function as intermediates for inpt and outpt care -primary difference is amount of time spent w/ the pts -Mon-Fri w/ ___ 1/5 a day -provide structured activities w/ nursing/med supervision, intervention, and treatment -located in gen hospitals, psych hospitals, and part of community mental health p.67

psych home care

treatment setting that is community based -Medicare requires these for reimbursement: homebound (inability to leave home due to phys or mental prob) status, psych dx, need of psych RN, plan of care by physician or advanced practice RN -Medicare gives pt a case worker and an RN (give eval, therapy and teaching; visit pt 1-3x wk p.66

Patient centered med homes

treatment setting that must have: 1. pt centered care- relationship based w/ pt; takes into account unique needs of whole person and pt is core member of team 2. comprehensive care- all lvls of mental and phys care are addressed (preventative, acute and chronic); physicians or advanced practice nurses lead teams of nurses, physician assistants, pharmacists, nutritionists, soc workers, educators,and core coordinators 3. coordination of care- care coordinated w/ broader health system 4. improved access- extended hrs of service and email and home support 5. systems approach- evidence based care w/ cont. feedback loop of eval and quality improvement p.65-66

least restrictive environment

treatment setting that provides the necessary care while allowing the greatest personal freedom p.63

Assertive community treatment

treatment setting that was developed in response to hard to engage community living needs of ppl w/ serious, persistent psych S&S making them unable/unwilling to participate in traditional forms of treatment -work in the pt's home, agencies, hospitals, clinics, or wherever else the pt might find themselves in -creative prob solving and intervention -on call 24hr -composed of PMH RN, soc worker (visit pt 3-5x wk), psychologist, advanced practice RN, and psychiatrist p.66-67

Community Mental health centers

treatment setting thats federally funded; provide free to low cost scale care w/ emergency services, community/homebased services, outpt services -offer meds, individual therapy, pychoeducational and therapy groups, fam therapy, dual dx treatment (mental health and substance abuse), rehab, vocational services, residential services, psych case management p.66

emergency care

treatment setting w/ main objective to provide triage and stabilization w/ 3 different models: 1. comprehensive emergency service model- full service ED in hospital, PMH RN, psych tech, mental health specialist, soc worker, mental health counselor, psychiatrist, triage and stabilization in care plan 2. hospital based consultant model- NO dedicated area or staff unlike #1, PMH staff on call/ on site and add into ED staff, psych clinicians manage emergency psych evals, ED staff hold responsibility for all immediate care needs while clinicians due lvl of care assessment/stabilize/ready for discharge 3. mobile crisis team model- stabilize in the field p.67

crisis stabilization/obs units

treatment setting where care models prioritize stabilization and short length of stay; overnight/short term obs 1-3days for pts w/ S&S that will go away in 72 hrs or less p.69

Personality Structure Id ego superego *in a well adjusted adult, these 3 work together under the administrative leadership of the ego *if the id is too strong the pt is too impulsive *if the superego is too strong the pt may self critique and suffer from inferiority

we are ___ from birth; totally UNCONSCIOUS AND IMPULSIVE and the source of all drives, instincts, reflexes, and needs; cant deal w/ frustration and tries to discharge tension and return to comfy lvl of energy; lacks prob solving and is illogical (ex: hungry screaming infant) Within the first few yrs of life we develop the ___ as we interact with others which resides in the ALL 3 LVLS OF CONSCIOUSNESS and is the problem solver and reality tester as it attempts to navigate the outside world; differentiates subjective experiences, objective reality, and memory images; regulates the UNCONSCIOUS AND IMPULSIVE and says " you cant have what you want right now" and sets a course of action (ex: a hungry man uses this personality structure to devise his plan to go seek food) ___ comes around age 3-5 and is our moral compass also residing in ALL 3 LVLS OF CONSCIOUSNESS; consists of conscience(the "should nots" from parents and soc) and the ego ideal(the "shoulds" from parents and soc) (ex: when we fall short of ideal=guilt, meet ideal=pride) p.19-20

Peplau's theory of interpersonal relationships

wrote the Interpersonal Relations in Nursing -first nurse to identify PMH as essential to gen nursing and a specialty w/ specific governing principles -first nurse theorist to describe nurse-pt relationship as the foundation of nursing practice shifting the focus from what the nurse can do to with pt to what the nurse can do with the pt -concerned w/ process of nurse makes positive changes in health and wellbeing -illness offered a unique opportunity for experiential learning, personal growth, and INC coping -nurses are both participants and observers; self awareness important to keep focus on the pt -most universal contribution is application of Sullivan's theory to anxiety; created 4 different categories: mild, mod, severe, panic and described their effects on perception and learning; devised interventions to DEC anxiety and improve pt's abilities to think and function w/ more satisfaction p.22