Therapeutic communication

GOAL OF MILLEU THERAPY

while the client is in a therapeutic environment , he will learn the tools necessary to cope adaptively, interact more effectively and appropriately and strengthen relationship skills.

THERAPEUTIC COMMUNICATION

"An interaction between two people in which input from both participants contributes to a climate of healing, growth promotion, and /or illness prevention"

RESTRAINTS AND SECLUSION

1) Always use the least restrictive means first 2) Only used to prevent serious harm or injury to self or others 3) MD writes order and examines patient, specified duration of time 4) Only amount of restraint needed for safetY

DSM

standard classification of mental disorders used by mental health professionals in the United States.

Pre-existing conditions affecting interpersonal comminicaton

values, attitudes,beliefs, culture, religion , gender

COGNITIVE THERAPY

suggests that thought processes are the basis of emotions and behavior. Changing faulty learning makes development of new adaptive behaviors possible

THREE COMPONETS OF THE DSM

the diagnostic classification the diagnostic criteria sets the descriptive text

A _____Is a false belief that has no basis in reality. Although anxiety can increase delusional responses, it isn't considered the primary symptom.

DELISION

According to Peplau, a nurse who provides an abandoned child with parental guidance and praise following small accomplishments is serving which therapeutic role?

SURROGATE

false imprisonment?

A patient has been irritating and attention seeking much of the day. Now a nurse escorts the patient down the hall saying, "Stay in your room or you'll be put in seclusion."

INPATIENT PATIENT GOALS

Acute crisis stabilization Begin behavior modication Idenify coping skills Initiate outpatient treatment

Therapeutic nurse-client relationship

Asssist the client to delvelop problem solving abilities & coping mechancisms

GIVING FEEDBACK

Be specific Ensure it is well-timed Be objective- do not give your opinion Be aware of your non-verbals Focus on behavior not person

OUTPATIENT PATIENT GOALS

Behavior modification identify and implent coping skills Reduction of symptoms

A client with chronic schizophrenia receives 20 mg of fluphenazine decanoate (Prolixin Decanoate) by I.M. injection. Three days later, the client has muscle contractions that contort his neck. This client is exhibiting which extrapyramidal reaction?

DYSTONIA

Acording to Peplau, treatment of client symptoms should involve which nursing action?

Establishing a therapeutic nurse-client relationship

INPATIENT NURSE GOALS

Initiate recovery model Manage milleu' Ensure safety Instill hope

OUTPATIENT NURSE GOALS

Initiate recovery model Manage milleu' Ensure safety Instill hope

Recovery model

Instill hope Patient driven and centered Support

A nurse directs the client interaction and plans for interventions to achieve client goals. According to Peplau's framework for psychodynamic nursing, what therapeutic role is this nurse assuming?

LEADER

What is ...influenced by the individuals functions; relative not absolute; individualized response to stress?

MENTAL HEALTH

influenced by the cultural factors, an adaptive stress response;outside socialite norms, interfere with functioning

MENTAL ILLNESS

A client who takes neuroleptic medication for treatment of chronic schizophrenia is admitted to the psychiatric unit. Nursing assessment reveals rigidity, fever, hypertension, and diaphoresis. Which life-threatening

Neuroleptic malignant syndrome

COUNTERTRANSFERENCE

Occurs when the NURSE has unconscious positive or negative reaction to the patient based on the nurse's past experiences

TRANSFERENCE

Occurs when the patient has pos/ or neg reactions to the nurse based past experiences

Which concepts should a nurse identify as being included in the DSM-IV-TR definition of personality?

Personality is an enduring pattern of perceiving. Personality is influenced by relationships between the environment and self. Personality is influenced by a wide range of social and personal contexts.

NON VERBAL COMMUNICATION

Physical appearance and dress Body movement and posture Touch Facial expressions (See Table 6-2) Eye behavior Vocal cues/paralanguage

THERAPEUTIC COMMUNICATIONS EXAMPLES

Placing events in time & sequence Encouraging comparison Restating Reflecting Silence Accepting Giving recognition Offering self Broad openings General leads

Freud

Psychoanalytical

Peplau

Psychodynamic

Erikson

Psychosocial

Benztropine is an anticholinergic medication administered to

Reduce the extrapyramidal adverse effects of chlorpromazine and other antipsychotic medications.

A client taking lithium is ordered citalopram (Celexa) for panic disorder. Five days after starting the citalopram, the client reports sweating and feelings of anxiety, restlessness, and confusion. The nurse suspects the client is experiencing:

SERATOIN SYNDROME

Millieu therapy creates an environment that is _____,____ &______

SUPPORTIVE THERAPEUTIC SAFE

A nurse at the mental health center prepares to administer a scheduled injection of haloperidol decanoate (Haldol depot) to a patient with schizophrenia. As the nurse swabs the site, the patient shouts, "Stop, stop. I don't want to take that medicine anymore because I hate the side effects." Select the nurse's first action.

Stop the medication administration procedure and say to the patient, "Tell me more about the side effects you've been having."

Clozapine is used to manage

Symptoms of schizophrenia in clients who don't respond to other antipsychotic drugs.

A newly admitted acutely psychotic patient is a private patient of the chief of staff and a private-pay patient. To whom does the psychiatric nurse assigned to the patient owe the duty of care?

THE PATIENT

Several nurses are concerned that agency policies related to restraint and seclusion practices are inadequate. Which understanding about the relationship of substandard institutional policies and individual nursing practice should guide nursing practice?

The policies do not absolve an individual nurse of the responsibility to practice according to professional standards of nursing care.

WHAT IS MILLEU THERAPY ?

Therapeutic environment conducive to meeting goals of therapy Team approach to determine goals and treatment - shared responsibility

A client begins taking haloperidol (Haldol). After a few days, he experiences severe tonic contractures of muscles in his neck, mouth, and tongue. The nurse should recognize this as

These symptoms describe dystonia, which commonly occurs after a few days of treatment with haloperidol.

ACTIVE LISTENING

the nurse is able to hear, observe and understand what the patient communicates and provide feedback Builds trust because the listener is engaged in the conversation both verbally and nonverbally. Acceptance and honesty are encouraged

Sullivan

believed that the nurse's role includes educating patients and assisting them in developing effective interpersonal relationships. Mutuality, respect for the patient, unconditional acceptance, and empathy are cornerstones of Sullivan's theory. Interpersonal

What is the legal significance of a nurse's action when a patient verbally refuses medication and the nurse gives the medication over the patient's objection? The nurse:

can be charged with battery.

A patient meets criteria for involuntary commitment for psychiatric treatment if they

threatening to harm self and others.

Chlorpromazine is used

to control the severe symptoms (hallucinations, thought disorders, and agitation) seen in clients with psychosis.

Cocaine blocks reuptake of ___,____&______ causing an excess of these neurotransmitters at postsynaptic receptor sites. thIS drug is likely to cause __

norepinephrine, epinephrine, and dopamine, tachyarrhythmias.

Hallucinations, which characterize most psychoses, are

perceptual disorders of the five senses; the client may see, taste, feel, smell, or hear something in the absence of external stimulation.

Identify conditions ESSENTIAL to the development of therapeutic communication

rapport, truest, genuineness, empathy & respect

Signs and symptoms of akathisia

restlessness, pacing, and inability to sit still.

Parkinsonism results

muscle rigidity, shuffling gait, stooped posture, flat-faced affect, tremors, and drooling.

The most common adverse effects of lithium

nausea, diarrhea, tremor, and lethargy.

"SOLER"

sit squarely, face the patient open posture lean forward eye contact relax