Mental health Exam 1
reaction formation (defense mechanism)
- Preventing unacceptable thoughts or behaviors from being expressed by exaggerating opposite thoughts or types of behaviors. EX: Jane hates nursing. She attended nursing school to please her parents. During career day, she speaks to prospective students about the excellence of nursing as a career.
Suppression: Defense Mechanism
- The voluntary blocking of unpleasant feelings and experiences from ones awareness. EX: "I don't want to think about that now. I'll think about that tomorrow."
If a patient tells you information in 'confidence' that may affect their care, what would be the best course of action to take (consider legal/ethical terms)?
"Duty to warn and protect"
What are anticholinergic side effects?
Blurred vision ** can't see Urinary retention ** can't pee Dry mouth ** can't spit Constipation ** can't $hit
Leaving a highly suicidal patient alone
Breach of Duty
Define Competency
Competency is related to the capacity to understand the consequences of ones decision
Civil Law Torts
Connects to negligence
A person who is angry with their boss goes home and beats up their spouse in an effort to relieve their feelings of anger
Displacement
Acetylcholine increases
Depression
A client on the psychiatric unit is undergoing a pretreatment evaluation for electroconvulsive therapy (ECT). Because of the client's profoundly depressed behavior, the nurse doubts that the client can provide informed consent. What should the nurse's initial intervention be?
Having the client verbalize understanding and the outcomes of the procedure
Parkinsonism
Having tremor, muscle rigidity, stooped posture, and a shuffling gait.
Making observations (Therapeutic communication Technique)
Here, the nurse shares with the patient her observations regarding behavior. The patient who has a need is often unaware of the source of this distress, or reluctant to communicate it verbally. However, the tension or anxiety created by his need creates energy which is transformed into some kind of behavior, nail biting, scratching, hand clenching, or general restlessness. By sharing her observations of this behavior with him, the nurse is inviting the patient to verify, correct or elaborate on her observations. In doing so, she is attempting to find out from him the meaning of his behavior rather than assuming she knows.
Medications For ECT
Hold meds such as benzodiazepines and sedatives night before. Why? (may affect the seizure threshold)
Toxic levels of tyramine causing headache, ↑BP, diaphoresis, flushing
Hypertensive Crisis
Which of these is a one-on-one communication between a nurse and another person?
Interpersonal communication
You seem upset
Interpreting
A student does poorly on two of their final exams so blame the professors for their poor lectures during the semester
Projection
Alzheimer's
Protective placement
Developmental or cognitive impairment
Protective placement
Is chronic, long-term and irreversible
Protective placement
Traumatic brain injury
Protective placement
Walking in traffic in only pajamas in below zero temperatures
Protective placement
Examples of Patient advocacy
Provdinging infome and conscent Respectining desicitons protecting against threats being informed about the best preactices
Are you saying you feel anxious?
Seeking Information
In regards to the plan of care for a patient who is hospitalized the nurse recognizes that the most effective was to reduce a lawsuit when caring for a patient is to?
Selecting the least restrictive treatment environment for the patient
The day shift nurses are 'just great' while all of you on the pm shift don't care about me as a person or as a patient
Splitting
How do the 6 QSEN competences impact on the nurse's nursing practice?
Standard of practice of care that prepare future nurses with the knowledge, skills, and attitudes required to enhance the quality, care, and safety in the health care setting in which they are employed.
A person with sexual indiscretions/desire for pornography takes a job photographing individuals in the nude [negative defense]
Sublimation
Taking the dogs for a walk when having the urge to eat junk food [positive defense)
Sublimation
How is serotonin syndrome treated?
The medication should be stopped immediately. Alert the physician. Cyproheptadine or Periactin may be given to relieve hyperthermia and muscle rigidity and prevent seizures, but condition often resolves itself with little intervention
Warning Signs that indicate a 'Blurring' of the Nurse-Patient Relationship
Over helping - doing things for patients that they are able to do for themselves ● Controlling - asserting authority and assuming control 'for the patient's own good' ● Narcissism - having the need to find weakness or helplessness at the 'expense' of the patient in order for the nurse to feel better and helpful
What are examples of least restrictive measures
PRN meds, decreasing stimulation, 1:1 time, 'sitter', room next to the nursing station, camera monitoring, 15" safety checks, being in view of staff for safety reasons
Dopamine decrease
Parkinson's and depression
SSRI's Antidepressants
Paxil, Zoloft, Celexa, Prozac ▪ best to take in the morning due to potential side effect of insomnia ▪ if stopped abruptly after being on the drug may see withdrawal sx (i.e. - headaches, tremors, sensory disturbances - shadows, different colors or shapes, anxiety, nausea, dizziness)
What are the key components of a Mental Status examination?
Personal information Appearance Behavior Speech Affect and Mood Thought Perceptual distances (hallucinations) Cognition
I am not the devil, I am your nurse
Presenting Reality Making
Norepinephrine decreases
depression
Seritonin decrease
depression
SLUMS test
exam given to people that are suspected to have dementia or Alzheimer's Disease.
Social communication
has no goal or purpose; you are at the same level with sharing information casually as with friendships or socialization. Conversation can be used as an ice breaker prior to engaging in a therapeutic conversation
Splitting (defense mechanism)
will view things as 'all good or all bad'; there is 'no in-between' or middle ground with the situation. Commonly seen is splitting between the different shifts with nurse-nurse or nurse-doctor
Serotonin syndrome symptoms
• Hyperactivity or restlessness • Tachycardia → cardiovascular shock • Fever → hyperpyrexia • Elevated blood pressure • Altered mental status (e.g., delirium) • Irrationality, mood swings, hostility • Seizures → status epilepticus • Myoclonus, incoordination, tonic rigidity • Abdominal pain, diarrhea, bloating • Apnea → death
Common side effects from ECT
▪ *Headache, *muscular aches, forgetfulness, temporary amnesia, *mild confusion, body soreness, drowsy to being up ad lib the same day of treatment ▪ Fewer cognitive side effects with memory loss with unilateral or prefrontal electrode placement ▪ Treating side effects:
Verbal vague threat vs. high risk threat. What interventions would the nurse do?
▪ Common levels of suicide precautions (q 5", q 15", q 30", hourly, one-on-one) ▪ Camera rooms ▪ Being close to the nursing station ▪ Reducing social isolation
How does a nurse determining what the priorities is for a suicidal patient?
▪ Protect from self harm ▪ Is the patient hearing voices? Are the voices giving commands of harm? - this significantly increases the risk
Benefits vs. risks of ECT
▪ Shorter or less frequent hospitalizations ▪ Risks with anesthesia, meds, fractures, cardiac ▪ ECT is considered a high risk procedure (not the first choice for treatment) ▪ Certain diagnoses that may be treated with ECT are: Mood disorders
You are caring for Malcolm, an 83-year-old African American patient with Alzheimer's disease. Malcolm exhibits agitated behavior at times, especially when he felts he is missing work, and he sometimes attempts to leave the unit to "get to school where I teach." Which of the following interventions is appropriate for de-escalating Malcolm's agitation?
Use validation therapy and ask Malcolm about the school and his job."
Dissociation defense mechanism
The unconscious separation of painful feelings, memories, thoughts or aspects on one's identity (Varcarolis, 2017, pg. 135). An example is: ● A person is brought to the emergency room by the police and is unable to explain who she is, where she lives or where she works
Therapeutic conversation Goal
Therapeutic communication needs to have a goal or stated purpose*, parameters are clear that your conversation is to help the patient.
Nursing interventions for a patient with a mental health disorder who makes threats for harm to self or others
Use least restrictive restraint
SNRI antidepressants
Venlafaxine or duloxetine, are effective in the treatment of anxiety disorders have the following acute side effects sweating, tremors, agitation, GI upset, sedation
Telling the truth, giving factual information
Veracity
No one would believe that
Voicing Doubt
A patient can be held for extended care and treatment up to 6 months
Long-term commitment (60-180 days)
Avoiding foods in the diet such as chocolate, bananas, beer, wine, cheese, yogurt due to drug-food reactions
MAOI's
Need to follow a low tyramine diet
MAOI's
Consider types of non-verbals a nurse needs to be aware and what the action might imply? Examples: Crossing your arms (defensive, not interested), rolling your eyes, sighs, tone of voice facial expressions, constantly looking out the window or away from the patient, fidgeting, etc
The pt. might imply that you don't care and are judgmental.
Introjection: Defense Mechanism
- Integrating the beliefs and values of another individual into ones own ego structure. EX: Children integrate their parents value system into the process of conscience formation.
Statement of a threat to place in seclusion as being verbally loud
Assault
Post ECT care/assessment of the patient
Assess Gag reflex, orientation, vital signs, oxygen sats, respiratory, cardiac (BP, EKG changes, K+ level), neuro (memory lapses, orientation)
Presenting Reality (Therapeutic communication Techniques)
"I see no one else in the room", "That sound was a car backfiring, "and "Your mother is not here; I'm a nurse." When it is obvious that the patient is misinterpreting reality, the nurse can indicate that which is real. She does this not by way of arguing with the patient or belittling his own experiences, but rather by calmly and quietly expressing her own perceptions or the facts in the situation.
A patient states, "I'm really tired of all these group activities, it is just becoming stressful at this point". Using supportive confrontation, the best response by the nurse should be:
"I think you are doing just wonderful, try using those relaxation skills next time"
Mrs. Chauncey receives a visit from her priest. He runs out of her room and then pulls the nurse assistant back into her room. Mrs. Chauncey is cutting her left wrist (superficially) with the 5 x 7 glass from a framed photo of a grandchild. She is taken to the emergency department, where her wrist is bandaged. Her daughter and son-in-law are notified. As her nurse, which of the following statements help clarify what has taken place?
"When your mom's priest arrived, he found her cutting her wrist with the glass from a framed photo." This statement is a clear representation of what has actually happened. Once the family members understand this, then dialog related to care options can begin.
What is the basic premise for initiating a Chapter 51
'dangerousness', acute, short-term or patient is decompensating by not meeting their basic needs
Conversion reaction (defense mechanisum)
(is unconscious); this is when a patient has temporary physical symptoms (i.e. - blindness, paralysis) as a result of severe psychological stress they can't handle emotionally
Emergency detention
(sometimes called "psychiatric hold" or "pick-up") in a treatment facility for psychiatric evaluation; typically short intervention of fixed duration (e.g., 72 hours)
projection (defense mechanism)
- Attributing feelings or impulses unacceptable to ones self to another person. EX: Sue feels a strong sexual attraction to her track coach and tells her friend, "Hes coming on to me!"
Voicing Doubt (Therapeutic Communication Techniques)
- Ct: The FBI wants to kill me - Ns: I find that hard to believe
What are therapeutic approaches/responses to assessing for suicide?
.Consider therapeutic techniques such as clarifying or validating as to what the patient's statement means so the nurse knows the level of risk (and can implement the necessary interventions to keep the patient safe) .Need to ask the patient directly if suicidal with a matter-of-fact approach (avoid using vague statements) --- use a direct approach (asking this is part of the standard of care for patients with disorders who may be at risk for suicidal behaviors) - Example: Are you having thoughts of hurting yourself?
Suiside Assessmen Includes risk factors such as?
.Suicidal behaviors: ideation, threats, attempts, completion .Is there a plan, it is detailed or vague, method, means available to carry it out, intent? .Has there been previous attempts, a social crisis, recent losses, depressive symptoms, alterations in thought process? .What might a patient say (verbal) or do (nonverbally) that the nurse would recognize it as a risk for suicide?
What are the 3 criteria in regards to "the duty to warn?"
1. Assessing and predicting the persons level of danger for violence towards others 2. Identifying the specific individuals being threatens v. general vage threat 3. Taking appropriate action to protect the identified victims
vegetative signs of depression
1. Change in bowel movement pattern (constipation) 2. Eating habits (anorexia) 3. Sleep 4. Disinterest in sex
4 Clarification techniques
1. Paraphrasing (Restating in a different word content) 2. Restating (Nurse mirrors what the patient conveyed) 3. Reflecting (help the pt. better understand their own feeling and thoughts ) 4. Exploring (Used to gather further information)
What are the 6 QSEN competences?
1. Patient-centered care (Respect the patient's preferences, values, and needs) 2.Quality improvement (Use data to monitor the outcomes of care, new information provides the improvement of pt. care) 3.Safety (Minimise the risk of harm to pt.) 4. Informatics (use technology to communicate, and support decision making) 5.Teamwork and Collaboration (Function as a team) 6.Evidenced-based practice (Integrate best clinical evidence with clinical experience)
hypertensive crisis
180/110 or higher
tardive dyskinesia
A side effect of long-term use of traditional antipsychotic drugs causing the person to have uncontrollable facial tics, grimaces, and other involuntary movements of the lips, jaw, and tongue.
Involuntary Admission
Admission to a psychiatric facility without the patient's consent.
Acetylcholine decrease
Alzheimer's, Huntington's, Parkinson's
A nursing student is listing the characteristics of an ethical issue. Which point listed by the nursing student requires correction?
An ethical issue occurs if the problem aims at the greatest good for the greatest number of people.
Tricyclic Antidepressants (TCAs)
Anitriptyline, Doxepin, Imipramine ▪ takes 2-4 weeks for improvement in mood to be noted ▪ serious implications with overdoses due to cardiac events (limit # of pills with prescription) ▪ risk for orthostatic hypotension
Experiencing dry mouth, blurred vision, urinary retention, constipation
Anticholinergic effects
Sertraline, Paroxetine, Fluoxetine
Antidepressants SNRI's
Mrs. Chauncey, 80 years old, is taking a selective serotonin reuptake inhibitor (SSRI) and Tylenol PM daily plus other medications. She has multiple, vague somatic complaints. This morning she complains of a "stomach ache" and "gas." What is your best initial nursing response?
Assessing bowel sounds is the best initial response. Older adults are at risk for constipation, and some medications can cause constipation. Mrs. Chauncey is taking an SSRI and Tylenol PM, which contains diphenhydramine.
Takes 2-4 weeks to be therapeutic in bloodstream
Atypical Antidepressants
A client is presented with the treatment option of electroconvulsive therapy (ECT). After discussion with staff members, the client requests that a family member be called to help make the decision about this treatment. What ethical principle does the nurse consider when supporting the client's request?
Autonomy
Allowing the patient to make their own decisions
Autonomy
Doing no harm
Beneficence
most commonly used anti anxiety medication
Benzodiazepines promote GABA
Battery
Carry out a threat towards another** A nurse carried out putting the patient in restraint who refused their medications
Signs/symptoms of improvement. When will you know the patient's depression is lifting?
Changes in vegetative signs/symptoms such as better sleep, improved appetite, increased physical activity, increased concentration, increased libido, brighter affect, can state something positive about themselves (↑ self-esteem, self-concept), etc.
Protection involving minors
Child protection
I want to be sure I understood what you said
Clarification
Please explain what you mean 'feeling useless'
Clarification
Evidenced based practice is a concept that uses
Clinical knowledge and nursing experiences
The premise that an individual's behavior and affect are largely determined by his or her attitudes and assumptions about the world underlies:
Cognitive-behavioral therapy
A patient experiences temporary blindness after learning that their significant other is having a sexual affair with their best friend
Conversion Reaction
Is an unconscious reaction with temporary symptoms such as blindness or paralysis in a response to an inability to handle the psychological stress that they are feeling at the time
Conversion Reaction
When can the patient be 'required' or 'forced' to take medication?
Court ordered medication from judge or demonstrate dangerous behaviors
Duloxetine
Cymbalta Antidepressant, Serotonin/Norepinephrine Reuptake Inhibitor
Patient vocalized understanding of side effects from SSRIs to the RN after teaching about antidepressants only to have the patient tell his family that no one explained about the new medication
Denial
A client with a mental illness in the emergency unit needs to undergo an emergency surgery. What would be the nurse's first course of action to prevent any legal complications?
Obtain consent from a person legally authorized to give it on the client's behalf, if available.
What is measured by the standard of care ?
Duty
PHQ-9 (Patient Health Questionnaire)
Dx: Any population Assesses severity of depression, >12: Major depressive disorder Domain: Body Structure and Fxn
Shooting gun towards another person
Emergency Detainment
An acute situation involving dangerous behaviors of self-harm
Emergency detainment
Taking an overdose as a suicide attempt
Emergency detainment
Two clients in the same medical facility receive differing levels of care due to the lack of financial resources of the family of one of the clients. The nurse in charge tries to resolve the ethical dilemma at hand. The nurse collects all relevant information regarding the problem from multiple sources. What should be the nurse's next course of action?
Examine own values regarding the issue at hand based on the information obtained.
Not allowing a patient to leave AMA who has no risk for self-harm
False imprisonment
Physically restraining a patient without just cause
False imprisonment
A nurse administering a benzodiazepine should understand that the therapeutic effect of benzodiazepines results from potentiating the neurotransmitter
GABA
Nursing interventions for a patient with a mental health disorder who refuses/unwilling to comply with treatment plan
Get a court order for medication
Clarification (Therapeutic communication Techniques)
If the nurse has not understood the meaning of what the patient has said, she clarifies immediately. She can use such phrases as "I'm not sure I follow..." or "Are you using this word to mean..." to request that the patient make his meaning clear to her.
A depressed client is admitted to the mental health unit. What factor should the nurse consider most important when evaluating the client's current risk for suicide?
Impending anniversary of the loss of a loved one
What do selective serotonin re uptake er's inhibit
Inhibit re uptake of Seritonin and making it stay longer in the some synapses
Worthlessness
Life is not worth living" this may be a key to the emotional thinking and if they are more risk for suicide.
Dressing or trying to talk like a famous movie star who is highly admired by the person
Introjection
Dystonias of the neck and trunk
Involuntary muscle contractions that cause slow repetitive movements or abnormal postures The movements may be painful
Transference
Is the process where the patient unconsciously displaces (transfers) to another individual (i.e. their nurse) some of their own experiences and emotional reactions that relate to significant figures from childhood o Example: the patient may state to the nurse "You remind me of my mother and you think you are high and mighty" or 'You are the most insensitive nurse I have ever met'
Countertransference
Is the tendency of the nurse to displace (transfer) their own feelings related to people they know onto the patient ● The nurse may feel angry or frustrated if being verbally attacked by the patient's comments ● Or the nurse may feel flattered and 'needed' by being dependent on the patient
What considerations would the nurse take when obtaining consent (i.e. - medication, treatment) for a patient with impaired cognitive ability?
It is important for the nurse to know that the presence of psychotic thinking does not mean the patient is incompetent or incapable of understanding. If found incompetent then court ordered medication may be ordered
A nurse manager on the psychiatric unit discusses the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) with a group of staff members. Which statement by the nurse manager reflects the primary purpose of the manual?
It provides clinicians with a classification of mental disorders and guidelines to aid diagnosis.
Offering prn medications to a patient with escalating behaviors
Least restrictive measures
Sitter on a 1:1 with patient who is engaging in self-harm behaviors
Least restrictive measures
During a home visit the nurse obtains information regarding a postpartum client's behavior and suspects that she is experiencing postpartum depression. Which assessments support this conclusion? Select all that apply. Lethargy Ambivalence Emotional lability Increased appetite Long periods of sleep
Lethargy Ambivalence Emotional lability
What is meant by the term 'unit milieu'?
Milieu is the overall 'feel' of the unit as to the atmosphere/environment (is it safe, human, respectful, therapeutic, engaging, therapeutic, etc?
What's the difference between mood and affect?
Mood - ('normal' is called euthymic) Affect -
A nurse is caring for depressed older adults. What precipitating factors for depression are most common in the older adult without cognitive problems? Select all that apply.
Multiple losses Declines in health
MAOI's Antidepressants
Nardil, Marplan, Parnate ▪ Last drug of choice to treat depression; why? • is critical with overdoses • Requires special diet - low tyramine foods include beer, wine, cheese, processed meats. • need to be off SSRIs for at least two weeks before starting MAOIs
A nurse is assigned to care for a group of clients who have been found to have depression. Which clinical manifestations does the nurse anticipate? Select all that apply.
Neglect of personal hygiene "I don't know" answers to questions Apathetic response to the environment
Are patients on a Chapter 51 required to take medications as prescribed by a physician based on their legal status?
No, you can not force a pt. to take medications because of their civil right to refuse.
Hypnosis
Not within nursing scope of practice
When the duty owed to the patient is breached by the nurse; a cause and effect can be established that caused harm
Nursing Negligence or Malpractice
2 I see that you have been pacing in the halls
Observations
atypical antipsychotics
Olanzapine (obesity) Clozapine (agranulocytosis) Respiradone (increase prolactin)
"A national imitative created on patient safety and quality of care."
QSEN
A caregiver forcefully spanks a 16 month old toddler stating it doesn't hurt as the diaper has lots of cushioning so justifies their action for the severe spanking
Rationalization
Doing the opposite of what one is really feeling
Reaction formation
A 6 year child begins sucking her thumb when her newborn baby brother is brought home from the hospital
Regression
Were you feeling that no one cares about you?
Rephrasing
When the nurse is managing the care of an acutely depressed client, which of these demonstrates that the nurse recognizes the client's fundamental mental health need? Role modeling a hopeful attitude regarding life and the future Sharing that life has presented depressing situations for all of us at times Devoting time with the client and trying to focus on happy, positive memories Identifying the client's personal weaknesses and designing interventions to strengthen them
Role modeling a hopeful attitude regarding life and the future
Has the lowest potential for harm with drug overdose
SSRI's
Too high of a dose or too many SSRIs causing side effects such as restlessness, tremors, headaches, ataxia, N/D
Serotonin Syndrome
What Biochemical factors affect depression
Serotonin and norepinephrine are two major neurotransmitters involved in depression
Common neurochemical transmitters
Serotonin, Dopamine, Norepinephrine Most dominant theory is biological as the cause of mood disorders due to faulty regulation of the neurotransmitter most involved Abnormal regulation of Serotonin
Risk factors for suicide
Sex (Male), Age (Teenager or Elderly), Depression, Previous Attempt, Ethanol or Drug Use, Loss of rational thinking, Sickness (medical illness), 3 or more prescription medications, Organized plan, No spouse (divorced, widowed, or single especially if childless). Social support lacking. Women try more often. Men succeed more often.
Sitting quietly without responding directly back to the patient's statement
Silence
Mrs. Chauncey, 80 years of age, complains of stomach pain and is now mute and staring out of her window. She is refusing food. Which of the following interventions are appropriate? (Select all that apply.)
Sitting with Mrs. Chauncey and speaking to her lets her know you are available. You are legally and ethically responsible to offer patients regular food and fluids whether they accept them or not. Vital signs are an important regular assessment, as well as skin turgor assessment. The older adult who is depressed is at risk for dehydration and possible hypotension.
Athetosis
Slow, twisting movements of extremities, especially severe in the hands
I don't want to talk about (painful event or traumatic experience)
Suppression
Caitlin is beige seen in the outpatient clinic for medication follow-up. She tells you that she is taking St. John's worth to help her symptoms of depression. Your response to make sure to let her primary care provider know that she is taking St. John's worth is guided by what knowledge
Taking St. John's Wort along with an SSRI antidepressant may cause serotonin syndrome
Nursing interventions for a patient with a mental health disorder who Demonstrates risky behaviors
Talk to the patient and ask them about what is going on
What are the key components of a psychosocial nursing assessment?
This is the subjective part of the assessment it focuses on the pt. perception and recollections of current lifestyle, and life in general. (family, friends, education, work, coping styles*alchole/substances, and religious beliefs)
Assault
Threat from someone who has the ability to carry is out and the individual feels afraid ** A nurse verbalizes that if the pt. does not take their medication, they will be in restraints or seclusion
What are the 5 elements are needed to prove negligence?
Tort Law (1)Duty: a duty of care owed when the nurse is providing care (2) A Breach of that duty: expose patient to unreasonable risk ** leaves suicidal pt alone (3) Cause in fact: an actual causal connection between the defendant's conduct and the resulting harm (4) Proximate or legal cause: which relates to whether the harm was foreseeable **not following protocol (5) Damages: loss of damages ** income, medical expenses, psycho trama
True or faulse, are psychotropic meds considered a "chemical restraint"?
True
Depressive signs and symptoms
Worthlessness, hopelessness, dejection, exaggerated feelings of sadness, not tending to ADLs, anhedonia, sleep disturbances, depressed mood, alexithymia (inability to describe emotions)
What are Yalom's curative factors? How do they relate to nursing practice?
Yalom's eleven therapeutic factors that influence change and healing in group therapy
Dysthymia
a form of depression that is not severe enough to be diagnosed as major depression. s/s in vegetative state
cognitive behavioral therapy
a popular integrative therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior) **Adult feeling like a fauiler after losing 4th job
Silence (Therapeutic communication Techniques)
allows for a time for self-reflection, allows for cognitively impaired patient to 'process' what was just asked of them/said to them by the nurse; silence may be awkward for the nurse but can be very therapeutic when used at appropriate times during a conversation/interaction
Which drug group calls for nursing assessment for development of abnormal movement disorders among individuals who take therapeutic dosages
antipsychotics
SNRI also treats
anxiety and neuropathic pain
serotonin increase
anxiety states
What is the basic premise for initiating a Chapter 55 (protective placement)?
chronic, long-term, and irreversible **Dementia, traumatic brain injury, Alzheimer
Hamilton Rating Scale for Depression
clinician-rated depression scale used like a clinical interview
Fidelity
is keeping one's promises. The nurse must be faithful and true to their professional promises and responsibilities by providing high quality, safe care in a competent manner.
displacement (defense mechanism)
is transferring one's feelings or reactions from one event to another event or situation that is less threatening
Rationalization (defense mechanism)
is using justification for certain behaviors with faulty logic so that it will be viewed as socially acceptable
The ethical principles that nurses must adhere to are
justice, beneficence, nonmaleficence, accountability, fidelity, autonomy, and veracity.
The nurse administers each of the following drugs to various patients. The patient who should be most carefully assessed for fluid and electrolyte imbalances is the one receiving
lithium
Anhedonia
loss of ability to experience any pleasure in life. This is typical of individuals as they describe disinterest in those things that created pleasure or joy previously.
Norepinephrine increase
mania, anxiety, schizophrenia
Lithium
mood stabilizer drug
Risk factors for depression. What are they?
multiple losses, chronic illness, substance abuse, family genetics, living alone, etc.
What would be a few nursing problems (diagnoses) for depression and risk for suicide?
potential for self-directed violence, risk for injury, ineffective coping, powerlessness, insomnia, hopelessness, risk for self-harm, guilt, interrupted family processes, low self-esteem, disturbed sleep pattern, risk for loneliness, self-neglect (bathing, personal hygiene), risk for self-mutilation (harm)
What is the primary goal for QSEN?
prepare future nurses with the knowledge, skills, and attitudes required to enhance the quality, care, and safety in the health care setting in which they are employed.
Dopamine increases:
schizophrenia, mania
Denial (defense mechanism)
the negation of reality (unconsciously) of threatening or unpleasant situations despite having factual evidence so will ignore it ● A person who states that she does not have a problem with alcohol use despite objective data (i.e. - DWI, late for work, BAL 0.33 mg%, drinks 12-pack beer daily) ● A girl who has a miscarriage continues to wear maternity clothes telling others she is still pregnant
What is false imprisonment?
the unlawful restraint of someone against his/her will and without legal justification
Amitriptyline, Imipramine
tricyclic antidepressants
What is negligence?
when the duty 'owed' the patient is breached by the nurse; there needs to be a 'cause and effect' with an injury that what the nurse 'did or didn't do' is 'connected' as the standard of care was not followed. (lack of supervision, carelessness, recklessness, no pt. concent, inappropriate delegated tasks)
