Psych test 1
Defense mechanisms:
(coping styles) psychological mechanisms that help individual respond to and cope with difficult situations, emotional conflicts, external stressors that the individual is often unaware about -some can be maladaptive while others are adaptive
-Describe medication groups -describe reminiscence groups
-transmit information about medications (action, dosage, ADRs, compliance, lifestyle adjustments) -remember past events, usually for older individuals
Describe characteristics of a small group
- <8 members -cohesive -fewer subgroups -ideal for patients who are highly motivated to deal with complex emotional problems (sexual abuse, eating disorders, trauma) -1 or 2 leaders
Describe characteristics of large groups
- >8-10 members -can be therapeutic -more cost effective -open ended, ongoing -less intense transference and countertransference (effective for specific problems or issues such as smoking cessation or medication information)
Glutamate
-excitatory amino acid -relay of sensory information -decrease in schizophrenia
Suicide death stats: -every _______ someone in the US takes their life -for every 1 suicide there are ______ attempts -suicide is the ______ leading cause of death in the US -the suicide rate has ________ (decreased, increased) over the last 16 years
-12 minutes -25 attempts -10th -increased
If someone is involuntary brought to a mental hospital under an ECO, they are under a TDO -how long is this good for -what do you need during this
-72 hours -mental health hearing
Describe the following levels of practice -basic -advanced
-RN with baccalaureate education, credentialed by American nurses credentialing center -Master's level preparation, nationally certified by the ANCC (clinical nurse specialist, nurse practitioner in psychiatric nursing, doctorate in nursing science, doctor of philosophy, doctorate of nursing practice)
Thyroid gland -produces -importance of these hormones being balanced -hypothalamus produces what that is important
-T3 and T4 -normal body functioning -thyroid stimulating hormone (signals the pituitary gland to message the thyroid gland to produce more or less T3/T4)
Define Neuroplasticity
-ability of the brain to change -compensates for loss of function in specific area -nerve signals may be rerouted, cells learn a new function, nerve tissues may be regenerated
-empathy: -sympathy: -empathetic linkages
-ability to experience, in the present, a situation as another did at some time in the past (don't actually have to have the experience but must be able to imagine the feelings associate with it), the nurse must receive information with an open nonjudgmental acceptance and communicate their understanding of the patient's experience and emotions so the patient feels understood -expression of compassion and kindness -direct communication of feelings that commonly occurs with anxiety (when talking to a patient that has anxiety, the nurse may realize that they have started to talk fast and feel anxious), requires being aware of personal feelings and analyzing these feelings and addressing associated problems
The therapeutic community: -is directed by _________ -treatment plan is formulated by ___________ -disciplines may include:
-an interdisciplinary team -the team (sign and meet regularly to update the plan) -psychiatry, psychology, nursing, mental health technician, social work, art/ music/ recreation therapy, dietitian, occupational therapist, chaplain
Restraints and seclusion: -must obtain what before implementing? -role of licensed independent practitioner? -orders may be renewed up to maximum of ________ -when would you use these options? -who must you notify if there is an episode?
-an order for each episode (no prn orders) -evaluate person within 1 hour -24 hours -management of violent or self-destructive behavior that jeopardizes immediate physical safety of patient, staff or others -family (if requested for each episode) -state, joint commission, CMS, and hospital administration if results in death/ serious injury while in restraints/ seclusions
Identify big points of Carl Jung
-analytical psychology -existence of two different types of personalities: extroverted or introverted
When are restraints used? Why are they used?
-as a last resort after all therapeutic interventions have failed -prevent client rom harming self or others (not as a coercion or form of discipline/ retaliation/ convenience of staff)
documentation for suicidal patient
-assess and reassess of suicide risk -immediate plan of intervention, safety plan -any changes in patients condition or behavior -observation level -patients self report of suicidal ideation, thoughts or plan -degree of hopelessness -engagement in creating and accessing safety plan -involvement in milieu treatment -communication among interdisciplinary team
what are important things to keep in mind when selecting communication technique?
-assess/ interpret the meaning of the client's verbal and nonverbal communication -identify the desired client outcome, keep the client's feelings as the focus -anxiety: short attention span so use short sentences -depression: use silence and empathetic techniques -schizophrenia: use clear short sentences and clarify and assist patients for more specific communication
ethical principles for nursing
-autonomy -beneficence -justice -nonmaleficence -veracity -fidelity -paternalism
Basic assumptions of the therapeutic community: -the health of each individual is to ____ -every interaction is an opportunity for __________ -each client owns their own ________ -_________ is a useful and powerful tool -_____________ are dealt with as they occur -____________ are to be avoided
-be realized and encouraged to grow -therapeutic intervention -environment, behavior -peer pressure -inappropriate behaviors -restrictions and punishment
Resolution phase/ termination stage
-begins first day of relationship (nurse explains to patient that this relationship is time-limited) -problems resolved -relationship ends -redirect patient toward life without this specific therapeutic relationship -direct patient toward community resources (patient takes responsibility for follow-up appointments) -don't address new problems -can be stressful for patient (express anger, won't show up to last appointment, may raise old problems that have already been resolved) -focus on the future
What are the 3 main classes of medications used to chemically restrain a patient? If a patient is willing to cooperate with treatment, what medication route should be used first?
-benzodiazepines, typical or class antipsychotics, and atypical antipsychotics -PO
what aspects are a part of the biologic, social, and psychological aspects of a psychiatric nursing assessment
-biologic: health status, physical examination, physical function, pharmacologic -social: functional status, social systems, cultural, family, community, spiritual, occupation, legal, quality of life -psychological: responses to mental health problems, mental status, behavior, self-concept, stress and coping, risk assessment
What do the following psychotropic medications do? -antidepressants -antipsychotics -benzodiazepines -psychostimulants
-block reuptake of serotonin and NEpi -block dopamine receptors -facilitate the transmission of GABA -increase the release of Nepi, serotonin, and dopamine
What are examples of tests that can be done in the biologic domain of the physical examination? What are physical functions you should evaluate?
-body systems review, neurologic status, laboratory results -elimination, activity and exercise, sleep, appetite and nutrition, hydration, sexuality, self-care
Define: -Id: -Ego: -Superego:
-born with, unconscious desires, primitive instincts, sought to get basic needs met as an infant, instant gratification, no consideration for others -reality, developed, part of personality that allows you to form relationships with others, suppresses memories that threaten mental health, tries to get needs met in socially acceptable way -morality and values, personal ethics, criticize self, role models and family members, personal feelings are about right and wrong
Describe the following lobes of the brain: -frontal -parietal -occipital -temporal
-broca area, highest or most complex aspects of cortical functioning, personality, working memory, planning and initiate activity with future goals in mind, insight, judgment, reasoning, concept formation, self-evaluation (schizophrenia, adhd, dementia) -coordinate visual and somatosensory information -visual area -primary auditory and olfactory areas, Wernicke area written and verbal language skills, sense of space, hippocampus
What would a physician have to do if they wanted to do something that wasn't on the advance directive
-call the legal authorized representative (if they don't answer..) -call the next to kin (if they won't answer/ help...) -call the mental health judge (doesn't need to be done by an attorney/ notary, it just needs to be witnessed)
Identify Jean watson's psychological theory
-caring is central to nursing practice and promotes health better than a simple medical cure -transpersonal caring -caritas field
Acetylcholine
-cholinergic neurotransmitter -stimulates muscle contractions (thus all behavior) -is required for proper memory and cognition as well as motor control -lack of acetylcholine is associated with ADHD and alzheimers -transmitter of parasympathetic NS
Describe Pavlovian theory
-classical conditioning -explain how people learn and act -conditioned stimulus elicits an unconditioned response
What are principles of therapeutic communication?
-client as primary focus -professional attitude -self-disclosure only for therapeutic purpose -no advice or social relationships with clients -client confidentiality -assessment of client's intellectual competence -interventions based on theory -nonjudgmental attitude -guiding client to reinterpret experiences rationally -clarification to track the client's verbal interaction
define the following defense mechanisms: -splitting -suppression -undoing -repression
-compartmentalizing opposite affect states and failing to integrate the positive and negative qualities of the self or others into cohesive images (one friend is perfect and an old perfect friend is now seen as evil) -intentionally avoiding thinking about disturbing problems, wishes, feelings or experiences (anxiously waiting test results so go to the movies to stop thinking about it) -words or behavior designed to negate or make amends symbolically for unacceptable thoughts feelings or actions (man has sexual thoughts about wife's sister so he takes his wife away for a romantic weekend) -expelling disturbing wishes, thoughts, or experiences from conscious awareness (don't remember being raped in the basement but feel anxious when down there)
Basal Ganglia -involved in: -damage to this area is associated with:
-control of posture and movements (primarily by inhibiting motor functions) -OCD, autism, ADHD, changes in muscle tone, abnormal movements (Tardive Dyskinesia)
describe the following hemispheres of the brain -left -right
-controls right side of the body, speech, comprehension, math -controls left side of the body, creativity, nonverbal communication, spatial orientation and recognition
What are examples of psychologic nursing interventions?
-counseling interventions (interactions between patient and a nurse) -conflict resolution and cultural brokering (process of helping an individual/ family identify a problem underlying a disagreement) -reminiscence (thinking about or relating of past experiences) -Behavior therapy (reinforce or promote desirable behaviors or alter undesirable ones) -token economy (applies behavior modification by rewarding patients with tokens for selected desired behaviors that they can use to purchase meals, watch TV, or wear street clothes) -psychoeducation (educational strategies to teach patients the skills they lack) -health teaching (integration of principles of teaching and learning with the knowledge of health and illness) -spiritual interventions (assist patients to feel balance and connection within their relationships)
identify the big points of Hildegard Peplau:
-created the middle-range nursing theory of interpersonal relations -focused on nurse-patient relationship (empathetic linkage) -recognized that if anxiety isn't recognized it escalates to panic (describes levels of anxiety as mild, moderate, severe, panic) -led the way towards humane treatments of patients with behavior and personality disorders
Identify big points of Margaret Mead
-culture and gender -established the importance of culture in determining human behavior
Hypothyroidism -_________ T3/T4, _______ TSH -s/s:
-decreased, increased -trouble sleeping, tired/ fatigue, difficulty concentrating, dry skin and hair, depression
Transitional Relationship Model/ Transitional Discharge model:
-developed to ease the transition from long-term hospitalization to living within the community -reduces time spent in hospital and number of readmissions
-direct leadership: -indirect leadership:
-direction and information, allows little discussion, tells members what to do -leader primarily reflects the group members' discussion, there is little guidance or information to the group, balance of direction and group freedom
What 3 questions make up an assaultive or homocidial ideation risk assessment?
-do you intend to harm someone? if yes, who? -do you have a plan? If yes, what are the details of the plan? -do you have the means to carry out the plan?
describe the function of the following: -limbic system -hippocampus -thalamus -hypothalamus -pituitary gland
-eat of emotions (needs, drive, instincts, hate, love) considered with mood disorders as well as schizophrenia and anxiety disorders -stores information attached to memories, damage would impact ability to pull short term memories -integrates sensory input involved with emotions and mood, filters out sensory information, prevents cortex from becoming overwhelmed by sensations (damage: hallucinations) -basic human activities- sleep/ rest patterns, body temperature, physical desires -attached to hypothalamus, works to control homeostasis
How do neurons communicate with each other
-electrical process must change to a chemical communication (happens in synaptic cleft) -electrical action potential reaches the terminals and Ca ion channels open allowing an influx of Ca ions into the neuron which stimulates the release of neurotransmitters into the synapse -the neurotransmitter than crosses the synaptic cleft to the receptor site on the postsynaptic neuron and stimulates adjacent neurons
What are the 10 Caritas processes
-embrace -inspire -trust -nurture -forgive -deepen -balance -co-create -minister -open
What is an ECO? Who can get one?
-emergency custody order (allows police to bring person to hospital for assessment) -general public
What are some psychological factors/ theories in suicidal behavior
-emotional factors -cognitive triad of hopelessness, helplessness, and worthlessness (Aaron Beck) -enhancing perception of helplessness and hopelessness, loss and grief, emotional distress
Motivational interviewing:
-engages a patient's own decision-making ability by focusing and reinforcing the client's own arguments for change -collaborative process of directed counseling and focused discussions -success can be influenced by external factors -may not be appropriate for all patients
describe a psychoeducation group
-enhance knowledge, improve skills, and solve problems -focus on transmission of information necessary for making some type of change and providing a process for making the change -members are selected, usually only last a few sessions, recovery-oriented, and mindfulness groups
-Confidentiality: -what is a breach of confidentiality? -what are exclusions of this?
-ethical duty of nondisclosure (provider has information about patient and shouldn't disclose it) -confidentiality is broken (a person's privacy can be violated but confidentiality maintained, but if confidentiality is broken then their privacy is also violated) -duty to warn: if someone is threatening someone else, we have to tell that person they're making threats against
-psychoneuroimmunology: -chronobiology: -molecular genetics
-examines the relationships among the immune system, nervous system, and endocrine system and our behaviors, thoughts, and feelings -day-night cycle that affects the human organism when the earth rotates -genetic contribution to development of psychiatric disorders
Indicators that a nurse-patient relationship is no longer professional:
-exchanging gifts -defending the patient to colleagues -keeping secrets -spending more time with a specific patient -feeling as if you're the only one who understands the patient
Dopamine
-excitatory -involved in cognition, motor, and neuroendocrine functions -stimulates feel good pathways, surges when there is a pleasant stimulation (levels are decreased in Parkinson and are abnormally high in schizophrenia)
Serotonin
-excitatory -plays a role in emotions, cognition, sensory perceptions, and essential biologic functions such as sleep and appetite -depression and insomnia are related with decreased serotonin, mania is associated with increased
Norepinephrine
-excitatory -plays a role in generating and maintaining mood states -dysfunction plays a role in anxiety and depression
Histamine
-excitatory amino acid -autonomic and neuroendocrine regulation -ADRs: weight gain and hypotension and sedation
Define the following defense mechanisms -dissociation: -help-rejecting complaining -humor -idealization -passive aggression -projection
-experiencing a breakdown in the usually integrated functions of consciousness, memory, perception of self or the environment or sensory and motor behavior (when referring to sexual assault from childhood the woman says it feels as if she were outside her body watching) -complaining or making repetitious requests for help that disguise covert feelings of hostility or reproach toward others which are then expressed by rejecting the suggestions, advice, or help that others offer (student asks for help after bad score but rejects all suggestions) -emphasizing the amusing or ironic aspects of the conflict or stressor -attributing exaggerated positive qualities to others (adult falls in love and fails to see the new qualities in the other person) -indirectly expressing aggression towards others -falsely attributing to another one's own unacceptable feelings, impulses, or thoughts (child is angry at parent but accuses the parent of being angry)
*true or false* -people who talk about suicide rarely die by suicide -the suicidal person wants to die and feels there is no turning back -person who attempts suicide will always have thoughts of suicide -you should talk about suicide with someone who was once suicidal
-false, people who die by suicide often give a clue or warning -false, suicidal person often has mixed feelings -false, suicide attempt is made during a particularly stressful period but if that stressor can be well managed they can go on with life -true, it is best to be direct about suicide and suicidal thoughts
Explain what happens when the sympathetic NS is turned on
-fight or flight -dilation of iris, increase rate/ contractility of heart, constriction of vessels, relaxation of lungs, relaxation of GI tract, sphincters/ uterus contracts, increased secretion of sweat glands
What are the three most common ways someone dies from suicide?
-firearm -suffocation (hanging) -poisoning (OD)
describe Task groups
-focus on completion of specific activities (planning a week's menu) -leader must encourage equal participation and cohesiveness
-Describe supportive therapy groups -describe self-help groups
-focus on helping individuals cope with their illnesses and problems -people who are concerned about coping with a specific problem or life crisis (AA)
define the following terms in relation to affect: -range -intensity -appropriate -stability
-full or restricted -flat, increased, or blunted -emotional response in the situation -mobile or liable
What are aspects of the social domain assessment?
-functional status -social systems (family/ cultural assessment, community support and resources) -spiritual assessment -occupational status -economic status -legal status -quality of life
Define the following: -autonomy: -beneficence: -justice: -nonmaleficence: -paternalism: -veracity: -fidelity:
-fundamental right of self-determination -HCP uses knowledge of science and incorporates the art of caring to develop an environment in which individuals achieve their maximal health care potential -duty to treat all fairly -duty to cause no harm -belief that knowledge and education authorize professionals to make decisions for the good of the patient -duty to tell the truth -faithfulness to obligations and duties
Identify the main points of Imogene King
-goal attainment -learn to promote selves and advocate for themselves
What 5 questions make up a suicidal ideation risk factor assessment?
-have you ever tried to harm or kill yourself? -do you have thoughts of suicide at this time? if yes, do you have a plan?, if yes can you tell me the details of the plan? -do you have the means to carry out this plan? (if the plan requires a weapon, does the patient have it available?) -have you made preparations for your death (writing a note to loved ones, putting finances in order, giving away possessions) -has a significant episode in your life caused you to think this way? (recent loss of spouse or job)
orientation phase:
-honeymoon phase -goal= develop trust and security within the relationship -first meeting -nurse and patient get to know each other -confidentiality -testing the relationship -testing behaviors by the patient, a normal way to develop trust (forget/ show up late to session, express anger, accuse nurse of breaking confidentiality, introduce a relatively superficial issue as if it were the major problem) -discuss the patient's expectations and outline the responsibilities of the nurse and patient (purpose, boundaries, participation, expected length of relationship) -the nurse is responsible for active listening
What are the warning signs for someone at risk of committing suicide?
-ideation -substance abuse -purposelessness -anxiety -trapped -hopelessness -withdrawal -anger -restlessness -mood changes (IS PATH WARM, ideation is the primary sign)
What are nursing interventions for psychological domain of suicide prevention?
-increase tolerance to distress -develop coping skills -distraction techniques when suicidal thoughts happen (teach patient to distract themselves, validate patient, reinforce patients positive beliefs) -commitment to treatment (ask patient to make a commitment to try new approaches)
Hyperthyroidism -_________ T3/T4, _______ TSH -s/s:
-increased, decreased -anxiety, irritability, moodiness, sweating, hands trembling, hair loss, missed menstrual periods
If a person is involuntary confined there must be evidence of:
-individual is mentally disordered -dangerous to self or others -unable to provide for basic needs (related to psychiatric condition)
describe the following group roles: -task -maintenance -individual
-individuals concerned about the purpose of the group -help keep the group together -played to meet personal needs
GABA
-inhibitory amino acid -slows down body activity -decrease of GABA = anxiety
Self-determinism -effect in medicine
-internally motivated to make choices based on personal goals -right to choose one's own health-related behaviors (right to refuse treatment)
Identify big points of Harry Sack Sullivan
-interpersonal forces -importance of human relationships (instincts and drives are less important) -interpersonal relations as the basis for human development and behavior (we wouldn't have our personality without other people)
describe the following restraints: -physical restraint: -mechanical restraint: -chemical restraint: -seclusion:
-involuntary restriction of freedom of movement, physical activity or use of body parts -device/ equipment (vest, Geri-chair, restraint chair, bedrails, tied blanket or lap blanket) -medications given to control behavior or limit movement (emergency situation, patient is actively trying to harm someone) -involuntary restriction/ confinement to room or area, physically not permitted to leave/ told not to leave (someone must stay with individual outside of the door, no longer need when the patient isn't a threat aka asleep)
What are important things to do during a first group meeting?
-leader sets the tone -introductions (avoidance of self-disclosure by leader) -explanations of group structure, purpose, and rules -observation of group dynamics (verbal and nonverbal interactions within the group)
What are two examples of formal group roles? What are three informal group roles?
-leader, member -task, maintenance, individual
-biological markers: -EEG: -fMRI:
-levels of neurotransmitters and other CNS substances in the blood, urine, CSF that provides clues (not definitive), more predictive if psychiatric symptoms are present -spikes and wave patterns can indicate brain abnormalities and can help differentiate (seizures) -visualizes processing and functioning. Used for diagnosis of some dementias (Alzheimer's) and is emerging in other psychiatric illness
What is an advance care directive in mental health?
-living will, durable power of attorney -tells the health care team what the patient wants/ doesn't want if there was a crisis, it also lists a contact person (a legal authorized representative) who would make decisions for that person if they weren't able to
What are some biologic factors/ theories in suicidal behavior
-low serotonin levels -genetics (children of depressed and suicidal parents have higher rates of suicidal behavior)
What are the nurses role in the therapeutic community?
-manage the environment on 24/7 basis -ensuring the client's physiological and psychological needs are met -medication teaching and administration -1:1 relationship -role modeling -setting and maintaining limits and boundaries -health promotion and teaching
When assessing the patients response to mental health problems, what are two things you should identify?
-meaning of life changes to the patient and family members -current strategies or behaviors in dealing with the disorder
Describe the characteristics of a closed group
-members begin the group at one time and no members are admitted -the group is more cohesive -groups is more likely to dissolve when members drop out
What groups of people are at higher risk for suicidal behavior:
-men (4x greater) -those who've experienced childhood physical/ sexual abuse -social distress/ isolation, unemployment, poverty -LGBTQ -American Indians and Alaska Natives -individuals who have lost someone to suicide -those int he justice or child welfare systems -those who engage in non-suicidal self-injury -people with chronic or painful medical conditions -psychiatric illness patients -substance use disorder -armed forces and veterans
between men/ women who have the highest suicide rates and at what age
-men above 65 (women have more attempts, men are more successful)
What are examples of challenging group behaviors?
-monopolizer (constantly talking or interrupting others) -"yes, but..." (best to avoid problem solving for the members and encourage the person to develop their own solutions) -disliked member -silent member -group conflict
What are important current/ past health status questions you need to assess during the biologic domain?
-most recent medical evaluation -past hospitalizations and surgical operations -cardiac problems -respiratory problems -neurologic problems -endocrine disorders -immune disorders -use, exposure, abuse, or dependence on substances
-acute dystonic reactions -akathisia -pseudoparkinsonism
-muscular spasm of neck, jaw, back, extremities, eyes, throat, and tongue (highest risk in young men) -a feeling of internal motor restlessness that can present as tension, nervousness, or anxiety -drug-induced Parkinsonism
Describe the characteristics of an open group
-new members may join -members may leave at any time -new members are at a disadvantage -advantage: the group can continue (found in impatient)
Substance P and somatostatin
-nonopioid neuropeptides -pain transmission and endocrine functioning
explain the following communication techniques and whether they are therapeutic or non therapeutic: -defending: -seeking clarification and validation: -requesting an explanation: -presenting reality: -voicing doubt -reflecting: -literal responses:
-nontherapeutic, ex: your doctor is very good -therapeutic, explain what is vague, searching for mutual understanding -nontherapeutic, ex: why did you do that? -therapeutic, clarifying misconceptions that client may be expressing -therapeutic, expressing uncertainty as to reality of client's perception -nontherapeutic, ex: you are not supposed to talk like that -nontherapeutic, ex: if you feel empty then you should eat more
explain the following communication techniques and whether they are therapeutic or non therapeutic: -incongruence: -accepting: -offering self: -underloading: -offering general leads: -placing the event in time or sequence:
-nontherapeutic, sending verbal and non-verbal messages that contradict one another -therapeutic, conveys positive regard -therapeutic, making oneself available -nontherapeutic, remaining silent and unresponsive, not picking up cues, and failing to give feedback -therapeutic, encourages client to continue -therapeutic, clarifies relationship of events in time
What are rules for nursing care of individuals in restraints?
-physical/ mechanical restraints can only be applied by trained staff -must have continuous one-to-one monitoring -remove device and perform ROM at least every 2 hours, make sure patient isn't in danger of aspiration -provide fluids and bathroom breaks every 2 hours -maintain the dignity of the client -document all observations
Describe psychotherapy groups
-treat individuals emotional problems and can be implemented from various theoretic perspectives -examine emotions and help individuals face their life situations
explain the following communication techniques and whether they are therapeutic or non therapeutic: -false reassurance/ agreement: -invalidation: -focusing on self: -making observations: -encouraging description of perceptions: -encouraging comparison: -changing the subject:
-nontherapeutic, using cliché to reassure client -nontherapeutic, ignoring or denying another's presence, thought's or feelings -nontherapeutic, responding in a way that focuses attention to the nurse instead of the client -therapeutic, verbalizing what is observed or perceived -therapeutic, asking client to verbalize what is being perceived -therapeutic, asking to compare similarities/ differences (ideas, experiences, or relationships) -nontherapeutic, introducing new topic inappropriately, a pattern that may indicate anxiety
Describe what the following moods mean: -euthymic -euphoric -labile -dysphoric
-normal -elated -changeable -depressed, disquieted, and restless
Once a patient is fit to stand trial what are possible outcomes from the hearing?
-not guilty by reason of insanity, treated in a hospital -guilty but mentally ill (mental illness is considered a factor in the crime but not to the extent considered for a NGRI conviction), treated in jail
Describe big points of Ida Jean Orlando
-nurse-client relationship -nurse's professional role -identity and development of knowledge that is distinctly nursing (focus on whole patient)
What is important to document in nursing to help with liability?
-observations of subjective and objective physical, psychological, and social responses -interventions implemented and the patient's response -observations of therapeutic and side effects of medications -evaluation of outcomes of interventions
active listening: passive listening:
-ongoing activity, nurse focuses on what patient is saying and interprets the underlying meaning and responds objectively, follow the client's lead when appropriate, use open-ended sentences/ questions to elicit additional responses -sitting quietly and letting the client to talk (allows rambling/ not focused or guided thought process), body language usually communicates boredom and this is nontherapeutic
What does care look like for a patient who is in intermediate and long term risk?
-ongoing preventative interventions -assess support system, psychological factors, past episodes -teach to expect setbacks -review goals already achieved
features that should appear in every application of motivational interviewing
-openness to collaboration with client's own expertise -proficiency in client-centered counseling -recognition of key aspect of client speech that guides the practice of MI -eliciting and strengthening client change talk -rolling with resistance -negotiating change plans -consolidating client commitment -switching flexibly between MI and other intervention
endorphins, enkephalins, and dynorphins
-opioid neuropeptides -endocrine functioning and pain suppression
What are aspects of the mental status examination?
-orientation -mood and affect -speech -thought processes -cognition and intellectual performance -attention and concentration -abstract reasoning and comprehension -memory: recall, short-term, recent, and remote -insight and judgment -behavior -self-concept (body image, self-esteem, personal identity) -stress and coping patterns -risk assessment (suicidal ideation, assaultive or homicidal ideation)
Working phase:
-patient begins identifying problems to work on -trust has developed -problem identification has occurred -nurse will use various verbal and nonverbal techniques to help the patient examine problems and support the patient through the healing process -transference and countertransference becomes an important issue in this phase
What are ways to evaluate outcomes of nursing interventions?
-patient benefits -patient's level of satisfaction -appropriate level of care, bridge to community, cost effective -outcome diagnosis specific or nonspecific
Competency: -definition -what should a patient be able to do if they're competent
-patient's cognitive ability to process information at a specific time, longer period of time and is determined by the physician -communicate choices, understand relevant information (paraphrase understanding), appreciate the situation and its consequence (discuss treatment and likely outcomes), use a logical thought process to compare the risk s and benefits of treatment (logical reasons of choice)
-define family dynamics: -what are formal support systems: -what are informal support systems:
-patterned interpersonal and social interactions -hospital, nursing homes -family, friends, neighbors
After a TDO hearing what 3 things can happen?
-person can get released -they can stay voluntarily if they have capacity -committed (judge determines for how long, can't be longer than 180 days)
Forensic:
-pertains to legal proceedings and mandated treatments of persons with a mental illness (individuals with a mental illness are at a higher risk for incarceration and are often not provided with the treatment they need in these forensic settings)
Describe Abraham Maslow hierarchy of needs
-physiological: breathing, food, water, sex, sleep -safety: security of body, employment, resources, morality, family, and health -love/ belonging: friendship, family, intimacy -Esteem: self-esteem, confidence, achievement -Self-actualization: morality, creativity, spontaneity, problem solving
describe decision- making groups
-plan activities, develop unit rules and select learning materials (observe for any group-think)
When a patient is in a restraint, they should be checked every 15 minutes to document what 4 things:
-position of body parts in alignment -placement of device on the patient -padding of bony prominences, friction spots -pulse characteristics distal to restraint device
What are some social factors/ theories in suicidal behavior
-poverty, homelessness, losing a job, social stressor -lack of social connection, social exposure to suicide
describe the following levels of anxiety: -mild anxiety: -moderate: -severe: -panic: -general:
-prepares you to take action and makes you more active -mild stress starts to dip into distress (attention span decreases, can't concentrate, test anxiety) -concentration and attention is severely limited, difficulty completing simple tasks, palpations, headaches, sleep affected, confusion and dread -very intense with sudden onset (may/ may not be a result from a specific event/ activity) -mild-moderate (based on how often it happens)
Mood: Affect:
-prominent, sustained, overall emotions that person expresses and exhibits -person's capacity to vary outward emotional expression
What are examples of biologic/ physical interventions
-promotion of self-care activities -activity and exercise interventions -sleep interventions -nutrition interventions -relaxation interventions -hydration interventions -thermoregulation interventions -pain management -medication management (basically just healthy lifestyle)
What are extrapyramidal symptoms associated with tardive dyskinesia
-protrusion and rolling the tongue -sucking and smacking movements of the lips -chewing motion -facial dyskinesia -involuntary movements of the body and extremities (involuntary muscle movements in the lower face and distal extremities, this can be a chronic condition associated with long-term use of antipsychotics)
Identify big points of Sigmund Freud:
-psychoanalytic theory -studies unconscious (personality and its development) -anxiety (self defense mechanism) and defense mechanisms -sexuality -object relations and identification (someone has a psychosocial attachment to another person really early and they are shaped by them) -psychoanalysis (assess unconscious from childhood and try to fix problems with adult mind) -transference and countertransference -Id, Ego, Superego
Define the following two relaxation techniques: -distraction -guided imagery
-purposeful focusing of attention away from undesirable sensations -purposeful use of imagination to achieve relaxation or direct attention away from undesirable sensations
what are our priorities if a patient is in imminent risk for suicide? What is an inpatient units initial priority?
-reconnecting client to others/ instilling hope, restoring emotional stability/ reducing suicidal behavior, ensuring safety -safety (reduce ligature risks, observation 1:1 in line of sight, 15 minute checks)
Informed consent:
-requires patient must be given adequate information upon which to base decisions -if a patient has capacity, then they have to be the one to sign the consent (may need consent for some medications)
Explain what happens when parasympathetic NS is turned on
-rest and digest -decrease rate/ contractility of heart, blood vessels dilate, lungs constrict, increased motility of GI tract, increased secretion
Nursing interventions to prepare for inpatient discharge:
-review the patients safety plan with them -encourage patient to stay with family or friends -enlist the help of family or friends to check the environment for drugs or guns -schedule frequent appointments -the outpatient counselor should establish rapport and promote a trusting relationship -continue to be direct and talk matter-of-factly about suicide
how might damage to these areas produce symptoms of mental illness -pituitary gland -hippocampus -thalamus
-schizophrenia -Alzheimer's -hallucinations
Milieu therapy -definition -containment: -validation: -structured interaction: -open communication:
-scientific structuring of the environment in order to effect behavioral changes and to improve the psychological health and functioning of the individual, client learns adaptive coping and interactive skills for incorporation into other aspects of their lives -providing safety and security and involves the patient's access to food and shelter -affirms patient individuality -purposeful interaction that allows patients to interact with others in a useful way -staff and patient willingly share information (therapeutic community)
Identify main points of Dorothea Orem
-self-care -5 step approach: nurse can meet self-care requisites through acting or doing for, guiding, teaching, supporting, and providing an environment to promote the patient's ability to meet current or future demands
what is the purpose of the code of ethics for nursing
-serves as an ethical framework for a nurses practice -provides a nurse with direction in respect to their ethical relationships, nursing responsibilities, appropriate behaviors and in making day to day choices in their practice
how can nurses assess a patients protective factors?
-skills in problem solving -social support -cultural/ spiritual connections and beliefs -future goals -use of leisure time -responsibility to children or pets -support through ongoing mental/ medical health care -elective clinical care for disorders -easy access to clinical interventions and support -restricted access to highly lethal means of suicide -meaning in life
Why is it important to understand your own personal feelings?
-so you can avoid projecting them onto clients -so you can change learned behaviors to engage effectively in effective interactions
What are examples of social nursing interventions?
-social behavior and privilege systems -Milieu therapy -promotion of patient safety -home visits -community action
What is important for the settings of group meetings?
-space and privacy is important -members are able to see and hear each other -circular arrangement enhancing group work -those sitting close to the group leader usually have more power in the group
-verbal communication: -nonverbal communication: -therapeutic communication:
-spoken word, underlying emotion, context, connotation -gestures, expressions, body language -ongoing process of interaction in which meaning emerges
-suicidal ideation: -suicidality -suicide attempt: -parasuicide: -lethality:
-suicidal thoughts (we need to find out if they have a plan, what it is, can they do it) -all suicide-related behaviors and thoughts of attempting or completing suicide and suicidal ideation -non-fatal self-inflicted intent to die -potential suicide gesture -what is the potential of this person being successful (higher lethality- firearm, lower lethality- overdose)
What information should we share family and friends about a patient who attempted to commit suicide or has suicidal ideation?
-take any hint of suicide seriously and seek help -don't leave them alone -be a good listener, don't keep secrets -express feelings of personal worth to the client -restrict access to firearms -provide feelings of hopefulness -acknowledge/ accept the person's feelings -don't blame the person or provoke guilt in them -know the suicide intervention resources
describe what lack of capacity means
-temporary -patient isn't understanding treatments provided for them, they don't understand consequences of refusal, they can't articulate why they're refusing or what a refusal will do -physician needs to assess every day whether or not they lack capacity
-define transpersonal caring: -describe caritas field:
-the interaction in nurse-patient relationships in which the nurse affects and is affected by the patient -a field of consciousness created when the nurse focuses on love and caring as his or her way of being and consciously manifests a healing presence with others
What is a nontherapeutic relationship?
-the nurse and patient both are frustrated and grappling/ struggling to reach common ground -eventually they will move into mutual withdrawal (nurse makes pt the last pt of the day and then can't get to them, or the patient is always busy during appointment time)
explain the following communication techniques and whether they are therapeutic or non therapeutic: -using silence -overloading: -giving recognition: -giving broad openings: -value judgments:
-therapeutic, allows client to take control of discussion, if he or she so desires -nontherapeutic, talking rapidly, changing subjects too often and asking for more information than can be absorbed at one time -therapeutic, acknowledging, indicating awareness -therapeutic, allows client to select topic -nontherapeutic, giving one's own opinion, evaluating, moralizing or implying one's values by using words such as nice/ bad/ right/ wrong/ should/ ought
explain the following communication techniques and whether they are therapeutic or non therapeutic: -restating: -giving advice: -reflecting: -focusing: -exploring: -internal validation:
-therapeutic, lets client know whether expressed statement has or has not been understood -nontherapeutic, telling the client what to do, giving opinions or making decisions for the client, implies client cannot handle their own life decisions and that the nurse is accepting responsibility -therapeutic, directs questions or feelings back to client so that they may be recognized and accepted -therapeutic, taking notice of single idea or even single word -therapeutic, delving further into subject, idea, experience, or relationship -making an assumption about the meaning of someone else's behavior that is not validated by the other person (jumping to conclusion)
explain the following communication techniques and whether they are therapeutic or non therapeutic: -attempting to translate words into feelings: -having a closed posture: -verbalizing the implied: -making false promises: -ignoring the patient: -showing disapproval: -formulating plan of action:
-therapeutic, putting into words feelings client expressed only indirectly -nontherapeutic, ex: crossing arms on chest -therapeutic, putting into words what client has only implied -nontherapeutic, ex: I'll make sure to call you when you get home -nontherapeutic, ex: I can't talk to you right now -nontherapeutic, ex: you should not do those things -therapeutic: striving to prevent anger/ anxiety/ escalating to unmanageable level of stress
-what does it mean if a person is found unfit to stand trial -what follows after? -if they're still unfit the court may:
-they are unable to understand the nature and purpose of the proceedings or to assist in the defense -hospitalization in a forensics mental health facility to become fit (not to treat mental illness) -dismiss charges and order a civil commitment, extend period of hospitalization for further treatment to attain fitness
identify big points of Aaron Beck
-thinking and feeling -cognitions (link internal thought process with human behavior) -form of talking therapy which can be used to treat people with a wide range of mental health problems (focuses on findings errors of judgment and habitual errors in thinking)
psychosis -definition -treated with: -side effect of ^^ is
-thought processes is disorganized and they're not able to take care of themselves, not relating to reality in the right way (hallucinations: 5 senses - hearing/ seeing/ feeling/ tasting/ smelling things) (delusions: fixed ideas about something that isn't true) -antipsychotics -Tardive Dyskinesia (also a result of damaged basal ganglia)
Identify big points of Madeleine Leininger:
-transcultural health care -various mental health beliefs among cultures
What are Erik Erikson's 8 stages of psychosocial development?
-trust vs mistrust -autonomy vs shame (1.5 -3) -initiative vs guilt (3-5) -industry vs inferiority (5-12) -identity vs role confusion (12-18) -intimacy vs isolation (18-40) -generativity vs stagnation (40-65) -ego integrity vs despair (65+)
Define the following defense mechanisms: -acting out -denial -displacement -rationalization -reaction formation
-using actions rather than reflections or feelings during periods of emotional conflict (girl gets mad at her parents so she stays out late) -refusing to acknowledge some painful aspect of external reality or subjective experience that would be apparent to others (teenagers best friend moves away but he says he's not sad) -transferring a feeling about, or a response to, one object onto another substitute object (woman has argument with boss and comes home and yells at kids) -concealing the true motivations for one's own thoughts, actions, or feelings through the elaboration of reassuring or self-serving but incorrect explanations (man gets left by girlfriend but tells friends its for the best bc his family wouldn't like her) -substituting behavior, thoughts, or feelings that are diametrically opposed to one's own unacceptable thoughts or feelings (wife finds out about husbands affairs and tells friends that she thinks his affairs are appropriate and she doesn't feel any anger on a conscious level)
define the following: -assault: -battery: -medical battery: -false imprisonment: -negligence:
-verbal threat made to an individual -physical harm -treating without consent, didn't follow advance directive -keeping patients when inappropriate -purposefully/ legitimately ignored policy and patient was injured (breach of duty of responsible care for a patient)
describe the function of the following CNS structures -extrapyramidal motor system: -pineal body: -locus ceruleus: -brain stem: -cerebellum:
-voluntary movement, muscle tone, posture, common reflexes. Dysfunction can lead to hypertonicity and Parkinson's -controls release of melatonin -clusters of neurons that affect attention, time perception, sleep-rest cycles, arousal, learning, pain, and mood -brain stem: mediates symptoms of emotional dysfunction, source of neurochemicals (serotonin) -controls movement and postural adjustments
Boundaries and body space zones: -intimate zone -personal zone -social zone -public zone -what is important to remember?
-whispering, embracing (6-18 inches) -close friends (18- 47 inches) -acquaintances (47 inches - 3 yd) -strangers (over 3yd) -size of boundaries vary by culture and are dynamic not fixed, we must differentiate the intimate/ personal zone for each client as well as ourselves
Identify main points of Betty Neuman
-wholistic model -client system (physiological, psychological, sociocultural, developmental, spiritual) interacting with the environment
What are the phases of a deteriorating patient- nurse relationship?
-withholding phase: nurse is perceived as withholding nursing support -avoiding and ignoring phase -struggling with and making sense of phase: patient struggles with and tries to understand the unsatisfactory relationship
-Symbolism: -content themes
-word or phrase represents object, event, or feeling (not uncommon for it to be unexplainable if the patient has a mental disorder) -possibly recurrent thread of story (test for recurrent fear and assist client to develop strategies to cope, include clients in analyzing concept themes so they can learn that skill)
What is an important communication technique when doing a psychiatric assessment?
Clarify (words or habits can vary from person to person based on cultural norms and other conditions) Summarize (allows the patient to correct the nurse's interpretation)
least restrictive environment
The patient has the right to be treated in the least restrictive environment possible for the exercise of free will; an individual cannot be restricted to an institution when he or she can be successfully treated in the community.
Self-examination
a willingness to be introspective (best to do with someone else who will give honest feedback to avoid bias)
therapeutic verbal communication techniques:
acceptance, confrontation, doubt, interpretation, observation, open-ended statements, reflection, restatement, silence, validation
What did the patient self-determination act bring about
advance care documents -now need to give patients information about advance care documents as well as ask them questions and provide them information about rights to complete one on admission
Strength-based communication:
focuses on the patient's strengths rather than potential deficits
Steps of the nursing process
assessment, diagnosis (and outcome development), intervention, evaluation
Is suicide a diagnosis, disorder, or behavior
behavior
Rapport:
development of interpersonal harmony characterized by understanding and respect and is important in developing a trusting/ therapeutic relationship (helps lessen patient loneliness, increase sense of sharing)
What happens in stress
epinephrine floods the body and increases the heart rate which sends blood to the muscles and our pupils dilate so we can see, liver will excrete a bunch of glucose for energy (stress = silent killer from high BP and high sugar level)
Genetic susceptibility
identification of increased risk for psychiatric disorders
What should you do if the client asks a personal question?
the nurse should elicit underlying reason for the request or redirect client, information revealed should be purposeful and have identified therapeutic outcomes
Health Insurance Portability and Accountability Act (HIPAA)
patient authorization necessary for the release of information with the exception of that required for treatment, payment, and health care administrative operations
What are common areas for lawsuits?
patients who are suicidal or violent
importance of neurotransmitters:
play an important role in human emotion and behavior and are the target for the mechanism of action in many psychotropic medications
Define de-escalation:
process of calming and redirecting a patient who has an immediate potential for violence directed towards self or others
Self-awareness:
process of understanding one's own beliefs, thoughts, motivations, biases, and limitations and recognizing how they affect others (physical problems experienced, significant traumatic life events, prejudice or embarrassing beliefs and attitudes about others background sociocultural factors, affect of above experiences when caring for others)
What should you do if concerns arise about whether the nurse-patient relationship is professional?
seek clinical supervision or transfer care of patient immediately
what is the purpose of audio/ video/ process recordings
so the nurse can monitor interactions and analyze for symbolic meanings, content themes, and blocks to communication
What are the functions of a group?
socialization, support, task completion, camaraderie, informational, normative, empowerment, governance
voluntary commitment:
sound mind, able to give consent, patient wants treatment and they understand what they're getting into and doing
What does self care mean
the ability to perform activities of daily living successfully
Communication block:
topic changes by either client or nurse -may be related to being uncomfortable with the subject (the nurse should try and redirect conversation back to the topic unless the client is too uncomfortable)
What are extrapyramidal symptoms usually caused by?
typical antipsychotic drugs that antagonize dopamine D2 receptors (haloperidol, fluphenazine)
How long should the therapeutic relationship be continued if the patient is leaving the hospital
until a new relationship forms with another care provider, or the patient is getting trained peer support by a psychiatric survivor who successfully transition into the community
What are protective factors?
what is going to keep a person from not committing suicide, buffer individuals from suicidal thoughts and behaviors
When do defense mechanism become maladaptive?
when its persistent use interferes with the person's ability to function and quality of life
nursing diagnosis for the suicidal client
•Risk for Suicide •Interrupted Family Processes •Anxiety •Ineffective Health Maintenance •Risk for Self-directed Violence •Impaired Social Interaction •Ineffective Coping •Chronic Low Self-esteem •Insomnia •Social Isolation •Spiritual Distress
