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NUR 201 Week 1 > Basic Concepts & Foundations in Psychiatric Mental Health Nursing > Flashcards

Basic Concepts & Foundations in Psychiatric Mental Health Nursing Flashcards

(4) [includes other lesson] - Introduction to psychiatric nursing - Psychopharmacology

1
Q

Historical Overview
* Primitive beliefs
* Ancient beliefs
* Colonial Americans
* The 19th century
* Today

A

* Etiology based on superstitions related to the supernatural
* Leaders such as Benjamin Rush, Dorothea Dix, Linda Richards

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2
Q

Maslow’s hierarchy of needs

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is the fulfillment of one’s highest potential

A

Self-actualization

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3
Q

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Viewed as “the successful adaptation to stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are age-appropriate and congruent with local and cultural norms”

A

Mental health

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4
Q

___ response

* Behavior that disrupts the integrity of the individual

* Negative or unhealthy

A

Maladaptive

* Remember, there is no definitive definition of stress.

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5
Q

___ response

* Maintains the integrity of the individual

* Positive, healthy

A

Adaptive

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6
Q

Psychological Adaptation to Stress: Anxiety

* A diffuse, vague apprehension that is associated with feelings of uncertainty and helplessness

* Low levels are adaptive, motivator

* Problematic when interferes with ability to meet basic needs

* Peplau’s 4 levels of anxiety (mild, moderate, severe, panic)

* Behavioral adaptation responses to anxiety

A

* Anxiety and grief as 2 primary psychological responses to stress

* Behaviors associated are coping mechanisms, ego defense mechanisms, psychophysiological responses, psychoneurotic responses, and psychotic responses

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7
Q

Stress as

* Biological event (fight-or-flight response)

* Environmental event

* Transaction between the individual and environment

A

Defense Mechanisms

* Some defense mechanisms are more adaptive than others

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8
Q

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Failure to acknowledge real issues (conflicts and situations), especially those that are painful

A

Denial

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9
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Overachieving or emphasizing a desirable trait to cover a real or perceived deficiency

A

Compensation

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10
Q

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Modeling of behavor, attitudes, or belief of an admired individual

A

Identification

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11
Q

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Transfer of intense feelings to less threatening person(s) or not at fault

A

Displacement

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12
Q

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Integration of another person’s beliefs or values into one’s own ego

A

Introjection

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13
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Acknowledging the facts of a situation without acknowledging the feelings

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Intellectualization

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14
Q

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Separating a thought or memory from the feeling, tone or emotions associated with it

A

Isolation

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15
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Attributing feelings or impulses unacceptable to oneself to another person

A

Projection

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16
Q

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Unacceptable thoughts or feelings or behaviors are prevented from being exhibited by exaggerating the opposite behavior

A

Reaction Formation

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17
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Justification of unacceptable feelings or behaviors with logical reasons

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Rationalization

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18
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Involuntarily blocking unpleasant feelings or experiences from one’s conscious awareness

A

Repression

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19
Q

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Retreating in response to stress to an earlier development and comfort measures associated with that level of functioning

A

Regression

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20
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Voluntary blocking of unpleasant thoughts or feelings from conscious awareness

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Suppression

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21
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Rechanneling or substitution of drives of socially or personally unacceptable into activities that are constructive

Example - a mother whose son was killed by a drunk driver becomes president of MADD

A

Sublimation

22
Q

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Symbolically negating or canceling out an experience that one finds intolerable

Example - a man yells at his wife because he is stressed about his new job at work and buys her flowers on his way home from work

A

Undoing

23
Q

Psychological Adaptation to Stress: Grief

* Emotional (mourning)

* Physical

* Social

* May be prolonged

* Anticipatory grieving

* Kubler-Ross’ 5 stages of the grief response (__, __, __, __,__)

* Maladaptive grief

A

Denial > anger > bargaining > depression > acceptance

24
Q

Psychobiology

The study of the biological foundation of cognitive, emotional, and behavioral processes

* Neurophysiological

* Psychoneuroimmunology

* Genetics

* Neuroendocrinology

A

* Psychiatric nursing moving from a psychosocial to biopsychosocial focus

* Psychoneuroimmunology examines the relationship between psychological factors, the immune system, and the nervous system

* Genetics can be implicated in the etiology of schizophrenia, bipolar, depressive disorder, panic disorder, anorexia, alcoholism, and OCD

25
Q

Cerebral Lobes

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Perception and interpretation of sensory information

A

Parietal

26
Q

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* Thinking

* Judgement

* Expression of feelings

A

Frontal

27
Q

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* Hearing

* Short term memory

* Sense of smell

* Expression of emotion

A

Temporal

28
Q

?

* Reception of visual output and interpretation

* Spatial relationships

A

Occipital

29
Q

What are the 2 components of the diencephalon?

A

Thalamus, hypothalamus

30
Q

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Regulates pituitary gland, ANS, temperature, appetite, BP, circadian rhythm

A

Hypothalamus

31
Q

?

* Integrates all sensory input (except smell)

* Temporarily blocking minor sensations

* Impacted by dopamine

A

Thalamus

32
Q

?

The “emotional brain”

Associated with feelings of fear, anxiety, anger, rage, aggression, love, joy, and hope; sexuality and social behavior

A

Limbic system

33
Q

?

Generates and transmits electrochemical impulses across synapses

A

Nerve tissue

34
Q

Neurotransmitters (are chemicals that convey information across synaptic clefts to neighboring target cells)

* Associated with numerous disorders

* Central to the therapeutic action of many psychotropic medications

* ?
Process of neurotransmitter INACTIVATION; neurotransmitter is reabsorbed

* Classified into categories based on their chemical structure or their effect

A

Reuptake

35
Q

?

* Study of the interaction between the nervous system and endocrine system

  • Can affect various hormones of cognitive, emotional, and behavioral functioning including the pituitary and anterior pituitary glands
  • Hormones, in their circadian rhythm of regulation, significantly influence a number of physiological phenomenon including mood, sleep, arousal, stress response, appetite, libido, and fertility
A

Neuroendocrinology

36
Q

Psychopharmacology

Psychotropic meds

  • Effect psychic function, behavior, or experience
  • Not a cure
  • Intended to be used as ADJUNCTIVE therapy with individual or group
A

Role of the nurse involves assessment, medication administration and evaluation, and patient education

37
Q

Ethical & Legal

* ANA Code of Ethics for nurses

* Psychiatric Mental Health Nursing Scope and Standards of Practice

A

Ethical Principles

* Autonomy

* Beneficence

* Nonmaleficence

* Justice

* Veracity

38
Q

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Involves the principle of to do no harm

A

Nonmaleficence

39
Q

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Is the duty to benefit; to serve the client’s best interest(s)

A

Beneficence

40
Q

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Is to be honest and to tell the truth

A

Veracity

41
Q

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Is the right of the individual to be treated equally regardless of race, sex, marital status, diagnosis, social and economic status, and religion

A

Justice

42
Q

?

Where patients are capable of making independent choices

Determining of one’s own destiny

A

Autonomy

43
Q

Hospitalizations

* Voluntary

* Involuntary

* Emergency

* Involuntary outpatient

A

Emergency commitments are time-sensitive and a court hearing is scheduled usually within 72 hours. The court may decide if the client can be discharged or if deemed necessary, voluntary admission is refused by the client an additional period of involuntary hospitalization may occur

44
Q

Ethical & Legal Issues in Psychiatric Mental Health Nursing

___ is conduct that falls below the standard of care or a claim and does not protect the patient

If patient care was not rendered in a manner that is consistent with a standard of care or the patient was injured, this can result in ___. ___ can be applied to professional persons whereas ___ can be applied to anyone

A

Negligence

Malpractice; malpractice; negligence

45
Q

Avoiding Liability

* Responding to the patient; educating the patient; complying with the standards of care; supervising care; adhering to the nursing process; documenting carefully; and following up on evaluating the care that was given

* Good interpersonal skills are the mainstay to avoid liability

A

Cultural & Spiritual

* Generalization

* Stereotyping

46
Q

6 cultural phenomena

* Communication

* Space

* Social organization

* Time

* Environmental control

* Biological variation

A

Spirituality

* Meaning and purpose
* Spiritual needs
* Religion

Implications for the nurse

  • Cultural
  • Spiritual
  • Religious
47
Q

Psychotropic Medications

* Medication that affects psychic function, behavior, or experience

* Intended to be used as an adjunctive therapy to individual or group psychotherapy

A

Ethical & Legal Implications

* Most states adhere to a client’s right to refuse treatment except in emergency situations where a client is likely to harm themselves or others

48
Q

Baseline Assessment

* History and physical examination

* Ethnocultural assessment

* Comprehensive medication assessment

A

Role of the Nurse

* Assessment

* Monitor for side effects, adverse effects, and therapeutic effects

* Client education

49
Q

How these meds work

* Psychotropic medications affect neurotransmission

* Most psychotropic medications affect the neuronal synapse, producing changes in neurotransmitter release and the receptors to which they bind

* Reuptake is the process of neurotransmitter inactivation

A
50
Q

?

* Increasing concentration of norepinephrine, serotonin, and/or dopamine in the body either by blocking their reuptake by the neurons (TCAs, tetracyclics, SSRIs, SNRIs)

* Inhibiting the release of MAOIs

* Serotonin syndrome

* Interactions with MAOIs

* Black box warning for SSRI’s

A

Antidepressants

51
Q

Mood-stabilizing Agents

* Lithium (is affected by fluid and salt intake; has a narrow therapeutic range)

* Anticonvulsants (Depakote, valproic acid)

A

Antipsychotics

  • Typical vs atypical
    * Typical - medications that have been around much longer such as haloperidol, Thorazine
    * Atypical - are newer and include risperidone (Risperdal)
  • Clozapine = agranulocytosis
  • EPS = extrapyramidal side effects
    * Involves abnormal movements like tremors, shuffling gait; pseudoparkinsonism
  • TD = tardive dyskinesia
  • NMS = Neuroleptic Malignant Syndrome
  • Prolonged QT intervals
    * This can put the patient at risk for ventricular tachycardia or ventricular fibrillation

NUR 201 Week 1 (4 decks)

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