Basic Concepts & Foundations in Psychiatric Mental Health Nursing Flashcards
(4) [includes other lesson] - Introduction to psychiatric nursing - Psychopharmacology
Historical Overview
* Primitive beliefs
* Ancient beliefs
* Colonial Americans
* The 19th century
* Today
* Etiology based on superstitions related to the supernatural
* Leaders such as Benjamin Rush, Dorothea Dix, Linda Richards
Maslow’s hierarchy of needs
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is the fulfillment of one’s highest potential
Self-actualization
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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”
Mental health
___ response
* Behavior that disrupts the integrity of the individual
* Negative or unhealthy
Maladaptive
* Remember, there is no definitive definition of stress.
___ response
* Maintains the integrity of the individual
* Positive, healthy
Adaptive
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
* 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
Stress as
* Biological event (fight-or-flight response)
* Environmental event
* Transaction between the individual and environment
Defense Mechanisms
* Some defense mechanisms are more adaptive than others
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Failure to acknowledge real issues (conflicts and situations), especially those that are painful
Denial
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Overachieving or emphasizing a desirable trait to cover a real or perceived deficiency
Compensation
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Modeling of behavor, attitudes, or belief of an admired individual
Identification
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Transfer of intense feelings to less threatening person(s) or not at fault
Displacement
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Integration of another person’s beliefs or values into one’s own ego
Introjection
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Acknowledging the facts of a situation without acknowledging the feelings
Intellectualization
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Separating a thought or memory from the feeling, tone or emotions associated with it
Isolation
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Attributing feelings or impulses unacceptable to oneself to another person
Projection
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Unacceptable thoughts or feelings or behaviors are prevented from being exhibited by exaggerating the opposite behavior
Reaction Formation
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Justification of unacceptable feelings or behaviors with logical reasons
Rationalization
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Involuntarily blocking unpleasant feelings or experiences from one’s conscious awareness
Repression
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Retreating in response to stress to an earlier development and comfort measures associated with that level of functioning
Regression
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Voluntary blocking of unpleasant thoughts or feelings from conscious awareness
Suppression
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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
Sublimation
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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
Undoing
Psychological Adaptation to Stress: Grief
* Emotional (mourning)
* Physical
* Social
* May be prolonged
* Anticipatory grieving
* Kubler-Ross’ 5 stages of the grief response (__, __, __, __,__)
* Maladaptive grief
Denial > anger > bargaining > depression > acceptance
Psychobiology
The study of the biological foundation of cognitive, emotional, and behavioral processes
* Neurophysiological
* Psychoneuroimmunology
* Genetics
* Neuroendocrinology
* 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
Cerebral Lobes
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Perception and interpretation of sensory information
Parietal
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* Thinking
* Judgement
* Expression of feelings
Frontal
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* Hearing
* Short term memory
* Sense of smell
* Expression of emotion
Temporal
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* Reception of visual output and interpretation
* Spatial relationships
Occipital
What are the 2 components of the diencephalon?
Thalamus, hypothalamus
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Regulates pituitary gland, ANS, temperature, appetite, BP, circadian rhythm
Hypothalamus
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* Integrates all sensory input (except smell)
* Temporarily blocking minor sensations
* Impacted by dopamine
Thalamus
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The “emotional brain”
Associated with feelings of fear, anxiety, anger, rage, aggression, love, joy, and hope; sexuality and social behavior
Limbic system
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Generates and transmits electrochemical impulses across synapses
Nerve tissue
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
Reuptake
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* 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
Neuroendocrinology
Psychopharmacology
Psychotropic meds
- Effect psychic function, behavior, or experience
- Not a cure
- Intended to be used as ADJUNCTIVE therapy with individual or group
Role of the nurse involves assessment, medication administration and evaluation, and patient education
Ethical & Legal
* ANA Code of Ethics for nurses
* Psychiatric Mental Health Nursing Scope and Standards of Practice
Ethical Principles
* Autonomy
* Beneficence
* Nonmaleficence
* Justice
* Veracity
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Involves the principle of to do no harm
Nonmaleficence
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Is the duty to benefit; to serve the client’s best interest(s)
Beneficence
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Is to be honest and to tell the truth
Veracity
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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
Justice
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Where patients are capable of making independent choices
Determining of one’s own destiny
Autonomy
Hospitalizations
* Voluntary
* Involuntary
* Emergency
* Involuntary outpatient
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
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
Negligence
Malpractice; malpractice; negligence
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
Cultural & Spiritual
* Generalization
* Stereotyping
6 cultural phenomena
* Communication
* Space
* Social organization
* Time
* Environmental control
* Biological variation
Spirituality
* Meaning and purpose
* Spiritual needs
* Religion
Implications for the nurse
- Cultural
- Spiritual
- Religious
Psychotropic Medications
* Medication that affects psychic function, behavior, or experience
* Intended to be used as an adjunctive therapy to individual or group psychotherapy
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
Baseline Assessment
* History and physical examination
* Ethnocultural assessment
* Comprehensive medication assessment
Role of the Nurse
* Assessment
* Monitor for side effects, adverse effects, and therapeutic effects
* Client education
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
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* 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
Antidepressants
Mood-stabilizing Agents
* Lithium (is affected by fluid and salt intake; has a narrow therapeutic range)
* Anticonvulsants (Depakote, valproic acid)
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
