Community health test 1 Flashcards
________ - __________ ____________ is the setting that provides the necessary care allowing the greatest personal freedom.
Least-restrictive environment
The nurse’s role in acute mental health and community-based mental health care settings are similar in that the nurse provides client education and administers medications in both settings.
true
Benefits of group therapy include
Sharing common feelings and concerns
Sharing stories and experiences
Diminishing feelings of isolation
Creating a community of healing and restoration
Providing a more cost-effective environment than that of individual therapy
termination phase of group development
Marks the end of the group sessions; group members discuss termination issues; group leader summarizes work of the group and individual contributions.
orientation phase of group development
Focus is to define the purpose and goals of the group; group leader sets a tone of respect, trust, and confidentiality among members; members get to know one another and the group leader; discussion about termination to prepare group members.
working phase of group development
Focus is to promote problem-solving skills to facilitate behavior change; group leader uses therapeutic communication to encourage group work toward meeting goals; group members may take informal roles within the group.
Assisting the client with cessation of smoking is an example of what type of mental health therapeutic strategy?
health promotion and health maintenance
Providing incentives to promote client self-care is an example of what type of mental health therapeutic strategy?
promotion of self care activities
Administering prescribed medications; monitoring for adverse effects of medications is an example of what type of mental health therapeutic strategy?
psychobiological interventions
Coordinating holistic care to include medical, mental health, and social services is an example of what type of mental health therapeutic strategy?
case management
___________ - ___________ ___________ is care consisting of:
- dignity and respect
- information sharing
- patient and family participation and
- collaboration in policy and program development
patient centered care
_________ _________ is a small version of the larger society; provides an opportunity for the patient to test new behaviors and increases the patient’s ability to interact adaptively when discharged to the community.
milieu therapy
goals of acute mental health treatment?
Prevention of client harming self or others
Stabilizing mental health crises
Return of clients to community care settings
transference
Feelings that the client has developed toward the therapist in relation to similar feelings toward significant persons in the client’s early childhood
Countertransference
when the nurse displaces onto the patient feelings that are a response to people in the nurse’s past. Strong positive or strong negative reactions to a patient may be indicative of countertransference
Cognitive-Behavioral Therapy (CBT)
Based on the underlying theoretical principle that feelings and behaviors are largely determined by the way people think about the world and their place in it
Dialectical Behavioral Therapy (DBT)
A cognitive-behavioral therapy for clients who have a personality disorder and exhibit self-injurious behavior
Focuses on gradual behavior changes and provides acceptance and validation for these clients
A nursing student new to psychiatric mental health nursing asks a peer what resource he can use to determine which symptoms are present in a specific psychiatric disorder. The best answer would be:
A. Nursing Interventions Classification (NIC)
B. DSM-5
C. Nursing Outcomes Classification (NOC)
D. NANDA-I Nursing Diagnoses
B
Providing a safe environment for patients, orienting the patient to the physical setting, and assisting the patient to participate in appropriate activities are all part of: A. Milieu therapy B. Cognitive-behavioral therapy C. Behavior therapy D. Interpersonal psychotherapy
A
A nurse is planning care for a client who has a mental health disorder. Which of the following actions should the nurse include as a psychobiological intervention?
A. Assist the client with systemic desensitization therapy.
B. Teach the client appropriate coping mechanisms.
C. Assess the client or comorbid health conditions.
D. Monitor the client for adverse effects of medications.
D
persecution
Feels singled out for harm by others (e.g., being hunted down by the FBI)
Grandeur
Believes that he/she is all powerful and important, like a god
somatic delusions
Believes that his/her body is changing in an unusual way, such as growing a third arm
religiosity
Is obsessed with religious beliefs
magical thinking
Believes his/her actions or thoughts are able to control a situation or affect others, such as wearing a certain hat makes him/her invisible to others
thought withdrawal
Believes that her thoughts have been removed from her mind by an outside agency
thought insertion
Believes that others’ thoughts are being inserted into his mind
thought broadcasting
Believes that her thoughts are heard by others
ideas of reference
Misconstrues trivial events and attaches personal significance to them, such as believing that others, who are discussing the next meal, are talking about him
antipsychotics appropriate for positive symptoms
First-Generation (Conventional, Typical) Antipsychotics
antipsychotics appropriate for positive and negative symptoms
Second-Generation/Atypical Antipsychotics
antipsychotics appropriate for positive, negative, and cognitive symptoms
Third-Generation Antipsychotics
medication examples for second generation/atypical antipsychotics
risperidone, clozapine, quetiapine, olanzapine, ziprasidone
medication examples for first generation (Conventional, Typical) Antipsychotics
haloperidol, chlorpromazine, loxapine, fluphenazine
medication examples for Third-Generation Antipsychotics
aripiprazole
A nurse is caring for a patient who has schizoaffective disorder. What type of statement indicates the client is experiencing depersonalization?
“I am no one, and everyone is me”
Signs and symptoms that precede the acute, fully manifested signs and symptoms of disease; occurs in 80-90% of persons with schizophrenia before the emergence of frank psychosis
prodromal phase of schizophrenia
Periods of florid positive symptoms (hallucinations, delusions) as well as negative symptoms (apathy, withdrawal, lack of motivation) and cognitive symptoms
acute phase of schizophrenia
Period in which acute symptoms, particularly the positive symptoms, decrease in severity
stabilization phase of schizophrenia
Period in which symptoms are in remission, although their might be milder persistent symptoms (residual symptoms)
maintenance phase of schizophrenia
Period in which symptoms are in remission, although their might be milder persistent symptoms (residual symptoms)
maintenance phase of schizophrenia
flight of ideas
Associative looseness - A flight of ideas occurs when a person rapidly shifts between conversation topics, making his or her speech challenging or even impossible to follow
neologisms
Made-up words that have meaning only to the client
echolalia
Client repeats the words spoken to him
clang association
meaningless rhyming of works, often in a forceful manner
word salad
Words jumbled together with little meaning or significance to the listener
positive symptoms of schizophrenia
hallucinations, delusions, disorganized speech (associative looseness), bizarre behavior
flat affect, poverty of thought or speech (alogia), lack of motivation (avolition), inability to experience pleasure or joy (anhedonia)
negative symptoms of schizophrenia
inattention, impaired memory, poor problem-solving skills, poor decision-making skills
cognitive symptoms of schizophrenia
depression, anxiety, demoralization, suicidality, hopelessness
affective/mood symptoms of schizophrenia
true or false: Prevention of relapse with schizophrenia can be more important than the risk of side effects from medications because most side effects are reversible, while the consequences of relapse may be irreversible.
true
agranulocytosis
Serious blood-dyscrasia; can be fatal; most often seen with clozapine; requires frequent monitoring of WBC
extrapyramidal symptoms
Acute dystonia, pseudoparkinsonism, akathisia, tardive dyskinesia
neuroleptic malignant syndrome
Life-threatening medical emergency; sudden high fever, blood pressure fluctuations, diaphoresis, tachycardia, muscle rigidity, drooling, decreased LOC, tachypnea, coma
neuroleptic malignant syndrome
Life-threatening medical emergency; sudden high fever, blood pressure fluctuations, diaphoresis, tachycardia, muscle rigidity, drooling, decreased LOC, tachypnea, coma
milieu therapy
opportunity for patient to test new behaviors; increase the patient’s ability to interact adaptively when discharged to the community
nurses role in milieu Therapy
Orienting the client to the physical setting
Identifying rules and boundaries of the setting
Ensuring a safe environment for the client
Assisting the client to participate in appropriate activities
psychoanalysis
Therapeutic process of assessing unconscious thoughts and feelings, and resolving conflict by talking to a psychoanalyst
Clients attend many sessions over the course of months to years
non pharmacological therapeutic therapies
free association, dream analysis and interpretation, transference, and defense mechanism
Psychodynamic psychotherapy
Employs same tools as psychoanalysis, but focuses more on the client’s present state, rather than on his early life
Interpersonal psychotherapy
Assists clients in addressing specific problems
Can improve interpersonal relationships, communication, role-relationship, and bereavement
psychotherapy
Involves more verbal therapist-to-client interaction than classic psychoanalysis
best communication strategies for working with a patient who is hallucinating, paranoid, or experiencing delusions
Overall goal is patient safety and stabilization, Support, psychoeducation, guidance
Supervision & structure in a therapeutic environment (milieu)
depersonalization
positive sign of schizophrenia- A feeling that one is somehow different or unreal or has lost his identity
May feel that body parts do not belong to them or may sense that their body has drastically changed
Derealization
positive sign of schizophrenia- A false perception that the environment has changed (e.g., everything seems bigger or smaller, or familiar surroundings seem somehow strange and unfamiliar)
Extreme motor agitation
positive sign of schizophrenia- Excited physical behavior, including pacing and rocking; can be harmful to self or others
Stereotyped behaviors
positive sign of schizophrenia- Motor patterns that originally head meaning to client such as sweeping the floor or washing windows, but now are mechanical and lack purpose
Automatic obedience
positive sign of schizophrenia- Responding in a robot-like manner
Waxy flexibility
positive sign of schizophrenia- Maintaining a specific position for an extended period of time
Stupor
positive sign of schizophrenia- Motionless for long periods of time; may even appear to be in a coma
Negativism
positive sign of schizophrenia- Doing the opposite of what is requested
Echopraxia
positive sign of schizophrenia- Purposeful imitation of movements made by others
affect
negative sign of schizophrenia - Usually blunted (narrow range of expression) or flat (facial expression never changes)
Severe reduction in the expression of emotions on the face, lack of eye contact, bland intonation of speech
alogia
negative sign of schizophrenia -Poverty of thought or speech
The client might sit with a visitor but only mumble or respond vaguely to questions
anergia
negative sign of schizophrenia - Lack of energy, passivity, lack of persistence at work or school
anhedonia
negative sign of schizophrenia - Lack of pleasure or joy
The client is indifferent to things that often make others happy, such as looking at beautiful scenery
Avolition
negative sign of schizophrenia - Lack of motivation in activities and hygiene; inability to initiate tasks, such as social contacts, grooming, and other aspects of activities of daily living
Cognitive symptoms include
Disordered thinking
Inability to make decisions
Poor-problem solving ability
Difficulty concentrating to perform tasks
Memory deficits
Working memory, such as inability to follow directions to find an address
First-generation (conventional) antipsychotics potential side effects
Extrapyramidal Symptoms (EPS) Acute dystonia Pseudoparkinsonism Akathisia Tardive Dyskinesia (TD Anticholinergic Symptoms Neuroleptic Malignant Syndrome Cardiovascular Effects Hypotension Tachycardia Severe dysrhythmias (prolonged QT interval)
Second-generation/atypical antipsychotics potential side effects
Extrapyramidal Symptoms (EPS)
Anticholinergic Side Effects
Sedation
Adverse effects of agitation, dizziness, sedation, and sleep disruption can occur
Instruct client to report these symptoms as the prescriber might need to change the medication
Orthostatic Hypotension
Monitor BP and HR for orthostatic changes
Weight Gain/Diabetes
To minimize weight gain, advise client to follow a healthy, low-calorie diet, engage in regular exercise, and monitor weight
Metabolic Syndrome: weight gain, dyslipidemia, altered glucose metabolism
Agranulocytosis (in particular with clozapine)
Inform client of the need for blood tests to monitor
Third-generation antipsychotics nursing considerations
Produces little risk of EPSs or tardive dyskinesia
Unlikely to cause significant metabolic effects, hypotension, or prolactin release
Produces little anticholinergic effect
Does not seem to cause dysrhythmias
dopamine relationship to mental health disorder
Increased in schizophrenia and mania.
Decreased in depression.
norepinephrine relationship to mental health disorder
Decreased in depression.
Increased in schizophrenia, mania, and anxiety.
serotonin relationship to mental health disorder
Thought to play a role in thought disorders of schizophrenia.
Decreased in depression.
Possibly decreased in anxiety and obsessive compulsive disorder.
GABA relationship to mental health disorder
Decreased in anxiety and schizophrenia.
Dopamine
Sleep/wake cycle. Signals muscles to become active.
norepinephrine
Affects attention, learning, memory, and regulation of mood, sleep, and wakefulness.
serotonin
Affects sleep and wakefulness, especially falling asleep. Affects mood and thought processes.
GABA
Amino acid that modulates other neurotransmitters.
the five major families of psychotropic medications
- Antidepressants
- Antianxiety agents (Anxiolytics)
- Antipsychotics
- Mood Stabilizers
- Stimulants
anticholinergic effects
Can’t see- blurred vision
Can’t pee- urinary retention
Can’t spit- dry mouth
Can’t s***- constipation
pseudoparkinsonism
stooped posture, shuffling gait, rigidity, bradykinesia, tremors, pill rolling
acute dystonia
facial grimacing, involuntary upward eye movement, muscle spams to tongue/face
akathisia
restless, trouble standing still, pacing, feet inconstant motion
tardive dyskinesia
protrusion and rolling of the tongue, sucking and smacking movements of lips, chewing motion, facial dyskinesia, involuntary movements
antidepressants have an effect on what neurotransmitter?
norepinephrine and serotonin
Selective Serotonin Reuptake Inhibitors (SSRIs)
block the reuptake of serotonin which increase the availability of that neurotransmitter for use in the synapse.
Tricyclic Antidepressants (TCAs) side effects
sedation, orthostatic hypotension, anticholinergic effects, cardiac dysrhythmias.
overdose can be deadly
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
Increase the levels of both serotonin and norepinephrine by inhibiting their reuptake into cells in the brain
Selective Serotonin Reuptake Inhibitors (SSRIs) side effect
Serotonin syndrome is a potentially life-threatening condition resulting from excess serotonin agonist activity
Monoamine Oxidase Inhibitors (MAOIs)
MAOIs block monoamine oxidase by binding to the enzyme and permanently inactivating it
restrictions when taking MAOIs
Tyramine-free diet - if not followed can lead to hypertensive crisis
initial drugs of choice for many patients with depression
SSRIs
Withdrawal Emergent Syndrome from SSRI’s
caused by abrupt cessation of SSRIs causes cholinergic rebound: dizziness, flu-like, paresthesias, myalgia, insomnia, chills, tearfulness, sensory-perceptual
anti-anxiety medications
benzodiazepines
anti-anxiety medications neurotransmitter
increases the receptor responsiveness to GABA
risks of anti-anxiety medications
Risk of dependence
Caution when driving
Do not use with alcohol
Do not stop abruptly
full therapeutic effect of Antipsychotic Drugs
Takes time to have a full therapeutic effect however the antipsychotics may be used for rapid sedation.
intrapersonal communication
Communication that occurs within an individual.
Also referred to as “self talk”
interpersonal communication
Communication that occurs one-on-one with another individual
Small-group communication
Communication that occurs between two or more people in a small group
Public communication
Communication that occurs with large groups of people
Transpersonal communication
Communication that addresses an individual’s spiritual needs and provides interventions to meet those needs
therapeutic communication skilla
open ended questions, closed ended questions, projective questions, presupposition questions, restating, reflecting, paraphrasing, exploring, offering general leads, broad opening statements, showing acceptance, focusing, giving information, presenting reality, summarizing, offering self, touch
nontherapuetic communication techniques
presenting reality, summarizing, offering self, touch if inappropriate, irrelevant questions, why questions, excessive questioning, personal opinions, advice, false reassurance, minimizing feeling, changing the topic, offering value judgements, responding approvingly, responding disapprovingly
true or false: Asking excessive questions and using “why” questions are examples of effective communication techniques.
false
true or false: Intrapersonal communication is communication that occurs within an individual, while interpersonal communication is communication that occurs one-on-one with another individual.
true
phases of therapeutic relationship
pre-orientation, orientation, working, termination
orientation phase
Introduce self to the client and state purpose
Set the contract: meeting time, place, frequency, duration, and date of termination
Discuss confidentiality
Build trust by establishing expectations and boundaries
Set goals with the client
Explore the client’s ideas, issues, and needs
Explore the meaning of testing behaviors
Enforce limits on testing or other inappropriate behaviors
working phase
Maintain relationship according to the contract
Perform ongoing assessment to plan and evaluate therapeutic measures
Facilitate the client’s expression of needs and issues
Encourage the client to problem-solve
Promote the client’s self-esteem
Foster positive behavioral change
Explore and deal with resistance and other defense mechanisms
Recognize transference and countertransference issues
Reassess the client’s problems and goals, and revise plan as necessary
Support the client’s adaptive alternatives and use of new coping skills
Remind the client about the date of termination
termination phase
Provide opportunity for the client to discuss thoughts and feelings about termination and loss
Discuss the client’s previous experience with separations and loss
Elicit the client’s feelings about the therapeutic work in the nurse-client relationship
Summarize goals and achievements
Review memories of work in the sessions
Express own feelings about sessions to validate the experience with the client
Discuss ways for the client to incorporate new healthy behaviors into life
Maintain limits of final termination
which terms are used in Nevada to refer to a temporary emergency admission for mental health care?
legal 2000 and 72 hour hold
Psychiatric Advance Directives (PAD)
Allows patients concerned they may be subject to involuntary psychiatric hospitalization to prepare a Psychiatric Advance Directive that expresses their treatment choices.
Can clarify the patient’s choice of a surrogate decision maker and instructions about hospital choices, medications, treatment options, and emergency interventions.
Identifies individuals who are to be notified of the patient’s hospitalization and who may have visitation rights.
true or false: The use of the least restrictive means of restraint for the shortest duration is always the general rule and even the law.
true
Beneficence
The quality of doing good, can be described as charity
Autonomy
The client’s right to make their own decisions. However, the client must accept the consequences of those decisions. The client must also respect the decisions of others
Justice
Fair and equal treatment for all
Fidelity (nonmaleficence)
Loyalty and faithfulness to the client and to one’s duty
Veracity
Honesty when dealing with a client
Documentation of seclusion and restraint must include which of the following:
Precipitating events and behavior of the client prior to seclusion or restraint
Alternative actions taken to avoid seclusion or restraint
Time treatment began
Time released from restraints
types of admission to mental health facility
1. Voluntary admission;
2. Emergency admission; and
3. Involuntary court-ordered admission.
