Counselling, Crisis, Difficult pt + Disability Flashcards

1
Q

Factors to consider when counselling pts

A

Set clear therapeutic goals
allow adequate time for assessment, identify context and pt’s understanding of problem, evaluate own skills, recognise when your beliefs may interfere with counselling
remain aware of risks of offering advice vs providing options
pay close attention to quality of therapeutic relationship
Recognise transference/ counter-transference

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2
Q

What are the aspects of counselling to educate pt on

A

Expectations
Timing
Frequency
Costs
Duration
Homework

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3
Q

Approach to pt in crisis

A

Acknowledge feelings + help de-escalate
Identify pt’s personal supports
Offer appropriate community resources
Assess suicidality

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4
Q

How to manage difficult pt

A

Seek out info about pt’s life circumstances, context + functional status
Remain vigilant for new sx
Identify own attitude and contribution to situation
set clear boundaries

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5
Q

What dz to look for in difficult pts

A

PDs

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6
Q

When to end therapeutic relationship

A

take steps to end physician-patient relationship when it is in pt’s best interests to

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7
Q

What to screen for in elderly for disability risks

A

falls, cognitive impairment, immobilization, decreased vision

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8
Q

What are the spheres of function?

A

emotional, physical, social

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9
Q

,approach to disability

A

orthotics, lifestyle mods, time off work, community support

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10
Q

When to think about driving safety

A

after bad news, any new meds, flying, operating heavy machinery, cancer dx, cast/mobility, eye dz

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11
Q

What strategies can you use for difficult pts?

A

Limit appointment duration + frequency, avoid polypharmacy w/ benzos, opioids, drugs of abuse, Z drugs, quetiapine, think about countertransference, consider terminating relationship, speak to CPSBC

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12
Q

Dx criteria for schizotypal disorder

A

impairments in self functioning, self direction, interpersonal function, eccentricism, cognitive dysregulation, unusual beliefs, withdrawal

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13
Q

What to cover in appt w/ disabled person

A

support and education for family, ensure FU, community engagement, monitoring for AE, monitoring for abuse

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14
Q

What are the criteria for disability tax benefit?

A

Blindness, 1+ ADLs severely impaired, 2+ ADLs significantly impaired, needs life-sustaining therapy - must be ongoing x1yr

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15
Q

What are the requirements for canada pension plan disability?

A

Mental or physical disability, prolonged and prevents any work

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16
Q

What are registered disability savings plans?

A

Only if the person is eligible for disability tax credit, max age 59, not taxed on withdrawal

17
Q

Signs of abuse/ neglect in people w/ developmental disabilities?

A

Change in weight, noncompliance, aggression/ withdrawal, depression, avoidance, poor self esteem, sexualised behaviour, sleep or eating disorders, substance use

18
Q

What is often underdiagnosed in people w/ dev difficulties?

A

Vision + hearing impairment, dental dz

19
Q

What conditions are those with intellectual disability at risk of?

A

Vision impairment, hearing impairment, thyroid dz, resp dz, obesity, OP, AD, depression

20
Q

Aggressive patient management

A

name the emotion (I can see you’re angry), ask how you can help, consider other causes, safety first (suicidal, homicidal, weapons, kids)

21
Q

Causes of aggression

A

DIM FACES = drugs, dehydration, infection, metabolic, meds, failure, anemia/ alcohol, cardiac/ stroke, electrolyte, structural (brain tumor)

22
Q

Steps for trauma informed care

A

Bear witness to pt’s trauma experience
Create safe space and recognise emotional and physical safety
Include pt’s in healing process
Believe in pt’s strength and resilience