EXAM 1 Flashcards
Id
Sigmund freud
- is unconscious and impulsive. it is the drive of all instincts, reflexes, and needs
- the id cannot tolerate frustration & seeks to discharge tension and return to a more comfortable level of energy
- lacks the ability to problem solve and is illogical
Ego
Sigmund freud
- child beings to interact with others within the 1st few years of life
- unconscious, conscious, preconscious levels of awareness
- differentiate subjective experiences, memory images & objective reality
- The reality principle
superego
- develops between the ages of 3 and 5
- represents the moral component of personality
- resideds in the conscious, preconscious and unconscious levels of awareness
- conscience –all of the should nots internalized from parents and society
- ego ideal– all of the shoulds internalized from parents and society
- guilt can occur when the behavior falls short of ideal
- if the superego is too powerful, then the person can be self-critical and suffer from inferiority
transference
unconscious feelings that the patient has toward a healthcare worker orininally felt in childhood for a significant other
“you remind me exactly of my sister” the transference can be positive (affectionate) or negative (hostile)
countertransference
refers to unconscious feelings that the healthcare worker has torwards the patient
If the patient reminds you of someone you do not like, then they may uncounsciously react as if the patient were that person
maslows hierachy of needs
Physiological needs The most basic needs are the physiological drives—needing food, oxygen, water, sleep, sex, and a constant body temperature. If all needs were deprived, this level would take priority over the rest.
Safety needs: Once physiological needs are met, safety needs emerge. They include security; protection; freedom from fear, anxiety, and chaos; and the need for law, order, and limits.
Belonging and love needs People have a need for intimate relationships, love, affection, and belonging and will seek to overcome feelings of loneliness and alienation. Maslow stresses the importance of having a family and a home and being part of identifiable groups.
Esteem needs People need to have a high self-regard and have it reflected to them from others. If self-esteem needs are met, they feel confident, valued, and valuable. When self-esteem is compromised, they feel inferior, worthless, and helpless.
Self-actualization becoming everything one is capable of
self-transcendence (overcoming limits of the individual self and desire in spiritual contemplation and realization)
Erikson’s stages of development
Trust versus mistrust
* infancy (0–1½ years) Forming attachment to mother, which lays foundations for later trust in others
Autonomy versus shame and doubt
* Early childhood (1½–3 years) Gaining some basic control of self and environment (e.g., toilet training, exploration)
Initiative versus guilt
* Preschool (3–6 years) Becoming purposeful and directive
Industry versus inferiority
* School age (6–12 years) Developing social, physical, and school skills
Identity versus role confusion
* Adolescence (12–20 years) Making transition from childhood to adulthood; developing sense of identity
Intimacy versus isolation
* Early adulthood (20–35 years) Establishing intimate bonds of love and friendship
intimacy vs isolation
* Middle adulthood (35–65 years) Fulfilling life goals that involve family, career, and society; developing concerns that embrace
Integrity versus despair
* Later years (65 years to death) Looking back over one’s life and accepting its meaning
pre-orientation phase
- preparing for assessment
- recognizing your own thoughts and feelings regarding the 1st meeting
orientation phase
first time the nurse and the patient meet & is the phase where the nurse conducts the initial interview
- pt may begin to express thoughts, and feelings, identify problems & discuss realistic goals
i. Establish Rapport by displaying empathy, genuineness, unconditional
positive regard
ii. Specify a contract- either stated or written, place, time, date, and duration of the meetings, also discussing termination of relationship.
iii. Explaining Confidentiality- who will be given the information shared with the nurse, the information might be shared with clinical supervisor, physician, staff, or other nursing students in conference
working phase
Gathering further data
* Identifying problem-solving skills and self-esteem
* Providing education about the disorder
* Promoting symptom management
* Providing medication education
* Evaluating progress
termination phase
- final integral phase of the nurse-patient relationship
- discuss termination during the 1st meeting and again during the working state
- can occur during discharge
- Summarizing the goals and objectives achieved
- Reviewing patient education and providing handouts
- Discussing ways for the patient to incorporate new coping strategies
- Reviewing situations that occurred during the nurse-patient relationship
- Exchanging memories, which can help validate the experience for both nurse and patient and facilitate closure of that relationship
western worldviews
roman, greek, judeo-christian, the enlightenment; decartes
* the “real” has form and essence; reality tends to be stable
* cartesian dualism: body and mind spirit
* self is the staring point of idenity
* time is linear
* wisfom: preparation for the future
* disease has a cause that creates the effect: disease can be observed and measured
Eastern worldviews
- chinese and indian philosphers: buddha, confucius, laotse
- The “real” is a force or energy; reality is always changing
- mind-body-spirit unity
- family is the starting point of idenity
- time is circular, flexible
- wisdom; acceptance of what is
- disease is caused by lack of balance and energy forces (yin-yang, hot-cold) imbalance between daily routine, diet, and constituational type
- one is born into an unchangeable fate
indigenous worldview
- deep relationship with nature
- the “real” is multidimensional; reality transcends time and space
- mind, body, and spirit are united; there may not be words to indicate them as distinct entities
- community is the starting point of idenity; a person is only an enity in relation to others; there may be no concept of person or personal ownership
- time is focused on the present
- wisdom; knowledge of nature
- disease is caused by a lack of personal, interpersonal, environment, or spiritual harmony; thoughts and words can shape reality; evil spirits exist
stigma of mental illness
- stigma presents significant barriers that delay or prevent individuals from seeking treatment
- some associate mental illness with weakness or dangerousness
- in some cultural groups, the stigma of mental illness may be more prevalent or severe
- In cultural groups that emphasize the interdependence and harmony of the family, mental illness may be perceived as a failure of the family
- Stigma and shame can lead to reluctance to seek help, so members of these cultural groups may delay or prevent entry into the mental healthcare system.
worldview
A system of thinking about how the world workds and how people should act, especially in relation to one another
stigma
negative attitudes toward mental illness and its treatments in which they engage
serotonin syndrome
onset abrupt
course rapidly resolving
neuromuscular findings mycoclonus and tremors
reflexes increased
pupils mydriasis
classic traits of the four levels of anxiety
perception
mild=focused
moderate= selective inattention
severe= distortive, scattered, detail focused
painic= lack of processing, depersonalization, derealization
problem-solving
mild= effective, appropriate action
moderate= effective but not at an optimal level
severe= ineffective due to confusion
panic= ineffective due to irrational reasoning
characteristics
mild= restlessness, irritability, fideting, nail biting
moderate= increased HR and RR, GI distress, voice tremors, pacing
severe= rapid speech, hyperventilation, sense of doom
panic= hallucination, impulsivity, unintelligible, communication, withdrawl
seperation anxiety
- seperation from home or attachment figures, developmentally inappropriate
- lasts greater than 4 weeks in children/ adolescents, 6 months in adults
EXAMPLE– fear over accidents, clingling or shawdowing, traveling independently
specific phobias
- crippling fear or anxiety over a particular object or situation with active avoidance
- most individuals have more than one phobia
EXAMPLES
Arachnophobia- spiders
ophidiophobia- snakes
acrophobia- heights
agoraphobia- open or enclosed spaces
cynophobia- dogs
social anxiety
- fear or anxiety over exposure to possible scrunity by others with an attempt to avoid socai situations
- typically lasts greater than 6 mo
Examples
public speaking, performing arts, eating in front of others
panic disorders
- recurrent, unexpected panic attacks (abrupt onset of fear with feelings of impending doom)
- panic attacks can last for several minutes, followed by one month of persistant worry about future panic attacks
generalized anxiety disorder
- excessive worry over multiple events, lasting greater than 6 months
- females are at a greater risk
- must display a minimum of 3 following symptoms; restlessness, easy to fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbances
- cannot be explained by other physiological or psychological disorder, or substance use
obsessive-compulsive disorder
- obsessions-anxiety and stress caused by persistent thoughts, urges, or images with attempts to ignore or suppress by performing another thought or action
- compulsion- repetitive actions an individual needs to perform in response to the obsession; goal to eliminate the anxiety associated with the obsession
- four areas- checking, contamination/ mental contamination, hoarding, rumination, intrusive thoughts
body dismorphic disorder
- peroccupation with one or more perceived flaw or defect in physical appearance that is not obserable to others
- performs repetitive behaviors or mental comparisons in response to the appearance concern, average 3-8 hours every day
- does not meet diagnostic criteria for an eating disorder
hoarding disorder
- difficulty getting rid of items regardless of actual value
- accumulation of items that clutter living areas and impede safety, social functioning
- not related to another physical or psychological disorder
hair pulling/ skin picking disorder
- Trichotillomania- recurrent pulling of hair that may lead to permanent loss, despite attempts to cease acivity
- Excoriation- recurrent picking at skin that results in lesions (commonly in the face and arms), despite attempts to cease activity
- both disorders impede social functioning, and not related to another physical or psychological disorder
Tricyclics
- 1st generation
- indigestion
- HA
- dry mouth
- drowsiness
- elevated HR
SSRIs
- 2nd generation
- sweating
- indigestion and nausea
- HA
- dry mouth
- drowsiness
- sexual side effects
SNRIs
- tremors
- nausea
- HA
- dry mouth
- blurred vision
- increased blood pressure
- sexual side effects
- nervousness
- dizziness
MAOIs
- insomnia
- muslce aches
- low blood pressure
- dry mouth
- sexual side effects
- nervousness
- dizziness
- avoid decongestants & certain foods
new combinations of antidepressants
- appetite changes
- indigestion and constipation
- HA
- dry mouth
- insomnia
- sweating
- nervousness
- sexual side effects
- vomitting
benzodiazepines
- GABA agonist
- used as antianxiety, hypnotic (sleep-inducing), anticonvulsant, amnestic (loss of memory), and muscle relaxant properties
- sedation is a potential side-effect
- is a controlled substance with the pontial of misuse
- caution with the use of machinery
- monitor for side effects including sedation, ataxia, and decreased cognitive function.
- fall/ fracture risk in the elderly
- ataxia (impaired coordination)
antianxiety medications MOA
increase the effectiveness of the neurotransmitter GABA
Assessment for anxiety
- patients are experts when it comes to their own illnesses
- assessment should be patient centered to be helpful or meaningful
- ask about what has helped in the past
- identify expectations for the patients personal participation in care and for the family’s or significant others participation in care.
- assess for cultural, ethnic, and social backgrounds that may affect the care that you and the patient plan
- objectively you can use scales to help measure anxiety related symptoms
- phobias are measured on the fear questionnaire
- panic symptoms are measured on the panic disorder severity scale
Assessment guidelines for anxiety
- Ensure that a physical and neurological examination is conducted to help determine whether the anxiety is primary or secondary to another psychiatric disorder, medical condition, or substance use.
- Determine the patient’s current level of anxiety (mild, moderate, severe, or panic).
- Assess for the potential for self-harm and suicidal ideation. People suffering from high levels of intractable anxiety may become desperate and attempt suicide.
- Perform a psychosocial assessment. Always ask the person, “What is going on in your life that may be contributing to your anxiety?” The patient may identify a problem (stressful marriage, recent loss, stressful job, or school situation) that could be addressed by counseling.
Mild level of anxiety
- heightened perceptual field
- focus is flexible and is aware of the anxiety
- Able to work effectively toward a goal and examine alternatives
Physical or other characteristics
* Slight discomfort
* Attention-seeking behavior
* Restlessness
* Easily startled
* Irritability or impatience
* Mild tension-relieving behavior (foot or finger tapping, lip chewing, fidgeting)
severe to panic levels of anxiety
- greatly reduced and distored perceptual field
- focuses on details or one specific detail// attention is scattered
- problem solving seems impossible & unable to see connections between events or details
Physical or other characteristics
* Feelings of dread
* Confusion
* Purposeless activity
* Sense of impending doom
* More intense somatic complaints (chest discomfort,
* dizziness, nausea, sleeplessness)
* Diaphoresis (sweating)
* Withdrawal
* Loud and rapid speech
* Threats and demands
Antidepressants
- SSRIs are considered 1st line of defense in most anxiety disorders
- paroxetine (Paxil), fluoxetine (Prozac), escitalopram (Lexapro), and sertraline (Zoloft).
- some can increase anxiety initally (fluoxetine & sertraline)
- paroxetine tends to have a more calming effect than the others
- Antidepressants have the secondary benefit of treating comorbid depressive disorders
- Venladaxine (Effexor) and duloxetine (cymbalta) are SRNIs that help treat anxiety
antianxiety drugs
- Antianxiety drugs are often used to treat the somatic and psychological symptoms of anxiety disorders.
- Buspirone is an alternative to benzo, that do not cause dependence. it can take 2-4 weeks to reach its full effect & can be used long-term. This drug is not recommended for individuals with impaired hepatic or renal function.
- can cause dizziness, insomnia, HA, nervousness, lightheadedness, insomnia
maladaptive defense against anxiety
- Maladaptive use of defense mechanisms occurs when one or several are used to excess, particularly immature defenses.
adaptive use of denfense mechanisms
Adaptive use of defense mechanisms helps people to lower their levels of anxiety and to achieve their goals in acceptable ways
defense mechanisms
Alturism
* large unconscious motivation to feel caring and concern for others and act for the well-being of others
compensation
* is used to counterbalance perceived deficiencies by emphasizing strength
conversion
* unconscious transformation of anxiety into a physical symptom with no organic cause.
denial
* involves escaping unpleasant, anxiety-causing thoughts, feelings, wishes, or needs by ignoring their existence.
displacement
* the transference of emotions associated with a particular person, object, or situation to another nonthreatening person, object, or situation
dissociation
* the transference of emotions associated with a particular person, object, or situation to another nonthreatening person, object, or situation.
identification
* attributing to oneself the characteristics of another person or group. This may be done consciously or unconsciously.
intellectualization
* a process in which events are analyzed based on remote, cold facts and without passion, rather than incorporating feeling and emotion into the processing.
projection
* refers to the unconscious rejection of emotionally unacceptable features and attributing them to others.
rationalization
* consists of justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations that satisfy the teller and the listener.
reaction
* formation is when unacceptable feelings or behaviors are controlled and kept out of awareness by developing the opposite emotion or behavior.
regression
* reverting to an earlier, more primitive and childlike pattern of behavior that may or may not have been exhibited previously
repression
* unconscious exclusion of unpleasant or unwanted experiences, emotions, or ideas from conscious awareness.
splitting
* inability to integrate the positive and negative qualities of oneself or others into a cohesive image.
sublimation
* an unconscious process of transforming negative impulses into less damaging and even productive impulses.
suppression
* the conscious decision to delay addressing a disturbing situation or feeling.
undoing
* when a person makes up for a regrettable act or communication.
moderate level of anxiety
- narrowed perceptual field, graps less of what is going on
- focuses on the source of the anxiety// less able to pay attention
- able to solve problems but not at an optimal level
physical or other characteristics
* Change in voice pitch
* voice tremors
* Poor concentration
* Shakiness
* Somatic complaints (urinary frequency, headache, backache, insomnia)
* increased respiration, pulse, and muscle tension
* More tension-relieving behavior (pacing, banging hands on table)
panic level of anxiety
- unable to attend to the environment
- focus is lost; may feel unreal (depersonalization) or that the world is unreal (derealization)
- Completely unable to process what is happening
Disorganized or irrational reasoning
physical or other characteristics
* Experience of terror
* Immobility, severe hyperactivity, or flight
* Unintelligible communication or inability to speak
* Amplified or muffled sounds
* Somatic complaints increase (numbness or tingling,
* shortness of breath, dizziness, chest pain, nausea, trembling, chills, overheating, palpitations)
* Severe withdrawal
* Hallucinations or delusions
* Likely out of touch with reality
Interventions for mild to moderate levels of anxiety
- Help the patient identify anxiety. “Are you comfortable right now?”
- Anticipate anxiety-provoking situations.
- Use nonverbal language to demonstrate interest (e.g., lean forward, maintain eye contact, nod your head).
- Encourage the patient to talk about feelings and concerns.
- Avoid closing off avenues of communication that are important to the patient. Focus on the patient’s concerns.
- Ask questions to clarify what is being said. “I’m not sure what you mean. Give me an example.”
- Help the patient to identify thoughts or feelings before the onset of anxiety. “What were you thinking right before you started to feel anxious?”
- Encourage problem solving with the patient.
- Help the patient to develop alternative solutions to a problem through role-play or modeling behaviors.
- Explore behaviors that have worked to relieve the patient’s anxiety in the past.
- Provide outlets for working off excess energy (e.g., walking, playing ping-pong, dancing, exercising)
interventions for severe to panic levels of anxiety
- maintain a calm manner
- always remain with the person experiencing an acute, severe, or panic level of anxiety
- minimize environmental stimuli. move to a quieter setting and stay with the patient
- use clear and simple statements and repetition
- use low-pitched voice; speak slowly
- reinforce realirt if distortions occur (seeing or hearing things that are not there)
- listen for themes in communication
- attend to physical and safety needs when neccessary
- offer high caloric fluids if moving or pacing a lot
- assess need to medication or seclusion after other interventions have been unsuccessful
Health teaching and health promotion for anxiety
- Use counseling, milieu therapy, promotion of self-care activities, pharmacotherapy, biological, and health teaching interventions.
- Guide patients through slowing exercises along with progressive muscle relaxation.
- Identify community resources that can offer the patient specialized treatment proven to be highly effective for people with a variety of anxiety disorders.
- Identify community support groups for people with specific anxiety disorders and their families.
maturational crisis
- When a person reaches a new stage, former coping methods may no longer be effective, and new coping mechanisms have yet to be developed. Thus, for a time, the person is without sufficient defenses. This often leads to feelings of lack of control, resulting in increased tension and anxiety.
- Examples of events that can precipitate a maturational crisis include leaving home for the first time, marriage, the birth of a child, retirement, and the death of a parent.
situational crisis
- arises from events that are external rather than internal (oftern anticipated)
- Ex: loss or change of a job, death of a loved one, abortion, divorce, mental illness
adventitious crisis
- not a part of everyday life, caused by unplanned or accidental experiences
- can be due to a natural disaster, national disaster (terroism, war, riots) a crime or violence (rape, assault, murder)
- can experience more than one type of crisis simutaneously= PTSD, depression
primary intervention
- reduce mental illness to decreases the incidence of crisis
- EX: teach pt. specific coping skills, decision making, problem solving
secondary intervention
- intervention during an acute crisis to prevent prolonged anxiety from diminishing personal effectiveness and personality organizations
- ensure pt safety
tertiary intervention
- provides support for those who have experienced a severe crisis and are now recovering from a disabling mental state
- goal is to facillitate optimal levels of functioning and prevent further emotional disruptions
EX–> critical incident stress debriefing
phase 1 of crisis
- a person is confronted with a conflict or problem that threatens his or her self-concept and responds with increased feelings of anxiety. Increase in anxiety stimulates use of problem solving and defense mechanisms in effort to address problem and lower anxiety
phase 2 of crisis
if the usual defensive response fails and threat persists, anxiety continues to rise and produce rising levels of discomfort. Individual functioning becomes disorganized. Trial and error attempts at solving problem and restoring balance begin
phase 3 of crisis
- trial and error attempts fail, anxiety escalates to severe and panic levels. Person mobilizes automatic relief behaviors such as withdrawal and flight
phase 4 of crisis
problem is not solved and new coping skills are ineffective, anxiety can overwhelm the person and lead to personality disorganization, depression, confusion, violence, and suicidal behavior
role of the nurse
- Set realistic meaningful goals and plan possible solutions
- SAFETY is priority (assess potential risk for suicide)
- Assess perception of the event
- Clearly identify the problem through the individual’s eyes
- Ask open ended question to initiate conversation
- Assess situational supports
- Who does the individual know that can provide material or emotional support?
- Assess personal coping skills
- Identify level of anxiety, previous ways of coping
- Evaluation = return to pre-crisis levels of anxiety
continuum of metal health
- well-being; no serious impairments in daily functioning
- mild to moderate distress= insomnia, lack of appetite and concentration
- moderate to disabling–> altered thinking, mood, and behavior (anxiety, depression)
The role of resilience in the prevention of and recovery from mental illness
- Resilience is the ability to and capacity for people to secure the resources they need to support their well-being
- Effective at regulating their emotions and not falling victim to negative, self-defeating thoughts
Anorexia
- culture bound syndrome in North America and Australia
running amok
- southeast asia is a syndrome recognized that means a male is running around engaging in violent behavior
Discuss the nature/nurture origins of psychiatric disorders.
- Psychiatric disorders result from a combo of genetic vulnerability and negative environmental stressors
- Diathesis-stress model: biological predisposition and stress represents environmental stress or trauma
- Nature-plus-nurture argument: most psychiatric disorders results from a combination of genetic vulnerability and negative environmental stressors
Summarize the social influences of mental health care in the United States.
- NAMI (1979): national advocacy group for families with mental illness to resist traditional arrangement of mental health care providers dictating treatment without the input of the patient (making patients seem incompetent)
- SAMHA (2012): consumer-focused process defining recovery as “a process of change through which individuals improve their health and wellness, live a self-directed life and strive to reach their full potential
explain how epidemiological studies can improve medical and nursing care.
- The quantitative study of the distribution of mental disorders in human populations
- Incidence: conveys information about the risk of contracting a disease
- Prevalence: the total number of cases new and existing in a given population during
- a specific period of time, regardless of when they became ill
- Epidemiology studies can reveal the frequency with which psychological symptoms
- appear together with physical illness
- Studies interventions used to treat people with illness or symptoms as well
identify how the Diagnostic and Statistical Manual, 5th edition (DSM-5) is used for diagnosing psychiatric conditions.
The DSM-V details the diagnostic criteria for psychiatric clinical conditions. It is the official guideline for diagnosing psychiatric disorders. The other references are good resources but do not define the diagnostic criteria.
The DSM-V classifies disorders people have rather than people themselves. The terminology of the tool reflects this distinction by referring to individuals with a disorder rather than as a “schizophrenic” or “alcoholic,” for example.
- Collects epidemiological statistics about the diagnosis of psychiatric disorders
- AVOIDS LABELS (alcoholic….. A person with alcoholism)
Compare and contrast a DSM-5 medical diagnosis with a nursing diagnosis.
The medical diagnosis is concerned with the patient’s disease state, causes, and cures, whereas the nursing diagnosis focuses on the patient’s response to stress and possible caring interventions. Both tools consider culture. The DSM-V is multiaxial. Nursing diagnoses also consider potential problems.
Compare and contrast a social relationship and a therapeutic relationship regarding purpose, focus, communications style, and goals.
Social relationship is primarily initiated for the purpose of friendship, socialization, enjoyment, or accomplishment of a task
- Mutual needs are met during social interaction, give advice, superficial communication
- Roles may shift
- Therapeutic relationship: the nurse maximizes communication skills, understanding of human behaviors and personal strengths to enhance the patients growth
- Address patient concerns, respect decision making and use straightforward language
- Focus is on patients feelings, ideas, and experiences
Explore qualities that foster a therapeutic nurse-patient relationship and qualities that contribute to a non therapeutic relationship.
Therapeutic: Establishment of boundaries, identifying needs of patient, encouraging alternate problem solving approaches, help patient develop new coping skills, support behavioral change
Nontherapeutic: blurring of boundaries, blurring of roles (countertransference and transference)
Discuss the influences of disparate values and cultural beliefs on the therapeutic relationship.
Values: abstract standards that represent an ideal, either positive or negative (EX: self-reliance, honesty, cleanliness, organization)
Beliefs are an opinion/conviction (what you hold to be true), confidence/trust/faith, religious faith
Being SELF AWARE helps us accept the differences in others
empathy
occurs when the helping person attempts to understand the world from the patient’s perspective. More understanding, focused, and caring
- We understand the feelings of others- conveys respect, acceptance, and validation for the patient’s strengths
genuiness
the nurse’s ability to be open, honest and authentic in interactions with patients. Key to building trust.
Listen and communicate clearly to patients (therapeutic communication)
positive regard
implies respect. The ability to view another person as being worthy of caring about and as someone who has strengths and achievement potential
- Displayed indirectly through attitudes and actions rather than words
- attitude: willing to work with patient
- Action: suspending valve judgements, attending (listen), help with resources
attending behaviors
Attending is a special kind of listening that refers to an intensity of presence or being with the patient (staying silent can indicate reflection)
communication process
Stimulus (need to communicate) → sender (initiates interpersonal contact) → message (information sent or expressed) → channel (auditory, visual, tactile, olfactory, or combination of theses channels) → receiver (interpret message and responds with feedback)
- Feedback that validates the accuracy of the sender’s message is extremely important
- Clarity (accurately understand the message) and continuity (promotes connection amongst ideas)
Identify two personal and two environmental factors that can interfere with communication.
Personal factors
- Depression results in slow thinking and communication
- Anxiety can cause lack of concentration
- Cultural differences (gender-related beliefs)
- Cognitive factors (problem solving ability, knowledge level, language use)
Environmental factors
- Background noise
- Lack of privacy
- Uncomfortable accommodations
paraphrasing
restating in basic, fewer words that summarizes basic content of a pt’s messag
restating
Different than paraphrasing in that you use the same key words
as the pt
reflecting
assisting pt’s to better understand their thoughts and feelings, sometimes in the form of a question or a simple statement that reflects the
nurses observation of pt when discussing sensitive info
exploring
“Tell me more about your relationship with your wife”, “Describe your relationship with your wife”
open-ended questions
What is an example of some of the stress you are under right now?”
close-ended question
“Did you seek therapy after your first suicide attempt?”
miracle question
goal setting question that helps pt see what the future would be like if a particular problem were to vanish
communication in the hispanic community
-intensely emotional styles of communication
- Will avoid eye contact with authority figures - sign of respect
- Touch is considered a gesture of warmth, support and consolation
French and Italian Americans
show animated facial expressions and hand gestures
asain culture
expression of positive or negative emotions is a private affair, open expression is bad taste and a weakness
japanese culture communication
direct eye contact is a lack of respect and a personal insult
german and british communication
value self-control and show little facial emotion
- Eye contact indicates the person listens or trusts
- Touch is infrequent (hand shake)
native american communication
believe it is disrespectful of a sign of aggression to engage in direct eye contact
hatian communication
hold eye contact with everyone EXCEPT the poor
ethics
the study of philosophical beliefs about what is right or wrong in a society
bioethics
the study of specific ethical questions that arise in healthcare
beneficence
the duty to act to benefit or promote the good of others
autonomy
respecting the rights of others to make their own decisions
justice
the duty to distribute resources or care equality regardless of personal attributes
fidelity (nonmaleficence)
maintaining loyalty and commitment to the patient and doing no wrong to the patient
vericity
the duty to communicate truthfully
Describe a patient’s rights and legal concerns with regard to restraint and seclusion.
- RESTRICTING A PATIENT’S MOVEMENT IS A RESTRAINT
- MEDICATIONS ARE RESTRAINTS
- A PERSON WHO IS PHYSICALLY RESTRAINED IN AN OPEN ROOM IS NOT
- CONSIDERED TO BE IN SECLUSION
- Restraints may be renewed for a total for 24 hours (asses 15-30 min FOR THE WHOLE TIME)
malpractice
A special type of negligence meeting 5 criteria: duty, breach of duty, cause in fact, proximate cause, damages
state board of nursing
state governmental agencies that regulate nursing practice to protect the health of the public by overseeing the safe practice of nursing (nurses are legally allowed do their scope of practice)
suicide in the USA
- 10th leading cause of death in US
- 2nd leading cause of death in 2014 in 10-34 year olds.
- Suicide rates among veterans is also increasing at higher rates than among american citizens, especially for women
Identify comorbid psychiatric disorders that accompany suicidality.
- Major depression
- Anorexia
- PTSD
- Schizophrenia
- Substance use disorders
risk facators for the development of suicide
Biological: genetic factors in suicide along with LOW SEROTONIN levels in the frontal cortex
Psychological: all-or-nothing thinking, inability to see different options, and perfectionism
Environmental: copycat suicide (follows a highly publicized suicide of a public figure)
** adolescents at greater risk due to immature prefrontal cortex (controls judgment, impulse control, and frustration tolerance)
evidence-based practice suicide risk assessment tools.
First get a history of ideations and attempts
- SAFE-T (suidcide assessment five-step evaluation and triage)
- Identify risk factors
- Identify protective factors (sense of responsibility to family, pregnancy, religious beliefs, satisfaction with life, positive social support, etc.)
- Will reduce possibility that an individual will complete sucide
- Conduct suicide inquiry (sucidal thoughts, plans, behavior, intent)-have you had thoughts about suicide? Do you have a plan? Do you have access to carry out this plan?
- Determine risk level/intervention (choose appropriate intervention to reduce the risk)
- Document (assessment of risk, rationale, intervention, follow up)
major components of Peplau’s Theory of Interper
Developed the idea of self-awareness to keep the focus on the patient and in keeping the social/personal needs of the nurse OUT of the nurse-patient conversation
hypothalamus
control basic drives = hunger, sex, thirst (the 4 F’s: fighting, fleeing,feeding, and fornication = lmibic system) and sleep/wake cycle
- Links thought, emotion, and function of internal organs
- Secretes the corticotropin releasing hormone leading to secretion of cortisol in response to mental/physical stressors
amygdala
anxiety and fear
brain parts
Frontal lobe: movement, problem solving, thinking, behavior, mood, personality
- Temporal lobe: hearing, language, memory
- Brain stem: consciousness, breathing, heart rate (processing center for sensory
info, central for survival) - Parietal lobe: sensations, language, perception, body awareness, attention
- Occipital lobe: vision and perception
- Cerebellum: posture, balance, and coordination of movement
specific cautions you might incorporate into your medication teaching plan with regard to herbal treatments.
Do not take ginkgo biloba with warfarin == Increased bleeding
- Kava increases risk of hepatotoxicity
performing an assessment with a child, an adolescent, and an older adult.
Children:
- Caregivers often can best describe the behavior, performance, and conduct
of the child, able to interpret words and responses when child is reluctant
(especially in cases of sexual abuse)
- Consider development levels (tendency to regress back to old habits)
- Assess through interview and observation
- Play is a safe area for children to act out thoughts and emotions
Adolescents
- Especially concerned with confidentiality and may fear that you will tell
their parents
- Adolescents should receive and explanation on the role of the treatment
team in providing care and the need to share information (EX: threats of suicide, homicide, sexual abuse, or behaviors that put the patient/others at risk)
Older adults
- MUST IDENTIFY PHYSICAL DEFICITS AT THE ONSET OF THE ASSESSMENT
- Be aware of any physical limitations (may be sensory, motor, or medical)
short term response to stress
increased BP, HR, RR, and cardiac output.
- Increased glucose, triglycerides, platelet aggregation, blood to skeletal
muscles, and muscular tension
- Decreased fluid loss, inflammation, brain NE, kidney clearance
long term response to stress
Immune system compromise, atherosclerosis, depression, HTN, insulin
insensitivity, obesity, protein breakdown (bones, muscles, blood), heart disease, digestive problems, chronic anxiety/anger
alarm stage
Adaptive response (fight or flight) to the stressor
- Response fires to the brain’s amygdala
stage 3; exhaustion stage
Resources are depleted and the stress may become chronic = long-term illness
biofeedback
provides immediate and exact information regarding muscle activity brain waves, skin temperature, heart rate, blood pressure and other bodily functions (ex: apple watch)
deep breathing exercises
most common; slow, deep, even breaths
guided imagery
focus on pleasant images to replace negative or stressful feelings
(can increase pain threshold by reducing cortisol, Epi, and catecholamines and
produce B-endorphins)
progressive relaxation
anxiety results in tense muscles so we can decrease anxiety by eliminating muscle contraction
cognitive reframing
To change the individual’s perceptions of stress by reassessing a situation and replacing irrational beliefs
EX: “i can’t pass this course”–> if I choose to study for this course, my chances of success increase”
Which client-focused scenario best demonstrates an example of eustress?
The client receives notification that their employer is experiencing financial problems and some workers will be terminated.
The client receives a bank notice that there were insufficient funds in their account for a recent rent payment.
The client loses a beloved family pet.
The client prepares to take a vacation to a tropical island with a group of close friends.
sublimation
always considered to be a positive coping mechanism
SAFE-T
- Identify risk factor
2.Identify protective factors - Conduct suicide inquiry
- Determine risk level/intervention
- Document
