Exam 1 Flashcards
What is an asylum?
safe refuge or haven
what does deinstitutionalization mean?
shift from institutional care to community care
What were common psychiatric treatments in acnient times?
blood letting
What did people think caused mental health issues in the early christian era?
demons and exorcisms
How was mental health dealt with in the Renaissance era?
they had “lunatic” zoos
What defined mental health treatment in the colonial times?
witch hunts
What changes to psychopharmacology occured in the 1950s?
thorazine and lithium developed
shorter hospital stays
people coud stabilize
less choatic hospitals
What changes were made to faciliate deinstitutionalization in the 1960s?
community mental health center construction act
shift from institutional to community care
SSI income for disabled people
involuntary commitment process harder
What are the healthy people 2020 goals
Reduce suicide rate
- Reduce major depressive episodes
- Increase number of primary care facilities that treat MH
- Increase number of persons with MI who are employed
- Increase treatment for dual diagnosis
- Increase care of MI for homeless persons
What is the DSM 5?
Provides standard “language” for MH
- Lists defining “characteristics” of disorders
- Helps identify “underlying” causes of these disorders
What is the diathesis stress model?
Diathesis:
- Biological factor (genes, disordered biochemistry, brain anomalies)
- Social Factor (maladaptive, upbringing, chronic stress, etc.)
- Psychological factor (unconscious, conflict poor skills, maladaptive cognitions, etc.)
+
Stress:
- Biological trigger (onset of a disease, exposure to toxins)
- Social trigger (traumatic event, major loss)
- Psychological trigger (perceived, loss of control, violation of a trust)
What does it mean for mental health to exist on a continuom?
It means that we acknowledge that mental health does not start and end at a certain point, but can go back and forth between good, bad, and everything in between.
What is acuity?
severity of symptoms
What is anhedonia?
inability to find joy in the things that they once did
What happens during the orientation phase of Peplau’s model?
engage w/ patient
provide explanations and info
answer questions
What happen during the identification phase of Peplau’s model?
when the patient works with nurse
expresses feelings
begins to feel stronger
What is the exploitation phase of Penlau’s model?
patient makes full use of services
What ist he resolution phase of Penlau’s model?
Patient no longer needs professional services
What is cognitive behavioral therapy? (CBT)
focuses on faulty thinking
focuses on learned patterns of unhelpful behavior
emphasis on individual being own therapist
What is dilectical behavior therapy? (DBT)
clients learn mindfulness
distress tolerance
emotional regulation
interpersonal effectiveness
treats personality disorders
Who is DBT used for?
personality disorders
substance dependence
eating disorder
PTSD
Who is ECT used to treat?
people with depression
What is ECT?
electroconvulsive therapy; electrical impulses are sent to the brain to cause a seizure
it is thought the shock stimulates the brain chemsitry to correct itself
What is light therapy used to treat?
Season affective disorder (SAD)
What is transference?
occurs when the client views a member of the healthcare team as having characteristics of another person in their life.
What is countertransference?
when a health care team member displaces characteristics of people in their past onto a client
What is an auditory hallucination?
hearing voices or sounds
What is the biggest concern with auditory hallucinations?
The client harming themself or others
What is a visual hallucination?
seeing persons or things
What is an olfactory hallucination?
smelling odors
What is a gustatory hallucination?
Experincing tastes
What is a tactile hallucination?
feeling bodily sensations
What is a defense mechanism?
A way to manage conflict in response to anxiety
What is beneficence?
doing good
What is autonomy?
patient’s right to choose
What is justice?
fair and equal treatment
what is fidelity?
loyalty and faithfulness
What is veracity?
honesty
What is assault/battery?
treatment without consent
What is it your duty to warn about?
homicidal ideations
What is your duty to report?
any abuse
What is informed consent?
education prior
What is confidentiality?
protected PHI
What is voluntary admit?
meets criteria
may request AMA discharge
What is an involuntary admission?
court hold up to 60 days
Client admitted to hospital becuase they are a threat to others or themselves
What is seclusion?
involuntary confinement
What is restraint?
physical, mechanical or chemical method to restrict physical movement
What are some examples of nonverbal communication?
facial expression
eye contact
gestures
personal space
silence
sounds
restlessness
What are some examples of therapeutic communication?
accpeting
broad openings
exploring
focusing
general leads
making observations
voicing doubt
silence
clarification
What are examples of nontherapeutic techniques?
advising
belittling
challenging
defending something
rejecting client experience
disapproving or giving approval
interpreting for client
changing topic or probing
What are some examples of defense mechanisms?
altruism
regression
suppression
denial
rationalization
(this is not every example)
What is the CAGE assessment used for?
substance abuse
What is the BECK assessment used for?
depression
What is the HAMILTON A assessment used for?
Anxiety
What is the HAMILTON D assessment used for?
depression
What is the AIMS assessment used for?
abnormal movements
What is the CIWA assessment used for
withdrawal
What is anergia?
lack of energy
What is anhedonia?
inability to find pleasure in things they used to enjoy
What is avolition?
lack of follow through/no motivation
What is alogia?
few words
What is affective blunting
minimal facial expressions
What is aphasia?
cant find the right word
What is agnosia?
dont recognize familiar objects anymore
What is aphraxia?
loss of purposeful movement
What is anosognosia?
no knowlesge of illness
What is apathy?
loss of initiative
What assessment is used for suicide risk?
SAD PERSONS
What assessment is used to objectively assess a clients cognitive status?
MMSE (mini mental state examination)
What does the SAD PERSONS acronym stand for?
Sex
Age
Depression
Previous attempts
Excessive alcohol or substance abuse
Rational thinking loss
Social supports lacking
Organized plan or serious attempt
No spouse
What are delusions?
a false belief
What is affirmation?
Therapeutic communication technique used to empower client behavior and decision making
How long can seclusion last for 18+
4-hour limit
How long can seclusion last for 9-17y/o?
2 hours
How long can seclusion last for 9y/o?
1 hour
What kind of observation is required for seclusion/restraint?
1:1 the entire time
What does ADPIE stand for?
Assessment (tools, observations)
Diagnosis (nursing diagnosis)
Planning (creating a care plan)
Interventions (using the care plane)
Evaluations (assess for efficacy)
T or F, A client can be admitted to a mental health clinic in spite of a physical health crisis
False, the physical health of a client ALWAYS takes priority
What is the Mini Mental Status Exam for?
to assess vitals of the brain
What is a person’s affect?
What your face looks like
What’s an example of poor insight?
Dr Harrington says Jack’s coffee is good for you because “it’s a dairy product”.
What is an example of insight?
Dr. Harrington knows that Jack’s coffee is bad for you and can tell you why.
What is an example of impaired judgement? (Take this with a grain of salt)
Dr. Harrington knows that Jack’s coffee is bad for you, but drinks it anyway.
What is the Global Assessment of Functioning used for?
Impairments across multiple areas
What is included in the general appearance field for mental health assessments?
General appearance
Dress
Posture
Hygiene
Movements
What is included mood and affect field for mental heatlh assessments?
Mood can be what client says or labeled
Affect: how their face looks
( blunted, broad, flat, inappropriate, restricted)
What is included in the though processes/contennt field for mental health assessments?
Speech and thought disturbances
Flight of ideas
Loose associations
Thought blocking
Word salad
Cognitive distortions
Paranoia
Ruminations
Clanging
Neologisms
What is included in the harm to self/others field?
Must as directly (are you planning on killing yourself?)
Ask about their harm plans
Duty to warn (warn possible targets)
Contract for safety (will you let staff know if you plan to harm yourself?)
What is included in the sensorium/intellectural processes field?
Memory
Concentration
Abstract thinking
Concrete thinking
Intellectural functioning
What is included in the sensory field?
Things you feel
What is included in the self concept field?
Patient’s self worth
Coping skills
Body image
What is included in the roles and relationships field?
Client support/stress
Client perceptio and satisfaction with services
What is a delusion?
A false fix belief
( Dr Harrington is a famous rockstar even though she has never put out a record etc.)
What is a hallucination?
Things that you feel with your body, but aren’t real (they think it is real, ex; hearing voices)
A sensory disturbance
What is a cognitive distortion?
Automatic thought (usually not true)
What is sundowning?
Personality changes when the sun goes down (not sure about this one)
What is echolalia/exchopraxia?
They mirror your words and actions
What is rumination?
Going over something over and over in your mind
What is impulsivity?
No pause between thought and action
Contract to safety often fails here
What is hypervigilance rooted in?
Paranoia/fear
What are some mood descriptors?
Euphoric/labile/full range/dysphroic
What are examples of types of thinking?
Abstract
Concrete
What is concrete thinking?
you get the exact answer based on the words you said
(You: what brought you to the hospital?
Patient: ….The ambulance?)
What is abstract thinking?
Use strange words to describe things
(Dr. Harrington said she’d run to her office but you took that literally when she actually walked)
What is a contract for safety?
When you and the client agree that they will contact a staff member if they have thought of harming themselves
Why don’t we ask people “why questions”?
It can make them defensive
What does the Mental Status Exam assess? (NOT the mini!)
orientation
ability to interpret proverbs
math calculation
memorization
short-term recall
( cognitive abilities )
Who is the mental status exam for?
dementia patients
also depressed or psychotic patients
What is a psychosocial assessment?
used to determine clients
emotional state
mental capacity
behavioral function
(similiar to basic bedside)
What is voluntary admission?
A client admits themselves and agrees to treatment
What is court ordered admission?
most common among persons with severe and persistent mental illness who have had frequent and multiple contacts with mental health, social welfare, and criminal justice agencies
What is an emergency hold?
A person can be detained in a psychiatric facility for 48 to 72 hours on an emergency basis until a hearing can be conducted to determine whether or not they should be committed to a facility for treatment for a specified period
What is ACT; Assertive Community Treatment?
Case management – services/resources to reduce
rehospitalization
What is the basis for involuntary admission? (why are they there?)
Based on need for care due to risk for harm to self or others or inability to care for
self.
Can involuntary admits refuse treatment?
these clients are still considered competent and can refuse treatment – unless
deemed incompetent – a guardian needs to be appointed.
* This right to refuse treatment can be temporarily suspended if the client is an active
threat to self or others (PRN medication administration).
What is required to make someone an involuntary admit? (legality)
Requires legal “commitment” but usually limited to 60 days and then must have
review
T or F, a guardian can sign in a voluntary admit
True
What is a SMART goal? (think about the acronym)
Specific
Measureable
Attainable
Relevant
Time-Bound
What patient would the Columbia Suicide Severity Rating be for?
a suicidal patient
What is Peplau’s nurse-patient relationship in order? (probably not on the test; included in case its helpful)
Orientation
Identification
Exploitation
Resolution
“Yes.”
“I follow what you said.”
Nodding
These are examples of what therapeutic technique?
accepting
“Is there something you’d like to talk about?”
“Where would you like to begin?”
These are examples of what therapeutic technique?
Broad openings
“Tell me whether my understanding of it agrees with yours.”
“Are you using this word to convey that…?”
These are examples of what therapeutic technique?
“Was it something like…?”
“Have you had similar experiences?
These are examples of what therapeutic technique?
Encouraging comparison
“Tell me when you feel anxious.”
“What is happening?”
“What does the voice seem to be saying?”
What type of therapeutic communication is this?
encouraging description of perceptions
“What are your feelings in regard to…?”
“Does this contribute to your distress?”
What type of therapeutic communication is this an example of?
Encouraging expression
“Tell me more about that.”
“Would you describe it more fully?”
“What kind of work?”
What kind of therapeutic technique is this?
Exploring
“This point seems worth looking at more closely.”
“Of all the concerns you’ve mentioned, which is most troublesome?
What type of therapeutic technique is this?
focusing
“What could you do to let your anger out harmlessly?”
“Next time this comes up, what might you do to handle it?
What kind of therapeutic technique is this?
formulating a plan of action
“Go on.”
“And then?”
“Tell me about it.”
What kind of therapeutic technique is this?
general leads
“My name is…”
“Visiting hours are…”
“My purpose in being here is…”
What kind of therapeutic communication is this?
giving information
“Good morning, Mr. S…”
“You’ve finished your list of things to do.”
“I notice that you’ve combed your hair.”
What kind of therapeutic communication is this?
Giving recognition
“You appear tense.”
“Are you uncomfortable when…?”
“I notice that you’re biting your lip.”
What kind of therapeutic information is this?
making observations
“I’ll sit with you awhile.”
“I’ll stay here with you.”
“I’m interested in what you think.”
What kind of therapeutic communication is this?
offering self
“What seemed to lead up to…?”
“Was this before or after…?”
“When did this happen?”
What kind of therapeutic communication is this?
placing event in time or sequence
“I see no one else in the room.”
“That sound was a car backfiring.”
“Your mother is not here; I am a nurse.”
This is an example of what therapeutic communication?
presenting reality
Client: “Do you think I should tell the doctor…?”
Nurse: “Do you think you should?”
Client: “My brother spends all my money and then has nerve to ask for more.”
Nurse: “This causes you to feel angry?”
This is an example of what type of therapeutic communication?
Reflecting
Client: “I can’t sleep. I stay awake all night.”
Nurse: “You have difficulty sleeping.”
Client: “I’m really mad, I’m really upset.”
Nurse: “You’re really mad and upset.”
This is an example of what kind of therapeutic communication?
Restating
Nurse says nothing but continues to maintain eye contact and conveys interest.
What kind of therapeutic communication is this?
Silence
“Perhaps you and I can discuss and discover the triggers for your anxiety.”
“Let’s go to your room, and I’ll help you find what you’re looking for.”
What kind of therapeutic communication is this?
suggesting collaboration
Have I got this straight?”
“You’ve said that…”
“During the past hour, you and I have discussed…”
What kind of therapeutic communication is this?
summarizing
Client: “I’m dead.”
Nurse: “Are you suggesting that you feel lifeless?”
Client: “I’m way out in the ocean.”
Nurse: “You seem to feel lonely or deserted.”
What kind of therapeutic communication is this?
translating into feelings
lient: “I can’t talk to you or anyone. It’s a waste of time.”
Nurse: “Do you feel that no one understands?”
What kind of therapeutic communication is this?
verbalizin the implied
“Isn’t that unusual?”
“Really?”
“That’s hard to believe.”
What kind of therapeutic communication is this?
voicing doubt
