Exam 1 Flashcards
Peplau’s 4 phases of the Nurse-Patient Relationship
Orientation: pt and nurse mutually identify the pt’s problem; establish trust
Identification: pt identifies with the nurse accepting help for the problem
Exploration: pt makes use of the nurses’s help (puts into action. some call this the exploitation phase)
Resolution: pt accepts new goals and fees self from the help of the nurse
Primary prevention
- identifying persons at risk
- reinforcing existing coping responses
- education/teaching
- collaborate w/patients and families
- measures must be culturally sensitive and congruent w/person’s values & belief system
secondary prevention
- measures are used to curtail the disease process
- case management is a good example of secondary prevention
- once sxs are identified and interventions are initiated
- treatment focuses on minimizing long-term disability
tertiary prevention
- minimize relapse and chronic disability
- institute outpatient treatment plans for patients to maintain best baseline in community setting
- Examples: ongoing health education, supportive housing, relapse prevention programs, fostering of patients adaptive coping behaviors, reinforcement of patient’s strengths
essential qualities of PMHN
- therapeutic use of self
- genuineness and warmth
- empathy
- acceptance
- maturity and self-awareness
- leadership
the limbic system
- the part of the brain associated with behavior, physiologic changes and emotional “tone” or feeling
- responses to mood, memory, and learning.
- temporal cortex
the brain stem
- midbrain, pons, medulla
- central nerve pathway that receives and sends impulses between the brain and the rest of the body
- important in respect to the hypothalamus
hippocampus & amygdala
- structures generally considered being part of the limbic system
- recent studies indicate that dysregulation may play a role in exaggerated stress responses found in various anxiety disorders such as PTSD
- amygdala: modulates fear response. converts short term experiences to long term ones.
hypothalamus
- influences sensory and motor tracts that meet and diverge in the brain stem for normal physiologic maintenance
- plays a role along with the pituitary gland, in producing stress and anxiety responses (cortisol).
- HPA axis: hypothalamus, pituitary, adrenal
- cortisol: changes in people’s behaviors
dopamine
- largely secreted in the substantia nigra
- hyperactivity of the dopaminergic system is implicated in schizophrenia and mania
- hypoactive dopamine systems are believed to contribute to Parkinson’s Disease and Depression
- Dopamine plays a major role in addiction because drugs (cocaine, opiates, alcohol) increase the amount of dopamine to act on D2 receptors and stimulate the reward system in the brain
- Id stage of Freud’s theory
serotonin (5-HT)
- secreted in the raphe nuclei (brain stem)
- hypothesized to play a significant role in states of consciousness, mood, depression, anxiety, and possibly schizophrenia
- highest concentrations in blood platelets and GI tract: nausea at onset of taking SSRIs
- alters platelet count- anticoagulation effect
- nausea at onset
- helps with anxiety and depression
GABA
- inhibitory in nature
- serves as the brains modulator and limits the effects of excitatory transmitters
- inhibits neuronal transmission by hyperpolarizing the receptor site to render it less sensitive to continual stimulation (anti-kindling effect)
- low levels of brain GABA predispose a person to convulsions (seizures) and disorganized sensorimotor function
- benzos enhance GABA binding to receptor sites and are effective in treating anxiety
- limits anxiety and mania
Anticonvulsants
- work in a similar manner to GABA to modulate hyper-stimulation by their anti-kindling effect to prevent seizures
- the efficacy of anticonvulsants as mood stabilizers stem from these properties
goals of mental status exam
- gather baseline data about the patient’s functioning
- identify actual and potential problems
- assist the team in making accurate psychiatric and medical diagnoses
- tool for assessing psychological dysfunction
general description of MSE
First part.
A. Appearance
B. Behavior & Psychomotor activity
C. Attitude toward examiner
MSE- mood & affect
Second part.
mood- assessment of current emotional state. pervasive feeling or state of mind.
affect- flat: unresponsive; bipolar: expansive
appropriateness- respectful boundary
MSE: speech
third part.
- tone
- quality
- express thoughts, ideas, feelings?
- paranoia: whisper
- trauma: hesitancy
- bipolar: spontaneous, rapid
MSE: perceptual disturbances
fourth part.
- hallucinations: false sensory stimuli. auditory most common
- delusions: fixed false belief. No way to change patients’ mind.
- illusion: misinterpretation of external stimuli. Seeing a shadow, thinking it’s a person.
Neurobiological Theory
- all behaviors are a reflection of brain function
- all thought processes represent a range of functions mediated by nerve cells in the brain (neurons)
- brain is the origin of disorders of affect, perception, and cognition
MSE- thought
thought process: manner in which thoughts are associated/connected.
thought content: subject matter that occupies the person’s thoughts. Congruent with mood & affect.
MSE- sensorium & cognition
- alertness & LOC
- orientation: a&o? eye contact?
- memory: ability to have recent & remote memory. 3 objects/words test.
- concentration: very important. sustain thoughts. write down discharge instructions.
- abstract thinking: get past concrete concepts. Use of proverbs. Indiv. with schizophrenia and dementia have a hard time with this.
- fund of information & intelligence: everyday information. news, education, grammar.
MSE- impulse control
ability to control aggressive impulses. Explore history of violence, drugs, alcohol abuse.
MSE- insight and judgement
patient’s ability to talk about illness. how they handle their emotions, previous symptoms in the past.
MSE- reliability
reality testing. how they judge the world outside for themselves and manage feelings. Common for competency evaluation.
DSM Axis I
- clinical disorders: schizophrenia, bipolar, depression
- biological
- substance abuse
DSM Axis II
- personality disorders
- mental retardation
- developmental disorders
DSM Axis III
- general medical conditions.
- intertwine with medical and psychiatric conditions. DM, HTN, stroke.
DSM Axis IV
- psychosocial and environmental problems
- events and problems that affect diagnosis. family, relationships, homelessness.
DSM Axis V
- global assessment of functioning (GAF)
- functionality on a scale of 0-100.
- changes frequently
- healthiest person usually in the 80s.
- lower values- suicidal.
elements of psychosocial assessment
- recent stressors
- strengths
- current medications
- hx of psychiatric treatment
- substance use, abuse, dependence
- quality of support systems and strengths
- presence and hx suicidal/homicidal ideations
- present and past coping skills
- self-concept, self-esteem, strengths
- spiritual and cultural needs
- legal and occupational hx
Freud’s stages of development
oral stage: birth-18 months. fixating, oral gratification. narcissistic.
anal stage: 18mo-3yr. toilet training. translates to releasing (flamboyant and compulsive) and holding in(anal retentive).
phallic: 3-6. attracted to parent of opposite sex. object relations.
latency: 6-12. internal and external demands. super ego.
prepuberty/adolescence: 12-15.
genital stage: 15-adult. heterosexual behavior becomes evident. personality develops in the 1st 5 years.
Freud’s psychoanalytic theory
anxiety plays a central role in maladaptive behavior
Erikson’s stages of ego development
birth-18mo: trust vs. mistrust 18mo-3yr: autonomy vs. shame 3-6yr: initiative vs guilt 6-12: industry vs. inferiority 12-20: identity vs. role confusion 20-30: intimacy vs. isolation 30-65: generativity vs. stagnation (self-absorption) 65-death: ego integrity vs. despair
basis of Maslow’s theory
- needs are hierarchical: lower level needs are essential to survival and must be met prior to achievement of higher level needs
- goal: self actualization. “a sense of fulfillment in life and actualization of one’s potential.”
- supports human growth. needs motivate behavior.
Maslow’s hierarchy
(most basic to goal)
- physiologic: food, shelter, water.
- safety: security, order, physical safety, avoiding harm.
- love and belonging: affection, companionship, group identification
- esteem and recognition: self-esteem, respect, prestige
- self-actualization: unique potential
Harry Stack Sullivan’s Interpersonal Theory
ties individual behavior and personality development to interpersonal relationships
- Personal or self-concept: good me, bad me, not me.
Interpersonal theory application to nursing
creates a nurse/patient relationship that:
- creates an environment of acceptance that instills hope
- helps patients understand their situational stressors about relationships, related sxs and maladaptive behaviors
- improves pt’s self esteem & worth, dignity
- promotes healthier social interaction and interpersonal skills
Bowlby’s attachment theory
- early key interactions with primary caregivers play a key role in how an individual perceives themselves and others (quality of relationships)
- the infant internalizes early child-caregiver experiences and forms cognitive models or schemata
- if the person deserves care (self-perception)
- whether others are reliable providers of care (perception of others)
seen a lot in anxiety disorders
Id
first structure to develop in personality, operates on the pleasure principle to reduce tension
characterized by:
- primary process thinking
- irrational thinking, not based in reality
Ego
CEO of the mind
- mediating between the drives, forces or conflicts of the Id and Superego. Anxiety can develop
- maintains a reality orientation for the person
- keeps strong forces of the Superego from being extremely inhibitive
- keeps the Id from causing person from being overly exhibitionistic