exam 1 pp slides Flashcards
Therapeutic Communication Technique where taking what the patient is saying and concentrating on a feeling or emotion
Reflecting
what 3 types of meds to hold before ECT?
benzos anti anxiety anti seizure
what needs to be filled out with an involuntary admission
Petition and certificate
criteria for restraints
Actively harming self or others and all other methods of interventions have not worked
do you need parent permission with restraints and minors
no
Stage of Development in Erikson’s Psychosocial Theory where: To develop a basic trust in the mothering figure and learn to generalize it to others Infancy (Birth–18 months)
Trust vs. mistrust
An alteration in mood expressed by feelings of sadness, pessimism and despair. Mild to severe with or without psychotic features most severe
Major Depressive Disorder
Stage of Development in Erikson’s Psychosocial Theory where: To review one’s life and derive meaning from both positive and negative events, while achieving a positive sense of self-worth Old age (65 years-death)
Ego integrity vs. despair
depressive syndrome usually present for most of day, more days than not, for at least a 2-year period Onset is early childhood→ young adulthood and are at risk for developing MDD No psychosis
Dysthymia
patient agrees to treatment and signs themselves in
Voluntary admission
Follow through with what you say you’re going to do Spend time with them Don’t lie to them Don’t pass judgement on them Be patient with them
Ways to build trust with patient
can you keep the paient in restraints if they are asleep?
no
Stage of Development in Erikson’s Psychosocial Theory where: To develop a sense of purpose and the ability to initiate and direct own activities Late childhood (3–6 years)
Initiative vs. guilt
nursing diagnosis for ___________ Risk for self-directed violence Self Care Deficit Ineffective coping
Major Depressive Disorder
double vision vertigo blurred vision thrombocytopenia pancreatitis are all common side effects of what type of meds
mood stabalizers
Therapeutic Communication Technique where repeating the main idea of the client with different vocabulary
Restating
when assessing a clients memory ask the client to repeat a series of numbers or list of object
immediate
first line of treatment for the depressive disorders and most commonly used might also be used for anxiety
SSRI Fluoxetine (prozac) Sertraline (zoloft) Citalopram (selexa) Escitalopram (lexapro)
phase involves preparation for the first encounter with the client. Tasks include the following: Obtaining available information Examining one’s feelings, fears, and anxieties about working with a particular client
The Preinteraction Phase
The therapeutic work of the relationship is accomplished during this phase. Tasks include: Maintaining the trust and rapport that was established during the orientation phase Promoting the client’s insight and perception of reality Problem-solving using the model presented earlier in this chapter Overcoming resistance behaviors on the part of the client as the level of anxiety rises in response to discussion of painful issues Continuously evaluating progress toward goal attainment
The Working Phase
An ethical principle that refers to one’s duty to benefit or promote the good of others. doing what’s good for the greatest amount of people
beneficence
if a patient is not able to take a mood stabalizer they can take ________ for bipolar disorder
lithium
Believed that individual behavior and personality development are the direct result of interpersonal relationships. Human behavior could be observed in social interaction with others.
Interpersonal theory
Valproic Acid Carbamazepine Topiramate Lamotrigine are what kind of meds
mood stabalizers
theory where the influence of social processes on the development of the personality
Psychosocial Development
(detaching from a memory) inability to recall: Some events All events Entire lifetime
Dissociative amnesia
Nurse displaces feelings related to people in one’s past onto the patient when nurse puts their feelings toward the patient because they remind them of someone (if the patient reminds the nurse of someone that they don’t like then they will be mean to them and vice versa) may be bad if the feeling is positive because they might treat others who aren’t the person that they like badly
Counter transference
a situational based crisis (unexpected) external (loss of job, divorce, moving, death)
Dispositional or situational-
Stage of Development in Erikson’s Psychosocial Theory where: To gain some self-control and independence within the environment Early childhood (18 months-3 years)
Autonomy vs. shame and doubt
Stage of Development in Erikson’s Psychosocial Theory where: To form an intense, lasting relationship or a commitment to another person, cause, institution, or creative effort Young adulthood (20–30 years)
Intimacy vs. isolation
phase where Self assessment- how are we going to feel about taking care of the patient Collecting data- secondary sources (family, medical records)
Pre-interaction phase:
- Involuntary movements, seizures, paralysis, blindness, Pseudocyesis (fake pregnancy)
Conversion disorder
Therapeutic Communication Technique where when the client has a misperception of the environment “i understand that the voices seem real to you but i do not hear any voices”
Presenting Reality
Therapeutic Communication Technique where expressing uncertainty as to the clients reality “I understand that you believe that to be true, but I see the situation differently” “i find that hard to believe”
Voicing doubt
Venlafaxine Duloxetine Buproprion are all type of what kind of meds?
Atypical
sick to your stomach (nausea) sexual dysfunction rise up slowly (dizziness) major side effects for for what type of meds
SSRI
what is the therapeutic range for lithium
0.6 - 1.2
Therapeutic Communication Technique where give the client time to collect their thoughts
Use of silence
when a patient is taking ______ they need to have adequate water and salt in diet
lithium
internal crisis,(values, gender role conflict)
Maturational or developmental –
crisis where first episode of mental illness (breakdown, overdose, panic attack)
Psychiatric-
Cognition: flight of ideas, GRANDiose (bigger than life) Emotions: Euphoria, labile, irritable Physical: appetite, sleep Behavior: speech, appearance, impulsive, sexual indiscretion
bipolar disorder
manic attack dig fast
Distractibility Indiscretion Grandiosity Flight of ideas Activity increase Sleep deficit Talkativeness
restraints should not be used more than: _____ continuously is the max for adults ______ continuously is the max for minors
4 hours 2 hours
normal time period for grieving
6-8 weeks
doctor has up to __ days (non weekend or holiday) to decided about discharge. Alerts physician patient wants to leave
5
crisis where traumatic event (sexual assault, natural disaster, violent attack)
Traumatic stress-
– has no reaction to the change in their symptoms (indifferent)
“La Belle Indifference”
Serotonin Syndrome if mixed with other type of antidepressant syndrome (must be off other antidepressants for about 2 weeks) is the most common side effect of what kind of meds
MAOIs
-Finding unfamiliar clothes in closet -Being called an unfamiliar name by strangers -Core personality is unaware of others
Dissociative identity disorder (multiple personality disorder)
what medications are used for somatic and dissociative disorders
no specific drugs but may be treated with anti anxiety meds
Within ______ of being put into restraints, physician has to come in and evaluate the patient
1 hour
psychiatric crisis but not your first episode
Psychopathology-
phase where: Explore areas in patient’s life that cause problems Gather and analyze data Promote patient problem solving Facilitate/practice behavioral changes Expect patient to use ineffective coping mechanisms until can be taught otherwise
working
Stage of Development in Erikson’s Psychosocial Theory where: To integrate the tasks mastered in the previous stages into a secure sense of self Adolescence (12–20 years)
Identity vs. role confusion
maladaptive ( inappropriate) responses to stressors from the internal or external environment evidenced by thoughts, feelings and behaviors that are incongruent with the local cultural norms and interfere with the individual’s social, occupational and or physical functioning
Mental Illness
crisis where something expected in life (life, having a baby, getting married)
Anticipated life transition-
mini metntal status exam
theory where considered the first 5 years of a child’s life to be the most important, because he believed that an individual’s basic character had been formed by the age of 5. Cause of suffering, value of talk sessions, correct inappropriate learning patterns
Psychoanalytic Theory
Atypical meds can not be given to somone with a __________ disorder
seizure
what is the major difference between grief and depression?
self esteem
is a petition and certificate needed for a minor?
no
when a patient is taking ______ they need to have adequate water and salt in diet 2-3L of water
lithium
Phi –
protected health information (only first names with patient)
- Medical symptoms and no medical diagnosis
Somatization disorder
Persistent experiences of feeling detached from the body Person feels mechanical or dream “I don’t even know how I got here”
Depersonalization disorder-
success adaptation to stressors from the internal or external environment observed as thoughts feelings and behaviors that are age appropriate and congruent with local and cultural norms
Mental Health
when a patient is in restraints offer food, fluids and toileting every ___ mins and vitals.
15
upon admission will a patient loose their FOID card?
yes
The individual identifies thought distortions Examines evidence for those thought distortions Reframes thinking and replaces with more realistic thoughts Learn to use healthy coping mechanisms in order to not return to thought distortions
Cognitive Behavioral Therapy
Therapeutic Communication Technique where allows patient to take initiative in introducing the topic “tell me what you are thinking”
Giving Broad Openings
relationship where both needs are being met
Social relationship
petition can be filled out by any one and is good for _______ certificate has to be filled out by medical professional and is good for _________
72 hours 24 hours
Medical or physical complaint but and underlying psychiatric disorder (no medical issue but still has symptoms) Non measurable
somatic disorders
Symptoms/sensations leading to preoccupation and fear of having a serious disease (hypochondriac)
Illness anxiety disorder –
4 compliations for an ECT that are not normal and would be an indication to discontinue
reactions to anesthesia pain ecg changes relapse of depression
2 ways for going impatient mental health
Suicidal with a plan or homicidal with a plan or both
conditioning where Positive behavior is reinforced
Operant Conditioning
___ and up is considered and adult for release of information
12
Therapeutic Communication Technique where making oneself available unconditionally “i’ll stay with you” “i’m here for you”
Offering Self
Therapeutic Communication Technique where verbalizing what is observed or percieved “you seem tense” “i notice you pacing a lot”
Making Observations
– needs to be signed in order to share information about the patient (insurance, other providers, etc.)
Release of information
Nursing Diagnosis for _________
bipolar disorder
Cardiac side effects Orthostatic hypotension Sedation common side effects for what kind of meds
Tricyclic
Dietary restriction is tyramine free (anything aged) otherwise they could have a life threatening hypertensive crisis for what kind of meds
MAOIs
risk factors for depression Age Gender Family Medical
Age (18-25 and elderly) Gender (female) Family (history) Medical (pain, diabetes, hypertension, traumatic brain injury)
is ECT safe for pregnancy?
yes
Stage of Development in Erikson’s Psychosocial Theory where: To achieve a sense of self-confidence by learning, competing, performing successfully, and receiving recognition from significant others, peers, and acquaintances School age (6–12 years)
Industry vs. inferiority
5 risk factors for aggression
history of violence (what do you do when you become angry) Verbal and non verbal cues (physical) (clenched fist, huffing and puffing, pacing, verbalizing they will become violent) Suspiciousness or paranoid thinking (think other people are trying to harm them) Substance abuse (not thinking clearly) Possession of a weapon (do you have anything on you that could hurt others or yourself)
Therapeutic Communication Technique where striving to explain information that is vague “im not sure that I understand, can you please explain”
Seeking clarification and validation
a wrongful act or injury committed by an entity or person against another person or another person property
tort
phase where: Establish parameters of the relationship Establish rapport & TRUST Clarify roles of the Nurse and patient Contracting
Orientation or introduction:
the clients right to make their own decision
autonomy
4 candidates for ECT are
Major Depressive Disorder Schizophrenia Disorders Acute Manic Episodes Rapid cycling
combination of mania and depression
bi polar disorder
refers to the learning of new behaviors by imitating the behavior in others.
Modeling
Amitriptyline Doxepin Nortriptyline are all what kind of meds
Tricyclic
if someone is homicidal with a plan you can break confidentiality to warn that person
Duty to warn
when assessing a clients memory ask the client to state a fact from his past that is verifiable such as birth date or maiden name
remote
Stage of Development in Erikson’s Psychosocial Theory where: To achieve the life goals established for oneself, while also considering the welfare of future generations Adulthood (30–65 years)
Generativity vs. stagnation
Patient unconsciously displaces emotional reactions and patterns of behaviors onto others when patient puts their feelings toward the nurse because they remind them of someone (if the nurse reminds the patient of someone that they don’t like then they will be mean to them and vice versa) may be bad if the feeling is positive because they might treat others who aren’t the person that they like badly
Transference
The ability to use ones personality consciously to establish rapport and structure interventions
Therapeutic Use of Self
relationship where only the patients needs are getting met (patient centered)
Therapeutic relationship
Phenelzine Selegiline are what kind of meds
MAOIs
Patients are taught techniques and then exposed
Systematic Desensitization
If parent does not want to admit their child and a physician thinks that they need it then the physician has the right to take ____________________
medical protective custody (temporary)
when giving a patient an injection against their will a _______ form must be documented, if you do not fil it out it can be assault and battery
restriction of rights
Therapeutic Communication Technique where delving deeper into a subject “tell me more”
Exploring
__________ is a normal side effect to ect
short term memory loss
ECT can not be used with what type of 3 patients?
Increased ICP High risk pregnancy Severe osteoporosis
code that is needed to acknowledge that the patient is there to anyone who visits or calls
Confidentiality code-
honesty when dealing with a patient
Veracity
Cognition: Impaired memory & concentration, SI, hallucinations Emotions: Helpless, Hopeless, worthless, Anhedonia Physical: appetite,sleep, pain Behavior: crying, withdrawn, lack of ADLs, dishelved, psychomotor retardation
Major Depressive Disorder
A type of psychotherapy based on identifying negative thinking/emotions and restructuring them into positive. Usually a time limited therapy Effective: Depression, Anxiety, Eating Disorders
Cognitive Therapy (Beck)
phase where the nurse and client become acquainted. Tasks include: Creating an environment for the establishment of trust and rapport Establishing a contract for intervention that details the expectations and responsibilities of both nurse and client Gathering assessment information to build a strong client database Identifying the client’s strengths and limitations Formulating nursing diagnoses Setting goals that are mutually agreeable to the nurse and client Developing a plan of action that is realistic for meeting the established goals
The Orientation (Introductory) Phase
when assessing a clients memory ask the client to recall recent events such as visitors from the current day, or the purpose of the current mental health appointment or admission
recent
The goal of _______ is to manipulate the environment so that all aspects of the client’s hospital experience are considered therapeutic.
milieu therapy
phase where: Discuss ways to incorporate new coping strategies Reinforcing education received during relationship Mutually evaluate patient progress and goal attainment Thanking patient
termination
7 toxic effects of lithium
Persistent nausea, vomiting, diarrhea Blurred vision Jerking or twitching legs Slurred speech Excessive dilutes urine Confusion Coma
doing what you say you will
Fidelity
