FINAL Flashcards

Question

creativity

Answer 1

activity producing a sense of peace, comfort, and soulfulness for the individual

Answer 2

- process/experience beyond the usual sensory phenomena - associated with classical mystic experiences of God - not reserved for religious experience alone - may be related to aesthetic reactions to art and music or the response to the majesty of creation (regarding a feeling of wonder or awe)

Answer 3

disturbance in the person's core value system, which provides strength, hope and meaning to life

Answer 4

- holy days - sacred writings - spiritual symbols - prayer/meditation - beliefs: diet nutrition dress birth & death medical procedures

Answer 5

- growth - development - lifespan - expected life events - unexpected life events - transition

Answer 6

- Physical changes: increase in bone & muscle growth - hormone fluctuations = development of sex characteristics: puberty - massive brain growth, pruning, poor impulse control - self identity - gender identity, peer relationships, sexuality, independence from family unit - health risk - MVA, violence, suicide, substance abuse, eating disorders, STIs, depression

Answer 7

- careers - marriage - raising children - physical changes: physcial growth is completed to 20 y/o, active (@ physical peak), avoid seeking help due to illness - psychological changes: choosing occupation, pursing education, intimate, mature relationships, financial independence, parenthood, body image issues - health risks: lifestyle habits, accidents, substance abuse, fertility issues, stress, pregnancy, mental illness

Answer 8

- sandwich generation - financial responsibilities - balancing career & family against aging process - physical: major physical: grey hair, wrinkles, metabolic change, decrease in hearing and vision, hormone fluctuations for both M/W (menopause) - psychosocial: assisting children as they leave the nest, dealing with separation/divorce or death of a loved one health risk: stress, anxiety, depression, obesity, long-term effects of poor lifestyle choices

Answer 9

- physical: Normal physiological changes in most body systems eg. Decreased muscle mass, degenerative joint changes, lower cardiac output, decreased elasticity, etc. - psychosocial: Retirement, transitions & role change, social isolation (loss d/t death of friends, loved ones), Maintaining sexual identity - health risks: Cancer, heart disease, delirium, dementia, arthritis, falls

Answer 10

- Erikson believed personality develops in a series of stages. - In each stage, each person needs to accomplish a particular task (challenge) in order to move onto the next stage - Each stage builds upon the successful resolution of the previous developmental challenge - According to Erikson’s theory, unsuccessful resolution of one stage will result in the chronic inability to master these tasks

Answer 11

- adolescence (teens into 20's) - teenage work at refining a sense of self by testing roles and then integrating them to form a single identity, or they become confused about who they are

Answer 12

- young adult (20s-early 40s - young adults struggle to form close- relationships and to grain the capacity for intimate love, or they feel socially isolated

Answer 13

- middle adult ( 40s-60s) - middle-aged discover a sense of contributing to the world, usually through family and work, or they maybe feel a lack of purpose

Answer 14

- late adults (late 60s+) - when reflecting on his or her life, the older adult may feel a sense of satisfaction or failure

Answer 15

crisis is identity vs. role confusion

Answer 16

Crisis is Intimacy vs. Isolation

Answer 17

Crisis is Generativity vs. Stagnation

Answer 18

Crisis is Integrity vs. Despair

Answer 19

Medical administration record

Answer 20

- any written or electronically generated information about client that describes the care or service provided to that client - nursing action, produces a written account of pertinent patient data, nursing clinical decisions and interventions, and patient responses in a health record

Answer 21

- communication - safe and appropriate nursing care - professional and legal standards

Answer 22

standard 2: competent, evidence-informed practice - doc the application of the clinical decision-making process in a responsible, accountable and ethical manner - applies documentation principle to ensure effective written/electronic communication

Answer 23

- client's record is permanent/legal document - be used to provide evidence in court/coroner's - nurse must clearly document all nursing care given: care decision was based on assessment, and the nurse will continue to monitor, document, and report patient responses - in court care not documented is not given - freedom of information and protection of privacy act (FOIPPA)

Answer 24

#8: protects the confidentiality of all information gathered in the content of the professional relatoinship #9: practices within relevant legislation that governs privacy, access, use

Answer 25

- computer passwords -mindful of screens and papers - aware of agency policies: documenting sensitive info - all written documentation is secured RPN safeguard privacy, security, and confidentiality health records

Answer 26

- document care you personally provided - only use agency-approved abbreviations - never use pencil, black ink only - document ASAP, chronological order, never prior - follow proper protocol for errors, no erasing or white out - document clear, concise, factual, objective, timely, and legible - do not leave any blank spaces or lines - add signature

Answer 27

- initial assessment/admission forms - nursing care plan - flow sheets - nursing notes - interdisciplinary notes/history - kardex - incident reports (not part of the health record)

Answer 28

- purpose: make information readily available - continuously updated (pencil)- not legal document - content: pertinent information/demographics daily treatments-dressings Dx procedures ie blood work allergies specific data: diet, assistance with transfer, walking aids, safety Dx/goals MH: status- certified, privileges, passes, clothes, pjs, obs level breif shift summary

Answer 29

- status and health concern (assessment data) - changes in MH status (MSE) - nursing care/interventions - completeness: reflect nursing process - appropriateness: significant to assessment and care - advocacy by nurse on behalf of client - chart client responses and evaluate the effectiveness of the care provided - effectiveness of medications and prn medications

Answer 30

narrative: written chronologically in paragraph form in progress notes problem-oritented/charting by exception: DARP/SOAP(IE)R- focuses on documenting only deviations from the norm, narrative format; often seen with checklist flowsheets source oriented medical records: each discipline writes in a separate section of the chart (Dr's , physio, dietician)

Answer 31

D: data eg: what is the pain? headache 9/10, LOTTARP A: action eg: @ 11:10 650 mg R: response eg: how did the pt respond? does the pt still have a headache P: plan eg: what is next? follow up with pt

Answer 32

S: subjective (how does client feel) O: objective (vital signs) A: assessment (what is the clients status) P: plan (does plan stay. the same or change) I: Intervention (what occurred/what did nurse do) E: evaluation (what is the clients outcome) R: revision (what changes are needed) only deviations problems focussed

Answer 33

- familiarize style/type of docs used at the agency - read documentation already contained - balance relative details - be objective state facts - use patient's words - use current diagnosis LATE ENTRIES: - follow agency policy - write "late entry" after last recorded note

Answer 34

- concise and accurate - state name and relationship to client - state medical diagnosis, changes in nursing assessment, vital signs related to baseline, siginpificantly laboratory data, related nursing interventions - have chart ready - what does the staff ned to know

Answer 35

purpose: document unusual unanticipated occurrences a risk management tool. Internal quality control only – standalone report/not in patient’s chart eg. medication errors, falls -Identification of the client by name, initials, and hospital or identification number - Date, time, and place of the incident - Description of the facts of the incident (no conclusions or blame) - Incorporation of the client’s account of the incident in quotes - Identification of all witnesses - Identification of any equipment by number and any medication by name and dosage

Answer 36

- not dating, timing, and signing entries correctly - illegible handwriting - forgetting to chart important health info: allergies, medications given - leaving blank lines in progress notes or blank spaces on forms - using subjective language - entering information into the wrong chart - using inappropriate abbreviations

Answer 37

- body alignment (posture) - joint mobility (ROM) - balance - coordination

Answer 38

- max movement possible for joint - varies: age health and overall activity level genetics general health status (baseline health) - active or passive

Answer 39

- done first - less intrusive - uses patients own strength to create the movements through the joints - ask patients to slowly move each joint through it's full ROM (flexion/extension) - tell pt to stop the movement and tell you if they experience any pain

Answer 40

- more intrusive - manipulate the person's joints for them - tell the patient to relax and then support the joint and move it through it's range of motion - observe and compare each side of the body for symmetry, pain, inflammation, or stiffness

Answer 41

- congenital or acquired postural abnormalities eg scoliosis - damage to the CNS as it regulates voluntary movement - impaired muscle development eg MS - Direct trauma to the musculoskeletal system eg. fracture - Inflammatory diseases eg. Rheumatoid Arthritis - Bed rest or reduced activity tolerance - Pain - Medications

Answer 42

- chronic (exacerbated/remission) inflammatory disease primarily impacts SYNOVIAL MEMBRANE but may impact other systems/organs (lungs/pericardium) - both systemic/local effects eg inflamed knee - cause: unknown (autoimmune disease, genetic/hereditary factors, infections) exacerbated by stress - symptoms/assessment: inflammation objective: heat, redness, swelling over joint, tenderness subjective: pain, fatigue, report flare ups, morning joint stiffness

Answer 43

- degeneration of the joint that causes localized pain. deterioration of CARTILAGE in the joints = inflammation - most common chronic condition of the joints - risk factors: older than 65, increasing age, obesity, previous joint injury, overuse of the joint, weak thigh muscles, genes symptoms: pain that worsens with activity, joint stiffness and loss of function, decreased ROM signs: limited joint motion, crepitation health promotion: encourage weight bearing exercies, increase Vit D and Ca intake; teach and encourage ROM exercises

Answer 44

- decreased density of bones and deterioration of bone tissue, leading to bone fragility, and increased risk for fractures - bone mass is lost faster than it can be replaces - common in hips, wrists, and spine risk factors: gender (female), 65+, post-menopausal ( early menopause), ethnicity (caucasion/asian), history of fractures (from minor falls/injuries), family history, bone structure, body weight-thin, "small boned", smoking, alcohol abuse health promotion/prevention: diet, exercise, fall prevention

Answer 45

- can lead to disuse osteoporosis - muscle atrophy & deconditioning - contractures - stiffness and pain in the joints - cardiovascular changes eg orthostatic hypotension - metabolic changes eg loss of calcium, constipation - respiratory complications eg atelectasis, pneumonia - urinary changes eg increased risk for urinary stasis or renal calculi - poor hygiene r/t immobility can lead to skin breakdown, and sustained pressure on joints can lead to pressure ulcers

Answer 46

- uniformity/thickness - colour - amount of hair (alopecia) - body hair (lanugo) - texture (oily/dry) - scalp is free of lesions - parasites (lice)

Answer 47

- texture: smooth, thick, thin - colour: capillary refill, cyanosis - cleanliness - length eg: nail biting - shape - curvature

Answer 48

- type eg pressure ulcer - size, shape and texture - colour - location/distribution - surrounding skin - elevation - exudate/discharge - odour - measure height, width, and depth

Answer 49

- pressure ulcer - aka decubitus ulcer

Answer 50

1. epidermis 2. dermis 3. Subcutaneous fat 4. bone

Answer 51

- colour: pallor (pale), erythema (red), cyanosis (blue), jaundice (yellow) - redness, open wounds, lesions - edema - bruising, moles - tattoos, marking eg birthmark - rash, scratches/itchiness (itch is technically subjective) - mucous membranes: pink, moist, intact

Answer 52

- temperature-: use your hand and feel skin = indicates circulation/infection - moisture: look for dryness, flaking; dehydration, eczema - turgor: hydration status, age - edema: swelling, fluid retention in tissues - texture/thickness: smooth, rough, thin, uniform

Answer 53

- can be short or long term - must be singular, observable, measurable, time-limited, mutual, and realistic

Answer 54

- CRISIS* (Stress, Anxiety) - COMFORT* (pain) - HOPE* (hopelessness) LOSS (grief) - POWER* (powerlessness) - RESILIENCY* (coping, strengths) - INTEGRITY (death, dying, acceptance)

Answer 55

- stimulus, process, response, and a state - stressors = stimuli - stress = response or reaction TO stressors - subjective - internal and external causes - response to demands that exceeds one's ability to cope - occurs on a continuum with anxiety and crisis

Answer 56

- physiological component - cognitive component - emotional component

Answer 57

- fight or flight - general adaptation syndrome (selye)

Answer 58

- stage 1: alarm reaction - stage 2: resistance stage - stage 3: exhaustion stage

Answer 59

- considers the appraisal of stressors and how they influence the stress response - cognitive appraisal theory (lazarus & folkman) - cognitive triangle

Answer 60

- person is under stress only if they perceive themselves to be - PRIMARY appraisal: what does this situation mean to me? - SECONDARY appraisal: can i cope with it?

Answer 61

- triangle of: emotions, thoughts, and behavior

Answer 62

- apprehension or dread in response to internal or external stimuli that can be experienced in physical, emotional, cognitive, and or behavioural ways - range: mild-severe/panic level - BUT: is it normal? dangerous? adapative?

Answer 63

- Slight arousal that enhances perception, learning and productivity.

Answer 64

- Increased arousal with tension, nervousness and perception is narrowed.

Answer 65

- It is consuming, poor focus, very uncomfortable and requires intervention. - overpowering and frightening.

Answer 66

- Strategies that minimize/reduce or eliminate the stress response. - Strategies can be short- term/immediate, or longer term adaptations.

Answer 67

- May temporarily be “effective”, but cause longer term negative consequences and results in worsening distress. - Defense mechanisms- denial, projection, regression etc.

Answer 68

- COMFORT IS CLOSELY RELATED TO CARING - IT IS AN ESSENTIAL PART OF OUR ROLE AS RPN’S - MAY INVOLVE CONSOLATION, SUPPORT OR ASSISTANCE TO PROMOTE WELL-BEING. - DON’T CONFUSE IT WITH PITY! - WHEN WE AREN’T SURE HOW TO COMFORT SOMEONE- ASK THEM!

Answer 69

Hope is the anticipation of a continued good or of an improvement in, or lessening of something unpleasant

Answer 70

- The perception & process of gaining or maintaining control or influence over aspects on one’s environment. - A client receiving mental health treatment can at times feel powerless. - We must recognize & minimize the power differential inherent in our therapeutic relationships and our practices as RPN’s. - The goal is to empower our clients by mobilizing their strengths.

Answer 71

- DEVELOPMENTAL: retirement, empty nest, puberty - SITUATIONAL: - Illness - Death of a loved one - Separation or divorce - Loss of job - Moving - Traumatic experience - Unplanned pregnancy

Answer 72

- early intervention - stabilization - Facilitate Understanding - problem solving - encourage self reliance

Answer 73

- Establish a therapeutic relationship - Gather relevant data - Bear witness to their pain - Validate their feelings - Provide education - Teach new coping skills - Offer hope – “I believe you will get through this”

Answer 74

-grief - actual loss - perceived loss - bereavment

Answer 75

The emotional response (subjective) to the perception of loss

Answer 76

A loss of a person or object that can no longer be felt, heard, known or experienced

Answer 77

A loss that can’t be seen by others

Answer 78

The response to the loss or death of a loved one

Answer 79

- Feel physically drained - Can’t sleep - Forgetful, can’t think clearly - Appetite changes - Physical symptoms: chest pains, headaches - Poor concentration - Senses or dreams about the deceased - Guilt - Tearfulness - Sadness that comes in waves

Answer 80

- Personality and temperament before the loss (external vs. internal locus of control) - The degree of attachment with the person who died -Culture & religious background -Nature of the loss eg. sudden or traumatic - Presence of pre existing mental illness & coping skills - The amount of support they have - The number or previous losses person as experienced (grief is cumulative) - The bereaved person feels responsible in some way for the loss

Answer 81

- Self esteem intact - Good days and bad days - Maintains feelings of hope - Able to experience pleasure - Accepts comfort from others - Physical symptoms are transient

Answer 82

- Self esteem is disturbed - Feels persistent dysphoria - Feelings of hopelessness - Anhedonia is prevalent - Does not respond to support from others - Expresses chronic physical complaints

Answer 83

- stuck in the grieving process - unhealthy mourning following a death - lasts at least 6 months - Pt doesn’t progress through the stages of grief - Preoccupation with the deceased or death - Recurrent intrusive images - Avoidance of painful reminders of death - Grief response continues to impact daily living - Seek to isolate or avoid support systems - Extreme feelings of guilt/ worthlessness - Meet criteria for Major Depression

Answer 84

the emotional experience of the normal grief response before the loss actually occurs

Answer 85

- Assess the client’s stage in the grief process (gather an accurate baseline) - Develop trust. Show empathy and unconditional positive regard. - Provide ongoing support (friends, support groups...) - Help client actualize the loss by talking about it. (reviewing events of the loss helps increase awareness) - Help client identify and express feelings (repressed feelings of guilt/ anger can stall grieving) - Understand and explain the normal grief process - Be present and bear witness to their pain - Identify maladaptive coping strategies (avoidance of pain can stall grieving)

Answer 86

- latin word "integer" = whole and complete - The quality of having an inner sense of ‘wholeness’ and consistency of character. - You demonstrate a consistency in your values, beliefs and actions in all areas of your life. - Satisfaction of attaining own life goals. - Integrity contributes to trust and authenticity. - Maintaining patient’s sense integrity is a key role of the nurse e.g. dying patient, grieving patient

Answer 87

- preparing, giving, and evaluating the effectiveness of prescription and non-prescription drugs

Answer 88

- knowledge about practice standards (BCCNM) - education on drug being administering: what it does, works, normal dosages, why was it ordered? - what could go wrong once you give it: side effects and contradictions for use - any barriers to medication compliance: aware of why people may want to discontinue their meds - nursing process: assessment of patient, create nursing diagnosis, planning (set client centered goals), perform interventions, evaluate if goals were met or not

Answer 89

RPNS: - responsible for admin. meds. within their scope - knowledgeable about the effects, side effects and interactions of medications and take action as necessary. - adhere to the “7 rights” of medication administration. - administer only medications they themselves or a pharmacist have prepared, except in an emergency. - do not pre-pour medication because it increases the likelihood of errors. - take appropriate steps to resolve and report any medication administration error or near miss in a timely manner.

Answer 90

- right medication - right patient - right dose - right route - right reason - right time - right documentation

Answer 91

- right to refuse - right patient education - right evaluation

Answer 92

study or science of drugs - RPNs need to know about pharmacological principles so they can understand how each drug given will affect the patient (both beneficial and adverse effects)

Answer 93

- one medication can be known by up to 3 different names - generic name - trade name - chemical name

Answer 94

- name given to the drug by the developer of the medication - becomes the official name - used in all formal publications - eg acetaminophen, ibuprofen, dimenhydrinate

Answer 95

- aka brand name - commercial name given to drug by manufacture - vary in other countries - eg tylenol, advil, gravol

Answer 96

- describes the medications molecular structure - eg N-acetyl-para-aminophenol is acetaminophen (generic name) or Tylenol (brand name)

Answer 97

- the desired effect on the body system - tells what type of drug it is eg antipsychotic, antihypertensive

Answer 98

- form of the med indicated the route of administration - nurse must ensure they use the correct form of medication as this affects absorption and metabolization eg tablet, ointment, suppository eg Tylenol comes in many different forms such as tablets, capsules, liquid and suppositories.

Answer 99

study of what the drug does to the body

Answer 100

intended or expected effect on the body eg tylenol will relieve a headache

Answer 101

unintended a secondary effects eg morphine may cause a rash

Answer 102

serious, negative effects eg gravol may cause hallucinations (rare)

Answer 103

a build up or accumulation of medication in the body - to the point it is poisonous eg Lithium is used to treat bipolar disorder and major depressive disorder. Blood levels must be monitored several times a year to ensure chronic toxicity does not occur (this may happen over time if daily dose is just a little too high). Acute toxicity may occur if, for example, double doses are taken in error or on purpose.

Answer 104

any characteristic of the patient - disease state - other medication - pregnancy = makes the use of the medication dangerous for them

Answer 105

-various medication forms/routes influence the way in which the body metabolizes a drug and the way in which the drug effects the body eg -Oral - Sub-lingual - Subcutaneously - IM - IV - Transdermal - Inhalation - Topical

Answer 106

how medication moves into, through and out of the body - absorption, distribution, metabolism, and excretion

Answer 107

movement of the drug from the site of administration to the bloodstream

Answer 108

transport of drug in the body by the bloodstream to it's site of action

Answer 109

biological transformation or metabolic breakdown of a drug in the body - liver

Answer 110

elimination of drugs from the body - The kidneys are the primary way that drugs are eliminated from the body; to a lesser extent the bowel and liver are also responsible for elimination

Answer 111

- IV - IM - subcutaneous

Answer 112

- nebulizers - nasal sprays

Answer 113

sublingual

Answer 114

- PO - suppositories

Answer 115

- patches - creams - ointments

Answer 116

- time it takes for the drug to elicit a therapeutic response

Answer 117

- time needed for a drug to reach it's meximum therapeutic response

Answer 118

- length of time that the concentration is sufficient to elicit a therapeutic response (time it lasts before it wears off)

Answer 119

the time it takes for one half of the drug in the body to be eliminated from the body

Answer 120

needs prescription in order to sell eg amoxicillin, sertaline

Answer 121

Abuse potential drugs, require a triplicate/duplicate prescription in order to sell (MD keeps a copy, pharmacist a copy – to prevent forgeries and for prescription tracking purposes) e.g. Tylenol # 3 (has 30 mg of codeine), fentanyl

Answer 122

no prescription required but pharmacist supervises the sale (medications are kept behind the counter) e.g. Tylenol # 1 - 8 mg of codeine, cough syrup with codeine

Answer 123

Drugs that can be sold without a prescription by a pharmacist (medications are locked in grocery stores after pharmacy closes. If no pharmacist on duty, cannot sell the medications) -e.g. hydrocortisone topical cream, Pepcid AC

Answer 124

prescription by pharmacist

Answer 125

no restriction on sale of this drug e.g. Tylenol, Tums – available at 7/11, etc.

Answer 126

NSAIDS (Non-steroidal anti-inflammatory drugs) ASA (Aspirin) Advil (Ibuprofen) Non-opioid Analgesics Acetaminophen (Tylenol) Anti-emetics Dimenhydrinate (Gravol) Antihistamines Diphenhydramine (Benadryl)

Answer 127

Complementary medicines or traditional remedies based on premise that plants contain natural substances that can promote and alleviate illness. E.g. Marijuana, St. John’s Wort, Melatonin

Answer 128

Adjunct therapy to support conventional pharmaceutical therapies.

Answer 129

Drug-drug interactions E.g. Evening primrose interferes with antipsychotic drugs Allergic reactions Adverse side effects People believe they are safe due to “Natural” label

Answer 130

Gather a comprehensive medication profile including: - All medications your patient takes on a regular basis - History of allergies - Use of OTC and Natural Health Products - Intake of alcohol, tobacco, caffeine - Illicit drug use - Past/ present health/ medication history - Family history - Client’s beliefs about their medications and their effectiveness

Answer 131

- Developed from the assessment data through critical thought, analysis, creativity and accurate data collection. - Nursing diagnoses related to medication therapy may include: - Variance in Knowledge Base (knowledge deficit) - Variance in Protection (risk of injury from over-medicating) - Variance in Health Beliefs (non-adherence)

Answer 132

- Goals are patient focused - They include a time frame - GOAL: Patient will take medication as prescribed on a daily basis, starting immediately.

Answer 133

- Interventions are based on evidenced based practice - Interventions are done as independent nursing functions or as collaborative interdisciplinary care - Nurse to discuss with patient the risks of not taking meds as prescribed - Have pharmacist discuss side effect profile with patient and how to manage each side effect (this is often done by the nurse) - Provide education on long term consequences of stopping medications abruptly

Answer 134

- Includes monitoring whether or not the patient goal has been met or not - Includes observing for therapeutic effects and adverse effects/toxicity of a medication - If the goal is not met then nursing care plan will need to be revised

Answer 135

- A structured approach to assessing psychological, emotional, social and neurological functioning – “An attempt to objectively describe the behaviours, thoughts, feelings, and perceptions of the patient throughout the course of the interview itself” – Provides an overall picture of current mental health. – Clinical knowledge, judgment, interpretation & communication skills are required to do it well. – Uses a combination of observation (objective data) and questioning (subjective data).

Answer 136

- during interview - assess cognition - Sensitive questions should be asked after more general, less sensitive topics are addressed & some rapport is established.

Answer 137

1) Appearance and Behaviour 2) Mood and Affect 3) Speech 4) Thought Form/Process 5) Thought Content 6) Perception 7) Cognition 8) Insight and Judgment 9) Risk Assessment

Answer 138

- Sex – Apparent age (vs. chronological) – Height/weight – Ethnicity/race – Grooming, hygiene – Distinguishing features – Eye colour, hair colour, length

Answer 139

– Psychomotor retardation or agitation – Hyperactivity, restlessness, repetitive movements – Eye contact (prolonged, intense, minimal, intermittent) – Attentiveness – Mannerisms, gestures – General Attitude (uncooperative, cooperative, withdrawn, passive, inappropriate, suspicious, guarded, interested) – Attitude towards the interviewer (neutral, positive, negative, dismissive, ambivalent, hostile, uncooperative, vague) – “Client was pleasant and cooperative with the interview.”

Answer 140

- “Good”, Happy, Cheerful, Euphoric, Elated - Neutral, Calm, Peaceful - “Okay”, “Blah” - Depressed, Hopeless, Sad, Angry, Agitated - Anxious, Nervous, Worried – How are you feeling today? – What word(s) would you use to describe your mood? – Do you experience highs and lows? – Is there any pattern to these mood changes? – Suicide/Self-Harm risk assessment – Homicide/harming others assessment – *What is your mood on a scale from 0 to 10?

Answer 141

– Elated, bright, animated – Hostile, fierce, disgruntled – Blunted, flat, downcast – Restricted range – Labile – Euthymic* – Note range of affect, appropriateness to context/situation, & congruency with stated mood

Answer 142

- Rate (average, slow, fast, pressured) - Volume/tone (loud, average, soft, variable, monotone) - Spontaneity/Hesitant - Characteristics (accent, dialect, language) - Response time (latency? Poverty of speech?) - Speech production (unremarkable, incoherent, irrelevant, pressured, minimal, muttering, clear, slurred, appropriate inflection, hesitant, mute, poverty, echolalia)

Answer 143

- Thought process is determined by the flow of conversation and quality of thoughts. Essentially it is the “how” the person is thinking. It is how thoughts are formed and if they are easy to follow or not. - Can only be determined through the patient’s speech and how they describe thinking. - Logical, organized, goal directed. - Illogical, disorganized, non-sensical. - Racing thoughts - Loose associations, tangential, flight of ideas - Thought blocking or slow, hesitant. - Neologisms (inventing new words)

Answer 144

– Thought content is the “what” the client is thinking about. – what topics they are spending their time thinking about. – looking for bothersome thoughts, preoccupations or symptoms of psychosis, particularly delusions. - can include persecutory, grandiose, religious, referential, thought control (broadcasting, insertion, withdrawal). – looking for phobias or obsessions. - “What do you spend most of your time thinking about?” - “Do you worry about your safety?” - “Do you ever feel as if there’s someone spying on you or out to get you in some way?” - “Do you have any special powers or abilities?” - “Do you have any specific fears?” - “Are there certain thoughts that you ruminate over or spend your entire day thinking about? - “Do these thoughts ever compel you to do something??”

Answer 145

- Hallucinations: auditory, visual, gustatory, olfactory, somatic/tactile - Command hallucinations - Illusions - Objective data: responding to internal stimuli? - Assess content of hallucinations, client’s interpretation/extent of belief in them being real, client’s reaction (positive vs. negative) - Ways of coping?

Answer 146

- MMSE/Folstein - Level of arousal (alert, drowsy) - Orientation (person, place, time, situation) - Concentration and attention - Memory (short-term, recent, remote) - Intellectual capacity/knowledge - Abstraction/concrete

Answer 147

- Awareness of situation, context - Recognition of illness, need for help - Understanding of factors contributing to illness - Motivation to work on identified problems - Stated as “full, partial, limited, impaired, no”

Answer 148

- The process one uses to reach a decision or take action. - Ability to consider the pros and cons of decisions/choices - “Poor judgment” may be demonstrated by impulsivity, engaging in actions with damaging consequences

Answer 149

– Self-harm and suicide are not the same – Ask routinely during initial assessment & periodically throughout treatment process. – When a change in behaviour is noted that may indicate elevated risk. – Following a major stressor. – When we get ”clues” that the client may feel hopeless or be experience suicidal thoughts. – Consider: suicidal thoughts, plan, intent, means, impulsivity, risk & protective factors (next slides) – Suicide risk assessment tools can inform level of risk (low, moderate, high)

Answer 150

– Age – Sex – History of psychiatric disorder (including personality d/o) – Current psychiatric diagnosis – Characteristic symptoms: hopelessness, anger, depression, guilt, anxiety, insomnia, diminished attention/concentration – Previous hx of suicidal behaviour. – Hx of abuse, trauma – Substance use – Situational risk factors & life stressors (interpersonal conflict, recent changes, losses) – Family hx of suicide & psychiatric disorders – Living alone – Social Relationship problems (isolation, lack of support, conflict) – Access to lethal means – Physical health issues

Answer 151

– Strong sense of competence – Sense of purpose – Effective interpersonal skills – Effective problem-solving skills – Adaptive coping skills – Self-understanding – Optimistic outlook – Religious affiliation

Answer 152

– Sense of accomplishment – Positive peer support and colleague relationships – Supportive, non-punitive work environment – Professional development opportunities (e.g., career development, stress management workshops) – Core values are present in the workplace (e.g., integrity, honesty) – Access to employee assistance programs

Answer 153

– Sense of responsibility to family. – Relationships characterized by warmth and belonging.

Answer 154

– Opportunities to participate – Affordable, accessible supportive resources – Hope for the future – Community self-determination and solidarity

Answer 155

- mental health treatment philosophy or approach that promotes resilience, personal recovery, full community integration, and a sense of purpose and meaning for those who have been diagnosed with any mental health condition and/or addiction issue.

Answer 156

Deinstitutionalization (1970’s) - Focus on community reintegration required shift in focus from pharmacology & therapy to life skills required to function in the community. - Created a niche for non-medical professionals such as PSR support workers.

Answer 157

freedom of information and protection of privacy act

Answer 158

- "continuity of care" - we can share information with others (FOIPPA does not specify who) if that information is being shared for the same reason it was collected- to offer health care.

Answer 159

is the right of individuals to determine for themselves when, how, and to what extent information about themselves is communicated to others.

Answer 160

means ensuring that the personal and health information belonging to another individual is kept private, safe from access or use by or disclosure to people who are not authorized to have the information.

Answer 161

- medical certificate - detain 48 hours - authority for anyone to take the individual to a designated facility - second form 4 completed by different physician within 48 hours to further involuntary admission failure = pt discharged or admitted as a voluntary pt - second form 4 valid up to one month from the initial admission - pt should be informed when form 4 cert are completed

Answer 162

- police intervention - give police authority to apprehend a person and take them to physician for examination - doesnt mean arrested - section 22: different criteria between officers and physicians - officer must be satisfied on the basis of personal observation and/or info received from others that the person has a mental disorder and is acting in a manner that is likely to endanger their own safety or the safety of others - safety = higher standard to meet than the criteria used by physicians

Answer 163

- Anyone who has reason to believe a person has a mental disorder and meets criteria for involuntary admission according to Section 22 can apply to a provincial court judge or justice of the peace to have a person apprehended for assessment by a physician. - form 9: Application for Warrant (Apprehension of Person with Apparent Mental Disorder for Purpose of Examination) is completed by friend/family member or other individual and submitted to the judge. - form 10: If the judge is satisfied the conditions are met, the judge may issue a warrant under Section 28 (4). giving police the authority to apprehend him or her.

Answer 164

- extended leave - cert/invol intervention: treatment implications

Answer 165

1. to know the name and location of the facility. 2. to know the reason why you are here. 3. to contact a lawyer. 4. to be examined regularly by a medical doctor to see if you still need to be an involuntary patient. 5. to apply to the Review Panel for a hearing to decide if you should be discharged 6. to apply to the court to ask a judge if your medical certificates are in order. 7. to appeal to the court your medical doctor’s decision to keep you in the facility. 8. to request a second medical opinion on the appropriateness of your medical treatment.