Final Exam Flashcards
what is mental health?
successful performance of mental function, resulting in productive activities, fulfilling relationships, and the ability to adapt to change and cope with adversity
what is the definition of mental illness?
thinking, feeling, mood, ability, to relate to others and daily functioning - a clinical significant behavioral or psychological syndrome experienced by a person and marked by distress, disability, or the risk of suffering disability or loss of freedom
what biological factors can influence mental health
perinatal period, anatomical abnormalities, injuries to the brain
what are the psychological influences on mental health?
self concept, developmental stages, relationships in childhood and adulthood, traumatic events
what are the sociocultural influences on mental health?
drugs, home-environment, housing, school, religion/spirituality, poverty, cultural expectations
what is the diathesis-stress model?
says that there is a biological predisposition (diathesis) and an environmental stress or trauma (stress) that combine to cause mental illness. it is the most widely accepted explanation for mental illness.
what is a major barrier to mental health treatment and recovery?
stigma
what is the nursing process and standards of care committed to?
promoting mental health through assessment, diagnosis, and treatment of human responses to illnesses and disorders
what can RNs do in the mental health feild?
assessment of functioning, case management, medication design and management, medication administration and teaching, crisis intervention, supportive counseling
what are the three stages of Freud’s psychoanalytic theory - describe each
ID - most primitive. focused on getting what we want, it is a natural way to respond and a reflex action that is focused on pleasure
ego - problem solver personality - it is our personality - tests reality
super ego - moral component
what are the three levels of awareness? describe each.
conscious - things that are in our current awareness
preconscious - things that we can bring to the surface of our consciousness pretty easily
unconscious - things that are buried deep in our consciousness
stage of development for infants
trust vs mistrust
stage of development for toddler
autonomy vs shame/doubt
stage of development for preschool age
initiative vs guilt
stage of development for school-age
industry vs inferiority
stage of development for adolescent
identity vs role confusion
stage of development for young adult
intimacy vs isolation
what does interpersonal theory say?
early interpersonal relationships are crucial for personality development and anxiety is an interpersonal phenomenon. states that all behavior is aimed at avoiding anxiety and threats to self esteem
how does interpersonal therapy work?
guides and challenges maladaptive behavior with emphasis on relationship issues. uses the therapist as a “participant observer” and wants the client to assume awareness of dysfunctional patterns and want this to lead to changes in behavior
what does Hildegard Peplau say the difference between the art of nursing and the science of nursing is?
the art of nursing is to provide care, compassion, and advocacy and enhance comfort and well-being; the science of nursing is to apply knowledge to understand the broad range of human problems and psychosocial phenomena and to intervene in relieving the patient’s suffering and promote growth
what is the difference between modeling and shaping?
with modeling, we as the nurse try to model good behavior to the patient; with shaping, we try to teach the patient little by little to change the behavior and reward them along the way
what do you try to do in applied behavioral analysis?
try to get the patient to analyze their behavior
what is systematic desensitization?
expose patient slowly, overtime, to what they are afraid of and pairing with some relaxation exercises
what is aversion therapy?
a more aggressive form of therapy. more focused on keeping you from doing something because it had a negative consequence - like giving Antabuse if they drink.
what do people do with cognitive therapies?
analyze their thinking and try to get them to reframe or rethink their thoughts
what does rational emotive behavioral therapy do?
beliefs about events are the most direct and important cause of how people act and feel. the focus of therapy is refuting irrational beliefs and teaching clients to do analysis of own behaviors
what is the ABCD approach to rational emotive behavior therapy?
antecedent/activating event, belief about the event, consequences of belief, d - refute the false/irrational belief
what are the d-motives in maslow’s hierarchy of needs?
deficiency needs - air, water, and food
what are the b-motives in maslow’s hierarchy of needs?
being needs and esteem needs
what are the different types of leaders?
autocratic leader - wants lots of control
democratic leader - like to reach consensus among the group
laissez-faire leader - hands off leader
what is the difference between group content and process?
group content is what the group talks about and group process is who speaks first and how the communication is handled
what is health?
a state of complete physical, mental, and social well-being
what is universiality?
knowing you’re not the only one who has that problem
what is catharsis?
knowing you can say what you really feel because you’re in a group that can understand what you are saying
what kinds of groups can basic-level RNs lead?
psychoeducational, medication education, health education, symptom management, stress-management, support and self help group
what should you do with the monopolizing member of a group?
redirect them. recognize what they have said, but redirect them back to the topic and remind them that everyone needs a chance to talk
what do you do with the complaining member of a group?
allow them to complain a little bit, but after a while redirect them back to the group and if it still doesn’t get better they may need to be asked to leave
what do you do with the demoralizing member of the group>
may need to pull them out in the middle of the group and talk to them individually
what should you do with the silent member of a group?
allow them a chance to talk. don’t be confrontational, but direct a question toward them. if they don’t want to talk, understand and respect that because some people get a lot out of a group from just sitting there
personal beliefs about the worth of a given idea, attitude, custom, or object
values
study of philosophical beliefs about what is considered right or wrong in society
ethics
ethical questions arising in health care
bioethics
what are the four ethics included in the professional nursing code of ethics?
advocacy, responsibility, accountability, and confidentiality
beneficence
doing good for the patient
autonomy
respecting the rights of others to make their own decisions
justice
distributing care equally among all people
fidelity
faithfulness, maintaining loyalty to the patient
veracity
maintaining truthfulness
where does a statutory law come from?
other nurses
where does regulatory or administrative law come from?
congress
where does common law or judicial decisions come from?
cases that have occurred before
what must be noted in order for a patient to be admitted against their will for a 72 hour hold?
a clear and present danger to self or others
what is due process in civil commitment?
courts have recognized involuntary commitment to a mental hospital is a “massive curtailment of liberty” that requires due process protection, so the least restrictive measure must be used first
what is the difference between a conditional release, an unconditional release, and an AMA?
a conditional release is saying that you are released from the hospital or facility, but must come back for some form of followup treatment, an unconditional release is saying that you are free to go and no other treatment is required, and AMA is a release against medical advice
what are the patient’s rights?
right to treatment, right to refuse treatment, right to informed consent, right to the least restrictive measure for the shortest time
what are the patient’s rights in mental health?
right to treatment, right to refuse treatment, even if a hospital does not specialize in the area of treatment required they must stabilize the patient, right to informed consent, implied consent, right to the least restrictive measure for the shortest amount of time
a wrongful act or infringement of a right leading to a civil legal liability
torts
what elements are necessary to prove malpractice?
you must have a duty to that patient, breach in duty, have to prove that the patient would be okay if it wasn’t for what you did or didn’t do
what are some common negligent acts?
failure to asses/monitor, failure to notify the health care provider, failure to follow orders, failure to follow the 6 rights of medication, failure to do discharge instructions or doing them incorrectly, failure to make sure the patient is safe, failure to follow policies and procedures, failure to properly delegate and supervise
what factors affect communication? what is each?
personal factors - beliefs, moods, cognitive factors, intellectual ability, previous experiences, cultural background
environmental factors - environment in which you are talking with the patient
relationship factors - way you relate to different individuals based on their social status
what are double-bind messages?
saying one thing while you really mean another
what are some non-therapeutic communication techniques?
excessive questioning, giving disapproval or approval, giving advice, don’t ask why, giving false reassurance, changing the subject
should you tell a patient how they are making progress?
no, instead ask them how they feel they are doing with their progress, it needs to be about them
what are the goals of therapeutic relationships?
facilitate communication of distressing thoughts and feelings, assist patients with problem-solving skills, help patient examine self-defeating behaviors and test alternatives, promote self-care and independence, promote dependence
what are necessary behaviors for nurses in a therapeutic relationship?
accountability, advocate for patient, clinical competence, delayed judgement
what is the difference between transferrance and counter transferrance?
transerence is when the patient unconsciously displaces onto the nurse feelings and behaviors related to significant figures in the patient’s past; counter-transference is when the nurse displaces feelings onto the patient that are related to significant figures in the nurse’s past
what are the three phases of Peplau’s model of nurse-patient relationship?
orientation, working, and termination
what occurs during the orientation phase?
when you first meet the patient, establish rapport and parameters of the relationship, confidentiality, terms of termination - you are establishing a structure for them and letting them know what to expect
what factors help the nurse-patient relationship?
consistency, neutral pace, listening, initial impressions - neutral attitude, promoting patient comfort and balancing control, patient factors include trust and active participation
when do somatic symptom disorders usually set in?
at a younger age- usually before 30
what might be a big factor in somatic symptom disorders?
underlying anxiety and depression
are people with somatic symptom disorder faking their symptoms?
no, we might not see them, but they are not making it up. it might just be psychological pain that is manifesting itself physically
the presence of deficits in voluntary motor or sensory function that can be sudden
conversion disorder
what are some common symptoms of conversion disorder?
paralysis, blindness, movement and gaid disturbances, numbness, paresthesia, loss of vision or hearing, episodes resembling epilepsy
what comorbid conditions are common with conversion disorder?
depression, anxiety, personality disorders
who is conversion disorder more common in?
more common in females, people in lower socioeconomic groups, lower education levels, history of severe trauma
how should you assess the symptoms and unmet needs of someone with a somatic disorder?
OLDCARTS, how do they describe these symptoms? are their basic needs being met?
what things should you assess with a patient with a somatic symptom disorder?
symptoms and unmet needs, voluntary control of symptoms (somatic symptom disorder will have no voluntary control), secondary gains, cognitive style, ability to communicate feelings and emotional needs, dependence on medication
what are some basic-level interventions for patients with somatic symptom disorder?
promotion of self-care activities, health teaching and promotion because a lower education level could be why they think the way they do, case management, pharmacological interventions
disorder in which a person deliberately fabricates symptoms of illnesses or self-injury without obvious gains
factitious disorder
what is Münchausen syndrome?
a more severe form of a factitious disorder in which a patient is desperately trying to make themselves or someone else sick and may go so far ast to contaminate lab orders, inject themselves with things, push for treatments
consciously feigning an illness for obvious benefit
malingering
disturbances in the normally well-integrated continuum of consciousness, memory, identity, and perception that is an unconscious defense mechanism that protects a patient from overwhelming anxiety
dissociative disorders
alterations in perception of self. may feel as if they are seeing themselves from a distance, but reality testing is still intact
depersonalization
experience of unreality of surroundings, while reality testing remains intact
derealization
inability to recall important personal information that almost always has to do with trauma. the memories are still there, they are just buried deep
dissociative amnesia
what is dissociative amnesia with fugue?
sudden unexpected travel away from the customary locale and an inability to recall one’s identity and some or all of the past
presence of two or more distinct personality states (usually more than two) that consists of a host and alters
dissociative identity disorder
what biological factors play a roll in dissociative disorders?
think the limbic system and serotonin levels might play a roll
what psychological factors might play a roll in dissociative disorders?
try to avoid or suppress any kind of severe trauma and the more they try to suppress those memories, the more likely they are to dissociate
how should you assess a dissociative disorder?
rule out medical causes, identity and memory, history of head trauma or seizures, underlying depression and anxiety, impact on patient and family, suicide risk
what are some basic level interventions for dissociative disorders?
milieu therapy (calm and quiet, avoid stimulations), health teaching and promotion, pharmacological interventions
what are the c’s of addiction?
continued use despite adverse consequences, loss of control from chronic relapsing brain disorder, cognitive impairment
what is the prevalence of psychiatric comorbidities?
5 or 6 out of every 10 people affected by substance use disorders also are affected by mental health disorders
what medical comorbidities often exist with marijuana abuse?
impaired lung structure, susceptible to infection, possible chromosomal abnormalities, amotivational syndrome, stroke
what are common medical comorbidities with caffeine?
gastric reflux, peptic ulcers, increased intraocular pressure, tachycardia, increased glucose and lipid levels
what biological factors contribute to substance abuse disorders?
hit dopamine centers in their brain and send an explosion of dopamine through their brain which makes them feel good
what are psychological factors that contribute to substance abuse?
lack of tolerance for frustration and pain, lack of success in life, lack of affectionate and meaningful relationships, lack of self-regard and low self-esteem, risk-taking propensity