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concepts 4 > midterm > Flashcards

midterm Flashcards

1
Q

important legislation

A
  • BCMHA
  • freedom of information & protection of privacy act (FOIPPA)
  • adult guardianship act (AGA)
  • criminal code of canada (assault/sexual)
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2
Q

psychiatric nursing definition

A
  • promotion, maintenance, and restoration of health, focus psychosocial, mental, emotional health
  • prevention, treatment, and palliation of illness and injury, focus psychosocial, mental or emotional disorders, & associated comorbid physiological conditions primarily assessing health status, planning, implementing, and evaluating interventions and coordinating services
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3
Q

what guides your practice

A
  • prof standards
  • practice standards
  • scope of practice
  • code of ethics
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4
Q

prof standards

A
  • TR
  • competent, evidence-informed
  • professional responsibility & accountability
  • leadership and collaboration in quality
  • professional ethical practice
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5
Q

code of ethics values

A
  • safe competent & ethical practice ensure to protection of public
  • respect for the inherent worth, right choice, and dignity of persons
  • health, mental health, and well-being
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6
Q

4 levels of control

A
  1. regulation & legislation
  2. BCCNM standards, limits & conditions
  3. organizational policies
  4. individual nurse competence
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7
Q

scope of practice

A

activities that a group of professional are educated and authorized to perform rather than what any individual can do

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8
Q

autonomous scope of practice

A

non-restricted activities and restricted activities (does not require order)

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9
Q

activities that aren’t restricted

A

don’t need orders, daily responsibilities

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10
Q

restricted activities that don’t require order

A
  • wound care
  • nursing diagnosis
  • inhalation
  • IV
  • assessing clients and treating conditions
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11
Q

restricted activities with order

A

require order!!

rpns be sure restricted activities fall within scope even with order from listed health professional

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12
Q

listed professionals are

A

regulated bodies with authorization to give rpn order

physician, dentist, midwife, naturopath, pharmacist, RN, NP

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13
Q

activities that require orders

A
  • procedures below body surface
  • administering a substance
  • putting items into body openings
  • putting substancecs in ear
  • medications
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14
Q

rpns have authority to diagnose conditions only t/f

A

true

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15
Q

cultural safety principals

A
  • self reflective practice
  • building knowledge through education
  • anti-racist practice
  • cerating safe health care experiences
  • person-led care (relational care)
  • strengths based and trauma informed practice
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16
Q

foippa

A
  • personal & private information required to be kept confidential
  • some conditions when personal and private information can be accessed or shared
  • people ahve right to access their personal and private information
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17
Q

stress

A

normal response to situational pressures especially if perceived as threatening

repsonse to a changing environmental conditions

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18
Q

limitations of the recent life changes questionnaire

A
  • perception = could be good or bad thing
  • coping
  • implications of chronic or re-occurring event
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19
Q

stress symptoms

A
  • physical (headache, fatigue)
  • emotional (crying, upset, nervous, overwhelmed)
  • cognitive (memory loss, difficulty making decision)
  • behavioural (isolation, compulsive eating)
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20
Q

emotional response

A

situation = something happens

thought = situation is interpreted

emotion = feeling occurs as a result of thought

behaviour = action in response to emotion

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21
Q

primary appraisal

A

evaluates whether in danger or threat

  • demands, role expectations, what to do, goals
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22
Q

if answer is NOT feeling a threat then…

A

stress will resolve

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23
Q

if answer is YES feeling a threat then….

A

secondary appraisal

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24
Q

secondary appraisal

A

considers options for dealing with situation

look into toolbox & try strategies (coping, medication, deep breathing)

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25
Q

allostasis

A

mechanisms that change the controlled variable by predicting what level will be needed and overriding local feedback to meet anticipated demand

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26
Q

fight, flight, fawn

A
  • anger, range
  • fear, anxiety
  • passive, pleasing, clinging
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27
Q

vulnerable individuals are…

A

ppl traumatized & victimized & more suspectible

  • youth, women, first nations, elderly, LGBTQ+, refuges
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28
Q

resolution of crisis

A

depends on realisitic perception of events, strategies available and support system

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29
Q

coping

A

individual’s constantly changing cognitive and behavioural efforts to manage specific external or internal demands that are appraised as taxing or exceeding their resources

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30
Q

positive coping

A

leads to adaption (well-being & max social functioning)

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31
Q

inability to cope

A

leads to maladaption = illness, poor self-concept, reduced social functioning

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32
Q

problem focused coping (2)

A

inner-directed strategies

outer-directed strategies

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33
Q

inner directed strategies

A

= altering one’s own beliefs, attitudes, responses

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34
Q

outer directed strategies

A

attempt to eliminate or alter a situation or another’s behaviour

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35
Q

emotion focused coping

A

seek to manage own emotional distress (exercise, meditation, talking to friends)

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36
Q

nursing interventions = stress, panic, and crisis

A
  1. establish or re-establish routine (self care, exercise, sleep)
  2. observe, assess, explore, discuss (changes in behaviour & mental status, social supports, appraisal of significant life events & stressors)
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37
Q

small stress can be good thing, give you push you need, motivating to do best (t/f)

A

TRUE

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38
Q

crisis

A

coping and defensive mechanism that has been used to solve problems and adapt to change is no longer effective

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39
Q

situational crisis

A

sudden & unexpected (accidents, natural disasters)

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40
Q

developmental crisis

A

occur as part of the process of growing and developing through various periods of life

sometimes predictable part of life cycle

(leaving home, having baby)

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41
Q

existential crisis

A

inner conflicts related to things such as life purpose, direction, and spirituality

(person questions if life has meaning, purpose, value)

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42
Q

phases of crisis response

A
  1. problem arise, increase anxiety, stimulates usual problem-solving techniques
  2. usual problem-solving techniques are ineffective, anxiety continue to rise, trial & error attempts made to restore balance
  3. trial & error fail, anxiety escalates to severe/panic, person adopts automatic relief behaviours
  4. doesn’t work, anxiety overwhelms person = serious personality disorganization which signals person in crisis
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43
Q

seven stage crisis intervention model

A
  1. conduct crisis & biopsychosocial assessment (lethality measures)
  2. establish rapport & relationship
  3. identify dimensions of presenting problems (“last straw of crisis precipitants)
  4. explore feelings and emotions (including active listening and validation)
  5. generate and explore alternatives (untapped resources and coping skills)
  6. develop and formulate plan
  7. follow up plan and agreement
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44
Q

crisis intervention

A

provision of emergency psychological care to assist victims in returning to an adaptive level of functioning and to prevent or moderate the potentially negative effects of psychological trauma

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45
Q

5 principles of crisis intervention

A
  1. early intervention
  2. stabilization
  3. facilitating understanding
  4. focusing on problem solving
  5. encouraging self reliance (empowerment)
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46
Q

benzo for anxiety

A
  • short term use, quick relief (30 mins)
  • dependence & withdrawal (2 week use)
  • s/e: interactions, resp depression, drowsiness, poor memory, confusion
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47
Q

paradoxical effect benzo

A

increased anxiety, irritability, agitation, aggression, mania, impulsive behaviour, hallucinations

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48
Q

withdrawal sx benzo

A

increased anxiety, insomnia, depression, pounding heart

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49
Q

ssri anxiety

A

slow down nervous sx

  • 4-6 weeks for improvement
  • ineffective short term
  • taper!
50
Q

buspirone anxiety

A
  • mild tranq
  • improvement = 2 weeks
  • increasing serotonin & decreasing dopamine
  • low risk dependence
  • GAD
  • no PRN
51
Q

beta blockers (propranolol, atenolol)

A
  • blocks effects of norepinephrine
  • improve physical symptoms, NO psych symptoms
52
Q

bupropion

A
  • GAD & anxiety r/t depression
  • improvements noted shortly after starting
  • not first choice, no PRN
53
Q

hydroxyzine

A

antihistamine

  • sx = nervousness & tension
  • alters histamine & serotonin
54
Q

delusions

A

false fixed belief, based on incorrect, inference about reality, not shared by others, inconsistent with individual’s intelligence or cultural background and which cannot be corrected by reasoning

55
Q

thought insertion

A

belief that thoughts are being inserted into one’s mind by someone else

56
Q

thought broadcasting

A

belief that one’s thoughts are obvious to others or are being broadcast to world

57
Q

ideas of reference

A

belief that other people, objects are related to or have a special significance for one’s self

58
Q

schizotypal

A

social & interpersonal deficits, having difficulty forming relationships, holding odd/unusual beliefs which are not consistent with cultural or societal norms, and abnormalities in thought form/speech

59
Q

delusional disorder

A
  • presence of delusions, includes several subtypes: erotomania, grandiose, jealous etc and unspecificed or with bizarre content
  • no hallucinations
  • thoughts organized & logical
60
Q

delusional disorder duration

A

1 month or longer

61
Q

brief psychotic disorder

A

uncommon, brief duration and sudden onset

  • pre-existing conditions predispose
  • duration = at least 1 day but less than month
62
Q

schizophreniform

A

same criteria A schizophrenia, shorter duration

early manifestation of schizophrenia?

interruption in one or more areas of daily functioning

63
Q

schizophreniform duration

A

lasts at least 1 month but less than 6 months

64
Q

schizophrenia

A

impacts ability to think clearly, manage emotions, and interact with others

65
Q

positive (first rank) sx

A

excess or distortion of normal functioning (hallucinations)

66
Q

negative (second rank) sx

A

lessening or loss of normal functions (affective flattening, alogia, avolition, anhedonia

67
Q

schizophrenia duration

A

continuous sugns persist for at least 6 months with 1 month of symptoms

68
Q

schizoaffective

A

similar sx to schizophrenia (+, -, neurocognitive sx) in addition to mood instability (depression & mania)

69
Q

schizoaffective duration

A

delusions & hallucinations for 2 or more weeks in absence of major mood episode

70
Q

psychotic disorder due to another medical condition

A

medical condition that causes hallucinations which result in clinically significant distress or impairment in functioning & not better explained by another mental disorder

71
Q

examples of psychotic disorder d/t another medical condition

A
  • brain tumor
  • lupus
  • hypoglycemia
  • parkinsons
  • dementia
  • HIV
  • huntingtons
  • malaria
72
Q

delirium

A

temp disorder of physical origin with an abrupt onset characterized by fluctuating consciousness and attention

73
Q

risk factors for developing delirium

A
  • post op opioid
  • old age
  • severe illness
  • polypharmacy
  • alcohol abuse
  • infection
  • pain
74
Q

assessment for psychosis

A
  • MSE, head to toe, diagnostics, critical thinking, RISK assessment, history, collateral
75
Q

risk assessmetn

A
  • tetrad lethality
  • risk factors
  • history of aggression, suicide, self harm
  • CASE
  • substance
  • protective factors
76
Q

priorities of care psychosis

A
  • establish safety
  • MSE & HTT
  • rule out medical causes (MMSE, MOCA, scans, BW)
77
Q

interventions psychosis

A

identify interventions most appropriate based on factors: setting, treatment goals, rapport & relationships, safety, resources, stage of treatment (acute, stabilization, maintenance, relapse)

78
Q

examples of interventions for psychosis

A
  • therapeutic self of self
  • acknowledge distress
  • choices
  • decrease environmental stimuli
  • set limits
  • de-escalation techniques
  • education
  • reality feedback
  • PRN
79
Q

antipsychotic meds psychosis (1st)

A
  • reduce + sx, min effect on - & cognitive sx

block dopamine

s/e: EPS, elevated prolactin, ortho hypotension, anticholingeric

80
Q

2nd gen antipsychotics

A
  • block dopamine and effect serotonin
  • treat - + cog
  • lower EPS
81
Q

s/e antipsychotic meds

A
  • cardio: QT prolongation, ortho hypo, myocarditis
  • metabolic: weight gain, T2DM, dyslipidemia
  • neuro: EPS
  • agranulocytosis
  • NMS
82
Q

dystonia, akathisia, parkinsonism, TD medications

A

benztropine, procyclidine, propranolol, lorazepam, clonazepam

83
Q

acute dystonia med

A

benztropine, diphenhydramine

84
Q

aggression

A

defined as verbal statements & physical actions that re intended to threaten

abusive or intimidating behaviour

85
Q

violence

A

threatned, attempted or actual physical harm to someone

86
Q

affective violence

A
  • intense anger or emotion, impulsivity to act out, often in response to interpersonal stress, frequently under influence of drugs
87
Q

predatory violence

A
  • often premeditated or preplanned
  • frequently the predator derives pleasure from violent act
88
Q

prevention of violence

A
  • trauma informed approach
  • recovery oriented & person centered practice
  • cultural awareness
  • sex & gender competence
89
Q
  • trauma informed approach
  • recovery oriented & person centered practice
  • cultural awareness
  • sex & gender competence

looks like&raquo_space;»>

A
  • respect, acceptance, empathy
  • recognition of individual, their journey, & link b/w their experience
  • promotes physical & psychological safety
  • decreases chance of triggering client
  • decrease misunderstandings b/w client & care provider
  • helps to build the therapeutic relationship
90
Q

important to remember with violence

A
  • focus on safety & engagement
  • recognize the need for physical and emotional safety
  • recognize need for choice and control in decision making
91
Q

predicting violence/aggression

A
  1. past violence
  2. male, young, environment (grew up in impoverished area with frequent violent behaviours)
  3. presence of psychiatric disorder
  4. relationship instability, employment problems, lack of insight, lack of interpersonal support
92
Q

tetrad of lethality

A
  • presenting with recent violent episode
  • presenting with dangerous psychotic process
  • indication from interview that pt intends to engage in violence
  • indication from interview that pt lying and collaborative evidence suggests intended violence
93
Q

chronological assessment of dangerous events (CADE)

A
  1. presenting event
  2. exploration of recent violent events
  3. elicitation of past violent events
  4. elicitation of immediate violent or homicidal ideation
94
Q

physiologcal & behavioural cues of anger

A

internal: increased pulse, respirations, BP
prickly sensation, numbness, nausea, choking sensation

external: increased muscle tone, clenched fists, changes to eyes, lips pressed together, flushing, sweating

95
Q

core pains

A

loneliness, self loathing, wronged, grief, loss of external/internal control, loss of meaning, fear of unknown, physical pain

96
Q

type 1 moments of angry disengagement

A
  1. confrontational disagreement
  2. oppositional behaviours
  3. passive aggressive attitudes
97
Q

type 2 potentially disengaging questions

A

provocative qts that, depending on how they are managed by clinician, may lead to disengagement

98
Q

methods for transforming points of disengagement

A

sidetracking, content response, process response, combo

99
Q

tips for crisis prevention

A
  • empathetic
  • clarify messages & focus on feeling
  • respect personal space
  • flexible
  • ignore challenging qt
  • avoid overreacting
  • nonverbal cues nonthreatening
  • set & enforce reasonable limits
100
Q

minimizing nurses own risk

A
  1. use nonthreatening body language
  2. respecting the client’s personal space & boundaries
  3. positioning themselves so that they have immediate access to the door of room in case
  4. choosing to leave door open to an office while talking to client
  5. knowing where colleagues are and making sure those colleagues knwo where they are
  6. not wearing clothing that could be used to harm
101
Q

crisis prevention institute stages

A

anxiety level (pt acting different) –> supportive approach (know pt, intervene gently)

defensive level (irrational) –> directive approach (calm, be in control)

acting out level (loses control & be verbally/physically aggressive) –> non-violent physical intervention (keep everyone safe, witness present, make report)

tension reduction (emotionally & physically drained) —> therapeutic rapport (allow rest & relax, debrief)

102
Q

de-escalation

A

interactive process of calming and redicting a patient who has an immediate potential for violence directed at others or self

103
Q

de-escalation strategies

A
  • comfort rooms/carts/boxes (mats, art, books)
  • comfort plans (written guide developed collab w/ client & staff)
  • safety plans
104
Q

code white

A

call for help when workers perceive themselves to be in danger of physical harm

team approach

105
Q

rule for seclusion

A
  • least restrictive & least amount of time possible
  • focus is prevention, reduction, and elimination of seclusion
106
Q

chemical restraints

A

medications to manage behaviours

  • prn given with client specific orders
  • offer choice & use TR
107
Q

3 meds used for chemical restraints

A
  • benzo, typical & atypical antipsychotics
108
Q

administer prn upon early signs of agitation to prevent further escalation & violence (t/f)

A

TRUE

109
Q

benzo can be used for

A

alcohol withdrawal, seizures, agitation, panic/axniety

110
Q

typical antipsychotics target

A

++ sx & effective in reducing agitation & violent behaviour

111
Q

a client placed in restraints can not be ….

A

behind locked door or in closed seclusion room

112
Q

seclusion flow sheet…

A

legal doc goes in chart

113
Q

seclusion care

A
  • q15 checks
  • assessed by dr q24hr
  • specific order
  • food & fluids
  • hygiene
114
Q

What are the 4 elements necessary for a formal complaint to be about a nurse with BCCNM.

A
  • name & contact info of person making complaint must be included
  • full name of nurse whom complaint is about
  • location where complaint occurred
  • details of complaint
115
Q

What are the 2 ways in which a formal complaint to BCCNM is resolved?

A
  • consensual complaint resolution: consent agreements (legal agreement b/w BCCNM & registrant to address issue & take measures to better)
  • investigation, inquiry: formal hearing, discipline committee decides disciplinary action
116
Q

What health authority policy should you review prior to providing information to Law Enforcement if you are unsure if the information should be provided or withheld?

A
  • release of information & belongings to law enforcement policy
117
Q

Provide an example and rationale for 3 nursing interventions to help a client manage acute stress and/or panic.

A
  • Re-establish routine and ADLs
  • Facilitate in the development of positive coping skills
  • Pharmaceutical interventions using benzodiazepines and antidepressants
118
Q

What are 3 benefits to stress?

A
  • Increases learning
  • Increases alertness
  • Develops resilience
119
Q

The Psychiatric Nursing Assessment is not just the MSE. What other elements of the psychiatric nursing assessment are necessary? Why?

A
  • Risk assessment for self-harm or suicide, important to establish safety measures
  • Previous history of violence or aggression, important to become aware of potential behaviors
  • Substance use history, may affect mood and behavior, health concerns
  • Protective factors and supports, Helpful for planning resources and instilling hope/recovery
120
Q

Consider the examples of Nursing interventions listed in the PowerPoint. Select four of these interventions and provide a rationale for each.

A
  • Decrease environmental stimulation: Reducing stimulus can help to natural de-escalate
  • Ask the client what they need: Inquiring and providing choice helps collaboration and problem-solving
  • Administer medication: Sometimes medication is needed first in order to establish other interventions
  • Allow space: Distance and time alone can help to alleviate feelings and emotions
121
Q

What are the main significant potential side effects of antipsychotic medication, and what are the characteristic symptoms of each?

A

EPS
- acute dystonia: involuntary muscle contractions
- parkinsonism: mask-like face, drooling, tremors
- akathisia: restlessness
- akinesia: absence of movement
- pisa: leaning to one side
- rabbit syndrome: rabbit movement of face
Agranulocytosis
- flu-like symptoms (fever, headache, muscle aches, fatigue)
- decreased WBCs
Neuroleptic Malignant Syndrome (NMS)
- Changes in LOC
- Increased HR
- Diaphoresis
- Incontinence

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