MIDTERM (wk1-8) Flashcards
History of mental illness 1790
- evil spirits “possession”
- chains, shackles, and confinement were treatment
history of mental illness 1792
- pineal (france) believed patients were “inhumanely” treated
- removal of chains
history of mental illness 1835-1867
- 1835 first “lunatic” asylum
- 1867 insanity act, later updated to mental health act
what was the era of asylum buildings in canada
quebec 1845 - bc 2011
what did dorothea dix advocate for?
- humane treatment
- mental health care
- more hospitals
- social reform: nursing care for the mentally ill was born
what triggered political concern?
- veterans had to rely on psychiatric facilities for PTSD
what is shell shock
post traumatic stress disorder
what was the first antimaniac agent for bipolar disorder
lithium
first antipsychotic medication
chlorpromazine (cpz) - powerful calming effect
what was chlorpromazine first developed for?
surgical anesthetic
first antidepressant medication
maoi and tricyclic
what medications were first developed to treat tuberculosis?
maoi and tricyclic
how do we view mental health?
as a continuum
projection
falsely attributing to others your own unacceptable thoughts and feelings
transference
when the client unconsciously transfers aspects of a past relationship with someone else onto you as a nurse
what does self concept include
- self identity
- self ideal
- body image
- self esteem
- sexuality
what are the influences of development of self concept
- parents/family members
- relationships with SO
- gender
- developmental stage
- socioeconomic status
- culture
- environment
healthy self-concept
- provides a sense of meaning of wholeness
- is relatively stable
- generates positive feelings toward the self
- helps individuals cope with stress
what is included in self identity
- gender
- age
- ethnicity
- culture
- religion
- social class
is the way we see ourselves incongruent or congruent
Incongruent
ideal self
- the person we want to be
- goals, ambitions in life, changes over time
actual self
our true imperfect self
ideal self vs actual self (carl rogers)
- when theres discrepancy between ideal self and actual self this leads to anxiety and unhappiness
> incongruence =
lower self esteem
what stressors influence the individual’s ideal-self
environment affects self concept
Body dysmorphic disorder (BDD)
- mental illness, linked with OCD
- belief that one’s appearance is unusually defective; reality the perceived flaw may be non existent or is negliglible
- find their flaw repulsive and try to hide flaw
- experience intrusive negative thoughts
- higher in women
- can lead to depression, self injury, repeated surgeries, and even suicide
self esteem
- the way which a person defines their self worth
gender identity
do we identify ourselves as a male, female, or other
gender dysphoria
a person who identifies with a different gender from which they were born (the distress resulting from it)
role performance
- way individuals perceive their ability to carry out significant roles
- ex: parent, child, spouse, employee, student
- social processes influence role performance and role standards:
-reinforcement-extinction - inhibition
- substitution
- imitation
- identification
behavioural clues of altered self concept
- avoidance of eye contact
- slumped posture
- poor grooming
- derogatory self talk “im so fat”
- being overly apologetic
- hesitancy in expressing views or opinions
- difficulty making decisions
what is theory
a set of assumptions that identifies the relationships between concepts
what is nursing theory
articulates nursing knowledge with the goal of guiding nursing practice
what does nursing theory do
- systematically organize
- formalizes knowledge and nursing practice into professional knowledge
- used to inform nursing practice
- explains, describes, predicts, prescribes nursing care
why did nursing theory evolve
- need for nurses to describe their role within health care team
- nursing education was changing
- health care system was changing
nursing theory vs. conceptual frame work (CF)
- theory linking of concepts to provide broad overviews. AKA paradigms
- Conceptual framework: use core concepts to organize/synthesize knowledge; aim of applying said knowledge
what are 4 metaparadigm concepts of nursing
- person
- environment
- health
- psychiatric nursing
what does a person mean in DCCF
- person is viewed as a client system (family, group, or community)
- open system that constantly interacts with environment
- 5 interconnecting variables
what are the 5 interconnecting variables of a person
- sociocultural
- psychological
- physiological
- developmental
- spiritual
what does environment mean in DCCF
- person and environment in reciprocal, dynamic relationship
- consists of internal, external, and interpreted influences
- intra/extrapersonal stressors can disrupt balance
what does health mean in DCCF
- viewed on a wellness-illness continuum
- protective factors are a persons resistance to stressors
- baseline health is persons normal range of responses to stressors
What does psychiatric nursing mean in DCCF?
- RPN works with client to maintain/restore system stability
- Conducts holistic assessment to create nursing dx, care plans, and evaluate the care collaboratively with the patient
- Primary, secondary, and tertiary prevention
Who created the environmental theory? What did she do?
- Florence Nightingale
- Made clear the diff between medicine and nursing
- Focus on healing rather than disease and disease prevention
Who was responsible for the Needs Theories?
Virgina Henderson
Dorothea Orem
What was Virginia Henderson’s theory and what did it say?
- Needs theory
- promote client’s independence by understanding their needs and assisting in meeting their needs until they can do it themselves
What was Dorothea Orem’s theory and what did it say?
- Self-care theory
- nurse promotes active engagement of patient. Shift from passivity to patient responsibility
- nurse only acts for patient when they cannot do it themselves
What was Hildegard Peplau’s theory and what did it say?
- theory of interpersonal relations
- focus on nurse/patient relationship
- views nursing as healing art with communication and interviewing skills as fundamental tools
- nurse can have diff roles: teacher, counsellor, surrogate, etc.
who was responsible for systems theories
- Betty Neuman
- Sister Callista Roy
What was Betty Neumans theory and did it say
- Neuman’s system model
- views patient as a client system; holistic nursing focused on prevention
what was sister callista roy theory and what did it say
- adaptation theory focuses on how people cope and respond to stressors
- views patient as adaptive being, constantly interacts with environment
what was jean watsons theory and what did it say
- theory of human caring
- care is valued over cure
- pt need for dignity comes before tasks
- care is both an art and a science
who created the 6 C’s of caring and what were they
Sister simone roach (theory of human caring)
- compassion
- competence
- confidence
- conscience
- commitment
- comportment
what is compassion? (6 C’s)
- spending time, listening and talking, gathering info, showing interest and concern
- developing understanding of pts situation (empathy)
- pt depend on the nurses doing what they cannot do themselves
- pt place trust in their nurses
what is competence (6 C’s)
- “having knowledge, judgement, skills, energy, experience, and motivation required. to respond adequately to the demand of one’s professional responsiblilities
what is confidence (6 C’s)
quality which fosters trusting relationships
what is conscience (6 C’s)
state of moral awareness guiding the health care workers attentiveness to ethical issues
what is commitment (6 C’s)
the loyal endeavour to devote ourselves to the welfare of the pt
what is comportment (6 C’s)
- how you present yourself as a caring professional
- appropriate attitude, dress, appearance, language
who created the tidal model and what is it
Philip Barker
- focussed on assisting pt with reclaiming their lives after a setback
- philosophical approach to mental health (MH theory)
- emphasizes pts own person theory
- uses metaphors of water
what is the nursing process
problem solving approach to identifying, diagnosing, and treating the health issue of clients
what are the steps in the nursing process (ADPIE)
- assessment
- diagnosis
- planning
- implementation
- evaluation
what is assessment
systemic gathering of relevant and important pt data to establish a database of client’s health problems
what are sources of assessment data
- client (interview q’s)
- family/friends
- other health care providers (charts)
- direct observation (MSE, physical exam)
- measurements/tests results
what is subjective data
client reports
ex: nausea, dizziness, pain
what is objective data
data obtained from measurements
ex: BP, HR, temp
what is nursing diagnosis
- differs from medical dx (ex: diabetes)
- conclusion about the ways in which the illness is most impacting ur pt and how plan to plan to intervene
- holistic and patient centered
- variance in variable/system (assessment data) related to stressor
what is NANDA
- North American Nursing Diagnosis Association
- organization who standardized nursing terminology for dx
- dx categorized under 13 domains
what is planning
- creating client centred goals in tx
- short term: 0-3 mo
- long term 3-6 mo
what does S.M.A.R.T. stand for
- specific
- measurable
- achievable
- realistic
- time frame
what is nursing care plan
- individualized and client centred
- documentation of each stage of nursing process
- legal document/health record
- outline goals, rationales, and evaluation
what is implementation
- putting care plan into action
- documenting activities and pt response
- carrying out drs orders
- assess and reassess throughout implementation process
- support client strengths
- prevent, reduce, resolve
what the 3 methods of prevention
- primary
- secondary
- tertiary
what is primary prevention
- health promotion and illness prevention/maintenance
- enacted before stressor has disrupted baseline health
what is secondary prevention
- symptoms already present
- stressor has disrupted baseline health
- goal: regain system balance
what is tertiary prevention
- rehabilitative therapies and monitoring of health to prevent complications or further: illness, injury, or disability
- associated with longterm goals
what is evaluation
- determining if and how well the goals have been achieved
- identifying factors that positively or negatively influence goal achievement
- decide if needed to: continue, modify, or terminate plan of care
- revise care at any stage of nursing process
what information are you gathering for health history in neuro assessment
- ex: pain, headaches, seizures, alcohol/drug history, head injuries, behavioural changes, dizziness, vision changes, medications
what are the neuro vitals
- PERRLA
- GCS
- motor strength and sensation
- vital signs
what is LOC
- level of consciousness
- alert?
- unconscious?
- what does it take to wake them if they wake at all?
what is PERRLA?
- pupils
- equal
- round
- reactive
- reactive to light
- accommodation
what is GCS
Glascow coma scale
- standardized scale to asses pts arousal and cognition
- 3-15
- eye opening
- verbal response
- motor response
what can balance and coordination indicate
- damage to cerebellum (CVA)
- disease process (ex: parkinson’s/huntington’s)
- deconditioning
what is ataxia
- presence of uncoordinated, abnormal movements
- collection of symptoms affecting balance, coordination, speech, fine motor control
what is MMSE
- mini mental status exam (7-8 mins)
- usually used in hospital setting to assess progression of dementia in elderly clients
- scores out of 30
what is MoCA
- montreal cognitive assessment (10-12mins)
- usually used in hospital setting to assess for cognitive impairment
- may capture info missed by MMSE
what does the mental status exam measure
- intellectual functioning, made up by:
- judgment
- abstract thinking
- attention span
- memory
- knowledge
pain is considered the _____
5th vital sign
what is the “gold standard” for pain assessment? how would you do this?
- pt self report
- use of appropriate measuring scaled
what does LOTTARP stand for/what does it do
- helps you remember what to as the pt
- L ocation
- O nset
- T iming: is it worse at certain times of day/how long does it last?
- T ype of pain
- A ssociation symptoms: nausea, fever, etc
- A lleviating factors
- R adiating
- P recipitating even
what is pain perception influenced by
- age
- culture
- anxiety/stress levels
how does age impact pain perception
older adults tend to under report pain
- may be less sensitive or learned to be more stoic
- effects of pain may lead to confusion
how do beliefs impact pain perception
- thoughts and feelings
- ex: “this will never get better”
what is the nurses role in dealing with pain
- est. rapport so pt feels comfortable discussing pain
- believe your pt
- recognize that history of chronic pain, depression/anxiety can lead to more severe experience
- be culturally sensitive and aware
- use rating scales that fit your pt
- admin meds as ordered
- awareness of other pain relief measures
- assess pain frequently pre/post meds
what are the pharmacological interventions for pain
- NSAIDs and nonopioids
- opioids
- co-analegesics
what health history are you gathering for respiratory assessment
- smoker, cough, difficulty breathing, pain, meds, history of respiratory illness, drug misuse, risk factors, exposure to disease (ex: TB)
What are the steps in respiratory assessment
- airway: patent vs obstructed
- chest auscultation: listen for adventitious sounds
- respirations: rate, depth, rhythm, use of accessory muscles
- O2 delivery system
- SpO2: diffusion and perfusion and inspection of skin colour
- cough: frequency, productive vs dry, sputum characteristics
- mental alertness/LOC
- activity tolerance
what is the flow of the heart’s conduction system
SA node > atria > AV node > bundle of his > R + L bundle branches > ventricles
normal pulse rate (HR)
60-100 bpm
what is tachycardia?
fast heart rate, faster than 100 bpm
what is bradycardia
slow heart rate, less than 60 bpm
what do you measure when assessing pulse
- rate
- rhythm (regular/irregular)
- quality (thready, weak, bounding)
where is the apex of the heart
5th intercostal space
what are the apical heart sounds
S1 Lub
S2 Dub
what is the S1 apical heart sounds
- “lub”
- closure of the mitral and tricuspid valves
- signals beginning of systole
what are the 4 common alterations in heart functioning
- conduction issues
- heart failure
- valve issues
- ischemic issues
what are some examples of conduction isses
- dysrhythmias
- atrial fibrillation
- ventricular tachycardia
- ventricular fibrillation
- asystole
what 2 examples cause valve issues
- stenosis
- regurgitation
what is angina
- Insufficient oxygen to the heart muscle
- causing sudden, severe substernal pain
- radiating to the left arm
- Symptoms of coronary artery disease
what are examples of ischemic heart issues
- angina
- myocardial infarction (heart attack)
- acute coronary syndrome (sudden reduced blood flow to heart)
difference between myocardial infarction and angina
- MI: complete blockage of coronary arteries
- angina: narrowing of coronary arteries, doesn’t cause permanent damage
what occurs during systole
heart contracts and blood is squeezed into the body (time between S1 and S2)
what occurs during diastole
blood is refilling from aorta into ventricles (time between S2 and next S1)
systolic/diastolic range
systolic: 100-139 mmHg
diastolic: 60-89 mmHg
what is the optimal BP
-120/80
- but be familiar with pt baseline
systemic BP is
cardiac output (CO) x peripheral resistance (PR)
what is cardiac output
vol of blood pumped by each ventricles in 1 min
what is peripheral resistance
- resistance of the arteries to blood flow
- determined by a change in diameter of arterioles
what are 10 factors that impact BP
- vol of blood
- HR
- diameter of arteries
- elasticity of arteries
- viscosity of blood
- time of day
- stress
- emotional state
- exercise
- age (gradual increase in systolic)
systolic pressure is especially affected by
cardiac output (left ventricular pumping)
diastolic pressure is especially affected by
pulse rate (heart at rest)
what is hypotension
- abnormally low blood pressure
- systolic < 100 mmHg
- diastolic < 60 mmHg
what can cause hypotension
- dilation of arteries
- loss of blood
- inadequate pumping of the heart
- dehydration
- anemia
what is hypertnesion
high blood pressure
- systolic > 139 mmHg
- diastolic > 89 mmHg
what is orthostatic hypotension
- systolic pressure suddenly falls > 15 mm Hg
- occurs upon sitting or standing
signs and symptoms of hypotension: what would you assess
- dizziness
- lightheadedness, weakness
- unsteady/falls
- blurred vision
- measure BP lying down, sitting, standing waiting 1-3 mins between
what are some causes of orthostatic hypotension
- autonomic neuropathy disease
- dehydration
- blood loss
- anemia
- beta blockers
- anti - hypertensives
what are some risk factors of hypertension
- family history
- smoking
- race
- obesity
- age
- high fat and sodium diet
- stress
- excessive alcohol consumption
- diabetes
- menopause
- sedentary lifestyle
- oral contraceptives
subjective health history for cardiovascular issues
have you had any of the following:
- chest pain
- dyspnea
- orthopnea
- cough
- fatigue
- edema
ask:
- cardiac history
- family cardiac history, personal habits (any risk factors)
what objective data would you collect in the cardiovascular physical exam
- colour
- edema
- palpate
- temp
- pulses
- extremities for pitting edema
- auscultate: apical pulse, blood pressure
structure and function of arteries
- carry oxygenated blood away from heart
- can withstand pressure from heart
- elastic fibres
structure and function of veins
- return deoxygenated blood to heart via low pressure
- uses: skeletal muscles, breathing pressure gradients, intraluminal valve and calf pump
what do you ask in vascular subjective assessment
- history of circulatory problems
- leg pain or cramps
- skin changes in arms/legs
- swelling in arms/legs; lumps
- skin ulcers
- blood clots
- meds
what do you assess in vascular objective assessment (inspection)
- colour (pallor, rubor, cyanosis
- size: bilateral comparison
- swelling
- edema (pitting or non-pitting)
- ulcers
What do u assess in vascular objective assessment? (palpation)
- temp
- moisture
- cap refill
- pulses
What is ARTERIOsclerosis?
- peripheral blood vessels lose elasticity; grow rigid
- increase blood pressure
What is ARTHEROsclerosis?
- deposit of fatty materials in vessels
- blockages
3 main functions of lymphatic system
- maintain fluid balance
- immune system function
- absorption of fat
what do you ask in subjective lymphatic assessment
- lymph node enlargement: swollen glands, where are they, how long have you had them?
- recurrent infections
- history of chronic illness
- swelling/edema
- delayed healing
- fam history; malignancy
what system are assessed in vascular assessment
- vascular system/peripheral vascular
- lymphatic system
neurovascular assessment (ortho patients): - CWMS
- pulses
- edema to affected extremity
what do you do when performing an objective assessment of the lymphatic system
- inspection and palpation
- region by region during head to toe assessment
compare - each side for size
- consistency
- tenderness
- warmth
what are older adult considerations for lymphatic assessment
- number and size of lymph nodes decreases with age
- some lymphoid elements are lost
- nodes = more fibrotic and fatty than in younger people = impaired infection resistance
what is the sequence in head to toe assessment (10)
- general appearance
- skin, hair, nails (don’t throughout assessment)
- head/face/neck
- chest
- abdomen
- extremities
- back area
- tubes, drains, assessment, IV
- mobility
- report/document/assess findings
what do kidneys do
- filter blood (remove toxins) and produce urine
- regulate blood pressure
- regular pH
- make red blood cells
- maintain healthy bones
3 common kidney alterations
- renal failure
- kidney stones
- pyelonephritis
what does renal failure cause
- electrolyte imbalance
- hypertension
- pitting edema
- low urine production
- metabolic acidosis
pyelonephritis
- kidney infection
- often after complications of UTI
symptoms: flank pain, fever, chills, dysuria, foul smelling urine
dysuria
painful or difficult urination
6 alterations in urinary elimination
- urinary incontinence; neurogenic bladder
- UTI
- urinary retention
- nocturia
- hematuria
- polyuria
- oliguria
what info do you gather in a genitourinary subjective data assessment
- health history thru interview
- normal patters of urination
- symptoms of thirst
- history of oliguria, polyuria, diabetes, fever, surgeries, meds
- diet
- impact on self-concept, sexuality, beliefs
- pt’s primary concerns to ensure goals align
- be culturally sensitive
what info do you gather on genitourinary physical exam (objective)
- skin (perineal area) - breakdown, rash, discharge, inflammation
- palpation: bladder (tender/distended)
- urine sample: characteristics
- measure fluid intake vs output
what is normal urine
- 95% water
- pH (4.6 - 8.0)
- no: protein, glucose, blood, ketones, bacteria
- specific gravity: 1.010=1.025
what are 6 common alterations in bowel elimination
- incontinence
- constipation
- diarrhea
- fecal impaction
- flatulence
- hemorrhoids
what info do you gather from health history (elimination problems)
- assess normal bowel patterns/habits
- assess patient’s description of stool characteristics
- assess med hx
- assess diet hx
- assess fluid intake
- assess any unplanned weight gain/loss
- ask about recent surgery/GI related illness
- assess pain/discomfort around elimination
- assess for any nausea or vomiting
What are you assessing during a physical exam (bowel elimination)
Inspection: mouth (concerns w/ chewing), 4 quadrants of abdomen, feces (Bristol Stool Chart)
Auscultate: B4 palpation, 4 quadrants; bowel sounds
Palpation: all 4 quadrants; distension, tenderness
what are you looking for when inspecting the 4 quadrant of the abdomen
- masses
- shape
- symmetry
how often do bowel sounds occur
every 5-15 seconds
what is reproductive and sexual health
WHO: “a state of physical, mental, and social well-being in all matters relating to sexuality”
Relates to:
- healthy & safe sex life
- infertility issues
- access to contraception & fam planning
- HIV and STI’s screening/treatment
- safe pregnancy, prenatal care, childbirth
- postpartum depression, testicular/breast/prostate cancers
what are 4 alterations in sexual health
- gender dysphoria
- infertility
- sexual abuse
- sexual dysfunction
What are the 6 STIs discussed in lecture?
- chlamydia (most common): bacterial, genital discharge, burning unrination
- gonorrhea (2nd most common): bacterial, pain during sex/urination. Can lead to infertility if not tx
- human papilloma virus (HPV): warts, cervical/reproductive cancer
- syphilis: bacterial, easily tx, dx w/ blood test, can cause impaired neuro functioning
- Hep C: viral; attacks liver
- Herpes (HSV): high prevalence, high stigma, incurable
what occurs during a sexual health screening
- sexual health history
- swab for cultures/bacteria
- bloodwork
- pelvic exam
- inspection of symptomatic area
Taking a sexual health history
- routinely as part of holistic assessment prior to physical exam
- est. rapport 1st
- clients/nurses may feel embarrassment/discomfort discussing
- nurses: convey openness, use appropriate language, remain “matter of fact”, suspend judgements
- be aware of cultural sensitivities
- self awareness
- nurses: manage own anxiety
- may need to frame questions differently depending on client’s age/culture etc.
what is stigma
- negative beliefs that impact the way we see the truth
- can prevent adequate care and seeking care
what is a stereotype
- generalized belief about a group of people
- expecting them to act in a certain way
what is discrimination
behavioural manifestation of prejudice
what is prejudice
hostile attitudes towards people belonging to a specific group
what are some common myths about mental illness
- violent and dangerous
- caused by personal weakness
- less intelligent
- rare, untreatable
when did BC’s first asylum open
1872
What happened to Riverview? Empowerment and Deinstitutionalization
1909: construction begins on “Hospital for the Mind”; Essondale, later became Riverview
1913: opened, had 4,630 patients at peak
1970s/80s: patient advocacy groups emerged
1980s onwards: beginning of deinstitutionalization
1990s: Riverview began downsizing
2009: 256 active beds remain
2012: only 3 wards w/ less than 15 patients
2013: lights out
brief history of mental illness
Prior to 1790: evil spirits, possession. Chains, shackles, and confinement as tx
1792: Pinel believed human were inhumanely tx; removal of chains
1835: first lunatic asylum
1836: insanity act formed, later became MHA
define asylum
peace, relief; we added negative stigma
define insanity
not of a sounds mind; made derogatory
What is sensorium
Assessment used to assess the patient’s orientation to time, place, person and situation
What are you assessing during the MSE? (GESTTPCIJ)
- general appearance and psychomotor behaviour
- emotional state: affect and mood
- speech
- thought process/form (HOW are they thinking)
- thought content (WHAT are they thinking)
- perception
- cognitive functioning/sensorium
- insight
- judgement
What falls under the spiritual variable?
- purpose and meaning
- interconnectedness
- faith
- religion
- forgiveness
- creativity
- transcendence
What falls under the sociocultural variable?
- language/communication patterns
- cultural roles and expectations
- social history
- relationships/ SOs
- health beliefs
- habits/practices
- ethnicity and race
What falls under the developmental variable?
- expected life events
- unexpected life events
- growth
- development
- transition
What falls under the psychological variable?
- emotions
- cognition
- perception of self
- self esteem
- body image
- self-ideal
- sexuality
- self-identity
What is recovery?
- represents return and maintenance of system stability following treatment
- complete recovery may occur beyond baseline, may stabilize system to lower level, or return to level of wellness prior to illness
What are the methods of physical assessment?
- inspection
- auscultation
- palpation
- percussion
- olfaction
What is the purpose of a conceptual framework?
- guide/organize assessment
- assist in identifying an dx health problems
- guide planning evaluation of care
- guides curriculum for education
- frame of reference to organize nursing research
What is the difference between insight and judgement?
insight: someone’s thoughts on their actions - do they understand their illness/know why they are there?
judgement: behavioural manifestation of insight - do they understand if their actions are good/bad?
Head to toe assessment:
- general survey
- vital signs
- head
- neck
- upper extremities
- chest/back
- abdomen
- anus and rectum
- lower extremities
What does the MSE assess?
- appearance and psychomotor behaviour
- mood/affect
- speech (nature of speech)
- thought form (how are they thinking?)
- though content (what are they thinking)
- perception (5 senses, hallucinations and delusions)
- cognition (memory, concentration, intelligence)
- insight/judgement
- risk assessment
What are the components of a health history
- biographical/demographic data (age, gender, address, etc.)
- chief concern/reason for visit (record verbatim: offers insight into experience)
- history of present illness
- past health history (including psych history)
- family history
- holistic assessment (physiological, psychological, sociocultural, developmental, spiritural)
- perception of health
- MSE
What is an emergency assessment?
A quick focused assessment in an emergency situation to identify life-threatening problems
What is a complete health assessment?
non-emergent data collected at initial visit, or on hospital admission
open-ended questions
questions that allow respondents to answer however they want
- who, what, when, how
close-ended questions
Questions that can be answered in short or single word responses.
3 types of questions in problem solving:
- there is a correct answer: required knowledge
- no ‘right’ answer: calls for subjective opinion/preference
- multi ‘right’ answers: clinical judgment
What is the problem solving process?
-Clarify the nature of a problem and suggests possible solutions
-Evaluate solutions and choose best one to implement
How do we measure the quality of our thinking
- Clarity
- Accuracy
- Precision
- Relevance
- Depth
- Breadth
- Logic
Elements of critical thinking:
-purpose
-question at issue
-information
-concepts
-assumptions
-inferences
-point of view
-implications
What is sociocentric thinking?
Results from internalization of the dominant prejudices of our society or culture
It involves taking on group norms, beliefs, and to blindly conform to group standards without questioning them.
We begin to view situations from this lens and dont consider alternate perspectives/cultures
What is egocentric thinking?
Results form our tendency to be self-centered and to view situations/info from our own point of view with the assumption that it is “right”
Definition of critical thinking:
- art of analyzing and evaluating thinking with a view to improve
- encompasses both cognitive processes and attitudes
- consciously examining our own thinking processes
What are the 4 classifications of futility?
- not futile (beneficial)
- futile (not beneficial)
- futile from patient perspective
- futile from clinician perspective
What is medical futility?
interventions unlikely to produce any significant benefit to patient
mental health care issues
Behaviour control and restraint
- relational engagement and boundaries
- confidentiality
- ethical practice environments
- social justice
Health care ethical principles:
- Autonomy
- Beneficence
- Non-maleficence
- Dignity
- Justice
- Truthfulness, informed consent & confidentiality
CRPNBC Professional standards
- Therapeutic Relationships
- Theory/knowledge base
- Professional Accountability
- Ethical Practice
RPN code of ethics:
Primary purpose: protect the public
- defines/provides RPN’s w/ practice standard
- governed by Health Professions Act
What is ethics:
- study of good conduct, character, motives.
- Accountability!
- Each practitioner has the responsibility to adhere to standards of ethical practice
what is self awareness
understanding one’s biases, beliefs, thoughts etc. and recognizing how they affect self and others
Explain choice community integration (MH care and reform):
- ongong community involvement, enhanced understanding
- greater advocacy to protect rights and freedoms of mentally ill people
- empowerment of client to help themselves; psych nurse acts as “facilitator”
- providing opportunities for people w/ MI to make their own decisions in treatment
Explain choice community integration (MH care and reform):
- ongong community involvement, enhanced understanding
- greater advocacy to protect rights and freedoms of mentally ill people
- empowerment of client to help themselves; psych nurse acts as “facilitator”
- providing opportunities for people with mental illness to make their own decisions in treatment
history of mental health treatment
1915: Malaria Fever Therapy
1920s: hyrdotherapy
1930-50s: Insulin Coma Therapy
1938 - present: ECT
1936-1970’s: Lobotomy
- all were aimed to ‘reset’ the brain
What does pyschotherapy do?
helps the patient to help themselves by asking strategic Q’s
renal failure
- leads to electrolyte imbalance
- hypertension
- pitting edema
- low urine production
- metabolic acidosis
kidney stones
- build up of minerals or waste products inside kidney that clump together
- small stones can move through urinary tract with no symtoms
- large stones can cause pain during urination, blood in urine (hematuria), nausea, vomiting, sharp back pain
urinary incontinence
involuntary loss of urine
- can lead to skin breakdown, pressure ulcers, and social isolation
- can lead to significant psychological impairment
neurogenic bladder
a problem which a person lacks bladder control due to brain/spinal cord damage (MS)
