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PNUR: concepts > MIDTERM (wk1-8) > Flashcards

MIDTERM (wk1-8) Flashcards

1
Q

History of mental illness 1790

A
  • evil spirits “possession”
  • chains, shackles, and confinement were treatment
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2
Q

history of mental illness 1792

A
  • pineal (france) believed patients were “inhumanely” treated
  • removal of chains
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3
Q

history of mental illness 1835-1867

A
  • 1835 first “lunatic” asylum
  • 1867 insanity act, later updated to mental health act
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4
Q

what was the era of asylum buildings in canada

A

quebec 1845 - bc 2011

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5
Q

what did dorothea dix advocate for?

A
  • humane treatment
  • mental health care
  • more hospitals
  • social reform: nursing care for the mentally ill was born
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6
Q

what triggered political concern?

A
  • veterans had to rely on psychiatric facilities for PTSD
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7
Q

what is shell shock

A

post traumatic stress disorder

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8
Q

what was the first antimaniac agent for bipolar disorder

A

lithium

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9
Q

first antipsychotic medication

A

chlorpromazine (cpz) - powerful calming effect

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10
Q

what was chlorpromazine first developed for?

A

surgical anesthetic

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11
Q

first antidepressant medication

A

maoi and tricyclic

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12
Q

what medications were first developed to treat tuberculosis?

A

maoi and tricyclic

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13
Q

how do we view mental health?

A

as a continuum

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14
Q

projection

A

falsely attributing to others your own unacceptable thoughts and feelings

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15
Q

transference

A

when the client unconsciously transfers aspects of a past relationship with someone else onto you as a nurse

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16
Q

what does self concept include

A
  • self identity
  • self ideal
  • body image
  • self esteem
  • sexuality
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17
Q

what are the influences of development of self concept

A
  • parents/family members
  • relationships with SO
  • gender
  • developmental stage
  • socioeconomic status
  • culture
  • environment
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18
Q

healthy self-concept

A
  • provides a sense of meaning of wholeness
  • is relatively stable
  • generates positive feelings toward the self
  • helps individuals cope with stress
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19
Q

what is included in self identity

A
  • gender
  • age
  • ethnicity
  • culture
  • religion
  • social class
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20
Q

is the way we see ourselves incongruent or congruent

A

Incongruent

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21
Q

ideal self

A
  • the person we want to be
  • goals, ambitions in life, changes over time
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22
Q

actual self

A

our true imperfect self

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23
Q

ideal self vs actual self (carl rogers)

A
  • when theres discrepancy between ideal self and actual self this leads to anxiety and unhappiness
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24
Q

> incongruence =

A

lower self esteem

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25
Q

what stressors influence the individual’s ideal-self

A

environment affects self concept

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26
Q

Body dysmorphic disorder (BDD)

A
  • 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
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27
Q

self esteem

A
  • the way which a person defines their self worth
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28
Q

gender identity

A

do we identify ourselves as a male, female, or other

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29
Q

gender dysphoria

A

a person who identifies with a different gender from which they were born (the distress resulting from it)

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30
Q

role performance

A
  • 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
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31
Q

behavioural clues of altered self concept

A
  • 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
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32
Q

what is theory

A

a set of assumptions that identifies the relationships between concepts

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33
Q

what is nursing theory

A

articulates nursing knowledge with the goal of guiding nursing practice

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34
Q

what does nursing theory do

A
  • systematically organize
  • formalizes knowledge and nursing practice into professional knowledge
  • used to inform nursing practice
  • explains, describes, predicts, prescribes nursing care
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35
Q

why did nursing theory evolve

A
  • need for nurses to describe their role within health care team
  • nursing education was changing
  • health care system was changing
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36
Q

nursing theory vs. conceptual frame work (CF)

A
  • theory linking of concepts to provide broad overviews. AKA paradigms
  • Conceptual framework: use core concepts to organize/synthesize knowledge; aim of applying said knowledge
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37
Q

what are 4 metaparadigm concepts of nursing

A
  • person
  • environment
  • health
  • psychiatric nursing
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38
Q

what does a person mean in DCCF

A
  • person is viewed as a client system (family, group, or community)
  • open system that constantly interacts with environment
  • 5 interconnecting variables
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39
Q

what are the 5 interconnecting variables of a person

A
  • sociocultural
  • psychological
  • physiological
  • developmental
  • spiritual
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40
Q

what does environment mean in DCCF

A
  • person and environment in reciprocal, dynamic relationship
  • consists of internal, external, and interpreted influences
  • intra/extrapersonal stressors can disrupt balance
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41
Q

what does health mean in DCCF

A
  • viewed on a wellness-illness continuum
  • protective factors are a persons resistance to stressors
  • baseline health is persons normal range of responses to stressors
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42
Q

What does psychiatric nursing mean in DCCF?

A
  • 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
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43
Q

Who created the environmental theory? What did she do?

A
  • Florence Nightingale
  • Made clear the diff between medicine and nursing
  • Focus on healing rather than disease and disease prevention
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44
Q

Who was responsible for the Needs Theories?

A

Virgina Henderson

Dorothea Orem

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45
Q

What was Virginia Henderson’s theory and what did it say?

A
  • Needs theory
  • promote client’s independence by understanding their needs and assisting in meeting their needs until they can do it themselves
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46
Q

What was Dorothea Orem’s theory and what did it say?

A
  • 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
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47
Q

What was Hildegard Peplau’s theory and what did it say?

A
  • 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.
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48
Q

who was responsible for systems theories

A
  • Betty Neuman
  • Sister Callista Roy
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49
Q

What was Betty Neumans theory and did it say

A
  • Neuman’s system model
  • views patient as a client system; holistic nursing focused on prevention
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50
Q

what was sister callista roy theory and what did it say

A
  • adaptation theory focuses on how people cope and respond to stressors
  • views patient as adaptive being, constantly interacts with environment
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51
Q

what was jean watsons theory and what did it say

A
  • theory of human caring
  • care is valued over cure
  • pt need for dignity comes before tasks
  • care is both an art and a science
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52
Q

who created the 6 C’s of caring and what were they

A

Sister simone roach (theory of human caring)
- compassion
- competence
- confidence
- conscience
- commitment
- comportment

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53
Q

what is compassion? (6 C’s)

A
  • 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
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54
Q

what is competence (6 C’s)

A
  • “having knowledge, judgement, skills, energy, experience, and motivation required. to respond adequately to the demand of one’s professional responsiblilities
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55
Q

what is confidence (6 C’s)

A

quality which fosters trusting relationships

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56
Q

what is conscience (6 C’s)

A

state of moral awareness guiding the health care workers attentiveness to ethical issues

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57
Q

what is commitment (6 C’s)

A

the loyal endeavour to devote ourselves to the welfare of the pt

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58
Q

what is comportment (6 C’s)

A
  • how you present yourself as a caring professional
  • appropriate attitude, dress, appearance, language
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59
Q

who created the tidal model and what is it

A

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

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60
Q

what is the nursing process

A

problem solving approach to identifying, diagnosing, and treating the health issue of clients

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61
Q

what are the steps in the nursing process (ADPIE)

A
  • assessment
  • diagnosis
  • planning
  • implementation
  • evaluation
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62
Q

what is assessment

A

systemic gathering of relevant and important pt data to establish a database of client’s health problems

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63
Q

what are sources of assessment data

A
  • client (interview q’s)
  • family/friends
  • other health care providers (charts)
  • direct observation (MSE, physical exam)
  • measurements/tests results
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64
Q

what is subjective data

A

client reports
ex: nausea, dizziness, pain

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65
Q

what is objective data

A

data obtained from measurements
ex: BP, HR, temp

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66
Q

what is nursing diagnosis

A
  • 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
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67
Q

what is NANDA

A
  • North American Nursing Diagnosis Association
  • organization who standardized nursing terminology for dx
  • dx categorized under 13 domains
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68
Q

what is planning

A
  • creating client centred goals in tx
  • short term: 0-3 mo
  • long term 3-6 mo
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69
Q

what does S.M.A.R.T. stand for

A
  • specific
  • measurable
  • achievable
  • realistic
  • time frame
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70
Q

what is nursing care plan

A
  • individualized and client centred
  • documentation of each stage of nursing process
  • legal document/health record
  • outline goals, rationales, and evaluation
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71
Q

what is implementation

A
  • 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
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72
Q

what the 3 methods of prevention

A
  • primary
  • secondary
  • tertiary
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73
Q

what is primary prevention

A
  • health promotion and illness prevention/maintenance
  • enacted before stressor has disrupted baseline health
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74
Q

what is secondary prevention

A
  • symptoms already present
  • stressor has disrupted baseline health
  • goal: regain system balance
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75
Q

what is tertiary prevention

A
  • rehabilitative therapies and monitoring of health to prevent complications or further: illness, injury, or disability
  • associated with longterm goals
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76
Q

what is evaluation

A
  • 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
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77
Q

what information are you gathering for health history in neuro assessment

A
  • ex: pain, headaches, seizures, alcohol/drug history, head injuries, behavioural changes, dizziness, vision changes, medications
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78
Q

what are the neuro vitals

A
  • PERRLA
  • GCS
  • motor strength and sensation
  • vital signs
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79
Q

what is LOC

A
  • level of consciousness
  • alert?
  • unconscious?
  • what does it take to wake them if they wake at all?
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80
Q

what is PERRLA?

A
  • pupils
  • equal
  • round
  • reactive
  • reactive to light
  • accommodation
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81
Q

what is GCS

A

Glascow coma scale
- standardized scale to asses pts arousal and cognition
- 3-15
- eye opening
- verbal response
- motor response

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82
Q

what can balance and coordination indicate

A
  • damage to cerebellum (CVA)
  • disease process (ex: parkinson’s/huntington’s)
  • deconditioning
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83
Q

what is ataxia

A
  • presence of uncoordinated, abnormal movements
  • collection of symptoms affecting balance, coordination, speech, fine motor control
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84
Q

what is MMSE

A
  • mini mental status exam (7-8 mins)
  • usually used in hospital setting to assess progression of dementia in elderly clients
  • scores out of 30
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85
Q

what is MoCA

A
  • montreal cognitive assessment (10-12mins)
  • usually used in hospital setting to assess for cognitive impairment
  • may capture info missed by MMSE
86
Q

what does the mental status exam measure

A
  • intellectual functioning, made up by:
  • judgment
  • abstract thinking
  • attention span
  • memory
  • knowledge
87
Q

pain is considered the _____

A

5th vital sign

88
Q

what is the “gold standard” for pain assessment? how would you do this?

A
  • pt self report
  • use of appropriate measuring scaled
89
Q

what does LOTTARP stand for/what does it do

A
  • 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
90
Q

what is pain perception influenced by

A
  • age
  • culture
  • anxiety/stress levels
91
Q

how does age impact pain perception

A

older adults tend to under report pain
- may be less sensitive or learned to be more stoic
- effects of pain may lead to confusion

92
Q

how do beliefs impact pain perception

A
  • thoughts and feelings
  • ex: “this will never get better”
93
Q

what is the nurses role in dealing with pain

A
  • 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
94
Q

what are the pharmacological interventions for pain

A
  • NSAIDs and nonopioids
  • opioids
  • co-analegesics
95
Q

what health history are you gathering for respiratory assessment

A
  • smoker, cough, difficulty breathing, pain, meds, history of respiratory illness, drug misuse, risk factors, exposure to disease (ex: TB)
96
Q

What are the steps in respiratory assessment

A
  • 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
97
Q

what is the flow of the heart’s conduction system

A

SA node > atria > AV node > bundle of his > R + L bundle branches > ventricles

98
Q

normal pulse rate (HR)

A

60-100 bpm

99
Q

what is tachycardia?

A

fast heart rate, faster than 100 bpm

100
Q

what is bradycardia

A

slow heart rate, less than 60 bpm

101
Q

what do you measure when assessing pulse

A
  • rate
  • rhythm (regular/irregular)
  • quality (thready, weak, bounding)
102
Q

where is the apex of the heart

A

5th intercostal space

103
Q

what are the apical heart sounds

A

S1 Lub
S2 Dub

104
Q

what is the S1 apical heart sounds

A
  • “lub”
  • closure of the mitral and tricuspid valves
  • signals beginning of systole
105
Q

what are the 4 common alterations in heart functioning

A
  1. conduction issues
  2. heart failure
  3. valve issues
  4. ischemic issues
106
Q

what are some examples of conduction isses

A
  • dysrhythmias
  • atrial fibrillation
  • ventricular tachycardia
  • ventricular fibrillation
  • asystole
107
Q

what 2 examples cause valve issues

A
  • stenosis
  • regurgitation
108
Q

what is angina

A
  • Insufficient oxygen to the heart muscle
  • causing sudden, severe substernal pain
  • radiating to the left arm
  • Symptoms of coronary artery disease
109
Q

what are examples of ischemic heart issues

A
  • angina
  • myocardial infarction (heart attack)
  • acute coronary syndrome (sudden reduced blood flow to heart)
110
Q

difference between myocardial infarction and angina

A
  • MI: complete blockage of coronary arteries
  • angina: narrowing of coronary arteries, doesn’t cause permanent damage
111
Q

what occurs during systole

A

heart contracts and blood is squeezed into the body (time between S1 and S2)

112
Q

what occurs during diastole

A

blood is refilling from aorta into ventricles (time between S2 and next S1)

113
Q

systolic/diastolic range

A

systolic: 100-139 mmHg
diastolic: 60-89 mmHg

114
Q

what is the optimal BP

A

-120/80
- but be familiar with pt baseline

115
Q

systemic BP is

A

cardiac output (CO) x peripheral resistance (PR)

116
Q

what is cardiac output

A

vol of blood pumped by each ventricles in 1 min

117
Q

what is peripheral resistance

A
  • resistance of the arteries to blood flow
  • determined by a change in diameter of arterioles
118
Q

what are 10 factors that impact BP

A
  • 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)
119
Q

systolic pressure is especially affected by

A

cardiac output (left ventricular pumping)

120
Q

diastolic pressure is especially affected by

A

pulse rate (heart at rest)

121
Q

what is hypotension

A
  • abnormally low blood pressure
  • systolic < 100 mmHg
  • diastolic < 60 mmHg
122
Q

what can cause hypotension

A
  • dilation of arteries
  • loss of blood
  • inadequate pumping of the heart
  • dehydration
  • anemia
123
Q

what is hypertnesion

A

high blood pressure
- systolic > 139 mmHg
- diastolic > 89 mmHg

124
Q

what is orthostatic hypotension

A
  • systolic pressure suddenly falls > 15 mm Hg
  • occurs upon sitting or standing
125
Q

signs and symptoms of hypotension: what would you assess

A
  • dizziness
  • lightheadedness, weakness
  • unsteady/falls
  • blurred vision
  • measure BP lying down, sitting, standing waiting 1-3 mins between
126
Q

what are some causes of orthostatic hypotension

A
  • autonomic neuropathy disease
  • dehydration
  • blood loss
  • anemia
  • beta blockers
  • anti - hypertensives
127
Q

what are some risk factors of hypertension

A
  • family history
  • smoking
  • race
  • obesity
  • age
  • high fat and sodium diet
  • stress
  • excessive alcohol consumption
  • diabetes
  • menopause
  • sedentary lifestyle
  • oral contraceptives
128
Q

subjective health history for cardiovascular issues

A

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)

129
Q

what objective data would you collect in the cardiovascular physical exam

A
  • colour
  • edema
  • palpate
  • temp
  • pulses
  • extremities for pitting edema
  • auscultate: apical pulse, blood pressure
130
Q

structure and function of arteries

A
  • carry oxygenated blood away from heart
  • can withstand pressure from heart
  • elastic fibres
131
Q

structure and function of veins

A
  • return deoxygenated blood to heart via low pressure
  • uses: skeletal muscles, breathing pressure gradients, intraluminal valve and calf pump
132
Q

what do you ask in vascular subjective assessment

A
  • history of circulatory problems
  • leg pain or cramps
  • skin changes in arms/legs
  • swelling in arms/legs; lumps
  • skin ulcers
  • blood clots
  • meds
133
Q

what do you assess in vascular objective assessment (inspection)

A
  • colour (pallor, rubor, cyanosis
  • size: bilateral comparison
  • swelling
  • edema (pitting or non-pitting)
  • ulcers
134
Q

What do u assess in vascular objective assessment? (palpation)

A
  • temp
  • moisture
  • cap refill
  • pulses
135
Q

What is ARTERIOsclerosis?

A
  • peripheral blood vessels lose elasticity; grow rigid
  • increase blood pressure
136
Q

What is ARTHEROsclerosis?

A
  • deposit of fatty materials in vessels
  • blockages
137
Q

3 main functions of lymphatic system

A
  1. maintain fluid balance
  2. immune system function
  3. absorption of fat
138
Q

what do you ask in subjective lymphatic assessment

A
  • 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
139
Q

what system are assessed in vascular assessment

A
  • vascular system/peripheral vascular
  • lymphatic system
    neurovascular assessment (ortho patients):
  • CWMS
  • pulses
  • edema to affected extremity
140
Q

what do you do when performing an objective assessment of the lymphatic system

A
  • inspection and palpation
  • region by region during head to toe assessment
    compare
  • each side for size
  • consistency
  • tenderness
  • warmth
141
Q

what are older adult considerations for lymphatic assessment

A
  • 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
142
Q

what is the sequence in head to toe assessment (10)

A
  1. general appearance
  2. skin, hair, nails (don’t throughout assessment)
  3. head/face/neck
  4. chest
  5. abdomen
  6. extremities
  7. back area
  8. tubes, drains, assessment, IV
  9. mobility
  10. report/document/assess findings
143
Q

what do kidneys do

A
  • filter blood (remove toxins) and produce urine
  • regulate blood pressure
  • regular pH
  • make red blood cells
  • maintain healthy bones
144
Q

3 common kidney alterations

A
  1. renal failure
  2. kidney stones
  3. pyelonephritis
145
Q

what does renal failure cause

A
  • electrolyte imbalance
  • hypertension
  • pitting edema
  • low urine production
  • metabolic acidosis
146
Q

pyelonephritis

A
  • kidney infection
  • often after complications of UTI
    symptoms: flank pain, fever, chills, dysuria, foul smelling urine
147
Q

dysuria

A

painful or difficult urination

148
Q

6 alterations in urinary elimination

A
  1. urinary incontinence; neurogenic bladder
  2. UTI
  3. urinary retention
  4. nocturia
  5. hematuria
  6. polyuria
  7. oliguria
149
Q

what info do you gather in a genitourinary subjective data assessment

A
  • 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
150
Q

what info do you gather on genitourinary physical exam (objective)

A
  • skin (perineal area) - breakdown, rash, discharge, inflammation
  • palpation: bladder (tender/distended)
  • urine sample: characteristics
  • measure fluid intake vs output
151
Q

what is normal urine

A
  • 95% water
  • pH (4.6 - 8.0)
  • no: protein, glucose, blood, ketones, bacteria
  • specific gravity: 1.010=1.025
152
Q

what are 6 common alterations in bowel elimination

A
  • incontinence
  • constipation
  • diarrhea
  • fecal impaction
  • flatulence
  • hemorrhoids
153
Q

what info do you gather from health history (elimination problems)

A
  • 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
154
Q

What are you assessing during a physical exam (bowel elimination)

A

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

155
Q

what are you looking for when inspecting the 4 quadrant of the abdomen

A
  • masses
  • shape
  • symmetry
156
Q

how often do bowel sounds occur

A

every 5-15 seconds

157
Q

what is reproductive and sexual health

A

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

158
Q

what are 4 alterations in sexual health

A
  1. gender dysphoria
  2. infertility
  3. sexual abuse
  4. sexual dysfunction
159
Q

What are the 6 STIs discussed in lecture?

A
  1. chlamydia (most common): bacterial, genital discharge, burning unrination
  2. gonorrhea (2nd most common): bacterial, pain during sex/urination. Can lead to infertility if not tx
  3. human papilloma virus (HPV): warts, cervical/reproductive cancer
  4. syphilis: bacterial, easily tx, dx w/ blood test, can cause impaired neuro functioning
  5. Hep C: viral; attacks liver
  6. Herpes (HSV): high prevalence, high stigma, incurable
160
Q

what occurs during a sexual health screening

A
  • sexual health history
  • swab for cultures/bacteria
  • bloodwork
  • pelvic exam
  • inspection of symptomatic area
161
Q

Taking a sexual health history

A
  • 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.
162
Q

what is stigma

A
  • negative beliefs that impact the way we see the truth
  • can prevent adequate care and seeking care
163
Q

what is a stereotype

A
  • generalized belief about a group of people
  • expecting them to act in a certain way
164
Q

what is discrimination

A

behavioural manifestation of prejudice

165
Q

what is prejudice

A

hostile attitudes towards people belonging to a specific group

166
Q

what are some common myths about mental illness

A
  • violent and dangerous
  • caused by personal weakness
  • less intelligent
  • rare, untreatable
167
Q

when did BC’s first asylum open

A

1872

168
Q

What happened to Riverview? Empowerment and Deinstitutionalization

A

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

169
Q

brief history of mental illness

A

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

170
Q

define asylum

A

peace, relief; we added negative stigma

171
Q

define insanity

A

not of a sounds mind; made derogatory

172
Q

What is sensorium

A

Assessment used to assess the patient’s orientation to time, place, person and situation

173
Q

What are you assessing during the MSE? (GESTTPCIJ)

A
  • 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
174
Q

What falls under the spiritual variable?

A
  • purpose and meaning
  • interconnectedness
  • faith
  • religion
  • forgiveness
  • creativity
  • transcendence
175
Q

What falls under the sociocultural variable?

A
  • language/communication patterns
  • cultural roles and expectations
  • social history
  • relationships/ SOs
  • health beliefs
  • habits/practices
  • ethnicity and race
176
Q

What falls under the developmental variable?

A
  • expected life events
  • unexpected life events
  • growth
  • development
  • transition
177
Q

What falls under the psychological variable?

A
  • emotions
  • cognition
  • perception of self
  • self esteem
  • body image
  • self-ideal
  • sexuality
  • self-identity
178
Q

What is recovery?

A
  • 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
179
Q

What are the methods of physical assessment?

A
  1. inspection
  2. auscultation
  3. palpation
  4. percussion
  5. olfaction
180
Q

What is the purpose of a conceptual framework?

A
  • 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
181
Q

What is the difference between insight and judgement?

A

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?

182
Q

Head to toe assessment:

A
  • general survey
  • vital signs
  • head
  • neck
  • upper extremities
  • chest/back
  • abdomen
  • anus and rectum
  • lower extremities
183
Q

What does the MSE assess?

A
  • 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
184
Q

What are the components of a health history

A
  • 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
185
Q

What is an emergency assessment?

A

A quick focused assessment in an emergency situation to identify life-threatening problems

186
Q

What is a complete health assessment?

A

non-emergent data collected at initial visit, or on hospital admission

187
Q

open-ended questions

A

questions that allow respondents to answer however they want
- who, what, when, how

188
Q

close-ended questions

A

Questions that can be answered in short or single word responses.

189
Q

3 types of questions in problem solving:

A
  1. there is a correct answer: required knowledge
  2. no ‘right’ answer: calls for subjective opinion/preference
  3. multi ‘right’ answers: clinical judgment
190
Q

What is the problem solving process?

A

-Clarify the nature of a problem and suggests possible solutions

-Evaluate solutions and choose best one to implement

191
Q

How do we measure the quality of our thinking

A
  • Clarity
  • Accuracy
  • Precision
  • Relevance
  • Depth
  • Breadth
  • Logic
192
Q

Elements of critical thinking:

A

-purpose
-question at issue
-information
-concepts
-assumptions
-inferences
-point of view
-implications

193
Q

What is sociocentric thinking?

A

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

194
Q

What is egocentric thinking?

A

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”

195
Q

Definition of critical thinking:

A
  • art of analyzing and evaluating thinking with a view to improve
  • encompasses both cognitive processes and attitudes
  • consciously examining our own thinking processes
196
Q

What are the 4 classifications of futility?

A
  1. not futile (beneficial)
  2. futile (not beneficial)
  3. futile from patient perspective
  4. futile from clinician perspective
197
Q

What is medical futility?

A

interventions unlikely to produce any significant benefit to patient

198
Q

mental health care issues

A

Behaviour control and restraint

  • relational engagement and boundaries
  • confidentiality
  • ethical practice environments
  • social justice
199
Q

Health care ethical principles:

A
  • Autonomy
  • Beneficence
  • Non-maleficence
  • Dignity
  • Justice
  • Truthfulness, informed consent & confidentiality
200
Q

CRPNBC Professional standards

A
  • Therapeutic Relationships
  • Theory/knowledge base
  • Professional Accountability
  • Ethical Practice
201
Q

RPN code of ethics:

A

Primary purpose: protect the public

  • defines/provides RPN’s w/ practice standard
  • governed by Health Professions Act
202
Q

What is ethics:

A
  • study of good conduct, character, motives.
  • Accountability!
  • Each practitioner has the responsibility to adhere to standards of ethical practice
203
Q

what is self awareness

A

understanding one’s biases, beliefs, thoughts etc. and recognizing how they affect self and others

204
Q

Explain choice community integration (MH care and reform):

A
  • 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
205
Q

Explain choice community integration (MH care and reform):

A
  • 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
206
Q

history of mental health treatment

A

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
207
Q

What does pyschotherapy do?

A

helps the patient to help themselves by asking strategic Q’s

208
Q

renal failure

A
  • leads to electrolyte imbalance
  • hypertension
  • pitting edema
  • low urine production
  • metabolic acidosis
209
Q

kidney stones

A
  • 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
210
Q

urinary incontinence

A

involuntary loss of urine
- can lead to skin breakdown, pressure ulcers, and social isolation
- can lead to significant psychological impairment

211
Q

neurogenic bladder

A

a problem which a person lacks bladder control due to brain/spinal cord damage (MS)

PNUR: concepts (2 decks)

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