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N353: Practice of Nursing II > Module 4 - Introduction to Psych Nursing > Flashcards

Module 4 - Introduction to Psych Nursing Flashcards

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1
Q

Mental Health

A

WHO: STATE OF WELLBEING in which the individual realizes his or her own abilities, can cope with life’s normal stressors, can work productively and can make a contribution to society

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2
Q

Mental Health is the successful performance of what 4 mental functions

A
  1. Results in Productivity
  2. Fulfilling Relationships
  3. Ability to adapt to change
  4. Ability to cope with adversity, life’s events
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3
Q

Mental health provides the capacity for what?

A

rational thinking

learning

emotional growth

resilience

self esteem

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4
Q

Elements of Mental Health

A
  1. self governance ability to act independently, dependently, or interdependently without losing autonomy
  2. progress toward growth or self realization
  3. tolerance of the unknown - coping ability
  4. reality orientation
  5. master of environment
  6. stress management

*some degree of variance exists but inability leads to mental illness

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5
Q

3 Areas that Influence/Drive Mental Health

A

Biologic Influences

Psychological Influences

Sociocultural Influence

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6
Q

Examples of Biologic Influence of Mental Health

A

prenatal, perinatal, and neonatal events

physical health status

nutrition

history of injuries

neuroanatomy

physiology

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7
Q

Examples of Psychological Influence of Mental health

A

Interactions

intelligence quotient

self concept

skills

creativity

emotional developmental level

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8
Q

Mental Disorders

A

APA: Clinically significant disturbances in cognition, emotional regulation, or behavior that reflects a dysfunction in the physiological, biological, or developmental processes underlying mental dysfunction.

They are usually associated with distress or impaired functioning.

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9
Q

How can mental health be viewed?

A

as an illness continuum

it can be viewed on end points of a continuum with movement back and forth during life (like a pendulum swinging back and forth)

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10
Q

What are the 4 levels of Mental Health?

A

Physical

Personal

Interpersonal

Societal

*All four of these impact your mental health on a continuum)

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11
Q

Can mental health and illness be used interchangeably?

A

NO they cannot be defined completely in terms of one another

Individuals and families are complex

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12
Q

Incidence and Prevalence of Mental Illness is ____

A

non-discriminatory (can happen to anyone at any time)

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13
Q

At any given time how many Americans could be diagnosed with mental illness 18 yo and older?

A

1 in 4 Adults

26% of 18+

57.7 Million Americans

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14
Q

How many with mental illness will never seek treatment?

A

1/2

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15
Q

Dual Diagnosis

A

A diagnosed mental disorder co-occurring with substance abuse problems

15% of adults with MI have this

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16
Q

___% of homeless people have schizophrenia or bipolar disorder

A

25%

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17
Q

___ is the most often missed and under diagnosed mental health problem

A

depression

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18
Q

What group has the highest depression leading to suicide rates?

A

People 65+

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19
Q

What is the etiology for Mental illness?

A

IT is largely identified, and it is believed to be caused by complex interactions among genetics and environmental influences

A combination of biological and environmental factors with exact definitions unknown

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20
Q

What is the one common thread of mental illness etiology?

A

Many mental illnesses are undefined/we largely do not know the precise causes - individual aspects can play a big role in MI

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21
Q

The experience and consequences of Mental Illness are …

A

much more complicated than a list of symptoms and diagnosis

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22
Q

___ ___ of mental illness are elusive

A

precise definitions

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23
Q

___ in and of itself is not sufficient to produce a mental illness

A

Stress

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24
Q

What are the 2 main diagnostic tools for classifying Mental Illness?

A

ICD-10 (WHO)

DSM-5 (APA)

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25
Q

ICD-10

A

WHO’s Classification of Mental and Behavioral Disorders, ICD-10 international diagnostic standard for general epidemiological and many health management purposes monitoring and analysis of the general health of a population and the incidence and prevalence of diseases.

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26
Q

DSM-V

A

APA developed Diagnostic and Statistical Manual of Mental Disorders ( DSM ) multi-axial classification system groups disorders by symptom clusters and differentiates between normality and psychopathology based on duration and severity of symptoms.

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27
Q

In 2015, the DSM V…

A

moved away from the multi-axial system to a more unified approach aimed at improving diagnostic care

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28
Q

5 Axis of DSM

A

Axis I - Clinical Disorder

Axis II - Personality Disorders and Mental Retardation

Axis III - General Medical Conditions

Axis IV - Psychosocial and Environmental Problems

Axis V - GAF - Global Assessment Scale # system meaning current functioning/highest level of functioning in the past year

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29
Q

Each disorder has ___ that describes behaviors, symptoms, or signs; duration and other qualifiers, the ___ do NOT determine ___.

A

each disorder has criteria that describes behaviors, symptoms, or signs; duration and other qualifiers, the criteria do NOT determine diagnosis

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30
Q

Many clients have ___ dx on the first 3 axes

A

1+

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31
Q

Axis I Criteria

A

Includes most of the psychiatric disorders EXCEPT personality disorders and issues of developmental disorders

If a person has more than 1 axis I disorder, list them all with the chief complaint listed first

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32
Q

Axis II Criteria

A

Personality Disorders

Intellectual Developmental Disorder

Other Prominent Maladaptive and Defense Mechanisms

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33
Q

Axis III Criteria

A

General medical conditions that may be relevant to understanding and/or managing the mental disorder

Does NOT include mental disorders that are thought to be a direct cause for a mental disorder - those are coded on Axis I

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34
Q

Axis IV Criteria

A

Problems with Primary Support Group

Problems r/t Social Environment

Educational, Occupational, Housing or Economic Problems

Problems w/ access to health care services

Problems w/ legal system

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35
Q

Axis V Criteria

A

Clinician makes a judgment about a person’s overall level of functioning

GAF Scale: 0-100

The lower the number, the lower the level of function

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36
Q

What are some of the Limits of the DSM System?

A
  1. Categories are descriptions, not explanations and labeling - can cause tautology
  2. Divides normal and abnormal
  3. clients can suffer from the same disorder and manifestations, but personal experience differs for each client
  4. inflexibility of duration
  5. criterion utilized for adults and children
  6. cultural discrepancies
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37
Q

Tautology

A

Focusing on someone’s label

avoid it

a nurse must avoid expecting a persons behavior based on a diagnostic label

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38
Q

What changes were made to the DSM multi axial system?

A

A new approach the APA moved to with a single axis rather than multiple axis approach

The previous approach created an arbitrary hierarchy of mental disorders between the first two axes. It also implied a separation of mental disorders from physical disorders, when in fact mental disorders are physical disorders.

This current approach still uses all of the same mental, physical and social considerations as the multi-axial system but does it in a more unified manner aimed at improving diagnosis and care, informing new research and allowing for global information sharing.

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39
Q

DSM Single Axis Approach

A

First 3 Axis were combined containing all mental and other medical diagnoses - allowing for removal of artificial distinctions among conditions, benefitting both clinical practice and research use

Axis IV still represents contributing stressors, but now uses ICD codes which allow providers to better indicate other problems like relationship problems, that need clinical attention

GAF of Axis V is no longer used d/t lack of clarity and was replaced by the WHO disability assessment schedule - this change brings the DSM into better alignment with other medical disciplines

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40
Q

Parity of the DSM Single Axis Approach?

A

It is a term meaning that mental disorders are now on the same level of physical disorders

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41
Q

What does the WHO Disability Assessment Schedule do?

A

Measures disorders and their associated disabilities which are shown as conceptually distinct and are assessed separately

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42
Q

What is the HP2020 goal for mental health?

A

Improve mental health through prevention and by ensuring access to appropriate quality mental health services

Key: TREAT VIA PREVENTION

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43
Q

In what ways can a nurse prevent and treat mental health issues?

A

Health promotion and illness prevention

Attention to medically underserved populations (Advocate)

Involvement of managed care in behavioral health

Quality management, including client outcomes

Expanded practice of advanced clinical providers PNP

Community based primary care

Influence of consumer and family advocacy (educate family too)

Decreased benefits for Medicare, Medicaid, disability programs

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44
Q

What are some of the Issues related to Mental Health treatment?

A

Failure to Seek Treatment

Cost (Inpatient care and medications)

Stigma

Revolving Door Treatment

Lack of Parity

Limited Access to Care (inadequate, inappropriate, no care, difficulties for families to determine appropriate care)

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45
Q

How many people fail to seek mental illness treatment, what does it cause, and why does it happen?

A

2/3 fail to seek it

It leads to increase expenses r/t loss productivity, increase in criminal justice system and social service costs

It can be due to a variety of factors such as the area they live, a long waiting list, etc

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46
Q

What is the Stigma behind mental health treatment?

A

There are misconceptions, discrimination, and stereotyping occurring which leads to people not seeking help

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47
Q

Revolving Door Treatment

A

A person going in and out of a hospital as they have troubles with medicine compliance and sometimes insurance companies will discharge them early before they are ready

Decreased length of stay, managed care mandates, deinstitutionalization, lack of community supports can all lead to this

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48
Q

Deinstitutionalization

A

Trying to keep people out of mental hospitals

It is a good thing because we want them to be able to leave, but they still need services to make sure they can deal with long term issues

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49
Q

What is the parity like with mental health treatments?

A

Inequalities: of coverage or what’s most effective versus what is actually received

ex: We can talk about diabetes casually but not depression

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50
Q

Goals for Improving Mental Health Care

A

Increase the number of Mental Health Professionals caring for children and adolescents

Expand Mental Health Services

Cultural understanding

Improve understanding

Redesign rehabilitation services to meet client needs- social, physical, cultural needs

Integration and collaboration in services

Reintegration into Society- family involvement, employment, continued education, social and recreational activities, community participation

Legislation to improve coverage

Culturally competent care

Medication Adherence

Self-Help and Advocacy

National Alliance for the Mentally Ill

Psychiatric Advanced Directives- treatment wishes during stable periods

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51
Q

What is a huge issue with mental health client populations?

A

Medication Compliance

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52
Q

What is crucial to medication compliance?

A

EDUCATION - on the medication and the side effects

53
Q

What does a nurse do in Psychiatric Nursing

A

Work with individuals and families who have psychiatric problems and disorders, such as depression, schizophrenia, bipolar disorder, psychosis or dementia.

54
Q

What sort of tasks might a nurse do in psychiatric nursing?

A

Assess mental health and physical needs and provide interventions based on individual needs

Develop and evaluate nursing care plans to ensure positive outcomes

Crisis intervention and counseling

Help patients regain or improve their coping abilities

Manage and work with a team to ensure and enhance the therapeutic environment

Assist patients with self-care activities

Administer and monitor treatment regimens

55
Q

What roles does a Psychiatric Nurse have?

A

Participation in the interdisciplinary mental health team

Advocacy

Health promotion and maintenance

Case management

Screening

Milieu therapy

Health teaching

Psychobiologic interventions

56
Q

Why is Case management so important?

A

A person can be stable but they may have issues with housing and pay so case managers and communication with them is very important

57
Q

What is a highly critical role of the nurse in psych nursing?

A

to advocate for the patient

58
Q

Milieu Therapy

A

Therapy where patients can practice life skills in a safe controlled environment where healthcare professionals can help with interactions and actions (unlike in the community where they cannot help)

59
Q

What are some important Qualities a Psychiatric Nurse should have?

A
  1. Therapeutic Use of Self (forming a trusting relationship providing comfort, safety, and acceptance)
  2. Genuineness and Warmth (openness, realness, lack of defenses)
  3. Empathy
  4. Leadership (empower, direct, and manage care)
  5. Acceptance (suggests neither approval nor disapproval but tolerance and appreciation of the client - know how to care for everyone even someone who did a heinous crime)
  6. Maturity and Self Awareness (major role in nurses ability to tolerate differences)
60
Q

Empathy

A

Ability to “walk a mile in a clients shoes”

Crucial to therapeutic relationship

61
Q

Where should you never be with a psych patient?

A

Alone in an isolated spot

Alert staff to your whereabouts at all times

62
Q

Always have a __ __ in psych nursing, never put yourself in a position where …

A

Always have an exit plan, do not put yourself in a position where your back if to a closed in area

63
Q

Avoid what when caring for psych patients?

A

provocative clothing and having too much skin exposed

64
Q

What topics of discussion should be avoided and why unless you have experience in managing them?

A
  1. Religion
  2. Politics
  3. Sexual Topics

Psychotic patients generally experience delusional themes in these three areas

65
Q

Avoid wearing what when working with psych patients?

A

Necklaces or other items that can be used as a weapon to strangle

Do not wear loop earrings

66
Q

Safety comes first in psych nursing, always …

A

listen to your gut or primary instinct

67
Q

What are some differences in the nursing process for psych nursing?

A
  1. Observations are extremely important. This should be the manner and focus of the nurses’ observations
  2. The particulars of interviewing during data collection
  3. The types of interventions sued for identified problems
68
Q

What is a crucial thing to have as a nurse that can impact the nursing process?

A

A therapeutic nurse client relationship where you have self awareness in order to reduce barriers to effective data collection and assessment

69
Q

What can impact your self awareness?

A

Personal feelings, values, beliefs, perceptions, communication skills, developmental stage of the client, spirituality, and religion all may interfere with accurate data collection

70
Q

What are some components of the psych physical examination?

A

Review of systems

Diagnostic testing

Vital signs

Neurological status

Changes in sleep patterns, appetite, libido, concentration

Elimination

Activity & exercise

Hydration

Self-care

71
Q

What are some components of the psych mental status examination?

A

General appearance

Orientation

Mood and affect

Quality of speech

Thought process

Cognitive Intellectual Performance

Insight & Judgement

72
Q

What are some psychosocial components of a psych nursing assessment?

A

Recent stressors
Strengths
Current medications
History or psychiatric treatment
Substance abuse history
Quality of support systems
Family definition of problem
Behavior
Self-concept
Body image
Self- esteem
Personal identity
Suicidal/homicidal ideation (Safety is critical)
Coping patterns
Spiritual and cultural needs
Legal and occupational history
Economic status
Quality of life

73
Q

What area of examination may be most important?

A

Mental Status Exam

74
Q

Affect

A

capacity to vary outward emotional expressions (like the weather)

75
Q

Mood

A

prominent and overall emotional state expressed (like a season)

76
Q

How do mood and affect compare?

A

Mood is more consistent like a season while affect is more changing per day

77
Q

Insight

A

Awareness of a problem going on

should a patient have this they will be more likely to comply and assist, but if they are not they are more likely to take risks or be noncompliant to a care plan

78
Q

What are some Life Span Considerations for Children and Adolescents in the psych nursing field?

A

Growth and development stage

Family dynamics - parental involvement and permission

Parenting styles

79
Q

What are some life span considerations for older adults in the psych nursing field?

A

AVOID AGEISM

developmental stage

determine how to address them (e.g. surname)

80
Q

Psych Nursing Diagnosis

A

Analyze assessment data to determine diagnoses

DIAGNOSIS DRIVES CARE

Do it according to NANDA classification system

81
Q

Outcome Identification Care Plan Goals in Psych Nursing

A

psych nurse identifies expected outcomes that are individualized to the client and measurable

Update constantly as things always are changing

82
Q

What is planning like for a psych nurse?

A

the psych nurse develops a plan of care that prescribes interventions to attain expected outcomes.

Safety needs often a priority

patient involvement is critical once they are well enough or stable enough to be involved

83
Q

Types of nursing Interventions

A

Biologic

Psychological

Social

84
Q

Examples of Biologic Nursing Interventions

A

Promote self care

Encourage physical activity

Sleep intervention

Encourage proper nutrition

Relaxation techniques

Medication management

85
Q

Examples of Psychosocial Nursing Interventions

A

Cognitive interventions

Counseling

Conflict resolution

Bibliotherapy

Reminiscence

Behavior therapy

Psychoeducation

86
Q

Examples of Social Nursing Interventions

A

Milieu therapy

Containment

Validation

Structured interventions

Open communication

Patient Safety

87
Q

Bibliotherapy

A

Use of literature to help people cope with emotional problems, mental illness, or change their lives back

Also can be used to produce effective change and promote personality growth and development

88
Q

What is Evaluation like in Psych Nursing?

A

Psychiatric nurse evaluates the clients progress in attaining expected outcomes

it is a dynamic process that changes as the clients condition changes

89
Q

What are the key components of documentation?

A
  1. Becomes a part of the clients permanent record
  2. Objective and Subjective data is documented
  3. Written documentation should be clear and legible
  4. nurses should avoid inferences or judgments
  5. nurses should use concrete and specific terms
90
Q

__ determines what is “right” or “wrong” within a society

A

legislation

91
Q

__ ultimately preps you and protects the client

A

Knowledge (of law, of practice, etc)

92
Q

Malpractice

A

a tort action that a consumer plaintiff brings against a professional defendant when the plaintiff believes the professional injured him or her within the consumer-professional relationship

93
Q

Common Liability Issues

A

Protection of clients

Defamation of character (Libel and Slander)

Supervisory liability

Short-staffing issues

94
Q

Libel

A

published false statements

95
Q

Slander

A

spoken false statements

96
Q

What are short staffing issues ?

A

there is always a call in or staffing issue occurring that can lead to safety issues

97
Q

What is one of the best ways to prevent safety risks?

A

Be a part of a team and have teamwork with the psych nurses

98
Q

What are the guideline recommendations for avoiding liability from more important to least?

(All are still extremely important though)+

A
  1. Always put the client’s rights and welfare first
  2. Comply with the rules and regulations in the hospital’s or agency’s policy manual
  3. Practice within the scope of the state’s nurse practice act
  4. Maintain current understanding and knowledge of established practice standards
  5. Keep accurate, concise, and timely nursing records
99
Q

Basic Rights of Psychiatric Clients

A

Appropriate treatment

Individualized plan of care

Ongoing participation in treatment

Right to refuse treatment, except in emergency situation

Decision making around experimental treatment

Freedom from restraint or seclusion except during emergency situation with written provider order

Humane treatment environment

Confidentiality of records

Right to access records

Access to visitors, telephonic and mail communications

Access to these rights

Right to assert grievance if rights are infringed upon

Right to access protection, service, and a qualified advocate in order to understand one’s rights

Right to assert these rights without reprisal

Right to referral to other providers upon discharge

100
Q

Always use the least ___ treatments

A

restrictive

101
Q

Informed Consent

A

consent that patient gives to provider after receiving sufficient information allowing the patient to understand a procedure

102
Q

What sort of sufficient information needs to be given to a client to get informed consent?

A

Benefits/ Costs

Way procedure will be administered

Prognosis

Side effects/ Risks

Possible consequences of refusing treatment

Other alternatives

103
Q

What is a psych special consideration regarding consent?

A

Many psych clients are unable to give informed consent due to symptoms and need substituted consent

104
Q

Substituted Consetn

A

situation that comes into play if competency is a problem

it is obtained in competency issue cases from a healthcare proxy, guardian, or next of kin

105
Q

Confidentiality in Psych Nursing

A

Preservation of confidentiality is especially important for Mental illness clients

It can carry stigma

HIPPA, responsible record keeping, and the client’s employer are all important factors here

106
Q

What are the exceptions to psychiatric confidentiality?

A
  1. Duty to warn and protect third parties
  2. child and elder abuse reporting statues
107
Q

What are the 4 most important Legal Rights of the Psych Patient?

A
  1. Right to Treatment
  2. Right to treatment in the LEAST RESTRICTIVE ENVIRONMENT
  3. Right to refuse Treatment
  4. Right to Aftercare
108
Q

Types of Hospital Psych Admissions

A

Voluntary

Involuntary

109
Q

Voluntary Admission

A

paperwork signed by the patient for admission

for the competent patient

In NYS they cant just check out tho, need doctor permission

110
Q

Involuntary Admission

A

“Commitment”

Code 939

Have to consider the 3 main things to do this involuntarily and they must not be competent or have questionable competency

111
Q

3 Big things to evaluate in order to Commit/Involuntarily Admit someone?

A
  1. Danger to Self
  2. Danger to Others
  3. Inability to care for self
112
Q

What are some procedures that can allow for involuntary admissions?

A

Judicial

Administrative

Agencies

113
Q

What nature, purpose and reasoning can lead to involuntary admission?

A

Emergency

Observation or Temporary Stay

Long Term or Formal Outpatient care

114
Q

What is the steps for involuntary admission?

A

Petition –> Examination –> Determination by Medical, Court, or Administration –> 2 possible outcomes

Outcome 1: Release

Outcome 2: Hospitalization -> 3 Paths:
(1) Emergency - to control an immediate threat to self or others
(2) Short Term - for diagnosis and short term therapy
(3) Long Term - for treatment until determined ready for discharge

115
Q

Ethics

A

the study of philosophical beliefs about what is considered right or wrong in a society

116
Q

Ethical Dilemma

A

situation that requires a choice between morally conflicting alternatives

117
Q

Bioethics

A

used in relation to ethical dilemmas surrounding client care

118
Q

5 Principles of Bioethics

A
  1. Beneficence
  2. Autonomy
  3. Justice
  4. Fidelity (nonmalficence)
  5. Veracity
119
Q

Beneficence

A

the duty to promote good

120
Q

Autonomy

A

the right to make one’s own decisions and respect for the rights of others to make their own decisions

121
Q

Justice

A

treating others fairly and equally

122
Q

Fidelity

A

nonmaleficence

maintaining loyalty commitment; doing no wrong to a client

123
Q

Veracity

A

One’s duty to always tell the truth

124
Q

Exception to Veracity Principle

A

when the truth would be knowingly harmful to a client

125
Q

Resources for Guidelines in Ethical Dilemmas

A

Nurse practice acts

Hospital and organizational polices

Patient bill of rights

Code of Ethics for Nurses with Interpretive Statements of the American Nurses Association

Standards of Care from the Scope and Standards of Psychiatric-Mental Heath Nursing Practice

126
Q

Nurses must ___ ___ in institutional or community settings

A

protect themselves

127
Q

Are employers held responsible for employee injuries caused by violent client behavior?

A

Not usually

This is because nurses have placed themselves knowingly in the range of danger by agreeing to acre for unpredictable clients

128
Q

Good judgment means…

A

not placing oneself in a potentially violent situation!!!

129
Q

It is important to KNOW ___ ___ while working

A

YOU ENVIRONMENT

N353: Practice of Nursing II (14 decks)

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