NUR 304 Flashcards
Therapeutic Use of self
the ability to intentionally use one’s personality to build a relationship and form nursing interventions.
Mental health- A state of well-being in which each individual is able to realize his own potential, cope with normal stress, work productively, and
make a contribution to society
Mental illness
all mental disorders with definable diagnoses
DSM –V- the official guideline for diagnosing psychiatric disorders. It also provides
epidemiological statistics
DSM –V organization
child disorders are listed first in the chapter, and adults are listed later. Also, disorders that are related (eating disorder and elimination disorder) are usually bunched together.
ICD-10 Includes all diseases. Divides mental illness into 2 main categories, which are
psychosis and neurosis
Maslow’s Hierarchy
Physical Safety Love Esteem (achievement and praise) Self-actualization Self-Transcendence
cognitive theory includes
rational-emotive behavior therapy (REBT) and Cognitive-Behavioral Therapy
REBT
- Developed by Ellis.
- The goal is to eliminate negative thoughts that are illogical.
- The illogical thoughts are things like, I SHOULD always be nice or I MUST be the best.
- Ellis said negative thoughts are an ABC event.
- REBT is about seeing the glass as half full.
- It focuses more on the present than the past
CBT
- Developed by Beck.
- Neo-freudian.
- The way people feel is determined by the thoughts they have about the world.
- The thoughts people have are called schemas.
- Rapid, unthinking responses based on schemas are called automatic thoughts or cognitive distortions.
- Cognitive distortions are irrational; CBT identifies these distortions, reality tests them, and corrects the distortion
Ego
reality tester. Leader.
Superego
strict morality. Super christian
Psychoanalytic- came up with
transference and countertransference
Behavioral theory
- Personality is not about inner thoughts, it’s just about learned behaviors.
- Behaviorism was originally thought of by Watson.
- Watson did the experiment with little albert. –Operant conditioning was developed by Skinner.
Behavior therapy works best on
specific problems, like a phobia of snakes
There are 5 kinds of behavior therapy:
modeling, OC, desens, aversion therapy, biofeedback
Interpersonal
- Sullivan believed that personality is behaviors that can be seen in interpersonal relationships.
- Sullivan said that the purpose of all behavior is to get needs met through interpersonal interactions and to decrease anxiety.
- Sullivan coined the term security operations to describe measures the individual employs to reduce anxiety and enhance security. All of the person’s security operations combined are called the self-system.
Peplau
Influenced the shift from what nurses do TO patients to what nurses do WITH patients.
Emphasized keeping the nurse’s needs out of the picture.
Described 4 levels of anxiety (mild, moderate, severe, panic)
Lithium adverse effects
tremor ataxia confusion convulsions NVD arrhythmia polyuria polydipsia edema goiter hypothyroidism
Lithium TI
.8 to 1.5
Lithium contraindication
pregnancy
below age 12
Lithium drink…
plenty of water
Lithium, older adults are
more sensitive to it
Lithium, diet
don’t change the amount of salt you eat
Lithium patient instructions
take with food to avoid GI problems
Clozaril
- Atypical antipsychotic
- Blocks DA, ACH, NE, and histamine
- Emotional quieting and reduced movement
- Antiemetic
- Alter temp
- Increases prolactin
- HAS ANTICHOLINERGIC EFFECTS (dry mouth, urine retention, constipation)
- Orthostatic hypo
- Causes sedation (because it’s antihistamine)
TCA general info
- Anticholinergic effects
- Antihistamine effects
- Takes 2-3 weeks to work
- Can cause arrhythmia
- Very severe interaction with MAO
- Also interacts with barbis
TCA SE
dizzy
ortho
sedation
risk of suicide
TCA toxic effects
cardiac
coma
seizure
delirium
SSRI has no
anticholinergic effects
SSRI SE
insomnia
nervous
tinnitus
weight loss followed by gain
MAOI
- irreversibly inactivate MAO to increase amine levels
- reduce REM sleep
- enhances effects of anesthesia, sedatives, narcotics, and TCAs
MAOI toxic effects
- liver
- don’t take it within 2-3 weeks of taking TCA
- agitation, cardiac, convulsions
Criteria for admission: harm to self, harm to others or
unable to care for self
Even if the patient is involuntarily admitted, they have the right to refuse
meds
Informal admission
similar to a regular hospital admission, there’s no formal application.
Voluntary admission
- patients formally requests in writing to be admitted.
- If the person is a minor, the guardian may be allowed to apply on their behalf.
- They can ask to leave, however if their condition is really bad it may be forced to stay
Temporary admission
- used for people so confused that they can’t make a decision or people so ill that they need to be admitted right away.
- Usually they can only be held under temporary admin for 15 days
Long-term involuntary admission doesn’t always require a
judicial hearing beforehand, but usually the patient can have a hearing at a later point
Tort
A civil wrong for which money damages may be collected by the injured party (plaintiff) from the responsible party (the defendant)
Intentional tort
Willful or intentional acts that violate another person’s rights or property
Intentional tort examples
➢ Assault ➢ Battery ➢ False imprisonment ➢ Invasion of privacy ➢ Defamation of character (slander or libel)
Unintentional tort example
negligence
Cause in fact
if it was not for what the nurse did, would this injury have occurred?
Proximate cause
aka legal cause, may be evaluated by figuring out what caused the harm
Accepting
Doesn’t necessarily communicate agreement, but it’s nonjudgemental
Giving recognition
Indicates awareness of change and personal efforts. Does not imply good or bad
Restating
Repeats the main idea expressed. It’s different from paraphrasing because it repeats so of the exact same words the patient used
Example of Reflecting
You sound as if you’ve had many hard times.
Projective questions
Asking a “what if” question
Presupposition question
What if you woke up and this problem went away? What would your life be like?
Alarm (acute) stress level
Characterized by sympathetic response, corticosteroids, endorphins. It’s very brief and intense.
Resistance stage of stress
Aka adaptation phase. It’s the time of sustained and optimal stress resistance. Normally stressors are overcome here, but if not you can fall into the exhaustion stage.
Exhaustion stage of stress
Resources are depleted and you can no longer combat the stress.
Mild anxiety
Normal amount.
The person perceives more information and can better problem solve.
Moderate anxiety
Perception decreases. The person has selective attention. Problem solving can occur, but it’s not optimal. Sympathetic nervous system kicks in. May have tremors and shaky voice.
Severe anxiety
- Unable to problem solve.
- Behavior is automatic and aimed at reducing stress.
Panic
May lose touch with reality.
Hallucinate.
Indicates that the nurse has heard and has followed the trend of though; e.g. “I follow what you said.” “Yes” “Uh Huh”.
Accepting – giving indication of reception
Not only words are important but the facial expression, the tone of voice and inflection, and the posture of the nurse.
Accepting
To greet the patient by name, to note efforts the patient has made, to indicate awareness of change “Good morning Mr. M.”
Giving Recognition
“I’ll sit with you awhile.”
Offering self
By calling patient’s attention to what is happening to him, the nurse seeks to encourage the patient’s noticing for himself so that he can do the describing
Making observations
“Tell me whether my understanding of it agrees with yours.”
Seeking consensual validation
PATIENT: “I’m dead.” NURSE: “Are you suggesting that you feel lifeless or is it that life seems without meaning?”
Attempting to translate into feelings
“Perhaps you and I can discuss and discover what produces your anxiety.”
suggesting collaboration
Paraphrasing: restating another’s message more briefly and in your own words; lets another know
you are actively seeking understanding of what they are saying
help person be aware of inconsistencies in his/her feelings, attitudes, beliefs, or behaviors
confrontation
Diathesis
biological predisposition
Stress (in terms of the diathesis-stress model)
Environmental stress or trauma
Diathesis-Stress Model
Most accepted explanation for mental illness
Combination of genetic vulnerability and negative environmental stressors
New Freedom Commission on Mental Health
created to conduct a study of the U.S. mental health service delivery system and make recommendations based on its findings.
Incidence
the of new cases popping up
Prevalence
how many people have the condition at the a given time
Sullivan’s Interpersonal Theory: Purpose of all behavior is to get needs met through interpersonal interactions and to reduce or avoid
anxiety
5 Foundations of Peplau’s theory
Participant observer Mutuality Respect for the patient Unconditional acceptance Empathy
The art of nursing and science
Peplau
Peplau’s theory aims to
improve patient’s ability to think and function
Theory: Dynamic interplay between individuals and the environment
Cognitive
Theory: Thoughts come before feelings and actions
Cognitive
Cognitive theory: Thoughts about the world and our place in it are based on our own unique perspectives, which
may or may not be based on reality
Theory: Test distorted beliefs and change way of thinking; reduce symptoms
CBT (Beck)
Theory: Recognize thoughts that are not accurate
REBT (Ellis)
Theory: Emphasis on human potential and the patient’s strengths
Maslow
