PMHNP Expert Flashcards
Standard of practice
- think standard of care
- determined by the ANA
- Law requires NP to carry out car per criteria that other nurses would do in similar circumstances
- Way to judge the nature of care provided
- can be legally described
Scope of practice who sets the minimum requirements
- State and state board of nursing
- Questions stating to report to state board of nursing are usually correct, not reporting to supervisor or colleague
Standards of nursing practice examples
- assessment
- Diagnosis
- outcome identification
- planning
- Implementation -coordination of care, health teaching and health promotion, consultation, prescriptive authority
- evaluation
standards of professional performance
- quality of practice
- education
- professional practice evaluation
- collegiality
- collaboration
- ethics
- research
- resource utilization
- leadership
what could be done if person is uncomfortable in group setting although interpersonal learning could be advantagous
encourage attendance to group settings alongside individual therapy
Emeshment (simple definition)
- relationship involving 2 or more individuals with unclear boundaries
- may occur in countertransferance scenarios
Key function limbic system and where is it
- regulates and modulates emotions and memory
- takes shape of a closed fist in the middle of forebrain (largest region of brain)
- limbic means limbus = border. The components sit on the border above the brain stam and under the cerebral cortex
main structures of limbic system
- hypothalmus
- thalamus
- amygdala
- hyppocampus
- fornix
- cingulate gyrus
key roles of hypothalmus
WHAT HEC
* Water balance
* Hunger
* Appetite
* Temperature
* Hormones
* sEx/libido
* Circadian rhythm
Key roles of the amygdala
responsible for aggression, fear, ANXIETY, emotions and sense of smell (attach to memory)
hippocampus primary functions
involved in emotions, STRESS, learning, and memory (short term into long term)
Thalamus functions
major relay station between the senses and the cortex -processes sensory information (hearing, taste, sight, and touch) helps with memory, planning, and emotions
what is one of the first structures affected by Alzheimer’s disease
hippocampus
what does cyngulate gyrus do
plays a role in processing conscious emotional experience
what does the fornix do
an arch-like structure that connects the hippocampus to other parts of the limbic system
Cerebellum functions
- coordinates complex muscle movements (walking, hiking, playing ball) combines sensory information from eyes, ears, and muscles to help movement coordination
- balance and posture
- muscle tone
- issues with cerebellum loss of muscle coordination (ataxia)
anterior cingulate cortex
- part of cerebral cortex, found in medial portion of cerebral hemispheres
- Divided into anterior and posterior regions
- Anterior cingulate cortex (ACC) interconnected to limbic system and prefrontal cortex
- responsible for cognitive functions, decision making, empathy, impulse control, and emotions
- posterior cingulate (PCC) default mode network (DMN). regulates balance between internally and externally focused attention
corpus collusum and is the largest area of what in the brain
thick bundle of nerve fibers that connects the left and right hemispheres of the brain (largest white matter of the brain)
gray matter versus white matter of brain
- gray matter is found on the surface white matter is deeper
- gray matter is made up of cell bodies, processes information, controls movement, memory and emotions. It gets its gray color from cell bodies of neurons.
- white mater is made up of nerve fibers connects different regions of brain, which help with focus, learning, and problem solving and balance. Gets its white color from myelin sheaths that surround the nerve fibers, which helps protect them and transfer signals faster
what causes an elevates erythrocyte sedimentation rate (ESR)
- infections that affect blood, bone, heartm skin or lungs (TB, rheumatic fever and severe skin infections)
- Autoimmune disease like Lupus and RA
- cancer - leukemia, lymphoma and myeloma
- Other inflammatory conditions - temporal arteritis, polymyalgia rheumatica, inflammatory bowel disease
what can cause elevated cytokines
- they are signaling proteines that help control inflammation
- allow immune system to mount a response
- in excess lead to excessive inflammation and autoimmune dsease
can be caused by
any autoimmune disease, viral infection
Iatrogenic effect
another term for side effect
FDA issues sever warning for med what do you do
If patient is stable on med, assess risk versus benefits. Discuss with patient and document. Do not stop medication unless risk outweighs benefit.
Clear basic description of delirium (not list of S/S)
- acute disturbance of level of conciousness, cognition, and attention
What to use to treat psychotic and agitation symptoms of delirium
- Haldol
delirium dose 0.5 mg every 30-60 minutes - max 5 mg - Agitation/psychosis
5 mg IM
In elderly among other tests, what should not forget to check in cases of delirium
Urinalysis with culture and sensitivity
Key points regarding dementia
- progressive decline
- irritablity and personality shifts
when ruling out dementia, what blood test is very important
deficient levels of b12 and folic acid
Defining symptoms of cortical dementia
impaired language abilities (aphasia) and memory loss (amnesia)
Typical examples of cortical dementia
alzheimers, dementia with lewy bodies, and frontotemporal lobe dementia
2 key points regading lewy body dementia
- noted for hallucinations
- Do NOT GIVE ANTIPSYCHOTICS - make worse
Defining points of Pick’s disease
- frontotemporal dementia (knife edge fronto-temporal atrophy, abnormal tau proteins)
- prominent personality changes (first symptoms)
- decline in basic care (first symptoms)
- behavioral changes and language disruptions
Defining characteristics of subcortical dementia
- motor symptoms, lack of coordination, tremors, ataxia, and dystonia
- symptoms of depression, increased irritability and apathy
which conditions fall under subcortical dementia
huntington’s disease, parkinson’s dementia, AIDS dementia complex
Key points of AIDS related dementia
cognitive deterioration, motor abnormalities, and behavioral changes
what condition is also known as pseudodementia
MDD
Differences in pseudodementia (MDD) versus dementia
- dementia - typically precedes with a history of gradually declining function, may exhibit confabulation
- MDD - acute onset, presents with instances of unknowk or unclear memory
are steroids and hypothetically, flonase inducers or inhibitors
inducer
Bulmia nmeonic BINGE
binging episodes,** i**nappropriate compensatory behavior to avoid weight gain, normal weight or overweight typically, guilt after binging, excessive concern with body shape and weight
neurotransmitters involved in ASD
glutamate, gamma-aminobutyric acid (GABA), serotonin, norepinephrine, dopamine (GGSND)
The broken mirror theory
hypothesis that ASD are due in part to the brain’s dysfunction in the mirror neuron system. Suggests tthat mirror neurons are involved with abilities such as empathy, and understanding the intention of others.
two characteristics of the eyes in opioid withdrawl
dilated pupils and lacrimation (pinpoint pupils = opioid intoxication)
miosis
pinpoint pupils (opioids, mescaline, LSD when using -pupils dilate in opioid withdrawl)
mydriasis
pupil dilated
SBIRT
- screening -Quickly assesses substance use risk behaviors and its severity; identify the appropriate level of intervention. Identifies immediate, current health needs, determines need for further evaluation & treatment/support, short in length and quick to administer and score
- brief intervention -MOTIVATIONAL (may be more than one appointment) increase insight and awareness of substance use and risks, promote motivation towards behavior change
- referral to treatmentm-provide those identified as needing more extensive treatment with access to specialty care
at risk ETOH behavior values in men and women
Men - more than 14 drinks in a week or more than 4 on one occasion
Women - more than 7 in a week and more than 3 on occasion
65+ - same as women regardless of gender
Standard drink definitions
- 12 0z beer
- 6-9 ounces of male liquor (zima)
- 5 ounces of table wine
- 3-4 ounces of fortified wine (sherry, port)
- 2-3 ounces of cordial liquor (schnapps
- 1.5 ounces of hard liqour, brany whiskey
How long is SBIRT
3-5 minutes ideally
DAST
drug abuse screening test (0-10), can be used for young adults and adults
palmar grasp reflex ages
normal occurs at around 5-6 months of age, abnormal to persist beyond 24 months
moro/startle reflex ages
normal - present around 5-6 months of age
babinski plantar reflex ages
normal - up to 24 months, abnormal after (can detect issues in the cortical spinal tract - runs from the cortex through the brainstem to the spinal cord (upper motor neuron system)
Apply realtion between ADHD and substance abuse - straight
-screen all adolescents for ADHD sx
-identify adolescents who are at risk for substance use based on their symptoms
Apply realtion between ADHD and substance abuse - backward
-screen all adolescents with susbtance use risk to identify underlying ADHD sx
-provide appropriate inverventions and support for adolescents with both ADHD and substance use
when might a patient be ready to be transferred to a less intensive program (inpatient to outpatient)
-increased coping skills
-not blaming others
habeas corpus
legal principle that patient can leave against medical advise, protects against unlawful hospitalization.
disseminated ecephalomyelitis
brief but widespread attacks of inflammation in the brain and spinal cord that damages the myelin causing paresthesia, weakness, fatigue, asymmetrical movement of extremities
** priority is to do a neuro exam
Leve I and Level II evidence
Level I -systemic review or metanalysis
Level II- evidence obtained from at least one well-designed RCT
how can you increase buy-in on a policy
- highlight its role in elevating the standard of care
- by showing its benefit to improve the quality of patient care
why use scales in psychiatry
- drive quality improvement for conditions such as depression
- use to assess baseline scores and at regular intervals during treatment
anchoring questions
question that sets a reference point or anchor that influences subsequent responses
- can be used in eldery to help recall timeline of symptoms - “did you have them during the election on TV”
what score and how to treat mild symptoms of opiate withdrawl
5-12 (mild) = clonidine
what score and how to treat moderate symptoms of opiate withdrawl
13-24 (moderate) buprenorphine, suboxone
How do you treat a CIWA score of >8 less than 15
PRN only
How do you treat a CIWA score of > than 15
PRN + scheduled
treatment for mild, moderate, severe anxiety/depression
- mild = therapy or nothing
- Moderate medication and/or therapy
- severe - assess for suicide
What is the EPDS
Edinburgh postnatal depression scale, recommended to screen all patients during and after pregnancy
first thing you should do when child exhibits signs of irritability, mood swings, and a depressed mood. Assess the situations]
use a mood questionaire to gather more information if needed
are children’s nightmares hereditary
yes
swelling or tenderness in breast area for young boys
common during pubery (9-16)
typically resolves within 6 months
one not medicinal or therapy intervention to increase resilence and self-esteem in children
exercise
what could you do if child has trouble developing a narrative (may be a situation that is too painful for them to discuss.
use closed ended questions
what medication can be used to treat bedwetting in children
desmopressin
an infant who presents tiwht a high pitched shrill cry that cant be consoled may indicate
increased intracranial pressure
signs of lead poisoning in children
- developmental delays
- learning difficulties
- irritability
- loss of appetite
- weigh loss
- fatigue
key points of structure family therapy
- uses **genogram, mapping, hierarchy **to show the client how things are currently working within the family and how the power is distributed
- **joining **- the therapist “joins” the family through empathy and continued interactions
- **enactment/role playing **- dyfunctional interactions identified through role playing scenarios
- **restructuring /boundary making **- having family adopt clear boundaries so family can adjust to hierarchy as needed.
reflective practice
- implement debriefing sessions to analyze unsuccesful results
- aims to enhance future perfromance
potential contributing factors to reduced libido in older women
reduced blood flow to the pelvic area, low levels of testosterone
what makes women more susceptible to liver disease and alcohol symptoms
decreased levels of alcohol dehydrogenase
key points of reactivve attachment disorder
- dysfunction in early relationships
- not reaching out for comfort and support from caregiver
- children in foster care
- lack of emotional regulation
- limited positive affect or episodes of unexplained irritability, sadness or fearfulness
exceptions to confidentiality rule
- need for informaion outweighs the confidentiality
- intent to hurt self or others
- court orders, subpoenas, summonses
- given to attorneys during litigation
- releasing information to insurance
- mandated reported of child or elder abuse
tarasoff vs regents at university of CA
duty to warn potential victims
what are the elements of informed consent
competence, disclosure, understanding, voluntary, consent
full disclosure informed consent
- nature of treatment
- alternatives
- risks
- benefits
- opportunity for questions
*
ford versus wainwright
patient must be competent to be executed
hypocretin/orexin mediates what and also facilitates
wakefulness and motivational behaviors such as increased food intake
For the PMNHP, what requires 2 separate forms of consent
psychiatric and substance use must be two separate consents
labs when diagnosing insomnia
cbc, chem panel. thyroid, ferritin (RLS) b12 to rule out metabolic causes, drug screen if appropriate
homeostatic sleep drive
dependent on adenosine and gaba
what is a common adenosine antagonist
caffeine
most common neurotransmitters in learning
acetylcholine (learning) glutamate (memory)
they are both involved in both
is acetylcholine increased or decreased in parkinsons
increased
serotonin syndrome 2 highs, 2 Di’s. 2 H, 2 muscle, TICC
HTN, high HR, diaphoresis, diarrhea, headache, hallucination, muscle spasms/rigid, tremors, irritability, confusion, crytohetadine (+benzo may help)
5HT2A receptor antagonist
SGA - acts as both a serotonin and dopamine antagonist
best type of medication for initial psychotic break
SGA
which 2nd generation antipsychotics come in injectable forms
Invega, zyprexa, abilify, risperidone (geodon short acting for agitation)
another name for MMSE
folstein scale
Parts of MMSE
- concentration, attention, and calculation (serial substraction of 7’s)
- orientation (current date, location, season, year)
- Registration asess the ability to learn new material in one minute (saying the name of 3 objects and having them repeated within one minute.
- recall (memory) asking them to say the same words after 5 minutes
- fund of knowledge (who is the governor or current president)
clock drawing test
- quick assessment - completed in 2 minutes or less
- impairment to the right lobe or hemisphere
- constructional apraxia - the inability to construct, assemble, or draw objects. (stroke, Alzheimers)
how to manage TD
- benzotropine (cogentin) is not effective
- may involve reducing dose or switching to an atypical antipsychotic
which side effects are seen in patients presenting with EPS to nigostriatal dopamine blockade through antipsychotic medication and what is treatment
- SE include: dystonia, parkinsonian, akathisia
- treat with benzotropine (cogentin) an anticholinergic medication
- anticholinergiccs or antihistamine (diphenhydramine) for acute dystonia. IV or IM. Symptoms usually improve within 10-30 minutes
key points of the nigostriatal pathway
- dopamine blockade here increases acetylcholine
- increased acetylcholine can lead to salivation, teary eyes and diarrhea
what other medication can cause EPS like TD and dystonia
Reglan
which medication can decrease psychotropic medication absorption
antacid/PPI
wait 2 hours after taking antacids to take antipsychotic
Paradoxical effect
has the opposite effect
benzodiazepines can agitate a patient instead of calming
key point regarding citalopram
- can cause QT prolongation >
- adults no more than 40 mg per day
- Older adults, no more than 20 mg per day
big risk with clomipramine (anafranil)
risk of serotonin syndrome
most serotongenic medication
FDA approved OCD used only refractory due to SE profile
why should you not give schizophrenic patients stimulants?
they cause an increase in dopamine = more (+) sx
which medications do schizophrenia patients tend to have a low tolerability
alpha 2 adrenergic blocker
clonidine and guanfacine
how to switch from oral to haldol depot
first month, 20 mg x daily dose (maximum of 100 per injection) may need to come back in 5 days
which brain structures are affected in schizophrenia
prefrontal cortex, amygdala, basal ganglia, hippocampus, limbic region
leading to aggression, impulsivity, and problems with abstract thinking
which psychiatric conditions can increase suicidality
- schizophrenia
- bipolar
- depression
- ETOH abuse
- eating disorder
which disorder is associated with homicidal ideations
antisocial personality disorder
how can hyponatremia increase lithium levels
- in hyponatremia, the body tries to dilute the blood by excreting more water
- this leads to increased urine output
- lithium reabsorbs in the kidneys along with water as a compensatory mechanism to prevent excessive na loss
- The reabsorption leads to less lithium being excreted and thus higher blood levels
chronic neuropathic pain what can you prescribe
SNRI, TCA, or alpha 2 delta ligand (gabapentin, pregabalin (lyrica)
when patients with depression are concerned about sexual SE what can be prescribed
buproprion
what medication works well for depression with low energy
buproprion
what affect can SSRIs have in the elderly
increased anxiety/agitation
SSRI, SNRI, TCA, MAOI how long washout period before switching
2 weeks
when switching from fluoxetine TO MAOI
5-6 weeks
switching from MAOI to fluoxetine
2 weeks
what is the safest washout period
5 half lives
half lives
the amount of time it takes for 50% of the drug to be excreted
Example of 5 half lives
* 100% at 0.0 hours
* 50% at 5 hours
* 25% at 10 hours
* 12.5% at 15 hours
* 6.25% at 20 hours
* 3.13 at 25 hours
what medications used for migraines can cause Serotonin syndrome
triptans (sumatriptan (Imitrex))
collaborate with PCP switch to
name a NRI
atomoxetine (straterra) - non-stimulant ADHD
name an NDRI
Wellbutrin
name DNRI
methylphenidate
amphetamine (adderall)
lisdexamfetamine (vyvanse)
which medication can be used in binge eating disorder and for ADHD with less abuse potential
Vyvanse - long acting amphetamine less likely to be abused due to delays in onset of action
two important things to assess for in depressed patients
suicidality and ETOH abuse
types of muscle movements associated with serotonin syndrome
hyperreflexia - twitching spastic tendencies
myoclonic jerks - twitch spasms
symptoms of neuroleptic malignant syndrome
- extremember muscular rigidity
- mutism
- hyperthermia
- tachycardia
- diaphoresis
- altered mental state
- elevated CPK - muscle breakdown
- myoglobinuria
- elevated WBC (leukocytosis)
- elevated LFT
treatment of NMS
DC offending agent
bromocriptine (D2 agonist)
dantrolene (muscle rigidity)
when are lithium levels considered toxic
1.5 and above
1.3-1.4 continue to monitor unless SYMPTOMATIC
which medication is neuroprotective and reduces risk of suicidality in manic bipolar disorder
Lithium
which is the only medication to reduce suicidality in schizophrenia
clozaril
what to do when large amount of protein is found on UA of patient on Lithium
if stable, monitor CLOSELY
side effects of lithium
- hypothyroidism
- fine hand tremors
- macular papular rash
- GI issues
- T-wave inversion
- poluria & polydipsia
- diabetes insipidous (causes body to make too much urine, blood glucose is normal, kidneys cannot concentrate urine)
- leukocytosis
Lithium toxicity S/S
- severe nausea and vomiting, diarrhea
- confusion and drowsiness
- coarse hand tremors
- gait abnormality
- ataxia
- PRIORITY - discontinue lithium and check levels
what can increase lithium levels
- kdiney disease
- drugs that use renal clearance, NSAID, HCTZ, ACEI, medications used for HF, and lisinopril
- dehydration
- sodium imbalance
- hyper and hyponatremia
how does hypernatremia effect lithium levels
in hypernatremia, the body conserves water by reducing urine output, decreased urine output = less lithium is being excreted
which medications can cause agranulocytosis
carbamzepine and clozaril
S/S agranulocytosis
Decreased WBC
signs of infection - sudden fever, sore throat, weakness
aplastic anemia symptoms
pallor, fatigue, headache, fever, nosebleeds, bleeding gums, skin rash, SOB
AAA’s of carbamazepine
agranulocytosis, asian (steven johnson HLA-B1502), aplastic anemia
D/c for ANC less than 1000 regardless of sx.
antipsychotics with least weight gain
ziprasidone, aripiprazole, lurasidone (ZAL)
which SGA is least sedating
aripriprazole
when checking ofr metabolic syndrome, best way to check BMI and what are the values
hip to waist ratio
(healthy for men is .90 or less and .80 or less for woman; 1.0 or greater increased risk of health issues.) weight divided by hip cm or inches
least weight gain mood stabilizer
lamictal
Side effects of lamictal
SJS, fever, body aches, peeling skin, face and tongue swelling, dizziness, fatigue, headache, double or blurred vision, benign rashes too. Most symptoms occur in first 2-8 weeks.
(taper over 2 weeks unless urgent need to stop)
Key points regarding kava kava, what do you not adminster with, when should definitely be discontinued
can cause liver damage - do LFT, dont administer with benzo, discontinue before surgery
when is depakote toxic
levels greater than 150
Normal 50-125
black box warnings for depakote
liver toxicity and pancreatitis
(neural tube defect spinal bifida)
signs of depakote toxicity
disorientation, lethargy, resp depression, N&V,
signs of toxicity depakote - what do you do
stop it, check LFT and amonia levels
S/S liver toxicity
abdominal pain in RUQ, reddish brown urine, yellowing of skin and whites of eyes, fatigue
pancreatitis s/s
abdominal pain radiating to the back, fever, rapid pulse, N&V, oily stools
when are clonidine and propranolol contraindicated
clonidine, apha-2 adrenergic (contraindicated in patients with heart conditions)
Propranolol - contrainidicated in asthma and heart failure (beta adrenergic atagonist/blocker)
how does clonidine work
stimulates alpha 2 autoreceptor reduces norepinephrine, relaxing peripheral arteries to relax
are there any antidepressants that have been shown to decrease suicidality
NO
what does interpersonal therapy do
addresses distress causing interpersonal issues
resolving relationship difficulties
managing marital disputes
if it is a joint appointment, both parties must be present or reschedule
humanistic therapy
- carl rogers
- person centered
- self-directed growth and self actualization
objext of multisystemic family therapy
at risk youth (conduct disorder AKA youth antisocial behavior)
minimize obstacles hindering families from getting help, equipping parents with necessary resources and skills.
clonidine approved for childhood ADHD
long acting, called Kapvay (ages 6-17)
Piaget basic concept (not stages)
- believed that human development evolves through cognition, learning and comprehending.
- native endowment, biological, and environmental factors set the course for a child’s development.
Piaget’s first stages of cognitive development
- sensoriomotor (birth - 2 years) object permanence
Piaget’s second stage of cognitive development
preoperational age 2-6, more extensive use of language and symbolism, magical thinking
piaget’s 3rd stage of cognitive development
- concrete operations (age 7-12), child begins to use logic, reversability and conservation
what are piaget’s concepts of reversability and conservation
- stage 3 (7-12)
- reversability - something can turn into one thing and then back again (water - ice)
- **Conservation **- ability to recognize that although the shape of an object may change, it will still maintain characteristics tahat enable it to be recognized as the object (clay)
Piaget’s 4th cognitive stage
formal operational (12-adult): ability to think abstractly, thinking operates in a formal, logical manner.
Freud’s psychosocial stages of development (name and age of stage)
- oral (0-18 mos)
- anal (18 mos - 3 years)
- phallic (3-6 years)
- latency (6-12 puberty)
- genital (puberty and beyond)
freud’s oral stage
0-18 mos - chewing, sucking, feeding, crying
(substance abuse, schizophrenia, paranoia)
Freud’s anal stage
18 mos to 3 years - sphincter control, excresion and retention (depression)
Freud’s phallic stage
3-6- exhibitionism, masturbation, fear of loss of maternal love (sexual identity)
Freud’s latency stage
6-puberty - peer relationships, learning, motor skills development, socialization (inability to form social relationships)
Freud’s genital stage
puberty forward - genital based sexuality, integration of other stages (sexual perversions)
Freud’s benefits of defense mechanisms
*conflict is normally dealth with through the use of defense mechanisms
1. function of ego
2. unconciously called into action
3. used to reduce anxiety
4. become part of the personality
5. maintain a sense of safety
6. promote safety and a sense of well-being
7. may be used episodically or habitually
8. may be used constantly and become fixed, neurosis
Denial (concious or unconcious)
avoidance of unpleasant realities by UNCONCIOUSLY ignoring their existence
Projection
unconcious rejection of emotionally unacceptable personal attributes, beliefs or actions by attributing them to another person, situation or events.
regression
return to more comfortable thoughts, behaviors, or feelings used in earlier stages of development in response to current conflict, stress or threat.
repression
Unconcious exclusion of unwanted, disturbing emotions, thoughts or impulses from consious awareness.
Reaction formation
AKA overcompensation; unacceptable feelings, thoughts or behaviors are pushed from the concious awareness by displaying and acting on the opposite feeling, thought or behavior.
rationalization
justification of illogical, unreasonable ideas, feelings or actions by developing an acceptable explanation that satisfies the person.
undoing
behaviors that attempt to “undo” an unacceptable feeling, action or impulse.
intellectualization
attempt to master current stressor or conflict by expansion of knowledge, explanation or understanding.
suppresion
a concious analog of repression, concious denial of a disturbing situation, feeling or event
altruism
meeting the needs of other in otder to discharge drives, conflicts or stressors.
ego
external reality, rational mind, responsible for logic and abstract thinking, functions in adaptation, responsible for use of defense mechanisms. “I think, I evaluate”
Freud’s thoughts on anxiety
conflict is experienced conciously as anxiety. Anxiety is the alert to the concious mind to the presence of conflict.
Lewins change theory 3 main parts
describes how to implement change in organizations or groups of people
* driving forces (positive forces push for change)
* restraining forces (obstacles that counter driving forces and maintain status quo)
Lewin’s change model
3 step process
1. unfreezing (creating awareness of the need for a change, and help people let go of old ways)
2. Changing - initiate the change process, seek alternatives, demonstrate the benefits of change
3. refreezing -stabilize the new status quo
Tuckman’s 5 stages of group development
- forming -initial phase team members are unsure of roles, expectations, and norms
- storming - members may become competitive, jealous, may criticize eachother or leader
- norming -members get to know eachother, agree on norms, establish working styles
- performing - team works together with a positive attitude to achieve goals
- adjourning - final phase, team members bond and bring a sense of closure after completing their tasks.
Four main nursing theories
- theory of cultural care (madeline, leninger)
- Theory of self-care (dorothy orem)
- therapeutic nurse relationship theory (hildegard paplau)
- caring theory (watson)
key points of nurse-client relationship theory
- hildegard - first significant psychiatric nursing theory
- nurse client relationship is central
- phases of nure client relationship
-orientation, working phasie (identification, exploration), termination phase (resolution) - behavior represents the person trying to adapt to internal or environmental forces
Keypoints of the recovery model in mental health care
- holistic, person-centered approach
- it is possible to recover from a mental health condition
- the most effective recovery is patient-directed
10 principles of the recovery model
- emerges from hope
- is person-driven
- occurs through many pathways
- is holistic
- is supported by peers and allies
- supported through realationships and social networks
- culturally based and influenced
- supported by addressing trauma
- involves the individual, family, and community, strengths and responsibility
- based on respect
core principles of trauma-informed care
- safety - patients feel physically and psychologically safe
- **trustworthiness and transparency **- decisions are made with transparency and with the goal of building and maintaining trust
- **peer support **- individuals with shared experiences are integrated into the organization and viewed as integral to service delivery
- collaboration - power struggles are leveled to support shared-decision making
- empowerment - patient and staff are recognized, built on and validated, includes belief in resilience and ability to heal from trauma
- humility and responsiveness- biasis and stereotypes are recognized and addressed
which two antipsychotics have the adverse effect of photosensitivity
mellaril and thorazine
Two phases that people with bipolar personality disorder may experience
- idealization - a person may attribute overly positive qualities to someone (putting them on a pedestal)
- Devaluation - the opposite of idealization where somone with BPD attributes overly negative qualities to someone
Also known as splitting
Buspar
5-HT partial agonist
May improve sexual function
Buspar not effective for GAD kids under 18
Which hypnotic drug has the longest half life
Eszopiclone (Lunesta)
Good for sleep onset & maintenance (ambien is too)
Which hypnotic is approved for initial insomnia
Ramelton (rozerem)
