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Cathey Parkes > Psychatric/Mental Health Nursing > Flashcards

Psychatric/Mental Health Nursing Flashcards

1
Q

What is voluntary admission?

A

Patient requests a mission and make sign out at any time. However, admission maybe change to involuntary if patient meets criteria established by state law. For example, pink slip.

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2
Q

What is involuntary commitment admission?

A

Admission without consent if the patient poses a risk to self or others, or is gravely disabled. Requires at least two physicians to confirm justification for commitment.

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3
Q

What is an emergency commitment admission?

A

Patient is immediate threat to self or others. Requires court hearing usually within 24 to 72 hours to determine if the patient may be discharged or involuntary commitment is required.

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4
Q

What is patient confidentiality?

A

Hyppa law protects patients right to privacy. Patient information may not be disclosed to anyone that it’s not directly involved in care of patient without patient consent.

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5
Q

What is the exception to patient confidentiality protected by Hyppa?

A

If the nurse determines the patient poses a serious threat to another person, the nurse has to protect the third-party.

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6
Q

What is the right to refuse treatment?

A

Patients have the right to refuse medications or other therapies even if they were involuntary admitted, except a in a emergency.

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7
Q

What is the right to least restrictive environment?

A

Restraints or seclusion should only be used as a last resort in for the shortest duration of time possible.

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8
Q

What is the providers role in obtaining informed consent?

A

Explain the nature of the procedure, risks and benefits of the procedure, alternatives to the procedure, risks and benefits of the alternatives. Assess the patient’s understanding of the information.

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9
Q

What is the nurses role in obtaining informed consent?

A

Sign consent form as a witness, confirmed patient received understands above information, ensure patient is competent and gave consent voluntarily.

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10
Q

How do we document informed consent?

A

All elements of informed consent must be documented on a form or in the patient’s medical record.

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11
Q

What are some examples of patients not being in the right mind where they could not consent because they are not competent?

A

Patients are under the influence of drugs and alcohol.

Patient has dementia, delirium, schizophrenia.

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12
Q

When are minors allowed to give consent without their parents.?

A

If they are emancipated, married, in the military, or require substance abuse her mental health treatment.

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13
Q

If a patient has questions about the procedure before after provided consent what must you do?

A

Contact the provider to answer them. We should not answer their questions.

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14
Q

Even after consent has been obtained Kim the patient change their mind?

A

Yes.

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15
Q

What are the legal indications for using restraint and seclusion?

A

Patient poses in immediate danger to themselves or others.

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16
Q

What is a physical restraint?

A

Any device that limits their movement. For example, handmaids, lemon restraints, belts, vests.

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17
Q

What is the chemical restraint?

A

Using drugs to shut the patient up.

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18
Q

What should be the first thing you do when it comes to restraints?

A

Try to Descalate the situation first before turning to restraints.

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19
Q

Our nurses allowed to apply restraints in emergency situations?

A

In an emergency, nurses can apply restraints. Orders need to be obtained from the provider ASAP after application.

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20
Q

When it comes to choosing a method between restraint and seclusion what should be done first?

A

Use the least restrictive method to correct the issue.

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21
Q

When a patient is in restraints what must be done?

A

You must assess the patient every 15 minutes. Take vital signs, provide range of motion exercises, and offer fluids and toileting every two hours.

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22
Q

What are some common de-escalation techniques?

A

Decrease stimuli, provide diversion, offer PRN medications, use simple nonthreatening language.

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23
Q

What are the four phases of the nurse client relationship?

A

Pre-orientation,
Orientation,
Working,
Termination.

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24
Q

What happens during the pre-orientation of the nurse client relationship?

A

Prepare for meeting with patient. Reviewed chart and examine your own feelings about working with the person.

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25
Q

What is going on during the orientation phase of the nurse client relationship?

A

Perform introductions, establish rapport, set mutually agreeable goals and plan of action. Confirm date, time, place and duration of meetings. Discuss confidentiality. And establish boundaries.

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26
Q

What goes on during the working phase of the nurse client relationship?

A

Gather data, identifying practice problem-solving and coping skills, provide education, evaluate progress towards goals.

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27
Q

What is going on during the termination phase of the nurse client relationship?

A

Summarize goals achieved during the relationship. Discuss incorporation of new coping skills and discharge plans. Allow patient to share feelings regarding termination of the relationship. Remember, this may Alyssa sense of grief from the patient.

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28
Q

What is transference?

A

Patient redirects or transfers feelings about a person from their past onto the nurse. For example, nurses appearance remains a patient of their abusive mother, resulting in antagonistic behavior. Remember, this may interfere with the nurse client relationship.

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29
Q

What is counter transference?

A

Nurses feelings in response toward the patient based on the nurses past relationships and experiences. For example, patient remains the nurse of her daughter, so she unconsciously treats her in a way that encourages dependence.

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30
Q

What is the therapeutic communication technique of brought opening remarks?

A

What would you like to talk about today?

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31
Q

What is an example of an opened it it question?

A

Tell me more about the voices you here.

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32
Q

What is an example of the therapeutic communication technique of sharing observations?

A

You seem a little sad to me today.

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33
Q

What is an example of the therapeutic communication technique of clarification or validation?

A

Do I understand you correctly when you say?

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34
Q

What does reflection mean?

A

Refer the questions back to the patient. For example, what are your thoughts about it?

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35
Q

What is the therapeutic communication technique of offering self?

A

Making yourself available to the patient. For example, I will keep you company while you eat your breakfast.

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36
Q

What is the therapeutic communication technique of restating?

A

Repeat what the patient said to confirm understanding. For example, patient says I am so anxious that I can’t get to sleep the nurse would say you’re excited is keeping you up at night.

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37
Q

What is the therapeutic communication technique of presenting reality?

A

Correct patient misinterpretation. For example, I understand that you were hearing voices, but I do not hear any voices. Don’t play into it.

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38
Q

What is the mental status exam?

A

Standardized method of evaluating the mental status of a patient.

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39
Q

What goes into a mental status exam?

A

Appearance, behavior, motor activity, speech mood and affect, thought process, perception, cognition, insight, judgment.

40
Q

What is stress?

A

Barry’s physical and emotional reaction to pressure.

41
Q

What are the three stages of the general adaptation syndrome?

A

Alarm reaction stage, resistant stage, exhaustion stage,.

42
Q

What is going on during the alarm reaction stage of the general adaptation syndrome?

A

Fight or flight response to a stressor. Signs and symptoms include increased cortisol levels, BP and HR.

43
Q

What is going on during the resistance stage of the general adaptation model syndrome? Signs and symptoms?

A

During the resistance stage after initial shock of the stressful event has subsided, the bottoms to normalize vital signs on the hormone levels. Signs and symptoms include poor concentration, irritability, and frustration.

44
Q

What’s going on during the exhaustion stage of the general adaptation syndrome? What are some signs and symptoms?

A

Prolong stress to place the bodies resources and we can see immune system. Signs and symptoms include fatigue, depression, anxiety, and disease.

45
Q

What must’ve provider do when restraints are ordered?

A

The provider must do an in person assessment within 24 hours of initiation a restraints or seclusion.

46
Q

What is the maximum amount of time that someone can be in restraint and seclusion?

A

24 hours.

47
Q

How often must orders be renewed for restraints in seclusion of an adult greater than 18 years or older?

A

Every four hours for adults.

48
Q

How often miss orders be renewed for older children and adolescents that are for ages 9 to 17 years of age that are in the restraint and seclusion?

A

Every two hours.

49
Q

How often must orders be renewed for a younger child that is less than nine years old that is in our strength in seclusion?

A

Every hour.

50
Q

Our PRN orders allowed with restraint and seclusion?

A

Never.

51
Q

How often is a new order required when dealing with restraint and seclusion?

A

Every 24 hours if restraints are still needed.

52
Q

What does the nursing documentation for a restraint and seclusion look like?

A

You need to document the rationale for the restraints in seclusion, time in restraints and cook seclusion, patient assessment findings, patient care offered and provided during their restrain time.

53
Q

What are the characteristics of mild anxiety?

A

Normal, expected response to daily events. Heightened awareness, and increase his perceptual field, allows for optimal functioning. This is beneficial for learning.

54
Q

What are the symptoms of mild anxiety?

A

Restlessness, irritability, increase motivation.

55
Q

What are the characteristics of moderate anxiety?

A

Decrease concentration, attention span, and perceptual field. May hinder problem-solving.

56
Q

What are the signs and symptoms of moderate anxiety?

A

Increase heart rate and RR, G.I. discomfort, muscle tension.

57
Q

What are the characteristics of severe anxiety?

A

Greatly decreased perceptual field, difficulty completing a simple task. Effective learning is not possible.

58
Q

What are the Symptoms of severe anxiety?

A

Feeling of dread, headache, nausea, diarrhea, insomnia, palpitations, hyperventilation.

59
Q

What are the characteristics of panic level of anxiety?

A

Loss of contact with reality. Functioning in communication and effective. Learning not possible. Can be life-threatening.

60
Q

What are the symptoms of panic level of anxiety?

A

Feeling of terror or impending doom, hallucinations or delusions, dilated pupils, severe trembling, diaphoresis.

61
Q

Diaphoresis?

A

Sweating.

62
Q

What is the nursing care for mild to moderate anxiety?

A

How patient with problem-solving,
Evaluate coping mechanisms the patient and successfully used in the past,
Provide outlet to relieve tension. For example, exercise.

63
Q

What is the nursing care for severe and panic level anxiety? 

A

Move patient to quiet setting,
Remain with patient,
Speak slowly and clearly,
Provide for patient’s physical needs and safety.
Problem-solving not possible for patient experiencing severe panic level anxiety

64
Q

Can a patient have a good problem-solving skills when they are at the panic level or severe level of anxiety?

A

No.

65
Q

What is a crisis?

A

Overwhelming events to call significant psychological stress.

66
Q

What is a maturational crisis?

A

Life changing event occurs as a normal part of development. For example, marriage, retirement.

67
Q

What is situational crisis?

A

Unexpected life event. For example, job loss, sudden death of a loved one.

68
Q

What is an adventitious crisis?

A

Natural disasters such as a tornado, national emergency such as terrace attack, or violent crimes such as rate.

69
Q

What is the nursing care for a patient in crisis?

A

Provide the patient safety and assist with anxiety reduction,
Assess patient’s perception of the event and their support system,
Ask patient about coping skills used in the past.

70
Q

What is actual loss?

A

When the loss is recognized by others such as the death of a loved one.

71
Q

What is perceived lost?

A

When the loss is not felt by others for example loss of mental acuity.

72
Q

What is mental acuity?

A

Being mentally sharp.

73
Q

What are the five stages of grief?

A 
Denial,
Anger,
Bargaining,
Depression,
Acceptance.
74
Q

What is complicated grief?

A

Intense, prolong sorrow for more than a year. Grief interferes with the individuals daily functioning.

75
Q

What is anticipatory grief?

A

Response to an impending loss.

76
Q

What is disenfranchise grief?

A

Experience of a loss that is not publicly acknowledged. For example, miscarriage or death of an extra marital lover.

77
Q

What are defense mechanisms?

A

Conscious or unconscious coping mechanisms used to decrease anxiety.

78
Q

What is avoidance?

A

Avoiding people, places, or situations associated with distressing thoughts or feelings.

79
Q

What is compensation?

A

Focusing on strength versus perceived weaknesses. For example, student who struggles academically focuses on sports.

80
Q

What is conversion?

A

Development of physical symptoms in response to stress, without an underlying injury or medical calls.

81
Q

What is denial?

A

Refusing to except the reality of the situation.

82
Q

What is displacement?

A

Transfer of feelings and emotions from one target to another. For example, patient distressed about diagnosis yells at his nurse.

83
Q

What is dissociation?

A

Compartmentalizing or disconnecting from reality. For example, soldier fighting in the war feels like he is it is observing himself from the outside.

84
Q

Define compartmentalization?

A

Divide into sections or categories.

85
Q

What is identification also known as Introduction?

A

Adopting the beliefs or behaviors of another individual.

86
Q

What is Intellectualization?

A

Avoiding emotions associated with a stressful situation by focusing on facts and logic. For example, nurses nervous about her new job and I see you focuses on how this will help her career.

87
Q

What is projection?

A

Attributing your own thoughts or feelings on to someone else. For example, nurse who dislikes her coworker insist that she hates me.

88
Q

What is rationalization?

A

Attempting to justify unacceptable behavior with a logic based exclamation. For example student who cheats on a test states I don’t really need to know the information anyway.

89
Q

What is reaction formation?

A

Expressing the office of feelings or behavior from what is actually felt. For example, boy is mean to a girl that he actually likes.

90
Q

What is regression?

A

Reverting to an earlier developmental level in response to stress.

91
Q

What is repression?

A

Involuntarily subconsciously blocking of unpleasant feelings are memories.

92
Q

What is the difference between repression and suppression?

A

Repression as you don’t realize you’re doing it.

93
Q

What is splitting?

A

So your direct nice positive or negative attributes of an individual, common with borderline personality disorder. This is an all or nothing mentality.

94
Q

What is sublimation?

A

Unacceptable impulses are transformed into socially acceptable behaviors. For example, taking out anger by hitting a punching bag.

95
Q

What is suppression?

A

Conscious voluntary blocking of unpleasant feelings.

96
Q

What is undoing?

A

Attempt to cancel out or an unacceptable thought or behavior. For example, Manager is excessively harsh on the employee and then goes out of her way to be overly nice and praise the individual.

97
Q

Left off on card 25

A

Left off on card 25.

Cathey Parkes (4 decks)

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